Khan v. AT&T Umbrella Benefit Plan No 3

CourtDistrict Court, N.D. Texas
DecidedAugust 23, 2022
Docket3:21-cv-01367
StatusUnknown

This text of Khan v. AT&T Umbrella Benefit Plan No 3 (Khan v. AT&T Umbrella Benefit Plan No 3) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Khan v. AT&T Umbrella Benefit Plan No 3, (N.D. Tex. 2022).

Opinion

United States District Court NORTHERN DISTRICT OF TEXAS DALLAS DIVISION

IMRAN KHAN § V. CIVIL ACTION NO. 3:21-CV-1367-S AT&T UMBRELLA BENEFIT PLAN NO. 3 §

MEMORANDUM OPINION AND ORDER Before the Court are Defendant’s Motion for Summary Judgment (“Defendant’s Motion”) [ECF No. 15] and Plaintiff's Motion for Summary Judgment (“Plaintiffs Motion”) [ECF No. 21]. The Court has considered Defendant’s Motion, Defendant’s Brief in Support of its Motion for Summary Judgment (“Defendant’s Brief”) [ECF No. 16], Plaintiffs Motion, Plaintiffs Brief in Support of Motion for Summary Judgment (“Plaintiffs Brief’) [ECF No. 21-3], Defendant’s Summary Judgment Response [ECF No. 22], Defendant’s Brief in Support of its Motion for Summary Judgment (“Defendant’s Response Brief’) [ECF No. 22-1], the undisputed administrative record, see App. vol. 1 [ECF No. 17]; App. vol. 2 [ECF No. 18], and the applicable law. For the following reasons, the Court GRANTS Defendant’s Motion and DENIES Plaintiffs Motion. I BACKGROUND Plaintiff Imran Khan worked as a “Customer Service Representative”! for AT&T. Id. at 18. As part of his employment benefits, Plaintiff was covered under the AT&T Umbrella Benefit Plan No. 3 (“Defendant” or “Plan’”), an “employee welfare benefits plan” under the Employee

! As a “Customer Service Representative”, Plaintiff “[alnswer[ed] customer/client requests or inquiries” and “[plerformed complex data collection and reporting.” App. vol. 2 at 663, This role is classified as “sedentary,” with physical requirements limited to “typing; computer use.” App. vol. 1 at 6.

Retirement Income Security Act of 1974 (“ERISA”). Jd. at 1162-1212. Defendant offers short- and long-term disability benefits to employees under the following circumstances: Short-Term Disability Benefits: You are considered Totally Disabled when, because of illness or injury, you are continuously unable to perform your customary job or another available job assigned to you by your Participating Company, with the same full-time or part-time classification for which you are reasonably qualified. If you can do your job or another available job for some part of the time, you are not considered Totally Disabled. You are considered Partially Disabled when, because of illness or injury, you are unable to perform your customary job or another available job assigned to you by your Participating Company within the same full-time or part-time classification for which you are reasonably qualified and for the same number of hours that you were regularly scheduled to work before your Partial Disability. Id. at 1119. Long-Term Disability Benefits: In order to be considered for Long-Term Disability Benefits, you must... [hlave received the maximum amount (52 weeks) of Short-Term Disability Benefits under the [Plan]. Id. at 1134. Sedgwick Claims Management Services, Inc. (“Sedgwick”) administers claims under the Plan and has “complete discretionary fiduciary responsibility .. . to determine whether a particular Eligible Employee who has filed a claim for benefits is entitled to benefits under the [Plan], to determine whether a claim was properly decided, and to conclusively interpret the terms and provisions of the [Plan].” Jd at 1151, 1154. Plaintiff's last day of work at AT&T was on October 22, 2019. App. vol. 1 at 6. Approximately one week later, he applied for short- and long-term disability benefits. Jd at 5-6. According to Plaintiff, he was unable to do his job due to pain associated with his multiple sclerosis, which was diagnosed in 2003. Jd. at 7; App. vol. 2 at 563. Following his request for disability benefits, Plaintiff was evaluated by his primary care physician, Dr. Maria Biard, on November 5, 2019. Plaintiff complained of back and neck pain that was “aggravated by any

activity.” Jd. at 700. Dr. Biard noted that “[a]pparently” because of pain, Plaintiff is limited in most daily activities, and that the medications he was taking limited his focus and driving. Jd. at 701. Dr. Biard opined that Plaintiff was incapacitated and that he would remain so for the next “few months.” Id. On November 20, 2019, Defendant denied Plaintiffs short-term disability claim because Plaintiff did not submit medical records within the seven-day deadline after applying for benefits. Id. 681. Plaintiff appealed that decision on November 26, 2019. App. vol. 1 at 146. He then proceeded to visit doctors and submit medical records to Defendant as he received them. Plaintiff visited Dr. Biard on December 11, 2019, for a follow-up evaluation. App. vol. 2 at 657. Plaintiff reported difficulty driving because of back and neck pain, as he was unable to sit for long periods of time. Id Dr. Biard administered therapeutic injections to Plaintiff, refilled his pain medication,” and referred him to a pain management specialist. Id. Pain management specialist Dr. Stephanie Jones evaluated Plaintiff on December 23, 2019. Plaintiff complained of neck and back pain that was aggravated by prolonged sitting but “improved with moving/activity.” Jd. at 563-64. After administering a physical examination, Dr. Jones observed pain and palpitation in Plaintiff's cervical and mid-lumbar spine. Jd. at 565-66. She stated that there was no limitation in Plaintiff's ability to flex, extend, or rotate his neck, and only slight limitation in his ability to extend his lower back. Jd. The strength of Plaintiffs bilateral upper and lower extremities were rated “5/5.” Jd. An x-ray of Plaintiffs cervical spine revealed no acute abnormality, fractures, or dislocations, and his alignment was “maintained.” Jd. at 555. An x-ray of Plaintiff's lumbar spine revealed “[g]ood alignment” with joints appearing normal. Id. at 580.

2 Dr. Biard noted that she had a “lengthy talk about limiting [Plaintiffs] use of narcotics” and that she would “no longer be writing his meds.” Id. at 658. ;

In an undated affidavit, Dr. Biard stated that “[Plaintiff]’s subjective complaints are not consistent with his diagnosed conditions. He has seen several doctors (ortho and neurology) and severity of pain does not equal physical findings. But we feel his multiple sclerosis is a big contributing factor in his severity of pain. He indeed has the above symptoms but his multiple sclerosis makes everything much more worse.” Jd. at 214. According to Dr. Biard, Plaintiff “is and has been completely and totally disabled from performing his own occupation .. . since he ceased working in October 2019” and “will remain so indefinitely into the future.” Jd. at 215. Plan physicians Dr. Stephen Broomes’ and Dr. Howard Grattan’ reviewed Plaintiff's medical records as they were submitted to Defendant. Dr. Broomes first reviewed Plaintiffs file on January 7, 2020. See id. at 146-50. He indicated that Plaintiff's occupation “entails sedentary physical demand.” While Dr. Broomes acknowledged Plaintiffs complaints of neck and back pain, he observed that Plaintiffs “physical examination was normal.” Jd. at 147-48. According to Dr. Broomes, “based on the clinical evidence submitted for review, from the perspective of Internal Medicine, [Plaintiff] is capable of any work without restrictions” and “is not disabled from □

his regular job duties.” Jd. at 147-48. The next day, Dr. Grattan conducted his first review of Plaintiff's file and reached the same conclusion. Dr. Grattan opined that “[f]rom a physical medicine and rehabilitation/pain medicine perspective, [Plaintiff] is not disabled from his regular job duties.” Jd. at 163. He further found that “there are not enough significant clinical findings to support restricted work or an inability to work” and “no evidence of impingement.” Jd. at 164. On January 16, 2020, Plaintiff returned to Dr. Biard for evaluation. Dr. Biard prescribed Plaintiff medication for his diabetes, hypertension, and pain. /d. at 250-51. Plaintiff saw Dr.

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Khan v. AT&T Umbrella Benefit Plan No 3, Counsel Stack Legal Research, https://law.counselstack.com/opinion/khan-v-att-umbrella-benefit-plan-no-3-txnd-2022.