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Carson v. UNUM Life Insurance Company of America

United States District Court, N.D. Ohio, Eastern Division

June 18, 2019

DREW A. CARSON, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.

          OPINION AND ORDER

          Christopher A. Boyko, United States District Judge.

         This matter comes before the Court upon Plaintiff's Motion (ECF DKT #20) to Overturn the Plan Administrator's Claim Denial and Defendant's Motion (ECF DKT #19) to Uphold Plan Administrator's Claim Denial. For the following reasons, the Court DENIES Plaintiff's Motion and GRANTS Defendant's Motion.

         I. Factual Background

         Plaintiff, Drew A. Carson, filed this Employee Retirement and Income Security Act of 1974 (“ERISA”) action against Defendant, Unum Life Insurance Company of America (“Unum”). Plaintiff was, during part of the time relevant to this case, employed as a corporate attorney at Miller Goler Faeges LLP. During this term of employment and after he quit working there, Plaintiff filed a claim seeking to be insured under a Long-Term Disability (“LTD”) Benefits Policy governed by ERISA.

         A. Long-term Disability Plan

         As an employee benefit, Miller Goler Faeges LLP provided a LTD plan through Defendant to its employees. This plan provides:

“‘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. . . . [W]hile unable to perform all of the material duties of his regular occupation on a full-time basis is: performing at least one of the material duties of his regular occupation or another occupation on a part-time or full-time basis; and earning currently at least 20% less per month than his indexed pre-disability earnings due to that same injury or sickness.”

         According to the LTD policy, an insured must provide proof of continued disability and regular attendance of a physician. An insured must also satisfy an elimination period of 180 days between when he or she sustained an injury and the initial receipt of benefits. Defendant further states it must receive proof of claim no later than thirty days after the elimination period ends. Finally, a claimant cannot bring legal action more than three years after the time Defendant required proof of claim.

         Defendant is also the Claims Administrator of the LTD benefit plan. Therefore, Defendant has the sole discretion to interpret the Plan's definition of “disability” and determine an individual's benefit eligibility. Defendant's Plan also provides an avenue for an appeal process, after benefits are determined.

         B. Plaintiff's Medical History

         The information contained in this section regarding Plaintiff's medical history and the subsequent section regarding the claim and appeals process is a short restatement. A much more detailed history is contained in the cross-motions entered by Plaintiff and Defendant and the full record submitted to the Court.

         Plaintiff suffered from pre-existing mental health issues before the time period relevant to this case. From 2003 onwards, Plaintiff suffered from insomnia and sleep apnea. (Record[1] at 63-66, 78-84).

         Plaintiff's billable hours began to decrease in July of 2011, although his non-billable hours and pay had not changed yet. The first time Plaintiff was entirely unable to work due to his condition was on November 18, 2011, when Plaintiff and his employer ended their relationship. (Record at 36, 42-43). This coincides with the same day Plaintiff last entered billable hours for Miller Goler Faeges, LLP. (Id. at 36, 42-43). On December 8, 2011, Plaintiff submitted a disability claim to Defendant, which stated he could no longer perform the material duties of a litigator, including “appearing in court, researching, drafting, [and] communicating with clients.” (Id.).

         In December 2010, Plaintiff suffered a “debilitating physical injury” and began to experience “bilateral chronic groin pain. (ECF DKT #20) After the onset of this pain, Plaintiff met with five separate doctors to determine the cause of and potential cure for his pain. (Id. at 727, 738, 753, 851, 1445). He began to attend physical therapy at this time. (Id. at 839). In March of 2011, Plaintiff admitted himself to the behavioral health unit at Marymount Hospital due to suicidal thoughts related to his lack of improvement. (Id. ...


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