Brainard v. Liberty Life Assurance Co.

173 F. Supp. 3d 482, 2016 U.S. Dist. LEXIS 38279, 2016 WL 1171542
CourtDistrict Court, E.D. Kentucky
DecidedMarch 24, 2016
DocketCivil Action No. 6: 14-110-DCR
StatusPublished
Cited by4 cases

This text of 173 F. Supp. 3d 482 (Brainard v. Liberty Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brainard v. Liberty Life Assurance Co., 173 F. Supp. 3d 482, 2016 U.S. Dist. LEXIS 38279, 2016 WL 1171542 (E.D. Ky. 2016).

Opinion

MEMORANDUM OPINION AND ORDER

Danny C; Reeves, United States District Judge

This matter is pending for consideration of Plaintiff John. Brainard’s motion for judgment. [Record No. 40] Pursuant to 29 U.S.C. ,§ 1132(a)(1)(B), Brainard ' challenges the defendant’s denial of his claim for long-term disability (“LTD”) benefits under an employee benefit program sponsored by his former employer, Community Trust Bancorp, Inc. The record does not clearly indicate that Brainard is entitled to benefits. Therefore, his motion for judgment will be denied. However, the defendant’s decision to deny him benefits was arbitrary and capricious. As a result, the Court will remand the matter back to the plan administrator 'for a full and fair review.

I.

From 1996 to 2011, Brainard workéd as a branch manager at Community Trust Bank in Somerset, Kentucky. [See Administrative Record, p. 893; hereinafter, “Adm. Rec.”] At all relevant times, Brainard was covered under the bank’s group LTD plan (“the Plan”) governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Defendant Liberty Life Assurance Company of Boston (“Liberty”) provides LTD coverage to Community Trust Bank in addition to administering the Plan. This requires Liberty to act in a dual role. The Plan also delegates to Liberty the discretion to make benefit determinations and interpret the terms of the Plan. [Adm. Rec., p. 39]

According to the Plan,
i. ‘Disability’ or ‘Disabled’ means that during the Elimination. Period and the next 24 months of Disability you, as a result of Injury or Sickness, are unable to perform the Material and Substantial Duties of your Own Occupations; and
ii. thereafter, you are unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.”

[Adm. Rec., p. 8] The Plan defines “Own Occupation” as “the Covered Person’s occupation that he was performing when his Disability or Partial Disability began. For the purposes of determining Disability under this policy, Liberty will consider the Covered Person’s occupation as it is normally performed in the national economy.” [Adm. Rec., p. 12]

Brainard reports that he began experiencing neck and back pain in 1989 after he was injured in an automobile accident. [Record No. 40-1, p. 2; Adm. Rec., pp. 61, 155, 616] Brainard claims that the pain worsened during-his period of employment with the bank, According ■ to Brainard, [485]*485combined with depression, and the-side effects of medication, the pain left him unable to perform his job. On September 16, 2011, Brainard stopped working at the bank and filed a claim for LTD benefits with Liberty. [Adm. Rec., p. 893] Brainard received LTD benefits from September 16, 2011, until May 8, 2012, when Liberty informed him that he no longer qualified for disability benefits under the Plan. [Adm. Rec., p. 734] Brainard subsequently appealed the denial and submitted additional medical documentation. [Adm. Rec., p. 258]

On March 14, 2013, Liberty reinstated Brainard’s LTD benefits. [Adm. Rec., p. 53] Liberty then requested that psychiatrist Dr. Sanjay Chandragiri review ■ of Brainard’s medical records. [Adm. Rec., pp. 166-69] Following this review, Dr. Chandarigi determined that the medical record did not contained psychiatric diagnoses. Id.

Liberty next required Brainard tó tm-dérgo an independent medical evaluation performed by Dr. Ellen Ballard. [Adm. Rec., pp. 155-159] Based on her physical examination and a review of Brainard’s medical records, Dr. Ballard reached a diagnosis of degenerative disc disease. She concluded that Brainard should not lift more than fifteen pounds and also avoid constant cervical motion. [Adm. Rec:, p. 158] However, she opined that,

[Brainard] would be capable of light physical activity, if not moderate physical activity, as I am unable to explain the severity of [his] symptoms based on the records and testing to date. If he is having to use large quantities of pain medication to treat his pain then this could affect his ability to work, but he is not doing that at the present time.

[Adm. Rec., p. 159]

Liberty sido requested an updated Occupational Analysis/Vocational Review. In the first Occupational Analysis, Liberty’s vocational specialist determined that Brai-nard’s occupation as a branch manager “is most often performed at the light to medium level of physical demand.” [Adm. Rec., p. 883] Based on subsequent .changes to the Dictionary of Occupational Titles, the second Occupational Analysis concluded that the branch manager position “is performed at the sedentary and light level of physical demand with sufficient opportunity at both levels of exertion.” [Adm. Rec:, p. 152] According to the updated Occupational Analysis, sedentary work only requires occasional exertion of up to ten pounds of force. [Adm. Rec., p. 151] • ■

Relying on the opinions of Dr. Ballard, Dr. Chandragiri, and its vocational specialist, Liberty again concluded that Brainard was not eligible for LTD benefits beyond July 19,2013. [Adm. Rec., pp. 145-48] Brai-nard appealed this denial of benefits and submitted additional medical records along with a letter from Dr. Jeffery Golden, his primary care physician. [Adm. Rec., pp. 105, 113-14] Dr. Golden wrote that “John Brainard is a long term patient of mine who suffers from intractable neck and back pain.” [Adm. Rec., p. 113] Dr. Golden explained that, at the time of Dr. Ballard’s review, Brainard had been able to wean himself off of pain medication for a short time, but was currently taking a daily dose of the medication. Id. Dr. Golden predicted that Brainard would always require some narcotic pain medications which causes fatigue as well as memory and concentration problems. Id. In Dr. Golden’s opinion, “[Brainard] could not function well as a loan . officer or bank executive if he is having problems with concentration and memory or if he is distracted by fairly severe pain.” Id. Dr. Golden further observed that Brainard experienced “labile moods and depressive symptoms related to his chronic pain” that contribute to his disability. [Adm. Rec., p. 114] Finally, he concluded that “[n]othing changed with regard to his health or long term prognosis [486]*486during the past 4 months that justified revoking his benefits.” Id.

By letter dated March 17, 2014, Liberty denied Brainard’s appeal and advised him that he was still ineligible for benefits as of July 19, 2013. [Adm. Rec., pp. 63-66] In support of this decision, Liberty again relied on the reports of Dr. Chandragiri, Dr. Ballard, and the vocational expert. [Adm. Rec., p. 64] Additionally, Liberty considered another file review performed by Dr. Howard Grattan, who found that Brai-nard’s subjective complaints of pain were not supported by the record. [Adm. Rec., p. 66] Liberty explained that, based on its review, Brainard was capable of performing the material and substantial duties -of his branch manager position, disqualifying him from receiving LTD benefits under the Plan. [Adm. Rec., p. 66]

Having exhausting the appeal process, Brainard filed a Complaint in this Court on May 14, 2014, seeking review of Liberty’s decision to deny him LTD benefits. [Record No. 1] Brainard now claims that he. is entitled to.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
173 F. Supp. 3d 482, 2016 U.S. Dist. LEXIS 38279, 2016 WL 1171542, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brainard-v-liberty-life-assurance-co-kyed-2016.