United States District Court, E.D. Tennessee
KIMBERLY D. BUCHANAN, Plaintiff,
SUN LIFE AND HEALTH INSURANCE COMPANY, Defendant.
A. VARLAN, CHIEF UNITED STATES DISTRICT JUDGE
civil action is before the Court on the Report and
Recommendation (“R&R”) issued by United
States Magistrate Judge C. Clifford Shirley, Jr. [Doc. 31].
In the R&R, Judge Shirley recommends that defendant's
Motion for Summary Judgment on the ERISA Record [Doc. 17] be
granted, and plaintiff's Motion for Judgment on
Administrative Record [Doc. 19] be denied. Plaintiff filed an
objection to the R&R [Doc. 32], and defendant responded
to the objection [Doc. 33]. For the reasons stated herein,
the Court will overrule plaintiff's objection and accept
the R&R in whole.
brought this action against defendant seeking long-term
disability benefits under an Employee Retirement Income
Security Act (“ERISA”) plan that is insured by
defendant [Doc. 31 p. 1]. She asserts that she was
“totally disabled” under the terms of the policy
and thus was entitled to benefits [Id.]. Defendant
denied plaintiff's claim, determining that she did not
satisfy the definition of “totally disabled” as
provided in the plan [Id. at 8-9].
policy defines “Total Disability and Totally
Disabled” as follows:
Total Disability must be caused by Sickness or Injury and
must commence while you are insured under the policy. You
will be considered Totally Disabled if:
1. During the Elimination Period and the following 24 months,
you are unable to perform all the material and substantial
duties of your Regular Occupation.
2. After the Elimination Period and the following 24 months,
you are unable to perform the duties of Any Occupation
[Id. at 3].
completed an application for long-term disability benefits on
August 14, 2011 [Id. at 4]. She provided that she
had not worked since May 2010 [Id.]. In the job
description section, plaintiff stated: “Being the
owner[, ] I do everything in the store. Over all employees,
billing, sales and the operation of store”
[Id. at 5].
determine whether plaintiff satisfied the policy
requirements, defendant consulted with Jeffrey Bannon, a
certified public accountant [Id. at 7]. In a report
dated September 10, 2013, Bannon provided that plaintiff had
submitted copies of cancelled checks from June 2009 through
June 2013, and that these checks “indicate that
[plaintiff] has been continually involved in the operation of
the business” [Id. at 8]. He concluded this
because “the majority of the 110 to 120 monthly checks
were signed by [plaintiff], ” and he further provided
that, “[a]t a minimum, this reflects an ongoing
financial/managerial participating in the business”
September 24, 2013, defendant sent plaintiff a letter
informing her that she failed to prove she was totally
disabled because the numerous checks she signed
“reflects an ongoing financial/managerial participation
in the business” [Doc. 9-9 p. 98]. Defendant further
explained that the signing of the checks “suggest
that [plaintiff] continued to perform at least one of the
material duties of [her] Regular or Any Occupation on a
Full-time or Part-time Basis” [Doc. 9-10 p. 6].
Defendant then notified plaintiff of her right to appeal that
If you disagree with any part of our decision, you may
request in writing a review within 180 days after receiving
You may submit written comments, documents, records, or other
information relating to your claim for benefits, and may
request free of charge copies of all documents, records, and
other information relevant to your claim for benefits
March 3, 2014, plaintiff appealed defendant's denial of
benefits [Doc. 31 p. 10]. In a decision letter dated October
1, 2014, defendant responded to the appeal [Id.].
The letter references a flash drive plaintiff submitted
during the appeal, which contained video statements from
plaintiff and her husband, as well as audio statements from
other employees [Id.]. In addition, plaintiff
submitted her own description of her duties at the store
[Doc. 9-8 p. 51]. She stated that she was responsible for
hiring and training staff, shipping and receiving,
merchandising, inventory and vendor relations, dress repairs,
returns, and certain accounting duties [Doc. 9-10 p. 54]. ...