Hinchey v. First Unum Life Ins. Co.
| Decision Date | 20 March 2020 |
| Docket Number | 17-cv-08034 (NSR) |
| Parties | JOSEPH J. HINCHEY, Plaintiff, v. FIRST UNUM LIFE INSURANCE COMPANY and MANHATTANVILLE COLLEGE, Defendants. |
| Court | U.S. District Court — Southern District of New York |
Plaintiff Joseph J, Hinchey ("Plaintiff") brings this action against First Unum Life Insurance Company ("First Unum") and Manhattanville College ("Manhattanville") (collectively, "Defendants"), asserting claims under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001, et seq. (ECFNo. 5.) Plaintiff's claims arise from First Unum's denial of long-term disability benefits ("LTD Benefits") to which Plaintiff was purportedly entitled under the terms of an employee benefit plan issued to him through his employer.
Before the Court are Defendants' Motion for Summary Judgment (ECF No. 46) and Plaintiff's Cross-Motion for Summary Judgment (ECF No. 49). For the following reasons, Defendants' motion is GRANTED, and Plaintiff's cross-motion is DENIED.
The following facts are drawn from the administrative record and the parties' Rule 56.1 statements1 and are not in dispute unless otherwise noted.
The Manhattanville College Employee Benefit Plan (the "Plan"), established and administered by Manhattanville, provides disability benefits to covered employees pursuant to the terms of Group Policy Number 906667 002 (the "Policy"). (Defs. 56.1 ¶ 1; Pl. 56.1 ¶ 1; AR2 67-110.) The Policy is issued by First Unum. (Id.) The Plan confers to First Unum discretionary authority to administer the Policy, stating that "[w]hen making a benefit determination under the policy, Unum has discretionary authority to determine your eligibility for benefits and to interpret the terms and the provisions of the policy." (Defs. 56.1 ¶ 2; Pl. 56.1 ¶ 2; AR 78.)
The Plan contains various definitions relevant to the parties' respective motions. Under the Plan, a claimant is disabled when:
[he or she is] limited from performing the material and substantial duties of [his or her] regular occupation due to [his or her] sickness or injury; and [he or she] [has] a 20% or more loss in [his or her] indexed monthly earnings due to the same sickness or injury.
(Defs. 56.1 ¶ 3; Pl. 56.1 ¶ 3 AR 82 (emphasis in original).) The Plan continues, "After 24 months of payments, [a claimant] is disabled when Unum determines that due to the same sickness or injury, [he or she] is unable to perform the duties of any gainful occupation for which [he or she is] reasonably fitted by education, training or experience." (Id. (emphasis in original).)
The Plan goes on to define "Gainful Occupation" as "an occupation that is or can be expected to provide you with an income within 12 months of your return to work[] that exceeds 80% of your indexed monthly earnings, if you are working; or 60% of your indexed monthly earnings, if you are not working." (Defs. 56.1 ¶ 4; Pl. 56.1 ¶ 4; AR 97.) The Plan next defines "Limited" as "what you cannot or are unable to do" and "Material and Substantial Duties" as "duties that[] are normally required for the performance of your regular occupation; and cannot be reasonably omitted or modified." (Defs. 56.1 ¶ 6; Pl. 56.1 ¶ 6; AR 98.) Finally, and critically for this motion, the Plan defines "Regular Occupation" as "the occupation you are routinely performing when your disability begins." (Defs. 56.1 ¶ 7; Pl. 56.1 ¶ 7; AR 100.) When assessing a claimant's regular occupation, "Unum will look at [the] 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." (Id. (emphasis added).)
Under the terms of the Plan, a claimant must submit, at the request of First Unum, "proof of a claim[] provided at [his or her] expense." (Defs. 56.1 ¶ 8; AR 73.) This includes (1) proof that a claimant is "under the regular care of a physician," (2) documentation of "monthly earnings," (3) the date claimant's disability began, and (4) the cause and extent of the disability, "including restrictions and limitations preventing [the claimant] from performing [his or her] regular occupation." (AR 73.) Notably, the Plan explains that First Unum may also request "proof of continuing disability." (Defs. 56.1 ¶ 9; Pl. 56.1 ¶ 8; AR 73.)
On December 8, 2010, following his August 2010 aortic valve replacement, Plaintiff applied for benefits. (Defs. 56.1 ¶ 10; Pl. 56.1 ¶ 9; AR 40, 42.) According to the physician statement by cardiologist Joseph J. Tartaglia, M.D. ("Dr. Tartaglia"), Plaintiff could not "stand orwalk except frequently [sic], not continuously," "climb twist, bend, stoop or reach above shoulder level except occasionally," or "operate heavy machinery." (AR 43.) The application further explained that Plaintiff could not "be in [a] position where he [was] exposed to risks of falls," could not "lift heavy objects," could not do "extreme bouts of heavy exertion," and should be "protected from stressful situations or combative situations at work." (Id.)
Plaintiff's application also included a letter from Dr. Tartaglia that mirrored his physician statement. (Defs. 56.1 ¶ 11; Pl. 56.1 ¶ 10; AR 44.) In the letter, Dr. Tartaglia described Plaintiff as a "51-year-old male with a history of recent aortic valve replacement," which included a "porcine valve for severe aortic insufficiency." (AR 44.) Dr. Tartaglia explained that "Plaintiff remain[ed] with paroxysmal atrial fibrillation and significant chest pain and tenderness" and "ha[d] to be on warfarin because [of] the danger of thromboemboli." (Id.) Dr. Tartaglia also explained that Plaintiff had "hyperactive airway disease for which he takes Singular and he needs to take beta blockers to control palpitations." (Id.) In summation, Dr. Tartaglia reiterated, consistent with his physician statement, that Plaintiff (1) could not "be in a position where he was exposed to risks of falls because of the danger of bleeding on warfarin," (2) could not "lift heavy objects because of his chest wall pain," (3) had a "somewhat limited" exercise capacity because of his heart disease, (4) "should not be requested to do extreme bouts of heavy exertion," and (5) "should be protected from stressful situations or combative situations at work." (Id.)
Several weeks later, Plaintiff had an initial phone call with First Unum. (Defs. 56.1 ¶ 13; Pl. 56.1 ¶ 13; AR 124-29.) During the call, Plaintiff told First Unum that he could not "lift anything heavy, could not "jog," was "tired during the day," had shortness of breath when going "up and down [] steps," and had "discomfort in his chest from time to time." (AR 124.) In a typical day,Plaintiff stated that he "showers and watches TV," "naps on and off all day," and possibly does "a little exercise such as go[ing] for a walk." (Defs. 56.1 ¶ 14; Pl. 56.1 ¶ 14; AR 126.)
Plaintiff was then asked about his job, his job duties, and his job's physical demands. (AR 127.) In response, Plaintiff explained that he "was an EMT," was "in charge of 30 guards and[] 110 acres," had to "keep crowd control," "patrolled the campus," "was the only member [of security] authorized to carry a gun," and "assume[d] all fire/police/emergency activities until authorities arrived." (Id.; see also Pl. 56.1 ¶ 17.) Plaintiff further explained that he "could be on his feet [f]or 16 hours straight some days or 6 hours another." (Id.) Ultimately, as Plaintiff continued, his activities varied: "Sometimes he would have to sprint up and down stairs to dorm rooms, other time he would drive to the necessary scene or walk across campus." (Id.) Plaintiff was also clear that he "had to be physically strong enough to restrain people and keep order." (Id.)
The next month, on February 16, 2011, Manhattanville provided a job description for its Director of Campus Security position. (Defs. 56.1 ¶ 15; Pl. 56.1 ¶ 15; AR 435.) According to the job description, the Director of Campus Security was "responsible for the day to day operation of the department" and oversaw "security officers, conduct[ed] investigations, stay[ed] current with OSHA regulations, and [saw] that all officers [were] current in training." (AR 433.) Specific responsibilities included, inter alia, (1) "[p]rovid[ing] leadership to all conflict solutions[, which] may involve students and/or members of the general public . . . [and] [m]ay involve physical confrontation and coordination of officers to insure maximum resolution of situations"; (2) "[p]rovid[ing] leadership to emergency situations including those that may involve immediate[] physical injury to members of" the Manhattanville community; (3) "[c]oordinating security detail for VIP guests of the College," which could include "identifying as well as confronting individuals who may pose a threat and/or are causing disruption at a campus event";and (4) "serv[ing] with VP of Student Affairs as [the] main campus contact for all campus emergencies," which required Plaintiff to "coordinate[] all emergency notification and response to the entire campus community." (AR 433.) The description noted that "other duties may be assigned from time to time." (Id.)
First Unum next consulted a Vocational Rehabilitation Consultant, Alan Lobel, MHS, CRC ("Lobel"), to determine Plaintiff's regular occupation in the national economy, "including physical demands [of that job] going forward." (AR 465; see also Defs. 56.1 ¶ 17; Pl. 56.1 ¶ 18.) Lobel reviewed, among other things, the job description sent by Manhattanville and Plaintiff's own job description. (See AR 466-67.) Lobel concluded "with a reasonable degree of vocational certainty" that Plaintiff's occupation as it is performed in the national economy was "most consistent with the eDOT3 occupation of Director Security[, or Security Director] eDOT 189.117-082." (AR 467; Def. 56.1 ¶ 18; Pl....
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