Ramdeen v. Prudential Insurance Co. of America

163 F. Supp. 3d 1218, 2016 U.S. Dist. LEXIS 20631
CourtDistrict Court, M.D. Florida
DecidedFebruary 19, 2016
DocketCase No: 6:15-cv-139-Orl-28TBS
StatusPublished

This text of 163 F. Supp. 3d 1218 (Ramdeen v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ramdeen v. Prudential Insurance Co. of America, 163 F. Supp. 3d 1218, 2016 U.S. Dist. LEXIS 20631 (M.D. Fla. 2016).

Opinion

ORDER

JOHN ANTOON II, United States District Judge

In this case brought under the Employment Retirement Income Security Act of 1974 (“ERISA”), Plaintiff Andrew Ram-deen challenges the termination of his [1220]*1220short-term disability (“STD”) benefits by Defendant The Bank of New York Mellon Corporation (“BNYMC”) and the denial of long-term disability (“LTD”) benefits by Prudential Insurance Company (“Prudential”). Both parties filed Motions for Summary Judgment. (Docs. 38 & 43). Upon consideration of the Motions, Responses, and Replies, (Docs. 38, 43, 45 & 50), Mr. Ramdeen’s Motion for Summary Judgment must be denied and Defendants’ Motion for Summary Judgment is due to be granted.

I. Background

BNYMC provides STD benefits to its eligible employees through a self-funded “payroll practice” that provides benefits to sick or injured employees for up to twenty-six weeks. (AR 002).1 An employee who is disabled after the STD benefits expire may then seek LTD benefits, which BNYMC provides through an insurance-based group contract with Prudential. Prudential is the administrator of the LTD plan.

In October 2008, while working as a vice president for a BNYMC subsidiary, Mr. Ramdeen suddenly collapsed at work from a stroke. (AR 117, 364). At that time, he was diagnosed with, among other ailments, “left carotid dissection with right hand resulting in the left cerebral infarction with the right hemiplegia and aphasia[;] mobility, self-care, and communication deficits!;] hypertension!; and d]eep venous thrombosis of the right lower extremity.” (AR 117). Mr. Ramdeen received STD benefits under BNYMC’s STD Plan while he recovered and underwent inpatient and outpatient rehabilitation.2 (AR 117, 131, 146, 171, & 175).

After several months of rehabilitation, Mr. Ramdeen’s condition improved significantly. In April 2008, his treating neurologist, Dr. Lata Bansal, stated that Mr. Ramdeen was “doing much better” and that “[o]n examination no weakness was detected.” (AR 528). Additionally, “[h]is right arm strength and coordination [have] improved” along with his typing skills, (Id.). She noted, however, that “[h]e had somewhat poor coordination on the right side!; that h]is gait was hemi-paretic on the right side!; and that he’s got] his right arm hanging.” (Id.). Despite any weakness noted by Dr. Bansal, Mr. Ramdeen “was not given a [follow up] appointment,” and he voluntarily went back to work full time on April 13,2009. (Id.).

When Mr. Ramdeen returned to work, he did not perform all of the same tasks that he had done before his stroke. (AR 135, 437; PL’s Mot. Summ. J., Doc. 38, at 4, 14; Pl.’s Reply, Doc. 45, at 9; Defs.’ Mot. Summ. J., Doc. 43, at 3). Instead, he “worked [with] deficits as [BNYMC] allowed [him] to perform ... alternate tasks than what he was doing prior to his [stroke].” (AR 437). He then worked continuously for four years — from April 2009 until July 2013 — when he stopped working and filed another claim for STD benefits. (AR 638, 640). At that time, Mr. Ram-deen’s request for STD benefits was approved in part.3 (AR 629).

In support of continuing his STD benefits over the next several months, Mr. [1221]*1221Ramdeen submitted reports from his treating physician, Dr. Rajan Kapoor. Dr. Kapoor filled out a Statement of Work Capacity and Impairment based on a July 24, 2013 visit stating that Mr. Ramdeen’s primary diagnosis was hypertension. (AR 503). Dr. Kapoor further noted that Mr. Ramdeen’s other complaints included “Hy-perlipidemia, CVA Left Carotid disection [sic], Right Leg DVT” and that physical examination findings were “unremarkable/ weakness (R) Side due to Prev. stroke.” (Id.). He concluded that Mr. Ramdeen was “unable to work at this time.” (AR 502). Dr. Kapoor filed an Update of Work Capacity and Impairment in September and October 2013,4 both of which largely echoed the initial assessment but included “Pain Hip/Pelvic” and “Dyslipidemia” among his impairments. (AR 505).

After extending Mr. Ramdeen’s STD benefits for several months, (AR 615, 628), BNYMC ultimately terminated those benefits on October 30, 2013, concluding that the records received from Dr. Kapoor did not support a continuing disability. (AR 599). Mr. Ramdeen appealed BNYMC’s decision that same day. (AR 590, 593). In support of his appeal, Mr. Ramdeen included Dr. Kapoor’s progress notes dated October 31, 2013 — the day after STD benefits were discontinued — stating that Mr. Ramdeen is “not able to make decision[s]” and “not able to work full time.” (AR 524).

In connection with Mr. Ramdeen’s appeal, a STD administrator on behalf of BNYMC spoke with Mr. Ramdeen in December 2013 seeking additional information about his condition and explaining that Dr. Kapoor’s notes were brief and without much detail. (AR 538). Mr. Ramdeen replied that “his memory, especially long-term is shot” and that “he didn’t remember his job title or what [he used] to do for [BNYMC].” (Id.). He further stated that “he struggled at work, and was not able to keep up, but [BNYMC] kept him on” and that “he did not receive poor performance reviews.” (Id.). He said that “he cannot do typing and writing [for] his job due to his cognitive issues.” (Id.).

BNYMC retained Dr. Stephen M. Selkirk M.D. Ph.D., who is board certified in Psychiatry & Neurology, to conduct a file review of Mr. Ramdeen’s condition. (AR 584, 690). Upon a review of all of Dr. Kapoor’s submitted reports, Dr. Selkirk issued a report opining that:

[Dr. Kapoor’s] office note from 10/31/2013 notes right-sided weakness on exam and that the claimant is “not able to make decisions.” ... While the records do support the claimant to have right-sided weakness, which would preclude activities such as heavy lifting and working at heights, there is no evidence provided to support the claimant’s inability to perform the duties of his own sedentary occupation. There is no clinical evidence of cognitive dysfunction or cognitive impairment noted in the records provided for review.5

(AR 584).

Based on the opinion of Dr. Selkirk, the available records from Dr. Kapoor’s office, and the 2008-2009 notes from Mr. Ram-deen’s treating neurologist after his stroke, BNYMC affirmed its denial of STD benefits on January 7, 2014. (AR 689). Mr. [1222]*1222Ramdeen appealed that denial and shortly thereafter filed a claim with Prudential for LTD benefits. (AR 363, 580, 578). In light of Mr. Ramdeen’s dual claims for STD and LTD benefits — and noting that Mr. Ram-deen did not submit any additional information to support his requested STD benefits — BNYMC decided to wait until the outcome of Mr. Ramdeen’s claim for LTD benefits before making a decision on Mr. Ramdeen’s second-level STD appeal. (AR 500).

In evaluating Mr. Ramdeen’s claim for LTD benefits, Prudential’s investigation found that “he is not using any assistive device ... [and] not doing any [physical therapy/occupational therapy].” (AR 429). Prudential requested additional Attending Physician Statements from Dr. Kapoor on December 16 and 17, 2013, but there is no response reflected in the record. (AR 498, 495).'

At the request of Prudential, Dr. Barbara Parke, who is board certified in Physical Medicine and Rehabilitation, conducted a full review of Mr. Ramdeen’s file6 and found:

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Bluebook (online)
163 F. Supp. 3d 1218, 2016 U.S. Dist. LEXIS 20631, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramdeen-v-prudential-insurance-co-of-america-flmd-2016.