Tunkle, M.D. v. Voya Financial, Inc.

CourtDistrict Court, M.D. Florida
DecidedAugust 2, 2024
Docket2:23-cv-00010
StatusUnknown

This text of Tunkle, M.D. v. Voya Financial, Inc. (Tunkle, M.D. v. Voya Financial, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tunkle, M.D. v. Voya Financial, Inc., (M.D. Fla. 2024).

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA FORT MYERS DIVISION

ALYOSHA S. TUNKLE, M.D.,

Plaintiff,

v. Case No.: 2:23-cv-10-SPC-NPM

RELIASTAR LIFE INSURANCE COMPANY,

Defendant. / OPINION AND ORDER Plaintiff Alyosha S. Tunkle, M.D. brought this action under the Employee Retirement Income Security Act (“ERISA”) for review of Defendant ReliaStar Life Insurance Company’s denial of his long-term disability claim. (Doc. 1). Before the Court are the parties’ cross-motions for summary judgment. (Docs. 63, 67). Each party has responded to the other’s motion (Docs. 68, 69),1 and Defendant replied (Doc. 70). For the below reasons, the Court grants Defendant’s motion for summary judgment and denies Plaintiff’s motion.

1 In Plaintiff’s response, he incorporated by reference the arguments he raised in his summary-judgment motion. (Doc. 68 at 19). This is improper. Indeed, since the response was filed, this District amended its local rules to forbid such tactics. See M.D. Fla. R. 3.01(f). BACKGROUND Plaintiff began working for 21st Century Oncology2 as a general surgeon

in 2010. (Doc. 56-1 at 481). On January 1, 2020, Defendant issued a group insurance policy to 21st Century for benefits to its employees. (Doc. 56-1 at 741). To qualify for coverage under the Policy, the insured employee must be in “active employment,” meaning the insured works at least thirty hours per

week. (Doc. 57-1 at 1, 4). Coverage under the Policy ends on the “last day [the insured is] in active employment except as provided under a covered leave of absence.” (Doc. 57-1 at 9). Plaintiff was enrolled for coverage under the Policy.

In January 2020, Plaintiff suffered a left shoulder injury, which required joint-reconstructive surgery. (Doc. 56-1 at 423). He underwent the procedure that same month with Dr. Michael Havig. (Doc. 56-1 at 386-87). Post-operation, Dr. Havig instructed Plaintiff to wear a sling for six weeks.

(Doc. 56-1 at 387). Nevertheless, Plaintiff returned to work the next day and continued performing surgeries less than a week later. (Doc. 56-1 at 135). Indeed, during each biweekly pay period from January 5 to March 14, 2020,

2 21st Century has since been acquired by GenesisCare USA, Inc. Through this acquisition, GenesisCare assumed the Policy. For consistency purposes, the Court will continue to refer to Plaintiff’s employer as 21st Century. Plaintiff logged eighty hours, or forty hours per week. (Doc. 56-1 at 551-59). Thus, he was actively employed.

In March, things began to change. For the next four pay periods— March 15th to May 23rd—Plaintiff recorded only 9.5 hours, roughly 4.75 hours a week. (Doc. 56-1 at 544-50). This, of course, falls well below the required thirty hours for active-employment status. During this timeframe, on May

14, 2020, Plaintiff consulted Dr. Havig with complaints of a tremor in his left arm, which made performing surgery difficult. (Doc. 56-1 at 430). Dr. Havig confirmed that Plaintiff “has a noticeable tremor in his hand,” adding that he would refer Plaintiff to a neurologist if the symptoms worsened. (Doc. 56-1 at

432). Subsequently, on June 3, 2020, Plaintiff treated with neurologist Dr. Michael Vickers for the same tremors. Nevertheless, Plaintiff resumed full-time work. During the four pay periods from May 24th to July 18th, he logged either seventy-two or eighty

hours. (Doc. 56-1 at 535-43). But on July 30th, Dr. Vickers placed Plaintiff out of work, explaining that “[g]iven Dr. Tunkle’s profession as a [] surgeon and given the level of tremor . . . continuing to operate presently is not an option and is not going to be an option going forward.” (Doc. 56-1 at 167).

More than three months later, Plaintiff submitted a claim for long-term disability benefits under the Policy. (Doc. 56-1 at 1, 703). As part of its investigation into the claim, Defendant reviewed Plaintiff’s employment records, which it obtained from 21st Century. It observed the

reduction in Plaintiff’s hours from March 15th to May 23rd. Because his hours during this period fell below the thirty-hour threshold to qualify for coverage, Defendant sought clarification from 21st Century as to the reason for this significant decrease. (Doc. 56-1 at 351, 417). A 21st Century

representative advised that their records did not indicate Plaintiff was on any formal leave of absence. (Doc. 56-1 at 407). And the office’s practice manager could not recall any reason for the reduction in Plaintiff’s hours.3 (Doc. 56-1 at 347). Based on this information, Defendant requested Plaintiff’s surgical

schedule during the relevant period. (Id.) 21st Century provided Defendant an Appointments Productivity Report, which identified the number of appointments Plaintiff conducted each day and the time spent in each. (Doc. 56-1 at 370-82). This report similarly reflected

hours below the minimum threshold for active employment. And it wasn’t just his time that decreased; other documentation revealed Plaintiff’s earnings were also reduced.

3 Nor did this decrease in hours have anything to do with Plaintiff’s shoulder surgery. Plaintiff asserted he was not disabled during this period, and ReliaStar confirmed with Dr. Havig that Plaintiff was not restricted in his physical abilities. (Doc. 56-1 at 19). Because Plaintiff apparently was not actively employed from March 15th to May 23rd, nor on any approved leave of absence, Defendant determined that

his coverage ended on March 15th. So when he returned to full-time work on May 25th, this became his new effective date under the Policy. (Doc. 56-1 at 343). This change in his coverage-effective date is critical because it opened the door for Defendant to deny Plaintiff’s claim.

The Policy excludes coverage for preexisting conditions. Specifically, it provides that “[b]enefits will not be paid if your disability begins in the first twelve months following the effective date of your coverage and your disability is caused by, contributed by, or the result of a pre-existing condition.” (Doc.

57-1 at 18). A “pre-existing condition” is defined as “any condition for which you have done 3 months just prior to your effective date of coverage: [r]eceived medical treatment or consultation[,] [t]aken or were prescribed drugs or medicine[,] or [r]eceived care or services, including diagnostic measures.”

(Doc. 57-1 at 6). Because Plaintiff was placed out of work and filed his long-term disability claim within twelve months of his new coverage-effective date of May 24th, Defendant reviewed the three-month “lookback” period for any treatment

related to his hand tremors. As discussed, he had consulted Dr. Havig on May 14th for such tremors, which falls within the lookback period. So Defendant concluded the hand tremors were a preexisting condition excluded from coverage. On October 5, 2021, it sent Plaintiff a letter formally denying his claim for long-term disability benefits. (Doc. 56-1 at 266-71).4

Plaintiff appealed.5 After several phone calls and letters between Plaintiff’s counsel and Defendant, Plaintiff sought to clarify his position. In a letter to Defendant, he tried to rebut the assertion that he worked only 9.5 hours for four consecutive pay periods. He explained that, as an essential

worker during the COVID pandemic, he was on call twenty-four hours per day, seven days a week. Although not recorded, he claimed to have spent much of his time performing surgery, evaluating patients pre- and post-operatively, reviewing and writing medical records, and engaging in other duties. As for

his salary reduction, he clarified this was done intentionally to continue paying his employees (and avoid layoffs) during the COVID pandemic. He concluded by insisting that he worked 35-40 hours per week “in addition to being on call 24/7.” (Doc. 56-1 at 152).

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