Herring v. Aetna Life Insurance

898 F. Supp. 2d 1313, 2012 U.S. Dist. LEXIS 148057, 2012 WL 4841714
Procedural entryThis page is a short order in Herring v. Aetna Life Insurance. Read the opinion of the Court — 843 F. Supp. 2d 1305
District Court, S.D. Florida·Decided October 11, 2012·No. Case No. 11-CV-81091·Published

Opinion

ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

KENNETH L. RYSKAMP, District Judge.

THIS CAUSE comes before the Court on Defendant Aetna Life Insurance Company’s motion for summary judgment [DE 30] filed on June 15, 2012. Plaintiff Patricia Herring filed a response [DE 35] on July 31, 2012. Defendant replied [DE 36] on August 7, 2012. The motions are fully briefed, and a hearing was held on September 12, 2012. This matter is ripe for adjudication.

I. Introduction

Plaintiff Patricia Herring (“Herring”) suffers from many medical problems. Her struggles associated with these problems are ongoing and her pain is chronic. While the Court sympathizes with Her[1314] ring’s condition, the law surrounding claims of the unlawful denial of disability benefits is clear: medical conditions, if not work preclusive, are not enough to establish a disability under the Employee Retirement Income Security Act (“ERISA”). Therefore, the Court grants summary judgment in favor of Defendant’s denial of Herring’s disability benefits under her insurance plan.

II. Background1

On March 30, 2009, Herring ceased work as an accounts payable clerk and filed a claim for long term disability (“LTD”) benefits. The following day she underwent coronary artery bypass surgery and was diagnosed as unable to work. Through her employer, she was eligible to receive LTD benefits as a participant in an employee welfare benefit plan under a group insurance policy issued by Defendant Aetna Life Insurance Company (“Aetna”). Aetna served as the plan’s claim administrator, meaning it had discretionary authority to determine whether Herring was entitled to benefits under the terms of the policy.

Under the policy, LTD benefits were payable for a period of “total disability.” The policy defines total disability as: (1) one who is not able to perform the material duties of his occupation; or, (2) one who is not able to work at any reasonable occupation. Statement of Undisputed Material Facts [DE 30] (“SUMF”) ¶3. Reasonable occupation is defined as “any gainful activity for which [one is], or may reasonably become, fitted by education, training, or experience.” SUMF ¶ 4. A reasonable occupation includes “sedentary work,” where standing and walking are required only occasionally. A period of total disability ends when one is not totally disabled or fails to give proof of his continued total disability.

Aetna approved Herring’s claim for LTD benefits, but it notified her that as of June 27, 2010, her eligibility for continued benefits would be contingent on evidence that she was totally disabled. Over a year later, on July 8, 2010, Aetna hired Dr. Josef Hudec, M.D., M.P.H., to conduct an Independent Medical Examination (“IME”) to determine if Herring was totally disabled and remained eligible for LTD benefits. Dr. Hudec reported that Herring was able to perform sedentary work. He further indicated that, subject to physical limitations, Herring was capable of working for eight hours a day. See SUMF ¶¶ 13-14. Following his report, Aetna employed a Vocational Rehabilitation Consultant (“VRC”) who identified five sedentary occupations which Herring could perform and located employers in Herring’s area for each occupation. On August 14, 2010, in light of the IME and the VRC’s findings, Aetna terminated Herring’s LTD benefits on the grounds that Herring could perform a “reasonable occupation” under the policy. SUMF ¶ 17.

Herring appealed Aetna’s decision on February 14, 2011, 843 F.Supp.2d 1305 (S.D.Fla.2012), stating that her “continuing cardiac condition, her diabetes and indeed her other conditions, involving her neck, shoulder, thoracic and lumbar pain continue to incapacitate her from being able to [1315] engage in employment.” SUMF ¶ 20. Included in her appeal was a letter from her treating cardiologist, Tobia Palma, M.D., stating that Herring was totally disabled and had “no ability to work.” SUMF ¶ 20(a). As the claim administrator of Herring’s plan, Aetna reviewed Herring’s appeal of its decision to terminate her benefits.

To assist in its evaluation, Aetna hired three physicians to review Herring’s medical records. Two of the three physicians concluded that Herring was capable of sedentary work and not totally disabled. The third reviewing physician offered a more restrictive projection of Herring’s physical capabilities. His review was consistent with comments made by Dr. Levy, a psychiatrist referred by Herring’s family practitioner and assigned by Aetna to offer his medical opinion on the results of her IME. See SUMF ¶ 19. In consideration of these reports, Aetna affirmed its decision to terminate Herring’s benefits on August 14, 2010. Herring now seeks to overturn this decision, claiming that she is totally disabled and Aetna failed to conduct a full and impartial review of her claim.

III. Legal Standard

“The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.CivP. 56(a). The movant “always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of ‘the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (quoting Fed.R.Civ.P. 56(c)(1)(A)). Where the non-moving party bears the burden of proof on an issue at trial, the movant may simply “[point] out to the district court that there is an absence of evidence to support the nonmoving party’s case.” Id. at 325, 106 S.Ct. 2548.

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Herring v. Aetna Life Insurance, 898 F. Supp. 2d 1313, 2012 U.S. Dist. LEXIS 148057, 2012 WL 4841714 (S.D. Fla. 2012).

898 F. Supp. 2d 1313 (Herring v. Aetna Life Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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Herring v. Aetna Life Insurance
843 F. Supp. 2d 1305 (S.D. Florida, 2012)