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

• Decision Date: 29 September 2022
• Docket Number: CIVIL 20-2472 (JRT/DTS)
• Parties: TRACY PROCTOR, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.
• Court: U.S. District Court — District of Minnesota

TRACY PROCTOR, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.

CIVIL No. 20-2472 (JRT/DTS)

United States District Court, D. Minnesota

September 29, 2022

Denise Y. Tataryn and Robert J. Leighton, Jr., NOLAN THOMPSON LEIGHTON & TATARYN PLC, 1011 First Street South, Suite 410, Hopkins, MN 55343; and Jodell M. Galman, GALMAN LAW OFFICES, 85 Grove Street, Mahtomedi, MN 55115, for plaintiff.

Lauren Hoglund, LIND JENSEN SULLIVAN & PETERSON, P.A., 1300 AT&T Tower, 901 Marquette Avenue South, Minneapolis, MN 55402; and Terrance J. Wagener, MESSERLI & KRAMER P.A 100 South Fifth Street, Suite 1400, Minneapolis, MN 55402 for defendant.

FINDINGS OF FACT, CONCLUSIONS OF LAW, AND ORDER FOR JUDGMENT

JOHN R. TUNHEIM UNITED STATES DISTRICT JUDGE

Plaintiff Tracy Proctor brings this action against Defendant Unum Life Insurance Company of America (“Unum”), pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. alleging that Unum improperly terminated her long-term disability benefits after she was injured in a car accident. Through her employer, Proctor was covered by a disability policy governed by ERISA and administered by Unum. The parties filed cross Motions for Judgment on the Administrative Record.

Proctor seeks an order reinstating her benefits, and Unum seeks an order affirming its decision.

After carefully considering the entire record and arguments presented in written submissions and at a hearing on the Motions, taking into account the credibility of the evidence and examining applicable law, the Court will find that Unum improperly terminated Proctor's benefits. Accordingly, the Court will order Unum to reinstate Proctor's benefits retroactively to the date of termination, resume paying Proctor ongoing benefits, and award Proctor reasonable attorney fees and costs and prejudgment interest. The Court, however, does not resolve whether Proctor is disabled under an “any gainful occupation” standard and so remands to Unum to resolve this question. Before ordering a specific amount of fees or prejudgment interest, the Court, however, will require Proctor to file an affidavit providing evidence supporting her request for fees and costs and will order additional briefing from the parties on the proper amount of prejudgment interest.

FINDINGS OF FACT^[1]

1. The Findings of Fact set forth herein are undisputed or have been proven by a preponderance of the evidence.

2. To the extent the Court's Conclusions of Law include what may be considered Findings of Fact, they are incorporated herein by reference.

I. THE PARTIES

3. Proctor, a resident of Minnesota, was employed as a Telephone Supervisor by LTCG. (Compl. ¶¶ 2, 4, Dec. 4, 2020, Docket No. 1; AR 1897.)

4. Unum is an insurance company that is licensed to do business in Minnesota. (Compl. ¶ 3; Answer ¶ 3, Dec. 22, 2020, Docket No. 4.)

5. LTCG provided group short- and long-term disability insurance plans governed by ERISA to its employees-including Proctor-through Unum. (AR 130.)

II. UNUM'S LONG-TERM DISABILITY POLICY

6. The relevant long-term disability policy (“Policy”) defines various terms and explains how to determine whether someone is disabled under the plan.

7. The Policy defines “disability” as:

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.

You must be under the regular care of a physician in order to be considered disabled.

(AR 146 (emphasis in original and some emphasis removed).)

8. 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.

(AR 161.)

9. The Policy defines “regular occupation” as:

the occupation you are routinely perform 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.

(AR 163.)

10. Unum may request that claimants “send proof of continuing disability indicating that you are under the care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us.” (AR 134.) Unum may also, in some cases, require claimants “to give Unum authorization to obtain additional medical information, or proof of continuing disability.” (AR 134.)

11. The Policy permits Unum to require a claimant to be evaluated by a medical practitioner or vocational expert of its choosing as often as it is reasonable to do so. (AR 146.)

12. Once Unum determines that someone is disabled, the claimant continues to receive benefits until, among other reasons, “the date [the claimant is] no longer disabled under the terms of the plan” or “the date [the claimant] fail[s] to submit proof of continuing disability.” (AR 152.)

III. PROCTOR'S OCCUPATION

13. At the time of the accident giving rise to Proctor's claim for disability, her regular occupation was as a telephone supervisor for LTCG.

14. The job classification that best represents this position is “Call Center Supervisor.” (AR 708.)

15. The physical and cognitive demands of the material and substantial duties of this job are:

Mostly sitting, may involve standing or walking for brief periods of time, lifting, carrying, pushing, pulling up to 10 Lbs occasionally.

The duties of this occupation would allow for changes in position for brief periods of time throughout the day.

Occasional reaching and handling.

Frequent fingering.

Constant keyboard use.

Near acuity, far acuity, depth perception and accommodation.

(AR 709.)

16. The skilled work demands of the material and substantial duties are:

Influencing people in their opinions, attitudes, and judgments.

Making judgments and decisions.

Dealing with people.

(AR 709.)

IV. INJURY AND EVALUATIONS BEFORE APPROVAL OF LONG-TERM DISABILITY BENEFITS

17. On February 26, 2018, Proctor was driving when her vehicle was rear-ended by another vehicle driving about 50 miles per hour. (AR 279-82, 392.) Her airbag did not deploy. (AR 281.) Her head hit the driver's side window. (AR 355.) Her head also whipped backwards on impact. (AR 355.) She did not lose consciousness. (AR 392.)

18. The police officer who responded to the accident reported that Proctor had “[n]o apparent injury,” and Proctor declined immediate medical attention. (AR 281-82.)

19. Later, on February 26, 2018, Proctor went to urgent care, reporting that she had a headache and had been dizzy since the car accident. (AR 355.) While there, she reported having a hard time concentrating including difficulty filling out paperwork and that her vision was blurry. (AR 355.) She was diagnosed with a “concussion without loss of consciousness” and a “trapezius strain.” (AR 355.) The examining doctor told her to not work that day, to rest, and to avoid computer and phone screens but that she soon should be able to return to work. (AR 356.)

20. Over the next several weeks, Proctor continued seeing additional medical providers and reporting similar issues. (E.g., AR 79, 83, 353, 392.) Below is a non-exhaustive review of these visits and evaluations.

21. On March 1, 2018, she reported headaches, dizziness, difficulty focusing, and pain from bright lights. (AR 353.) The evaluating doctor concluded that she “should improve in a few days.” (AR 354.)

22. On March 7, 2018, she reported similar symptoms and an evaluation of her mental status showed several difficulties leading the doctor to conclude Proctor “does have clearly ongoing problems with concentration, as well as headaches.” (AR 392-93.) A CT scan, however, was negative. (AR 393.)

23. On March 8, 2018, she reported similar symptoms as well as nausea and vomiting to Dr. Nam Ho. (AR 79.) Dr. Ho determined Proctor should not work for three weeks to give her brain rest and provided her with a letter to that effect. (AR 81.)

24. On March 29, 2018, Dr. Ho again indicated that Proctor was “[u]nable to work at this time,” referred her to a concussion clinic, and diagnosed Proctor with post-concussion syndrome. (AR 84-85.)

25. On April 4, 2018, she was seen by a developmental optometry specialist who diagnosed Proctor with “deficits of pursuits, binocular instability with convergence insufficiency, and photosensitivity.” (AR 649.)

26. On April 17, 2018, Proctor saw PA Brooke Dokken at a neurology clinic. (AR 661.) Proctor reported that she had daily headaches; right eye pain; nausea with worsening headache; headaches upon waking that can increase with activity and physical, mental, or emotional exertion; dizziness; difficulty balancing; fatigue; various vision problems; and that medication only reduced but did not resolve her headaches. (AR 661.) Proctor reported “difficulty with short-term memory, concentration, multitasking, slowed processing speed, and word-finding difficulties.” (AR 662.) She reported that she continued to drive but that she avoided it when fatigued or during bad weather. (AR 662.) Proctor was “not released to return to work.” (AR 663.)

27. On April 27, 2018, Proctor completed a post-concussion symptom questionnaire, reporting severe problems with most symptoms on the questionnaire and moderate problems with several others while reporting the symptoms were constant throughout...