Thomas v. Aetna Life Insurance Company et al

Filing 27

ORDER signed by District Judge John A. Mendez on 8/15/16 DENYING 16 Motion for Summary Judgment and DENYING 20 Cross-Motion for Summary Judgment. (Washington, S)

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1 2 3 4 5 6 7 8 9 UNITED STATES DISTRICT COURT 10 EASTERN DISTRICT OF CALIFORNIA 11 12 LASHAUN THOMAS, 13 14 15 16 No. 2:15-cv-01112-JAM-KJN Plaintiff, v. AETNA LIFE INSURANCE COMPANY, a corporation; FEDEX GROUND, a corporation; DOES 1 through 10, inclusive, ORDER DENYING PLAINTIFF’S AND DEFENDANTS’ MOTIONS FOR SUMMARY JUDGMENT 17 Defendants. 18 19 Plaintiff Lashaun Thomas (“Thomas”) alleges that she was 20 entitled to short-term disability (“STD”) benefits under the 21 Employee Retirement Income Security Act (“ERISA”)-governed self- 22 funded disability plan (the “Plan”) put in place by her employer 23 defendant FedEx Ground (“FedEx”). 24 Company (“Aetna”), which was designated as the Plan 25 Administrator, denied her request for STD benefits. 26 now before this Court because ERISA permits an insured to sue “to 27 recover benefits due to him under the terms of his plan.” 28 U.S.C. § 1132(a). Defendant Aetna Life Insurance The case is 29 Both parties seek summary judgment in their 1 1 favor. 2 motions for summary judgment and finds that there is a genuine 3 issue of material fact as to whether Thomas adequately 4 demonstrated that she was entitled to STD benefits. For the reasons stated below, the Court denies both 5 6 I. 7 FACTUAL ALLEGATIONS AND PROCEDURAL BACKGROUND On September 19, 2012, Thomas was traveling for work with 8 her boss when their car was rear-ended. Defendants’ Response to 9 Plaintiff’s Statement of Undisputed Facts (“P SUF”) (Doc. #20-1) 10 #1. 11 Grove”) and complained of back pain caused by the accident. 12 #2. 13 tenderness of the paraspinal muscles and prescribed pain 14 medication. 15 Elk Grove that revealed no fracture and that her disc spaces 16 appeared normal. 17 of Undisputed Facts (“D SUF”) (Doc. #22-1) #13. 18 2012, Thomas was reevaluated at Elk Grove and was diagnosed with 19 a back strain that was worse with movement. 20 February 4 and February 7, 2013, Thomas again went to Elk Grove 21 and it was noted that there were no neurological deficits. 22 #15. 23 Two days later, Thomas went to Elk Grove urgent care (“Elk Id. Thomas saw Dr. Allen Lin Do, who observed spasm and Id. On October 8, 2012, Thomas received an x-ray at Plaintiff’s Response to Defendants’ Statement On November 3, D SUF #14. Thomas was referred to physical therapy. On D SUF Id. On February 21, 2013, Thomas began receiving physical 24 therapy treatment at Laguna Physical Therapy. P SUF ## 4-5. 25 received this treatment until April 10, 2013. Id. 26 physical therapist noted that Thomas had tenderness in her right 27 shoulder girdle and her cervical paraspinal region. 28 pain was rated as between 5 and 7 out of 10 and was aggravated by 2 She Thomas’ Id. #4. Her 1 driving, prolonged sitting, and various other activities. 2 Id. On June 18, 2013, Thomas underwent two MRIs: a lumbar spine 3 MRI and a cervical spine MRI. 4 broad based disc bulges with osteophytic spurring at C4-5, C5-6, 5 and C6-7. 6 protrusion/herniation with right foraminal encroachment on the 7 C5-6 level and a C6 root compression. 8 that on the C6-7 level there was a central protrusion or 9 herniation with flattening of the ventral thecal sac. Id. Id. #6. The MRIs showed she had The MRIs also showed that she had a disc Id. The MRIs also showed Id. In 10 the MRI, the craniocervical junction appeared unremarkable; the 11 spinal cord was not enlarged; no bony destructive lesion or 12 cervical soft tissue mass was seen; and the anterior and 13 posterior ligament groups appeared intact. 14 lumbar spine MRI revealed no neural compression, unlike the 15 cervical MRI. 16 D SUF #16. The Id. #17. On August 25, 2013, Dr. Truong at Elk Grove excused Thomas 17 from work from August 26, 2013 through August 30, 2013. P SUF 18 #7. 19 September 16, 2013. 20 for 45 days on September 18, 2013. 21 2013, Thomas contacted Aetna to open a claim for short-term 22 disability benefits. 23 filled out an Attending Physician Statement (APS) stating that 24 Thomas was disabled from work from August 24, 2013 through 25 October 16, 2013, and that after October 16, 2013, Thomas could 26 return to work only on modified duty with occasional sitting, 27 driving, computer use, hand grasping and reaching, and no 28 lifting, pushing, pulling, bending, or stooping. Dr. Truong again excused Thomas from work for 30 days on Id. #8. Id. #10. Dr. Truong excused Thomas from work Id. #9. On September 26, On October 1, 2013, Dr. Truong 3 Id. #11. 1 On October 4, 2013, Aetna informed Thomas that FedEx 2 retained it to administer the STD Plan and that a clinical review 3 of the appropriateness of her work absence was required. 4 #19. 5 that Thomas should remain off work from October 16, 2013 through 6 November 29, 2013. 7 D SUF Dr. Truong wrote another note on October 9, 2013, stating Id. #20. On November 6, 2013, Aetna informed Thomas that it concluded 8 she did not meet the definition of disabled and explained why. 9 D SUF #21; Administrative Record (“AR”) 324-325. The letter 10 explained that Thomas could appeal the decision and provided a 11 list of items she could provide that may help prove her claim. 12 Id. #22. 13 December 16, 2013, the Aetna Appeals Specialist evaluating 14 Thomas’s appeal conducted a telephone interview with Thomas in 15 which Thomas stated that Dr. Truong had released her back to work 16 but that her employer was unable to accommodate her because of 17 the medications she was taking. 18 also explained the reason for denying the claim and the type of 19 information Thomas could provide to assist the review. 20 The Appeals Specialist reduced the conversation to writing and 21 confirmed that Thomas’s current condition was displacement of 22 lumbar invertebral disc without myelopathy. 23 Thomas later appealed the denial. Id. #25. Id. #23-24. On The Appeals Specialist Id. #26. Id. #27. Aetna then requested a peer review from Dr. Martin 24 Mendelssohn, who specializes in orthopedic surgery. D SUF #28. 25 Dr. Mendelssohn attempted a peer-to-peer consultation with Dr. 26 Heune and Dr. Truong but was unable to get in touch with them. 27 Id. ##29-30. 28 Wilson, who said Thomas was in a car accident and could not work Dr. Mendelssohn conducted a consultation with Dr. 4 1 because of her symptoms, but admitted that he had only seen 2 Thomas once and could not provide any evidence of any functional 3 or neurological deficits. 4 that “a comprehensive history and physical examination supporting 5 diagnostic studies that would indicate a functional impairment 6 from her regular occupation as a field contractor REL specialist, 7 which is sedentary from 8/26/13 through 1/6/14 cannot be 8 substantiated.” 9 able to return to her position without restrictions from August 10 Id. #32. Id. #31. Dr. Mendelssohn opined that Thomas was 26, 2013 through January 6, 2014. 11 Dr. Mendelssohn reported Id. #33. On January 15, 2014, Aetna again tried to contact Dr. Truong 12 and Dr. Heune, but was unable to reach them. 13 day, Aetna wrote to Thomas explaining that the appeal review 14 needed more time because Aetna could not reach the two doctors. 15 Id. #35. 16 Id. #34. That same On January 30, 2014, Thomas was seen by Dr. Thomas J. 17 O’Laughlin, who performed an examination on Thomas. P SUF #13. 18 Dr. O’Laughlin’s initial evaluation is presented in AR pages 513- 19 517. 20 cervical spine disclosed a broad-based disc bulge at C5 with 21 osteophytic spurring and right paracentral disc osteophyte with 22 mild neuroforaminal narrowing and that the lumbar spine MRI was 23 unremarkable. 24 Thomas had evidence of some underlying cervical degenerative disc 25 disease of varying degrees at C5-C6, C4-C5, and C5-C6. 26 He stated that Thomas “seems to have aggravated her underlying 27 degenerative cervical changes and appears to have some 28 superimposed disc protrusion that is continuing to promote Dr. O’Laughlin noted that the June 18, 2013 MRI of the D SUF #36. Dr. O’Laughlin also reported that 5 Id. #37. 1 intractable cervicscapular myofascial pain and chronic 2 cervicogenic headache.” 3 work because the stressors of work and the psychosocial pressures 4 would prevent her from improving. 5 Id. He agreed with keeping Thomas off Id. #39. The following day, Dr. O’Laughlin performed trigger-point 6 injections. P SUF #14. Dr. O’Laughlin saw Thomas five other 7 times between February 2014 and May 2014. 8 2014, Dr. O’Laughlin wrote Aetna a letter on behalf of Thomas 9 stating that “after reviewing the medical records of Lashaun Id. #15. On April 21, 10 Thomas, as well as performing a face-to-face medical examination, 11 it is my opinion that Ms. Thomas has been disabled and unable to 12 work since her accident on 9/19/2012.” 13 P SUF # 16; D SUF #43. Aetna then hired Dr. Priya Swamy to complete a peer review. 14 D SUF #46. The scope of what Dr. Swamy reviewed is under 15 dispute, but the parties agree that Dr. Swamy reviewed some 16 records from between August 26, 2013 through March 24, 2014, the 17 MRIs from June 18, 2013, and records from July 31, 2013 and 18 August 19, 2013. 19 O’Laughlin’s records Dr. Swamy reviewed. 20 Swamy also attempted a peer-to-peer consultation with Dr. 21 O’Laughlin but was unable to reach him. 22 concluded that Thomas had no functional impairments from August 23 26, 2013 through March 24, 2014. Id. #47. The parties dispute how much of Dr. Id. ## 48-50. Id. #51. Dr. Dr. Swamy Id. #52; AR 584-586. 24 Aetna wrote to Thomas on June 6, 2014, informing her that it 25 completed the appeal review of the denial of her STD benefits and 26 upheld the original decision to deny STD benefits effective 27 August 26, 2013. 28 Id. #53; AR 581. Thomas filed the complaint in this case, alleging that she 6 1 “was entitled to short-term disability, as well as other benefits 2 under the Plan.” 3 Defendants “arbitrarily and in bad faith refused to make payments 4 to [her] as required by the Disability Plan.” 5 seeks the past and future benefits allegedly owed to her under 6 the LTD Plan and “a declaration by this court . . . that all 7 benefits provided to Plan participants while they are disabled 8 under the Plan . . . be reinstated retroactive to the date her 9 LTD benefits were terminated.” Compl. ¶ 4 (Doc. #1). Thomas alleges that Id. at 3. Id. ¶ 6. Thomas Thomas then filed a 10 motion for summary judgment (Doc. #16). Defendants opposed the 11 motion and filed a cross motion for summary judgment (Doc. #20). 12 Thomas opposed Defendants’ cross motion (Doc. #22). 13 heard argument on the cross motions for summary judgment on 14 August 9, 2016. The Court 15 16 II. OPINION 17 A. Legal Standard 18 The preliminary issue the Court must decide is whether it 19 should review Aetna’s determination that Thomas did not qualify 20 for STD benefits under a de novo standard of review or an abuse 21 of discretion standard of review. 22 de novo review, while Aetna argues that abuse of discretion is 23 the appropriate standard. 24 25 1. Thomas asks the Court to apply Proper Delegation Thomas argues that the abuse of discretion standard would be 26 inappropriate here because Aetna was never unambiguously granted 27 discretion by the Benefits Committee. 28 Thomas concedes that the Benefits Committee was granted 7 P Reply (Doc. #22) at 1. 1 discretion for its determination of whether Thomas was disabled 2 but contends that “there is no language in the Plan granting 3 Aetna discretion and Defendants have not cited anything 4 evidencing that the Benefits Committee expressly delegated its 5 discretion to Aetna.” 6 section 5.1(d) of the Plan, which permits the Plan Administrator 7 to delegate its discretionary authority to a third party. 8 Reply at 2 (Doc. #25) (citing AR 060). 9 questioning from the Court during the August 9, hearing on the Id. In response, Defendants point to D In response to 10 cross motions, Defendants further noted that section 2.4 of the 11 Plan states that “Claims Paying Administrator” means Aetna and 12 that section 4.5(a) of the Plan states that the Claims Paying 13 Administrator is charged with “determin[ing] pursuant to the 14 terms of the STD Plan that a Total Disability exists.” 15 On this issue, the Court agrees with Defendants. The Plan 16 clearly states that Aetna, as the Claims Paying Administrator, 17 was charged with deciding whether Thomas was disabled under the 18 terms of the Plan. 19 provides the Plan Administrator with “the discretion and 20 authority to interpret and construe the provisions of the STD 21 plan . . . [and] decide any dispute which may arise with regard 22 to the rights of Participants entitled to benefits.” 23 Read as a whole, the Plan sufficiently delegates the Plan 24 Administrator’s discretionary authority to Aetna. 25 not apply de novo review on the basis of Thomas’s argument that 26 Aetna was not properly delegated discretion. 27 /// 28 /// The Plan contains a discretionary clause that 8 AR 060. The Court will 1 2 2. ERISA Preemption of Section 10110.6 The crux of the dispute over the proper standard of review 3 is whether ERISA preempts the application of California Insurance 4 Code section 10110.6 (“section 10110.6”) to self-funded plans, 5 such as the one at issue in this case. 6 ERISA preempts section 10110.6 because section 10110.6 “has an 7 impermissible connection with a key facet of ERISA plan 8 administration.” 9 courts that have ruled on this issue have determined that ERISA Opp. at 15. Defendants argue that Thomas argues that all previous 10 does not preempt section 10110.6, whether or not the plan is 11 self-funded. P Reply at 2. 12 ERISA permits a benefits plan participant to bring a civil 13 case in federal court to recover benefits allegedly owed to him 14 under a benefits plan. 15 is then charged with reviewing the plan administrator’s decision 16 denying benefits to the participant. 17 review in such cases is de novo. 18 584 F.3d 837, 846 (9th Cir. 2009) (“[D]e novo review is the 19 default standard of review in an ERISA case.”). 20 an insurance contract has a discretionary clause, the decisions 21 of the insurance company are reviewed under an abuse of 22 discretion standard.” 23 Bruch, 489 U.S. 101, 115 (1989) (“a denial of benefits challenged 24 under § 1132(a)(1)(B) is to be reviewed under a de novo standard 25 unless the benefit plan gives the administrator or fiduciary 26 discretionary authority to determine eligibility for benefits or 27 to construe the terms of the plan”). 28 29 U.S.C. § 1132(a)(1). A district court The default standard of Standard Ins. Co. v. Morrison, However, “[i]f Id. at 840; Firestone Tire & Rubber Co. v. Here, the Plan contains a discretionary clause: “[t]he Plan 9 1 Administrator shall have the discretion and authority to 2 interpret and construe the provisions of the STD plan, determine 3 the entitlement of any Participant to benefits hereunder, and 4 decide any dispute which may arise with regard to the rights of 5 Participants entitled to benefits.” 6 on the presence of this discretionary clause, the Court would 7 have to apply an abuse of discretion standard. 8 9 10 11 12 13 14 15 AR 060. Thus, based solely However, California law renders such discretionary clauses void and unenforceable. Section 10110.6 states that [i]f a policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not in California, that provides or funds life insurance or disability insurance coverage for any California resident contains a provision that reserves discretionary authority to the insurer, or an agent of the insurer, to determine eligibility for benefits or coverage, to interpret the terms of the policy, contract, certificate, or agreement, or to provide standards of interpretation or review that are inconsistent with the laws of this state, that provision is void and unenforceable. 16 17 If section 10110.6 applies in this case, then the discretionary 18 clause in the Plan is void, and the default de novo standard of 19 review would apply. 20 Defendants argue that section 10110.6 cannot apply in this 21 case because ERISA preempts its application. ERISA is meant to 22 “supersede any and all State laws insofar as they . . . relate to 23 any employee benefit plan.” 24 so-called “Savings Clause” states that ERISA “shall not be 25 construed to exempt or relieve any person from any law of any 26 State which regulates insurance, banking, or securities.” 27 U.S.C. § 1144(b)(2)(A). 28 states that an “an employee benefit plan described in section 29 U.S.C. § 1144(a). However, the 29 The so-called “Deemer Clause” then 10 1 1003(a) of this title, which is not exempt under section 1003(b) 2 of this title . . . shall [not] be deemed to be an insurance 3 company . . . or to be engaged in the business of insurance or 4 banking for purposes of any law of any State purporting to 5 regulate insurance companies, insurance contracts, banks, trust 6 companies, or investment companies.” 7 29 U.S.C. § 1144(b)(2)(B). The United States Supreme Court recently summarized ERISA 8 preemption by stating that ERISA preempts two categories of state 9 laws. ERISA preemption exists (1) where a state’s law acts 10 immediately and exclusively upon ERISA plans and (2) where a 11 state law has an “impermissible connection” with ERISA plans. 12 Gobeille v. Liberty Mut. Ins. Co., 136 S. Ct. 936, 943 (2016). 13 An “impermissible connection” “mean[s] a state law that ‘governs 14 a central matter of plan administration or ‘interferes with 15 nationally uniform plan administration.’” 16 Id. at 943. Defendants argue that section 10110.6 is preempted under the 17 second category of state law identified in Gobeille. 18 Gobeille, Defendants argue that section 10110.6 “has an 19 impermissible connection with a key facet of ERISA plan 20 administration” because “[v]oiding language conferring 21 discretionary authority to plan administrators disrupts the 22 uniform administration of plans and forces administrators to 23 master the laws of all 50 states.” 24 Citing Opp. at 14. Defendants’ citation to Gobeille in support of their pre- 25 emption argument is unavailing. Gobeille considered a Vermont 26 disclosure statute that required health insurers to report 27 payments relating to health care claims to a state agency that 28 would compile the payments in a database. 11 Under the statutory 1 scheme at issue in Gobeille, entities covered by the Vermont 2 statute that failed to comply with the reporting requirements 3 would be fined. 4 a new requirement for administrators of benefits plans, thereby 5 creating a whole new cause of action. 6 different than cases involving state laws, such as section 7 10110.6, that simply void discretionary clauses and therefore 8 only impact the procedures by which a party can challenge a plan 9 administrator’s determination in a federal district court. 10 Thus, Gobeille considered a state law that added That case is significantly In fact, the Ninth Circuit has concluded that state laws 11 that bar discretionary clauses (such as section 10110.6) are not 12 preempted by ERISA because they do not “authorize any form of 13 relief in state courts nor serve as an alternative enforcement 14 mechanism outside of ERISA’s civil enforcement provisions.” 15 Standard Ins. Co., 584 F.3d at 846 (rejecting claim that ERISA 16 preempted a policy implemented by the Montana insurance 17 commissioner of disapproving any insurance contract containing a 18 discretionary clause). 19 that these policies “merely force[] ERISA suits to proceed with 20 their default standard of review,” which is de novo, and 21 therefore do not “duplicate, supplement, or supplant the ERISA 22 remedy.” 23 policies at issue in cases such as Gobeille that involve a 24 state’s attempt “to meld a new remedy to the ERISA framework.” 25 Id. 26 that section 10110.6 is not preempted by ERISA. 27 Polnicky v. Liberty Life Assurance Co. of Bos., 999 F. Supp. 2d 28 1144, 1150 (N.D. Cal. 2013); Gonda v. Permanente Med. Grp., Inc., Id. In Standard Ins. Co., the court reasoned The court distinguished these policies from Multiple California district courts have similarly concluded 12 See, e.g., 1 10 F.Supp.3d 1091, 1094 (C.D. Cal. 2014). 2 not provide this Court with any case in which a California 3 district court has concluded that section 10110.6 is preempted 4 and unenforceable. Defendants also could 5 Defendants attempt to distinguish this case from the 6 overwhelming weight of authority in this Circuit that has 7 concluded that section 10110.6 is not preempted by arguing that 8 self-funded plans should be treated differently. 9 argued at the hearing that the Deemer Clause prevents courts from Defendants 10 applying section 10110.6 to self-funded plans. 11 believe that section 10110.6 treats self-funded plans as if they 12 are insurance. 13 And Defendants During the hearing, however, Defendants conceded that the 14 only court that has directly addressed the issue of whether the 15 application of section 10110.6 to self-funded plans is preempted 16 by ERISA concluded that there is no preemption. 17 Life Insurance Company, 2015 WL 5145499, *5 (C.D. Cal. Aug. 31, 18 2015). 1 19 in this case “that the insurance code does not apply because (1) 20 the STD benefits are self-funded . . . and (2) Aetna is granted 21 discretion by the Plan, which is not an insurance policy, and 22 thus, not regulated by the insurance code.” 23 Williby court rejected this argument. 24 Williby v. AETNA The defendant in Williby argued just as Defendants argue Id. at *5. The By its plain language, section 10110.6 applies to contracts. 25 Cal. Ins. Code § 10110.6(a) (“If a policy, contract, [or] 26 1 27 28 Defendants argue that Williby was incorrectly decided and note that the case has been or will be appealed. Until the Ninth Circuit takes up this issue, however, this Court is free to agree with Williby. 13 1 certificate . . . that provides or funds life insurance or 2 disability insurance coverage for any California resident 3 contains a provision that reserves discretionary authority . . . 4 to determine eligibility for benefits or coverage . . . that 5 provision is void and unenforceable.”) (emphasis added). 6 ERISA plan is a contract.” 7 F.3d 1233, 1240 (9th Cir. 2015), cert. denied, 136 S. Ct. 1448, 8 194 L. Ed. 2d 549 (2016). 9 a plain reading of section 10110.6 demonstrates that it applies “An LeGras v. AETNA Life Ins. Co., 786 Thus, as the Williby court concluded, 10 to contracts such as self-funded ERISA plans. 11 accords with the purpose behind section 10110.6. 12 in Williby, the legislative history of section 10110.6 13 demonstrates that the California legislature was concerned over 14 how a discretionary clause, even in a self-funded plan, “deprives 15 California insureds of the benefits for which they bargained, 16 access to the protections of the Insurance Code[,] and other 17 protections in California law.” This reading As pointed out Id. at *5. 18 Defendants’ concern that discretionary clauses “force[] 19 administrators to master the laws of all 50 states” is misplaced. 20 As pointed out above, the Ninth Circuit has already rejected this 21 argument. 22 laws that bar discretionary clauses merely enforce the 23 application of the default standard of review and do not 24 “duplicate, supplement, or supplant” ERISA). 25 argument is the recognition that the initial decision made by a 26 plan administrator to deny or grant disability benefits is a 27 technical medical decision based on the evidence before the 28 administrator. Standard Ins. Co., 584 F.3d at 846 (finding that state Implicit in this Whether that decision will be subject to de novo 14 1 or discretionary review should not impact the administrator’s 2 decision. 3 the standard of review will “force[] administrators to master the 4 laws of all 50 states.” 5 10110.6, whether applied to self-funded plans or not, do not 6 “govern[] a central matter of plan administration or interfere 7 with nationally uniform plan administration.” 8 Ct. at 943. 9 courts [or] serve as an alternative enforcement mechanism outside And so it’s not clear how state laws that only impact Plainly, state laws such as section Gobeille, 136. S. Nor do they “authorize any form of relief in state 10 of ERISA’s civil enforcement provisions.” 11 F.3d at 846. 12 enforce the default de novo standard of review, and therefore are 13 not preempted by ERISA under Gobeille. 14 Standard Ins. Co., 584 Section 10110.6 and similar state laws simply Discretionary clauses are controversial. “The use of 15 discretionary clauses, according to National Association of 16 Insurance Commissioners, may result in insurers engaging in 17 inappropriate claim practices and relying on the discretionary 18 clause as a shield.” 19 same time, “insurers . . . argue [discretionary clauses] keep 20 insurance costs manageable . . . and that the wide ranging nature 21 of de novo review will lead to increased per-case costs.” 22 841. 23 application of state laws that bar discretionary clauses. 24 further direction from the Ninth Circuit, the Court is reluctant 25 to forge a new path through case law that has unanimously 26 concluded that the application of section 10110.6 to disability 27 plans, whether insured or self-funded, is not preempted by ERISA. 28 Standard Ins. Co., 584 F.3d at 840. At the Id. at The Court recognizes the competing interests in the Absent For these reasons, the Court concludes that section 10110.6 15 1 applies to self-funded plans in the same way it applies to 2 insured plans and effectively bars the Court from applying the 3 abuse of discretion standard of review. 4 review Aetna’s decision on a de novo basis. The Court will therefore 5 B. Analysis 6 To resolve the summary judgment motion, the Court must 7 determine whether there is a genuine issue of material fact as to 8 whether Thomas was disabled under the Plan. 9 applies de novo review, the Court may not defer to Aetna’s 10 11 Since the Court determination that Thomas was not entitled to STD benefits. Under the Plan, disability is defined as “the inability of a 12 Participant, because of a medically-determinable physical 13 impairment or mental impairment, to perform the duties of his 14 regular occupation.” 15 not considered disabled “unless he is, during the entire period 16 of Disability Absence, under the direct care and treatment of a 17 Physician and such disability is substantiated by significant 18 objective findings which are defined as signs which are noted on 19 a test or medical exam and which are considered significant 20 anatomical, physiological, or psychological abnormalities which 21 can be observed apart from the individual’s symptoms.” 22 AR 051. Additionally, the Participant is AR 051. Here, Thomas was employed by FedEx as a Contractor Relations 23 Specialist. Thomas’ job duties included ensuring contractors 24 complied with FedEx’s business models and operation agreements, 25 providing guidance to independent contractors regarding FedEx’s 26 operating agreements, investigating disputes between FedEx and 27 contractors, implementing business strategies, building business 28 relationships, recommending improvements for FedEx programs, 16 1 educating field operators about FedEx’s business model, 2 performing temporary staffing audits, verifying business 3 documentation and compliance, and documenting communications 4 between contractors and FedEx. 5 not list any physical demands as essential functions, but it does 6 state that standing is required 25%-50% of the time, sitting is 7 required 50%-75% of the time, and walking is required 25%-50% of 8 the time. 9 carrying, pushing, and pulling are not essential functions and AR 437. AR 436. Bending, stooping, reaching, lifting, 10 are never required. 11 is required 50%-75% of the time. 12 The job description does AR 438. Travel is an essential function and Id. Under the Plan, Thomas has the burden to prove with 13 sufficient objective evidence that she was disabled because she 14 was unable to perform her regular occupation. 15 v. ADT Sec. Servs. Pension Plan, 820 F.3d 1060, 1065 (9th Cir. 16 2016) (“[A] claimant may bear the burden of proving entitlement 17 to ERISA benefits” when “the claimant has better – or at least 18 equal – access to the evidence needed to prove entitlement.”). 19 Thomas argues that she provided sufficient objective evidence, 20 Mot. at 11-13, while Defendants argue that her evidence was 21 faulty and that she did not meet her burden, Opp. at 16-18. Estate of Barton 22 Taking into consideration the parties’ arguments and 23 evidence, the Court concludes that there is a genuine issue of 24 material fact as to whether Thomas proved with objective evidence 25 that she was disabled. 26 Thomas was disabled and two doctors have concluded that Thomas 27 was not disabled. 28 evidence because they are “signs which are noted on a test or First, two doctors have concluded that Also, the MRI results count as objective 17 1 medical exam.” 2 in conjunction with other evidence to conclude that Thomas had 3 “significant anatomical, physiological, or psychological 4 abnormalities.” 5 O’Laughlin’s opinion was at least partly based on his 6 observations “apart from [Thomas’] symptoms.” 7 Defendants even admit that there are some pieces of objective 8 evidence. 9 records providing objective, measurable evidence.”). AR 051. Id. At least one doctor considered the MRI Consideration of the MRI means that Dr. AR 051. D Reply at 5 (“there are extremely limited medical The mere 10 existence of such limited evidence means that summary judgment in 11 favor of Defendants would be inappropriate at this point. 12 this evidence, along with other evidence, was enough for several 13 doctors to conclude that Thomas was unable to perform her regular 14 tasks. And 15 On the other hand, Defendants provide multiple reasons why 16 this limited evidence is not sufficient to conclude that Thomas 17 was disabled. 18 exact opposite conclusion as Dr. O’Laughlin and opined that 19 Thomas was not disabled. 20 MRI report was “very sparse.” AR 511. 21 there was no clinical evidence of any motor or sensory loss, 22 weakness, or gait dysfunction. 23 2012 x-ray revealed no fracture and normal disc spaces and facet 24 joints. 25 degenerative disc disease, the lumbar spine MRI revealed no 26 neural compression. 27 28 Their two records reviewer doctors reached the AR 340-345. Dr. O’Laughlin himself opined that the And Dr. Swamy found that AR 586. Moreover, the October 8, Though the cervical spine MRI demonstrated AR 379. At the summary judgment stage, the Court simply analyzes whether there is a genuine issue of material fact that should be 18 1 reserved for trial. 2 that Thomas was disabled and there is some evidence that Thomas 3 was not disabled. 4 reserved for a trier of fact. Here, there is some evidence to conclude Resolution of the competing facts should be 5 6 7 8 III. ORDER For the reasons set forth above, the Court DENIES Thomas’s and Defendants’ motions for summary judgment. 9 IT IS SO ORDERED. 10 Dated: August 15, 2016 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 19

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