Conway v. Reliance Standard Life Insurance

34 F. Supp. 3d 727, 2014 WL 3708533, 2014 U.S. Dist. LEXIS 102369
CourtDistrict Court, E.D. Michigan
DecidedJuly 28, 2014
DocketCase No. 13-11164
StatusPublished
Cited by7 cases

This text of 34 F. Supp. 3d 727 (Conway v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Conway v. Reliance Standard Life Insurance, 34 F. Supp. 3d 727, 2014 WL 3708533, 2014 U.S. Dist. LEXIS 102369 (E.D. Mich. 2014).

Opinion

ORDER DENYING PLAINTIFF’S MOTION (DKT. 14), AND GRANTING DEFENDANT’S MOTION (DKT. 13) FOR JUDGMENT ON THE ADMINISTRATIVE RECORD

TERRENCE G. BERG, District Judge.

This is an ERISA action for the recovery of benefits under an Employee Benefit Plan. Plaintiff John Conway is seeking to overturn the decision of Defendant Reliance Standard Life Insurance Company (“Reliance”), which denied him disability benefits.

On December 13, 2013, Plaintiff filed a motion for judgment on the administrative record (Dkt. 14), claiming that because he submitted sufficient proof of disability, Defendant’s denial was improper. That same day, Defendant filed its own motion for judgment (Dkt. 13), maintaining that Plaintiffs proof was insufficient and that Defendant’s decision to deny benefits should be upheld.

For the reasons set forth below, Defendant’s Motion is GRANTED, and Plaintiffs Motion is DENIED.

I. FACTS

For the past twenty-seven years, Plaintiff John Conway has practiced as a personal injury defense attorney for the law firm of Ogne, Alberts & Stuart, PC (“Ogne”) (Dkt. 6, R. at 143). Roughly five years ago, on November 9, 2009, Plaintiff suddenly lost hearing in his left ear. Id. at 140. Though Plaintiff returned to work three days later — and has continued to work as an attorney ever since — his hearing loss has required him to reduce the number of hours he works per week. Id. at 140, 149, 300. Before losing his hearing, Plaintiff typically worked seventy hours per week; now Plaintiff is only able to work fifty hours per week. Id.

Following the loss of his hearing, Plaintiff visited two otolaryngologists. Id. at 146-47. On November 10, 2009 — the day after his hearing loss — Plaintiff saw Dr. Stachler, a close friend of his, who diagnosed him with sudden acute sensorineural hearing loss.1 Id. at 318-19. Nine days [731]*731later, Plaintiff saw Dr. Zappia who confirmed Dr. Stachler’s diagnosis and added that Plaintiff seemed to be experiencing some tinnitus (ringing in his ears) and loss of balance. Id. at 320.

On December 9, 2009, Plaintiff submitted a claim for disability benefits to Defendant Reliance. Id. at 140. The claim was made under a policy of insurance that Ogne had obtained from Reliance approximately six months prior to Plaintiffs hearing loss, for the purpose of insuring Ogne’s long term disability plan (“the Plan”). Id. at 1. To obtain benefits, the Plan requires a claimant to submit satisfactory proof of total disability. Id. at 19. Under the terms of the Plan, total disability means the inability to perform the material duties of the claimant’s regular occupation.2 Id. at 12.

On March 9, 2010, after reviewing the reports of Dr. Zappia and Dr. Stachler, Defendant denied Plaintiffs claim. Id. at 119. Defendant concluded that Plaintiff had not provided evidence sufficient to establish that he was unable to perform the material duties of his position as an attorney. Id. at 119-21.

On February 10, 2012, Plaintiff appealed Defendant’s decision, relying on the previous findings of Dr. Stachler and Dr. Zappia. Id. at 332-36. In response to Plaintiffs appeal, Defendant requested additional medical records and conducted an independent review of Plaintiffs claim. Id. at 134-38. The additional medical records included the reports of Dr. Baxter, a psychiatrist whom Plaintiff saw on May 21, 2012 and May 23, 2012. Id. at 518-19. Dr. Baxter found Plaintiffs hearing loss was not psychological, though he did find that Plaintiff was anxious about the impact his loss of hearing was having on his work and family. Id. at 519. Defendant’s independent review consisted of their oto-laryngologist, Dr. Carpenter, reviewing the findings of Dr. Stachler and Dr. Zap-pia, as well as their psychiatrist, Dr. Ace-ñas, reviewing the findings of Dr. Baxter. Id. at 134-38. Dr. Carpenter concluded that, though Plaintiff suffered from sudden hearing loss in his left ear and experienced ringing in his ears and loss of balance as a result, these conditions did not affect his work capacity. Id. at 135. Similarly, Dr. Aceñas concluded that though Plaintiff was anxious, his anxiety was “non-impairing.” Id. at 526. For these reasons, on September 21, 2012, Defendant denied Plaintiffs appeal. Id. at 134.

[732]*732In response to that denial, Plaintiff filed suit under ERISA. The matter is now before the Court on the parties’ cross motions for judgment. Pursuant to Eastern District of Michigan Local Rule 7.1(f)(2), the motions will be determined based on the parties’ briefs and the administrative record.

II. STANDARD OF REVIEW

Generally, an ERISA plan administrator’s decision to deny benefits is reviewed de novo. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). But if a benefit plan grants discretionary authority to the plan administrator, the court reviews the decision to deny benefits under an arbitrary and capricious standard. Id. The Sixth Circuit has interpreted the language used in the Plan at issue here, “submit satisfactory proof of total disability to us,” as clearly granting the plan administrator discretion to determine eligibility for benefits; therefore the arbitrary and capricious standard of review would be expected to apply. Yeager v. Reliance Standard Life Insurance Co., 88 F.3d 376, 380 (6th Cir.1996). However, in 2007, Michigan banned the use of discretionary clauses in insurance policies. See Mich. Admin. Code r. 500.2202(b). As a result, discretionary clauses contained in plans issued in Michigan after June 1, 2007 are void, and the de novo standard of review applies to ERISA lawsuits arising under such plans. See generally Am. Council of Life Insurers v. Ross, 558 F.3d 600, 609 (6th Cir.2009) (holding Michigan law banning discretionary clauses in insurance policies is not preempted by ERISA).

The Plan at issue in this case 'came into effect in 2009, and the parties agree that the appropriate standard of review is de novo. Under a de novo review, “the role of the court reviewing a denial of benefits is to determine whether the plan administrator made the correct decision.” Hoover v. Provident Life and Acc., Ins., 290 F.3d 801, 808 (6th Cir.2002) (internal quotations omitted). First, the Court must decide whether the administrator properly interpreted the Plan. Id. at 809. Applying general principles of contract law, the Court must read the Plan provisions “according to their plain meaning in an ordinary and popular sense” and construe any ambiguities in the Plan against the drafter. Williams v. Int’l Paper Co., 227 F.3d 706, 710 (6th Cir.2000).

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34 F. Supp. 3d 727, 2014 WL 3708533, 2014 U.S. Dist. LEXIS 102369, Counsel Stack Legal Research, https://law.counselstack.com/opinion/conway-v-reliance-standard-life-insurance-mied-2014.