Ferrin v. Aetna Life Ins. Co.

336 F. Supp. 3d 910
CourtDistrict Court, E.D. Illinois
DecidedSeptember 28, 2018
DocketNo. 16-cv-00469
StatusPublished
Cited by1 cases

This text of 336 F. Supp. 3d 910 (Ferrin v. Aetna Life Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (illinoised 2018).

Opinion

Honorable Thomas M. Durkin, United States District Judge

On January 13, 2016, Plaintiff Kathy Ferrin sued Defendant Aetna Life Insurance Company seeking payment of long-term disability benefits pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). Specifically, Ferrin appeals Aetna's denial of her long-term disability ("LTD") benefits relating to her back and hip pain. Currently pending before the Court are the parties' motions for judgment. R. 85, 88.

The Court has carefully considered the arguments and evidence presented by the parties and, for the reasons set forth below, overturns Aetna's denial of LTD benefits from August 1, 2014. The following constitutes the Court's Findings of Fact and Conclusions of Law pursuant to Federal Rule of Civil Procedure 52(a). All findings are made by a preponderance of the evidence unless otherwise noted.

Findings of Fact

Ferrin began working for Southwest Airlines on or about July 13, 1992. R. 84 ("AR") at 270.1 Aetna issued a group disability policy (the "Policy") on behalf of Southwest, which provided long-term disability benefits to eligible employees.

*913A. The Policy

The policy provides a monthly benefit for a period of disability caused by a disease or injury. AR 548. Pursuant to the Policy, the test of disability is as follows:

From the date that you first become disabled; and until Monthly Benefits are payable for 24 months; you will be deemed to be disabled on any day if; solely because of: disease or injury ; either of the following applies to you:
• you are not able to perform the material duties of your own occupation ; or
• your earnings from working in your own occupation are 80% or less of: your adjusted predisability earnings .
* * *
During the own occupation period; there is no limit on earnings from working in another occupation. If you work in another occupation while disabled from your own occupation ; your monthly benefit may be adjusted as described on the Summary of Coverage; Benefit Adjustment While Disabled and Working.
Any Reasonable Occupation Period
After the first 24 months that any Monthly Benefit is payable during a period of disability; you will be deemed to be disabled on any day if; solely because of: disease or injury ; either of the following applies to you:
• you are not able to work at any reasonable occupation ; or
• your earnings from working in any occupation are 50% or less of: your adjusted predisability earnings .

Id. (emphasis in original).

The Policy defines reasonable occupation as "any gainful activity for which you are; or may reasonably become; fitted by: education; training; or experience." AR566 (emphasis in original). A period of disability ends on the first to occur of certain circumstances, including but not limited to:

• The date Aetna finds you are no longer disabled or the date you fail to furnish proof that you are disabled.
• The date Aetna finds that you have withheld information which indicates you are performing, or are capable of performing, the duties of a reasonable occupation (if you are receiving benefits for being unable to work any reasonable occupation).
* * *
• The date you fail to give proof that you are unable to perform the duties of any reasonable occupation for compensation or profit equal to more than 50% of your adjusted predisability earnings (if you are receiving benefits for being unable to work any reasonable occupation). (This does not apply to all other Non-contract, Stock Clerks, Flight Simulator Technicians, Flight Training Instructors and Dispatchers.)

AR549-50 (emphasis in original).

The Policy also reduces the amount paid by Aetna if claimants receive other income benefits through Workers' Compensation or the Social Security Act. Specifically, the Policy states that any monthly benefit actually payable will be reduced by "other income benefits," which includes "any amount you receive; or are eligible to receive: under Worker's Compensation," and "any amount you, your spouse or your children (under age 18) receive; or are eligible to receive; because of your disability or retirement under the Federal Social Security Act ... or similar plan, law, or act." AR551.

B. Ferrin's Injury and Treatment

On January 4, 2008, Ferrin suffered a lower back injury while lifting a heavy bag at work. AR31, 684. Due to back pain from that injury, Ferrin eventually stopped *914working on or around July 20, 2011. AR23, 27, 31, 99, 270, 684. As of her last day of work, Ferrin's job title was Customer Service Supervisor, which required lifting and moving items weighing up to 70 pounds on a regular basis, and repetitively lifting and/or moving items weighing 40-50 pounds on raised surfaces. This was considered a medium physical demand level occupation. AR23, 35, 132, 791-792. Ferrin's basic monthly pre-disability earnings, as defined by the Policy and calculated by Aetna, were $5,219.07. AR283.

Despite other conservative treatments, Ferrin's back pain eventually required surgical intervention. On August 10, 2011, Ferrin underwent lumbar decompression and instrumented fusion at L4-L5 for spondylolisthesis. AR31, 99, 902, 905. Following surgery, Ferrin took pain medications and attended physical therapy. AR872, 902.

On December 14, 2011, Ferrin submitted a claim for LTD benefits to Aetna. On December 15, 2011, Ferrin's treating neurosurgeon, Dr. Martin Luken, submitted a physician statement to Aetna that stated Ferrin was capable of sedentary work activity and was undergoing physical therapy following her back surgery. AR905-06. Dr. Luken saw Ferrin for 14 regular monthly follow-up appointments between November 2011 and January 18, 2013. AR815-21, 827-30, 854-58, 870-73, 902-03.

On February 8, 2012, Aetna performed a review and found Ferrin could not perform the lifting, carrying, pushing, and pulling requirements of her medium level job. AR21-30. As a result, Aetna determined that Ferrin was totally disabled from her own occupation, and on February 16, 2012, approved Ferrin's LTD claim, effective October 19, 2011. AR282-83. On February 24, 2012, Aetna informed Ferrin that she may be eligible for Social Security Disability Insurance ("SSDI") benefits and offered to submit an application on Ferrin's behalf. AR880.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
336 F. Supp. 3d 910, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ferrin-v-aetna-life-ins-co-illinoised-2018.