Oliver v. Aetna Life Insurance

55 F. Supp. 3d 1370, 2014 U.S. Dist. LEXIS 152074, 2014 WL 5460855
CourtDistrict Court, N.D. Alabama
DecidedOctober 27, 2014
DocketCase No. 4:13-CV-1947-VEH
StatusPublished
Cited by2 cases

This text of 55 F. Supp. 3d 1370 (Oliver v. Aetna Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Oliver v. Aetna Life Insurance, 55 F. Supp. 3d 1370, 2014 U.S. Dist. LEXIS 152074, 2014 WL 5460855 (N.D. Ala. 2014).

Opinion

MEMORANDUM OPINION

VIRGINIA EMERSON HOPKINS, District Judge.

I. INTRODUCTION AND PROCEDURAL HISTORY

Plaintiff Gregory Oliver (“Mr. Oliver”), a former employee of Federal Express Corporation (“FedEx”), initiated this employee benefits case in the Circuit Court of Etowah County, Alabama, on September II, 2013. (Doc. 1-1 at 4).1 On October 22, 2013, Defendant Aetna Life Insurance Company (“Aetna”) removed the lawsuit to [1373]*1373this court on the basis of federal question jurisdiction under the Employee Retirement Income Security Act (“ERISA”) and the doctrine of complete preemption. (Doc. 1 at 2-3 ¶¶ 6, 7). On November 26, 2013, Mr. Oliver filed an amended complaint which added Federal Express Corporation Long Term Disability Plan (the “FedEx Plan”) as a co-defendant to his lawsuit. (Doc. 10 at 1).

Currently pending before the court are the six following contested motions:

(1) Mr. Oliver’s Motion for Summary Judgment on Appropriate Standard of Review (Doc. 20) (the “SOR Motion”) filed on June 13, 2014;

(2) Mr. Oliver’s Motion for Judgment for Total Disability (Doc. 28) (the “Disability Motion”) filed on July 3, 2014;

(3) Defendants’ Motion For Summary Judgment (Doc. 31) (the “Cross Disability Motion”) filed on July 3, 2014;

(4) Mr. Oliver’s Motion To Add Documents to the Claim File (Doc. 25) (the “Motion To Add”) filed on July 3, 2014;

(5) Mr. Oliver’s Motion To Strike (Doc. 40) (the “Strike Motion”) filed on July 3, 2014; and

(6) Mr. Oliver’s Motion To Compel Log of Omitted Documents from the Administrative Record (Doc. 49) (the “Compel Motion”) filed on August 29, 2014.

The court has studied all these filings as well as the parties’ respective supporting and opposing materials. (Docs. 23, 26-27, 29-30, 32-39, 41-44, 51). For the reasons explained below, (1) Mr. Oliver’s SOR Motion is due to be denied; (2) Mr. Oliver’s Disability Motion is due to be denied; (3) Defendants’ Cross Disability Motion is due to be granted; (4) Mr. Oliver’s Motion To Add is due to be denied and alternatively is due to be termed as moot; (5) Mr. Oliver’s Strike Motion is due to be termed as moot; and (6) Mr. Oliver’s Compel Motion is due to be denied.

II. FACTUAL BACKGROUND AND ADMINISTRATIVE HISTORY2

Mr. Oliver formerly worked as courier for FedEx. Mr. Oliver experienced an on-the-job injury on'August 15, 2009, and has the impairments of degenerative disc disease and osteoarthritis in the left knee. Mr. Oliver submitted a disability claim under the FedEx Plan, and received short-term disability benefits for the time period of August 24, 2009, through February 21, 2010. (Doc. 23-1 at 2).3 Subsequently, Mr. Oliver received long-term occupational disability benefits under the FedEx Plan for the two-year period of February 22, 2010, through February 21, 2012. Id. This provided Mr. Oliver with the maximum coverage for long-term occupational disability, as the FedEx Plan places a 24-month cap on receiving that type of benefit. (Doc. 23-7 at 50; Doc. 23-1 at 2).

Prior to the exhaustion of his long-term occupational disability payments, on August 25, 2011, Aetna sent Mr. Oliver a letter which explained the more demand[1374]*1374ing definition of disability that applied to long-term benefits “beyond 24 months_” (Doc. 23-2 at 4).4 More specifically, that standard requires a claimant to show a “complete inability ... to engage in any compensable employment for twenty-five hours per week.” (Doc. 23-1 at 2; Doc. 23-7 at 42).

Mr. Oliver sought to qualify for long-term total disability benefits to cover the time period from February 22, 2012, to the present. (Doc. 23-1 at 2). This claim was denied initially on January 12, 2012, and Mr. Oliver filed an appeal. Id. Subsequently, on March 13, 2012, Linda Bizzarro (“Ms. Bizzarro”) sent a letter to Mr. Oliver on behalf of the Aetna Appeal Review Committee (“AARC”) (Doc. 23-1 at 2-3), notifying him that the AARC had denied his appeal on March 12, 2012, “because there [wa]s a lack of significant objective findings to substantiate a claim under the Plan for Total Disability.” (Doc. 23-1 at 3).

Before his long-term total disability claim was finally decided, Mr. Oliver received a favorable disability decision from the Social Security Administration (“SSA”) on January 17, 2012 (Doc. 23-2 at 8-21), which concluded that Mr. Oliver became disabled (within the meaning of the Social Security Act) on August 15, 2009, the same date as his job-related injury. Mr. Oliver contends that this SSA decision satisfies the total disability standard under the FedEx Plan and that “[t]he medical record reviewers were never provided [with a copy of it].” (Doc. 28 at 2).

The record reflects that Aetna received notice of Mr. Oliver’s favorable SSA decision (indicating a retroactive benefit amount of $28,334.00) sent via facsimile on February 28, 2012, by a nonparty entity named Allsup. (Doc. 23-2 at 23-32). Further, the appeal denial letter expressly references the AARC’s consideration of Mr. Oliver’s favorable SSA award. However, the AARC ultimately discounted its evidentiary importance. Specifically, the AARC pointed out that “the criteria utilized by the Social Security Administration for ... disability awards are different from the definition for Total Disability set forth in the Plan,” and underscored its “duty to follow the terms of the Plan.” (Doc. 23-1 at 3).

III. STANDARDS

A. Summary Judgment

Summary judgment is proper only when there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c).5 All reasonable doubts about the facts and all justifiable inferences are resolved in favor of the nonmovant. See [1375]*1375Fitzpatrick v. City of Atlanta, 2 F.3d 1112, 1115 (11th Cir.1993).6 A dispute is genuine “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986).

“Once the moving party has properly supported its motion for summary judgment, the burden shifts to the nonmoving party to ‘come forward with specific facts showing that there is a genuine issue for trial.’ ” International Stamp Art, Inc. v. U.S. Postal Service, 456 F.3d 1270, 1274 (11th Cir.2006) (citing Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986)). Although there are cross motions for summary judgment, each side must still establish the lack of genuine issues of material fact and that it is entitled to judgment as a matter of law. See Chambers & Co. v. Equitable Life Assur. Soc. of the U.S., 224 F.2d 338, 345 (5th Cir.1955) (“Both parties filed and argued motions for summary judgment, but this does not warrant the granting of either motion if the record reflects a genuine issue of fact.”).7

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55 F. Supp. 3d 1370, 2014 U.S. Dist. LEXIS 152074, 2014 WL 5460855, Counsel Stack Legal Research, https://law.counselstack.com/opinion/oliver-v-aetna-life-insurance-alnd-2014.