Renfro v. UNUM Life Insurance Co. of America

920 F. Supp. 831, 1996 U.S. Dist. LEXIS 4738
CourtDistrict Court, E.D. Tennessee
DecidedJanuary 23, 1996
Docket2:95-cv-00210
StatusPublished
Cited by2 cases

This text of 920 F. Supp. 831 (Renfro v. UNUM Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Renfro v. UNUM Life Insurance Co. of America, 920 F. Supp. 831, 1996 U.S. Dist. LEXIS 4738 (E.D. Tenn. 1996).

Opinion

MEMORANDUM OPINION

JORDAN, District Judge.

This is a civil action governed by the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001-1461 (ERISA). It is before the court for consideration of the defendant’s motion for summary judgment [doc. 11]. The parties have fully briefed the issues presented [docs. 12, 14, and 16], and the defendant has filed its claim record [doc. 12, attachment]. The court finds that oral argument would not assist it in ruling on the defendant’s motion.

The plaintiffs claim is for benefits under a group long-term disability insurance policy issued by the defendant to the plaintiffs employer, Overlook Center, Inc., for the benefit of the latter’s employees. While the plaintiff Ms. Renfro was working as Overlook Center’s Corporate Controller/Direetor of Financial Operations, she experienced a disability due to major depression, and the defendant paid disability benefits to her under the policy in issue for a périod of 24 months. The plaintiff claims in this civil action that at the end of this 24-month period, she continued to suffer disability due to multiple causes and conditions, and that the defendant therefore is hable for continuing benefits under the policy and under ERISA law concerning employee welfare benefits.

The claim record filed by the defendant UNUM reveals the following. The plaintiff Ms. Renfro applied on May 19, 1991, for long-term disability benefits, on a form provided by UNUM. On this form, the plaintiff stated that she had first noticed her disabling symptoms, and was first treated for them, on June 17, 1989, and that she had been unable to work due to disability since April 25, 1991 1 . In the space provided, she listed the following symptoms: “chronic headaches; sadness; crying; fatigue; concentration difficulty; chronic allergies; sleep disturbance.”

In support of this application for benefits, M. Weninger, M.D., the plaintiffs treating psychiatrist, completed a form on which he listed his diagnosis as major depression, and stated that the plaintiff had become totally *833 disabled about April 23,1991. Dr. Weninger stated that he was treating the plaintiff with psychotherapy and chemotherapy, and that the plaintiff might be able to attempt part-time work in two months. Dr. Weninger stated that the plaintiff was not a candidate for rehabilitation to return to her job, but that she might be rehabilitated to do other work, and that her present occupation might be modified to allow her to work in it.

In response to the defendant UNUM’s request for more information, Dr. Weninger stated on a form provided by the defendant an axis I diagnosis of major depression, and an axis III diagnosis of “COPD [chronic obstructive pulmonary disease], chronic HA [headaches], obesity.” In progress notes dictated on June 25, 1991, this physician described a long history of depression with chronic headaches, and noted the following concerning the plaintiffs medical history:

She has some extensive other medical history, including endometriosis until a complete hysterectomy in 1981 and also she has (sic: had) a Morton’s neurinoma in 1985 removed. She has multiple allergies and has had extensive allergy care over the years. She had Bell’s palsy in 1984. She has had a hiatal hernia and has had recurrent gastric ulcers on three occasions. Her cholesterol is chronically elevated in the 260 range.

Dr. Weninger noted that in January 1990, he had assessed the plaintiffs problems at that point “as being chronic depression, multiple allergies, obesity, chronic headache, chronic obstructive pulmonary disease, and hyperlipidemia, and chronic multiple pain medicines.” This physician described her headaches as “rather marked, profound,” and concluded that he was not certain about what could be done to rehabilitate the plaintiff gainfully.

The defendant UNUM approved the plaintiffs application for long-term disability benefits, for a period beginning on July 25,1991. In an August 15, 1991, letter advising the plaintiff of this decision, an UNUM disability benefit specialist advised that the defendant would periodically send supplementary claim forms for the purpose of obtaining continuing proof of disability, and wrote, “Benefits are payable as long as you continue to remain disabled as defined and meet all other provisions as outlined in the contract.” An attachment to this letter stated the policy’s mental illness limitation, which, with some exceptions, capped benefits for disability due to mental illness at 24 months of monthly benefit payments.

During this time period, the Social Security Administration determined that the plaintiff was disabled on April 24, 1991, for the purposes of the Social Security laws, and began to pay her monthly disability benefits beginning October 1991. Early in 1992, the defendant requested proof of continuing disability, and in response, Dr. Weninger completed a form showing his diagnosis as major depression, “COPD chronic HA’s (sic), obesity,” stated that his patient continued to be totally disabled, and stated concerning her progress since his last report that she was unchanged. In the space for remarks, Dr. Weninger wrote, “This lady is severely depressed + suffers chronic HA’s (sic) + environmental triggered asthma. I do not think she will be returning to gainful employment.”

In an accompanying February 26, 1992, letter, Dr. Weninger wrote that he had been unable to get the plaintiff free of headaches or to end her use of all abuse-potential substances, but that her depression had substantially improved while she had been away from the stress of her work environment. This physician reported extremely severe headaches of about two days’ duration about four times per month, poor sleep with multiple interruptions, and a recent decrease in appetite. Dr. Weninger noted that in addition to the stress of her job, the plaintiff Ms. Renfro had experienced problems with her allergies in a closed work environment, but he disclaimed any expertise with respect to allergies.

In October 1992, Dr. Weninger reported “no real change” in the plaintiffs condition. On June 24,1993, he reported that the plaintiff continued to experience chronic pain, frequent, recurrent and severe headaches, and chronic depression. Dr. Weninger wrote that it was “obvious” that the plaintiff had ongoing respiratory problems, and “that a significant part of her overall distress is re *834 lated to her chronic allergies and respiratory difficulty.” Dr. Weninger continued to believe that the plaintiff was disabled.

On May 7, 1993, Larry C. Brakebill, M.D., an internist, wrote to UNUM stating that he had been following the plaintiff, his patient, “with arthralgias, myalgias, weakness, hypercholesterolemia and other medical problems.” This physician stated a suspicion that the plaintiff had lupus, and stated also that due to her symptoms and her severe problems with allergies, she would not be able to return to work. Dr.

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Related

MacMillan v. Provident Mut. Life Ins. Co. of Phila.
32 F. Supp. 2d 600 (W.D. New York, 1999)
Holsey v. UNUM Life Insurance Co. of America
944 F. Supp. 573 (E.D. Michigan, 1996)

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Bluebook (online)
920 F. Supp. 831, 1996 U.S. Dist. LEXIS 4738, Counsel Stack Legal Research, https://law.counselstack.com/opinion/renfro-v-unum-life-insurance-co-of-america-tned-1996.