Lewis v. Unum Life Insurance Company of America (PLR3)

CourtDistrict Court, E.D. Tennessee
DecidedOctober 2, 2020
Docket1:18-cv-00127
StatusUnknown

This text of Lewis v. Unum Life Insurance Company of America (PLR3) (Lewis v. Unum Life Insurance Company of America (PLR3)) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lewis v. Unum Life Insurance Company of America (PLR3), (E.D. Tenn. 2020).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE AT CHATTANOOGA

BOYD LEWIS, ) ) Case No. 1:18-cv-127 Plaintiff, ) ) Judge Travis R. McDonough v. ) ) Magistrate Judge Christopher H. Steger UNUM LIFE INSURANCE COMPANY ) OF AMERICA, ) ) Defendant.

MEMORANDUM AND ORDER

In this action, Plaintiff Boyd Lewis seeks judicial review of Defendant Unum Life Insurance Company’s (“Unum”) decision to deny his claim for long-term disability (“LTD”) benefits under an employer-sponsored disability plan pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 101 et seq. (“ERISA”). Lewis alleges that Unum acted arbitrarily and capriciously in determining that he was not eligible for benefits under the policy. Both Lewis and Unum have moved for judgment on the administrative record.1 (Docs. 21, 23.) For the following reasons, Lewis’s motion for judgment on the administrative record (Doc. 21) will be DENIED and Unum’s motion for judgment on the administrative record (Doc. 23) will be GRANTED.

1 Though Lewis submitted this motion as a motion for summary judgment, Lewis’s motion is more accurately characterized as a motion for judgment on the administrative record. See Buchanan v. Aetna Life. Ins. Co., 179 F. App’x 304, 306 (6th Cir. 2006) (“Traditional summary judgment concepts are inapposite to the adjudication of an ERISA action for benefits . . . because the district court is limited to the evidence before the administrator at the time of its decision.”). I. BACKGROUND Lewis began his employment with Zycron Computer Services, Inc. (“Zycron”) on September 12, 2011, where he worked as an IT Infrastructure Administrator. (Doc. 15-1, at 55.)2 As a Zycron employee, Lewis was eligible for both short-term and long-term disability benefits under a policy issued by Unum (the “Policy”) through Zycron. Lewis’s employment with

Zycron ended on August 26, 2015, but, for purposes of his LTD benefits claim, Lewis claims he became disabled on September 4, 2015. (Doc. 15-1, at 61.) Under the Policy, a person is “disabled” when Unum determines: (1) You are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and (2) You have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. (Doc. 15-1, at 129) (emphasis in original). The policy defines material and substantial duties as “duties that: are normally required for the performance of your regular occupation; and cannot be reasonably omitted or modified.” (Id. at 143.) Finally, “regular occupation” is defined as “the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the works tasks are performed for a specific employer or at a specific location.”3 (Id. at 145.)

2 There was some confusion over the citation of the record in the briefing. When the Court cites a page number, it will be citing to the document ID which is located at the bottom center of the page on ECF. Lewis’s brief cited to the page number of the document in the PDF file, which is often obscured on ECF. 3 Unum, in its briefing, points out that there is another definition of disability that it could have used, the “any gainful occupation” standard. As Unum notes, it did not analyze the claim under this “more stringent” standard. Thus, it is irrelevant in determining whether the insurer’s actions were arbitrary and capricious. See Smith v. Grp. Short Term Disability & Long Term Disability Plan for Emps. of Walmart, No. 1:07-cv-139, 2008 WL 2278665 at *5 (E.D. Tenn. May 30, 2008). Additionally, Unum is granted “discretionary authority to make benefit determinations under the plan.” (Id. at 149.) These determinations “include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the plan.” (Id.) Under the Policy, Unum also had the right to “require [Lewis] to be examined by a physician.” (Id. at 129.)

In August 2015, Lewis was involved in a four-wheeler accident. (Doc. 15-1, at 223.) The day after the accident, he reported to Erlanger Medical Center. (Id.) The notes from the attending physician indicate that Lewis was suffering from chest pain and palpitations. (Id.) The attending physician noted that Lewis was in supraventricular tachycardia, meaning that he had an abnormally accelerated heartrate, and indicated that he reported feeling weak and experiencing occasional presyncopal episodes. (Id. at 224–227, 272, 280.) Lewis’s cardiac work-up proved to be negative, though he continued to experience episodes of palpitations and tachycardia. (Id. at 255.) Lewis has since been seen by many doctors and other medical professionals. These

include Ms. Jennie Phillips, a Physician Assistant (“PA”) who acts as Lewis’s primary care doctor; Dr. David Huffman, an endocrinologist; Dr. Ondrej Lisy, a cardiologist; Dr. Nathan Wyatt, a neurologist; and Dr. Timothy Callahan, a specialist in tickborne disease. According to his medical records, Lewis’s most consistent complaints are chest pain, fatigue, and tachycardia events, during which his heartrate can rise above 210 beats per minute. (Doc. 15-1, at 224.) Lewis also claims that he will lose consciousness, have seizure-like events, and experience tremors in his hands if he is sexually abstinent. (Id. at 354.) Dr. Lisy, his cardiologist, reported that Lewis complained of regular episodes of heart palpitations, feeling weak, and presyncopal episodes. (Doc. 15-1, at 303.) In November of 2016, Dr. Lisy wrote to Unum stating, “I do not see any cardiac limitations for his job as [sic] information technologist at the present time.” (Id. at 683.) Dr. Huffman, Lewis’s endocrinologist, similarly stated, “I am not restricting [Lewis] from an endocrine standpoint.” (Id. at 674.) Lewis does not challenge the conclusions of Dr. Huffman or Dr. Lisy that “there were no physical limitations from a cardiac or endocrine standpoint.” (Doc. 22, at 6.)

Lewis also saw Dr. Wyatt, a neurologist. Dr. Wyatt, like the doctors before him, could not diagnose Lewis with any medical condition. (Doc. 15-1, at 813.) Dr. Wyatt examined an MRI of Lewis’s spinal cord, but he found no evidence that Lewis’s accident with the four- wheeler caused a spinal-cord injury that would result in his symptoms. (Id. at 355.) Dr. Wyatt represented to Unum that “[Lewis] does not appear to have a neurological disease occurring.” (Id. at 813.) Dr. Wyatt, however, also told Unum that Lewis was not supposed to drive a car. (Id. at 824.) Lewis also repeatedly saw Dr. Callaghan, a tickborne disease specialist located in Tunica, Mississippi. (Doc. 15-2, at 1000.) Dr. Callaghan diagnosed Lewis with Lyme Disease. (Id. at

1065.) Thus, Dr. Callaghan was the only doctor to diagnose Lewis with any underlying medical condition. Dr. Callaghan tested Lewis for Lyme Disease three times. (Id. at 975–78.) One test was inconclusive, and the other two were negative. (Id.) Nevertheless, Dr. Callaghan still believed that Lewis had Lyme Disease and placed him on a course of antibiotic therapy. (Id. at 1084.) Lewis took the antibiotics for more than nine months with no improvement of his symptoms. (Id. at 1527.) At all times relevant to this litigation, Dr. Callaghan has maintained that Lewis is too sick to work due to a tickborne disease. Dr. Callaghan has stated that “I feel he cannot lift more than 5 lbs. of weight and should not be driving except to the doctor and for essentials such as food/shopping. I don’t think he can work at any job at all right now.” (Id. at 1065.) Lewis was granted short term disability benefits by Unum, and he was originally granted LTD benefits when Unum first analyzed the claim. (Doc.

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Lewis v. Unum Life Insurance Company of America (PLR3), Counsel Stack Legal Research, https://law.counselstack.com/opinion/lewis-v-unum-life-insurance-company-of-america-plr3-tned-2020.