Rebecca Filthaut v. AT&T Midwest Disability Benefit Plan

710 F. App'x 676
CourtCourt of Appeals for the Sixth Circuit
DecidedOctober 10, 2017
Docket16-2707
StatusUnpublished
Cited by3 cases

This text of 710 F. App'x 676 (Rebecca Filthaut v. AT&T Midwest Disability Benefit Plan) 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
Rebecca Filthaut v. AT&T Midwest Disability Benefit Plan, 710 F. App'x 676 (6th Cir. 2017).

Opinions

COOK, Circuit Judge.

Experiencing lower back pain, Rebecca Filthaut made three claims for short-term disability benefits under her employer’s disability plan, each of which the claims administrator denied. She sued, alleging a violation of the Employee Retirement Income Security Act of 1974 (“ERISA”). The district court granted summary judgment to Filthaut on two of her claims. But because the claims administrator’s denial of benefits was neither arbitrary nor capricious, we REVERSE the district court’s judgment.

I. BACKGROUND

Filthaut works at Michigan Bell Telephone Company as a call center service representative, a sedentary job. Through her employment, Filthaut participates in the AT&T Midwest Disability Bénefits Program, which is a component of the AT&T Umbrella Benefit Plan No. 3 (“the Plan”).

(a) Disability Plan

Four provisions of the disability plan are salient here.

First, the Plan gives the claims administrator discretion to interpret the disability plan’s terms and determine benefits eligibility.

Second, a Plan participant is entitled to disability benefits

if the Claims Administrator determines that [the participant is] Disabled by reason of sickness, pregnancy, or an off-the[-]job illness or injury that prevents [the participant] from performing the duties of [her] job (or any other job assigned by the Company for which [she is] qualified) with or without reasonable accommodation. [The] Disability must be supported by objective Medical Evidence.

Third, the disability plan defines “medical evidence” as

[objective medical information sufficient to show that the Participant is Disabled, as determined at the sole discretion of the Claims Administrator. Objective medical information includes, but is not limited to, results from diagnostic tools and examinations performed in accordance with the generally accepted principles of the health care profession. In general, a diagnosis that is based largely or entirely on self-reported symptoms will not be considered sufficient to support a finding of Disability.

Fourth, the Plan reserves for the claims administrator the right to order a physical examination of the claimant.

(b) Filthaut’s Treatment History

Filthaut’s short-term disability claims stem from lower back pain, which a January 2012 partial right nephrectomy for kidney cancer largely resolved. The pain slowly returned, however, prompting Filthaut to visit three physicians.

In August 2013, Dr. Mohammad Al Nouri diagnosed Filthaut with lumbar degenerative disc disease and spondylosis (another term for spinal degeneration). He administered two epidural steroid injections over the next few months, but they proved ineffective at controlling Filthaut’s pain. Filthaut visited Dr. Al Nouri again in December 2013. He found that she had normal motor strength and retained “full range of motion” with respect to “[fllexion, extension and lateral movement.” Dr. Al Nouri referred Filthaut for physical therapy, which she began shortly thereafter.

Dr. Richard Kovar, a neurologist, examined Filthaut in January 2014. He identified “a myofascial strain pattern involving the right mid to lower ribs including thora-columbar fascia and including the right lower scapular region with multiple segmental somatic dysfunctions noted throughout the thoracic region” — in other words, several strained ribs. Filthaut’s neurologic evaluation was normal; her “[m]otor [examination show[ed] good bulk and tone,” and her arm and leg “[strength [was] 5/5.”

Filthaut also visited Dr. George Carley, a family care physician. In December 2013, Dr. Carley wrote in his initial physician statement that Filthaut reported “pain in spine” and “constant pain” in her right kidney. Dr. Carley recommended “no work” for a month. Filthaut saw Dr. Car-ley again in March 2014, at which time Filthaut complained of “severe low back pain” and was “unable to ambulate.” In the section of his report regarding Filthaut’s “current functional restrictions,” Dr. Car-ley wrote “no work.” Yet Dr. Carley also prescribed multiple “at work” accommodations for Filthaut: breaks every five minutes, no sitting or standing for more than five-to-ten minutes, no lifting over two pounds, no reaching over her head, no bending, no twisting, no kneeling, and no stooping.

(c) Claim 1 (January 13 — February 23, 20U)

Filthaut first sought short-term disability benefits for the period between January 13 and February 23,2014, which the claims administrator denied both initially and on appeal. The district court upheld the denial of Claim 1 benefits, and Filthaut has not appealed; we therefore do not recite Claim l’s details here.

(d) Claim 2 (March 3 — April lk, 201k) .

Filthaut briefly returned to work but began another leave on March 3, 2014, prompting the claims administrator to initiate a claim for Filthaut’s relapse absence. Dr. Leela Rangaswamy, an orthopedic surgeon, conducted the independent physician advisor review of Filthaut’s records. In her report, she referenced Dr. Carley’s physician statement listing various work restrictions and limitations, but noted that the statement did “not include a detailed physical examination.” Dr. Rangaswamy — -who left a voicemail for Dr. Carley but never connected with him — identified no “well-defined focal physical findings that would substantiate” Dr. Carley’s determination that Filthaut could not work. Relying on Dr. Rangaswamy’s report, the claims administrator denied Filthaut’s disability claim.

■ Filthaut appealed for the period between March 3 and April 14, citing her back and kidney problems. The claims administrator referred the matter for additional independent physician advisor reviews in nephrology and physical-medicine- and-rehabilitation/pain medicine (“PM&R/pain medicine”).

Dr. Laurence Friedman, the reviewing nephrologist, spoke with Dr. Carley, who “reported that Ms. Filthaut has a complex chronic pain disorder on the basis of mus-culoskeletal disease and that there are no other renal issues beyond her previous partial nephrectomy for cancer.” From his review of the records and conversation with Dr. Carley, Dr. Friedman found that Filthaut had “no issues from the nephrolo-gy standpoint affecting her functional capacity/ability to work.”

Dr. Howard Grattan, the reviewing PM&R/pain medicine physician, attempted to, but could not, connect with Dr. Carley or Dr. Sandy Payne, Filthaut’s physical therapist. Nonetheless, he “reviewed the clinical notes, claim documents, diagnostics, claimant’s job description and appeal letter.” In his report,1 Dr. Grattan noted Filthaut’s back and kidney pain but concluded that “there are no measurable objective findings that would support restrictions, limitations and/or disability from [Filthaut’s] regular job.”

The claims administrator upheld the denial of benefits. The appeal-denial letter summarized Dr. Friedman’s and Dr.

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710 F. App'x 676, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rebecca-filthaut-v-att-midwest-disability-benefit-plan-ca6-2017.