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Rogers v. Reliance Standard Life Insurance Co.

United States District Court, N.D. Illinois, Eastern Division

May 6, 2015

LYNN ROGERS, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

MEMORANDUM OPINION

CHARLES P. KOCORAS, District Judge.

This matter comes before the Court on the cross-motions for summary judgment of Plaintiff Lynn Rogers ("Rogers") and Defendant Reliance Standard Life Insurance Company ("Reliance"), both pursuant to Federal Rule of Civil Procedure 56 ("Rule 56"). For the following reasons, the Court denies the cross-motions for summary judgment and remands the case for further proceedings consistent with this Memorandum Opinion.

BACKGROUND

I. Facts

A. Parties

Rogers is a resident of Oakbrook Terrace, Illinois. Rogers worked as a Neiman Marcus sales associate prior to leaving her employment on January 24, 2011, generating $28, 763.52 in annual salary and $45, 917.55 in commissions during a twelve month timespan. Reliance is an insurance company, licensed to do business in Illinois and was, at all times relevant hereto, doing business throughout the United States and within the Northern District of Illinois.

B. The Policy

Pursuant to 29 U.S.C. §§ 1132(a)(1)(B) and 1132(a)(3) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA"), Rogers seeks continued long term disability ("LTD") benefits under an employee welfare benefit plan, afforded by The Neiman Marcus Group, Inc. ("Neiman Marcus") to its eligible employees. Neiman Marcus's Long Term Disability Plan ("Plan") is insured by Group Policy No. LTD 668451 (the "Policy") issued by Reliance. The Plan is governed by ERISA and Reliance is the fiduciary of the Plan.

On August 1, 2010, the Policy for Rogers, and issued by Reliance on December 27, 2010, became effective. The Policy contains an insurance clause:

INSURING CLAUSE: We will pay a Monthly Benefit if an Insured:
(1) Is Totally Disabled as a result of a Sickness of Injury covered by this Policy;
(2) Is under the regular care of a Physician;
(3) Has completed the Elimination Period; and
(4) Submits satisfactory proof of Total Disability to us.

The Policy provides for the termination of the monthly benefit as follows:

TERMINATION OF MONTHLY BENEFIT: The Monthly Benefit will stop on the earliest of:
(1) the date the Insured ceases to be Totally Disabled;
(2) the date the Insured dies;
(3) the Maximum Duration of Benefits, as shown on the Schedule of Benefits page, has ended; or
(4) the date the Insured fails to furnish the required proof of Total Disability.

The Policy contains the following provision:

PHYSICAL EXAMINATION AND AUTOPSY: We will, at our expense, have the right to have a Claimant interviewed and/or examined:
(1) physically;
(2) psychologically; ...

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