Zaeske v. Liberty Life Assurance Co. of Boston

261 F. Supp. 3d 928
CourtDistrict Court, W.D. Arkansas
DecidedJune 5, 2017
DocketCASE NO. 5:15-CV-5305
StatusPublished

This text of 261 F. Supp. 3d 928 (Zaeske v. Liberty Life Assurance Co. of Boston) is published on Counsel Stack Legal Research, covering District Court, W.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zaeske v. Liberty Life Assurance Co. of Boston, 261 F. Supp. 3d 928 (W.D. Ark. 2017).

Opinion

MEMORANDUM OPINION AND ORDER

TIMOTHY L. BROOKS, UNITED STATES DISTRICT JUDGE

This case comes before the Court following Defendant Liberty Life Assurance Company of Boston’s (“Liberty Life”) decision to terminate Plaintiff Damon Zaeske’s long-term .disability benefits. The dispute arises under the Employee Retirement Income Security Act (“ERISA”), 29 .U.S.C. §§ 1001 et seq., which gives participants in an employee welfare benefit plan a cause of action “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of • the plan.” 29 U.S.C. § 1132(a)(1)(B).

Before the Court are the Administrative Record (Doc. 12), Plaintiffs Brief (Doc. 13), and Defendant’s Brief and Affidavit (Docs, 18,18-1). The Court also received a letter from Mr. Zaeske, (Doc. 19), on April. 19, 2017, after the Administrative Record had been submitted and the parties’ had submitted their briefs. Because the letter came directly from Mr. Zaeske, rather than his attorney, and was not part of the Administrative Record on appeal, the Court gave it no consideration. For the reasons explained herein, the Court finds that Liberty Life’s decision to deny long-term benefits to Mr. Zaeske is REVERSED and the claim REMANDED to Liberty Life for the correct calculation of past-due benefits.

I. BACKGROUND

At the time counsel briefed this ERISA appeal, Mr. Zaeske was a 52-year-old man formerly employed by Wal-Mart Stores, Inc. (“Walmart”) in the position of Project Manager I, Systems Strategy-Risks Manager (“Risk Manager”). His duties included observing associate, customer, and supplier behavior first-hand; making group presentations; using a computer to locate information; creating documents using a computer or writing instrument; visually verifying information, often in small print; safely operating a motor vehicle; and traveling both domestically and internationally to multiple facilities, requiring consecutive or extended overnight stays. (Doc. 12-3, p. 397). As an employee of Walmart, Mr. Zaeske was a member of its Associate Health and Welfare Plan (the “Plan”), which is insured by a Group Disability Income Insurance Policy issued by [931]*931Liberty Life (the “Policy”)- In addition to issuing the Policy and paying benefits, Liberty Life also serves as Policy Administrator.

Mr. Zaeske’s medical condition that gives rise to his claim for benefits was first documented in 2010. In August of that year, Mr. Zaeske visited Dr. David Garrett, a physician practicing at Mercy Clinic in Lowell, Arkansas (“Mercy Clinic”), and complained of depression and chronic pain, including back pain. (Doc. 12-3, p. 79). Dr. Garrett prescribed Darvoeet, a pain medication used to treat mild to moderate pain, for his “occasional use.” Id. On August 25, 2010, Mr. Zaeske had a follow-up appointment with Dr. Garrett, and during that examination, Dr. Garrett noted tenderness in the L5-S1 area of his lumbar spine. Id. at 80. Also during that visit, Mr. Zaeske complained that “he [could not] sit for very long” when his back pain struck, and he “ha[d] to constantly move.” Id. Dr. Garrett prescribed him a steroid injection for his back and refilled his pain medication prescription. Id.

Sometime later, on October 7, 2011, Mr. Zaeske returned to Dr. Garrett, complaining again of back pain and tenderness, anxiety, depression, restless leg syndrome, and fatigue. Id. at 82. Dr. Garrett prescribed oxycodone for pain and Celexa for depression. Id. at 83. Mr. Zaeske’s back exam “demonstrated tenderness on the right paravertebral muscle group.” Id. He returned to Dr. Garrett on May 4, 2012, complaining of chronic pain, and refilling his medications. Id. at 84. It appears that his back pain worsened in the ensuing months, as during the next check-up on January 2, 2013, Mr. Zaeske reported to Dr. Garrett that the oxycodone was not working well, and that the Darvoeet he had been taking for pain was now off the market. Id. at 85. Dr.- Garrett stopped his prescription for oxycodone, but prescribed Voltaren, a non-steroidal anti-inflammatory drug, .and Flexeril, a muscle relaxant. Id. at 86.

On October 29, 2013, Mr. Zaeske had an appointment with Dr. Janelle Potts, another physician at Mercy Clinic. During that visit, Mr. Zaeske complained primarily of lower back pain. He explained to Dr. Potts that he had experienced “low back pain for many years off and on,” but only recently had “a flair up [sic]” that caused his “[r]ight leg ... [to] go numb and tingly at times when laying in bed.” Id. at 87. Dr. Potts conducted a physical examination that revealed lumbar tenderness, so she scheduled a lumbar MRI and planned to perform two injections, one of methylpred-nisolone acetate and one of dexametha-sone—both corticosteroids used to treat inflammation. Id. The MRI, performed on November 6, 2013, revealed “chronic appearing disc protrusion with severe steno-sis at L4-5.” Id. at 282. Dr. Potts subsequently submitted a Certificate of Health Care Provider for Associate’s Serious Health Condition Form (an “FMLA form”) on November 15, 2013, in which she stated that Mr. Zaeske would be incapacitated for three days per month due to back pain'and the effects of pain medication, and that these restrictions would apply for six month's. She also noted that he had been “sent for [an] MRI and referred to [a] back surgeon.” Id. at 41-42. She further explained that “when incapacitated with back pain [he] cannot perform ány task,” id. at 41, and emphasized that the medication he was currently taking for back pain “can cause somnolence, decreased concentration, [and] inability to drive + make decisions,” id. at 42.

After a follow-up appointment on December 2, 2013, Dr. Potts wrote-in her progress notes that “hydrocodone [was] not really controlling [Mr. Zaeske’s] pain,” and that he-was “[finding it difficult to work due to pain.” Id, at 88. During that [932]*932same visit, she prescribed him Dilaudid, an opioid pain medication, to be used in conjunction with hydrocodone in order to control any breakthrough pain, and she instructed that he should not work for two weeks. Id. at 89. Then, on December 9, 2013, she completed another FMLA form, advising that Mr. Zaeske would be unable to work from December 2, 2013, through December 25, 2013, because he was “taking strong narcotics for pain” and was “unable to work while under the influence” of these medications. Id. at 43.

Dr. Potts’ progress notes from February 10, 2014 reveal that on, January 14, 2014, Mr. Zaeske underwent a lumbar medial bilateral branch nerve block at the Springfield Pain Management Center, which provided “good results.” Id. at 302, 305. However, Mr. Zaeske’s pain recurred shortly thereafter, due to effects of “spinal steno-sis and bulging discs,” and he was instructed to take Tizanidine—a muscle relaxant— and hydrocodone for pain. Id. at 302-03. Mr. Zaeske then visited Dr. Jonathan Nunley at Mercy Clinic on February 17, 2014. Dr. Nunley noted that Mr. Zaeske’s back pain worsened with extension, standing, and walking. Id. at 57. Dr. Nunley then made plans to perform a second lumbar medial branch nerve block on Mr. Zaeske’s lumbar spine. Id. at 60. On February 26, 2014, Dr. Nunley successfully performed that procedure and then scheduled a follow-up appointment.

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261 F. Supp. 3d 928, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zaeske-v-liberty-life-assurance-co-of-boston-arwd-2017.