Schiro v. Office Depot, Aetna Life Insurance

996 F. Supp. 2d 471, 2014 WL 295070, 2014 U.S. Dist. LEXIS 9618
CourtDistrict Court, E.D. Louisiana
DecidedJanuary 27, 2014
DocketCivil Action No. 13-1156
StatusPublished

This text of 996 F. Supp. 2d 471 (Schiro v. Office Depot, Aetna Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schiro v. Office Depot, Aetna Life Insurance, 996 F. Supp. 2d 471, 2014 WL 295070, 2014 U.S. Dist. LEXIS 9618 (E.D. La. 2014).

Opinion

ORDER AND REASONS

MARY ANN VIAL LEMMON, District Judge.

IT IS HEREBY ORDERED that Plaintiffs Motion for Summary Judgment [473]*473(Doc. # 32) is GRANTED, and this matter is REMANDED to the plan administrator for consideration of the opinions of Dr. Truax and Dr. Fautheree.

IT IS FURTHER ORDERED that Office Depot and Sedgwick Claims Management Services’s Motion for Summary Judgment (Doc. # 33) is DENIED.

BACKGROUND

This matter is before the court on cross-motions for summary judgment filed by plaintiff and defendants. The parties agree that there are no disputed issues of material fact, and each argues that it is entitled to summary judgment in its favor.

Plaintiff, Alvin Schiro began working for defendant, Office Depot on November 17, 1997, and eventually became the manager of the Office Depot store in Slidell, Louisiana. The working conditions and physical demands of an Office Depot store manager are:

Must be able to read, count, and write to accurately complete all documents.
Must be able to operate all equipment necessary to run the store.
Must be able to freely access all areas of the store including selling floor, stock and register areas.
Must be able to climb a ladder.
Must be able to move or handle merchandise throughout the store generally 0-50 pounds.
Must be able to work varied hours/days to oversee store operations.

As an Office Depot employee, Schiro was covered by Office Depot’s self-insured short-term disability insurance, which was administered by defendant, Sedgwick Claims Management Services, Inc.

In December 2011, Schiro sought medical treatment for “flu-like symptoms,” and was diagnosed with an umbilical and ven-tra hernia and associated problems of his stomach lining. He underwent surgery on January 18, 2012. Schiro was out of work from December 15, 2011 to February 13, 2012, and Sedgwick approved his medical leave of absence and short-term disability benefits claim.

Thereafter, Schiro experienced additional medical issues. On April 18, 2012, an x-ray revealed a total blockage of his colon, and he was admitted to the hospital for emergency surgery. Schiro was treated for an infection for seven days in the intensive care unit, and an additional three days in a regular hospital room. On April 24, 2012, Sedgwick was notified of Schiro’s short-term disability claim associated with this surgery. On April 27, 2012, Sedgwick notified the Office Depot human resources manager that Schiro’s claim would be denied if the medical documentation was not received by May 10, 2012. Schiro’s surgeon certified his disability though June 12, 2012. However, on May 21, 2012, Sedgwick approved Schiro’s short-term disability claim from April 18, 2012 through May 30, 2012, because their guidelines indicated that it should end on May 30, 2012, rather than the doctor’s recommended date of June 12, 2012. The Sedg-wick claims adjustor’s May 22, 2012, notes state that Schiro “may have post-op complications which may pose for a longer recovery time. However 6/13/12 does not seem unrealistic given [Shiro’s] heavy job demands and nature of the surgery.”

While recovering from the April 18, 2013, surgery, Schiro developed back pain and his surgeon referred him to neurologists, Dr. Walter D. Truax and Dr. Gregory L. Fautheree. On June 1, 2012, the surgeon informed Sedgwick that Schiro would see a neurologist.

On June 11, 2012, Dr. Truax wrote Schi-ro’s surgeon to inform him that he examined Schiro, and Schiro had some limited forward flexation, complained of some back pain, had diminished sensation to pinprick over the distribution of left lateral [474]*474femoral cutaneous nerve, symmetric reflexes and normal strength. Dr. Truax opined that Schiro had meralgia paraesth-entica. He ordered an electromyogram (“EMG”) of Schiro’s left leg and x-rays of his spine. Schiro said that he could not work, and Dr. Truax “said that was fine,” and he could “stay off work for the time being.”

On June 14, 2012, a registered nurse examiner at Sedgwick reviewed Schiro’s claim “to determine if the medical information presented substantiates potential extension as requested certification period extends beyond” the guidelines. The nurse reviewed Dr. Truax’s file, and noted that Schiro has “stinging burning pain associated with numbness” and that the “[pjhysical exam indicates that [Schiro] has some limited forward flexation, that he complains of some back pain, and that he has diminished pinprick over the left lateral femoral cutaneous nerve.” The nurse notes that Schiro’s reflexes and strength are normal and that the doctor ordered an EMG and x-ray. The nurse concludes:

Given there is no indication that [Schiro] is unable to ambulate, requires an assis-tive device, or that there are any other limitations, [the] medical information available does not support that [Schiro] would be unable to perform his essential job functions at this time. [Schiro’s] job as a store manager has a moderate to heavy physical demand but [the] medical information available does not support severity that [he] would be unable to perform his job functions. [Schiro’s] reports of being unable to do his job are not in themselves disabling.

On July 9, 2012, Dr. Truax noted on Schiro’s chart that his EMG was normal, and that the magnetic resonance imaging (“MRI”) scans showed multilevel degenerative disc disease. Dr. Truax attributed the burning over Schiro’s left anterolateral thigh to meralgia paraesthetica. Dr. Truax prescribed Neurontin, and scheduled a follow-up appointment. Schiro asked Dr. Truax if he could work. Dr. Truax said that it was Schiro’s choice, and Schiro indicated that he could not work, which Dr. Truax said was “fine.”

On July 10, 2012, Dr. Truax completed a Sedgwick form stating that Schiro is unable to return to work until further notice.

On July 16, 2012, Sedgwick denied Schi-ro’s claim for short-term disability benefits beyond May 30, 2012. Sedgwick stated that the “medical information provided did not support continuing disability,” because “there was no objective medical evidence in the claim file to support disability beyond 05/31/2012.” Sedgwick noted that Schiro’s EMG was normal, and that the MRI scans showed degenerative changes, but that the reports were not available for review. Further, Sedgwick notes that Schiro requested to stay off of work and Dr. Truax agreed.

On July 19, 2012 and on July 23, 2012, the Sedgwick claims adjustor spoke with “Tyrie,” an otherwise unidentified employee at Dr. Truax’s office by telephone. Tyrie stated that Dr. Truax signed the paperwork stating that Schiro was disabled, but the doctor “does not feel” that Schiro was disabled. Tyrie also stated that Schiro could not return to work until he saw Dr. Truax on August 21, 2012.

On July 23, 2012, a registered nurse examiner at Sedgwick again reviewed Schiro’s claim. The nurse concluded that the “[m]edical information does not substantiate extension of disability at this time” because “there is no indication that [Schiro] is unable to ambulate, requires an assistive device, or that there are any other limitations.”

On July 24, 2012, Sedgwick informed Office Depot that Schiro’s claim for short-term disability from May 31, 2012 through [475]

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996 F. Supp. 2d 471, 2014 WL 295070, 2014 U.S. Dist. LEXIS 9618, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schiro-v-office-depot-aetna-life-insurance-laed-2014.