Street v. Aetna Life Insurance Co.

188 F. Supp. 3d 1279, 2016 U.S. Dist. LEXIS 67226, 2016 WL 2961556
CourtDistrict Court, M.D. Florida
DecidedMay 23, 2016
DocketCase No: 8:15-cv-388-T-24 MAP
StatusPublished
Cited by1 cases

This text of 188 F. Supp. 3d 1279 (Street v. Aetna Life Insurance Co.) 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
Street v. Aetna Life Insurance Co., 188 F. Supp. 3d 1279, 2016 U.S. Dist. LEXIS 67226, 2016 WL 2961556 (M.D. Fla. 2016).

Opinion

ORDER

SUSAN C. BUCKLEW, United States District Judge

This cause comes before the Court on Defendants’, Aetna Life Insurance Company (“Aetna”) and Federal Express Corporation (“FedEx”), Motion for Summary Judgment (Dkt. 37), to which Plaintiff, Patricia Street, has filed a response in opposition (Dkt. 46).1 For the reasons stated [1281]*1281herein, the Court GRANTS summary judgment in favor of Defendants.

I. SUMMARY JUDGMENT STANDARD OF REVIEW

.Summary judgment is appropriate “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The Court must draw all inferences from the evidence in the light most favorable to the non-movant and resolve all reasonable doubts in that party’s favor. See Porter v. Ray, 461 F.3d 1315, 1320 (11th Cir.2006) (citation omitted). The moving party bears the initial burden of showing the Court, by reference to materials on file, that there are no genuine issues of material fact that should be decided at trial. See id. (citation omitted). When a moving party has discharged its burden, the non-moving party must then go beyond the pleadings, and by its own affidavits, or by depositions, answers to interrogatories, and admissions on file, designate specific facts showing there is a genuine issue for trial. See id. (citation omitted).

When the deferential standard of review applies, evidence is rarely taken and the usual tests for summary judgment, such as whether genuine issues of material fact exist, do not apply. Curran v. Kemper Nat. Servs., Inc., No. 04-14097, 2005 WL 894840, at *7 (11th Cir. March 16, 2005) (“In an ERISA benefit denial case.. .in a very real sense, the district court sits more as an appellate tribunal than as a trial court. It does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.”); see Providence v. Hartford Life & Acc. Ins. Co., 357 F.Supp.2d 1341, 1342 (M.D.Fla.2005); Garrett v. Prudential Ins. Co. of Am., 107 F.Supp.3d 1255, 1264 (M.D.Fla.2015).

II. BACKGROUND

A. The Long-Term Disability Plan

Plaintiff was insured under the employee welfare benefit plan known as The Federal Express Corporation Long Term Disability Plan, which provides for the funding and payment of long-term disability benefits to employees that are covered under the Plan. Dkt. 24-10 at 29; AR 01884. FedEx is the Plan administrator and Aet-na is the Claims Paying Administrator of the Plan. The Plan gives Aetna, as the Claims Paying. Administrator, “sole and exclusive discretion.. .with respect to all matters ... relating to the eligibility of a claimant for benefits under the Plan.” Dkt. 24-10 at 3. Further, “[t]he determination of the Claims Paying Administrator shall be made in a fair and consistent manner in accordance with the Plan’s terms and its decision shall be final, subject only to a determination by a court of competent jurisdiction that the individual’s or committee’s decision was arbitrary and capricious.” Id. at 3-4.

If an eligible FedEx employee becomes “Disabled” as defined by the Plan, then the employee “shall be entitled” to receive Long-Term Disability (“LTD”) benefits. Dkt. 24-10 at 47. The employee shall be paid a monthly disability benefit that is equal to 60% of that covered employee’s monthly income. Id. The Plan provides the following definition for “Disabled”:

Disability or Disabled shall mean "either an Occupational Disability or a Total Disability; provided, however, that a Covered Employee shall not be [1282]*1282deemed to be Disabled or under a Disability unless he is, during the entire period of Disability, under the direct care and treatment of a Practitioner and such Disability is substantiated by significant objective findings which are defined as signs which are noted on a test or medical exam and which are considered significant anatomical, physiological or psychological abnormalities which can be observed apart from the individual’s symptoms. In the absence of significant objective findings, conflicts with managers, shifts and/or work place setting will not be factors supporting Disability under the Plan.

Dkt. 24-10 at 33-34.

An employee is an “Eligible Employee” if she is “an Employee who is engaged in a Permanent Full-Time Employment_” Dkt. 24-10 at 34. However, an employee that is “classified as casual, temporary, permanent part-time..,or who is on a personal family (other than a family leave for his own illness or injury), unapproved disability or other leave of absence ... shall not be an Eligible Employee.” Id. at 34-35.

In order to prove a qualifying disability, the employee or the employee’s health care professional must provide proof that the employee is disabled, based on significant objective findings, such as: (1) medical examination findings; (2) test results; (3) X-ray results; and/or (4) observation of anatomical, physiological or psychological abnormalities. Pain alone is not proof of a disability.

If a covered employee suffers from an Occupational Disability, the Plan provides long-term benefits equal to 60% of the employee’s monthly income for up to two years. An “Occupational Disability” means “the inability of a Covered Employee, because of a medically-determinabie physical or functional impairment... to perform the duties of his regular occupation,” Dkt. 24-10 at 37-38.

In order to receive LTD benefits for more than two years under the Plan, a Covered Employee must be Totally Disabled. A “Total Disability” means “the complete inability of a Covered Employee, because of a medically-determinabie physical or functional impairment.. .to engage in any compensable employment for twenty-five hours per week.” Id. at 41.

Coverage under the Plan automatically terminates under a number of scenarios, including the date an employee ceases to meet the definition of an Eligible Employee. Mat 44,

B. Plaintiffs Employment and Medical History

Plaintiff worked as a Senior Business Systems Advisor at Fed.Ex. Dkt. 24-2 at 7. Plaintiff was given Short-Term Disability benefits from March 28, 2011 to September 25, 2011 when she suffered an intrailac thromboembolism, which resulted in Plaintiff not being able to work in her normal position at FedEx. Id. at 1. Plaintiff also suffered from other ailments, including emphysema, hypertension, chronic obstructive pulmonary disease (“COPD”) and complained of weakness and numbness in her thighs. Dkt. 24-1 at 2. Plaintiff then received LTD benefits under the Plan from September 26, 2011 to September 25, 2013. Dkt. 24-2 at 1. Because Plaintiff had received LTD benefits for the maximum of two years, she needed to qualify as having a Total Disability in order to continue to receive LTD benefits. On September 26, 2013, Plaintiff was denied LTD benefits because there was “a lack of significant objective findings to substantiate a claim under the'Plan for Total Disability,” i. e.,

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188 F. Supp. 3d 1279, 2016 U.S. Dist. LEXIS 67226, 2016 WL 2961556, Counsel Stack Legal Research, https://law.counselstack.com/opinion/street-v-aetna-life-insurance-co-flmd-2016.