Lumbermens Mutual Casualty Co. v. Combs

873 N.E.2d 692, 2007 Ind. App. LEXIS 2141, 2007 WL 2743676
CourtIndiana Court of Appeals
DecidedSeptember 20, 2007
Docket49A05-0608-CV-436
StatusPublished
Cited by21 cases

This text of 873 N.E.2d 692 (Lumbermens Mutual Casualty Co. v. Combs) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lumbermens Mutual Casualty Co. v. Combs, 873 N.E.2d 692, 2007 Ind. App. LEXIS 2141, 2007 WL 2743676 (Ind. Ct. App. 2007).

Opinion

OPINION

CRONE, Judge.

Case Summary

Lumbermens Mutual , Casualty Company (“Lumbermens”) appeals various ruling? and the award of damages, attorney’s fees, and prejudgment interest in favor of Donna Combs on her claims for breach of contract and bad faith termination of her long-term disability benefits. We affirm in part, vacate in part, and remand for an evidentiary hearing on attorney’s fees.

Issues

We restate the issues as follows:

I. Whether the trial court correctly concluded that Combs’s claims are not preempted by the federal Employee Retirement Income Security Act (“ERISA”);
II. Whether the trial court properly denied Lumbermens’ motions for judgment on the evidence;
III. Whether Lumbermens has preserved any error regarding the trial court’s admission of the testimony of Combs’s insurance expert, Mary Fuller;
IV. Whether Lumbermens has preserved any error regarding the trial court’s exclusion of the testimony of Lumbermens’ insurance expert, Dr. William Warfel;
V. Whether Lumbermens has shown that it was prejudiced by the admission of testimony of Combs’s treating physicians, Dr. Craig Johnston and Dr. James Ehlich, regarding matters postdating the termination of Combs’s benefits;
VI. Whether the bad faith damages award is supported by the record;
VII. Whether the trial court abused its discretion in awarding Combs attorney’s fees; and
VIII. Whether the trial court abused its discretion in awarding Combs prejudgment interest on her bad faith claim.

Facts and Procedural History 1

Combs was a senior offsite radiology technologist employed by Hancock Memorial Hospital and Health Services (“Hancock Hospital”) and earned approximately $3000 per month before taxes. Hancock Hospital is operated by its board of trustees. Appellant’s App. at 116 (affidavit of Hancock Hospital counsel C. Thomas Cone). Combs participated in Hancock Hospital’s long-term disability benefit plan (“the Plan”), which is insured and administered by Lumbermens. In 2000, Combs’s primary care physician, Dr. Craig Johnston, referred Combs to hematologist/oncologist Dr. Magaral Murali for evaluation of her persistent anemia and increasing fatigue. Dr. Murali diagnosed Combs with myelodysplastic syndrome. 2 Initially, Dr. Murali treated Combs with iron, vitamin B12, and steroids. When this treatment proved unsuccessful, Combs received injec *698 tions of erythropoietin. 3

Because of her illness, Combs stopped working at Hancock Hospital on July 29, 2001. On February 15, 2002, Combs filed an application for long-term disability benefits with Lumbermens’ subsidiary and claims administrator, Kemper National Services (“Kemper”), which later became Broadspire Services, Inc. (“Broadspire”). 4 In her application, Combs stated that she was unable to work because of “severe fatigue, weakness, bone & muscle pain, unable to lift or stand, difficulty concentrating, dizzinessf.]” Def. Exh. 14 at 98. Combs listed her illnesses as “myelodys-plastic syndrome, anemia, fibromyalgia, chronic fatigue syndrome[.]” Id. In a letter dated April 16, 2002, Kemper notified Combs that she had become eligible for $1,748.25 in monthly benefits effective January 26, 2002, based on Kemper’s determination that she had a disability that prevented her from performing the essential functions of her regular occupation for the following twenty-four months. Id. at 326-27. This is known as an “own occ” disability standard.

In a letter dated July 31, 2003, Kemper notified Combs that her benefits would be terminated as of January 25, 2004, unless she was prevented by her disability from performing the essential functions of any gainful occupation “that [her] training, education, and experience would allow [her] to perform[,]” id. at 335, and that would pay at least sixty percent of her pre-dis-ability income. Plf. Exh. V at 27. This is known as an “any occ” disability standard. Pursuant to the Plan, an employee cannot receive disability benefits after two years unless the employee meets the “any occ” standard. The letter stated that Kemper would “be conducting a thorough evaluation of [Combs’s] claim to determine [her] eligibility for benefits beyond” January 25, 2004, and that a vocational consultant from Kemper might contact her “to discuss [her] work experience and educational background.” Def. Exh. 14 at 336.

Also on July 31, 2003, one of Kemper’s consulting physicians, hematologist Dr. Marc Fishman, conducted a peer review of Combs’s medical records provided to him by Kemper’s claims specialist. Dr. Fish-man’s review reads in pertinent part as follows:

According to a note from Dr. Mureli [sic] of April 17, 2003, the claimant has myelodysplastic syndrome with chronic refractory anemia. However, from the same note, Dr. Mureli [sic] states “the patient with the erythropoietin has done remarkably well.” Physical examination on that date was normal and the claimant’s hemoglobin on that date was 11.7. The assessment was that the claimant was doing well with the myelodysplasia. Reviewing the available medical records, the claimant is receiving erythropoietin, generally on a weekly basis. The hemoglobin results from the available records range from 9.9 grams % to 12.0 grams%.[ 5 ] An Estimated Physical Abilities form was completed by Dr. Craig Johnson [sic] on May 24, 2003. He states that the claimant has chronic fatigue syndrome and that she is unable to *699 work. He indicates that she is never able to lift or carry anything and that she can sit, stand and walk only one hour per day. Also in an Attending Physician’s Statement dated May 29, 2003, Dr. Johnson [sic] states that the claimant is unable to work due to chronic fatigue and myelodysplasia and anemia.
Based upon the available information, the claimant is not disabled with respect to her hematologic disorder. While the claimant does have myelodysplastic syndrome, based upon the available information, she is responding very well to the erythropoietin. The hemoglobin has been maintained in a satisfactory level. Accordingly, at the present time, the claimant is not disabled from her own occupation or from any occupation with respect to her hematologic disorder.
The opinions rendered above reflect reasonable medical certainty based upon the available information.

Id. at 178-79.

In a letter to Combs dated September 9, 2003, Kemper claims specialist Alicia Lopez summarized Dr.

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873 N.E.2d 692, 2007 Ind. App. LEXIS 2141, 2007 WL 2743676, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lumbermens-mutual-casualty-co-v-combs-indctapp-2007.