Tikkanen v. Liberty Life Assurance Co.

31 F. Supp. 3d 913, 2014 WL 3418810, 2014 U.S. Dist. LEXIS 95122
CourtDistrict Court, E.D. Michigan
DecidedJuly 14, 2014
DocketCase No. 13-11462
StatusPublished
Cited by2 cases

This text of 31 F. Supp. 3d 913 (Tikkanen v. Liberty Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tikkanen v. Liberty Life Assurance Co., 31 F. Supp. 3d 913, 2014 WL 3418810, 2014 U.S. Dist. LEXIS 95122 (E.D. Mich. 2014).

Opinion

OPINION AND ORDER GRANTING DEFENDANT’S MOTION TO AFFIRM PLAN ADMINISTRATOR’S DECISION, DENYING PLAINTIFF’S MOTION TO REVERSE PLAN ADMINISTRATOR’S DECISION, AND DISMISSING COMPLAINT WITH PREJUDICE

DAVID M. LAWSON, District Judge.

This ERISA denial-of-benefits case presents two questions for resolution: (1) what is the appropriate standard of review; and (2) whether defendant Liberty Life Assurance Company of Boston wrongfully concluded that plaintiff Thad Tikka-nen could perform a limited range of sedentary work and therefore was ineligible for long term disability benefits. The Court heard oral argument on the parties’ cross motions on the administrative record on February 24, 2014. The Court now concludes that the arbitrary-and-capricious review standard applies, because there is no evidence in the record that any insurance “policy, contract, rider, indorsement, certificate, or similar contract document” was delivered to Tikkanen in Michigan so as to trigger Michigan Administrative Code Rule 500.2202(c), which would have voided the discretionary review clause. In addition, Liberty’s determination that Tik-kanen is able to perform sedentary work is not arbitrary or capricious because Liberty reasonably relied on the assessments of its consulting pulmonologist and Tikkanen’s treating physician in reaching that conclusion. Therefore, the Court will deny the plaintiffs motion to reverse the decision of the plan administrator, grant the defendant’s motion to affirm the decision, and dismiss the complaint.

I.

Tikkanen filed his complaint on March 31, 2013, seeking review of the plan administrator’s decision under Section 1132(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B), denying long term disability benefits. Tikkanen had worked at Home Depot as a department Supervisor in the lumber department from 1997 until February 26, 2011. AR 76, 84. The parties do not state the location where Tikkanen worked, but the record suggests that it was a Home Depot store somewhere near Port Huron, Michigan, where he resides. Tikkanen’s job duties included serving customers, supervising associates, maintaining stock within his department and keeping various sales records, and “driving sales” in his area of responsibility. AR 291-92. The exertional requirements of his job included “bending, stooping, reaching, twisting, lifting, pushing, pulling, moving items,” “responding to public address system announcements,” answering phones, “walking and standing,” reading reports and labels, climbing ladders “up to the height of 12-16 feet,” and lifting up to fifty pounds. AR 75-76, 293.

Liberty provides short term and long term disability insurance to Home Depot [916]*916employees through a group disability income insurance policy issued on January 1, 2011. 'The policy was negotiated and issued by employees of Liberty who work in the State of Georgia, and by employees or agents of Home Depot, which has its principal place of business in Atlanta and is incorporated in Delaware. Id. ¶¶ 3^4. Neither party points to any evidence in the record suggesting that any part of the underlying insurance transaction involving the group disability policy took place in Michigan. The Liberty policy contains a discretionary clause that states:

Liberty shall possess the authority, in its sole discretion, to construe the terms of this policy and to determine benefit eligibility hereunder. Liberty’s decisions regarding construction of the terms of this policy and benefit eligibility shall be conclusive and binding.

AR 54.

On March 27, 2011, Tikkanen submitted a claim to Liberty for short term disability benefits. Tikkanen reported that he had to leave work because of “asthmatic bronchitis,” explaining that he “was feeling ill 1 week prior to [his last day of work on] 2/27/11.” Tikkanen was treated by physician assistant Anthony Hamilton on February 28, 2011. Hamilton checked a box on a “Restrictions Form” provided by Liberty indicating that Tikkanen should be restricted to “sedentary” work only, defined on the form as “lifting/carrying up to 10 pounds occasionally, sitting over 50% of the time and standing^walking occasionally.” AR 300. “Sedentary” was the most restrictive category provided on the form for exertional restrictions. Hamilton also added more specific restrictions in the space provided below the • pre-defined checkboxes:

Pt. not to walk for more than 200 feet at a time; not to be up continuously moving around or doing exertional movements for more than a couple minutes at a time; also is to stay out of the cold air as much as possible.

AR 30. Hamilton noted that the restrictions were imposed from February 28, 2011 to March 13, 2011, and stated that Tikkanen could return to work on March 14th. Tikkanen was seen two more times in early March due to persistent asthma symptoms. On March 15, 20ll, based on the medical restrictions imposed by Hamilton and the exertional requirements in Tikkanen’s job description, Liberty approved his claim for short-term disability benefits through March 20, 2011. AR 75. Liberty ultimately extended his short-term benefits through the maximum six-month period allowed under the policy, which ended on August 27, 2011. AR 79.

Under the terms of the Liberty policy, a person in Tikkanen’s job classification (“Class 1”) is “disabled” for the purposes of long-term benefits if “as a result of Injury or Sickness the Covered Person is unable to perform the Material and Substantial Duties of Any Occupation.” AR 10. The term “Any Occupation” means “any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.”

Near the end of Tikkanen’s short-term eligibility period, Liberty initiated a file review to determine his eligibility for long-term benefits. AR 65-66. As part of this investigation, Liberty sent a request to Tikkanen’s treating physician, Dr. Syed Ali. Dr. Ali completed the form on July 28, 2011, noting the following restrictions: (1) no lifting over five pounds; (2) “limit pushing, pulling,” with no specified weight; (3) occasional twisting and bending (where “occasional was defined by Liberty as “1-33% of shift”); (4) never squatting, stooping, or kneeling; (5) standing five to ten minutes per hour; and (6) walking five to [917]*917ten minutes per hour. The restrictions listed “sitting” as “ok” with no specified duration. AR 177. Dr. Ali stated that he anticipated that Tikkanen could return to •work on September 1, 2011. Ibid. The form also includes a hand-written notation by Dr. Ali that “Pt. gets [shortness of breath] on walking few minutes or' carrying light load like laundry basket.” ■ Ibid.

On the medical records Dr. Ali attached to the form, he noted during Tikkanen’s office visit on July 28, 2011 that he was “doing well,” but his symptoms were “still present on exertion [and he cannot] do simple chores like taking laundry basket one flight of stairs.” AR 178. Ali stated that “the severity of the asthma attack(s) are moderate,” the “attacks are episodic, fluctuate in intensity and remain unchanged [from the last visit],” and “[exacerbating factors consist of cough, chest pain, fatigue and weight gain.” Ibid. Ali stated that “Relieving factors consist of allergen avoidance, beta-agonist, medication and rest,” and that Tikkanen was using inhaled steroids and a nebulizer. Ibid.

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Bluebook (online)
31 F. Supp. 3d 913, 2014 WL 3418810, 2014 U.S. Dist. LEXIS 95122, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tikkanen-v-liberty-life-assurance-co-mied-2014.