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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UNITED STATES DISTRICT COURT
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EASTERN DISTRICT OF CALIFORNIA
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LASHAUN THOMAS,
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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.
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Plaintiff Lashaun Thomas (“Thomas”) alleges that she was
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entitled to short-term disability (“STD”) benefits under the
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Employee Retirement Income Security Act (“ERISA”)-governed self-
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funded disability plan (the “Plan”) put in place by her employer
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defendant FedEx Ground (“FedEx”).
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Company (“Aetna”), which was designated as the Plan
25
Administrator, denied her request for STD benefits.
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now before this Court because ERISA permits an insured to sue “to
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recover benefits due to him under the terms of his plan.”
28
U.S.C. § 1132(a).
Defendant Aetna Life Insurance
The case is
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Both parties seek summary judgment in their
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favor.
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motions for summary judgment and finds that there is a genuine
3
issue of material fact as to whether Thomas adequately
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demonstrated that she was entitled to STD benefits.
For the reasons stated below, the Court denies both
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I.
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FACTUAL ALLEGATIONS AND PROCEDURAL BACKGROUND
On September 19, 2012, Thomas was traveling for work with
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her boss when their car was rear-ended.
Defendants’ Response to
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Plaintiff’s Statement of Undisputed Facts (“P SUF”) (Doc. #20-1)
10
#1.
11
Grove”) and complained of back pain caused by the accident.
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#2.
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tenderness of the paraspinal muscles and prescribed pain
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medication.
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Elk Grove that revealed no fracture and that her disc spaces
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appeared normal.
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of Undisputed Facts (“D SUF”) (Doc. #22-1) #13.
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2012, Thomas was reevaluated at Elk Grove and was diagnosed with
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a back strain that was worse with movement.
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February 4 and February 7, 2013, Thomas again went to Elk Grove
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and it was noted that there were no neurological deficits.
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#15.
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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.
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received this treatment until April 10, 2013.
Id.
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physical therapist noted that Thomas had tenderness in her right
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shoulder girdle and her cervical paraspinal region.
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pain was rated as between 5 and 7 out of 10 and was aggravated by
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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.
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broad based disc bulges with osteophytic spurring at C4-5, C5-6,
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and C6-7.
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protrusion/herniation with right foraminal encroachment on the
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C5-6 level and a C6 root compression.
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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
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the MRI, the craniocervical junction appeared unremarkable; the
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spinal cord was not enlarged; no bony destructive lesion or
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cervical soft tissue mass was seen; and the anterior and
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posterior ligament groups appeared intact.
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lumbar spine MRI revealed no neural compression, unlike the
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cervical MRI.
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D SUF #16.
The
Id. #17.
On August 25, 2013, Dr. Truong at Elk Grove excused Thomas
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from work from August 26, 2013 through August 30, 2013.
P SUF
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#7.
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September 16, 2013.
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for 45 days on September 18, 2013.
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2013, Thomas contacted Aetna to open a claim for short-term
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disability benefits.
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filled out an Attending Physician Statement (APS) stating that
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Thomas was disabled from work from August 24, 2013 through
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October 16, 2013, and that after October 16, 2013, Thomas could
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return to work only on modified duty with occasional sitting,
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driving, computer use, hand grasping and reaching, and no
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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.
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On October 4, 2013, Aetna informed Thomas that FedEx
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retained it to administer the STD Plan and that a clinical review
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of the appropriateness of her work absence was required.
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#19.
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that Thomas should remain off work from October 16, 2013 through
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November 29, 2013.
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D SUF
Dr. Truong wrote another note on October 9, 2013, stating
Id. #20.
On November 6, 2013, Aetna informed Thomas that it concluded
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she did not meet the definition of disabled and explained why.
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D SUF #21; Administrative Record (“AR”) 324-325.
The letter
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explained that Thomas could appeal the decision and provided a
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list of items she could provide that may help prove her claim.
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Id. #22.
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December 16, 2013, the Aetna Appeals Specialist evaluating
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Thomas’s appeal conducted a telephone interview with Thomas in
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which Thomas stated that Dr. Truong had released her back to work
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but that her employer was unable to accommodate her because of
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the medications she was taking.
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also explained the reason for denying the claim and the type of
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information Thomas could provide to assist the review.
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The Appeals Specialist reduced the conversation to writing and
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confirmed that Thomas’s current condition was displacement of
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lumbar invertebral disc without myelopathy.
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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
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Mendelssohn, who specializes in orthopedic surgery.
D SUF #28.
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Dr. Mendelssohn attempted a peer-to-peer consultation with Dr.
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Heune and Dr. Truong but was unable to get in touch with them.
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Id. ##29-30.
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Wilson, who said Thomas was in a car accident and could not work
Dr. Mendelssohn conducted a consultation with Dr.
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because of her symptoms, but admitted that he had only seen
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Thomas once and could not provide any evidence of any functional
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or neurological deficits.
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that “a comprehensive history and physical examination supporting
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diagnostic studies that would indicate a functional impairment
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from her regular occupation as a field contractor REL specialist,
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which is sedentary from 8/26/13 through 1/6/14 cannot be
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substantiated.”
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able to return to her position without restrictions from August
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Id. #32.
Id. #31.
Dr. Mendelssohn opined that Thomas was
26, 2013 through January 6, 2014.
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Dr. Mendelssohn reported
Id. #33.
On January 15, 2014, Aetna again tried to contact Dr. Truong
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and Dr. Heune, but was unable to reach them.
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day, Aetna wrote to Thomas explaining that the appeal review
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needed more time because Aetna could not reach the two doctors.
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Id. #35.
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Id. #34.
That same
On January 30, 2014, Thomas was seen by Dr. Thomas J.
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O’Laughlin, who performed an examination on Thomas.
P SUF #13.
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Dr. O’Laughlin’s initial evaluation is presented in AR pages 513-
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517.
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cervical spine disclosed a broad-based disc bulge at C5 with
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osteophytic spurring and right paracentral disc osteophyte with
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mild neuroforaminal narrowing and that the lumbar spine MRI was
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unremarkable.
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Thomas had evidence of some underlying cervical degenerative disc
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disease of varying degrees at C5-C6, C4-C5, and C5-C6.
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He stated that Thomas “seems to have aggravated her underlying
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degenerative cervical changes and appears to have some
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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
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Id. #37.
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intractable cervicscapular myofascial pain and chronic
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cervicogenic headache.”
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work because the stressors of work and the psychosocial pressures
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would prevent her from improving.
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Id.
He agreed with keeping Thomas off
Id. #39.
The following day, Dr. O’Laughlin performed trigger-point
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injections.
P SUF #14.
Dr. O’Laughlin saw Thomas five other
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times between February 2014 and May 2014.
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2014, Dr. O’Laughlin wrote Aetna a letter on behalf of Thomas
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stating that “after reviewing the medical records of Lashaun
Id. #15.
On April 21,
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Thomas, as well as performing a face-to-face medical examination,
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it is my opinion that Ms. Thomas has been disabled and unable to
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work since her accident on 9/19/2012.”
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P SUF # 16; D SUF #43.
Aetna then hired Dr. Priya Swamy to complete a peer review.
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D SUF #46.
The scope of what Dr. Swamy reviewed is under
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dispute, but the parties agree that Dr. Swamy reviewed some
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records from between August 26, 2013 through March 24, 2014, the
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MRIs from June 18, 2013, and records from July 31, 2013 and
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August 19, 2013.
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O’Laughlin’s records Dr. Swamy reviewed.
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Swamy also attempted a peer-to-peer consultation with Dr.
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O’Laughlin but was unable to reach him.
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concluded that Thomas had no functional impairments from August
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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.
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Aetna wrote to Thomas on June 6, 2014, informing her that it
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completed the appeal review of the denial of her STD benefits and
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upheld the original decision to deny STD benefits effective
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August 26, 2013.
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Id. #53; AR 581.
Thomas filed the complaint in this case, alleging that she
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“was entitled to short-term disability, as well as other benefits
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under the Plan.”
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Defendants “arbitrarily and in bad faith refused to make payments
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to [her] as required by the Disability Plan.”
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seeks the past and future benefits allegedly owed to her under
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the LTD Plan and “a declaration by this court . . . that all
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benefits provided to Plan participants while they are disabled
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under the Plan . . . be reinstated retroactive to the date her
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LTD benefits were terminated.”
Compl. ¶ 4 (Doc. #1).
Thomas alleges that
Id. at 3.
Id. ¶ 6.
Thomas
Thomas then filed a
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motion for summary judgment (Doc. #16).
Defendants opposed the
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motion and filed a cross motion for summary judgment (Doc. #20).
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Thomas opposed Defendants’ cross motion (Doc. #22).
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heard argument on the cross motions for summary judgment on
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August 9, 2016.
The Court
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II.
OPINION
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A.
Legal Standard
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The preliminary issue the Court must decide is whether it
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should review Aetna’s determination that Thomas did not qualify
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for STD benefits under a de novo standard of review or an abuse
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of discretion standard of review.
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de novo review, while Aetna argues that abuse of discretion is
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the appropriate standard.
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1.
Thomas asks the Court to apply
Proper Delegation
Thomas argues that the abuse of discretion standard would be
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inappropriate here because Aetna was never unambiguously granted
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discretion by the Benefits Committee.
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Thomas concedes that the Benefits Committee was granted
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P Reply (Doc. #22) at 1.
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discretion for its determination of whether Thomas was disabled
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but contends that “there is no language in the Plan granting
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Aetna discretion and Defendants have not cited anything
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evidencing that the Benefits Committee expressly delegated its
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discretion to Aetna.”
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section 5.1(d) of the Plan, which permits the Plan Administrator
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to delegate its discretionary authority to a third party.
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Reply at 2 (Doc. #25) (citing AR 060).
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questioning from the Court during the August 9, hearing on the
Id.
In response, Defendants point to
D
In response to
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cross motions, Defendants further noted that section 2.4 of the
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Plan states that “Claims Paying Administrator” means Aetna and
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that section 4.5(a) of the Plan states that the Claims Paying
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Administrator is charged with “determin[ing] pursuant to the
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terms of the STD Plan that a Total Disability exists.”
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On this issue, the Court agrees with Defendants.
The Plan
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clearly states that Aetna, as the Claims Paying Administrator,
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was charged with deciding whether Thomas was disabled under the
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terms of the Plan.
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provides the Plan Administrator with “the discretion and
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authority to interpret and construe the provisions of the STD
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plan . . . [and] decide any dispute which may arise with regard
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to the rights of Participants entitled to benefits.”
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Read as a whole, the Plan sufficiently delegates the Plan
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Administrator’s discretionary authority to Aetna.
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not apply de novo review on the basis of Thomas’s argument that
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Aetna was not properly delegated discretion.
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///
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///
The Plan contains a discretionary clause that
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AR 060.
The Court will
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2.
ERISA Preemption of Section 10110.6
The crux of the dispute over the proper standard of review
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is whether ERISA preempts the application of California Insurance
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Code section 10110.6 (“section 10110.6”) to self-funded plans,
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such as the one at issue in this case.
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ERISA preempts section 10110.6 because section 10110.6 “has an
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impermissible connection with a key facet of ERISA plan
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administration.”
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courts that have ruled on this issue have determined that ERISA
Opp. at 15.
Defendants argue that
Thomas argues that all previous
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does not preempt section 10110.6, whether or not the plan is
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self-funded.
P Reply at 2.
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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
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denying benefits to the participant.
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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
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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
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Administrator shall have the discretion and authority to
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interpret and construe the provisions of the STD plan, determine
3
the entitlement of any Participant to benefits hereunder, and
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decide any dispute which may arise with regard to the rights of
5
Participants entitled to benefits.”
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on the presence of this discretionary clause, the Court would
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have to apply an abuse of discretion standard.
8
9
10
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12
13
14
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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.
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If section 10110.6 applies in this case, then the discretionary
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clause in the Plan is void, and the default de novo standard of
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review would apply.
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Defendants argue that section 10110.6 cannot apply in this
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case because ERISA preempts its application.
ERISA is meant to
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“supersede any and all State laws insofar as they . . . relate to
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any employee benefit plan.”
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so-called “Savings Clause” states that ERISA “shall not be
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construed to exempt or relieve any person from any law of any
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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
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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
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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
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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
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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
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To resolve the summary judgment motion, the Court must
7
determine whether there is a genuine issue of material fact as to
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whether Thomas was disabled under the Plan.
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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
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regular occupation.”
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not considered disabled “unless he is, during the entire period
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of Disability Absence, under the direct care and treatment of a
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Physician and such disability is substantiated by significant
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objective findings which are defined as signs which are noted on
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a test or medical exam and which are considered significant
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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,
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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
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