Zurndorfer v. Unum Life Insurance Co. of America

543 F. Supp. 2d 242, 2008 U.S. Dist. LEXIS 26278, 2008 WL 857759
CourtDistrict Court, S.D. New York
DecidedMarch 31, 2008
Docket04 Civ. 3497(RJH)
StatusPublished
Cited by14 cases

This text of 543 F. Supp. 2d 242 (Zurndorfer v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zurndorfer v. Unum Life Insurance Co. of America, 543 F. Supp. 2d 242, 2008 U.S. Dist. LEXIS 26278, 2008 WL 857759 (S.D.N.Y. 2008).

Opinion

MEMORANDUM OPINION AND ORDER

RICHARD J. HOLWELL, District Judge.

Plaintiff Susan Zurndorfer (“Zurndor-fer” or “plaintiff’) worked at CSC Corpo *245 ration (“CSC”) from 1998 until 2002. Defendant Unum Life Insurance Company of America (“Unum”) is the administrator of CSC’s group life insurance and its short and long-term disability insurance. Zurn-dorfer was diagnosed with Multiple Sclerosis (“MS”) in November 2000. Her last day of work was August 15, 2002. On August 16, Zurndorfer had surgery on her right shoulder. Upon the advice of her MS doctor, she did not return to work. On November 11, 2002, Unum found that plaintiff was disabled within the meaning of the long-term disability plan as of August 16, 2002. However, on May 23, 2003, Unum terminated her benefits finding that plaintiff had not demonstrated that she remained disabled.

Before the Court are defendant’s motion for judgment on the administrative record asking this Court to confirm the administrator’s decision and dismiss the complaint, and plaintiffs cross-motion for summary judgment seeking reinstatement of her long-term disability benefits as of May 23, 2003.

BACKGROUND 1

I. The Long-Term Disability Plan

Zurndorfer began working for CSC in March 1998. (PL’s 56.1 Statement ¶ 3.) As a CSC employee, Zurndorfer received long-term disability (“LTD”) coverage through a policy issued to CSC by Unum. (Id. 13.) Under the plan, a covered employee is disabled when Unum determines that the employee is:

limited from performing the material and substantial duties of [her] regular occupation due to [her] sickness or injury; and [she has] a 20% or more loss in [her] indexed monthly earnings due to the same sickness or injury; and during the elimination period [she is] unable to perform any of the material and substantial duties of [her] regular occupation.

(R. 290.) The policy sets the elimination period at 90 days. (R. 290.) Regular occupation “means the occupation [the employee is] routinely performing when [her] disability begins.” (R. 308.) Material and substantial duties are those that “are normally required for the performance of [the employee’s] regular occupation; and cannot be reasonably omitted or modified.” (R. 307.) Effective January 1, 2002 Zurndorfer upgraded her coverage from a 50% benefit to a 66.666% benefit. (R. 41, 177-79, 290-91.) This increase in coverage could not apply to pre-existing conditions. (R. 296.) An employee has a pre-existing condition under the policy if she “received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to the date [her] coverage increased; and the disability begins in the first 12 months after [her] coverage increased.” (R. 296-97.) The policy grants Unum discretion to determine eligibility and to interpret the terms and provisions of the policy. (R. 286; Pl.’s 56.1 Statement ¶ 17.)

II. Plaintiffs Occupation

From September 1985 until August 2002, Zurndorfer sold legal services in New York City, first with Commerce Clearing House and then with CSC. (R. 849.) Before that, Zurndorfer had been a teacher in New York City public schools for twenty-five years and had worked as a special events coordinator for three years. (R. 222; Pl.’s 56.1 Statement ¶2.) In March 1998, Zurndorfer began working at CSC as a sales account manager. (R. 221, *246 225.) CSC provides legal services to corporate law firms. (R. 1343.) At CSC Zurndorfer was essentially a sales person. (R. 1196, 1343.) Her territory covered midtown and lower Manhattan. (R. 1200, 1343.) She was to make an average of fifteen in-person sales calls each week to her clients, 45 top corporate law firms in New York City. (R. 849, 1200, 1220.) As a result, Zurndorfer was required to spend 50% of the work week traveling throughout New York City. (R. 225, 1354.) To get to appointments, Zurndorfer was frequently required to walk several blocks and navigate the stairs of the New York City subway system, often while carrying presentation materials or a laptop. (R. 225, 1200, 1343.)

III. Plaintiffs Multiple Sclerosis

Multiple sclerosis is a common neurological disorder that affects the central nervous system. MS manifests itself in a variety of symptoms, including weakness in the extremities, a loss of dexterity, gait disturbance, a loss of sensation, nystagmus (involuntary eye movement), foot drop, and fatigue, and may take a number of different courses. 87 Attorneys’ Textbook of Medicine (3d. Ed.) ¶¶ 87.00, 87.20-.22. Zurndorfer was diagnosed with primary progressive MS in November 2000 by Dr. Mary Ann Picone, Medical Director of the Bernard W. Gimbel Multiple Sclerosis Comprehensive Care Center (“the Gimbel Center”). (R. 161, 181.) Dr. Lucien Cote had referred Zurndorfer to the Gimbel Center after MRIs of her brain and cervical spine revealed results consistent with MS. (R. 139-42, 1166.) Zurndorfer’s late brother had a long and disabling course of MS; he was treated at the Gimbel Center and Zurndorfer continued to do volunteer work at the Center after his death. (R. 137, 946; Pl.’s 56.1 Statement ¶ 5.) For about five years preceding the diagnosis, Zurndorfer had experienced increasing sluggishness and weakness in her left leg. (R. 136.) In 1998, Dr. Picone noticed that Zurndorfer had begun to limp. (R. 946.) Based on the MRI evidence, Zurndorfer’s personal and family medical history, 2 and her examination of Zurndorfer, Picone concluded that Zurndorfer had primary progressive MS in November 2000. (R. 181, 944.)

According to the medical evidence in the record, there are at least four basic types of MS: relapsing-remitting, secondary progressive, progressive-relapsing, and primary progressive. (R. 945) (citing Fred D. Lublin & Stephen C. Reingold, Defining the Clinical Course of Multiple Sclerosis: Results of an International Survey, 46 Neurology 907, 908-09 (1996) (hereinafter “Lublin & Reingold”).) The first three sub-types — relapsing-remitting, secondary progressive, and progressive-relapsing— require a history of one or more remissions or acute relapses. (R. 945, 1169-70); see also Lublin & Reingold at 908-09. By contrast, “[t]he essential element in [primary progressive MS] is a gradual nearly continuously worsening baseline with minor fluctuations but no distinct relapses.” Lublin & Reingold at 908; (see also R. 945) (“Whether steadily progressive or subject to plateaus, a course of disease which includes neither remission nor acute relapse but follows a course of overall progression, is properly characterized as ‘primary progressive.’ ”).

III. Defendant Awards Plaintiff Long-Term Disability Benefits

A. Initial Review

Unum opened its file on Zurndorfer’s life insurance and short and long-term dis *247 ability claims on September 26, 2002. (R. 1, 9.) By mid-October (R. 1,19,158), Unum had received relevant claim forms from Zurndorfer (R. 16364), CSC (R. 166-70), Dr.

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Bluebook (online)
543 F. Supp. 2d 242, 2008 U.S. Dist. LEXIS 26278, 2008 WL 857759, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zurndorfer-v-unum-life-insurance-co-of-america-nysd-2008.