Morris v. Lincoln Nat'l Life Ins. Co.

386 F. Supp. 3d 667
CourtDistrict Court, E.D. Virginia
DecidedMay 8, 2019
DocketCivil Action No. 1:16-cv-929 (AJT/JFA)
StatusPublished

This text of 386 F. Supp. 3d 667 (Morris v. Lincoln Nat'l Life Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morris v. Lincoln Nat'l Life Ins. Co., 386 F. Supp. 3d 667 (E.D. Va. 2019).

Opinion

Anthony J. Trenga, United States District Judge

In this ERISA-governed dispute, Plaintiff Stephanie Morris ("Plaintiff" or "Mrs. Morris") claims life insurance benefits based on the death of her husband, Stephen Morris ("Mr. Morris"). The dispositive *670issue is whether Defendant Lincoln National Life Insurance Company ("Defendant" or "Lincoln") abused its discretion by denying Plaintiff's claim for those benefits on the grounds that Mr. Morris was "Totally Disabled" on January 1, 2015 and therefore ineligible for coverage under the Lincoln policy.

Pending before the Court are Plaintiff's Motion for Summary Judgment ("Plaintiff's Motion") [Doc. No. 60] and Defendant's Motion for Summary Judgment ("Defendant's Motion") [Doc. No. 61] (collectively, the "Cross Motions"). For the following reasons, the Court concludes that under the applicable legal standard of review by this Court, Lincoln did not abuse its discretion in denying Plaintiff's claim for benefits and Plaintiff's Motion is therefore DENIED and Defendant's Motion is GRANTED.

I. BACKGROUND1

A. Progression of Mr. Morris's Illness

Mr. Morris was diagnosed with acute myeloid leukemia ("AML") on October 23, 2014 following an emergency room visit. LIN0533; LIN0152. At the time of this diagnosis, he was employed at OGSystems; and while he remained employed at OGSystems until his death on September 16, 2015, his illness prevented him from returning to work after October 23, 2014. LIN0533; LIN0152.

On October 24, 2014, Mr. Morris was admitted to the hospital to begin first-time chemotherapy treatments. LIN0665; LIN1280. As reflected in his medical records, Mr. Morris needed "ongoing therapy for leukemia after this cycle [of chemotherapy], plan dependent upon bone marrow biopsy results." LIN1261 (October 29, 2014 Progress Note by Nurse Practitioner Joyce Jackowski). Mr. Morris was advised that he would "need to be off work for at least 6 months" but "may work remotely at less than full-time hours as able depending upon physical condition." Id. It was also observed that Mr. Morris was "incapable of minimal (sedentary) activity" and should not be expected to return to work before April 1, 2015, as job modifications would not enable him to work without impairments. LIN0223 (October 30, 2014 Attending Physician Statement by Dr. Alix Spina).

After completing two lines of treatment, Mr. Morris was released from the hospital on December 6, 2014. LIN0665. On December 8, 2014 Mr. Morris's treating physician, Dr. Dipti Patel-Donnelly, indicated that he still had "significant residual disease" and that she was exploring other treatment options. LIN1536 (December 8, 2014 Treatment Note by Dr. Dipti Patel-Donnelly). Dr. Patel-Donnelly continued to closely monitor Mr. Morris's condition following his release from the hospital and noted that his symptoms had declined and his energy and ability to carry out basic tasks had improved during follow-up appointments on December 10, 12, and 14. See LIN1533; LIN1532; LIN1531. Nevertheless, in support of Mr. Morris's application for long-term disability benefits, Dr. Patel-Donnelly indicated that he remained severely immunocompromised and was being "worked up" for further treatment, including a stem-cell transplant. LIN1508 (December 19, 2014 Note Regarding Patient Status for Work/School by Dr. Dipti Patel-Donnelly). Thus, she wrote that Mr. Morris would be unable to work "at all" until June 30, 2015, when his status would be reevaluated. Id.

*671Dr. Patel-Donnelly again met with Mr. Morris on December 24 and 30, 2014, and the possibility of Mr. Morris's participation in other clinical trials was discussed. LIN0142; LINO I 43. Dr. Patel-Donnelly indicated that the goal with respect to Mr. Morris's treatment was "to continue to treat him to bridge him to transplantation." LIN0143. At the December 30 appointment, Mr. Morris reported few symptoms and stated that he "generally feels well." LINO 142. However, as Dr. Patel-Donnelly told him and Mrs. Morris at the December 24 appointment, his overall prognosis remained poor, based on his "poor prognostic cytogenics and his incomplete response to current therapies." LIN0143. Just a week after the December 30 appointment, during a January 5, 2015 telephone call with a representative from Reliance Standard Life Insurance Company ("Reliance"), his employer's disability carrier, Mr. Morris said that he could not perform basic household tasks including driving, cleaning, and taking the trash out due in part to fatigue, and that he would not be returning to his occupation or any other occupation in the foreseeable future as he was not in remission. LIN1470.

Mr. Morris began a new line of treatment, his third, on January 7, 2015. See LIN1737. On the first day of the treatment, Dr. Patel-Donnelly indicated that Mr. Morris was doing "very well," that his "ECOG status" was at 1,2 and that he was "clear to go ahead with the study." LIN0141. Mr. Morris was still doing well and reported few symptoms when Dr. Patel-Donnelly saw him a week later on January 14, 2015. LIN0140. However, approximately two weeks into the new treatment regimen, he began to develop complications, including achiness, fatigue, and a sore throat. LIN1382; LIN1384. Ultimately, Mr. Morris was forced to stop this line of treatment on February 4, 2015. LIN1377.

After his third treatment regime proved unsuccessful, Mr. Morris continued to meet with his doctors regularly. The progression of Mr. Morris's disease was not linear - notes from his treating physicians indicate that he experienced good spells, where his symptoms were minimal and he was able to participate in some activities, and bad spells, during which he was reliant on blood transfusions and hospitalized for complications from his leukemia. For example, on February 9, 2015, Dr. Yesid Alvarado reviewed Mr. Morris's suitability for a new trial, finding that he was "not overly tired" and once again giving him an ECOG score of 1. LIN2171. However, Mr. Morris complained of shortness of breath and fatigue in appointments with Dr. Patel-Donnelly on March 2 and Dr. Alvarado on March 12, LIN1366; LIN2171, and required blood transfusions on March 5 and March 13, LIN1364; LIN2168. Mr. Morris was then admitted to the hospital to continue treatment on March 13, LIN2163, before he was discharged on March 22, LIN2159-61, and re-admitted with complications on March 30, 2015, LIN2153.

While Mr. Morris's symptoms fluctuated, the underlying progression of the disease continued. A bone marrow biopsy on April 13, 2015 showed "persistent disease, *67235% blasts," indicating that Mr. Morris was not in remission. LIN2144. Another bone marrow biopsy on May 22, 2015 showed "74% blasts," meaning the disease was continuing to advance. LIN1356. On May 28, 2015, Dr. Alvarado indicated that there remained "evidence of pervasive disease" and that the prognosis was "very poor." LIN2139. Mr. Morris was hospitalized again on July 2, 2015, and though he was discharged four days later, the discharge note stated that his "[o]verall prognosis is exceedingly poor." LIN2107.

Despite Mr. Morris's increasingly poor prognosis, he still had good days. On August 3, 2015, Dr. Patel-Donnelly noted that Mr.

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Bluebook (online)
386 F. Supp. 3d 667, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morris-v-lincoln-natl-life-ins-co-vaed-2019.