Landree v. Prudential Insurance Co. of America

833 F. Supp. 2d 1266, 51 Employee Benefits Cas. (BNA) 2412, 2011 U.S. Dist. LEXIS 62907, 2011 WL 2414429
CourtDistrict Court, W.D. Washington
DecidedJune 13, 2011
DocketCase No. 3:10-CV-05353-RBL
StatusPublished
Cited by5 cases

This text of 833 F. Supp. 2d 1266 (Landree v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Landree v. Prudential Insurance Co. of America, 833 F. Supp. 2d 1266, 51 Employee Benefits Cas. (BNA) 2412, 2011 U.S. Dist. LEXIS 62907, 2011 WL 2414429 (W.D. Wash. 2011).

Opinion

ORDER DENYING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Dkt. # 17]

RONALD B. LIGHTEN, District Judge.

THIS MATTER comes before the Court upon Defendants’ Motion for Summary Judgment [Dkt. # 17]. Plaintiff John Lan[1268]*1268dree is a former employee of Simpson Tacoma Kraft (Simpson) who worked for nearly twenty years as a Shift Coordinator at Simpson’s Tacoma plant. Landree participated in Simpson’s Long Term Disability (LTD) insurance Plan (the Plan). Defendants Prudential Insurance Company of America and the Simpson Health & Welfare Plan (collectively Prudential) pay benefits under the Plan and also serve as the claim administrator. The Plan is governed by 29 U.S.C. § 1132, the Employee Retirement Income Security Act (ERISA).

After experiencing dizzy spells, Landree stopped working and applied for LTD under the Plan. Landree suffers from multiple ailments including type two diabetes, coronary artery disease, and hypertension. Prudential evaluated and denied Landree’s claim for LTD initially, and upon two appeals.

Landree brought this action under ERISA’s civil enforcement provision, 29 U.S.C. § 1132(a)(1)(B). The parties dispute the physical requirements of Landree’s occupation, the extent of Landree’s ailments, and the standard of review. Prudential seeks Summary Judgment, arguing the Court should review its decision under the deferential abuse of discretion standard because the plan contains a discretion clause. Prudential asks the Court to uphold its denial because substantial evidence supported Prudential’s decision. Landree argues the Court should review the denial of benefits de novo because WAC 284-96-012 invalidates the Plan’s discretion clause. He asks the Court to deny the Motion because there are genuine issues of material fact regarding Landree’s regular occupation and alleged disability. For the reasons that follow, Defendants’ Motion for Summary Judgment is DENIED.

il. FACTS

A. The Plan

The Plan purports to give Prudential “the sole discretion to interpret the terms of the Group contract, to make factual findings, and to determine eligibility for benefits. The decision of [Prudential] shall not be overturned unless arbitrary and capricious.” (0345-46.)1

In relevant part, the LTD coverage section of the Plan reads as follows:

How Does Prudential Define Disability?
You are disabled when Prudential determines that:
— you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury ...
Material and substantial duties means duties that are:
— normally required for the performance of your regular occupation; and
— cannot be reasonably omitted or modified ...
Regular occupation means the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location. (0323, emphases in original.)
B. Prudential Denies Landree’s Initial Claim for Long Term Disability
1. Landree Applies for Long Term Disability

On January 9, 2007, Landree saw his primary care physician, Dr. William [1269]*1269Brand. Brand noted Landree was experiencing “right anterior pleuritic chest pain” and had “fatty infiltration of the liver.” (0169.) Brand concluded Landree’s systems were “otherwise negative” and that his type two diabetes mellitus and hypertension were controlled. Brand listed ten conditions Landree suffered from, including hypercholestolemia and “chronic low pain.”

On January 20, Landree experienced two spells of dizziness at work and a coworker drove him home. (0167.) His wife wanted him to go the emergency room but he did not.

On January 26, Landree met with Dr. Theodore Lau, a Cardiac Health Specialist. Dr. Lau noted Landree had normal left ventricular systolic function, left ventricular diastolic dysfunction, mildly elevated systolic pulmonary artery pressure, and that there were “no significant changes” from an earlier study taken on March 10, 2006. (0174.) Dr. Lau administered an exercise test and concluded the “raw data was unremarkable.” (0175.)

From February to April of 2007, Landree attended counseling sessions with Lem Stepherson, Ph.D. According to a one-sentence note from Stepherson, this counseling addressed Landree’s anxiety related to the death of a co-worker, a heavy workload, and multiple health related conditions. (0134.)

On February 12, Landree saw Dr. John Rowlands for a pulmonary consultation. Rowlands concluded the test results were mostly negative. Rowlands opined Landree “also has problems with excessive daytime sleepiness in the midst of his shift work that involves rotating 12 hour shifts on a four day schedule where he works two days of days and two days of nights then has four days off. He obviously has significant problems with daytime hypersonolence in the midst of such occasionally.” (0173.)

Landree stopped working on February 22, 2007, and saw Dr. Brand on February 26. Brand noted Landree “feels anxiety and stress to the point where he feels he cannot return to work pending his disability evaluation.” (0164.)

On March 19, Landree saw Dr. Paul Darby, an occupational health specialist at the Franciscan Occupational Health Clinic in Tacoma. Darby opined Landree’s “medical problems have been mounting lately and the shift work is throwing his diabetes out of control.” (0094.) Darby made the following diagnoses: (1) Type 2 Diabetes mellitus (2) Recurrent near-syncope (3) Coronary artery disease (4) Hypertension (5) Paroxysmal atrial tachycardia (6) Dyslipidemia (7) Diverticulosis (8) Gastroesophagul reflux disease (9) Chronic back pain. Darby opined, “I have received all of his medical records and reviewed those ... Patient is not medically fit for the essential job functions. He is restricted from shift work, working alone or remote from observation, work at unprotected heights, working with dangerous equipment, or wearing any respirator.” (Id.)

2. Prudential Evaluates and Denies Landree’s Initial Claim

On June 12, 2007, Prudential received Landree’s claim for LTD. On that date, Dusti LaFlamme, a Claim Manager for Prudential, wrote the following on an internal note: “No eligibility issues. EE is [redacted] yr old shift coordinator TD since 2/23/07 due to type 2 diabetes mellitus, CAD, PAT and chronic back pain. EE reports dizzy spells and heart problems.” (0197.)

On June 14, Michael Chretien, a Vocational Rehabilitation Counselor at Prudential, created a short report for Prudential to understand how Landree’s job is normally done. Chretien based his report on reference manuals. Chretien briefly de[1270]*1270scribed the job duties of a “Pulp Plant Supervisor” but did not classify the work as light, medium, or heavy. (0198.)

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833 F. Supp. 2d 1266, 51 Employee Benefits Cas. (BNA) 2412, 2011 U.S. Dist. LEXIS 62907, 2011 WL 2414429, Counsel Stack Legal Research, https://law.counselstack.com/opinion/landree-v-prudential-insurance-co-of-america-wawd-2011.