Ross v. Reliance Standard Life Insurance

112 F. Supp. 3d 620, 2015 U.S. Dist. LEXIS 72749, 2015 WL 3559876
CourtDistrict Court, W.D. Michigan
DecidedJune 5, 2015
DocketCase No. 1:13-cv-1270
StatusPublished

This text of 112 F. Supp. 3d 620 (Ross v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ross v. Reliance Standard Life Insurance, 112 F. Supp. 3d 620, 2015 U.S. Dist. LEXIS 72749, 2015 WL 3559876 (W.D. Mich. 2015).

Opinion

OPINION

JANET T. NEFF, District Judge.

Plaintiff filed this case pursuant to the Employment Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., seeking reinstatement of his long-term disability (LTD) benefits by Defendant Reliance Standard Life Insurance Company, the plan’s claims administrator. Pending before the Court is Defendant’s Motion for Judgment on the Administrative Record (Dkt. 42), and Plaintiffs opposing “Initial Brief Challenging Administrative Decision” (Dkt. 41), with responses and reply briefs (Dkts. 44, 45, 48-49). The Administrative Record (AR) has also been filed (Dkts. 20-32). Having carefully considered the parties’ briefs and the Administrative Record, the Court denies Defendant’s Motion, ánd reverses Defendant’s decision terminating Plaintiffs LTD benefits.

I. Background

Plaintiff worked for Denso Manufacturing (“Denso”) as a forklift driver in a warehouse, and was 'covered by a disability benefit plan subject to ERISA.1 Plaintiffs date of hire at Denso was June 2, 2003, and his last day worked due' to disability was August 12, 2010 (AR at p. ID# 135). The following day, on August 13, 2010, Plaintiff obtained a consultation with Joseph C. Roth, D.O./Physician Assistant John D. Kehl, P.A.-C., of the Delton, Michigan, Medical Center due to chronic and worsening “shaking all over,” which had come “on gradually over past 1-2 years” and .“gotten worse in [thé] last 2-3 months,” and was accompanied by pain, an inability to sleep, balance and locomotion deficits, and memory failure during more acute attacks (id, at p. ID# 503). Plaintiff states that he was placed on narcotic pain medication, Vicodin, among other medications, and placed on medical disability from employment by P.A. Kehl (id. at p. ID# 376, 523). A December 27, 2010 “Dear Employer” disability letter, written by P.A. Kehl, stated'Plaintiffs diagnosis as “neurologic disorder, tremor” and prospectively disabled Plaintiff at least through June 1, 2011, stating a “return to work date” of “never” (id. at p. ID# 376, 523).

At that time, the plan administrator for Denso’s self-funded six-month short-term disability (STD) plan was Matrix Absence Management, Inc., and Matrix approved short-term disability benefits for Plaintiff for the maximum period (AR at p. ID# 386, 388). In a December 17, 2010 letter, Matrix advised Plaintiff that it also administered Reliance’s LTD Policy on Denso, and indicated he should consider applying for ongoing benefits thereunder if [622]*622he thought he would be totally disabled longer than anticipated under the STD benefit plan (id. at 388).

Plaintiff applied for LTD benefits, and, on January 11, 2012, received a letter from Theresa Callaway, Defendant’s “Integrated Claims Examiner,” advising him that Defendant, had deemed him “totally disabled from performing any occupation for which you are qualified” and that, accordingly, he would be paid LTD benefits to “2032 or , until you no longer meet the provisions of your policy, whichever occurs first” (AR at p. ID# 291, 662). However, on August 22, 2012, Lisa A. Murikelwitz, of Defendant’s “LTD Claims Department,” wrote Plaintiff to advise him that his LTD benefits would be prospectively terminated “on February 29, 2013” (id. at p. ID# 620-21). The sole enunciated reason for the termination of benefits was:' “Based on the medical information within your long-term disability claim file, it appears that your primary diagnosis is that of a mental or nervous disorder,” arid as a result, his LTD benefits were limited by the 24-month limitation provision in the LTD Policy for “Mental or Nervous Disorders” (id. p. ID# 293), which states:

MENTAL OR' NERVOUS DISORDERS: Monthly Benefits for Total Disability caused by or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months....

The policy defines “Mental or Nervous Disorders”, to include disorders which are diagnosed to include a condition such as:

(1) bipolar disorder (manic depressive syndrome);,
(2) schizophrenia;
(3) delusional (paranoid) disorders;
(4) psychotic disorders;
(5) depressive disorders;
(6) anxiety disorders; -
(7) somatoform disorders (psychosomatic illness);
(8) eating disorders; or
(9) mental illness.

(id. at p. ID# 102).

On October 3Q, 2013, Defendant denied Plaintiffs administrative appeal of the termination of his benefits (AR at p. ID# 335-341), and this case seeking judicial review followed.

II. Legal Standard

The parties have stipulated that the de novo review standard applies (Dkt. 36). Under this standard, “the role of the court reviewing a denial of benefits ‘is to determine whether the administrator ... made a correct decision.’” Hoover v. Provident Life & Accident Ins. Co., 290 F.3d 801, 808-09 (6th Cir.2002) (quoting Perry v. Simplicity Eng’g, 900 F.2d 963, 967 (6th Cir.1990)). “The administrator’s decision is accorded no deference or presumption of correctness.” Hoover, 290 F.3d at 809. “The review is limited to the record before the administrator and the court must determine whether the administrator properly interpreted the plan and whether, the insured was. entitled to benefits under the plan.” Id.

III. Analysis

Defendant asserts, and Plaintiff does not dispute that “[t]he sole issue before the Court is whether Plaintiffs disability was caused by or contributed to by a mental/nervous disorder and his claim therefore [is] subject to the mental/nervous limitation provision, limiting benefit payments to 24 months as determined by Reliance Standard” (Def. Mot., Dkt. 42, at p. ID# 1311). Defendant argues that the record before the Court unequivocally demonstrates that Plaintiffs claim is subject to the mental and nervous limitation provision in that (1) Plaintiff does not suf[623]*623fer from an organic neurological disorder but rather from a mental/nervous disorder (id. at p. ID# 1322); and (2) Plaintiff suffers from a nonorganic psychogenic tremor and a likely conversion and/or somatization disorder, which is referenced in the Policy as a mental disorder and limited to payment of benefits over - a period of 24 months during the lifetime of the claimant, and which benefits Plaintiff has exhausted under the policy (id. at p. ID# 1324). Further, and in any event, even if Plaintiff does have an organic neurological-condition, he also suffers from a psychiatric condition and his disability thus falls within the policy limitation as “caused by or contributed to by” a mental or nervous disorder,. such as depression or anxiety (id.).

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112 F. Supp. 3d 620, 2015 U.S. Dist. LEXIS 72749, 2015 WL 3559876, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ross-v-reliance-standard-life-insurance-miwd-2015.