Mohamed Mokbel-Aljahmi v. United Omaha Life Ins. Co.

706 F. App'x 854
CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 28, 2017
Docket16-2616
StatusUnpublished
Cited by3 cases

This text of 706 F. App'x 854 (Mohamed Mokbel-Aljahmi v. United Omaha Life Ins. Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mohamed Mokbel-Aljahmi v. United Omaha Life Ins. Co., 706 F. App'x 854 (6th Cir. 2017).

Opinion

HELENE N. WHITE, Circuit Judge.

Plaintiff-Appellee Mohamed Ahmed Mokbel-Aljahmi (“Aljahmi”) 1 brought this ERISA action after Defendant-Appellant United of Omaha Life Insurance Company (“United”) discontinued his long-term disability insurance benefits. United concluded that, despite his physical limitations, Aljahmi can perform sedentary work and earn a sufficient wage so as to not be “disabled” under the relevant policy definition. Reviewing United’s decision de novo, 2 the district court found Aljahmi eligible for benefits. United appeals, and we AFFIRM.

I. FACTS

The Group Long Term Disability Insurance Policy (the “Policy”) at issue contains two definitions of “disabled.” For the first two years after an injury, an insured is eligible for benefits if he is unable to do either his former job or any other job that would pay him more than 80% of his former regular monthly earnings. After two years, the definition changes. If the insured is qualified for and able to perform any job that would pay him more than 60% of his former regular earnings, he is not “disabled.” 3 The parties agree that the 60% threshold for Aljahmi is $1,467.44 per month.

The district court concisely summarized the underlying facts as follows:

Aljahmi worked for L & W Engineering Company from August 31, 1998 until February 11, 2011[.] Aljahmi performed various duties in the operation of welding machinery. The job description indicates that the position requires light strength and may require significant standing, walking, pushing, and/or pulling.
Aljahmi participated in L & W Inc.’s ERISA qualified benefit plan. United issued the Group Long Term Disability Insurance Policy (“Policy”) to L & W Inc. Under the Policy, United agreed to pay insured persons long-term disability benefits (“LTD”) subject to the terms and conditions of the Policy. L & W Inc. *858 self-insured a short-term disability (“STD”) benefits program for eligible employees; it retained United to review claims under the Policy.
Aljahmi began experiencing neck and back pain in 2003. In 2011, he was involved in a motor vehicle accident (“MVA”). His pain became more severe because of the accident and he experienced increased back, left leg, and neck pain, along with right arm pain and numbness. Aljahmfs doctor recommended that Aljahmi take off work. He did but never returned. Aljahmfs last day of work was February 11, 2011. He received STD benefits for 26 weeks.

(R. 25, PID 1846.)

After the car accident, Aljahmi underwent several MRIs of his back and shoulders, as well as EMGs of his limbs. Aljah-mi was subsequently .treated by multiple doctors, each of whom found him substantially impaired. As the district court noted:

Aljahmfs treating neurologist for 12 years, Bassam Maaz, M.D. diagnosed Aljahmi with lumbar radiculopathy, lower back pain from degenerative changes and bulging discs, neck pain secondary to herniated discs C3-C4, G4-G5, shoulder rotator cuff syndrome and depression. Dr. Maaz found that Aljahmi could not perform sedentary or light work on a sustained basis, could not sit, stand, and/or walk for more than one hour each day, could only lift and carry up to five pounds occasionally, required complete freedom to rest frequently without restriction ....
Dr. Mahmoud Rahim, M.D.[,] Aljah-mfs treating internist ... found that Aljahmi could not perform sedentary or light work on a sustained basis, could sit, stand, and/or walk for less than one hour each day, could not lift up to five pounds on a regular and sustained basis, could not use his hands on a regular and sustained basis, required complete freedom to rest frequently without restriction, and would need to elevate his lower extremities 3-4 hours a day.
Aljahmfs treating orthopedic specialist, Jiab Suleiman, M.D., limited Aljahmi to three hours of sitting and one hour of standing and walking, with restrictions on lifting/carrying, bending, squatting, crawling, climbing, and reaching above the shoulder level....

(R. 25, PID 1847-49 (record citations omitted).) United did not challenge Aljahmfs doctors’ opinions, and paid Aljahmi disability benefits from 2011 to 2013.

In 2013, the second, more limited definition of “disability” became effective, and United reconsidered Aljahmfs eligibility for benefits. Julie Grancer, a United nurse, reviewed Aljahmfs medical records in July '2013, but did not examine him. Grancer did not dispute Aljahmfs doctors’ diagnoses, but opined that Aljahmi was precluded only from work that involved “constant neck motion in flexion, extensión and rotation, frequent overhead reaching, crawling and. climbing, repetitive motion of the right shoulder, repetitive bending/twisting and lifting/carrying [greater than] 20 pounds.” (R. 11-5, PID 699.)

United also had a Transferable Skills Assessment (“TSA”) performed by Douglas Palmer of Palmer Vocational Services. Palmer did not interview Aljahmi, and United did not provide Palmer with Aljah-mfs medical records or his doctors’ opinions regarding work restrictions. Instead, Palmer relied on Nurse Grancer’s conclusions and Aljahmfs Education, Training and Work Experience form (“ETE”). In his ETE, completed in April 2013, Aljahmi reported that prior to his time at L & W, he had worked as a machine operator from 1997 to 1998 and as a cafeteria worker from 1994 to 1996. Aljahmi also reported that he was a high school graduate without *859 any additional education, no skills other than welding and stamping, and that the only language he spoke fluently was Arabic. Based on this information, Palmer concluded Aljahmi could perform several different jobs and earn up to $1,696.70 per month.

United discontinued Aljahmi’s benefits on August 27, 2013. Aljahmi initiated an administrative appeal, arguing that United had improperly ignored the diagnoses and conclusions of Aljahmi’s treating physicians and that, even accepting Nurse Grancer’s conclusions, Aljahmi would still be unable to work in any of the jobs identified by Palmer.

In response, United scheduled Aljahmi for an April 23, 2014 Independent Medical Evaluation (“IME”) with Joseph Salama, M.D. The appointment did not take place then, however, because of confusion regarding the location. In the meantime, United had arranged for covert surveillance of Aljahmi from April 22-24,2014. On April 22, Aljahmi was seen leaving his house once, walking with a cane. He drove himself to a convenience store and returned home within an hour. On April 23, Aljahmi left his house only once, riding as a passenger to the erroneously scheduled IME appointment, walking with a cane, and wearing wrist braces. On April 24, Aljahmi did not leave his house.

The rescheduled IME took place in May. Dr. Salama reviewed Aljahmi’s medical records and examined him. Dr. Salama confirmed that Aljahmi was suffering from a radiculopathy and chronic pain. Further, Dr. Salama agreed with the restrictions imposed by Aljahmi’s treating physicians, except that Dr.

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706 F. App'x 854, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mohamed-mokbel-aljahmi-v-united-omaha-life-ins-co-ca6-2017.