United States District Court, N.D. Ohio, Eastern Division
DREW A. CARSON, Plaintiff,
UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.
OPINION AND ORDER
Christopher A. Boyko, United States District Judge.
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.
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.
Long-term Disability Plan
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
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.
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.
Plaintiff's Medical History
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.
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 at 63-66, 78-84).
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.).
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. ...