Deborah Rubin v. Life Insurance Company of North America

CourtCourt of Appeals for the Eleventh Circuit
DecidedMarch 4, 2025
Docket24-10433
StatusUnpublished

This text of Deborah Rubin v. Life Insurance Company of North America (Deborah Rubin v. Life Insurance Company of North America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Deborah Rubin v. Life Insurance Company of North America, (11th Cir. 2025).

Opinion

USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 1 of 19

[DO NOT PUBLISH] In the United States Court of Appeals For the Eleventh Circuit

____________________

No. 24-10433 Non-Argument Calendar ____________________

DEBORAH SHOENBERG RUBIN, Plaintiff-Appellant, versus LIFE INSURANCE COMPANY OF NORTH AMERICA, NATIONAL FEDERATION OF INDEPENDENT BUSINESS,

Defendants-Appellees,

JOSEPH KENNEY, et al.,

Defendants. USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 2 of 19

2 Opinion of the Court 24-10433

Appeal from the United States District Court for the Southern District of Florida D.C. Docket No. 9:22-cv-81246-BER ____________________

Before NEWSOM, BRANCH, and GRANT, Circuit Judges. PER CURIAM: Deborah Rubin sued her former employer and her insurance provider pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(a)(1)(B) (“ERISA”), for denying her short-term disability claim after she was diagnosed with anxiety and depression. She alleges that the medical evidence submitted by her treating physician and reviewed by the insurance company demonstrates that she was unable to perform the essential functions of her job, entitling her to disability. The court below denied her claim because it found that, under the deferential standard of review required under ERISA, the insurer did not unreasonably construe the submitted medical evidence. After careful review, we affirm. I. Statement of Facts The Plaintiff-Appellant, Deborah Rubin, worked as a telephone sales representative for the National Federation of Independent Businesses (“NFIB”) until June 7, 2021, after which time she alleges she could no longer work due to depression and anxiety. While employed at NFIB, Rubin was insured under a USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 3 of 19

24-10433 Opinion of the Court 3

short-term disability (“STD”) policy through Life Insurance Company of North America (“LINA”). The STD policy (the “Plan”) is part of a welfare benefits plan governed by ERISA.1 The Plan defines a person as disabled if that person is (1) “unable to perform the material duties of your Regular Job”; and (2) “unable to earn 80% or more of your Covered Earnings from working in your Regular Job.” The Plan also vests LINA with the authority and discretion to make benefit determinations.2 Rubin submitted a claim for STD benefits under the Plan on September 29, 2021. LINA requested records from Rubin’s treating physician, Dr. Richard Phelps, on October 1, 2021. LINA simultaneously informed Rubin that it was requesting the records to determine whether she was disabled under the policy. Specifically, LINA requested a Behavioral Health Questionnaire, a document that LINA provided for describing Rubin’s mental

1 ERISA “allows an insurance-plan participant to bring a civil action to recover

benefits due to [her] under the terms of [her] plan.” Stewart v. Hartford Life & Accident Ins. Co., 43 F.4th 1251, 1254 (11th Cir. 2022) (quotation omitted). 2 The Plan states

The Plan Administrator has appointed [LINA] as the named fiduciary for deciding claims for benefits under the Plan, and for deciding any appeals of denied claims. [LINA] shall have the authority, in its discretion, to interpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan and to make any related findings of fact. All decisions made by [LINA] shall be final and binding on the Participants and Beneficiary to the full extent permitted by law. USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 4 of 19

4 Opinion of the Court 24-10433

condition, and a copy of Rubin’s relevant health records. 3 But for reasons not clear in the record, LINA’s requests went unanswered for several months.4 Dr. Phelps eventually returned a completed Questionnaire to LINA on November 26, 2021, which listed medications Dr. Phelps was currently prescribing to Rubin for her previously diagnosed major depressive disorder and general anxiety/stress. Relevantly, however, in the Questionnaire, Dr. Phelps described Rubin’s “[s]ocial function” as “improved” and attributed Rubin’s inability to work to her need to “tak[e] care of [her] husband who cannot work.” Ultimately, Dr. Phelps concluded in the Questionnaire that Rubin was functionally incapable even though

3 LINA also requested:

• Complete copies of office visit notes from June 16, 2021, to present; • Hospital Intake/Discharge summary, and/or Operative Report(s); • Test results/findings (for example: MRI’s, EKG’s, x-ray’s, etc.); • Treatment plan (including meds, frequency of treatment, referrals, Physical Therapy, etc.); • Restrictions and limitations that prevent(ed) patient from returning to work; • Estimated return to work date/date patient was released to return to work. 4 Rubin contends that LINA sent Dr. Phelps a record request that included her

pre-marriage name, Shoenberg, which led to the confusion. As noted by LINA, however, all subsequent requests included Rubin’s married name. USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 5 of 19

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he did not explain how her depression or anxiety made her unable to perform her job outside of her need to care for her husband. Finally, though LINA had requested copies of Rubin’s prior medical records, none were included. Accordingly, LINA denied Rubin’s STD claim on December 7, 2021. In its denial notice, LINA informed Rubin that a review of the information provided by her treating physician did not demonstrate psychiatric impairment because she had “essentially normal mental status exam findings;” no indication of an inability “to function on a day to day basis;” and no indication of a work restriction. Lastly, LINA noted that Rubin’s caretaking role “indicates a functional capacity.” Rubin appealed the denial. During the appeal period, Dr. Phelps sent LINA the requested office notes from June 2019 to January 3, 2022, included in Rubin’s medical file. 5 The records contained multiple “mental status exams” that demonstrated that Rubin had “appropriate mood and affect, no psychotic symptoms, no SI/HI [suicidal ideation/homicidal ideation], normal recent and remote memory, normal attention and concentration” and that subsequent exams noted relatively unchanged condition. Rubin was also going to the gym a few times a week and adequately performing all the necessary caregiving tasks for her cognitively

5 The office notes included the content of Dr. Phelps’s discussions with Rubin

and were dated July 12, 2021; July 13, 2021; August 26, 2021; October 8, 2021; October 15, 2021; November 26, 2021; and December 14, 2021. There were no office notes preceding Rubin’s cessation of work on June 7, 2021. USCA11 Case: 24-10433 Document: 36-1 Date Filed: 03/04/2025 Page: 6 of 19

6 Opinion of the Court 24-10433

impaired husband—cooking, cleaning, and driving him to all his appointments. During this same time period, Rubin also appears to have overseen the renovation of her condo. Notably, Rubin’s file contained no visitation notes or other medical documentation in May or June 2021, which immediately preceded her June 7, 2021, departure date from work. 6 Further, the notes from her July 13th appointment indicated that Dr. Phelps completed Rubin’s FMLA paperwork “for her caretaker role for her husband.” On February 10, 2022, LINA informed Rubin that it would uphold the denial of her claim based on Dr. Phelps’s notes and a LINA employee’s review of her medical records.

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Deborah Rubin v. Life Insurance Company of North America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/deborah-rubin-v-life-insurance-company-of-north-america-ca11-2025.