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

• Decision Date: 06 August 2018
• Docket Number: No. 17-CV-3019-LRR,17-CV-3019-LRR
• Parties: JEREMY J. TIMM, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.
• Court: U.S. District Court — Northern District of Iowa

JEREMY J. TIMM, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.

No. 17-CV-3019-LRR

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF IOWA CENTRAL DIVISION

August 6, 2018

ORDER

TABLE OF CONTENTS

I. INTRODUCTION ....................................... 1

II. RELEVANT PROCEDURAL HISTORY ........................ 2

III. SUBJECT MATTER JURISDICTION .......................... 2

IV. STANDARD OF REVIEW ................................. 2

A. Review of Final Decision .............................. 2

B. Review of Report and Recommendation .................... 4

V. RELEVANT FACTUAL BACKGROUND ........................ 5

A. The Plan ......................................... 5

B. Timm's Medical History ............................... 5

C. Unum Life's Denial ................................. 7

D. Timm's Appeal ..................................... 8

VI. ANALYSIS ............................................ 9

VII. CONCLUSION ........................................ 13

I. INTRODUCTION

The matter before the court is Plaintiff Jeremy J. Timm's Objections (docket no. 18) to United States Chief Magistrate Judge C.J. Williams's Report and Recommendation (docket no. 17), which recommends that the court affirm Defendant Unum Life Insurance Company of America's ("Unum Life") final decision to deny Timm long term disability benefits.

II. RELEVANT PROCEDURAL HISTORY

On March 16, 2017, Timm filed the Complaint (docket no. 2). In the Complaint, Timm claims that Unum Life violated the Employee Retirement Income Security Act of 1974 ("ERISA") when it denied his application for long term disability benefits under the Cyclone Contracting Long Term Disability Policy. On April 21, 2017, Unum Life filed an Answer (docket no. 5) generally denying liability and asserting several affirmative defenses. On October 26, 2017, Timm filed the Plaintiff's Brief (docket no. 13). On December 22, 2017, Unum Life filed the Defendant's Brief (docket no. 14). On February 27, 2018, Timm filed a Reply (docket no. 15). The matter was referred to Judge Williams. On April 9, 2018, Judge Williams issued the Report and Recommendation, which recommends that the court affirm the final decision of Unum Life to deny Timm long term disability benefits. On April 23, 2018, Timm filed the Objections. On May 4, 2018, Unum Life filed the Response to Objections (docket no. 19). Neither party has requested oral argument and the court finds that oral argument is unnecessary. The matter is fully submitted and ready for decision.

III. SUBJECT MATTER JURISDICTION

The court has jurisdiction over the instant action because it arises under ERISA, 29 U.S.C. § 1132(a)(1)(B). See 28 U.S.C. § 1331 ("The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States.").

IV. STANDARD OF REVIEW

A. Review of Final Decision

"ERISA provides a plan beneficiary with the right to judicial review of a benefits determination." Shelton v. ContiGroup Cos., Inc., 285 F.3d 640, 642 (8th Cir. 2002) (quoting Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir. 1998)). A district courtmust review a denial of benefits "under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). "When a plan gives discretion to the plan administrator, then a plan administrator's decision is reviewed judicially for an abuse of discretion." Ortlieb v. United HealthCare Choice Plans, 387 F.3d 778, 781 (8th Cir. 2004). "Under an abuse of discretion standard of review, a plan administrator's decision will stand if reasonable; 'i.e., supported by substantial evidence.'" Id. (quoting Fletcher-Merrit v. NorAm Energy Corp., 250 F.3d 1174, 1179 (8th Cir. 2001)). The court does "not 'substitute [its] own weighing of the evidence for that of the administrator.'" Gerhardt v. Liberty Life Assurance Co. of Boston, 736 F.3d 777, 780 (8th Cir. 2013) (quoting Sahulka v. Lucent Techs., Inc., 206 F.3d 763, 769-70 (8th Cir. 2000)). "This deferential standard reflects [the] general hesitancy to interfere with the administration of a benefits plan." Shelton, 285 F.3d at 642 (quoting Layes v. Mead Corp., 132 F.3d 1246, 1250 (8th Cir. 1998)).

The court must affirm the plan administrator's decision "if a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision." Prezioso v. Prudential Ins. Co. of Am., 748 F.3d 797, 805 (8th Cir. 2014) (quoting Ferrari v. Teachers Ins. & Annuity Ass'n, 278 F.3d 801, 807 (8th Cir. 2002)). "Any reasonable decision will stand, even if the court would interpret the language differently as an original matter." Manning v. Am. Republic Ins. Co., 604 F.3d 1030, 1038 (8th Cir. 2010). A decision is reasonable if it supported by substantial evidence. See Wilcox v. Liberty Life Assurance Co. of Boston, 552 F.3d 693, 700 (8th Cir. 2009). Substantial evidence is "more than a scintilla, but less than a preponderance." Id. (quoting Clapp v. Citibank, N.A. Disability Plan (501), 262 F.3d 820, 828 (8th Cir. 2001)). Although a plan administrator may not ignore relevant evidence without abusing his or her discretion, see id. at 701, only the evidence available to the planadministrator at the time of benefits denial is relevant to the court's review, see King v. Hartford Life & Accident Ins. Co., 414 F.3d 994, 999 (8th Cir. 2005). See Gerhardt, 736 F.3d at 780 ("A plan administrator abuses its discretion when it ignores relevant evidence." (quoting Wilcox, 552 F.3d at 701)).

B. Review of Report and Recommendation

The standard of review to be applied by the court to a report and recommendation of a magistrate judge is established by statute:

A judge of the court shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made. A judge of the court may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge.

28 U.S.C. § 636(b)(1); see also Fed. R. Civ. P. 72(b)(3) (providing that, when a party properly objects to a report and recommendation on a dispositive motion, a district court must review de novo the magistrate judge's recommendation). The Eighth Circuit has repeatedly held that it is reversible error for a district court to fail to conduct a de novo review of a magistrate judge's report and recommendation when such review is required. See, e.g., United States v. Lothridge, 324 F.3d 599, 600 (8th Cir. 2003); Hosna v. Groose, 80 F.3d 298, 306 (8th Cir. 1996); Hudson v. Gammon, 46 F.3d 785, 786 (8th Cir. 1995); Belk v. Purkett, 15 F.3d 803, 815 (8th Cir. 1994). The statute governing review provides only for de novo review of "those portions of the report or specified proposed findings or recommendations to which objection is made." 28 U.S.C. § 636(b)(1). The court reviews the unobjected-to portions of the proposed findings or recommendations for "plain error." See United States v. Rodriguez, 484 F.3d 1006, 1010-11 (8th Cir. 2007) (noting that, where a party does not file objections to a magistrate's report and recommendation, the party waives the right to de novo review and the court will review the decision for plain error).

V. RELEVANT FACTUAL BACKGROUND

A. The Plan

At all relevant times Timm was employed by Cyclone Contracting Corporation ("Cyclone Contracting") as a lead HVAC and plumbing installer. Complaint ¶ 5; Administrative Record ("AR") (docket no. 12) at 13, 44. Effective September 1, 2015, Unum Life issued a group disability insurance policy, Policy Number 632436 002 ("Policy") to Cyclone Contracting, which funded the Short Term Disability Plan and the Long Term Disability Plan ("LTD Plan") sponsored by Cyclone Contracting. Answer ¶ 6; AR at 64. Timm received coverage under the LTD Plan effective September 1, 2015. AR at 64. On May 10, 2016, Timm stopped working as a lead HVAC and plumbing installer due to a disability. Id. at 14.

The LTD Plan provided, in relevant part, that it "does not cover any disabilities caused by, contributed to by, or resulting from [a] . . . preexisting condition." Id. at 97-98. The LTD Plan further stated that an employee has a preexisting condition if: (1) the employee "received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the [six] months just prior to [the] effective date of coverage" and (2) "the disability begins in the first [twenty-four] months after [the] effective date of coverage unless [the employee] ha[s] been treatment free for [twelve] consecutive months after [the] effective date of coverage."¹ Id. at 98.

B. Timm's Medical History

On July 22, 2015, Dr. Kyle Alliman saw Timm at the Wolfe Eye Clinic for a routine follow-up examination. See id. at 162. Timm reported that "[h]e ha[d] beenexperiencing no symptoms." Id. During the examination, Dr. Alliman noted that Timm's right eye had "1+ disc edema" and his left eye had "3+ disc edema." Id. at 163. Dr. Alliman also noted that Timm had "[p]apilledema from increased intracranial pressure" in "both eyes," though greater in the left eye than the right eye. Id. Dr. Alliman stated that Timm's left eye "ha[d] a significant increase in optic disc edema" and his right eye "now [had] mild edema." Id. at 164.

On July 27, 2015, Timm returned to the Wolfe Eye Clinic to address concerns regarding the vision in his left eye. Id. at 165. At this time, Timm reported no symptoms in his right eye. Id. An examination revealed swelling in both eyes, though greater in the left eye than the right eye. Id. at 166. Dr. David Saggau noted that Timm had "[p]apilledema from increased intracranial pressure in both eyes" greater in the left eye than the right eye. Id. He determined that this "[a]ccount[...