Tassone v. United of Omaha Life Insurance Co.

264 F. Supp. 3d 867
CourtDistrict Court, N.D. Illinois
DecidedAugust 30, 2017
DocketCase No. 15 C 8557
StatusPublished
Cited by2 cases

This text of 264 F. Supp. 3d 867 (Tassone v. United of Omaha Life Insurance Co.) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tassone v. United of Omaha Life Insurance Co., 264 F. Supp. 3d 867 (N.D. Ill. 2017).

Opinion

Robert W. Gettleman, United States District Judge

MEMORANDUM OPINION AND ORDER

After plaintiff ceased working as a ..finance manager for her previous employer, MiraMed on March 30, 2012, due to a variety of ailments including morbid obesity, left lateral L4-L5 disc herniation with facet synovitis and synovial cyst producing foraminal stenosis, pulmonary embolism, fibromyalgia, and deep vein thrombosis (“DVT”), she applied for long term disability (“LTD”) benefits, which defendant United of Omaha Life Insurance Company (“United of Omaha”) approved and paid from June 2012 . through June 30, 2014. Defendant- continued paying from July 1, 2014 through August 31, 2014, under a reservation of rights while reviewing whether plaintiff was entitled to a continuation of benefits. Defendant terminated plaintiffs benefits on August 31, 2014. After exhausting her appeals, plaintiff brought the instant action against defendants United of Omaha and MiraMed Global Services, Inc. Long Term Disability Plan (the “Plan”)1, pursuant to ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), seeking reinstatement of LTD benefits. The parties have stipulated that the court will review: (1) the administrative record containing approximately 5,400 pages of medical records; (2) an April 6, 2016 Functional Capacity Evaluation (“FCE”); a report of Dr. Jared Reeves, performed at the request of Administrative Law Judge (“ALJ”) who ultimately awarded plaintiff social security disability benefits; and (4) the ALJ decision awarding those benefits. The parties have also stipulated that the court may conduct a trial on the papers [869]*869and issue judgment pursuant to Fed. R. Civ. P. 52, and have filed cross motions for judgment supported by statements of material fact in the form used to support motions for summary judgment. For the reasons that follow, plaintiffs motion (Doc. 44) is granted, and defendants’ motion (Doc. 47) is denied.2

FACTUAL BACKGROUND

Plaintiff suffers from a variety of conditions and ailments, including: morbid obesity; left lateral L4-L5 disc herniation with facet synovitis and synovial cyst producing foraminal stenosis; bilateral C5-C6 and C6-C7 paraspinals with neurogenic denervation myofascial pain; cervical ra-diculitis; bilateral leg radiculopathy; fibro-myalgia; interstitial cystitis; and a history of atrial fibrillation, pulmonary embolism, and deep vein thrombosis. Her health and ability to work began to deteriorate in December 2011 when she suffered a pulmonary embolism as a result of DVT in her left leg. Her treating physicians prescribed anticoagulants (Coumadin) to treat her DVT. She also had, however, a lengthy history of dysfunctional uterine bleeding that had not responded to treatment. As a result, plaintiff constantly required ongoing care for the interplay between the anticoagulants for the DVT and its effect on her dysfunctional uterine bleeding.

In February 2012 she experienced a sudden onset of chest pain, shortness of breath and heart palpitations. She went to the emergency room and was admitted for a full “work up.” The work up revealed no new DVT or pulmonary embolism. Following that hospitalization, her primary care physician referred her to Dr. Inderjit Hansra-Godfrey, who examined plaintiff and put her on Prednisone. Dr. Hansra-Godfrey instructed plaintiff to visit the emergency department if her symptoms did not improve, and referred her for a polysomnogram (all night sleep study).

On March 6, 2012, Dr. Leela Rao conducted a pulmonary evaluation. Dr. Rao noted that plaintiffs use of anticoagulants has caused her stress and anxiety and that she had some unresolved sub-segmental thrombi. Plaintiff had been started on a small dose of anti-anxiety medication and had been feeling better. Dr. Rao assessed plaintiffs physical abilities using the Eastern Cooperative Oncology Group (“ECOG”) performance status grading. She graded plaintiff at a 2, meaning that plaintiff was ambulatory and capable of all self-care, unable to carry out any work activities, but that she is up and about more that 50% of waking hours. Dr. Rao’s plan was for plaintiff to continue taking Coumadin, repeat a thrombophilia work up in six months because her lupus anticoagulant tests were positive, and at least six months of anticoagulation because her December 2011 DVT was her first. Dr. Rao ordered plaintiff to follow up with her gynecologist and opined that plaintiff might need a hysterectomy if she required long term anticoagulation.

On March 7, 2012, plaintiff was evaluated by Dr. James McMahon, a cardiologist. Dr. McMahon determined that plaintiffs heart palpitations were low risk for V arrhythmia due to known hyperdynamic LV systolic function and a structurally normal heart. Dr. McMahon placed plaintiff on a monitor to assess her tachypalpitations while plaintiff was on anticoagulants for DVT. Dr. McMahon also determined that [870]*870plaintiff had an abnormal echocardiogram, and that her condition remained stable.

On Monday, April 2, 2012, following plaintiffs last day of work; she went to the emergency room due to groin pain. She underwent several imaging studies including hip x-rays, MRI of her hip, x-ray of the lumbar spine, and a CT scan of the abdomen with pelvis. On April 6, plaintiff had reported pelvic and leg pain with fatigue, menstrual periods lasting 14-17 days, increased urinary frequency and positional pain when sitting down, leaning back while sitting, reaching from side to side while sitting, and standing up. Plaintiff applied for short term benefits by phone on April 3, 2012, and had been ordered to remain off work for four weeks by Dr. Beth Froese, plaintiffs physiatrist.

On May 1, 2013, Plaintiff applied for LTD benefits under the Plan, Defendants determined that plaintiffs regular occupation as a finance manager is considered a sedentary occupation. Defendants approved plaintiffs claim and provided her LTD benefits under the policy’s “Regular Occupation” definition of disability retroactive to July 1, 2012, acknowledging that plaintiff had been diagnosed with fibro-myalgia, chronic myofascial pain, far left lateral disc herniation of the L4-L5 with fact synovitis and foraminal stenosis, and comorbidity factors of “asthma, interstitial cystitis, history of pulmonary embolism, and deep vein thrombosis.”

On June 6, 2013, plaintiff saw Dr. John Hong, a pain management specialist for a follow up appointment because she was having pain in her left leg. She reported her pain as a 4 on a 10 point scale. Dr, Hong continued all of plaintiffs medications - and scheduled a follow up two months later. She returned to Dr, Hong’s office less than a week later on June 12, 2013, due to lower back pain that had been radiating to her left anterior thigh. She characterized the pain as intermittent, moderate and throbbing. The pain worsened when she sat and she felt relief when she stood. Dr. Hong opined -that plaintiff may benefit from an another transforami-nal epidural injection. She had been utilizing an increased dose of Norco to manage her pain, but Dr. Hong cautioned her regarding the increased use of pain medication.

On June 12, 2013, Dr. Rap, plaintiffs hematologist, evaluated her prior to schedr uling surgery for a hysterectomy. Dr. Rao summarized plaintiffs hematological health in a.letter to, other specialists. In that letter Dr.

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Related

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Cite This Page — Counsel Stack

Bluebook (online)
264 F. Supp. 3d 867, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tassone-v-united-of-omaha-life-insurance-co-ilnd-2017.