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Doe v. Unum Life Insurance Co. of America

United States District Court, S.D. New York

July 9, 2015

JOHN DOE, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant

For Plaintiff: Scott M. Reimer, REIMER & ASSOCIATES LLP.

For Defendant: Patrick W. Begos, BEGOS BROWN & GREEN LLP.

MEMORANDUM OPINION

Lewis A. Kaplan, United States District Judge.

Plaintiff alleges that he wrongfully was denied long-term disability benefits by Unum Life Insurance Company of America (" Unum" ) in violation of the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § 1001 et seq. The

Page 222

matter now is before the Court following a bench trial on a stipulated record.[1]

I. Background

Plaintiff began working in June 2006 as a partner in the financial restructuring group of a major law firm.[2] As a benefit of employment, plaintiff was covered under the terms of the firm's long-term disability plan (the " Plan" ) issued by Unum.

In early 2009, plaintiff sought treatment from Dr. Eric Hollander for mild anxiety related to his firm's restructuring practice and the departure of his chief client.[3] Plaintiff attended therapy sessions for several months and by August 2009 believed that his anxiety issues were sufficiently resolved.[4] In October 2009, however, plaintiff's wife was diagnosed with breast cancer and they were facing serious marital problems.[5] Plaintiff took a leave of absence from the firm to assist in his wife's treatment and to prevent, in his words, " the possible demise of my marriage." [6]

Plaintiff returned to Dr. Hollander in February 2010. This time, Dr. Hollander noted potentially debilitating psychological symptoms and immediately commenced pharmacological treatment.[7] Plaintiff returned to work in March 2010 while still under Dr. Hollander's care.[8] A few months later, however, plaintiff was informed that he was not producing significant billable hours and that he should consider alternate employment.[9] Plaintiff acknowledged his difficulties, informed the firm of his medical problems, and stated that he would undergo neuropsychological testing and resign if the results demonstrated that he was unable to work.[10]

After undergoing psychological and neuropsychological testing, Dr. Hollander diagnosed plaintiff with major depression, obsessive compulsive disorder (OCD), attention deficit hyperactive disorder (ADHD), obsessive compulsive personality disorder (OCPD), and Asperberger's syndrome. Dr. Hollander advised plaintiff to discontinue work on October 28, 2010, and plaintiff has not worked in any capacity since that date.[11]

On December 3, 2010, Plaintiff submitted a claim for long-term disability benefits under the Plan.[12] Unum denied the claim on November 17, 2011.[13] Unum twice denied plaintiff's appeal of that determination, and this litigation followed.[14]

II. Standard of Review

A beneficiary of an ERISA plan may bring a civil action " to recover benefits

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due to him under the terms of his plan, or to clarify his rights to future benefits under the terms of the plan." [15] While ERISA does not define the standard of review in such cases, the Supreme Court has held that review of a decision to deny ERISA benefits presumptively is de novo.[16] Moreover, the parties have stipulated that de novo review applies here.[17] Accordingly, " [u]pon de novo review, a district court may render a determination on a claim without deferring to an administrator's evaluation of the evidence." [18] In short, this Court acts as the finder of fact.[19]

The Second Circuit repeatedly has held that " as a matter of general insurance law, the insured has the burden of proving that a benefit is covered." [20] Plaintiff therefore must prove by a preponderance of the evidence that he was " disabled" as defined by the Plan and therefore entitled to benefits.[21]

III. Facts

1. The Plan

The Plan defines disability as follows:

" You are disabled when Unum determines that:
- you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and
- you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury." [22]

" Regular occupation" is defined as " your specialty in the practice of law which you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location." [23] Additionally, " [t]he lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months." [24]

2. Duties of Plaintiff's Occupation

The parties generally agree as to plaintiff's duties as a litigation partner with a specialty in bankruptcy law. Unum's internal vocational rehabilitation consultant, Laura Feeney, identified, among other things, the following ...


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