Rosalyn Caffey v. Unum Life Insurance Co.

302 F.3d 576, 29 Employee Benefits Cas. (BNA) 1971, 2002 U.S. App. LEXIS 18011, 2002 WL 2001526
CourtCourt of Appeals for the Sixth Circuit
DecidedSeptember 3, 2002
Docket00-5983
StatusPublished
Cited by126 cases

This text of 302 F.3d 576 (Rosalyn Caffey v. Unum Life Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rosalyn Caffey v. Unum Life Insurance Co., 302 F.3d 576, 29 Employee Benefits Cas. (BNA) 1971, 2002 U.S. App. LEXIS 18011, 2002 WL 2001526 (6th Cir. 2002).

Opinion

OPINION

MOORE, Circuit Judge.

In this pro se appeal, the plaintiff Rosalyn Caffey challenges a number of rulings by the district court in her suit to recover long-term disability benefits under an employee welfare plan. The defendant UNUM Life Insurance Company (“UNUM”), which administers claims for the plaintiffs long-term disability insurance plan, initially denied Caffe/s disability claim. Caffey filed suit against UNUM under the Employee Retirement Income Security Act (“ERISA”) to compel payment of benefits. The district court granted summary judgment to UNUM, but the Sixth Circuit reversed. On remand, the district court granted summary judgment to Caffey on her claim to recover benefits. On appeal, Caffey argues: (1) that the district court erred in ruling that her state-law claims were preempted by ERISA; (2) that the district court erred in finding that she was not entitled to certain equitable relief; (3) that the district court erred in failing to impose a statutory penalty for UNUM’s failure to supply certain plan information on request; (4) that the district court -erred in its calculation of prejudgment interest; (5) that the district court erred in declining to award post-judgment interest on its award of legal fees and prejudgment interest; (6) that the district court’s findings of fact concerning UNUM’s bad faith were in error; and (7) that the district court omitted one month’s payment of disability benefits in calculating its award. After reviewing the briefs and the record of the proceedings below, we determine that the district court erred only in failing to order payment of postjudgment interest on its prejudgment interest and attorney fees awards. We therefore AFFIRM IN PART, REVERSE IN PART, and REMAND to the district court solely for the purpose of entering an appropriate award for post-judgment interest.

I. FACTS AND PROCEDURE

A. Factual Background

The facts giving rise to the instant dispute are fully set forth in a prior opinion of this court, Caffey v. UNUM Life Ins. Co., 1997 WL 49128 (6th Cir.). The relevant facts are summarized below.

Caffey worked as a financial analyst for the Mansur Financial Group, Inc. (“Man-sur”) from September 11, 1989, until June 29, 1990. As a Mansur employee, Caffey participated in the company’s long-term disability benefits plan (the “Plan”). UNUM was responsible for claims administration under the Plan. The Plan contained a provision excluding benefits for certain pre-existing conditions. The preexisting conditions provision stated:

*579 This policy will not cover any disability:
1. caused by, contributed to by, or resulting from a pre-existing condition; and
2. which begins in the first 12 months after an insured’s effective date.
A “pre-existing condition” means a sickness or injury for which the insured received medical treatment, consultation, care or services, including diagnostic measures, or had taken prescribed drugs or medicines in the three months prior to the insured’s effective date.

Plan at L-BEN-5.

Caffey’s “effective date,” after which she was eligible for benefits under the Plan, was October 12, 1989. Caffey applied for long-term disability benefits on July 14, 1990, citing severe headaches and vision problems. UNUM reviewed Caffey’s medical records and discovered that Caffey had received treatment for similar symptoms on August 23,1989. In fact, Caffey’s medical records revealed that she had been receiving treatment for hormone-related headaches and visual anomalies for many years. Physicians who examined Caffey at the time of her initial claim, including Dr. Valerie Purvin, believed that Caffey’s symptoms were attributable to her long-standing history of migraine. Caffey, 1997 WL 49128, at *1.

Caffey’s condition failed to improve and she began to experience new symptoms such as memory loss and motion sickness. On March 27, 1991, Caffey was diagnosed with lupus erythematosus on the basis of a positive test for a DNA antibody characteristic of the disease. Based upon this new information, Dr. Purvin reassessed her previous determination that Caffey’s symptoms were due to migraine, and wrote a letter stating that “the headaches for which [Caffey] was treated in July and August of 1990 must have been a manifestation of her lupus rather than a flare-up of her previous migraine.” Dr. Purvin Letter, August 6, 1992. Dr. Jose Tord, another physician who treated Caffey, also wrote a letter distinguishing Caffey’s previous history of migraine from the onset of lupus in June of 1990.

A UNUM staff physician reviewed Caf-fey’s medical history and determined that her lupus was a pre-existing condition, because the migraines and visual anomalies experienced in the summer of 1990 were identical to symptoms reported in August of 1989. Accordingly, UNUM denied Caf-fey’s request for benefits in a letter dated May 22, 1991. Caffey appealed UNUM’s decision. Caffey supplied UNUM with letters from Dr. Tord and Dr. Purvin, which fixed the onset of lupus in the summer of 1990. After additional review of Caffey’s medical records, UNUM’s staff physician concluded that the diagnosis of lupus was incorrect; and alternatively, if Caffey did have lupus, that it was impossible to determine retroactively the date of onset of the disease to be in the summer of 1990.

B. Procedural History

Following UNUM’s denial of benefits, Caffey filed suit in the United States District Court for the Middle District of Tennessee on June 8, 1993. Caffey filed an amended complaint on January 12, 1995, alleging thirteen claims for relief. The claims are summarized as follows:

• Count One sought recovery of long-term disability benefits under ERISA.
• Count Two alleged breach of fiduciary duties under ERISA, violations of Indiana state insurance law, and common-law fraud arising from UNUM’s processing of her benefits claim.
• Count Three alleged that UNUM failed to comply with plaintiffs requests for plan information in violation of 29 U.S.C. § 1024(b).
*580 • Count Five 1 sought to remove UNUM as fiduciary of the Plan pursuant to 29 U.S.C. § 1109(a).
• Count Six claimed that UNUM should be equitably estopped from offsetting any recovery by the amount of Social Security payments received by plaintiff.
• Count Seven sought an injunction requiring UNUM to pay disability benefits in full.
• Count Eight sought prejudgment interest on all past due disability benefits.
• Count Nine sought payment of legal fees.
• Count Ten asserted a claim for “Damages for Vexation,” seeking recovery of certain money damages under ERISA, 29 U.S.C.

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302 F.3d 576, 29 Employee Benefits Cas. (BNA) 1971, 2002 U.S. App. LEXIS 18011, 2002 WL 2001526, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rosalyn-caffey-v-unum-life-insurance-co-ca6-2002.