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Tanya Mondolo v. Unum Life Insurance Company of America

January 16, 2013

TANYA MONDOLO, PLAINTIFF,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, DEFENDANT.



The opinion of the court was delivered by: Christina A. Snyder United States District Judge

I. INTRODUCTION

FINDINGS OF FACT AND CONCLUSIONS OF LAW

Plaintiff Tanya Mondolo filed the instant action in this Court on September 9, 2011. Plaintiff's complaint alleges that defendant Unum Life Insurance Company of America ("Unum") wrongfully denied disability insurance benefits. Plaintiff's complaint alleges a single claim for relief under the Employee Retirement Income Security Act, 29 U.S.C. § 1132 ("ERISA"). The relief plaintiff seeks is payment of disability benefits, a judgment clarifying plaintiff's rights to future disability benefits, and attorneys' fees and costs.

The parties filed opening trial briefs on November 13, 2012, and filed responsive trial briefs on November 27, 2012. Additionally, the parties submitted proposed findings of fact and conclusions of law on December 4, 2012. A court trial was held on December 12, 2012, and the case was taken under submission at the conclusion of the trial. After considering the parties arguments, the Court finds and concludes as follows.

II. FINDINGS OF FACT

A. The Parties

1. Plaintiff Tanya Mondolo was diagnosed with Acute Lymphocytic Leukemia in November 1998. (248).*fn1 After undergoing chemotherapy for several years, her cancer went into remission, and she received an AA degree and returned to the workforce in 2004. (792, 483 -- 484).

2. Plaintiff also suffers from depression. (72). Between 2006 and 2010, she attempted to have children and start a family. Unfortunately, each of the four times she became pregnant she experienced a miscarriage in the third trimester. (223, 727). Her fourth miscarriage, which took place in December 2009, required surgery.

3. As of January 2011, plaintiff has also been diagnosed with avascular necrosis ("AVN") and fibromyaglia ("FMS"), and suffers from bone infarct (bone death) within her femurs, tibias, and left elbow. (708, 737, 745). Plaintiff's physician believes that the bone death is a result of her chemotherapy regimen to treat her leukemia. (708). Plaintiff has difficulty walking. (708).

4. Defendant Unum is an insurance company. Unum insured the long term disability plan ("the LTD Plan") maintained by plaintiff's former employer, Jacobs Engineering. Unum insured the LTD Plan pursuant to Policy 578208001 ("the Policy"). (133 -- 173), and also acts as the claims administrator under the LTD Plan.

B. Plaintiff's First Claim for Disability Benefits

5. In 2005, plaintiff began working for Jacobs Engineering as a procurement clerk. Plaintiffs job duties involved clerical and administrative work. (178 -- 180, 485, 772).

6. On July 20, 2009, plaintiff's psychological treatment provider recommended that she stop attending work due to postpartum depression caused by plaintiff's miscarriages, anxiety, and stress. (72 -- 73).

7. Suffering from this depression, plaintiff stopped attending work in July 2009. Additionally, she filed a disability claim under the Policy, based primarily on her mental health difficulties. (79).

C. Unum's Disability Benefits Policy

8. The Policy grants Unum discretionary authority to determine a claimant's eligibility for benefits and interpret the provisions of the policy. (144, 170).

9. Policy benefits are distributed after a 180-day elimination period. (137).

10. The Policy defines disability as: "You are 'totally disabled' during any period covering a disability for your occupation, own occupation, normal occupation, regular occupation or usual occupation when a disability renders you unable to perform with reasonable continuity the substantial and material acts necessary to pursue your usual occupation in the usual and customary way.

"During any period covering a disability from any occupation, any other occupation, any gainful occupation, any other gainful occupation, reasonable occupation or another occupation when a disability renders you unable to perform with reasonable continuity the substantial and material acts necessary to pursue your usual occupation in the usual and customary way and unable to engage with reasonable continuity in another occupation in which you could reasonably be expected to perform satisfactorily in light of your age, education, training, experience, station in life, physical and mental capacity.

'Substantial and material acts' as used in the above definition of disability means acts that -are normally required for the performance of your usual occupation or another occupation, and -cannot be reasonably omitted or modified." (134).

11. The Policy provides for a maximum of 12 months of benefits for a disability that prevents a claimant from performing his or her own occupation ("own occupation period"). (148).

12. After 12 months of benefits, the Policy requires the insured to be disabled from any gainful occupation on a part-time basis to receive further benefits. The Policy defines "gainful occupation" to mean "an occupation that is or can be expected to provide you with an income at least equal to 60% of your indexed monthly earnings within 12 months of your return to work." (134, 154, 161 -- 163).

13. The Policy also limits benefits for disabilities primarily due to mental illness to a maximum of 12 months ("MIL"). "Mental Illness means a psychiatric or psychological condition regardless of cause such as schizophrenia, depression, manic depressive or bipolar illness, anxiety, personality disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment." (154, 162).

14. Policy payments stop, in relevant part, "after 12 months of payments, when you are able to work in any gainful occupation on a part-time basis but you choose not to," and also stop on "the date you are ...


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