Mennenoh v. UNUM Life Insurance Co. of America

302 F. Supp. 2d 982, 2003 U.S. Dist. LEXIS 24601, 2003 WL 23220837
CourtDistrict Court, W.D. Wisconsin
DecidedJuly 16, 2003
Docket02-C-567-C
StatusPublished
Cited by1 cases

This text of 302 F. Supp. 2d 982 (Mennenoh v. UNUM Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mennenoh v. UNUM Life Insurance Co. of America, 302 F. Supp. 2d 982, 2003 U.S. Dist. LEXIS 24601, 2003 WL 23220837 (W.D. Wis. 2003).

Opinion

OPINION AND ORDER

CRABB, District Judge.

In this civil action for monetary relief, plaintiff Sandra M. Mennenoh contends that defendant UNUM Life Insurance Company of America terminated her long-term disability insurance benefits in violation of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461. Jurisdiction is present under 28 U.S.C. § 1331.

Presently before the court is defendant’s motion for summary judgment. The issue is whether defendant acted arbitrarily and capriciously when it terminated plaintiffs disability benefits. Because I conclude that it did, I will deny defendant’s motion for summary judgment and, on the court’s own motion, I will grant summary judgment in favor of plaintiff. Although plaintiff did not file her own motion for summary judgment, “a district court can enter summary judgment sua sponte, or on its own motion, under certain limited circumstances.” Simpson v. Merchants Recovery Bureau, Inc., 171 F.3d 546, 549 (7th Cir.1999). In this case, because defendant had notice that the court would be considering summary judgment and because the evidence is limited to the administrative record, summary judgment in favor of plaintiff is appropriate even though plaintiff did not file her own motion. Id.

From the proposed findings of fact submitted by defendant and the record, I find the following facts to be material and undisputed.

UNDISPUTED FACTS

A. Disability Plan

Plaintiff Sandra M. Mennenoh, a resident of Grandview, Wisconsin, was employed by Memorial Medical Center from June 1997 until August 1999. Plaintiff was insured under Group Insurance Policy No. 390254001, administered by defendant UNUM Life Insurance Company of America, with an effective date of October 1, 1994.

The policy defines disability in the following provision:

You are disabled when UNUM determines that:
— you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and
— you have a 20 percent or more loss in your indexed monthly earnings due to the same sickness or injury.
After 24 months of payments, you are disabled when UNUM determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.
“Material and substantial duties” means duties that:
■— are normally required for the performance of a regular occupation; and
— cannot be reasonably omitted or modified.
“Regular occupation” means 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 work tasks are performed for a specific employer or at a specific location.

Under the policy, the insured is required to show the following at their expense.

— that you are under the regular care of a doctor;
■ — • the appropriate documentation of your monthly earnings;
■ — • the date your disability began;
*985 — the cause of your disability;
— the extent of your disability, including restrictions and limitation preventing you from performing your regular occupation; and
— the name and address of any hospital or institution where you received treatment, including all attending doctors.

The policy also states: “When making a benefit determination under the policy, UNUM has discretionary authority to determine your eligibility for benefits and to interpret the terms and provisions of the policy.”

B. Plaintiff’s Claim for Long-Term Disability Benefits

1. Plaintiffs medical history

Plaintiffs duties at Memorial included preparing food, stocking freezers and replenishing supplies. On April 14, 1999, plaintiff saw Dr. Marianne Anderson for the first time for “back pain radiating down.” On or about May 24, 1999, Memorial reduced plaintiffs hours from 72 hours every two weeks to 48 hours every two weeks. On May 25, 1999, James D. Callahan, M.D., a neurologist, restricted plaintiff to working only three days a week at Memorial. On August 30, 1999, Callahan recommended that plaintiff stop working as a food service worker because she was not physically able to perform her duties. Plaintiffs last day of work at Memorial was August 31, 1999. On September 21, 1999, Callahan performed back surgery on plaintiff.

2. Plaintiff’s application for long-term disability benefits

Plaintiff filed an application for long-term disability benefits, claiming that as of April 19, 1999, she was no longer able to perform the material and substantial duties of her occupation at Memorial because of “back pain and pains down legs.” Plaintiff claimed that standing on her feet and lifting at work caused or exacerbated these symptoms.

Included with plaintiffs claim was a statement by her employer, signed by Diane Lulich and dated August 1, 1999. According to the statement, plaintiffs position with Memorial of “cook/food service worker” required her to stand continuously, walk frequently, stoop, kneel and crouch occasionally, reach and work overhead frequently, push food carts and boxes weighing 100 pounds frequently, pull food carts weighing 100 pounds occasionally and lift and carry up to 100 pounds occasionally. The job analysis form provides that “occasionally” means the person does the activity up to 33% of the time, that “frequently” means the person does the activity 34% to 66% of the time and that “continuously” means the person does the activity 67% to 100% of the time.

In connection with her application for benefits, plaintiff submitted a statement from attending physician Anderson, dated September 16, 1999. The statement indicated that, as of April 19, 1999, plaintiffs symptoms were “back pain radiating down” and that plaintiffs work worsened her condition.

3.Other evidence considered by defendant

In addition to reviewing plaintiffs submitted materials, defendant collected information by telephone calls. Prior to making a decision to grant disability benefits, defendant was aware that plaintiff and her husband owned two taverns, Tim & Sandy’s Sports Bar, located in Ashland, Wisconsin, and Stagger Inn, located in Grandview, Wisconsin, which is south of Ashland.

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Related

Radford Trust v. First Unum Life Insurance Co. of America
321 F. Supp. 2d 226 (D. Massachusetts, 2004)

Cite This Page — Counsel Stack

Bluebook (online)
302 F. Supp. 2d 982, 2003 U.S. Dist. LEXIS 24601, 2003 WL 23220837, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mennenoh-v-unum-life-insurance-co-of-america-wiwd-2003.