Melenofsky v. Aetna Life Insurance Company

CourtDistrict Court, E.D. Michigan
DecidedSeptember 29, 2021
Docket2:20-cv-11222
StatusUnknown

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

Bluebook
Melenofsky v. Aetna Life Insurance Company, (E.D. Mich. 2021).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION

BRIAN MELENOFSKY, 20-CV-11222-TGB-RSW

Plaintiff, ORDER GRANTING DEFENDANT’S MOTION FOR vs. SUMMARY JUDGMENT AND DENYING PLAINTIFF’S MOTION FOR SUMMARY AETNA LIFE INSURANCE JUDGMENT COMPANY,

Defendant. Plaintiff Brian Melenofsky suffered a heart attack and subsequently applied for both short- and long-term disability benefits through his employer. Both were initially approved by Defendant Aetna Life Insurance Company (“ALIC”), the benefits plan administrator. On November 21, 2019, after determining that his health outlook had improved, ALIC terminated long-term disability benefits. Plaintiff filed this lawsuit alleging the termination of his benefits was in violation of ERISA. Defendant argues that it followed the necessary protocols under the law for re-evaluating his condition and that Plaintiff cannot meet the standard for liability. For the reasons that follow, ALIC’s Motion for Summary Judgment is GRANTED and Plaintiff’s Motion is DENIED. I. BACKGROUND

A. Plaintiff’s health Plaintiff Brian Melenofsky was a senior application developer for TriNet HR III, Inc. ECF No. 27, PageID.945. He had a heart attack (his second) on September 14, 2017, when he was fifty-seven years old. Id. He visited cardiologist Dr. Aziz Alkatib for the first time on September 22, 2017. Dr. Alkatib’s treatment notes from that visit indicate that Mr. Melenofsky has a prior history of hypertension, Type II diabetes, coronary artery disease, hyperlipidemia, obesity, and one prior

heart attack in 2003. Under “Tests Performed,” his notes also detail the results of the left heart catheterization performed on September 14, as well as the results of an echocardiogram performed on September 15: “normal LV size, mild LV hypertrophy, mildly reduced global systolic function, EF estimated at 45%.” Plaintiff reported some heaviness in his legs when walking, shortness of breath, and fatigue, but no chest pain or other symptoms. Dr. Alkatib’s assessment notes are categorized according to Mr. Melenofsky’s various diagnoses and/or symptoms, and generally involve medication recommendations and some

behavioral/lifestyle changes such as a low salt diet. One specific area for follow-up is a potential second surgery. ECF No. 17-4, PageID.674-76. At Plaintiff’s next visit on November 3, 2017, he stated that he had no chest pain, but that he still became short of breath and fatigued easily. He and Dr. Alkatib agreed that he would undergo the surgery, a left heart catheterization procedure and placement of a stent to address his

remaining symptoms related to coronary artery disease, specifically the 80% narrowing of one of his stents (“RCA with 80% mid in-stent restenosis”). Dr. Alkatib’s other recommendations remained unchanged. ECF No. 17-4, PageID.671-73. This procedure was performed on December 28, 2017. At the next follow-up visit on January 12, 2018, Dr. Alkatib noted that the left heart catheterization and stent placement was successful, and that “the stenosis was reduced from 80% to 0%. On today’s visit the patient is

asymptomatic, we recommend to continue with risk factors behavioral modifications and continue other current management.” ECF No. 17-4, PageID.668-70. The rest of Dr. Alkatib’s assessment and recommendations remained largely unchanged. Mr. Melenofsky no longer complained of general shortness of breath or fatigue. His only remaining respiratory symptom was dyspnea on exertion—a feeling of inability to get enough air during exercise. He received another echocardiogram on February 4, 2019 (ECF No. 17-4, PageID.681) that according to Dr. Alkatib’s notes showed “normal

LV systolic function” and an ejection fraction (“EF”) of 55-60%. This was an improvement from the echocardiogram taken immediately after his heart attack, which showed an EF of 45%. ECF No. 17-4, PageID.626. The treatment notes from the next follow-up visit on February 22 indicate that Mr. Melenofsky was “asymptomatic” with regards to coronary artery disease; Dr. Alkatib’s recommendations again focused on diet, exercise,

and medication and were largely unchanged from previous visits. ECF No. 17-3, PageID.624-26. Plaintiff saw Dr. Alkatib for regular follow-ups: notes from May 2018, September 2018, February 2019, and August 2019 visits are all in the record. All of these notes indicate Mr. Melenofsky still experienced dyspnea on exertion, but no chest pain, shortness of breath, or fatigue. The treatment recommendations continued to focus on diet, exercise, and medication, and were essentially unchanged from visit to visit.

Dr. Alkatib also submitted two “Attending Provider Statements” on Mr. Melenofsky’s behalf to ALIC over the course of these follow-up visits: one on December 11, 2018 (ECF No. 17-4, PageID.723-24), and one on April 5, 2019 (ECF No. 17-4, PageID.721-22).1 The first Attending Provider Statement indicates a treatment plan of “medical management,” and that Mr. Melenofsky’s symptoms include “shortness of breath, dyspnea on exertion, chest pain.” It states that his symptoms “worsen with stress, physical activity” and that he “can’t return to work.” The second Attending Provider Statement says that he is “incapable of

minimal activity” and that he “continues to be symptomatic with

1 In some parts of the record, this note is referred to as the “9/5/2019 Attending Provider Statement.” The Court agrees with Defendant’s conclusion that based on the contents of the note, the correct date must be April, and that the handwriting makes the “4” look like a “9”, leading to the confusion. See ECF No. 27 at n.10, PageID.956. shortness of breath, chest pain, dyspnea on exertion despite being

managed on medication” and that he “is stable, however not at full recovery . . . condition is lifetime.” B. ALIC’s disability plan The disability plan at issue here, issued by Mr. Melenofsky’s employer and administered by ALIC, is governed by ERISA. It provides long-term disability benefits for up to twenty-four months to qualified participants unable to perform the material duties of their own occupation. After twenty-four months, a claimant must establish they

cannot perform any reasonable occupation to continue receiving benefits. ECF No. 27, PageID.945; see also Policy Documents, ECF No. 17-1. C. Initial grant and subsequent reversal of benefits After his heart attack, Mr. Melenofsky applied for disability benefits through this employer-sponsored ERISA plan. He was initially approved for short-term disability benefits. On March 7, 2018, ALIC conducted an internal clinical assessment to determine his eligibility for long-term disability. In response to the question “do you believe [claimant] would be able to safely perform sedentary, high stress

occupational duties on a consistent basis?” the reviewer responded, “not at this time.” The reviewer further noted that Mr. Melenofsky “is unable to work in any occupation at this time but needs to be reevaluated in the future once [he] has recovered from recent PTCA and his cardiac management has successfully been optimized.” ECF No. 17-2, PageID.343. His long-term disability benefits were approved beginning

March 14, 2018. ECF No. 17-2, PageID.351. After this determination, he had two follow-up calls on March 7, 2019 and July 31, 2019 with ALIC employees to check in on his health and plans to return to work. See ECF No. 17-2, PageID.377; PageID.384-85. On September 9, 2019, ALIC referred Mr. Melenofsky’s case for an internal clinical review, with the reason for review listed as “ongoing claim assessment of function and/or work capacity.” ECF No. 17-2, PageID.404. This review was completed on September 26, 2019: the

reviewer indicated that additional follow-up and documentation were needed regarding Mr.

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