Smith v. Federal Express Corp. Long Term Disability Plan

991 F. Supp. 2d 992, 2014 WL 115753, 2014 U.S. Dist. LEXIS 4917
CourtDistrict Court, W.D. Tennessee
DecidedJanuary 13, 2014
DocketCase No. 11-02691
StatusPublished
Cited by1 cases

This text of 991 F. Supp. 2d 992 (Smith v. Federal Express Corp. Long Term Disability Plan) is published on Counsel Stack Legal Research, covering District Court, W.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Federal Express Corp. Long Term Disability Plan, 991 F. Supp. 2d 992, 2014 WL 115753, 2014 U.S. Dist. LEXIS 4917 (W.D. Tenn. 2014).

Opinion

OPINION AND ORDER GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [21] AND DENYING PLAINTIFF’S CROSS-MOTION FOR SUMMARY JUDGMENT [22]

ARTHUR J. TARNOW, Senior District Judge.

I. Introduction

Before the Court is Defendants’ Motion for Summary Judgment [21], and Plaintiffs Cross-Motion for Summary Judgment [22]. Plaintiffs Complaint [1] seeks action under the Employee Retirement Income Security Act (“ERISA”) to recover full benefits and a remedy for breach of fiduciary duty. Defendants’ Motion for Summary Judgment [21] claims Defendant Aetna Life Insurance Company (“Aetna”) has been misjoined and should be dismissed, and that denial of Federal Express Corporation Long Term Disability Plan (“LTD Plan”) benefits was not arbitrary and capricious. Plaintiffs Cross-Motion for Summary Judgment [22] claims that the LTD Plan’s denial of Plaintiffs benefits was arbitrary and capricious.

For the reasons stated below, Defendants’ Motion for Summary Judgment [21] is GRANTED, and Plaintiffs Cross-Motion for Summary Judgment [22] is DENIED.

II. Background

Plaintiff Smith worked for Defendant Federal Express Corporation (“FedEx”) from 1985 until May 28, 2007. Plaintiff received short-term disability benefits (“STD Plan”) through FedEx’s insurance plan provider Aetna from May 28, 2007 until November 26, 2007, at which time his LTD Plan coverage began. Plaintiff remained on the LTD Plan for two years, receiving 60% of a Covered Employee’s monthly income. Plaintiff was denied further benefits through the LTD Plan because the plan adjusts the definition of “disability” after the first two years of coverage. In order to continue receiving LTD Plan benefits after two years, the plan’s requisite level of disability is no longer Occupational Disability, defined as an inability to “perform duties of regular occupation,” but rather Total Disability, defined as an inability to “engage in any compensable employment for twenty-five hours per week.”

The parties agree that Plaintiff has suffered from numerous medical problems, most notably Class III heart disease, as diagnosed by Plaintiffs cardiologist Dr. Stevin Gubin in September 2008. The parties also agree that Plaintiffs New York Heart Association (“NYHA”) Class III cardiac status limits his physical activity, as evidenced by Plaintiff self-reporting a “shortness of breath” after cleaning his father-in-law’s gutters in a May 18, 2009 physician’s note. However, in a series of reports and statements made between October 2007 and April 2010, Plaintiffs personal physicians and Aetna-retained physicians have disagreed regarding whether Plaintiff is able to engage in sedentary employment.

In October 2007, Dr. Gubin reported that Plaintiff was unable to “tolerate any type of work.” However, in a September 22, 2008 physical examination, Dr. Gubin concluded that Plaintiff was able to sit for five hours, stand or walk for three hours in an eight-hour work day, and use his hands for a “repetitive motion such as writing or [995]*995typing.” Further, Plaintiff showed ability to use his feet for “repetitive movements as in operating foot controls” and could frequently lift up to ten pounds, and occasionally lift up to twenty pounds.

The Social Security Administration (“SSA”) granted Plaintiff Social Security disability on October 23, 2008, finding that Plaintiff had been unable to perform sedentary work since May 10, 2007.

A later examination by Dr. Gubin on August 31, 2009 described Plaintiff as “appearing hemodynamieally stable,” meaning that although his heart condition was chronic, it was stable and not anticipated to worsen. In anticipation of Plaintiffs LTD Plan coverage expiring, Plaintiff was also seen by his endocrinologist Dr. Harold Sacks on July 31, 2009. A report from this examination concluded that because of Plaintiffs widely varying levels of blood glucose and lipid readings, he was unable to perform twenty-five hours of weekly sedentary employment. However, as clarified by Dr. Sacks in the same report, and corroborated by Dr. Burton Hayes in a January 12, 2010 report, Plaintiffs variations were the result of his correctable non-compliance with diabetes treatment. Specifically, Dr. Hayes called Plaintiff a “ticking time bomb” in describing the possibility of recurrence of cardiovascular events as a result of Plaintiffs continued non-compliance with prescription medications, dietary and exercise recommendations, as well as continued use of tobacco and consumption of alcohol.

As Plaintiff neared the LTD Plan two-year benchmark in November 2009, examination of his medical records by LTD Plan Nurse Consultant Marilyn Hippie, RN and Aetna-retained physician Dr. Stephen Waggoner, confirmed by letter on August 31, 2009, determined that Plaintiff was able to work at any compensable employment for a minimum of twenty-five hours a week. Further examination of Plaintiffs records by Aetna-retained cardiologist Dr. Ira Feldman on October 16, 2009 concurred with Dr. Waggoner’s recommendation in concluding that Plaintiffs impairments were insufficient to prevent Plaintiff from performing the minimum employment to satisfy Total Disability.

These recommendations were based in part on a June 19, 2009 stress test performed at the Stern Cardiovascular Center that revealed Plaintiff had an increased, yet still low ejection fraction rate,1 and no definitive sign of ischemia,2 contradicting Dr. Gubin’s records. Aetna’s Administrative Record shows the test results demonstrated Plaintiffs stability from a “cardiac perspective,” requiring no further treatment. The record indicated that Plaintiffs heart conditions were stable, that his hypertension, high cholesterol, and blood sugar levels were controlled by medication, and that more than five years of physical examinations had yet to reveal chest pain.

An additional review of Plaintiffs records by Aetna-retained cardiologist Dr. Leonard Pianko concurred with the recommendations of Dr. Waggoner and Dr. Feldman, noting that although Plaintiffs heart function was unhealthy, he was “stable from a cardiac perspective,” as expressed in the Aetna Administrative Record. Further, Dr. Pianko expressed that although Plaintiffs heart function was not perfect, as had become generally accepted based on Plaintiffs low ejection fraction rate and chronic problems from a prior heart attack, his overall heart health had improved. As a result, Dr. Pianko also determined that in his opinion Plaintiff was [996]*996able to work at any compensable employment for a minimum of twenty-five hours a week.

In total, five physicians evaluated Plaintiffs health and provided an opinion as to his Total Disability status. Three of the five physicians, including the entirety of the Aetna-retained team, concluded that Plaintiff could perform the requisite twenty-five hours of sedentary employment weekly. Although Dr. Gubin stated as recently as April 2010 that “any type of stress at work would be extremely detrimental to [Plaintiffs] health,” the same statement also noted that Plaintiff was only limited in his ability to perform strenuous or stressful work.

III. Standard of Review

Under ERISA, when a plan administrator, such as Defendant Aetna in this case, has the discretionary authority to determine eligibility for benefits, courts review a decision to deny benefits under “the highly deferential arbitrary and capricious standard of review.” McDonald v. Westerm-Southern Life Ins. Co.,

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Related

Brown v. Federal Express Corp.
62 F. Supp. 3d 681 (W.D. Tennessee, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
991 F. Supp. 2d 992, 2014 WL 115753, 2014 U.S. Dist. LEXIS 4917, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-federal-express-corp-long-term-disability-plan-tnwd-2014.