Tanner v. Nationwide Mutual Insurance

804 F. Supp. 2d 601, 51 Employee Benefits Cas. (BNA) 1694, 2011 U.S. Dist. LEXIS 39083, 2011 WL 1238189
CourtDistrict Court, S.D. Ohio
DecidedMarch 28, 2011
DocketCase No. 2:09-cv-866
StatusPublished
Cited by2 cases

This text of 804 F. Supp. 2d 601 (Tanner v. Nationwide Mutual Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tanner v. Nationwide Mutual Insurance, 804 F. Supp. 2d 601, 51 Employee Benefits Cas. (BNA) 1694, 2011 U.S. Dist. LEXIS 39083, 2011 WL 1238189 (S.D. Ohio 2011).

Opinion

OPINION AND ORDER

MICHAEL H. WATSON, District Judge.

Plaintiff Sharon Joann Tanner filed this civil action after her employer, Nationwide Mutual Insurance Company, acting through its Benefits Administrative Committee, terminated her long-term disability benefits. The Court has jurisdiction to hear this case under provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., and particularly 29 U.S.C. § 1132(a)(1)(B). The case is before the Court on cross-motions for judgment on the administrative record (ECF Nos. 21 & 22) and the record itself (R., ECF Nos. 12 & 14) (“Record”). Ms. Tanner, in her motion, asks the Court either to reinstate her benefits, which were granted in April 2008 and discontinued in May 2009, or, in the alternative, to remand the matter to Nationwide for further consideration of her appeal from the termination of her benefits. For the reasons that follow, the Court DENIES Defendants’ motion for judgment [602]*602as a matter of law on the administrative record (ECF No. 21) and GRANTS Plaintiffs motion for judgment as a matter of law (ECF No. 22), and REMANDS this case to Defendant for further consideration.

I. FACTS

All of the pertinent facts in this case appear in the administrative record. Under Wilkins v. Baptist Healthcare System, “the district court [is] confined to the record that was before the Plan Administrator.” 150 F.3d 609, 615 (6th Cir.1998). The Court will summarize the pertinent portions of that record — particularly the medical evidence — here. The relevant portions of the long-term disability plan under which Ms. Tanner was first awarded, and then denied, benefits are set out in Section III below. The evidence summarized in this portion of the Opinion and Order is found in Part Two of the administrative record (ECF No. 14) which was filed under seal.

A. Medical Records

The medical charts and reports contained in the Record appear to be dated from 2002 through 2009. The earliest reports include notes from an anterior cervical vertebrectomy and diskectomies with bone grafts and hardware placement done on May 25, 2002. The pre-operative and post-operative diagnoses were right greater than left cervical radiculopathy, secondary to disc protrusion C5-6 and C6-7 with cervical stenosis, C5-6 through C6-7. That surgery pre-dated Ms. Tanner’s alleged date of disability by almost six years, and she was able to return to work after the surgery. (R. NW/Tanner 182-85).

In March 2005, as a result of an MRI of the cervical spine, Ms. Tanner was diagnosed with, among other conditions, central spinal canal stenosis at the C3-4 and C4-5 levels, as well as mild foraminal stenosis at C4-5. The canal stenosis was attributed to discogenic disease. There was also a spur evident on the right side at C6-7. A repeat study performed in November of that year showed multilevel disc dessication and some disc bulging as well as some spondylosis at the C5-6 and C6-7 levels. (R., NW/Tanner 213-216).

Following those studies, Ms. Tanner was seen by Dr. Degenova at Grant Sports Medicine on February 15, 2006. At that time, she was reporting substantial neck pain which also radiated down her left arm. She noted some improvement from a recent injection but not from physical therapy. She also reported hand weakness and pain in the upper back area. After discussion of the procedure, Ms. Tanner agreed to a left C6-7 posterior cervical neural foraminotomy and decompression, and Dr. Degenova performed that surgery on March 14, 2006. The operation is also described as a “keyhole foraminotomy.” On April 13, 2006, after the surgery, Ms. Tanner was doing very well, with no arm pain and only occasional tingling and numbness. She was released to return to work after therapy, which she apparently did, according to a treatment note dated June 21, 2006, which described her as “doing great.” (R., NW/Tanner 207).

Dr. Degenova did not see Ms. Tanner again until May 2008. At that time, she reported doing well with the prior foraminotomy, but was having “horrible” neck pain radiating into her left shoulder, made worse by working. At that point she had been off work for two weeks and had applied for disability. On physical examination, she moved quite slowly and gingerly and exhibited tenderness along the left paravertebral muscles. Dr. Degenova recommended physical therapy and agreed to complete disability paperwork for her. (R., NW/Tanner 205-06). He saw her again several times in 2008 for complaints of back and foot pain, and at one point [603]*603recommended epidural steroid injections for her back pain.

Ms. Tanner’s family doctor at this time was Dr. Seidt. He also completed disability forms for her in 2008, indicating on one of them that she became totally disabled on April 18, 2008, not just from her job, but from any job. Dr. Seidt listed the disabling diagnoses as cervical degenerative disc disease and chronic back pain. In the narrative portion of the form, he wrote “Sharon has tried various work modifications and reduced schedules at work with no success. Very minimal amounts of physical labor sets [sic] her back. She is permanently disabled.” (R., NW/Tanner 173-75). Dr. Seidt had completed a disability report the prior month that said essentially the same thing, and Dr. Degenova also completed a form indicating Ms. Tanner could never return to work. (R., NWYTanner 142 — 48).

At Nationwide’s request, Ms. Tanner was seen by Dr. Hannallah, an orthopedic surgeon, on November 3, 2008. Dr. Hannallah did this work under the auspices of an organization known as MLS National Medical Evaluation Services. He took a history from her which encompassed the two surgeries, the second of which did help with her radiculopathy. However, she said that she continued to have neck pain and had recently developed pain in her left leg. She had some moderate relief with steroid injections. Her symptoms also included occasional cramping of the hands, a two-year history of numbness and tingling in her left arm, and left arm weakness. She was taking thirteen separate medications, a number of which were for pain.

Dr. Hannallah performed a physical examination during which Ms. Tanner exhibited a good range of motion in her neck and good symmetric upper extremity strength and sensation with good reflexes. He also reviewed a number of medical records including the 2005 MRI studies and an August 2008 MRI of the lumbar spine showing mild to moderate degenerative changes from LI through SI. He did not have any records from either Dr. Degenova or Dr. Mayer, who performed the 2002 surgery. He stated after this examination and review that Ms. Tanner “has no objective weakness or changes in her neurologic exam. Her main complaint is of pain which I can neither refute nor substantiate.” His report also noted that he did not have the benefit of any records from her treating physician and that he did not have enough information to express an opinion about whether Ms. Tanner was disabled as defined in the Plan because of the lack of “post-operative medical notes or imaging studies.” He agreed that she “should refrain from vigorous activity involving her neck per her treating physician.” (R., NW/Tanner 176-79).

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804 F. Supp. 2d 601, 51 Employee Benefits Cas. (BNA) 1694, 2011 U.S. Dist. LEXIS 39083, 2011 WL 1238189, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tanner-v-nationwide-mutual-insurance-ohsd-2011.