Garrett v. Prudential Insurance Co. of America

107 F. Supp. 3d 1255, 2015 U.S. Dist. LEXIS 60602, 2015 WL 2169249
CourtDistrict Court, M.D. Florida
DecidedMay 8, 2015
DocketCase No. 8:14-cv-686-T-27AEP
StatusPublished
Cited by2 cases

This text of 107 F. Supp. 3d 1255 (Garrett v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Garrett v. Prudential Insurance Co. of America, 107 F. Supp. 3d 1255, 2015 U.S. Dist. LEXIS 60602, 2015 WL 2169249 (M.D. Fla. 2015).

Opinion

ORDER

JAMES D. WHITTEMORE, District Judge.

BEFORE THE COURT are competing motions for summary judgment (Dkts. 18, 19). Upon consideration, Defendant’s Motion for Summary Judgment (Dkt. 18) is GRANTED and Plaintiffs Motion for Summary Judgment (Dkt. 19) is DENIED. After careful consideration of the record, the Court concludes that Prudential’s decision to deny Plaintiffs claim for long-term disability benefits was not wrong or unreasonable.

I. INTRODUCTION

Plaintiff brought this action under Section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), alleging that Prudential violated ERISA when it terminated her claim for long-term [1258]*1258disability (“LTD”) benefits under the LTD plan (“the. Plan”) sponsored by her employer, Health Management Associates, Inc. (“HMA”). Prudential insures the Plan and serves as its claims administrator.

Although, as will be discussed, the Plan unambiguously vests Prudential with full discretion to determine1 Plaintiffs- eligibility for LTD benefits under the plan, a de novo review of its decision to deny Plaintiffs claim for LTD benefits confirms that its decision was not wrong. And, after review under the more deferential arbitrary and capricious standard, Plaintiff has not demonstrated that Prudential’s decision was unreasonable.

II. FACTUAL BACKGROUND

The factual record is largely undisputed. HMA provides LTD benefits to its eligible employees through a group contract with Prudential. A Group Insurance Certificate which details the terms of LTD coverage. (AR 1-65, 100-145).1 HMA also maintains an Employee Benefit Plan document (AR 146-182) which incorporates the disability insurance contracts. (AR 157).

Plaintiff worked as a Director of Nursing Services for HMA until August 8, 2012, when she contends she became disabled. She claims she suffers from several conditions, including Klippel-Feil Syndrome, cervical disk disease and herniated discs at C5-6 and C6-7 with radiculopathy, migraines, lumbar disc disease, fibromyalgia, anxiety and depression, thoracic radiculitis, carpal tunnel syndrome, adhesive capsulitis, hepatitis C, adrenal fatigue & depressed immune system, asthma, hypertension, GERD, and gastroparesis (Dkt. 19 at 2).

Prudential initially approved Plaintiff for short-term disability (“STD”) benefits, and on October 24, 2012, for LTD benefits while it obtained updated medical records.2 (AR 979-981, 957959). On or about February .1, 2013, Prudential received updated medical records from Plaintiff’s providers, including notes from her neurosurgeon, Dr. Ronzo, who opined that Plaintiff might need a. fusion surgery, and an MRI from September 25, 2012 reflecting a medium herniation in Plaintiff’s back. (AR 825-26.) Prudential had an internal physician, Dr. Jonathan Mittelman, review the updated medical records. (AR 824-825.) Dr. Mittelman concluded that Plaintiff had chronic neck pain that was being appropriately treated and was not in need of immediate surgery.' (Id.) Dr. Mittelman also concluded 'that Plaintiff has certain limitations due to self-reported pain involving excess neck movement and that it was reasonable to restrict Plaintiff from lifting more than 20 lbs on an occasional basis and from performing overheard work. (Id.)

Prudential also obtained an external mental health assessment of Plaintiff from an independent reviewer, Dr. Galina German, Psy.D., LPC. (AR 552-555.) Dr. German concluded there were no records to confirm that Plaintiff needed continuous mental health treatment and that the clinical information did not1 support functional limitations or restrictions from a psychological perspective from February 1, 2013 [1259]*1259forward (AR 555.) She noted that Plaintiffs mental health providers reported Plaintiffs mental status to be within normal limits, with no reports of depressive symptoms and that her medications and therapy sessions with Dr. Balandra did not indicate she was experiencing acute symptoms consistent with an impairing condition. (Id.) Dr. German further found any claim of mental health limitation belied by the fact that Plaintiff spent six-weeks out of state caring for her mother in late 2012. (Id.)

Prudential also conducted an internal regular occupation review and vocational assessment. (AR 817-820.) Diana Mitchell, MS, CRC, using a job description from Plaintiffs employer and referencing the Dictionary of Occupational Titles, determined Plaintiffs regular occupation requires her to oversee her employer’s nursing department, including quality care and accreditation.3 (AR 818.) Specifically, Plaintiffs position deals largely with the overall operation of the nursing department, including policy creation, preparation of departmental budget, drafting procedures, and handling personnel issues. (AR 819.) Ms. Mitchell concluded that this is a sedentary position requiring lifting, carrying, pushing, and pulling 10 lbs occasionally, mostly sitting and may involve standing or walking for brief periods of time, and requires occasional reaching, handling, and fingering, but no overhead work. (AR 820.)

In light of the medical and vocational reviews, Prudential concluded that Plaintiff did not meet the plan’s definition of disability and terminated her LTD benefits effective March 1, 2013. (AR 940-944.) Prudential advised Plaintiff that her physical limitations — ability to lift' 20 lbs on occasion and no overhead work — would not impede her ability to perform the material and substantial duties of her regular occupation. (AR 943.)

Plaintiff appealed. (AR 537-539.) In support of her appeal, she submitted additional medical records, claiming that they established that she was physically and mentally prevented from returning to work. (Id.) Plaintiff asserted Prudential’s analysis was flawed because its review of her mental health was performed by' a Doctor of Psychology, rather than a medical doctor. (AR 537.) In addition, she claimed that during her six-week trip visiting her mother, she provided emotional support rather than actual care. (Id.) Finally, Plaintiff argued Prudential underestimated her job duties and responsibilities, (Id.) Specifically, Plaintiff contended that her position requires her to be highly active, work sixty hours per week, and “often she needs to lift, pull, and move.” (Id.) Plaintiff also submitted letters from her treating physicians stating that she was [1260]*1260disabled and unable to work. (AR 538-539.)

Prudential referred the appeal to independent reviewer Rosyln Wright, Ph.D. Psychology, with an added expertise in Neuropsychology. (AR 463^468.) Dr. Wright found that Plaintiffs medical records were lacking in objective or quantitative data and were grounded largely on Plaintiffs self-report (Id.) She also found the reports unsubstantiated, given that Plaintiffs treating providers repeatedly affirmed Plaintiffs normal mental state. (Id.) Dr. Wright noted that two of Plaintiffs providers, Drs. Tracy and Fattah, described Plaintiffs mental status as normal, while a third treating physician, Dr.

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

Related

Street v. Aetna Life Insurance Co.
188 F. Supp. 3d 1279 (M.D. Florida, 2016)
Ramdeen v. Prudential Insurance Co. of America
163 F. Supp. 3d 1218 (M.D. Florida, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
107 F. Supp. 3d 1255, 2015 U.S. Dist. LEXIS 60602, 2015 WL 2169249, Counsel Stack Legal Research, https://law.counselstack.com/opinion/garrett-v-prudential-insurance-co-of-america-flmd-2015.