Kennedy v. Sun Life Assurance Co.

833 F. Supp. 2d 1088, 51 Employee Benefits Cas. (BNA) 2974, 2011 U.S. Dist. LEXIS 64146, 2011 WL 2435928
CourtDistrict Court, W.D. Arkansas
DecidedJune 16, 2011
DocketCase No. 08-CV-1034
StatusPublished

This text of 833 F. Supp. 2d 1088 (Kennedy v. Sun Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, W.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kennedy v. Sun Life Assurance Co., 833 F. Supp. 2d 1088, 51 Employee Benefits Cas. (BNA) 2974, 2011 U.S. Dist. LEXIS 64146, 2011 WL 2435928 (W.D. Ark. 2011).

Opinion

MEMORANDUM OPINION AND ORDER

ROBERT T. DAWSON, District Judge.

Plaintiff brings this action pursuant to the provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., alleging Defendant wrongly denied his claim for long term disability benefits and waiver of life insurance premiums under the El Dorado Chemical Company Employee Group Benefits Plan issued by Defendant. Before the Court are the Administrative Record (Doc. 6), Plaintiffs Brief (Doc. 16), and Defendant’s Brief (Doc. 22). For the reasons stated herein, the Court finds that Defendant’s decision to deny benefits was not supported by substantial evidence. Therefore, Plaintiffs claims for long term disability benefits and a waiver of premiums on life insurance benefits are GRANTED. Plaintiffs claim for attorney’s fees and costs is also GRANTED.

I. Background

A. Plaintiff’s Stroke

Plaintiff was employed by the El Dorado Chemical Company as a Chemical Facility Maintenance Supervisor. On August 22, 2005, Plaintiff suffered an apparent stroke. Plaintiff was at home washing his car when he began to feel nauseated and tired. He went into his house to rest. SL 0189. The following day, Plaintiff reported for work in the morning and shared a morning beverage with his co-workers. At that point, a co-worker asked Plaintiff what was wrong and pointed out that Plaintiff was spilling his drink. Plaintiff realized that the right side of his face was numb. He was taken to the emergency room of the Medical Center of South Arkansas in El Dorado. Id. When Plaintiff presented at the hospital, he complained of numbness of the right arm and leg, dysphagia (trouble swallowing), vertigo (dizziness), and hypertension (high blood pressure). SL 0152. The attending physician at the hospital, Dr. Richard Davis, noted Plaintiff dis[1090]*1090played “numbness with lack of temperature sensation in the right arm and leg,” and that Plaintiff had received a cardiac stent in the past due to unstable angina and a history of hypertension. SL 0153.

Plaintiff was admitted to the hospital and treated for hypertension and stroke. The CT scan administered to Plaintiff revealed no hemorrhage. He was administered the drugs Plavix and aspirin and underwent an MRI and an MRA, which showed a “very small lacunar infarct.”1 SL 0154. The MRI and MRA results showed a “mild to moderate frontal and convexity cortical cerebral atrophy,” as well as “... a 1 cm sphere of bright signal” and “... [s]mall bright T2 ... in the left frontal white matter.” SL 0163. While in the hospital, on August 25, 2005, Plaintiff underwent a swallowing test, which concluded that Plaintiff had “[m]arked weakness of that part of the swallowing that entails elevation of the larynx. The proximal esophagus remained opened through this study as evidence of weakness of the sphincter.” SL 0159.

Plaintiff saw a neurologist during his stay in the hospital, Dr. Ghulam Khaleel, who noted decreased sensory modalities in the right upper extremity and an unsteady gait due to right lower extremity weakness. Dr. Khaleel noted the MRI and MRA looked essentially normal, except for a small right frontal lacunar infarct. Dr. Khaleel concluded Plaintiff had reversible ischemic neurological deficit (RIND), which is a type of infarction (stroke) of limited duration, usually 24-72 hours. See http://en.wikipedia.org/wiki/Transient_ isehemic_attack.

When Plaintiff was discharged from the hospital on August 25, 2005, Dr. Davis diagnosed him as having had a “cerebrovascular accident” or CVA (stroke). SL 0169. Plaintiff was advised by Dr. Davis not to return to work “at present.” Id. At the time of discharge, Dr. Davis noted that Plaintiff still had “mild dysphagia” and “persistent numbness” in his right arm or right leg, but otherwise “no neurological deficits.” SL 0154.

The administrative record in this case reflects that Plaintiff returned to Dr. Davis for follow-up examinations approximately every two weeks following discharge from the hospital until February 14, 2006. SL 0142-0151. Thereafter, he saw Dr. Davis on March 28, 2006. SL 0217. Plaintiff was also seen in follow-up by Dr. Khaleel “on a regular basis, at least two times a month,” according to a letter Dr. Khaleel wrote on September 1, 2006. SL 0025. The record contains notes from Dr. Khaleel’s physical examinations of Plaintiff on September 28, 2005 and July 10, 2006. SL 0284.

B. Medical Reports by Dr. Davis

A cursory examination of the follow-up reports of Plaintiffs treating physician, Dr. Davis, reveals that Plaintiff continued to be treated for essentially the same symptoms he had while in the hospital. There is no evidence in the record that Plaintiffs symptoms normalized or disappeared during the year following Plaintiffs stroke.

During Plaintiffs examination by Dr. Davis on August 31, 2005, Dr. Davis wrote on the chart “dysphagia” and “dizziness”; on September 14, 2005, a follow-up examination with Dr. Davis for “HTN [hypertension] + CVA [stroke]” revealed that Plaintiffs blood pressure was 150/96, which is in the hypertensive range; during Plaintiffs [1091]*1091check-up on September 24, 2005, the diagnosis continued to be “CVA”; on October 25, 2005, Dr. Davis noted Plaintiffs blood pressure was 162/108 and that Plaintiff was “still numb R[ight] hand and leg”; in November, Plaintiff had another “follow up CVA” and continued to have uncontrolled high blood pressure of 150/100, despite taking prescribed medications; the examination on December 14, 2005, revealed continuing “HTN [hypertension]” “fingers + nails split on ends” and “dizziness”; Plaintiffs symptoms were no better on December 27, 2005, with continued high blood pressure readings of 180/120 and “dizziness”; on January 10, 2006, Plaintiffs blood pressure was 160/102, and under the “neurological” section of the chart, Dr. Davis noted “no change”; on January 24, 2006, Plaintiffs hypertension was still uncontrolled at 150/100, but Dr. Davis noted nothing further on the chart; finally, on February 14, 2006, Dr. Davis wrote down the names of the various medications prescribed for Plaintiffs hypertension, high cholesterol, and depression, and recorded his blood pressure at 134/80, which is the lowest it had been since the stroke. SL 0145-0151.

The last physical examination of Plaintiff by Dr. Davis in the record occurred on March 28, 2006, when Dr. Davis noted a normal blood pressure standing of 110/70, and a pre-hypertensive pressure lying down of 130/802. SL 0217. Dr. Davis wrote on the chart that Plaintiff was still “dizzy a lot” and jotted down the words “dizziness” “CVA” and “hypertension.” Id.

In a June 7, 2006 letter addressed to “To Whom It May Concern” and considered by Defendant in evaluating Plaintiffs claim for benefits, Dr. Davis opined:

“[Plaintiffs] rehabilitation from the stroke has been complicated by recurrent vertigo and disequilibrium. This has been a significant problem with quick head movements and quick changes of position of his body. At times, he has had episodic periods of a disequilibrium to where he has felt as if he was going to fall. He has actually had some episodes of falling since the stroke. This has been recurrent. It has not improved.” SL 0051.

As detailed above, Dr.

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833 F. Supp. 2d 1088, 51 Employee Benefits Cas. (BNA) 2974, 2011 U.S. Dist. LEXIS 64146, 2011 WL 2435928, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kennedy-v-sun-life-assurance-co-arwd-2011.