Williams-Sullivan v. Prudential Insurance Company of America

CourtDistrict Court, D. Arizona
DecidedNovember 20, 2020
Docket2:20-cv-00315
StatusUnknown

This text of Williams-Sullivan v. Prudential Insurance Company of America (Williams-Sullivan v. Prudential Insurance Company of America) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Williams-Sullivan v. Prudential Insurance Company of America, (D. Ariz. 2020).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Tia Williams-Sullivan, No. CV-20-00315-PHX-SMB

10 ORDER Plaintiff, 11 v. 12

13 Prudential Insurance Company of America, et al., 14

15 Defendants.

16 Plaintiff, Tia Williams-Sullivan, has filed a Motion to Supplement the 17 Administrative Record and to Remand Claim, or in the Alternative, to Supplement the 18 Administrative Record and to Consider the Evidence in the Dispositive Motions. (Doc. 27.) 19 Defendant, Prudential, opposed Plaintiff’s Motion, (Doc. 31), and Plaintiff replied. (Doc. 20 33.) The Court held oral argument on November 18, 2020. For the reasons discussed below, 21 the Plaintiff’s motion is denied 22 I. BACKGROUND 23 This case arises under the Employee Retirement Income Security Act of 1974 24 (“ERISA”) and concerns a rejected claim for long-term disability (“LTD”) benefits. 25 Plaintiff worked as a fraud investigator at JPMorgan Chase & Co. (“Chase”). (Doc. 27 at 26 4.) After becoming disabled on February 27, 2017 due to “cervical radiculitis” and 27 “shoulder pain,” Plaintiff filed for and was approved for short-term disability (“STD”) 28 benefits. (Id. at 4.) On September 8, 2017, Defendant Prudential Insurance Company of 1 America (“Prudential”) approved Plaintiff’s claim for long-term disability (“LTD”). (Id. at 2 5.) Plaintiff claims that Prudential approved her LTD claim solely on an attending 3 physician form completed by her doctor, Dr. Engstrom, which stated that Plaintiff was 4 scheduled to undergo “right shoulder arthroscopy with subacromial decompression.” (Id. 5 at 5.) On April 13, 2018, Prudential found that Plaintiff was no longer disabled and 6 terminated LTD benefits. (Id. at 5.) Prudential based its decision on a vocational expert’s 7 finding that Plaintiff could perform her sedentary job within the post-surgical restrictions 8 outlined by her surgeon, Dr. Padley. (Doc. 31 at 4; Doc. 27, Ex. A.) Plaintiff appealed the 9 decision on April 30, 2018. (Doc. 31 at 4.) During the appeals process, Prudential retained 10 Dr. Guernelli, “an independent physician board certified in physical medicine and 11 rehabilitation (“PM&R”) and pain management” to conduct a medical review. (Doc. 31 at 12 4.) Prudential went on to deny Plaintiff’s claim on May 31, 2018, July 12, 2018, and 13 October 15, 2018. (Doc. 27 at 5.) Plaintiff was unrepresented during these reviews. (Id. at 14 5.) Both parties agree that the reviews on May 31, 2018 and July 12, 2018 were mandatory 15 ERISA appeals. (Doc. 31 at 12.) Plaintiff claims that the final denial of her claim on 16 October 15, 2018 was based entirely on Dr. Guernelli’s opinions which disagreed with the 17 opinions of her own doctors. (Doc. 27 at 5.) On September 18, 2019, the Social Security 18 Administration’s (“SSA”) Administrative Law Judge (“ALJ”) concluded that Plaintiff had 19 been disabled and unable to work in any gainful occupation since October 1, 2018. (Doc. 20 ¶ 117.) However, Prudential refused to reopen Plaintiff’s claim and reconsider the ALJ’s 21 determination. On October 31, 2019, over a year after Prudential’s final denial of her claim 22 Plaintiff asked Prudential to supplement the record with various evidence. (Doc. 31 at 6.) 23 Prudential claims that it declined that request because its October 15, 2018 decision was 24 final. (Doc. 31 at 6.) Plaintiff submitted the complaint in this case on February 11, 2020. 25 (Doc. 1.) Plaintiff has filed this motion alleging that Prudential engaged in a host of 26 procedural errors, including the failure to engage in a “meaningful dialogue” as required 27 as part of providing a “full and fair” review. (Doc. 27 at 2.) 28 II. LEGAL STANDARD 1 Generally, when applying an abuse of discretion standard1 to an ERISA plan, the 2 district court’s review is limited to the administrative record. Burke v. Pitney Bowes Inc. 3 Long Term Disability Plan, 544 F.3d 1016, 1027-28 (9th Cir. 2008) (citing Abatie, 458 4 F.3d at 970). However, “when an administrator has engaged in a procedural irregularity 5 that has affected the administrative review, the district court should ‘reconsider [the denial 6 of benefits] after [the plan participant] has been given the opportunity to submit additional 7 evidence.’” Abatie, 458 F.3d at 973 (citing Vanderklok v. Provident Life & Accident Ins. 8 Co., 956 F.2d 610, 617 (6th Cir. 1992)). Even when procedural irregularities are smaller 9 and abuse of discretion review applies, “the court may take additional evidence when the 10 irregularities have prevented full development of the administrative record. In that way the 11 court may, in essence, recreate what the administrative record would have been had the 12 procedure been correct.” Id. at 973. 13 When a plan administrator fails to comply with the requirements of 29 U.S.C. § 14 1133 by properly notifying the claimant in writing of the reasons for denial or by failing to 15 afford a full and fair review after an initial denial, the “usual remedy” in the Ninth Circuit 16 is to remand to the plan administrator so that the claimant is afforded a full and fair review. 17 Chuck v. Hewlett Packard Co., 455 F.3d 1026, 1035 (9th Cir. 2006) (quoting Syed v. 18 Hercules Inc., 214 F.3d 155, 162 (3d Cir. 2000)). 19 III. DISCUSSION 20 Plaintiff seeks an order to supplement the Administrative Record with 2,000 pages 21 of evidence she submitted after retaining counsel and which she claims followed 22 Prudential’s final denial of her claim on October 15, 2018. (Doc. 27 at 1.) Further, Plaintiff 23 argues that remanding the case will “remedy a host of material ERISA procedural 24 violations committed by Prudential because they precluded a ‘full and fair’ review in 25

26 1 It appears that the Court’s eventual review on the merits will be for an abuse of discretion because Plaintiff never mentions what standard of review the Court will ultimately use to 27 evaluate Prudential’s denial of Plaintiff’s claim. However, Prudential’s opposition to 28 Plaintiff’s motion notes in passing that the standard of review will be for an abuse of discretion, and Plaintiff does not counter that assertion. (Doc. 31 at 7.) 1 violation of 29 U.S.C. § 1133(2).” (Id. at 2) (emphasis original). Plaintiff contends that 2 these violations include Prudential’s failure to provide notice of what evidence Prudential 3 believed was necessary for her to submit during her mandatory ERISA appeal in order to 4 perfect her claim, (Id. at 2-3.), Prudential’s failure to act as Plaintiff’s fiduciary and failure 5 to engage in meaningful dialogue as required by Montour v. Hartford Life & Acc. Inc. Co., 6 588 F.3d 623, 636 (9th Cir. 2009). Plaintiff also claims that Prudential violated Salomaa v. 7 Honda Long Term Disability Plan in failing to advise Plaintiff that it obtained Dr. 8 Guernelli’s report during her mandatory appeal and that “his opinions did not support her 9 claim and it was using them to uphold its termination.” (Id. at 3.); 642 F.3d 666, 679-80 10 (9th Cir. 2011). Plaintiff argues that, “A remand is warranted based on Prudential’s initial 11 termination of benefits on April 13, 2018.” (Id. at 6.) Further, Plaintiff claims that Abatie 12 v. Alta Health & Life Ins.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
Williams-Sullivan v. Prudential Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/williams-sullivan-v-prudential-insurance-company-of-america-azd-2020.