Waldoch v. Medtronic, Inc.

953 F. Supp. 2d 979, 2013 WL 3064446, 2013 U.S. Dist. LEXIS 84993
District Court, D. Minnesota·Decided June 18, 2013·No. Civil No. 12-1646 (JNE/JSM)·Published·Cited by 1 cases

Opinion

ORDER

JOAN N. ERICKSEN, District Judge.

Plaintiff Rodney Waldoch (“Waldoch”) brought this action under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001-1466 (2006), against Defendant Medtronic, Inc. (“Medtronic”), his former employer, seeking recovery of Long Term Disability (“LTD”) benefits under an employee benefit plan. Now before the Court are the parties’ Cross-Motions for Summary Judgment.

I. BACKGROUND1

A. The Disability Plan

Waldoch began working for Medtronic as a Senior Buyer/Planner on January 15, 2001. He was terminated for performance reasons on November 24, 2008. During Waldoch’s employment, Medtronic maintained a Long-Term Disability Plan (“Plan”). The Plan is self-funded, and Medtronic serves as the Plan Administrator. Hartford was the appointed Claims Administrator under the Plan.2 The Plan provides:

Long Term Disability is designed to provide benefits for qualifying disabilities lasting longer than 26 weeks....
Benefits may not begin until:
• You have been Totally Disabled for 26 weeks in a rolling 12-month period, and
• You have provided documentation satisfactory to Medtronic or its delegated claim administrator proving that you are Totally Disabled.

The Plan defines “Total Disability” and “Totally Disabled” as follows:

During the 26-week elimination period and during the first year that you are receiving Long Term Disability Benefits, you are considered to be Totally Disabled if you are under the care of a Physician and prevented from performing each of the essential functions of your regular occupation because of an illness or accidental injury and you are not working at all. The one year period begins on the first day as of which you have been approved to receive Long Term Disability Benefits.
To be considered Totally Disabled after this period of time, the illness or accidental injury must prevent you from working at any occupation for which you are, or could reasonably become, qualified by education, training or experience, and you are not working at all.

To file a claim for LTD benefits, the employee must submit an application to [984] the Claims Administrator. The Plan provides that the Claims Administrator must be able to obtain records and other information from physicians, health care professionals, and vocational experts who have treated, diagnosed, or evaluated the employee. If necessary, the “Claims Administrator may secure independent medical or other advice and require such other evidence as it deems necessary to decide your claim.” Within a reasonable time, the Claims Administrator will then “render a decision,” and provide written notice of an adverse benefit determination. If the claim is denied, the employee “may appeal the decision to the Claims Administrator,” who “will review and consider all written comments and other information [the employee] submit[s]” with the appeal. The Claims Administrator must review and decide the appeal within a reasonable time.

The Plan also provides that as part of the application process, the employee “must provide medical evidence, satisfactory to Medtronic or its delegated claims administrator, of your Total Disability.” The employee must provide “proof of your claim,” which “consists of the application for Long Term Disability Benefits and such additional medical, vocational and financial information satisfactory to Medtronic and necessary in Medtronic’s judgment to verify that you are Totally Disabled.” The Plan further provides that “[t]he Plan Administrator has complete and total discretionary authority to interpret and administer the Plan.” Additionally,

The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits, have the authority and responsibility to interpret the Plan, make rules, determine eligibility for benefits, determine coverage and benefit amounts, and resolve all claims and disputes regarding the Plan. The decisions of the Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits are final and binding on all persons. The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits may further delegate any and all authority under the Plan as they deem appropriate.

B. Waldoch’s Medical History3

Waldoch was diagnosed with Type I Diabetes Mellitus in 1969 at the age of ten. In his late teens, he was diagnosed with diabetes-related retinopathy and peripheral neuropathy. Waldoch was treated by an internal medicine physician as well as an endocrinologist, and in 2000 he began using an insulin pump to help control his blood sugars. Medical records from 1999 and 2000 note that Waldoch maintained good control of his diabetes.

In March 2003, Waldoch saw his primary care physician, Dr. Anita Buckler, to whom he reported that he felt fatigued after a day of work, and that “his stress level has affected his blood sugar level.” AR 2856-57. In July 2004, Waldoch’s endocrinologist, Dr. John Bantle, wrote a letter to Medtronic advising that Waldoch’s “diabetes control has recently been aggravated by the substantial stress he is under at work” and recommended that [985] Waldoch’s work schedule be reduced to thirty-two hours a week if possible. Id. at 2494. In December 2004, Dr. Buckler also advised Medtronic that “due to medical conditions,” Waldoch should not work over thirty-two hours a week. Id. at 2495.

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Waldoch v. Medtronic, Inc., 953 F. Supp. 2d 979, 2013 WL 3064446, 2013 U.S. Dist. LEXIS 84993 (mnd 2013).

953 F. Supp. 2d 979 (Waldoch v. Medtronic, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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