United States District Court, E.D. New York
MEMORANDUM AND ORDER
I. LEO GLASSER, Senior District Judge.
Plaintiff Rao Suryadevara ("Suryadevara") brings this action against Unum Group ("Defendant") for breach of contract of a disability insurance policy, seeking money damages and a declaratory judgment. Suryadevara claims that he suffered from two separate and unrelated periods of disability and, therefore, is entitled to greater benefits than he is currently receiving under the policy. Currently before the Court is Defendant's motion for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure. For the reasons that follow, Defendant's motion is hereby DENIED.
Unless otherwise noted, the following facts are undisputed. In 1992, Defendant issued Suryadevara the disability insurance policy that underlies his claims in this action (the "Policy"). Compl. [Dkt. No. 1] ¶ 7. Among other things, the Policy provided for an initial maximum monthly benefit of $4, 500 per month for total disability, Begos Decl. [Dkt. No. 25-2], Ex. D at 60, which increased each year until 1997 according to the following schedule:
Id. at 62. The Policy provided that a "[b]enefit increase will apply only to a period of disability which starts after the effective date of the increase. It must qualify as a separate period of disability." Id.
The Policy further provided that "period of disability' means a period of disability starting while this policy is in force. Successive periods will be deemed to be the same period unless the later period: 1. is due to a different or unrelated cause, or 2. starts more than twelve months after the end of the previous period... in which event the later period will be a new or separate period of disability." Id. at 63.
In 1995, Suryadevara began a cardiology fellowship at Harlem Hospital, where he remained until 1998. Millman Aff. [Dkt. No. 32], Ex. B at 3. From 1998 through 2001, he worked as an attending physician in the emergency department at New York Community Hospital. Id . In 1996, Suryadevara began behaving erratically, which behavior included following his supervisor, Dr. Eric Vanderbush ("Vanderbush") out of the hospital and continuing conversations after they ended. Id. at 4. At some point, Suryadevara also began experiencing hallucinations and delusions, which in 2000, led to his filing a lawsuit seeking $1, 000, 000, 000 in damages against Vanderbush, Paramount Pictures, 20th Century Fox, and James Cameron. Id. at 5. The lawsuit alleged that they had conspired to steal the plot for a movie he had narrated and had used it to write the screenplay for "Titanic." Id . Suryadevara also expressed the belief that he had originated the plots of "Gone in 60 Seconds" and "Mission Impossible: 2." Id. at 5.
In 2001, Suryadevara joined the cardiology department at the Veterans Affairs Hospital in Danville, Illinois. Id. at 3. On two occasions in 2002, Suryadevara called the police as a result of hearing voices he thought were real. Id. at 6. On the second occasion, on July 1, 2002, the police took Suryadevara to the emergency room, where he was diagnosed with "acute psychosis." Begos Decl., Ex. E; id. Ex. D at 103-04. As a result, Suryadevara was placed on medical leave until September 16, 2002. Millman Aff., Ex. B at 6; Begos Decl. Ex. D at 182-83. Following his return to work, he continued to experience performance problems, and ultimately resigned on August 9, 2003. Millman Aff., Ex. B at 6. On June 25, 2004, the New York Board for Professional Medical Conduct revoked Suryadevara's license to practice medicine, on the grounds that he had practiced while mentally ill. Id. at 17. The determination was upheld on administrative review on October 20, 2004. Begos Decl., Ex. D at 140.
On December 13, 2004, Suryadevara submitted a claim for disability benefits, alleging that he became disabled as of August 9, 2003 due to mental illness. Compl. ¶¶ 12-13. Defendant approved the claim on December 22, 2004 and began paying Suryadevara disability benefits in the amount of $6, 340 per month, retroactive to October 15, 2003. Id . ¶ 13. Suryadevara thereafter sought additional disability benefits dating back to January of 1996. Id . ¶¶ 14-17. Defendant investigated this new claim and ultimately determined that Suryadevara was residually, or partially, disabled from January 1996 through April 2002, with the exception of certain months in which his earnings were too high to qualify for benefits. Id . ¶¶ 18-24; Begos Decl. Ex. D at 186-87. In addition, Defendant determined that Suryadevara was totally disabled from July 1, 2002 through September 16, 2002, and from August 10, 2003 through the present. Compl. ¶¶ 18-24; Begos Decl. Ex. D at 186-87. Because Defendant determined that Suryadevara became disabled in January of 1996, the maximum monthly benefit due to Suryadevara pursuant to the benefits schedule in the Policy was $5, 530 per month, rather than the $6, 340 per month it had been paying him. Compl. ¶ 18; Begos Decl. Ex. D at 186-87.
Suryadevara disputed these determinations, and argued that he is entitled to the higher monthly benefit for his claim from August 9, 2003 through the present. First, he argued that the mental illness he suffered in August of 2003 was of a different kind than the illness he had experienced during his prior period of disability from 1996 through 2002. Compl. ¶¶ 25-27. Second, Suryadevara argued that he had neither applied for disability benefits nor suffered lost pay between July of 2002 and August of 2003, and therefore he was not disabled for a continuous twelve-month period prior to becoming totally disabled on August 9, 2003. Id . ¶ 29. Defendant rejected these claims and this litigation followed.
II. Procedural History
Suryadevara initiated this action on June 25, 2012 in the ...