Marshburn v. Unum Life Insurance Co. of America

119 F. Supp. 3d 1203, 2015 U.S. Dist. LEXIS 104736
CourtDistrict Court, C.D. California
DecidedAugust 6, 2015
DocketCase No. 2:14-cv-00242-CAS (PJWx)
StatusPublished
Cited by1 cases

This text of 119 F. Supp. 3d 1203 (Marshburn v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marshburn v. Unum Life Insurance Co. of America, 119 F. Supp. 3d 1203, 2015 U.S. Dist. LEXIS 104736 (C.D. Cal. 2015).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW RE: BENCH TRIAL HELD ON DEFENDANTS ERISA PREEMPTION DEFENSE

CHRISTINA A. SNYDER, UNITED STATES DISTRICT JUDGE

I. INTRODUCTION

On December 4, 2018, plaintiff Julie Marshburn, M.D., filed this lawsuit against defendant Unum Life Insurance Company of America (“Unum”) and Does 1 through 10. On January 10, 2014, Unum removed the action to this Court on the basis of diversity and federal question jurisdiction. Dkt. Nos. 1, 8. In brief, the complaint alleges that Unum failed to make disability payments owed to plaintiff under the terms of an insurance policy issued by Unum, having improperly determined that plaintiff was not disabled. See generally Compl. (attached to Dkt. No. 8). Plaintiff alleges claims under California law for breach of contract and breach of the duty of good faith and fair dealing. Id.

On December 8, 2014, Unum filed a motion seeking summary judgment on the ground that the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), governs plaintiffs claims for long-term disability benefits. Dkt. No. 20. Unum argued that plaintiff was ineligible to convert her ERISA-governed, employer-affiliated group policy to an individual policy governed by state law because she was already disabled at the time of conversion, and that as a result, her claims under the state-law-governed policy are preempted [1206]*1206and she could'proceed, if at all, only by making a claim for benefits under the ERISA plan. On January 5, 2015, the Court held a hearing on the matter, and concluded that ERISA governs the ineligi-. bility defense raised by Unum, but that Unum had ndt shown that it was entitled to summary judgment on that defense. Dkt. No. 30. Unum’s ERISA-based’ defense was tried to the Court on June 11, 2015. Michael Horrow and Nichole Pod-gurski of Donahue & Horrow LLP appeared for plaintiff, and Keiko Kojima and Daniel Maguire of Burke, Williams & Sor-ensen LLP appeared for Unum. Dkt. No. 38.

' Subsequently, the Court requested supplemental briefing on several legal issues. Dkt. No. 41. The parties filed their supplemental briefs on July 13, 2015. Dkt. Nos. 44, 45.' Having carefully considered the evidence and the parties’ arguments, the Court finds and concludes as follows.

II. FINDINGS OF FACT

1,After graduating from medical school in 2003, plaintiff was admitted to-a three-year internal medicine residency program at Cedars-Sinai Medical Center in Los Angeles, California (“Cedars-Sinai”). - Trial Tr. 19:19-22, 20:10-12. The residency program consisted of a series of clinical “rotations,” the purposes of which included attaining proficiencies in various medical procedures. Id. 42:14-43:10; 68:12-18. There were thirteen blocks of rotations in each year of plaintiff’s residency. Id. 44:710. Some rotations were required for completion of the residency program; others were elective. Id. 43:17-21; 78:15-18.

A. Unum’s Relevant Insurance Policies

2. Cedars-Sinai maintained an employee welfare benefit plan (the “Plan”) for its eligible’.employees. Dkt. No. 20-1 ¶5. Effective February 1, 1997, Unum issued Group Long Term Disability Policy No. 510733001 (the “Group Policy”), which funded in part the Plan’s long-term disability insurance coverage. Id.; see generally Trial Ex. 1. As a resident at Cedars-Sinai, plaintiff was eligible to participate in the Plan and for disability coverage under the Group Policy. Dkt. No. 20-1 ¶ 7.

3. For purposes of short-term disability benefits, thé Group Policy defines “disability” as when, “due to your sickness or injury .,. you are unable to perform the material and. substantial1 duties of your regular occupation;2 and [ ] you are not working in any occupation.” Trial Ex. 1 at 19. For purposes of long-term disability benefits, the Group Policy defines “disability” as when “you are limited3 from performing the material and substantial duties of your regular occupation due to your sickness and injury; and [ ] you have a' 20% or more loss in your indexed month[1207]*1207ly earnings due to the same sickness or injury.” Id. at 24.

4. The Group Policy had a “conversion” feature that allowed an employee whose employment was terminated to retain long-term disability insurance coverage as an individual.4 The explanation of these conversion benefits is included in the Group Policy as a subheading under the heading “Long Term Disability!!] Other Benefit Features.” Trial Ex. 1 at 33-34. This provision reads:

If you end employment with your Employer, your coverage under the plan will end. You may be eligible to purchase insurance under Unum’s group conversion policy. To be eligible, you must have been insured under your Employer’s group plan for at least 12 consecutive months.... You must apply for insurance under the conversion policy and pay the first quarterly premium within 31 days after the date your employment ends. Unum will determine the coverage you will have under the conversion policy. The conversion policy may not be the same coverage [Unum] offered you under your Employer’s group plan.

Id. at 34 (paragraph structure altered). The Group Policy explains that a person is “not eligible to apply for coverage under Unum’s group conversion policy if,” among other things, the person is “disabled under the terms of the plan.” Id.

B. Plaintiffs Residency, Injury, and Medical Treatment

5. In August 2003, while working at Cedars-Sinai, plaintiff injured her right shoulder while lifting a patient. Trial Tr. 22:17-23. Plaintiff was initially told that the injury was a sprain, and then a nerve injury, and that it would heal over time. Id. 24:1725. Although plaintiff did not miss any work because of the injury, id. 23:13-15, the injury did not heal on its own, and a doctor placed plaintiff on work restrictions in late 2005 or early 2006, id. 25:1-5.. Although these work restrictions altered the selection of rotations plaintiff planned to undertake, they did not prevent her from completing the rotations required to finish her residency, or completing the rotations to which she was assigned. Id. 25:14-26:10.

6. Plaintiff was eventually referred to a surgeon named Dr. Neal S. El-Attrache, whom she saw in February 2006. Id. 23:19-24:6. On June 5, 2006, Dr. El-At-trache performed surgery on plaintiffs right shoulder to repair a labrum tear. Id. 27:5-8. During this surgery, plaintiff suffered a torn ligament in her right thumb. Id. 54:7-12. Following the surgery, Dr. El-Attrache placed additional work restrictions on plaintiff, prohibiting her from pushing, pulling, or lifting with her right upper extremity. Id. 52:11-53:2; Trial Ex. 22 at 157. Some procedures that a resident must learn to complete the internal residency program require significant use of both hands such that plaintiff would have been unable to complete those rotations while under Dr. El-Attrache’s post-surgery restrictions. Trial Tr. 53:10-15; 80:19-81:16.

7.

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119 F. Supp. 3d 1203, 2015 U.S. Dist. LEXIS 104736, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marshburn-v-unum-life-insurance-co-of-america-cacd-2015.