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Yamarick v. Unum Group

United States District Court, E.D. Pennsylvania

July 14, 2017

WILLIAM YAMARICK
v.
UNUM GROUP, aka/dba/ UNUM PROVIDENT CORP., ET AL.

          MEMORANDUM

          R. BARCLAY SURRICK, J.

         Presently before the Court is Defendants' Motion to Dismiss Count III of the Amended Complaint. (ECF No. 3.) For the following reasons, Defendants' Motion will be granted.

         I. BACKGROUND

          Plaintiff William Yamarick purchased a life insurance policy through Defendant John Hancock Life Insurance Company ("John Hancock"), which provided him with residual disability benefits. This action arises as a result of Defendants' denial of Plaintiff s residual disability claims. Plaintiff brings suit against Defendants alleging bad faith, 42 Pa. Stat. Ann. § 8371, breach of contract, and violation of Pennsylvania's Unfair Trade Practices and Consumer Protection Law, 73 Pa. Stat. Ann. § 201-2(4)(xxi) ("UTPCPL").

         A. Factual Background[1]

         On January 13, 1987, Plaintiff purchased a life insurance policy from John Hancock. (Am. Compl. ¶ 8, ECF No. 9.) The policy included a Rider, which provided Plaintiff with additional coverage for Residual (partial) Disability Benefits. (Id. ¶ 9.) In order to receive the Rider benefits, Plaintiffs residual disability must: (1) begin while the policy is in force; (2) be due to injury or sickness; (3) require the regular care of a physician; and (4) cause a loss of monthly earnings of twenty percent or more. (Id. ¶ 24.) Plaintiff paid all of the necessary premiums in order to maintain this coverage. (Id. ¶ 10.)

         In May 2004, Plaintiff was diagnosed with a condition known as Familial Essential Tremor, a chronic condition that causes tremors and shakes in extremities, and which worsens over time. (Id. ¶ 11.) After being diagnosed with this condition, Plaintiffs symptoms were treated with medications that caused additional problems such as fatigue, mental fogginess, and lightheadedness. (Id. ¶ 17.) Over the course of the next ten years, Plaintiff received medical treatment from neurologist Dr. Thomas Graham, and psychological treatment from Dr. Eugene J. Huang and Dr. Jed Yalof. (Id. ¶¶ 12, 15, 23.)

         By 2014, Plaintiffs worsening condition began to significantly impact his ability to perform his job as the sole owner of an executive employment recruiting service. (Id. ¶ 12.) Plaintiffs tremors prevented or severely hampered his ability to use a keyboard, mouse, and cell phone. (Id. ¶ 16.) His condition also limited his ability to meet with and inspire confidence in his clients, and caused depression and anxiety. (Id. ¶¶ 18, 23.) Dr. Graham chronicled each of Plaintiffs visits in progress reports, which detailed Plaintiffs deterioration over the years. (Id. ¶¶ 18-21.)

         From 1987 until 2014, Plaintiff was "unaware" that his insurance policy provided him with Residual Disability Benefits. (Id. ¶ 13.) In 2014, after Plaintiff learned that he was entitled to these benefits, he filed a residual disability claim with John Hancock, and provided Defendant with his medical and financial records. (Id.) On March 18, 2014, Dr. Graham completed and submitted an individual disability claim form to John Hancock, which detailed Plaintiffs medical condition from 2007 to 2014. (Id. ¶ 22.)

         Defendant Unum Group ("Unum") was responsible for adjusting John Hancock's disability claims. On November 5, 2014, Unum sent a letter to Plaintiff, explaining that Unum had split Plaintiffs single claim into two individual claims. (Id. ¶ 27, Ex. G.) The first claim covered 2007 to 2013 ("Claim 1") and the second claim covered 2013 to 2014 ("Claim 2"). (Id.) In the letter, Unum denied Claim 1 because Plaintiff lacked "any physical restrictions or limitations neurologically." (Id. ¶ 26, Ex. G.) On April 10, 2015, Unum sent Plaintiff a second letter that confirmed its previous denial of Claim 1, and also denied Claim 2 because Plaintiff "failed to meet the twenty percent reduction in income requirement of the policy." (Id. ¶ 28, Ex. H.)

         On September 29, 2015, Plaintiff administratively appealed these denials. (Id. ¶ 29.) Plaintiff requested that his claims be re-evaluated, and provided Unum with additional proof that he had suffered a reduced income due to his condition. (Id.) Plaintiff sent Defendants a total of ten requests for re-evaluation. (Id. ¶ 31.) On September 28, 2016, Defendants sent a letter to Plaintiff confirming its denial of both of Plaintiff s claims. (Id. ¶ 32.) Defendants denied Plaintiffs claims based on the determination that "Mr. Yamarick is able to perform the material duties of his occupation and that he is not experiencing at least a twenty percent loss of monthly earnings due to an injury or sickness." (Id)

         Plaintiff alleges that Defendants John Hancock and Unum: (1) failed to promptly provide a reasonable explanation for its claim denial; (2) failed to act upon the claim within a reasonable amount of time; (3) deliberately ignored Plaintiffs evidence of his physical and psychological disability; (4) knowingly or recklessly disregarded its own policy requirements; and (5) knowingly or recklessly disregarded Plaintiffs evidence that demonstrated that he suffered a twenty percent loss in income. (Id. ¶¶ 33-39.)

         B. Procedural History

         On May 3, 2016, Plaintiff filed a Writ of Summons to commence this action in the Court of Common Pleas of Chester County, Pennsylvania. (Notice of Removal ¶ 1, ECF No. 1.) On October 24, 2016, Plaintiff filed his Complaint in the Court of Common Pleas. (Id. ¶ 2.) On November 23, 2016, the case was removed to this Court. (Id., Ex. A.) The Complaint asserts three claims against Defendants: bad faith, 42 Pa. Stat. Ann. ยง 8371 ...


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