Lechner v. Mutual of Omaha Life Insurance Company

CourtDistrict Court, W.D. Kentucky
DecidedMarch 4, 2025
Docket3:23-cv-00410
StatusUnknown

This text of Lechner v. Mutual of Omaha Life Insurance Company (Lechner v. Mutual of Omaha Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lechner v. Mutual of Omaha Life Insurance Company, (W.D. Ky. 2025).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION

TED LECHNER Plaintiff

v. Civil Action No. 3:23-cv-410-RGJ

MUTUAL OF OMAHA LIFE INSURANCE Defendant COMPANY

* * * * * MEMORANDUM OPINION & ORDER Plaintiff Ted Lechner (“Lechner”) moves for summary judgment against Defendant Mutual of Omaha Life Insurance Company (“Mutual”). [DE 15]. Mutual responded. [DE 18]. Mutual also moved for summary judgment. [DE 17]. Lechner has not responded to Mutual’s summary judgment motion and the time to do so has passed. Accordingly, these motions are ripe for adjudication. For the reasons below, the Court GRANTS Mutual’s motion for summary judgment, and DENIES Lechner’s motion for summary judgment. I. FACTUAL BACKGROUND According to the administrative record, Lechner filed a Short-Term Disability Claim for Employee Statement on May 9, 2022, requesting short-term disability benefits. [DE 13 at 250]. Lechner claims that he became unable to work on April 18, 2022, because of “severe anxiety, depression, panic attacks, sadness, hopelessness, [and] isolation.” [Id.]. He started treatment for these issues on February 14, 2022, with Dr. Kenneth Oder (“Dr. Oder”), his primary care doctor, and Dr. Katie DeShields, his psychiatrist (“Dr. DeShields”). [Id.]. As part of filing for Short-Term Disability, Dr. DeShields completed a Behavioral Health Attending Physician’s Statement on May 9, 2022. [Id.]. In this statement, Dr. Shields listed Lechner’s diagnosis as “unspecified obsessive compulsive and related disorders.” [Id.]. She also noted that Lechner began experiencing his symptoms 18 months ago, around the time he was infected with COVID-19, but his symptoms became significantly worse after receiving the COVID-19 vaccine. [Id.]. According to Dr. DeShields, Lechner “had brain fog, chronic fatigue, and memory issues” and it was her opinion that Lechner was “unable to perform management tasks that required sustained concentration and remembering a variety of information and/or

instructions at once.” [Id.]. Lechner was originally granted short-term disability, starting April 15, 2022. [Id.]. In relevant part, the short-term disability policy states that “[i]f you become Disabled due to an Injury or Sickness, while insured under the Policy, we will pay the Weekly Benefit shown in the Schedule in accordance with the terms of the Policy. Benefits will begin after You satisfy the Elimination Period shown in the Schedule.” [DE 13 at 199]. And the short-term disability policy defines disability or disabled as follows: Disability and Disabled mean that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred, as a result of which: 2) during the Elimination Period, you are prevented from performing at least one of the Material Duties of Your Regular Job (on a parttime or full-time basis); and b) after the Elimination Period, you are:

1. prevented from performing at least one of the Material Duties of Your Regular Job (on a part-time or full-time basis); and

2. unable to generate Current Earnings which exceed 99% of Your Basic Weekly Earnings due to that same Injury or Sickness.

Disability is determined relative to Your ability or inability to work. It is not determined by the availability of a suitable position with the Policyholder.

[Id. at 1093]. Although Lechner filed for short-term disability, Lechner never filed for long-term disability. On November 28, 2022, Mutual had an external physician consultant board certified in psychiatry complete a review of the records in Lechner’s claim file. [Id. at 250]. The physician consultant attempted to contact Dr. DeShields and Dr. Oder to discuss Lechner’s case; however, neither responded. [Id.]. At the end of the review, the physician’s consultant believed that Lechner met the criteria for major depressive disorder and obsessive-compulsive disorder based on Lechner’s self-reported symptoms, but the physician consultant also found that “there were no clinical findings documented by either doctor that supported functional impairment.” [Id.]. Thus,

on December 26, 2022, Mutual’s claims department completed a second review of Lechner’s claim and determined that Lechner “no longer met the Short-Term Disability Group Policy’s definitions of Disability and Disabled from his Regular Job.” [Id. at 251]. Accordingly, Lechner’s short-term disability claim was denied as of October 16, 2022. [Id. at 267]. On March 13, 2023, Lechner filed an appeal regarding the denial of his short-term disability benefits. [Id. at 251]. And Gordon Harris (“Harris”), a senior appeals specialist for Mutual, began investigating Lechner’s claim on appeal. [Id. at 247]. As part of the investigation, on March 31, 2023, Harris spoke with Lechner. [Id. at 251]. In sum, “Lechner asserted he was in no position to go back to work due to his mental status” because his “brain stutters, [he] lose[s]

focus, and its hard [for him] to connect the dots.” [Id.]. Lechner also stated that neither provider has referred him to receive a neurophysical evaluation and he did not want to participate in psychiatric treatments because the medications previously prescribed by Dr. Oder “were not effective in treating his behavior health and cognitive symptoms.” [Id.]. But Lechner also indicated that “he was very active physically and mentally.” [Id.]. Specifically, Lechner claimed he exercises two-hours per day, where he alternates between weightlifting and cardiovascular exercise. [Id.]. Additionally, Lechner has engaged in a “variety of construction projects” which involve various cognitive functions. [Id.]. On April 4, 2023, an internal physician consultant board certified in family medicine reviewed the medical records. [Id.]. And on April 18, 2023, another external physician consultant board certified in psychiatry completed a review of all the records. [Id.]. As part of the April 18th review process, the psychiatry consultant also attempted to speak with Dr. Oder and Dr. DeShields over the course of three days, but they did not respond during this time. [Id. at 313]. Accordingly,

the psychiatry consultant “explained the findings in the medical records did not support functional impairment from a psychiatric perspective as of October 17, 2022, to November 13, 2022.” [Id. at 252]. Specifically, the psychiatry consultant explained that “the record did not include any clinical observations that support significant cognitive deficits such as severe memory, concentration, or focus issues that would translate into restrictions in functioning[.]” [Id.]. On April 19, 2023, Harris provided Lechner with a copy of the April 4th and April 18th findings, and gave Lechner until May 3, 2023, to review the reports and provide a response. [Id.]. On May 1, 2023, Lechner responded saying, that the psychiatry consultant never reached out to Dr. DeShields and provided her contact information for moving forward. [Id.]. However, the

psychiatry consultant claims that he made further attempts to speak with Drs. DeShields and Oder on May 5, 8, and 9, 2023, but once again, they did not respond. [Id. at 318]. Harris updated the record accordingly. On May 11, 2023, Harris provided a copy of the updated psychiatrist physician consultant report, and gave Lechner until May 19, 2023, to review and provide a written response or any outstanding documentation. [Id. at 253, 322-23]. But on May 12, 2023, Lechner’s attorney stated that he would not be responding to the May 11th letter. [Id. at 253]. Thus, on May 15, 2024, Harris referred all records in the claim file to another internal physician consultant, who was board certified in family medicine, for further review. [Id.]. This consultant “was of the opinion that functional impairment from a physical and/or mental/cognitive perspective was not supported.” [Id.].

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Lechner v. Mutual of Omaha Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lechner-v-mutual-of-omaha-life-insurance-company-kywd-2025.