the district court may, in its discretion, merely conduct a de novo review of the record of the administrator's decision, making its own independent benefit determination." Id. Therefore, Paul Revere's motion regarding the record to be reviewed will be granted as to the Group Policy, but denied as to the Individual Policies.
D. Entitlement to Benefits
Paul Revere moves for summary judgment as to Morris' entitlement to benefits under the Group Policy. Because I review the denial of benefits under the Group Policy by the standard articulated in Rizzo, I must first determine de novo whether the administrator applied a correct interpretation of the plan. See supra Part III.B.2. I conclude, however, that genuine issues of material fact preclude this determination at the summary judgment stage of this litigation.
"Under ERISA, our construction of [an] insurance contract is governed not by state insurance law rules but by principles of federal law." Turner v. Safeco Life Ins. Co., 17 F.3d 141, 145 (6th Cir. 1994). Federal law requires that "straightforward language in an ERISA-regulated insurance policy should be given its natural meaning." Burnham v. Guardian Life Ins. Co. of America, 873 F.2d 486, 489 (1st Cir. 1989); see Kaufman v. Provident Life and Casualty Ins. Co., 828 F. Supp. 275, 283 (D.N.J. 1992), aff'd, 993 F.2d 877 (3d Cir. 1993).
The Group Policy is an occupational disability policy which covers Morris if "he is unable to pursue the particular occupation in which he was previously engaged." Oglesby v. Penn Mutual Life Ins. Co., 877 F. Supp. 872, 879 (D. Del. 1994). "The occupation to which such contracts refer in promising indemnity when the insured is unable to carry on an occupation refers to the occupation which the insured was carrying on at the time he was insured." Kaufman, 828 F. Supp. at 284.
To be eligible for benefits under the Group Policy, Morris must have been a "full time" employee of CHCC. See Mat. Facts at P 3. The Group Policy defines "full time" as the "employer's normal work week of at least thirty hours." See Id. at P 4. I must give that phrase its obvious meaning. See Burnham, 873 F.2d at 489 (holding that definition of full time as "working at least 30 hours per week" was "clear, precise, and definite"). According to his application for benefits, Morris worked thirty-six hours per week at CHCC performing chiropractic work. See Defendant's Ex. D, Exhibit 1 at 4; Mat. Facts at P 16. That allegation is sufficient to preclude a determination, at the summary judgment stage, that the administrator's decision was correct.
Paul Revere's alternative ground for summary judgment is equally unavailing. Paul Revere claims that Morris was able to perform his "important duties" because his "important duties" were administrative, rather than chiropractic. Morris, however, alleges that he performed manual chiropractic adjustments "daily." Mat. Facts at P 17. On his application for benefits Morris listed his first duty, "in order of importance," as performing "manual chiropractic adjustments" at CHCC. See Id. at P 16. In 1994, Morris saw 6,972 patients. Id. at PP 37-38. Morris has thus presented sufficient evidence to create a material issue of fact and, accordingly, Paul Revere is not entitled to summary judgment on this issue.
IV. MORRIS' MOTION FOR PARTIAL SUMMARY JUDGMENT
Morris moves for summary judgment as to his entitlement to benefits under the Individual Policies. Morris contends that he was disabled under the Individual Policies because he could no longer perform his chiropractic duties.
The Individual Policies define "total disability" in terms of "the important duties of your regular occupation." Plaintiff's C, E, G, I, K.
In this context, Morris again argues that his "important duties" were chiropractic and Paul Revere again counters that they were administrative.
Morris only saw patients on an "as needed" basis at CHCC. See Mat. Facts at P 39. In 1994, he spent the majority of his time at Statewide. See Id. at PP 35-36. In that one-year period, Morris saw only 311 patients at CHCC, while the full-time chiropractor at CHCC saw 5,009. See Id. at P 37. In addition, Morris had substantial non-clinical duties. As Morris himself testified:
One, I have a real estate company. The buildings I'm in, I have a therapy and rehab company, I'm responsible for a general partner; two, I'm in charge of Statewide in Cherry Hill to make sure--I go out with different attorneys, I go out to lunch with them, I go out to dinner, I do marketing. I look for prospective offices to open up.