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Ten Pas v. The Lincoln National Life Insurance Co.

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

December 10, 2019

HARLAN TEN PAS, Plaintiff,
v.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY, Defendant.

          OPINION AND ORDER

          SARA L. ELLIS, UNITED STATES DISTRICT JUDGE.

         On August 31, 2014, Harlan Ten Pas, a former tax attorney with McGladrey LLP (“McGladrey”), suffered a heart attack that required hospitalization and stents in his artery. Within a week, he suffered two strokes and had to take a medical leave of absence from work. Ten Pas now brings this action against Lincoln National Insurance Company (“Lincoln”), the administrator of McGladrey's long-term disability plan for employees, pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Ten Pas seeks a declaratory judgment that Lincoln erred by setting his “first day of Disability, ” Doc. 48 ¶ 11, on August 31, 2014, thereby reducing his monthly disability payments by several thousand dollars because of a raise he received on September 1, 2014. The parties now bring cross-motions for summary judgment. The Court finds that setting Ten Pas' first day of Disability on August 31, 2014, contravenes the plain language of the ERISA policy and that Lincoln unreasonably calculated his benefits according to his pre-September 1 salary. Consequently, the Court grants summary judgment to Ten Pas.

         BACKGROUND

         I. Ten Pas' Heart Attack and Strokes

         Ten Pas was a lead tax partner at the Chicago office of McGladrey, a tax and consulting firm, now known as RSM U.S. LLP. On Friday, August 29, 2014, Ten Pas worked a full day at the office. He worked part of the day on Saturday, August 30, and Sunday, August 31, before going to his summer cabin in Wisconsin for the Labor Day weekend. While at his cabin, Ten Pas suffered chest pains and went to Oconomowoc Memorial Hospital in Wisconsin. The treating cardiologist admitted Ten Pas to the intensive care unit. On Monday, September 1, which was Labor Day, Ten Pas underwent cardiac angioplasty. The procedure included the placement of a drug-eluting stent to keep an occluded artery open. Physicians discharged Ten Pas the next day, Tuesday, September 2, with several diagnoses, including myocardial infarction, i.e. a heart attack.

         On Wednesday, September 3, Ten Pas returned to work at the office. Ten Pas went home in the afternoon after experiencing some numbness, and later that day was admitted to the emergency room at Highland Park Hospital in Highland Park, Illinois. Ten Pas was “found to have subacute infarction, ” i.e. a stroke. Doc. 48 ¶ 33. Ten Pas remained at the hospital Wednesday night and Thursday, before returning home on Friday, September 5. On Saturday, September 6, Ten Pas went to Highland Park Hospital again, and underwent a CT scan. The treating physician noted that he had suffered an intracranial hemorrhage. Ten Pas remained hospitalized until Highland Park transferred Ten Pas to the Rehabilitation Institute of Chicago on September 12. The Rehabilitation Institute discharged Ten Pas to his home on October 20.

         II. The Long-Term Disability Insurance Policy

         Ten Pas was a participant in McGladrey's long-term disability plan for employees, which Lincoln administered according to the terms of McGladrey's Group Long-Term Disability Insurance Policy (the “Policy”). The Policy pays “a Total Disability Monthly Benefit, ” id. ¶ 16, to “Class 1” employees after an “Elimination Period” of 180 days of Disability, id. ¶¶ 11, 13. The Elimination Period “begins on the first day of Disability” and employees may return to fulltime work during that period so long as they accrue 180 days of Disability, “caused by the same or a related Sickness or Injury, ” within a one-year period. Id. ¶ 11.

         Ten Pas was a Class 1 employee, eligible for long-term Disability benefits equal to 60% of his basic monthly earnings. His benefits could “not exceed the amount shown in the Employer's financial records [or] the amount for which premium has been paid[.]” Id. ¶ 19. McGladrey paid premiums on a monthly basis as a percentage of their payroll.

         The Policy calculates an employee's benefits according to the employee's monthly salary on the “Determination Date.” Id. ¶ 19. The Determination Date is defined as “the last day worked just prior to the date the Disability begins.” Id. “Disability” or “Disabled” means “Total Disability or Partial Disability.” Id. ¶ 7. Total Disability and “Totally Disabled” are defined as: “During the Elimination Period . . . due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of his or her Own Occupation.” Id. ¶ 7. Partial Disability or “Partially Disabled” are defined as: “During the Elimination Period . . . due to an Injury or Sickness the Insured Employee[] is unable to perform one or more of the Main Duties of his or her Own Occupation; or is unable to perform such duties full-time; and is engaged in Partial Disability Employment.” Id. ¶ 8. Main Duties are defined as job tasks that: “are normally required to perform an occupation” and “could not reasonably be modified or omitted.” Id. ¶ 10.

         The Policy also contains a provision defining Active Work:

ACTIVE WORK or ACTIVELY AT WORK means an Employee's full-time performance of all Main Duties of his or her Own Occupation, for the regularly scheduled number of hours, at:
1. the Employer's usual place of business; or
2. any other business location where the Employer requires the Employee to travel.
Unless disabled on the prior workday or on the day of absence, an Employee will be considered Actively at Work on the following days:
1. a Saturday, Sunday or holiday that is not a scheduled workday;
2. a paid vacation day or other scheduled or unscheduled non-workday; or
3. a non-medical leave of absence of 12 weeks or less, whether taken with the Employer's prior approval or on ...

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