Radford Trust v. First Unum Life Insurance Co. of America

321 F. Supp. 2d 226, 2004 U.S. Dist. LEXIS 10916, 2004 WL 1368406
CourtDistrict Court, D. Massachusetts
DecidedJune 15, 2004
DocketCIV.A.02-12477-WGY
StatusPublished
Cited by29 cases

This text of 321 F. Supp. 2d 226 (Radford Trust v. First Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Radford Trust v. First Unum Life Insurance Co. of America, 321 F. Supp. 2d 226, 2004 U.S. Dist. LEXIS 10916, 2004 WL 1368406 (D. Mass. 2004).

Opinion

MEMORANDUM AND ORDER

YOUNG, Chief Judge.

This is an action under the Employment Retirement Security Act of 1974, codified as amended at 29 U.S.C. §§ 1001-1461 (ERISA). 1 The plaintiff, Radford Trust (“Radford”), alleged that the defendant, First Unum Life Insurance Company of America (“First Unum”), had wrongfully denied benefits owed to Radford’s beneficiary, John Doe (“Doe”) (who assigned his claim to Radford), under a group long term disability policy (the “Policy”) that First Unum managed for Doe’s former employer, New York City law firm Hawkins, Delafield & Wood (“Hawkins”). Radford’s action sought damages, costs, and attorney’s fees. First Unum maintained that its denial of benefits was proper, arguing that Doe had failed to establish that he was disabled before his coverage under the Policy was terminated. The company further argued that when Doe released all claims against Hawkins, he also released any claims against First Unum. Because Radford could only recover to the extent of Doe’s rights, First Unum’s arguments would require summary judgment in its favor. Finally, First Unum urged that should the Court hold that First Unum reached its decision incorrectly, the proper course would be remand to First Unum for further proceedings. The parties filed cross motions for summary judgment, and then stipulated that this case might be treated as a case stated. See Pl.’s Stip. [Doc. No. 34]; Def.’s Stip. [Doc. No. 33]. 2 This is a helpful procedure wherein the parties agree that the summary judgment record constitutes the entire case and the Court may draw such inferences therefrom as are reasonable. Where facts are in dispute, the Court notes each party’s contentions, and when necessary makes a determination as would an ordinary factfinder, without presumptively drawing inferences in either party’s favor. See Boston Five Cents Sav. Bank v. Secretary of Dep’t Hous. & Urban Dev., 768 F.2d 5, 11-12 (1st Cir.1985). This Court has used the technique to good effect. 3

*230 The Court issued an order and judgment on March 31, 2004, finding facts, declaring the respective rights of the parties in light of these findings, and entering judgment for Radford. The Court further held that Radford was entitled to costs, attorney’s fees, and prejudgment and post-judgment interest. This opinion explains the Court’s reasoning, amends its holding with regard to the date of accrual for prejudgment interest, and addresses Rad-ford’s Motion to Amend Judgment [Doc. No. 39],

I. INTRODUCTION

A. Factual Background

The facts in this case can be found in several documents: (i) First Unum’s Statement of Undisputed Material Facts of Record [Doc. No. 14] (“Def.’s 56.1 Stmt.”); (ii) Doe’s response thereto [Doc. No. 19] (“Pl.’s 56.1 Stmt.”); (iii) First Unum’s Response to Doe’s Undisputed Statement of Material Facts [Doc. No. 22] (“Def.’s Resp.”); and (iv) written documents that speak for themselves, as compiled in First Unum’s administrative record [Doc. No. 14] (“R.”). Because Doe, not Radford, is the real party in interest here, the Court does not distinguish between Doe’s contentions and Radford’s, and refers to all contentions made by either as Doe’s contentions.

1. The Policy

The Policy provided benefits for “disabled” employees. Def.’s 56.1 Stmt. ¶ 1; R. at FULCL00687-63 (copy of the Policy). The Policy stated:

“Disability” and “disabled” mean that because of injury or sickness:
1. the insured cannot perform each of the material duties of his regular occupation; or
2. the insured, while unable to perform all of the material duties of his regular occupation on a full-time basis, is:
a. performing at least one of the material duties of his regular occupation or another occupation on a part-time or full-time basis; and
b. earning currently at least 20% less per month than his indexed pre-disability earnings due to that same injury or sickness.
Note: For attorneys, “regular occupation” means the specialty in the practice of law which the insured was practicing just prior to the date disability started.

R. at FULCL00677. 4

With respect to payments made for disability, the Policy provided:

When [First Unum] receives proof that an insured is disabled due to sickness or injury and requires the regular attendance of a physician, [First Unum] will pay the insured a monthly benefit after the end of the elimination period. The benefit will be paid for the period of disability if the insured gives to [First Unum] proof of continued:
1. disability; and
*231 2. regular attendance of a physician.

Id. at FULCL00675.

The “elimination period” was “a period of [180] consecutive days of disability for which no benefit is payable ... and begins on the first day of disability.” Id. at FULCL00681; id. at FULCL00685 (specifying 180 days). “If disability stops during the elimination period for any 14 (or less) days, then the disability will be treated as continuous.” Id. at FULCL00681. “Benefits for disability due to mental illness will not exceed 24 months of monthly benefit payments,” except in circumstances not relevant here. See id. at FULCL00670. “ ‘Mental illness’ means mental, nervous or emotional diseases or disorders of any type.” Id.

The Policy provided that an “employee will cease to be insured on the earliest of the following dates” (other possible cessation events are not relevant here):

2. the date the employee is no longer in an eligible class;
5. the date employment terminates. Cessation of active employment will be deemed termination of employment, except:
a. the insurance will be continued for a disabled employee during:
i. the elimination period; and
ii. while benefits are being paid.

Id. at FULCL00669. “Active employment” was defined to mean that “the employee must be working ... for the employer on a full-time basis and paid regular earnings (temporary or seasonal employees are excluded) [and] at least [30] hours [per week].” Id. at FULCL00681; id. at FULCL00685 (specifying 30 hours per week).

2. Doe’s Schizophrenia

In 1993 and 1994, Doe was under treatment for schizophrenia, and was hospitalized twice for that condition. Pl.’s 56.1 Stmt. ¶ 115.

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Bluebook (online)
321 F. Supp. 2d 226, 2004 U.S. Dist. LEXIS 10916, 2004 WL 1368406, Counsel Stack Legal Research, https://law.counselstack.com/opinion/radford-trust-v-first-unum-life-insurance-co-of-america-mad-2004.