Anderson-Posey v. Unum Life Insurance Co. of America

237 F. Supp. 3d 1144, 2017 WL 723898, 2017 U.S. Dist. LEXIS 25399
CourtDistrict Court, N.D. Oklahoma
DecidedFebruary 23, 2017
DocketCase No. 16-CV-0086-CVE-FHM
StatusPublished
Cited by1 cases

This text of 237 F. Supp. 3d 1144 (Anderson-Posey v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, N.D. Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anderson-Posey v. Unum Life Insurance Co. of America, 237 F. Supp. 3d 1144, 2017 WL 723898, 2017 U.S. Dist. LEXIS 25399 (N.D. Okla. 2017).

Opinion

OPINION AND ORDER

CLAIRE V. EAGAN, UNITED STATES DISTRICT JUDGE

Plaintiff filed this action seeking, inter alia, to recover benefits and enforce her rights under the Employee Retirement Income Seéurity Act of 1974, 29 U.S.C. § 1101 et seq. (ERISA). Defendant termi[1147]*1147nated plaintiffs long term disability (LTD) benefits effective May 29, 2014. Plaintiff argues that defendant’s decision to terminate her LTD benefits was arbitrary and capricious and not supported by substantial evidence. Dkt. # 46, at 21. Defendant asserts that it conducted a thorough and reasonable investigation and that its decision to terminate plaintiffs LTD benefits was based on substantial evidence. Dkt. # 55, at 27.

I.

Plaintiff is a 50-year-old married mother of three children. At the time of her disability, plaintiff was working for CVS Pharmacy, Inc. (CVS) as a pharmacist. Dkt. # 35, at 94. Through CVS, plaintiff was insured by a group disability policy issued by defendant that became effective June 1, 2009. Id. at 106. The policy provides coverage for LTD. Id. at 128. CVS is the plan administrator and fiduciary, with the authority to delegate its duties. Id. at 142. CVS delegated its duties to defendant, and defendant acted as a fiduciary with the discretion to administer plaintiffs claim. Id. at 142-43. The policy defines disability as follows:

You are disabled when Unum determines that:

—you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and
—you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury
After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

Id. at 123 (emphasis omitted). Duties' are “material and substantial” if they “are normally required for the performance of your regular occupation” and “cannot be reasonably omitted or modified.” Id. at 139: The policy states that in determining whether a claimant can perform her regular occupation, the standard is how the occupation is normally performed in the national economy, not for a specific employer or at a specific location. Id. at 141,

On June 20, 2013, plaintiff tripped and fell on a curb outside her home. The next day she saw her primary care physician, Chris Hunter, M.D., and complained of back pain and an inability to sit , down. Id at 315. Dr. Hunter ordered an x-ray of plaintiffs tailbone, diagnosed her with coc-cydynia (pain in the coccyx) and a dislocated coccyx, and prescribed a narcotic, Lortab, to be taken every four hours as needed for pain. Id. at 315-16. Due to her injury, plaintiff did not go back to work at CVS after her fall. Id. at 11.

On July 1, 2013, a radiologist x-rayed plaintiffs tailbone as ordered by Dr. Hunter. The radiologist found that there was “abnormal ventral angulation at the sacro-coccygeal junction which probably represented] traumatic injury of indeterminate age,” but he did not see a definite acute fracture. Id. at 310. The same day, plaintiff had another appointment with Dr. Hunter, who diagnosed her with a fractured coccyx and re-prescribed Lortab for pain. Id. at 311-12. On August 7, 2013, defendant received a disability status update form from Dr. Hunter in which he noted under the physical restrictions and/or limitations section that plaintiff should “avoid all aggravating activities” until plaintiff was “able to perform unrestricted work activities.” Id at 65. Dr. Hunter referred plaintiff to Traci L. White, M.D., for pain management. Plaintiff first visited Dr. White on August 19, 2013. M, at 321. Dr. White noted that plaintiff had attempted a manual adjustment of her coccyx in July, but it had been [1148]*1148unsuccessful. Id. Plaintiff described her pain as a constant 7/10. Id. Dr. White diagnosed plaintiff with coccydynia with a fracture at the fourth vertebra from the tip of the coccyx and scheduled her for a coccygeal ligament injection and coccyx repositioning. Id. at 322. Dr. White performed the coccygeal ligament injection on August 27, 2013. Id. at 324.

Plaintiff saw Dr. Hunter again on October 8, 2013. Id. at 307. Plaintiff told Dr. Hunter that the injection did not help and that she felt like she was watching the clock until she could take her next Lortab dose. Id. Dr. Hunter also noted that plaintiff could not go back to work if on controlled substances. Id Dr. Hunter continued plaintiffs Lortab prescription and added prescriptions for two additional pain medications, Anaprox DS and Neurontin. Id. at 308-09. On October 9, 2013, defendant sent Dr. Hunter a letter asking him to opine on plaintiffs restrictions and limitations. Id. at 75-76. Dr; Hunter responded by stating that plaintiff was “unable to work while on controlled substances.” Id at 76. On October 29, 2013, plaintiff had another visit with Dr. Hunter. Id at- 304. Plaintiff complained of the same tailbone pain, and Dr. Hunter re-prescribed the same pain medications. Id. at 304-06. Plaintiff had an office visit with Dr. White on November 4, 2013, during which plaintiff reported that the injection did not help, but that Lortab reduced her pain from 9/10 to a 7/10. Id. at 198.

Dr. Hunter referred plaintiff to Clinton Baird, M.D., for a neurosurgical consultation. Plaintiff saw Dr, Baird on November 5, 2013. Id. at .234. Plaintiff reported that her pain: was at a 7/10 without medication, and 4/10. .or ,5/10 with medication. Id Dr. Baird told plaintiff that he would like to see a positive response to a sacrococcy-geal block before seriously discussing surgical options. Id. at 235. He.recommended plaintiff undergo a repeat sacrococcygeal joint injection. Id. On December 2, 2013, plaintiff visited Dr. Hunter and told him that she wanted to return to work because she was tired of not working and gaining weight. Id. at 300. Dr. Hunter added 'Mobic and Lyrica to the medications he prescribed for plaintiffs pain and recommended that plaintiff return to work gradually. Id at 301-02. On December 19, 2013, Dr. White performed a ganglion impar block on plaintiff. Id. at 285.

On December 6, 2013, one of defendant’s disability benefits specialists called plaintiff to gather information for plaintiffs LTD claim. Id. at 170. Plaintiff reported that her doctors had told her that her type of injury is about waiting and seeing if it would fix itself. Id. Plaintiff explained that she could not work as a pharmacist because she could not legally dispense medication while on narcotics. Id. at 171. Plaintiff stated that she could do normal household activities with breaks between tasks as long as she is on her medications. Id. On January 2, 2014, defendant received a response to .the letter it had sent to Dr. Baird asking him to opine on plaintiffs restrictions or limitations. Id. at 230. Dr. Baird wrote that he had no restrictions to put on plaintiff. Id. On January 6, 2014, a nurse, acting as a clinical consultant to defendant, performed a clinical analysis of plaintiffs claim. Id. at 257. The nurse determined that plaintiffs medical record supported finding plaintiff could not return to work at that time. Id On January 8, 2014, defendant approved plaintiffs claim for LTD benefits. Id. at 276.

On March 19, 2014, plaintiff had a follow-up visit with Dr. White. Id.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
237 F. Supp. 3d 1144, 2017 WL 723898, 2017 U.S. Dist. LEXIS 25399, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anderson-posey-v-unum-life-insurance-co-of-america-oknd-2017.