Bistany v. Reliance Standard Life Insurance

55 F. Supp. 3d 956, 2014 U.S. Dist. LEXIS 133008
CourtDistrict Court, S.D. Texas
DecidedSeptember 23, 2014
DocketCivil Action No. H-13-2776
StatusPublished
Cited by1 cases

This text of 55 F. Supp. 3d 956 (Bistany v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bistany v. Reliance Standard Life Insurance, 55 F. Supp. 3d 956, 2014 U.S. Dist. LEXIS 133008 (S.D. Tex. 2014).

Opinion

MEMORANDUM AND ORDER

NANCY F. ATLAS, District Judge.

This ERISA case alleging wrongful termination of benefits is before the Court on cross-motions for summary judgment. Defendant Reliance Standard Life Insurance Company (“Reliance”) filed a Motion for Summary Judgment [Doc. # 14], to which Plaintiff Michele Bistany (“Bistany”) filed a Response [Doc. # 18], and Defendant filed a Reply [Doc. # 19]. Plaintiff also filed a Motion for Summary Judgment and Memorandum of Law In Support of Motion for Summary Judgment [Docs. # 15 and # 16], to which Defendant filed a Response [Doc. # 17]. Plaintiff neither filed a reply nor requested additional time to do so. These motions are thus ripe for consideration. Having considered the parties’ briefing, the applicable legal authorities, and all matters of record, the Court denies Plaintiffs Motion for Summary Judgment and grants Defendant’s Motion for Summary Judgment.

I. BACKGROUND

Bistany was insured under a long-term disability policy with Reliance that provided for benefits in the event of total disability, defining total disability for the first thirty-six months of receiving benefits as someone who “cannot perform the material duties of his/her regular occupation” and after thirty-six months as someone who “cannot perform the material duties of any occupation ... that the Insured’s education, training, or experience will reasonably allow.” Administrative Record (“A.R.”) [collectively, Exhs. # 1 through # 72 to Doc. # 14], at 8.1 But the policy [959]*959limited the insured to twenty-four months of benefits if the total disability was “caused by or contributed to by mental or nervous disorders,” and defined mental and nervous disorders to include conditions such as depressive disorders, anxiety disorders, and somatoform disorders.2 A.R., at 20.

On October 16, 2008, Bistany stopped working for longtime employer, Resource Staffing, Inc., and, on January 9, 2008, she submitted a long-term disability claim to Reliance. A.R., at 1102. She claimed she was unable to work due to “Chronic Lyme Disease/Mono” and that her symptoms at various times included “loss of energy, memory, [and] ache in joints” as well as “headaches, nausea, vomiting, [and] dizziness.” Id. To support her claim, Bistany provided a form from her physician, Dr. Patricia D. Salvato, an internal medicine specialist, that stated she was unable to perform her work activities due to her severe symptoms. A.R., at 1100-01. Dr. Salvato listed Bistany’s primary diagnosis as “Lyme disease” and “Chronic Fatigue Syndrome [and] Fibromyalgia” as secondary conditions that contributed to her disability. Id. Reliance approved Bistany’s claim and paid Bistany benefits for thirty-four months, from January 14, 2009 to November 14, 2011. A.R., at 428.

In a letter dated November 20, 2011, Reliance terminated Bistany’s benefits, largely based on an Independent Medical Examination performed on October 21, 2011 by Dr. Arthur Hadley. A.R., at 421-24. Dr. Hadley conducted a number of tests and determined that Bistany did not have Lyme disease or fibromyalgia, and, instead, that her impairments were solely due to psychiatric factors, including soma-toform disorder. A.R., at 1474-82. Accordingly, Reliance concluded that, per the terms of her policy, Bistany could only receive a maximum of twenty-four months of benefits because her disability was caused or contributed to by a mental or nervous disorder. A.R., at 422-23.

Bistany appealed Reliance’s decision to terminate her benefits in a letter dated May 29, 2012, arguing that the evidence from her treating physicians and laboratory results proved she was totally disabled due to Lyme disease, fibromyalgia, and other physical conditions. A.R., at 1503-19. According to Dr. Salvato, Bistany’s physician for years and the doctor who diagnosed her with Lyme disease, Bistany was unable to perform any work, and both her low CD57 counts and the results of her Western Blot tests proved she was positive for Lyme disease. A.R., at 1580-81. Bis-tany included with her appeal an article from Dr. Joseph J. Burrascano, Jr., who apparently did not meet with Bistany or discuss her case with anyone. A.R., at 1615. The Burrascano article explained the significance of low CD57 counts when diagnosing Lyme disease. Id.

Dr. Charles L. Crist, a family practice doctor who specializes in borreliosis, which appears to be another form of or a condition closely related to Lyme disease, stated Bistany “is a patient of mine diagnosed with borreliosis.” A.R., at 1688-89. Dr. Crist met with Bistany to discuss her symptoms and determined she had “classic symptoms of tick-borne illness,” but he did not elaborate further on any tests with objective measures used to reach his conclusions. A.R., at 1688. Dr. Payman [960]*960Sadeghi, a neurologist, treated Bistany for neck pain and migraines and diagnosed her with fibromyalgia-using the same test Dr. Hadley conducted to reach the opposite diagnosis. A.R., at 1474-75, 1675-67. Another neurologist, Dr. William Gilmer, also suggested Bistany had fibromyalgia and chronic fatigue syndrome. A.R., at 919.

Bistany’s treating physicians further documented numerous incidents of anxiety, depression, and panic attacks. See, e.g., A.R., at 482, 552, 919 (containing notes from Drs. Salvato, Norris, and Gilmore). Dr. Athi Venkatesh, a psychiatrist who treated Bistany for five years, explained that Bistany suffers from severe anxiety and panic attacks and has been diagnosed with major depressive disorder. A.R., at 1681. In December 2011, Dr. Anand Balasubramanian conducted a cognitive assessment, noting Bistany’s diagnoses for multiple unspecified mental disorders and determining that Bistany scored “very low” on the neurocognitive index. A.R., at 1683.

Bistany applied for social security benefits in May 2009. A.R., at 938. Her claim was denied initially in September 2009 and upon reconsideration in October 2009. Id. She filed a written request for a hearing, which was held in March 2010, and the Social Security Administration issued a decision in September 2010 upholding the denial of benefits. A.R., at 938-48. According to the Social Security Administration, Bistany may have chronic fatigue syndrome, but she reported in a July 2009 examination that recent blood tests showed she had been “clear of the Lyme disease for the past six weeks.” A.R., at 941. The decision noted that her neurologist, Dr. Gavin Norris, treated Bistany for migraines but specifically did not diagnose her with Lyme disease. Id. The Social Security Administration concluded that Bistany was not disabled as she did not have a qualifying physical impairment and retained limited work functions. A.R., at 938-48.

Reliance hired Dr. Thomas Lafferty, a rheumatologist, and Dr. Michael Silver-man, board certified in internal medicine and infectious disease, to review the documents from Bistany’s treating physicians, Dr. Hadley’s examination, and the Social Security Administration, and to provide an opinion as to whether Bistany suffered from total disability as a result of Lyme disease, fibromyalgia, or any other physical condition. A.R., at 1742-46. Dr. Sil-verman found “no evidence” of Lyme disease and explained that there is ongoing debate in the scientific community over the significance of low CD57 counts in diagnosing Lyme disease. A.R., at 1745. With regards to the results of Bistany’s fifteen Western Blot tests, Dr.

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Bluebook (online)
55 F. Supp. 3d 956, 2014 U.S. Dist. LEXIS 133008, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bistany-v-reliance-standard-life-insurance-txsd-2014.