Petrusich v. Unum Life Insurance Co. of America

984 F. Supp. 2d 1112, 2013 WL 6175643, 2013 U.S. Dist. LEXIS 166160
CourtDistrict Court, D. Oregon
DecidedNovember 22, 2013
DocketNo. 3:12-cv-00779-BR
StatusPublished
Cited by3 cases

This text of 984 F. Supp. 2d 1112 (Petrusich v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Petrusich v. Unum Life Insurance Co. of America, 984 F. Supp. 2d 1112, 2013 WL 6175643, 2013 U.S. Dist. LEXIS 166160 (D. Or. 2013).

Opinion

OPINION AND ORDER

ANNA J. BROWN, District Judge.

This matter comes before the Court on Plaintiff Nancy Petrusich’s Motion (#29) for Summary Judgment and Defendant Unum Life Insurance Company’s Motion (# 37) for Summary Judgment. The parties filed under seal the Stipulated Administrative Record (AR) (# 19).

The Court heard oral argument on August 22, 2013. At the conclusion of oral argument the Court requested the parties to submit additional briefing as to (1) which party has the burden to develop the record at the administrative level and (2) the scope of the Court’s authority to remand to the plan administrator a case brought under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. The parties filed their supplemental briefs on September 9, 2013, and the Court took the Motions for Summary Judgment under advisement.

For the reasons that follow, the Court GRANTS Petrusich’s Motion (#29) for Summary Judgment and DENIES Unum’s Motion (# 37) for Summary Judgment.

BACKGROUND

I. Petrusich’s Claims

Petrusich asserts a claim against Unum under ERISA. Pursuant to 29 U.S.C. § 1332(a)(1)(B), Petrusich seeks to recover from Unum unpaid Long Term Disability (LTD) benefits under the LTD Plan purchased by CRESA Partners, Petrusich’s former employer.

II. Pertinent Facts

The following facts are undisputed unless otherwise noted:

Petrusich was employed by CRESA Partners as a principal project manager. On approximately April 18, 2011, Petrusich left work due to an alleged disability. Petrusich was diagnosed with, among other things, anxiety, depression, adjustment disorder, delayed-onset post-traumatic stress disorder (PTSD), normacelmic hyperparathyroidism, and osteopenia. On approximately May 10, 2011, Petrusich submitted an application to Unum for LTD benefits pursuant to the Plan.

A. The Plan

The Plan defines “disability” as:

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% or more loss in your indexed monthly earnings due to the same sickness or injury.
You must be under the regular care of a physician in order to be considered disabled.

AR at 140 (emphasis in original).

“Regular occupation” is defined in the Plan 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 work tasks are performed for a specific employer or at a specific location.” AR at 157. The Plan contains a 90-day elimination period, which is the length of time that a claimant [1115]*1115must be disabled before he/she is eligible to receive benefits. AR at 140.

The Certificate Section of the Plan provides: “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.” AR at 136. The Plan also has a discretionary clause that provides:

The Plan, acting through the Plan Administrator, delegates to Unum and its affiliate Unum group discretionary authority to make benefit determinations under the Plan .... Benefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim.
Once you are deemed to have exhausted your appeal rights under the Plan, you have the right to seek court review under Section 502(a) of ERISA of any benefit determinations with which you disagree. The court will determine the standard of review it will apply in evaluating those decisions.

AR at 164.

B. Petrusich’s Application for LTD Benefits

In her May 10, 2011, application, Petrusich and CRESA Partners identified her duties as follows: (1) manage, plan, and coordinate activities to ensure that project goals are accomplished within the prescribed timeframe and funding parameters; (2) review project proposals to determine timeframe, funding limitations, and allotment of resources; (3) establish work plan and staffing for each project phase; (4) in larger organizations, may have the responsibility of managing supervisors assigned to projects; (5) confer with project staff to outline work plan and assign duties, responsibilities, and authority; (6) may manage subcontractors and their workers; (7) direct and coordinate project personnel to ensure that project progresses on schedule and within budget; (8) review status reports and modify schedules; (9) prepare reports for management and clients; (10) assist clients, including real-estate agents and brokers, in solving their real-estate needs in a specific area such as listing, selling, leasing, or appraisal of commercial or residential property; (11) research, analyze, market, or negotiate the lease or sale of real estate. AR at 61-62, 338-39, 871-73.

C. Unum’s Denial of Plaintiffs Application

In a September 28, 2011 letter, Unum denied Petrusich’s claim for LTD benefits. Unum advised Petrusich in the denial letter that: “Your symptoms appeared to be in the mild to moderate range given that you have not required the use of psychotropic medications .... The paucity of notes and lack of medications suggests that your symptoms were not that pervasive and could be monitored concurrent with employment.” AR at 691. Unum concluded the medical evidence did not support Petrusich’s claim of an impairing disability of a psychiatric nature after four to six weeks from the time Petrusich stopped working on April 18, 2011. According to Unum, therefore, Petrusich did not meet the 90-day elimination period. AR at 691-92.

On October 10, 2011, Petrusich submitted to Unum a pre-litigation appeal of Unum’s decision denying her LTD claim. In a January 31, 2012, letter, Unum informed Petrusich that it denied her prelitigation appeal and affirmed its decision denying her LTD claim. In that letter Unum noted even though Petrusich’s doc[1116]*1116tors opined she was not well enough to return to work, Unum’s “psychiatrist review concluded that the medical evidence did not support that [Petrusich] was impaired enough from a psychiatric standpoint to be unable to work.” AR at 899-900. Unum stated in the letter that:

The psychiatrist review concluded that the medical information showed you had a job specific conflict and you chose not to return to your regular occupation. The notes demonstrated that you were able to function in recreational and personal activities and are able to go on a month-long trip to New Zealand.

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Related

Gary v. Unum Life Ins. Co. of Am., Corp.
388 F. Supp. 3d 1254 (D. Oregon, 2019)
Robertson v. Standard Insurance
139 F. Supp. 3d 1190 (D. Oregon, 2015)

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Bluebook (online)
984 F. Supp. 2d 1112, 2013 WL 6175643, 2013 U.S. Dist. LEXIS 166160, Counsel Stack Legal Research, https://law.counselstack.com/opinion/petrusich-v-unum-life-insurance-co-of-america-ord-2013.