Chapman v. Unum Life Ins. Co. of Am.
| Decision Date | 18 August 2021 |
| Docket Number | Case No. 20-CV-1155 (NEB/BRT) |
| Citation | 555 F.Supp.3d 713 |
| Parties | Melissa B. CHAPMAN, DDS, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant. |
| Court | U.S. District Court — District of Minnesota |
Alesia R. Strand, Thomas J. Beedem, III, Beedem Law Office, Scott A. Wilson, Attorney at Law, Minneapolis, MN, for Plaintiff.
Lauren Hoglund, Terrance J. Wagener, Messerli & Kramer P.A., Minneapolis, MN, for Defendant.
ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT
2
in her hands that rendered her disabled—she can no longer perform her job as an endodontist. She sought disability benefits from Provident, her insurer. Provident granted benefits under the insurance policy's "sickness" coverage, running until she turned 65. Dr. Chapman contended that she had been "injured" and is entitled to lifetime benefits. Provident disagreed and, after an administrative appeal process, denied her claim for "injury," but continued to pay benefits for "sickness." Dr. Chapman filed this lawsuit under the Employee Retirement Income Security Act of 1974 ("ERISA"), seeking to overturn Provident's decision. The parties moved for judgment under a de novo review standard. For the reasons below, the Court grants Dr. Chapman's motion, denies Provident's, and awards Dr. Chapman attorney's fees, subject to determination of the final amount.
Before the Court can consider the merits, a few observations on the legal standard the Court applies are in order. The parties agreed that the Court reviews Provident's ERISA benefits decision de novo , giving no deference to that decision. (ECF No. 19 at 12; ECF No. 26 at 18.) This standard follows the practice in this district, where review of ERISA benefits decisions are made by the district court acting "as the fact finder, mak[ing] credibility determinations, and weigh[ing] the evidence as applied to the governing insurance policy." Avenoso v. Reliance Std. Life Ins. Co. , No. 19-CV-2488 (WMW/DTS), 2021 WL 1140205 (D. Minn. Mar. 25, 2021) (citations omitted); Kaminski v. UNUM Life Ins. Co. of Am. , 517 F.Supp.3d 825, 858 (D. Minn. 2021) () (internal quotation omitted).
But the parties moved for summary judgment under Rule 56, which dictates a standard different from a de novo review of evidence: "Summary judgment is proper if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine [dispute] as to any material fact and that the movant is entitled to judgment as a matter of law." Gannon Int'l, Ltd. v. Blocker , 684 F.3d 785, 792 (8th Cir. 2012) (citing Fed. R. Civ. P. 56(c)(2) ).
At argument, the Court raised whether making credibility determinations and weighing the evidence at this stage violated Rule 56.3 The parties agreed that the standard they provided the Court was appropriate for resolution of their cross-motions. The Court requested a stipulation to that effect, which the parties filed. (ECF No. 37) (stipulating that "[t]he Court is to determine, de novo, whether Plaintiff has met her burden by a preponderance of the evidence, based on the administrative record, without consideration of Fed. R. Civ. P. 56 motion standards").
The Court therefore uses the de novo standard, under which Dr. Chapman bears the burden to prove that her disability is due to accidental bodily injury by a preponderance of the evidence, based on the administrative record. Applying this standard, the Court finds the following facts and conclusions of law.
The parties agree that Dr. Chapman is disabled, but they disagree sharply over the cause of her disability and whether the Policy requires Provident to pay benefits for it.
Dr. Chapman stopped working on October 31, 2018, at the age of 60. (ECF Nos. 31, 31-1 (together, "R.") at 32, 667–68.)4 The Policy provides that if Dr. Chapman suffered a disability because of a "sickness" between her 60th and 61st birthdays, Provident would pay benefits through her 65th birthday. (Id. at 139.) If, however, an "injury" caused her disability and it began before the age of 65, Provident would pay benefits for life. (Id. at 138.)
Under the Policy, "Injuries" are "accidental bodily injuries occurring while [the P]olicy is in force." (Id. at 142.) "Sickness" is a "sickness or disease which is first manifested while [the P]olicy is in force." (Id. ) And the (Id. at 144.)
The parties agree that Chapman is suffering from degenerative arthritis
in her hands and fingers that makes it impossible for her to carry out her work as an endodontist. (Compare ECF No. 19 at 1 (), with ECF No. 26 at 1 ().)
An endodontist is a specialized form of dentist that specifically focuses on treating tooth pain, mainly related to root canals and internal tooth problems. (R. at 664.) Generally, each time Dr. Chapman does a root canal or treats tooth pain, she must make multiple injections, use handheld files inside tooth canals, and then use powered tools to complete her work; at times, she may spend an hour hand filing a tooth during a procedure. (Id. at 40.) This work is highly repetitive and requires "a tremendous amount of pressure and force" to hold and operate the files and tools effectively. (Id. ) The process requires substantial fine motor control and delicate hand movements to accomplish. (Id. ) Before her disability, Dr. Chapman performed this work for over 29 years. (Id. )
Dr. Chapman stands 4 feet, 10 inches tall. (R. at 189.) She practices left-handed, but her tools are generally designed for right-handed endodontists, which may require her to alter her technique or operate the tools in a way that increases stress on her joints vis-à-vis endodontists who practice right-handed. (Id. at 664.) Dr. Chapman began suffering pain in her hands at the age of 40; this slowly worsened throughout her fifties. (Id. at 673.) At the beginning, she would start the day with little pain, but it would progress; often, after work, she would go home and ice her hands or treat them with heat so that she could work again in the morning. (Id. at 667.) At this point in her career, heat and ice, combined with ibuprofen
and night splints, were enough to permit her to continue her work. (Id. at 326–27.) In 2012, Dr. Chapman visited a rheumatologist, Dr. Berglund, to test for potential genetic indicators for arthritis ; Dr. Berglund found no such evidence. (Id. at 326, 667.) Dr. Berglund also stated that Dr. Chapman's condition resulted from a "dental injury." (Id. at 327.)
Four years later, in 2016, Dr. Chapman sought treatment from Dr. Thomas Varecka, an orthopedist. (Id. at 493–94.) Dr. Varecka first diagnosed Dr. Chapman with "diffuse chronic progressive degenerative joint disease
involving multiple digits in both hands." (Id. at 494) On her second visit to Dr. Varecka, Dr. Chapman's condition had worsened. (Id. at 496.) On at least two visits to Dr. Varecka in 2018, Dr. Chapman received steroid injections to help alleviate her pain. (Id. at 347–48, 350–51.)
About a month after her second steroid injection, Dr. Chapman filed a claim with Provident, asserting that she was disabled due to her arthritis
, and claiming an injury under the Policy. (R. at 32–35.) Dr. Chapman described the injury as a " Gillette injury"5 to her hands because of her work as an endodontist. (Id. )
In support of Dr. Chapman's claim, Dr. Varecka submitted an Attending Physician Statement, in which he stated that Dr. Chapman suffered from "Advanced Degenerative Joint Disease
of Both Hands Aggravated & Accelerated by Work as Endodontist." (Id. at 88.) Dr. Varecka noted that changes on Dr. Chapman's X-ray, as well as a clinical exam, supported this diagnosis. (Id. ) On the form, Dr. Varecka checked a box that said Dr. Chapman was not suffering from "sickness." (Id. ) The form also contains boxes to check for "accident" (yes or no); Dr. Varecka left them blank. (Id. ) In Dr. Varecka's view, Dr. Chapman's disability was permanent. (Id. at 89.) Provident told Dr. Chapman it would be administering her claim under the Policy's "sickness" provision. (Id. at 323–24.)
After its initial review of the claim, Provident sought the opinion of John R. Groves, M.D., who is board certified in orthopedic surgery. (R. at 506–07.) Dr. Groves reviewed Dr. Chapman's medical records and agreed with Dr. Varecka's conclusion that Dr. Chapman was disabled, but he disputed the cause of the disability. (Id. ) Dr. Groves concluded that the cause of Dr. Chapman's arthritis
was "most likely ... genetic" as Dr. Chapman did not claim or report a "specific traumatic event" and because, in his experience, (Id. at 507.) Dr. Groves did not develop the rationale behind his conclusion that "the arthritis that developed was due to a genetic predisposition to that condition." (Id. ) Despite disputing the initial cause, Dr. Groves agreed that, once arthritis had developed, Dr. Chapman's work "would reasonably accelerate and aggravate" it. (Id. ) Dr. Groves also believed that Dr. Chapman had insisted that...
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