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Heck-Johnson v. First Unum Life Insurance Co.

December 4, 2007


The opinion of the court was delivered by: Gary L. Sharpe U.S. District Judge

Memorandum-Decision and Order

I. Introduction

Karen A. Heck-Johnson sued in New York Supreme Court alleging that First Unum Life Insurance Company impermissibly terminated her long-term disability benefits. She alleged various state claims and violations of the Employee Retirement Income Security Act of 1974 ("ERISA").*fn1 See 29 U.S.C. §§ 1001 et seq. First Unum removed the action, and the action began a protracted and contentious trip through this court. See Heck-Johnson v. First Unum Life Ins. Co., Civil No. 9:01-CV-01739, 2006 WL 1228841 (N.D.N.Y. May 4, 2006) (familiarity with which is presumed).

Pending is First Unum's motion to dismiss Heck-Johnson's state claims on the basis of ERISA preemption. So too, both parties cross-move for judgment on the administrative record. As this court has stated, it treats such cross-motions as "sui generis ERISA motion[s] for judgment following the administrative denial of benefits." Robbins v. LaBerge Eng'g & Consulting Ltd., No. 1:01CV1738, 2005 WL 2039195, at *7 (N.D.N.Y. Aug. 24, 2005). And finally, there are other pending motions seeking miscellaneous relief.

For the reasons that follow, the court: (1) grants First Unum's motion to dismiss all state claims as preempted by ERISA; (2) denies First Unum's ERISA motion for judgment; (3) grants Heck-Johnson's ERISA motion for judgment; and (4) denies all other miscellaneous motions.

II. Facts*fn2

A. Heck-Johnson's Disability

In 1993, Heck-Johnson developed deep vein thrombosis in her left leg, and was out of work from May-October of that year. See Ayco SMF ¶ 3; Dkt. No. 40. In 1995, her physicians limited her weekly full-time schedule to forty hours. See id. ¶ 5. From September 1997 to January 1998, she was absent from work due to her disability but continued to receive her wages. See id. ¶¶ 6-7. In January 1998, she returned to work on a twenty hour, part-time basis in accordance with her doctor's instructions. See id. ¶ 8. Thereafter, she received partial disability benefits from First Unum and a reduced salary from Ayco commensurate with her reduced schedule. See id. In June 1999, she stopped working and took leave due to total disability. See Pl. SMF ¶ 6. Thereafter, she sought and received long-term disability benefits from First Unum until November 2000. See Ayco SMF ¶ 11. First Unum then terminated her benefits. See id. ¶ 13.

B. Long Term Disability Plan

As an Ayco employee, Heck-Johnson bought a long-term disability policy. See AR 80; Hall Aff.; Ex. B; Dkt. No. 32. First Unum was the insurer. See First Unum SMF ¶ 1; Dkt. No. 33. The relevant provisions of the Long Term Disability Plan are Section IV, subsection (C), and Section II, which state:

When the company receives proof that an insured is disabled due to sickness or injury and requires the regular attendance of a physician, the company will pay the insured a monthly benefit...for the period of disability if the insured gives the Company proof of continued: (1) disability and (2) regular attendance of a physician. Disability or disabled [means] that because of injury or sickness the insured cannot perform each of the material duties of his regular occupation.

See AR 89.

C. Medical Record

Throughout the relevant events, Dr. Lesile Danskin was Heck- Johnson's treating physician. See AR 001-652. On November 3, 1994, Heck-Johnson complained of recurrent pain in her thumb, left leg pain from deep vein thrombosis, and lower back pain. See AR 601. In February and March 1995, she continued treatment for her back and left leg pain. See AR 603. On September 21, 1995, a bilateral ultrasound of her left leg revealed no overt deep vein thrombosis. See AR 644. Although she received treatment for her pain, she continued to work. See AR 604-12.

On February 4, 1997, an MRI indicated that she had Type II degenerative disc disease at the L5-S1 level with a mild central bulge. See AR 646. On February 7, Dr. Danskin instructed her not to work more than forty hours. See AR 612. After she received treatment for carpal tunnel syndrome and depression, Dr. Danskin determined that she was totally disabled on September 24. See AR 619. On October 5, she filed a disability claim because of her depression, sleep disturbance and carpal tunnel syndrome. See AR 537, 547, 556. She continued treatment for carpal tunnel syndrome and depression until January 1998. See AR 619-23.

On June 5, 1998, First Unum approved Heck-Johnson's request for disability payments, retroactive to March 1998. See AR 481-82. On October 28, Dr. Danskin completed a Physical Capacities Evaluation (PCE), and limited Heck-Johnson to two hours sitting, one hour standing and two hours walking with no lifting over ten pounds.*fn3 See AR 418-19. On May 14, 1999, Dr. Danskin completed another PCE report, and stated that there was permanent, non-reversible, venous damage to Heck-Johnson's left leg. See AR ...

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