Greenwald v. Liberty Life Assurance Co.

932 F. Supp. 2d 1018, 56 Employee Benefits Cas. (BNA) 2418, 2013 WL 1156438, 2013 U.S. Dist. LEXIS 38652
CourtDistrict Court, D. Nebraska
DecidedMarch 20, 2013
DocketNo. 4:12-CV-3034
StatusPublished
Cited by4 cases

This text of 932 F. Supp. 2d 1018 (Greenwald v. Liberty Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, D. Nebraska primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Greenwald v. Liberty Life Assurance Co., 932 F. Supp. 2d 1018, 56 Employee Benefits Cas. (BNA) 2418, 2013 WL 1156438, 2013 U.S. Dist. LEXIS 38652 (D. Neb. 2013).

Opinion

MEMORANDUM AND ORDER

JOHN M. GERRARD, District Judge.

Plaintiff Todd Greenwald brings this case under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. Greenwald asserts three claims for relief. His first claim is for benefits under the Wells Fargo Short-Term Disability Plan (the “STD Plan” or “the Plan”). Greenwald argues that Wells Fargo and Liberty Life Assurance Company of Boston erroneously denied his claim for STD benefits.1 Previously, the parties agreed to remand Greenwald’s second claim, for benefits under the Wells Fargo Long-Term Disability Plan (the “LTD Plan”), for administrative review. Filing 35. On remand, Liberty Life approved Greenwald’s claim for benefits under the LTD Plan, and the parties have since stipulated to dismiss this claim, with prejudice. See filings 60, 81, and 82. Greenwald’s third claim seeks statutory penalties under 29 U.S.C. § 1132(c) for Wells Fargo’s failure to produce certain plan documents.

The parties have agreed to resolve Greenwald’s pending claims as if cross-motions for summary judgment had been filed. See filing 40. Greenwald has also moved to strike (filing 54) portions of an affidavit submitted by defendants (filing 51-1). The Court has considered the pleadings, briefs, administrative record, and the parties’ additional evidence (filings 47 and 51). For the reasons discussed below, the Court finds that defendants’ decision to’ deny Greenwald’s claim for short-term disability benefits was not supported by substantial evidence, and summary judgment will be entered in favor of Greenwald on his first claim. That claim will be remanded for further administrative proceedings consistent with this opinion. The Court finds, however, that Liberty Life is not a proper defendant to that claim, and Greenwald’s first claim will be dismissed as to Liberty Life. The Court further finds that Greenwald is entitled to summary judgment on his claim for statutory penalties. Greenwald has also requested an award of attorney fees under § 1132(g)(1). He may be entitled to such an award, and the Court requests the parties to submit additional briefing on the issue. Finally, Greenwald’s motion to strike will- be denied as moot.

[1022]*1022FACTUAL BACKGROUND

The STD Plan was a self-insured plan covered by ERISA; Wells Fargo was the Plan’s sponsor and administrator. Filing 48 at ¶ 3; filing 39-3 at 47, 145, 225. Liberty Life was the claims administrator for the STD Plan. Filing 48 at ¶ 2. Greenwald was a long-time employee of Wells Fargo and participated in the STD Plan. Filing 48 at ¶¶ 1, 7. He was employed as an “ITS Relationship Manager 2.” Filing 39 at 65; filing 39-1 at 148. He was responsible for, among other things, developing and maintaining customer relations for large and complex institutional trust accounts and ensuring that accounts met regulatory and internal banking requirements. Filing 48 at ¶ 5.

Greenwaid’s position required him to work 8 hours a day and 40 hours a week. Filing 39 at 85. Wells Fargo provided a description of the physical and mental demands of Greenwaid’s job. Filing 39 at 85. He was required to: “frequently” sit for 3 to 6 hours per day, “occasionally” walk 30 minutes to 3 hours per day, occasionally stand 30 minutes to 3 hours per day, and occasionally drive a car to meet with clients. Filing 39 at 85-86. When Greenwald drove to meet clients, the trips ranged from 110 to 800 miles round-trip. Filing 39-4 at 44. Greenwaid’s day-to-day duties mostly involved working on a computer, talking on the phone, and attending meetings. Filing 39 at 65.

Before moving to a more détailed discussion of the facts underlying this case, the Court will briefly summarize how the parties arrived before the Court. Greenwald has reported experiencing chronic lower back pain for at least the last 12 years. His back problems were the result of several factors, including scoliosis, muscle weakness in his right leg resulting from surgery to remove a tumor, and degenerative disc disease. Since 2005 he has been prescribed strong pain control medications, undergone multiple spinal surgeries, and participated in various forms of physical therapy.

Shortly before Greenwald filed the claim for STD benefits that underlies this case, he applied for and received STD benefits for an unrelated problem with his neck. On January 5, 2011, Greenwald underwent a planned surgery on his neck: a microdiscectomy and fusion2 at the C5-6 level.3 Filing 48 at ¶ 8. Greenwald applied for and received STD benefits from January 12 to January 17. Filing 48 at ¶ 8. Following surgery, he was released by his physician to return to work 4 hours per day from January 18 through January 31. Filing 48 at ¶ 9. Partial STD benefits were also approved for that period of time. Filing 48 at ¶ 9.

[1023]*1023On February 1, 2011, Greenwald returned to work full time. Filing 48 at ¶ 10. Soon after returning to work, Greenwald found he could not perform his job duties. He claims that he experienced fatigue and severe pain as a result of problems with his back and right hip, as well as pain and numbness in his right leg. Filing 48 at ¶ 10. He also claims that the pain medications he was taking made it difficult to concentrate. Greenwald left work on February 23, after working a 5-hour day. Filing 48 at ¶ 10. On February 25, Greenwald reapplied for STD benefits. Filing 48 at ¶ 11. On March 28, his claim was denied on its first review by Liberty Life. Filing 39-1 at 109-112. Greenwald appealed, and the denial was affirmed by Liberty Life on May 2, and affirmed again on the final level of review by Wells Fargo on September 8. Filing 39 at 70-74; filing 39-4 at 17-19.

Before discussing Greenwald’s medical history, the Court will review the terms of the STD Plan. The Court will then provide a brief chronological summary of the medical records generated up to Greenwald’s February 25, 2011, application for STD benefits. It is worth noting, however, that when Greenwald first submitted his claim, he did not include the majority of these records. After the first denial, the medical records and defendants’ eligibility determinations follow a more predictable chronological path.

I. The STD Plan

The STD “Plan Document” and “Summary Plan Description” were contained in one “Benefits Book.”4 Filing 39-3 at 1, 9-48, 143-55, 209-226. Chapter 9 of the Benefits Book was entitled “Short-Term Disability Plan” and explained that it, together with “ ‘Chapter 1: An introduction to your benefits’ and ‘Appendix B: Legal notifications’ ... constitute^] the Summary Plan Description” for the STD Plan. Filing 39-3 at 12, 145. Chapter -1 explained that the Benefits Book contained summary plan descriptions for various benefit plans, but that these summaries could not “replace or change any provision of the-actual plan documents.” Filing 39-3 at 11 (emphasis supplied). And in the case of a conflict between the summary descriptions and “the official plan document,” the official plan document controlled. Filing 39-3 at 11. The Benefits Book also explained how employees could obtain copies of official plan documents. Filing 39-3 at 11. In actual fact, however, there was no separate “official” plan document for the STD Plan. Filing 47 at 4-5; filing 51-1 at ¶ 14.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
932 F. Supp. 2d 1018, 56 Employee Benefits Cas. (BNA) 2418, 2013 WL 1156438, 2013 U.S. Dist. LEXIS 38652, Counsel Stack Legal Research, https://law.counselstack.com/opinion/greenwald-v-liberty-life-assurance-co-ned-2013.