Mcmillan v. At&T Umbrella Benefit Plan No. 1

161 F. Supp. 3d 1069, 2016 U.S. Dist. LEXIS 15542, 2016 WL 528230
CourtDistrict Court, N.D. Oklahoma
DecidedFebruary 9, 2016
DocketCase No. 14-CV-717-GKF-FHM
StatusPublished
Cited by2 cases

This text of 161 F. Supp. 3d 1069 (Mcmillan v. At&T Umbrella Benefit Plan No. 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
Mcmillan v. At&T Umbrella Benefit Plan No. 1, 161 F. Supp. 3d 1069, 2016 U.S. Dist. LEXIS 15542, 2016 WL 528230 (N.D. Okla. 2016).

Opinion

OPINION AND ORDER

GREGORY K. FRIZZELL, CHIEF' JUDGE, UNITED STATES DISTRICT COURT

Plaintiff Kevin McMillan brings this suit under the Employee Retirement income Security Act, 29 U.S.C. § 1001, et seq. (“ERISA”), seeking judicial review of the denial of his claim for short-term and long-term disability under the AT&T Umbrella Benefit Plan No. 1. McMillan contends that the plan administrator denied his claim without considering his ability to perform the cognitive and travel requirements of his position. For the reasons set forth in this opinion and order, the court agrees that the administrator denied McMillan’s short-term disability claim based on an incomplete understanding of his job duties and, consequently, that its decision was arbitraiy and capricious.

I. Background

McMillan began working for AT&T Corp. (“AT&T”) on or about August 13, 2007. As an employee of AT&T, McMillan received short term disability (“STD”) insurance under the AT&T Disability Income Benefit Program, a component of the AT&T Umbrella Benefit Plan No. 1. As relevant here, the plan provides that an employee is considered disabled “when, because of Illness or Injury, [the employee is] unable to perform all of the essential functions of [his or her] job or another available job assigned by [his or her] Participating Company with the same full-time or part-time classification for which [the employee is] qualified.” [AR15].1 During the time relevant to this case, the plan administrator for the AT&T Disability Income Benefit Program was Sedgwick Claims Management Services, Inc. (“Sedgwick”).

On April 25, 2013, McMillan initiated a claim for STD benefits. [AR72]. At the time, he worked as a senior IT client consultant. [AR176]. He estimated that his first day of absence would be June 1, 2013, but subsequently revised that date to May 14, 2013. [AR76], In reporting his claim, McMillan complained of sleep apnea, diabetes, stage III kidney disease, shortness of breath, chronic obstructive pulmonary disease, inability to walk or stand for long periods of time, and an inability to focus, concentrate, and retain short-term memory. [AR72],

By letter dated April 25, 2013, Sedgwick acknowledged receipt of McMillan’s claim and informed him of the need to submit medical information to substantiate his disability. [AR129]. In response, McMillan executed and returned a form authorizing release of his health information to Sedgwick. [AR165].

On May 23, 2013, Sedgwick contacted McMillan via telephone to verify information regarding his claim, including his job duties. Based on their conversation, Sedgwick recorded McMillan’s job duties as “[s]edentary; sitting, talking, typing.” [AR83].

Shortly thereafter, McMillan’s physician, Dr. Terence Grewe, sent Sedgwick an Initial Physician Statement and a patient visit note from May 14, 2013. The statement listed McMillan’s current diagnoses as coronary disease, type-two diabetes, hypertension, and sleep apnea, and his functional restrictions as excessive fatigue and sleep problems. [AR171]. A typed list accompanying the statement identified several issues as affecting McMillan’s job [1072]*1072performance, including extreme daytime fatigue, lack of concentration, poor memory, inability to multitask, difficulty with complex problem-solving, back and leg pain with little exertion, shortness of breath, and inconsistent sleep (usually less than three hours of continuous sleep and then trouble getting back to sleep). [AR172]. On the patient visit note, Dr. Grewe noted that the plaintiffs symptoms included a “[l]ikelihood of falling asleep during the day.” [AR173].

Upon receipt of Dr. Grewe’s records, two Sedgwick claim representatives reviewed the information and concluded that it “lackfed] significant observable clinical findings to approve benefits at [that] time.” [AR90], The representatives further concluded that the case should be forwarded to an independent Physician Advisor (“PA”) for review and consideration. [AR90].

Sedgwick referred McMillan’s claim- to Network Medical Review Co., Ltd. (“NMR”). [AR91]. The referral described plaintiffs job duties as sedentary, involving prolonged sitting, talking, and typing. [AR91]. NMR assigned Dr. David Hinkamp to review the claim. After reviewing Dr. Grewe’s records, Dr. Hinkamp concluded that “[t]here [were] insufficient objective medical findings to” conclude that McMillan was unable “to perform sedentary job duties.” [AR92-93]. Sedgwick reviewed and approved Dr. Hinkamp’s conclusions. [AR96]. By letter dated June 12, 2013, Sedgwick formally advised McMillan that it was denying his STD claim, noting that “[tjhere were no abnormal observable findings from [his] office notes received 05/30/2013 to show limitations preventing [him] from performing [his] job duties.” [AR187].

McMillan timely appealed the denial of his STD claim. In his appeal letter, he asserted that he was “unable to perform all of the essential functions of his job as Senior IT Consultant or another available job assigned by a participating company due to severe sleep apnea and resultant cognitive dysfunction.” [AR232], The letter included' a more detailed description of plaintiffs job duties as well as additional medical records in support of his claim. [AR233-37]. Those records included of the following:

• An April 22, 2013, patient visit note from Dr. Grewe, noting that McMillan had reported increased shortness of breath with minimal exertion, dyspnea while walking, and daytime somnolence. [AR391].
• An April 30, 2013, patient visit note from Dr. Grewe, noting that McMillan had reported no improvement in his breath and referring him to pulmonologists, Dr. Richard Bregman and Dr. Grace Kennedy. [AR395-98].
• A June 17, 2013, patient visit note from Dr. Grewe, noting that McMillan reported continued dyspnea while walking, weakness, and daytime somnolence. Dr. Grewe rated McMillan as a twenty-two (22) on the Epworth Sleepiness Scale (“ESS”),2 and recorded the following information under the heading “Discussed”: “Even if could physically go back to . work, cannot focus enough to ade[1073]*1073quately perform work tasks.” [AR403-405].
• A June 18, 2013, echocardiogram report on McMillan, stating, “The wall motion of the entire left ventricle is mildly hypokinetic. The left ventricle is normal sized and mildly hypertrophied and has normal diastolic function, an EF of 45-50% and mildly reduced systolic function. Trace mitral regurgitation. Trace tricuspid regurgitation.” [AR470].
• A June 19, 2013, pulmonary rehab assessment for McMillan. The lung function test returned a normal result at seventy-six (76) percent. McMillan could not complete the six minute walk test because of leg pain. Moderate dyspnea resulted from his five minutes of exertion. [AR473].
• A September 17, 2013, sleep study by Dr. Brent Stevenson, confirming McMillan’s earlier diagnoses of obstructive sleep apnea and hypopnea syndrome. [AR477-82].
• A September 19, 2013, neuropsychological assessment by Dr. Sharna Wood, detailing her interview of McMillan as well as his results on a variety tests. [AR484-97], Dr.

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161 F. Supp. 3d 1069, 2016 U.S. Dist. LEXIS 15542, 2016 WL 528230, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcmillan-v-att-umbrella-benefit-plan-no-1-oknd-2016.