Hailoo v. Disability RMS, First Unum Life Ins. Co., 14-cv-1992(ADS)(ARL)
| Decision Date | 25 November 2015 |
| Docket Number | 14-cv-1992(ADS)(ARL) |
| Parties | DR. OGINA HAILOO, Plaintiff, v. DISABILITY RMS, FIRST UNUM LIFE INSURANCE COMPANY, Defendants. |
| Court | U.S. District Court — Eastern District of New York |
APPEARANCES:
The Law Office of John F. Clennan, Esq.
Attorney for the Plaintiff
2206 Ocean Avenue
Ronkonkoma, NY 11779
McElroy, Deutch, Mulvaney & Carpenter LLP
P.O. Box 2075
1300 Mount Kemble Avenue
Morristown, NJ 07962
By: Randi F. Knepper, Esq.
Janet Nogotko, Esq., Of Counsel
On March 28, 2014, the Plaintiff Dr. Ogina Hailoo ("Dr. Hailoo" or the "Plaintiff") commenced this action against the Defendants Disability Reinsurance Management Services, Inc. ("DRMS") and First Unum Life Insurance Company ("First Unum", together with DRMS, the "Defendants"), seeking to recover benefits under a policy of disability insurance and related relief.
Presently before the Court is a motion by the Defendants, pursuant to Federal Rule of Civil Procedure ("Fed. R. Civ. P.") 56, for summary judgment dismissing the complaint.
Before turning to the merits of that motion, the Court notes that the Plaintiff submitted a document entitled "Civil Action - Rule 56.1 Statement in Opposition to Defendant's [sic] Motion for Summary Judgment and in Support of Summary Judgment for Plaintiff" ("Pl. 56.1 Opp"). However, despite the indication in its title that this document is submitted in support of summary judgment for the Plaintiff, the Court notes that Dr. Hailoo did not file a notice of cross-motion. Consequently, the Court does not recognize any portion of her filing as a request for such affirmative relief. See Local Civil Rule 7.1(a)(1) ().
Unless otherwise noted, the following facts are undisputed and are construed in favor of Dr. Hailoo.
Dr. Hailoo is an individual residing in Suffolk County, New York. At all relevant times, she was a practicing dentist; the sole owner of a dentistry practice in Farmingdale; and a member of the Nassau/Suffolk Physicians Guild (Dental) (the "Dental Guild").
First Unum issued a group policy of disability insurance to the Dental Guild, for which the Defendant DRMS acted as the claim administrator. In this regard, inor about 1990, a Disability Income Policy of insurance (the "Policy") was issued by First Unum to Dr. Hailoo. The following provisions of the Policy are at issue in this case:
Maximum Benefit Periods
* * *
Definitions
See Exhibit "A" to the May 26, 2015 Affidavit of Lynn Lamson (the "Lamson Aff.").
It is undisputed that the Policy provided for a monthly disability benefit of $2,000. See 56.1 Stmt. ¶ C.6.
Dr. Hailoo asserts that, at the time she purchased the Policy, she was provided with a summary of declarations. See June 26, 2015 Affidavit of Dr. Ogina Hailoo ("Pl. Aff.") ¶ 13. This purported summary is contained in a two-page document entitled "Application for Disability Insurance Income," which is in the record as Exhibit "A-2" to Plaintiff's 56.1 Opposition. However, the Court notes that this application was completed by one "Eugen N. Hailoo." There is no evidence that Dr. Ogina Hailoo is also known as, or ever went by the name of, Eugen N. Hailoo.
Nevertheless, this document contains the following information, which the Court has reproduced, in relevant part, below. The underscored portions of this chart are handwritten in the original document.
| For Company Use |
| Coverage Summary Section |
| Policy No. RXR 37131 |
| Effective Date 3-8-90 |
| Initial Premium $393.80 |
| Renewal Term 6 |
| Maximum Benefit Period |
| First Renewal Premium Due Date 9-1-90 |
| Accident Lifetime |
| First Renewal Premium $406.00 |
| Sickness Lifetime |
| Billing Mode ___ Annual |
| × Semi-Annual |
See Pl. 56.1 Opp., Ex. "A-2."
Dr. Hailoo asserts that, notwithstanding the portions of the Policy quoted above, this summary of declarations accurately reflects the coverage that she believed she would be receiving under the Policy, namely, "lifetime benefits for both sickness and accident." See Pl. Aff. ¶ 14.
Similarly, Dr. Hailoo relies upon a document of unspecified origin, which is undated and was created on the letterhead of an entity known as Endorsed Administrators, Inc. and/or J.J. Jerome Associates, Inc. See Pl. 56.1 Opp., Ex. "A-3." No attempt is made by Dr. Hailoo to authenticate this document, other than to describe it as a "letter [she] received on the subject." See Pl. Aff. ¶ 15. There also is no information from which the Court can determine what role, if any, Endorsed Administrators, Inc. and/or J.J. Jerome Associates, Inc. have in this case. Under these circumstances, the admissibility of this document is questionable.
Nevertheless, this document, which was sent via fax from one Anna Russo to a representative of Unum Associates Benefits, purports to outline the relevant terms of the Policy and denotes the "benefit period" as "L/L." Dr. Hailoo asserts that "L/L" means "Lifetime Limitation," although no basis is given for her conclusion in this regard and there is no evidence in the record relating to the meaning of "L/L."
Dr. Hailoo asserts that, in or about July 2000, she underwent surgery for carpal tunnel syndrome. The Court will take judicial notice that "[c]arpal tunnel syndrome is 'a condition caused by compression of the median nerve in the carpal tunnel and characterized especially by weakness, pain, and disturbances of sensation in the hand and fingers.' " Hilsdorf v. Comm'r of Soc. Sec., 724 F. Supp. 2d 330, 353 n.13 (E.D.N.Y. 2010) ().
Dr. Hailoo asserts that she made a full recovery from her carpal tunnel surgery; that she was thereafter asymptomatic; and that she returned to practicing dentistry without limitation. See Pl. Aff. ¶¶ 17-18.
However, on May 2, 2002, an incident allegedly occurred while Dr. Hailoo was extracting a patient's tooth (the "2002 Incident"). The Court notes that, in using the term "incident," it is not expressing an opinion as to whether the referenced event constitutes an "accident" within the meaning of the relevant Policy language, quoted above.
Dr. Hailoo describes the 2002 Incident as follows:
Upon attempting to excise the tooth, I unexpectedly found the tooth was impacted, a condition I had not anticipated. I used all my strength to yank or wrench the tooth out. The tooth wouldn't budge. I suddenly felt a sharp pain in my right wrist. I heard a click sound in my right wrist. I lost balance and fell on my right hand. Rising, I did try to finish the extraction, but felt a "Clicking" of my right wrist under my thumb so I could not complete the extraction.
Following the 2002 Incident, Dr. Hailoo asserts that she could not perform her duties as a dentist. Initially, she believed that her symptoms - which included swelling, numbness, and weakness in her right hand - would subside without the need for medical treatment. Rather than visit a physician, Dr. Hailoo asserts that, immediately following the 2002 Incident, she tried to ease her workload by hiring two dental assistants and a billing professional to help with the practice.
Eventually, on or about August 5, 2002, approximately three months after the 2002 Incident, Dr. Hailoo was examined by one Dr. Shafi Wani, a neurologist. In a related report, Dr. Wani stated as follows:
The patient states she became acutely symptomatic with right hand symptoms of pain, numbness and night paresthesias about two and a half years ago. The patient states, subsequently, she was diagnosed as having carpal tunnel surgery [sic]. The patient had carpal tunnel release surgery about two years ago. The patient states she had significant improvement in acute symptoms. About three months ago, the patient fell on her right hand with the thumb being hyperflexed during the trauma. The patient states, subsequently, she has had recurrence of hand symptoms of pain, numbness and weakness. The patient states she is experiencing difficulty at work because of weakness of her wrist and has had problems extracting teeth.
Pl. 56.1 Opp., Ex. "G."
The report indicates that Dr. Wani's initial clinical assessment was "[r]ight wrist and hand pain post status carpal tunnel surgery" with "[e]vidence of right trapeziometacarpal joint dysfunction." The doctor noted that "[t]he possibility of recurrence of carpal tunnel syndrome cannot be ruled out." X-rays taken of Dr. Hailoo's right wrist on August 1, 2002 were noted to be normal. Further, Dr....
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