Carrier v. Aetna Life Insurance

116 F. Supp. 3d 1067, 2015 U.S. Dist. LEXIS 97693
CourtDistrict Court, C.D. California
DecidedJuly 24, 2015
DocketCase No. CV 14-03932 BRO (FFMx)
StatusPublished
Cited by2 cases

This text of 116 F. Supp. 3d 1067 (Carrier v. Aetna Life Insurance) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carrier v. Aetna Life Insurance, 116 F. Supp. 3d 1067, 2015 U.S. Dist. LEXIS 97693 (C.D. Cal. 2015).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW AFTER COURT TRIAL

BEVERLY REID O’CONNELL, United States District Judge

I. INTRODUCTION

This action falls under the Employee Retirement. Income Security Act of 1974 [1069]*1069(“ERISA”), 29 U.S.C. § 1001 et seq. Plaintiff Gloria Carrier is a fifty-five-year-old woman who previously worked for Bank of America as a Credit Administrator. Through her position at Bank of America, Plaintiff enrolled in an employee welfare benefit plan that provides disability benefits to the bank’s employees. Defendant Aetna Life Insurance Company administers this plan, which' provides for both short-term disability (“STD”) benefits and long-term disability (“LTD”) benefits.

After being diagnosed with uterine cancer, Plaintiff underwent surgery and chemotherapy, which led her to develop significant neuropathy and become severely depressed. As a result, Plaintiff took a leave of absence from work and submitted a claim for STD benefits in August 20Í1. Defendant granted that claim, and Plaintiff received STD benefits for some time. When Plaintiff reached the maximum allowable number of weeks for STD benefits under her policy, Defendant began evaluating Plaintiff’s eligibility for LTD benefits. Finding her to be eligible, Defendant provided Plaintiff with .LTD benefits beginning on February 10, 2012. On July 11, 2013, however, Defendant terminated Plaintiff’s LTD benefits after determining that she no longer met the policy’s definition of disability.

Through an attorney named Donald Cooper, Plaintiff appealed this termination of benefits in August 2013. Mr. Cooper submitted a number of Plaintiff’s medical documents to Defendant in support of her appeal, but Defendant rejected Plaintiffs appeal on February 7, 2014, upholding its termination of Plaintiff’s LTD benefits. Believing that Defendant wrongfully withheld benefits due under the disability insurance policy, Plaintiff filed the instant action.. She now seeks review of Defendant’s termination of her -LTD benefits.

After a de novo review of the record and argument of counsel, the Court finds that Plaintiff is entitled to LTD benefits under the policy, and consequently that Defendant’s termination was improper. Accordingly, judgment is for Plaintiff.

II. FINDINGS OF FACT 1

A. The Policy

Plaintiff began working for Bank of America on July 30, 2010, when she was hired as a Credit Administrator. (AR0421.) As a Credit Administrator, Plaintiff’s role at Bank of America entailed “[s]upervis[ing] and coordinat[ing] activities of workers engaged in processing and recording commercial, residential, and consumer loans,” which involved minimal physical requirements such as occasionally “lifting, carrying, pushing, [and] pulling 10 Lbs.” (AR072Í.) Plaintiff’s job “[m]ostly” involved “sitting,” although it also included “standing or walking for brief periods of time.” (AR0721.) Accordingly, the physical demand level listed for her position is “sedentary.” (AR0421.) Nevertheless, the position also involves “[c]ommuni-cat[ing] risk analysis clearly through written and oral communication,” “[i]dentify[ing] problems on credit-related issues, guidelines & policies,” performing research on closed loans, and supervising between twenty and 100 people across multiple states. (AR0503, 0694.) .

As a Bank of America employee, Plaintiff enrolled’ in the employee welfare benefits policy administered by Defendant. {See AR0017-99.) This.policy provides for both short-term and • long-term disability benefits. (AR0012.) Pursuant to this poli[1070]*1070cy, an employee may seek- STD benefits for up to twenty-six weeks, after which the employee may apply for LTD benefits. (AR0348-49.) To be eligible for LTD benefits, an employee must meet the definition of “disability” under the policy:

From the date that you first became disabled and until monthly benefits are payable for 18 months you meet the test of disability on any day that:
• You cannot perform the material duties of your own occupation solely because of an illness, injury or disabling pregnancy-related condition; and
• Your earnings are 80% or less of your adjusted predisability earnings.
After the first 18 months of your disability that monthly benefits are payable, you meet the plan’s test of disability on any day you are unable to work, at any reasonable occupation solely because of an illness, injury or disabling pregnancy-related condition.

(AR1658.) It further states: “The loss of a professional or occupational license or certification that is required by your own occupation does not mean you meet the test of - disability. You must meet the plan’s test of disability to be considered disabled.” (AR1658.) As for the definition of “own occupation,” as referenced in this provision, the policy defines that term as:

The occupation that you are routinely performing when your period of disability begins. Your occupation will be viewed as it. is normally performed in the national economy instead of how it is performed:
• - For your specific employer; or
• At your location or work site; and
• Without regard to 'your specific reporting relationship.

(AR1673.) The policy also defines the term “reasonable occupation” as “any gainful activity ... [f]or which you are, or may reasonably become, fitted by education, training, or experience,” and “[w]hich results in, or can be expected to result in, an income of more than 60% of your adjusted predisability earnings.” (AR1675.)

Finally, the policy limits LTD benefits that result from a mental or psychiatric condition. Specifically, the policy states than an employee “will no longer be considered as disabled and eligible for long term monthly benefits after benefits have been payable for 24 months if it .is determined that [his or her] disability is primarily caused by” either (1) “[a] mental health or psychiatric condition, including physical manifestations of these conditions, but excluding conditions with ' demonstrable, structural brain damage,” or (2) “[a]lcohol and/or drug abuse.” (AR1660.)

B. Plaintiffs Diagnosis

In 2009,' Plaintiff was diagnosed with Stage 3C/4A uterine cancer. (AR0966, 1090-91.) On June 24, 2009, Plaintiff underwent surgery to remove her uterus. (AR1091.) She then underwent three cycles of chemotherapy, which led her to develop significant neuropathy. (AR1090.) Following this treatment, Plaintiff saw Dr. Andrew Seltzer, M.D., who, on July 27, 2011, reported that Plaintiff “recently has developed constant tingling and numbness from her elbows to her hands and her feet. She feels like something is smashing every part of her limbs. She reports weakness in the hands. In the past three or four months things have escalated. She is also having abdominal and rib cage pain.” (AR0943.) Dr. Seltzer subsequently diagnosed. Plaintiff with chronic myofascial pain syndrome and thoracic spine pain in a report dated August 31, 2011. (AR0947.)

C. Plaintiffs Receipt of STD Benefits

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Shaw v. Life Insurance Co. of North America
144 F. Supp. 3d 1114 (C.D. California, 2015)

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Bluebook (online)
116 F. Supp. 3d 1067, 2015 U.S. Dist. LEXIS 97693, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carrier-v-aetna-life-insurance-cacd-2015.