Israel v. Unum Life Insurance Company of America

Background

Jessica Israel brought claims against Unum Life Insurance Company of America for long-term-disability benefits and WOP benefits. The opinion addresses the parties’ objections to a Report and Recommendation issued by Magistrate Judge James L. Cott. Judge Cott recommended granting in part and denying in part Unum’s motion, including remanding Israel’s long-term-disability claim to Unum for a full and fair review and granting Unum summary judgment on the WOP benefits claim.

Objections and exhaustion

Unum objected to the recommendation concerning the long-term-disability claim. It argued that Israel had failed to exhaust the remedies available under the long-term-disability plan and that her June 1, 2018 letter did not constitute an administrative appeal. Israel responded to those objections. Israel separately objected to the recommendation that consideration of her attorney’s-fee request would be premature.

The court reviewed the unchallenged portions of the Report for clear error and reviewed the challenged portions independently. It adopted the Report in its entirety. The court agreed that, under the particular facts of this case, Israel’s correspondence was enough to notify Unum of her disagreement with its decision and that the claim should be treated as exhausted. The court emphasized that this ruling did not mean every communication sent to an insurer after an adverse benefit decision is automatically a valid appeal, nor did it decide whether insurers may offer review opportunities beyond the minimum required by law.

Attorney’s fees

The court overruled Israel’s objection concerning attorney’s fees but clarified that a remand alone does not necessarily make a fee request premature. Under the applicable employee-benefits law, a court has discretion to award attorney’s fees. The court nevertheless concluded that waiting was appropriate because Israel’s ultimate degree of success would depend on the result of Unum’s review on remand. The court therefore would not entertain an application for attorney’s fees at that time.

Disposition

The court granted Israel’s motion for summary judgment in part and remanded her long-term-disability benefits claim to Unum for a full and fair review. It granted Unum’s motion with respect to Israel’s WOP benefits claim and otherwise denied Unum’s motion. The court stated that it was inclined to stay the action while Unum completed its review, but it did not make that stay final in this order; instead, it directed the parties to submit a joint letter stating their positions by March 13, 2023. The clerk was directed to terminate the pending motions listed at Docket Nos. 36 and 42.