Levine v. Life Insurance Co. of North America

182 F. Supp. 3d 250, 2016 U.S. Dist. LEXIS 53286, 2016 WL 1621918
CourtDistrict Court, E.D. Pennsylvania
DecidedApril 21, 2016
DocketCIVIL ACTION NO. 14-7050
StatusPublished
Cited by8 cases

This text of 182 F. Supp. 3d 250 (Levine v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Levine v. Life Insurance Co. of North America, 182 F. Supp. 3d 250, 2016 U.S. Dist. LEXIS 53286, 2016 WL 1621918 (E.D. Pa. 2016).

Opinion

MEMORANDUM

Rufe, Judge.

Currently pending before the Court are Plaintiff Cheryl Levine’s and Defendant Life Insurance Company of North America’s cross-Motions for Summary Judg[253]*253ment. For the following reasons, Plaintiffs Motion will be granted and Defendant’s Motion will be denied.

I. FACTUAL BACKGROUND

A. The Disability Plan

On December 12, 2014, Plaintiff initiated the current litigation based on Defendant’s denial of short-term disability benefits under an employee welfare benefit plan governed by the Employee Retirement Income Security Act (“ERISA”).1 Her Complaint seeks short-term disability benefits under the benefit plan (the “Plan”) in which Plaintiff participated through her employment as a Hospital Account Manager with Quest Diagnostics (“Quest”). The parties agree that, at all relevant times, Plaintiff was a covered beneficiary under the Plan.

The Plan is a Group Insurance Policy— identified as Policy F.L.K. 908830—estab-lished by Quest Diagnostics for its employees and issued by Defendant Life Insurance Company of North America (“Cigna” or “Defendant”) to Quest.2 The Plan provides for twenty-six weeks of short-term disability payments following a fourteen-day benefit waiting period.3 The benefits end either when the disability ends or when the benefits are no longer payable, whichever comes first.4 Cigna is the “named fiduciary for deciding claims for benefits under the Plan, and for deciding any appeals of denied claims.”5 When a claim is denied, the claimant has a right to appeal.6 No deference is given to the original claim decision, and the appeal is not heard by either the person who made the initial claim decision or a subordinate of that person.7

B. Plaintiff’s June 11, 2013 Claim Under the Plan

At the time of her initial claim, Plaintiff was sixty years old.8 Approximately five years earlier, Plaintiffs son, Seth, had been involved in a car accident and suffered serious leg injuries that required multiple surgeries.9 On May 31,2008, while Seth was still in the hospital, he passed away as a result of what Plaintiff believed to be medical negligence.10 Plaintiff ultimately sued the hospital, and the matter settled.11 Seth’s death triggered a “deep, profound and lasting depression” that purportedly worsened over the years.12 By June 2013, Plaintiff believed she was no longer able to substantively function either with her daily activities or at work with Quest.13

On June 11, 2013, Plaintiff called in a claim to Cigna that she was unable to work due to depression, anxiety, headaches, and difficulty concentrating.14 A Cigna behavioral health specialist (“BHS”) documented their call, as follows:

Cx [claimant] reports that in 2008 she lost her only child. Cx states that she [254]*254has received a lot of support from Compassionate Friends. Cx states it has been very difficult. She states that this is the fifth anniversary of his death. She states that there are also a lot of changes at work. Has been with Quest for 20 years. Cx states she is a hospital service representative and at times has difficulty going into the hospital because she states son died due to hospital negligence. Cx states that there is a lot of expectation with job. Cx states she has sleeplessness and anxiety, panic attacks. Cx states she has difficulty driving not due to panic but states when she leaves a hospital at times she is so angry at hearing things that to her are inconsequential she cannot drive and do another hospital visit because of her anger and depression that she is the one who lost a son. Cx states that she is depressed, angry and gets irritable. Cx states that she feels hopeless, feels amotivated. Cx states that she does not care if she wakes up at all. Cx states she is not going to hurt self but just does not care, Cx states that initially she did a lot of things in her son’s name to help her with her grief but states that is [sic] never goes away.
Restricting provider—Dr. Jalil, PCP and Dr. Wittman, Ph.D. Cx states that she is on anti-depressant—lexapro and diazepam. Cx states that she has called a psychiatrist to see if maybe a different medication—has not heard back yet. Cx states that she uses a support group as well. NOV with Dr. Wittman is 7/19/13, Sees therapist q 3 weeks. NOV with Dr. Jalil is end of July.
Medically, cx reports that she is stable. No drug/alcohol use.
Cx states that she is smoking more as a result of her pent up anger and anxiety. Cx states that she got a puppy, does some volunteer work, tries to help a neighbor who is ill and who has triples all on the autism spectrum. Cx states that going to work brings up a lot of anxiety. RTW plan—cx has no plans. MD guidelines given to cx. BHS explained she would f/u with therapist and asked cx to call her with name of psychiatrist.15

Cigna notified Plaintiff on July 17, 2013 that her Short Term Disability (“STD”) benefits were approved through August 5, 2013.16 By letter dated September 11, 2013, Cigna then informed Plaintiff that her benefits were terminated effective August 5, 2013.17 In that letter, Cigna indicated that a BHS had spoken with Carol Wolf Witt-man, Ph.D., Plaintiffs treating psychologist, on August 30, 2013, and September 4, 2013.18 The BHS remarked, in pertinent part, that “[w]hile Dr. Wittman does note that she is restricting you from working, she does not provide any additional clarity with regard to symptom frequency, intensity or duration. And although she did note that you are anxious and depressed, Dr. Wittman did not provide any specific symptoms in order to indicate the severity of the condition.”19 The BHS’s notation went on to remark that

Dr. Wittman noted that you cannot drive on a regular basis; however, she previously noted that you had been able to drive to all of your appointments, are able to shop when needed, and are able to visit friends and neighbors. Additionally, your current treatment is not consistent with stated severity of symp[255]*255toms. Dr. Wittman reported- that you . are seen bi-weekly and are attending a support group on a regular basis. However, no referrals have been made to change the level of care to a more intense level of treatment.20

Cigna also indicated that it sent a medical request to Plaintiffs primary care physician and Plaintiffs psychiatrist, Jeffrey Herman, D.O.21 As of September 10, 2018, however, Dr, Herman’s office had provided no medical records.22

Plaintiff immediately appealed the September 11, 2013 decision.23 Plaintiff provided a letter description of her difficulties, as well as records from Dr.

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182 F. Supp. 3d 250, 2016 U.S. Dist. LEXIS 53286, 2016 WL 1621918, Counsel Stack Legal Research, https://law.counselstack.com/opinion/levine-v-life-insurance-co-of-north-america-paed-2016.