Bell v. Ameritech Sickness & Accident Disability Benefit Plant

399 F. App'x 991
CourtCourt of Appeals for the Sixth Circuit
DecidedOctober 15, 2010
Docket19-3551
StatusUnpublished
Cited by13 cases

This text of 399 F. App'x 991 (Bell v. Ameritech Sickness & Accident Disability Benefit Plant) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bell v. Ameritech Sickness & Accident Disability Benefit Plant, 399 F. App'x 991 (6th Cir. 2010).

Opinions

BOGGS, Circuit Judge.

Geraldine Bell (Bell) was a long-time employee of Michigan Bell and a participant in the company’s disability plan, the Ameritech Sickness and Accident Disability Benefit Plan (the Plan). Bell suffered several injuries in a car accident and filed a claim with the Plan for short-term disability benefits. The Plan initially granted Bell’s claim, but discontinued the benefits after two months. Bell appealed the Plan’s decision to discontinue her benefits, but the Plan affirmed its decision. Bell then brought an action against the Plan under 29 U.S.C. § 1132 (ERISA § 502). After allowing limited discovery and reviewing the administrative record, the district court granted judgment in favor of the Plan. Bell now appeals the district court’s [993]*993(1) refusal to allow broader discovery, (2) failure to fashion relief that mitigated the effects of the Plan’s failure to comply with a discovery order, and (3) decision to grant judgment in favor of the Plan. The Plan cross-appeals the district court’s decision to award monetary sanctions against the Plan for its alleged failure to comply with a discovery order. Because the district court neither abused its discretion in limiting discovery and imposing sanctions nor erred in granting judgment in favor of the Plan, we affirm the district court’s orders.

I

Bell worked as a telecommunications specialist for Michigan Bell, a job that involved sitting, talking on the phone, and typing. A.R. at 77, 217-23. As a Michigan Bell employee, Bell was covered by the Plan, which offered both short-term and long-term disability benefits. See R. 29.

On April 5, 2005, Bell was involved in a high-speed car accident. A.R. at 263. Although Bell was able to walk away from the accident, she suffered injuries that led her to seek medical attention. A.R. at 306-07. Bell’s physician, Dr. Zack Brown, diagnosed Bell with cervical whiplash, trauma to the lumbar spine, migraine headache, and a sprain of both hands. A.R. at 307.

Bell’s injuries led her to seek short-term disability benefits from the Plan. Under the terms of the Plan, Bell was only eligible for benefits if she met the Plan’s definition of disability: “a sickness or injury, supported by objective medical documentation, that prevents the Eligible Employee from performing the duties of his/her ... job----” R. 29 at 2.

On April 15, 2005, Bell began receiving conditional benefits from the Plan.1 A.R. at 321. On the same day, the Plan sent Bell a letter explaining that she and her physicians needed to submit “medical information to substantiate [her] disability.” Ibid. The letter stressed that “[i]t is critical that your physician demonstrates by his/her observations and clinical findings that you are unable to perform your work with or without accommodations,” because “[t]his is the information which will allow [the Plan] to make a determination of your eligibility for benefit payments.... ” Ibid.

On May 2, Dr. Brown sent his treatment notes to the Plan. A.R. at 305-09. These notes recorded (1) tenderness around Bell’s cervical spine; (2) tenderness along her lumbar spine; and (3) tenderness and swelling in both hands. A.R. at 307. They also included a diagnosis of cervical whiplash, trauma to the lumbar spine, migraine headaches, and a sprain of both hands. Ibid.

On May 5, the Plan sent Bell a letter approving the payment of benefits from April 13, 2005 through May 22, 2005. Id. at 305.

On May 18, 2005, at the Plan’s behest, Dr. Brown completed and submitted a form regarding Bell’s current diagnosis, functional limitations, and treatment plan. A.R. at 299. Five days later, the Plan approved an extension of Bell’s benefits to June 12, 2005. A.R. at 300. The Plan indicated that Bell would need to submit further medical documentation by June 7, 2005 if she wished to further extend her benefits. Ibid.

Neither Bell nor Dr. Brown submitted any further documentation by June 7. A Plan representative called Bell on June 7 and June 10 to reiterate the need for [994]*994further medical information, but Bell and her doctors still failed to submit documentation. See A.R. at 71. Finally, on June 16, the Plan dispatched a letter to Bell indicating that she did not qualify for further benefits because “no additional [medical] information has been received to support continued sickness disability benefits beyond June 12, 2005.” A.R. at 291. With the letter, the Plan also provided a copy of the Plan’s appeal procedures, which included a summary of the type of medical information and documentation that could support a claim for benefits. A.R. at 257-58.

On June 16, the same day that the Plan dispatched the denial letter, Dr. Brown finally faxed updated treatment notes to the Plan. A.R. at 288. These recorded various physical therapy visits and cataloged Bell’s continuing complaints of pain. A.R. at 289-90.

In response to this new submission, the Plan sent Bell a letter indicating that “this information does not alter the previous denial decision.” A.R. at 285. Although the letter did not elaborate further, the Plan’s internal records indicate that the Plan declined to reinstate benefits because Dr. Brown’s notes “contain[ed] no objective] physical] exam finds, [range of motion] and strength values, or any other documentation suggestive of severe impairment.” A.R. at 68.

Upon receiving this letter, Bell called the Plan and learned that the Plan denied her claim because “medical didn’t support” it. Ibid. Bell apparently reported this problem to Dr. Brown, who submitted a further note to the Plan on June 28, 2005. A.R. at 277-80. This note indicated that Bell continued to complain of pain in her wrists, hands, and back. A.R. at 278-79. The note also set forth Bell’s functional limitations, which included restrictions on her ability to (1) grasp, squeeze, carry, reach, push, and pull with her hands; (2) bend, stoop, twist, kneel, or squat; (3) bend or twist her neck; and (4) ambulate for long periods or climb stairs. A.R. at 278-79.

On June 29, 2005, the Plan sent Bell a letter indicating that Dr. Brown’s note “does not alter the previous denial decision.” A.R. at 27. Bell again called the Plan, and a Plan representative told her that “objective information,” such as an EMG, would help support her claim. A.R. at 62-63.

On July 13, 2005, Dr. Brown sent the Plan a neurological examination report and a mental status assessment. A.R. at 261-66. The neurological examination report indicated that a “complete neurological examination was done,” but did not include any further information regarding the exam. A.R. at 262. The report presented three diagnoses: (1) cervical and lumbro-sacral sprain; (2) “suspected” carpal tunnel syndrome; and (3) headache. A.R. at 262. The mental status assessment, completed by Bell’s psychiatrist, noted that Bell reported anxiety, fear, trouble sleeping, difficulty driving, and flashbacks. A.R. at 263. The assessment also observed that Bell looked anxious and had a depressed affect. A.R. at 264. Bell’s psychiatrist diagnosed her with post-traumatic stress disorder and assessed a GAF2 rating of 35. Ibid. He prescribed Klonopin and a “small dose of Lexapro.” A.R. at 265.

On August 3, 2005, Dr. Brown sent the Plan an MRI report and a note. A.R. at 243-47.

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399 F. App'x 991, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bell-v-ameritech-sickness-accident-disability-benefit-plant-ca6-2010.