Torres v. Reliance Standard Life Insurance

551 F. Supp. 2d 1221, 2008 U.S. Dist. LEXIS 20934, 2008 WL 732225
CourtDistrict Court, D. Oregon
DecidedMarch 14, 2008
Docket3:07-cr-00202
StatusPublished
Cited by3 cases

This text of 551 F. Supp. 2d 1221 (Torres v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Torres v. Reliance Standard Life Insurance, 551 F. Supp. 2d 1221, 2008 U.S. Dist. LEXIS 20934, 2008 WL 732225 (D. Or. 2008).

Opinion

OPINION AND ORDER

ANNA J. BROWN, District Judge.

This matter comes before the Court on Defendants’ Motion for Summary Judgment (#22) and Plaintiffs Cross-Motion for Summary Judgment (# 26). For the reasons that follow, the Court GRANTS Defendants’ Motion for Summary Judgment and DENIES Plaintiffs Cross-Motion for Summary Judgment.

BACKGROUND

Plaintiff Donna Osbourne Torres began working for Tektronix, Inc., on March 25, 1996, and worked there until October 31, 2003. As a benefit of her employment, Plaintiff was a participant in the Tektronix Long Term Disability (LTD) Plan. Defendant Reliance Standard Life Insurance Company is the insurer and “Claims Review Fiduciary” of the Plan. Defendant Matrix Absence Management, Inc., also administers the Plan.

*1225 I. Plan Language

The Plan provides Defendants will pay a “Monthly Benefit” if an insured:

(1) is Totally Disabled as a result of a Sickness or Injury covered by this Policy;
(2) is under the regular care of a Physician;
(3) has completed the Elimination Period; and
(4) submits satisfactory proof of Total Disability to us.

Administrative Record (AR) 725. The Plan defines “Totally Disabled” to mean as a result of Injury or Sickness:

(1) during the Elimination Period and for the first 24 months for which a Monthly Benefit is payable, an Insured cannot perform the material duties of his/her regular occupation; ...
(2) after a Monthly Benefit has been paid for 24 months, an insured cannot perform the material duties of any occupation. Any occupation is one that the Insured’s education, training or experience will reasonably allow.

AR 717.

II. Factual Background

In 1999 or 2000, Plaintiff moved from the position of fourth-level engineer with Tektronix to a job as a web applications developer/systems analyst, which is a sedentary “desk job.”

On March 21, 2004, Plaintiff filed a claim for LTD benefits under the Plan alleging she was unable to perform her job due to back pain. On June 1, 2004, Defendants approved Plaintiffs claim and found Plaintiff satisfied the Plan’s definition of Total Disability for her occupation. Defendants informed Plaintiff that “[pjeriodic documentation of [her] disability status will be required for further benefit consideration. Objective documentation of [her] continuous disability must be provided by the physician who is treating [her] and [be] satisfactory to us.” AR 303. Defendants further informed Plaintiff that the Plan “stipulates that in order to be eligible for Long Term Disability Benefits beyond 24 months [she] must be totally disabled from performing the material duties of Any Occupation ... [and she] will reach the 24th month on April 29, 2006.” AR 304.

In November 2005, Defendants attempted to schedule an Independent Medical Examination (IME) for Plaintiff with Thomas J. Rosenbaum, M.D. Plaintiff, however, objected to Dr. Rosenbaum performing such an examination because he had examined her previously in relation to a worker’s compensation claim and, according to Plaintiff, reported certain aspects of that examination incorrectly. Plaintiff, therefore, appeared for the examination with a tape recorder with the intention of recording it. Dr. Rosenbaum refused to allow the examination to be recorded, and the exam did not proceed. AR 1625-26.

On March 1, 2006, Defendants sent Plaintiff a letter reminding her that a different definition of “Totally Disabled” would apply for purposes of the Plan as of April 24, 2006. AR 1085. Defendants noted “[t]he medical documentation on file currently supports [Plaintiffs] disability [only] through June 30, 2006.” Defendants, therefore, requested Plaintiff to provide updated medical information from her doctors “in order to evaluate [Plaintiffs] entitlement to benefits beyond June 30,2006.” AR 1085.

On June 5, 2006, and June 16, 2006, Defendants reiterated their request for Plaintiff to provide them with updated medical information and asked to receive that information by July 17, 2006. AR 477. Defendants did not receive updated *1226 medical information from Plaintiff by July 17, 2006. On August 2, 2006, therefore, Defendants informed Plaintiff that they were suspending her ongoing benefit payments because the medical information in Defendants’ file did not support them. AR 1013-16.

On August 28 and September 5, 2006, Plaintiff submitted updated medical records to support her claim for benefits. On September 8, 2006, Defendants sent Plaintiff a letter notifying her that Defendants were denying continued LTD benefits for Plaintiff from August 1, 2006, after reviewing her updated medical records. AR 941-43. Defendants noted their medical department determined that, “absent [Plaintiffs] current psychiatric contributions, and based on physical conditions only, [Plaintiff] would be able to perform work of a sedentary nature.” AR 942. Plaintiff appealed the denial of her claim.

On January 19, 2007, Defendants informed Plaintiff by letter that they adhered to their original decision to deny her claim. Defendants relied on the medical records produced by Plaintiff; an independent medical review (IMR) conducted by Anne MacGuire, M.D.; a Residual Em-ployability Analysis (REA) conducted by a vocational expert, Jody Barach; an IMR psychiatric evaluation by Kevin P. Hayes, M.D., M.B.A.; and information found on the Internet that suggested Plaintiff was actively involved in the Wine & Food Society of Clark County and running a web-design business out of her home.

In her IMR, Dr. MacGuire reviewed the medical records provided by Plaintiff and noted diagnoses of chronic pain syndrome, degenerative arthritis of the lumbar spine, mild degenerative arthritis of the cervical spine, and “bilateral knees with improving osteoporosis.” AR 490. Dr. MacGuire found the electrical studies of Plaintiffs right median nerve “were so minimal that [she] would hesitate to even call it carpal tunnel. syndrome.” AR 490. Dr. MacGuire also observed “there is no evidence for a neuropathic process in any of the history and multiple physical exams. In my opinion this diagnosis [of fibromyal-gia] is not warranted.” AR 491. With respect to Plaintiffs prognosis, Dr. MacGuire noted

degenerative arthritis in the lumbar spine, knees and improving osteoporosis are all common chronic problems that most adults deal with.... Most adults over the age of 40 have changes consistent with mild to moderate degenerative arthritis of the lumbar spine and weight bearing joints. These are certainly not shockingly severe conditions.

AR 491. As for Plaintiffs prognosis for degenerative arthritis, Dr. MacGuire stated “it does not necessarily progress. Fitness, caution with lifting and activity are essential for maintenance and control of symptoms.” AR 491. Dr. MacGuire further reported the prognoses for Plaintiffs osteoporosis and for her chronic pain management are “excellent,” and any fibro-myalgia is not a disabling condition. AR 491. Dr.

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Bluebook (online)
551 F. Supp. 2d 1221, 2008 U.S. Dist. LEXIS 20934, 2008 WL 732225, Counsel Stack Legal Research, https://law.counselstack.com/opinion/torres-v-reliance-standard-life-insurance-ord-2008.