Mantooth v. AT & T Umbrella Benefit Plan Number 1

804 F. Supp. 2d 1171, 51 Employee Benefits Cas. (BNA) 1859, 2011 U.S. Dist. LEXIS 40383, 2011 WL 1400089
CourtDistrict Court, N.D. Oklahoma
DecidedApril 13, 2011
DocketCase No. 10-CV-0261-CVE-FHM
StatusPublished
Cited by2 cases

This text of 804 F. Supp. 2d 1171 (Mantooth v. AT & T Umbrella Benefit Plan Number 1) is published on Counsel Stack Legal Research, covering District Court, N.D. Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mantooth v. AT & T Umbrella Benefit Plan Number 1, 804 F. Supp. 2d 1171, 51 Employee Benefits Cas. (BNA) 1859, 2011 U.S. Dist. LEXIS 40383, 2011 WL 1400089 (N.D. Okla. 2011).

Opinion

OPINION AND ORDER

CLAIRE V. EAGAN, Chief Judge.

Plaintiff filed this action seeking, inter alia, to recover benefits and enforce his rights under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1101 et seq. (ERISA). Defendant AT & T Umbrella Benefit Plan Number 1 (AT & [1173]*1173T) terminated plaintiffs long term disability (LTD) benefits as of July 16, 2009 following a periodic review of plaintiffs file. Plaintiff argues that AT & T “b[ought] a different opinion from non-treating physicians” and the termination of his LTD benefits is the result of “self-dealing and bad faith.” Dkt. # 18, at 1-2, 5. AT & T responds that its decision was based on substantial evidence, and plaintiff has not shown that AT & T acted in an arbitrary and capricious manner by terminating his LTD benefits. Dkt. #23, at 15-19. Plaintiff filed an opening brief (Dkt.# 18) and defendant filed a response brief (Dkt.# 23). Plaintiff waived the right to file a reply. See Dkt. # 26.

I.

Stephen Mantooth worked for Southwestern Bell Telephone Company (SBTC) as a customer service technician from January 1999 to November 2005. SBTC classified this position as a “heavy” job requiring the employee to “drive, walk, stand, lift, carry, climb, crawl, bend, [and] stoop.” Dkt. # 16-2, at 110. Mantooth was eligible to participate in the SBC Communications Inc. Disability Income Plan,1 and this program was offered as part of a broader employee benefits plan of which SBC Communications Inc. was the plan administrator. Dkt. # 16-1, at 9. Mantooth suffered from back pain and Randy J. Grellner, D.O., performed a microdiskectomy at L4-5 and a foraminotomy at L5-S1 in 2003, but Mantooth continued to work as a customer service technician after the surgery. Dkt. # 16-3, at 3. Mantooth was lifting cable in May 2004 and “felt the onset of predominantly low back pain.” Id. at 4. Mantooth visited a neurosurgeon, Michael R. Hahn, II, M.D., who recommended that Mantooth have a single-level posterior lumbar interbody fusion. Man-tooth would not be able to return to his job as a customer service technician for at least four to six months, but he could perform sedentary or light work with significant restrictions on lifting, pushing, pulling, and climbing. Dkt. # 16-2, at 208-09. Mantooth underwent spinal fusion surgery on December 7, 2004. Id. at 204. Mantooth requested short term disability (STD) benefits by initiating a claim with the Plan, and he received STD benefits based on a date of disability of November 29, 2004. Id. at 114. '

The Plan authorizes an award of STD benefits for partial or total disability, but it is necessary for a claimant to prove total disability to receive LTD. Dkt. # 16-1, at 9. To qualify as partially disabled for an award of STD benefits, an employee must be “unable to perform all the essential functions of his job or another available position assigned by the Participating Company, within the same full- or part-time classification for which employee is qualified” due to injury or illness. Id. at 8. The definition of “total disability” or “totally disabled” depends on whether the claimant is seeking STD or LTD benefits:

“Total Disability” or “Totally Disabled” means, with regard to Short Term Disability, that because of Illness ’or Injury, an Employee is unable to perform all of the essential functions of his job or another available job assigned by the Par[1174]*1174ticipating Company with the same full- or part-time classification for which the Employee is qualified. “Total Disability” or “Totally Disabled” means, with regard to Long Term Disability, that because of Illness or Injury, an Employee is prevented from engaging in any employment for which the Employee is qualified or may reasonably become qualified based on education, training, or experience. An employee is considered Totally Disabled if he is incapable of performing the requirements of a job other than one for which the rate of pay is less than 50% of his Basic Wage Rate at the time his Long Term Disability started.

Id. at 9. The Plan administrator is authorized to appoint a claims administrator to review claims. Id. at 7. The Plan gives the Plan administrator or the claims administrator assigned to a claim “full and exclusive authority and discretion to grant and deny claims under the Plan, including the power to interpret the Plan and determine the eligibility of any individual to participate in and receive benefits.” Id. at 19.

On July 21, 2005, the Plan terminated Mantooth’s STD benefits due to insufficient evidence to support Dr. Hahn’s recommendation that Mantooth remained totally disabled. Dkt. # 16-2, at 125-26. Two physician advisors found that work restrictions imposed by Dr. Hahn were unreasonable, based on evidence that the spinal fusion was successful and Mantooth could return to work without restrictions. Id. at 52-54, 55-57. Mantooth underwent a functional capacity evaluation (FCE) and it was determined that Mantooth could permanently return to light work only. Id. at 39-40. However, Mantooth’s employer did not have any positions available that would accommodate Mantooth’s work restrictions. Id. at 36. Based on the results of the FCE and SBTC’s inability to accommodate Mantooth’s restrictions, the Plan reinstated Mantooth’s STD benefits. Mantooth exhausted his STD benefits on November 27, 2005. He applied for LTD benefits and the Plan approved his application for LTD benefits beginning on November 28, 2005.

Mantooth’s case manager, Douglas W. Geyer, advised Mantooth that the Plan would be monitoring his medical condition and would request periodic updates about his medical condition. Dkt. # 16-6, at 117. The Plan referred Mantooth for a transferable skill assessment (TSA) for “the possibility of identifying occupations that can be performed within the medical restrictions and limitations and capabilities provided.” Id. at 107. At the time of the TSA, Man-tooth was 37 years old and resided in Cushing, Oklahoma. The report states that Mantooth had completed high school, and had previously been employed as a customer service technician for SBTC and as a telephone operator for an unidentified employer. Id. The closest job to customer service technician in the Dictionary of Occupational Titles (DOT) was line installer, and the DOT classified this position as heavy work. Id. The reviewer concluded that Mantooth had many transferable skills, but his physical restrictions prevented him from performing even light work. Id. at 108. The town of Cushing had only 8,000 residents and there were no jobs in the Cushing labor market that Mantooth could obtain that would pay at least 50 percent of his base salary as a customer service technician. Id.

On May 25, 2006, Mantooth told Geyer that his ability to perform some physical tasks had improved. Dkt. # 16-3, at 115-16. Mantooth believed that he could climb a ladder and use heavy tools for a short period of time, lift 50 pounds often, and sit or stand for 45 minutes without interruption. Id. at 116. However, Mantooth also stated that he was “not able to do anything” and his ability to engage in his [1175]*1175hobby of small household construction projects was severely limited. Id. Geyer referred Mantooth for an independent medical examination (IME) and an FCE.

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804 F. Supp. 2d 1171, 51 Employee Benefits Cas. (BNA) 1859, 2011 U.S. Dist. LEXIS 40383, 2011 WL 1400089, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mantooth-v-at-t-umbrella-benefit-plan-number-1-oknd-2011.