Kaminski v. Unum Life Ins. Co. of Am.

• Decision Date: 08 January 2021
• Docket Number: Case No. 0:19-cv-1997 (SRN/DTS)
• Citation: 517 F.Supp.3d 825
• Court: U.S. District Court — District of Minnesota
• Parties: Peter A. KAMINSKI, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.

517 F.Supp.3d 825

Peter A. KAMINSKI, Plaintiff,

v.UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.

Case No. 0:19-cv-1997 (SRN/DTS)

United States District Court, D. Minnesota.

Signed January 8, 2021

Filed February 5, 2021

Katherine L. MacKinnon and Nicolet Lyon, Law Office of Katherine L. MacKinnon, 2356 University Ave. W., #230, St. Paul, MN 55114, for Plaintiff.

Christopher J. Haugen and Terrance J. Wagener, Messerli & Kramer, P.A., 100 S. 5th St., 1400 5th St. Towers, Minneapolis, MN 55402, for Defendant.

MEMORANDUM OPINION AND ORDER

SUSAN RICHARD NELSON, United States District Judge

Plaintiff Peter A. Kaminski brings this lawsuit against Defendant UNUM Life Insurance Company of American ("Unum"), challenging the denial of long-term disability ("LTD") and life waiver of premium benefits ("LWOP") under an employer-sponsored insurance plan governed by the Employee Retirement Income Security Act ("ERISA"). Before the Court are the parties’ cross motions for summary judgment [Doc. Nos. 17 & 23]. For the reasons set forth below, Defendant's Motion for Summary Judgment is denied, and Plaintiff's Motion for Summary Judgment is granted.

Kaminski was employed by Land O'Lakes ("LOL") starting on May 26, 2009, and last worked for the company on October 24, 2016. (Long-Term Disability File ("LTD") at 5, 11, 306, 394, 452.)¹ During his employment with LOL, Kaminski worked full-time in a variety of positions, concluding his employment as a senior sourcing analyst/buyer. (Compl. [Doc. No. 1] ¶ 16; LTD at 451–52.) He participated in the employee benefit plans offered by LOL, which included Group Disability Insurance Policy No. 99345-002 (the "Policy"), issued by Unum, (LTD at 2–3, 5–6, 11–12; Short-Term Disability File ("STD") at 32), and Life Insurance Policy No. 99345-003 (containing the "LWOP Provision"), also issued by Unum. (LWOP at 24–103.)

Kaminski received STD benefits under the Policy, discussed in greater detail below, during the following two time periods: (1) June 16, 2015 through December 5, 2015 (see LTD at 596); and (2) November 1, 2016 through April 22, 2017. (STD at 563, 567, 571–72.) On April 5, 2017, Kaminski's STD file transferred to Unum's LTD department. (LTD at 34–35; 338.) Following a review, Unum denied Plaintiff's LTD claim on May 31, 2017. (LTD at 542–46.) Kaminski filed an appeal on December 29, 2017, which included more detailed medical records from Kaminski's 2015 treatment for chronic pain at Craig Hospital as well as the results of a physical abilities test. (LTD at 587–667.) On February 9, 2018, Unum denied Kaminski's appeal. (LTD at 727–36.)

On July 29, 2019, Kaminski commenced this lawsuit under ERISA, 29 U.S.C. § 1132(a)(1)(B), seeking the payment of LTD benefits under ERISA, as well as LWOP benefits.² (Compl. ¶¶ 49–52.) The parties have filed cross motions for summary judgment.

I. BACKGROUND

A. Benefit Policies

1. The Policy

The LTD Policy bears an "effective date" of January 1, 2013, and has an annual "anniversary date" of January 1. (LTD at 342.) On May 1, 2016, the Policy was amended, although no part of the policy was in fact changed. (LTD at 341.) Instead, the amendment read: "The entire policy is replaced by the policy attached to this amendment." (Id. )

The Policy delegates to Unum "discretionary authority to make benefit determinations under the Plan .... Benefit determinations include eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing provisions of the Plan. All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim." (LTD at 384.)

With respect to LTD benefits, the Policy provides as follows:

How does Unum Define Disability?

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.

• After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, or experience.

(LTD at 357.)

The Policy defines "material and substantial duties" as duties that "are normally required for the performance of your regular occupation; and cannot be reasonably omitted or modified." (LTD at 373.) "Regular occupation" under the Policy "means the occupation 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." (LTD at 375.) "Gainful occupation" is defined as "an occupation that is or can be expected to provide you with an income at least equal to 80% of your indexed monthly earnings within 12 months of your return to work." (LTD at 373.)

To qualify for LTD benefits under the Policy, a claimant was required to be disabled for the duration of the Policy's 180-day elimination period. (LTD at 357.)

As applicable here, the Policy's basic LTD benefit was for 50% of monthly earnings, up to a maximum of $10,000. (LTD at 345.) Kaminsky's monthly LTD benefit payment would have been $2,969.48. (LTD at 445–46.)

2. The LWOP Benefit

To obtain the LWOP benefit offered in LOL's life insurance policy, a claimant was required to provide Unum with written proof of disability after the end of an elimination period of 180 days. (LWOP at 28.) To obtain the LWOP benefit, Unum defined "disability" as follows:

You are disabled when Unum determines that:

- during the elimination period, you are not working in any occupation due to your injury or sickness ; and

- after the elimination period, due to the same injury or sickness, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by training, education, or experience.

(LWOP at 67) (emphasis in original). The life insurance policy was subject to the laws of the state of Maine. (LWOP at 25.)

The life insurance policy was originally issued on January 1, 2013, with an annual anniversary date on January 1. (LWOP at 25.) On January 6, 2017, the life insurance policy was amended, although no part of the policy was in fact changed. (LWOP at 24.) Instead, it read: "The entire Summary of Benefits is replaced by the Summary of Benefits attached to this amendment." (LWOP at 24.) As with LTD benefits, the life insurance policy contained language vesting Unum with discretion to make benefit determinations. (LWOP at 99.)

B. History of Spinal Cord Injury and Medical Care

When Kaminski was home from college in the summer of 2008, he was seriously injured in a diving accident on Lake Minnetonka. (LTD at 395, 589, 626, 642, 650.) He suffered a spinal cord injury, fracturing his cervical spine at C-5, which resulted in paralysis for a period of time. (Id. ) Kaminski underwent a cervical fusion at C4-5 at North Memorial Hospital in Robbinsdale, Minnesota, and later underwent intensive rehabilitation and care at the spinal injury program of Craig Hospital in Denver, Colorado. (LTD at 106, 642, 650.) His condition improved significantly, and within ten months, he was walking and had increasing use of his arms. (LTD at 649.) Despite impairments to his gait and the use of his hands, Kaminski graduated from the University of Colorado with a bachelor's degree in environmental science. (LTD at 397, 650.) He eventually recovered his strength almost completely, but experienced ongoing issues with chronic pain. (LTD at 106.)

As noted, Kaminski began working for LOL on May 26, 2009. (LTD at 5, 11, 306, 394, 452.) During his tenure at LOL, Kaminski received four promotions, culminating in his position as a senior sourcing analyst/buyer. (LTD at 451–52.)

1. June 2015 to January 2016

By June 2015, Kaminski's work duties involved sitting at a desk for approximately nine hours a day. (LTD at 588.) At that time, he reported neck pain, muscle spasms, insomnia, anxiety, and depression. (LTD at 588, 598.) He applied for STD benefits. (Id. )

In July 2015, Kaminski returned to Craig Hospital in Denver for an interdisciplinary evaluation for neuropathic pain, as well as secondary symptoms of anxiety and depression. (LTD at 598–636.) He met with a physical therapist, occupational therapist, neurology nurse practitioner, consulting neurologist, and neurosurgeon. (LTD at 588–601.) The neurosurgeon performed a cervical MRI, which showed mild spinal curvature, but otherwise normal findings. (LTD at 600–01.) The neurosurgeon found that Kaminsky's reports of pain were mostly musculoskeletal in nature, and therefore, surgical intervention was not recommended. (LTD at 600.)

Kaminski sought help with pain management from the physical and occupational therapists at Craig Hospital, who noted the need for pain management, stating, "his pain is severe and debilitating and causes him to stay in bed and become depressed, anxious, and have to stop working." (LTD at 594.) He reported that the pain in his upper back and shoulder area was, at its worst, 8.5 on a 10-point scale. (Id. ) Kaminski was advised to consider a job in which he could be more active, with the team of medical evaluators "recommend[ing] that he ha[ve] a job/position where he is more active but not so active that it causes great fatigue." (LTD at 593.) Kaminski reported that he felt better when he moved around, which he was able to do on disability leave, when he was able to walk more and swim on a daily basis. (Id. )

Dr. William Daft, a primary care doctor who evaluated Kaminski, noted that the medical team supported his application for STD "so that he can get better control over his pain and spasticity." (LTD at 596.) Dr. Daft further stated, "His work is a computer/desk job and sitting all day is causing his pain," and his most recent job, which was sedentary, ...