Gorbacheva v. Abbott Labs. Extended Disability Plan

309 F. Supp. 3d 756
CourtDistrict Court, N.D. California
DecidedFebruary 12, 2018
DocketCase No. 5:14–cv–02524–EJD
StatusPublished
Cited by4 cases

This text of 309 F. Supp. 3d 756 (Gorbacheva v. Abbott Labs. Extended Disability Plan) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gorbacheva v. Abbott Labs. Extended Disability Plan, 309 F. Supp. 3d 756 (N.D. Cal. 2018).

Opinion

EDWARD J. DAVILA, United States District Judge

In this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132, Plaintiff Olga Gorbacheva ("Plaintiff") seeks long-term disability ("LTD") payments from Defendant Abbott Laboratories Extended Disability Plan ("the Plan" or "Defendant") after her request for benefits was denied. In June of 2016, the Court remanded the action to the Plan Administrator to make an initial determination of Plaintiff's claim in light of all of the evidence it should have considered in the first instance. On remand, the Plan Administrator upheld the termination of Plaintiff's benefits. The Plan Administrator found that Plaintiff did not meet the Plan's definition of disabled beyond July 31, 2012. The case was reopened in January of 2017.

Presently before the Court are Plaintiff's motion for "Judgment On The Record Or, In The Alternative, An Order Setting the Case for Trial De Novo" and Defendant Abbott Laboratories Extended Disability Plan's ("Defendant") motion for summary judgment. See Dkt Nos. 89, 91. Having considered the parties' arguments and evidence, Defendant's motion for summary judgment is granted and Plaintiff's motion for judgment on the record is denied.

I. FACTUAL AND PROCEDURAL BACKGROUND

A. The Plan

Plaintiff was a participant in the Plan, which entitled her to benefit payments if she was "Disabled" within the meaning of the Plan. The Plan would pay benefits for 24 months so long as Plaintiff was completely prevented from performing all the duties required to be performed in her own occupation or employment. Afterwards, the Plan would pay benefits if Plaintiff was completely prevented from performing any occupation or employment for which Plaintiff was qualified or could reasonably become qualified, based on her training, education, or experience.

*761The Plan Administrator, identified in the Plan as the Divisional President, Compensation and Benefits, at Abbott Laboratories ("Abbott"), delegated the duties of making initial claims determinations and deciding initial appeals to a third party, Matrix Absence Management, Inc. ("Matrix"). The Plan also provided for second-level appeals.

B. Plaintiff's Application for Benefits

Plaintiff was employed by Abbott as a Clinical Research Associate II. Her job involved monitoring clinical trials for new products, product improvements, and product process changes. It required her to do a variety of tasks on the computer and on the telephone, including writing in connection with clinical trials and sites. The job also required her to travel to some extent.

Plaintiff suffers from a number of conditions, including degenerative disc disease, spondylosis and scoliosis. She also has a history of knee problems, such as osteoarthritis and tears of her meniscus and posterior cruciate ligament. In 2011, Plaintiff applied for short-term disability benefits, citing continuous pain in her lower back and right leg resulting from these issues.

Matrix approved Plaintiff's application for short-term disability benefits, with an expected return-to-work date of October 19, 2011. Plaintiff was unable to return to work on the expected date. In January of 2012, Plaintiff applied for LTD benefits. Matrix approved Plaintiff for LTD benefits from February 20, 2012, the first day Plaintiff was eligible for LTD benefits, through May 20, 2012, and later extended the benefits through June 10, 2012. Because Plaintiff's nurse case manager ("NCM") was concerned about Plaintiff's sporadic treatment for systems, the NCM commissioned an independent medical examination ("IME") of Plaintiff. On the basis of an IME conducted by L. Neena Madireddi, M.D. ("Dr. Madireddi") on July 11, 2012, Matrix denied Plaintiff LTD benefits beyond July 31, 2012.

Plaintiff, through her counsel, timely appealed the denial of LTD benefits. On March 25, 2013, Plaintiff informed Matrix that Plaintiff had been approved for Social Security benefits, although Plaintiff did not submit a copy of the favorable Social Security Disability Insurance ("SSDI") opinion. Dkt. 91-1, Ex. 34. Matrix commissioned a peer review of Plaintiff's file by an orthopedic surgeon, who concluded that Plaintiff was capable of performing her job. A vocational rehabilitation consultant agreed that Plaintiff was able to perform her own occupation. Matrix denied Plaintiff's appeal in May of 2013.

Approximately six months later, Plaintiff requested a second-level appeal. During the months that followed, Plaintiff sought and obtained several extensions of the review deadline in order to submit further medical records and a release allowing the file reviewer to speak to Plaintiff's medical providers. On January 16, 2014, Matrix informed Plaintiff's counsel that it would proceed with the second-level review based on the information received to date.

As part of the second-level review, the Plan had Plaintiff's records peer reviewed by a second set of doctors, including another orthopedic surgeon. The surgeon concluded that Plaintiff was capable of performing sedentary work full-time. Abbott employee James Sipes ("Sipes") denied Plaintiff's second-level appeal in February of 2014. Dkt. 48-15.

On March 4, 2014, Plaintiff's counsel responded by letter and disputed the denial of Plaintiff's second-level appeal. Sipes took no further action regarding Plaintiff's claim.

*762C. Plaintiff's Medical History

On May 11, 2012, Matrix received updated records from Plaintiff's treating physician, Duc M. Nguyen, M.D. ("Dr. Nguyen") that indicated that Plaintiff did not follow a previously suggested course of treatment that involved medication changes, epidural steroid injections, physical therapy and an evaluation by a pain psychologist, because Plaintiff was not sure the suggested course of treatment was helpful. Dr. Nguyen recommended conservative treatment instead. Dr. Nguyen also estimated that Plaintiff could return to work on August 10, 2012. Plaintiff also submitted a report from Dean F. Weinberg, D.C. ("Dr. Weinberg"), in which Dr. Weinberg estimated that she could return to work on July 2, 2012 and could still improve given further treatment.

There is no record of any of Plaintiff's treating physicians evaluating her after Dr. Nguyen's May 2012 records. On June 29, 2012, Dr. Nguyen issued another report finding that Plaintiff could not work at all, although it does not appear that he examined her in person within the previous month.

In July of 2012, Dr. Madireddi conducted an IME and concluded that Plaintiff did have medical conditions that resulted in certain limitations, but that Plaintiff was able to perform her job because her job description was sedentary.

During her first-level appeal, as indicated above, Matrix asked an orthopedic surgeon, William Andrews, M.D., C.I.M.E. ("Dr. Andrews"), to review Plaintiff's file. Dr. Andrews found that Plaintiff's complaints of pain from her degenerative disc disease were consistent with the objective clinical findings and that her pain was impacting her ability to function. However, Dr.

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Bluebook (online)
309 F. Supp. 3d 756, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gorbacheva-v-abbott-labs-extended-disability-plan-cand-2018.