Nuffer v. Aetna Life Insurance Company

CourtDistrict Court, E.D. Michigan
DecidedSeptember 24, 2021
Docket1:20-cv-10935
StatusUnknown

This text of Nuffer v. Aetna Life Insurance Company (Nuffer 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
Nuffer v. Aetna Life Insurance Company, (E.D. Mich. 2021).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN NORTHERN DIVISION

RACHEL NUFFER,

Plaintiff, Case No. 1:20-cv-10935

v. Honorable Thomas L. Ludington Magistrate Judge Patricia T. Morris AETNA LIFE INSURANCE COMPANY,

Defendant, _________________________________________/ OPINION AND ORDER SUSTAINING AND OVERRULING IN PART PLAINTIFF’S OBJECTIONS, REJECTING MAGISTRATE JUDGE’S REPORT AND RECOMMENDATION, GRANTING AND DENYING IN PART PLAINTIFF’S MOTION FOR JUDGMENT, DENYING DEFENDANT’S MOTION FOR JUDGMENT, AND REMANDING CASE TO AETNA FOR FULL AND FAIR REVIEW

Plaintiff Rachel Nuffer (“Nuffer”) awoke on November 26, 2016, with a stunning migraine. Her pain was so intense that she raced to the emergency room, where doctors administered a “migraine cocktail.” Nuffer’s unexpected trip to the hospital marked the beginning of her long journey for medical relief—and disability benefits. In April 2020, Nuffer brought this action under the civil enforcement provision of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. Nuffer seeks to reinstate long-term disability benefits that were provided to her under a group insurance policy purchased by her employer, the Dow Corning Corporation (“Dow Corning”). Defendant Aetna Life Insurance Company (“Aetna”) administers the policy. Nuffer claims that she is disabled by persistent migraines and associated symptoms. The matter was referred to Magistrate Judge Patricia T. Morris. After considering the parties’ cross-motions for summary judgment, Judge Morris issued a Report and Recommendation, recommending that judgment be entered for Aetna. Nuffer timely filed objections. After reviewing Judge Morris’s Report and Recommendation under Federal Rule of Civil Procedure 72, this Court finds that Aetna did not provide Nuffer with the full and fair review required by 29 U.S.C. § 1133. Accordingly, this matter will be remanded to Aetna for a full and

fair review consistent with this Opinion. I. From January 2008 until the onset of her migraines in November 2016, Nuffer worked for Dow Corning as a “[p]roduction [o]perator,” driving trucks and operating other heavy equipment. ECF No. 29 at PageID.1275. As a benefit of her employment, Nuffer participated in Dow Corning’s Long-Term Disability Benefit Plan (the “Plan”), which Aetna administers. Id. The Plan determines long-term benefits using a two-tiered test: the “Test of Disability.”1 See ECF No. 12-5 at PageID.1053 (Administrative Record) (under seal). For the first 24 months, benefits are payable so long as the participant cannot perform her “own occupation” and earns

1 The Plan reads:

From the date that you first became disabled and until monthly benefits are payable for 24 months you meet the test of disability on any date that:

 You cannot perform the material duties of your own occupation solely because of an illness, injury, or disabling pregnancy-related condition; and

 Your earnings are 80% or less of your adjusted predisability earnings.

After the first 24 months of your disability that monthly benefits are payable, you meet the plan’s test of disability on any day you are unable to work at any reasonable occupation solely because of an illness, injury or disabling pregnancy- related condition.

ECF No. 12-5 at PageID.1053. “80% or less of [her] adjusted predisability earnings.” Id. (emphasis omitted). After the first 24- month period, benefits are payable only if the participant cannot perform “any reasonable occupation,” which is defined as “any gainful activity: [f]or which [the participant] [is], or may become, fitted by education, training, or experience; and [w]hich results in or can be expected to result in, an income of more than 80% of your adjusted predisability earnings.” Id. at PageID.1072

(emphasis omitted). Nuffer applied for long-term benefits on April 12, 2017, at the age of 44. See ECF No. 29 at PageID.1279. Her application relied largely on the supporting statement of her internist,2 LaTonya Thomas, M.D. See ECF No. 12-4 at PageID.839–843. According to a March 24, 2017 statement, Dr. Thomas diagnosed Nuffer with “concern of [sic] cervical disc radiculopathy,” “blurred [and] double vision,” and “severe [non-intractable] headache.” Id. Nuffer was prescribed pain medication to treat the headaches, which Dr. Thomas noted could cause “drowsiness” and other “unpredictable symptoms.” Id. at PageID.841. Dr. Thomas also identified various functional impairments: Nuffer could never climb, crawl, or kneel and could only “occasionally” lift, pull,

push, reach, carry, bend, twist, or grossly or finely manipulate her hands. Id. at PageID.843. Dr. Thomas ultimately concluded that Nuffer could not work. Id. Aetna approved Nuffer’s claim the following month and began paying benefits on May 31, 2017. Id. The letter approving Nuffer’s claim did not provide a specific rationale. But Aetna now claims that it approved Nuffer’s application only because “she was unable to drive trucks and forklifts as required by her ‘own occupation’ while taking pain medication that purportedly made her groggy.” See ECF No. 21 at PageID.1171.

2 An internist is a doctor who “special[izes] in internal medicine.” See Internist, Merriam-Webster, https://www.merriam-webster.com/dictionary/internist [https://perma.cc/964M-2FYC]. Aetna terminated Nuffer’s benefits by letter at the expiration of the initial 24-month period on May 31, 2019. ECF No. 29 at PageID.1282. Aetna cited the failure of Nuffer’s providers to produce medical records as requested. See ECF No. 12-5 at PageID.1002 (“Based on the lack of current medical documentation supporting restrictions and limitations precluding you from performing your own occupation or any occupation, we have determined you no longer meet the

definition of disability . . . .”). Aetna also faulted Nuffer for failing to apply for Social Security Disability Income (SSD) benefits. See id. at PageID.1003 (stating that Nuffer “[never] attempted to complete an application for SSD benefits.”). When her claim was first approved, Aetna advised Nuffer that she would have to apply for SSD benefits. See ECF No. 12-4 at PageID.872. Aetna even offered to refer Nuffer’s case to Allsup, Inc., which is Aetna’s cost-free “Social Security advocacy service.” See id. Shortly after Aetna terminated Nuffer’s benefits, she submitted a hand-written appeal, denying many of the facts alleged in Aetna’s termination letter. See ECF No. 12-3 at PageID.600- 01. Most notably, Nuffer claimed that she had been approved for SSD benefits with the help of

Allsup, and that she had submitted release forms for her medical records at Aetna’s request. Id. Nuffer was correct, at least with respect to the SSD benefits. The Social Security Administration (SSA) determined that Nuffer was disabled as of November 25, 2016, and it sent her an award notice on December 19, 2017. See ECF No. 12-4 at PageID.695. The SSA made its determination at the initial review stage, apparently finding no need for an evidentiary hearing. On June 17, 2019, Aetna reversed its decision and reopened Nuffer’s case. See ECF No. 12-5 at PageID.1011. The letter stated that Aetna was reopening her claim because of “additional medical records that were received at the time of the appeal.”3 Id. But Nuffer’s success was short-lived. On July 3, 2019, Aetna sent another letter to Nuffer stating that it had, once again, decided to terminate her benefits. Id. at PageID.1015. The letter

claimed that Nuffer could perform full-time “sedentary” work.4 Id.

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Nuffer v. Aetna Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nuffer-v-aetna-life-insurance-company-mied-2021.