Goros v. Sun Life Assurance Company of Canada
ORDER adopting 29 REPORT AND RECOMMENDATIONS re 19 MOTION for summary judgment or for Judgment on the Record, and memorandum of Law in Support filed by Sun Life Assurance Company of Canada, 22 MOTION for summary judgment < i>and Motion for judgment. Magistrate Judge Carol Mirando's Report and Recommendation 29 is ACCEPTED and ADOPTED and the findings incorporated herein. Sun Life's Motion for Summary Judgment 19 is GRANTED.Goros' Motion for Summary Judgment 22 is DENIED. The Clerk is DIRECTED to enter judgment accordingly, terminate any pending motions and deadlines, and to close the file. Signed by Judge Sheri Polster Chappell on 8/28/2017. (LMF)
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
FORT MYERS DIVISION
GEORGE T. GOROS,
Case No: 2:16-cv-233-FtM-38CM
SUN LIFE ASSURANCE COMPANY
OPINION AND ORDER1
This matter comes before the Court on consideration of the Honorable Carol
Mirando’s Report and Recommendation (Doc. 29), filed on June 28, 2017.
Mirando recommends that Plaintiff George T. Goros’ (“Goros”) Motion for Summary
Judgment (Doc. 22) be denied, and that Defendant Sun Life Assurance Company of
Canada's (“Sun Life”) Motion for Summary Judgment (Doc. 19) be granted. (Doc. 29 at
41-42). Thereafter, Goros filed his objections (Doc. 30), and Sun Life responded in
opposition (Doc. 31). The matter is ripe for review.
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This case involves an attempt to recover insurance benefits under the Employee
Retirement Income Security Act (“ERISA”) under a group policy (the “Policy”) issued by
Sun Life to Goros’ former employer, United Plastic Fabricating Inc. (“United Plastic”).
From October 1995 to November 2012, Goros was the Executive Vice President of
Manufacturing Operations for United Plastic. (Docs. 14-1 at 105; 14-4 at 58). In that role,
he wielded administrative responsibility for three manufacturing plants in Michigan,
Massachusetts and Florida. (Doc. 14-1 at 115). Notably, the Policy included a long-term
disability income provision (the “Long Term Disability Policy”) and a life insurance waiver
of premium provision (the “Premium Waiver Policy”) (collectively, the “Disability
Benefits”). (Doc. 14-1 at 34, 60).
Notably, the Long Term Disability Policy provides a monthly benefit to replace the
income a disabled person could otherwise earn. (Doc. 14-1 at 77). Its terms state that
eligibility for monthly benefits hinges on the production of proof of continued total or partial
disability and the continuing care of a doctor who provides regular examinations in
accordance with the disabling condition.
(Doc. 14-1 at 77).
It also requires such
information to be provided to Sun Life upon request. (Doc. 14-1 at 77).
Similarly, the Premium Waiver Policy provides for the continuation of life insurance
coverage over a totally disabled individual without payment of premiums. (Doc. 14-1 at
60). Its terms allow Sun Life to require periodic proof of the continuation of the total
disability condition and to designate a doctor to examine the individual as often as is
reasonable. (Doc. 14-1 at 60). Importantly, both the Long Term Disability Policy and the
Premium Waiver Policy grant Sun Life total discretionary authority to make all final
decisions regarding an individual’s eligibility for benefits. (Doc. 14-1 at 95).
Against this backdrop, on November 18, 2012, Goros first visited Dr. Daniel Kunz,
D.O. to seek treatment for lower-back and hip pain and stiffness he claimed had persisted
for the previous two years. (Doc. 14-1 at 145). While being examined, Goros further
claimed he experienced such a loss in his range of motion he could no longer drive. (Doc.
14-1 at 145). Dr. Kunz diagnosed Goros with ankylosing spondylitis, arthritis that affects
the spine.2 (Doc. 14-1 at 148). Goros was prescribed a medication called Simponi to
reduce his symptoms and to prevent spinal fusion. (Doc. 14-1 at 148). Thereafter, Goros
continued to work at United Plastic until November 20, 2012, when he ceased
employment-related activities. (Docs. 14-1 at 103; 14-4 at 58).
On January 4, 2012, Goros filed a claim for benefits under the Long Term Disability
Policy. (Doc. 14-1 at 103-116). With that filing, Dr. Kunz submitted an opinion that Goros
had severe limitations in his functional capacity, and could not drive or sit for more than
three hours, could not walk for more than four hours, and could not function in a full-time
or part-time employment capacity. (Doc. 14-2 at 7-8). Subsequently, Sun Life obtained
an occupational analysis of Goros’ position as the Executive Vice President of
Manufacturing Operations for United Plastic, which was classified as light work (the
“Occupational Analysis”). (Doc. 14-2 at 126). The Occupational Analysis stated that the
demands of light work included “exerting up to 20 pounds of force occasionally or up to
Arthritis and Ankylosing Spondylitis, W EBMD, http://www.webmd.com/backpain/guide/ankylosing-spondylitis#1 (last accessed August 21, 2017).
10 pounds of force frequently, or a negligible amount of force constantly to move
objects[,]” as well as “occasional traveling.” (Doc. 14-2 at 126).
Goros also participated in an in-person interview with a Sun Life representative on
January 22, 2013. (Doc. 14-4 at 54-63). While speaking about his medical history, he
stated his joint problems stretched back to the late 1990’s, but that some doctors since
then had attributed his ailments to his personal activities. (Doc. 14-4 at 58). In November
of 2012, Goros stated his pain had become excruciating, and it was then that he sought
treatment from Dr. Kunz. (Doc. 14-4 at 59). Notably, Goros also indicated that he was a
motorcycle enthusiast, and tearfully contemplated the probability he would never again
be able to ride his motorcycle. (Doc. 14-4 at 63).
Continuing its evaluation, on March 4, 2013, Sun Life had Dr. Nadia Habal, M.D.
conduct a peer review of Goros’ medical records. (Doc. 14-4 at 73-79). After doing so,
Dr. Habal opined that it was not medically reasonable for Goros to sustain full time light
work employment, regardless of whether there were restrictions or modifications. (Doc.
14-4 at 78-79). Likewise, she opined that it was not medically reasonable for Goros to
sustain full time sedentary employment. (Doc. 14-4 at 79).
Thereafter, on March 7, 2013, after conducting the Occupational Analysis, an inperson interview and a peer review of Goros’ medical records, Sun Life approved Goros’
request for benefits under the Long Term Disability Policy. (Doc. 14-4 at 86). On May
17, 2013, Sun Life also approved Goros’ benefits under the Premium Waiver Policy.
(Doc. 14-5 at 55).
On November 22, 2013, Sun Life offered Goros $202,351.80 to discharge its
obligation to pay the totality of the Long Term Disability Policy. (Doc. 14-6 at 18-19).
Similarly, Sun Life offered Goros $46,009.60 to discharge its obligation to pay the totality
of the Premium Waiver Policy. (Doc. 14-6 at 25-26). Goros indicated he was not
interested in the offer regarding the Long Term Disability Policy, but would consider the
offer regarding the Premium Waiver Policy. (Doc. 14-1 at 9-10). No final agreement on
either provision was ever reached.
On April 4, 2014, Sun Life began conducting an update of Goros’ claim file. (Doc.
14-6 at 28). During the process, Sun Life requested proof of Goros’ continued disability
and conducted a background check. (Doc. 14-6 at 28, 47-64). Upon reviewing the results
of the background check, however, Sun Life discovered that in June of 2013, Goros’ exwife had posted on social media she was “[h]ome from 5 hrs of riding. 300 miles. Back
from 3 great days at bike week w[ith] [Goros].” (Doc. 14-6 at 52). Among other posts,
she also uploaded a picture with Goros on December 30, 2013, with the caption “[Goros]
is ready for our Christmas drive down the coast!” (Doc. 14-6 at 55).
Suspicion triggered, from April 25, 2014 until April 27, 2014 Sun Life conducted
video surveillance of Goros. (Doc. 14-6 at 65-82). On the morning of the first day, a Sun
Life representative observed Goros getting in and out of a vehicle, driving, walking
quickly, bending, leaning forward, pushing a lawn fertilizer spreader in the yard outside
his home, examining sprinklers and stomping on the ground. (Doc. 14-6 at 68-69). In the
afternoon, Goros went to a bar where he was observed sitting on a barstool, leaning
against the bar, drinking martinis, and periodically exiting to smoke cigarettes over the
course of one hour and 50 minutes. (Doc. 14-6 at 70). The Sun Life representative then
made conversation with Goros, who was seemingly unaware of the representative’s true
identity. (Doc. 14-6 at 70). Goros represented that he was selling his home and moving
to Florida, and that he owned and used a motorcycle. (Doc. 14-6 at 70). Goros further
represented that he was retired, but that he had a separate business to purchase
appreciating properties and sell them for profit. (Doc. 14-6 at 70).
On the morning of the second day, Goros was observed driving back to the same
bar he had frequented on the previous day. (Doc. 14-6 at 72). Once there, he opened
the trunk, reached in, and bent at the waste to acquire a plastic bag containing multiple
items. (Doc. 14-6 at 72). He then closed the trunk, walked to the front door of the bar,
and entered. (Doc. 14-6 at 72). Shortly thereafter, he exited, retrieved an item from the
passenger side of his vehicle, and then re-entered the bar. (Doc. 14-6 at 72). Later,
Goros drove to another property he owned, an office supply store and a home goods
store, and was seen bending at the waste to remove a floor mat from his vehicle, shaking
the floor mat, and placing it back into his vehicle. (Doc. 14-6 at 72).
On the third day, Goros was observed bending at the waist and knees, carrying a
piece of glass under his arm, carrying a metal table frame above his head, carrying a
wood table with the help of another person, and carrying a couch with the help of another
person. (Doc. 14-6 at 74-76). As the day progressed, Goros was seen at a restaurant,
where he bent down while smoking a cigarette, and thereafter at a home development
store, where he pushed a shopping cart, picked up items such as small tables and plants,
and placed them in the shopping cart. (Doc. 14-6 at 78-79). Upon returning to his home,
Goros was again observed picking up a small table from the ground and carrying it. (Doc.
14-6 at 81).
Sun Life also obtained additional video surveillance of Goros between May 18,
2014 and May 24, 2014. (Doc. 14-7 at 4-16). While Goros was not seen on the first day
of surveillance, on the second day Goros was observed getting in and out of a newly
purchased sports car, driving to a bank, an office supply store, and to the same bar he
had been seen at during the prior surveillance. (Doc. 14-7 at 4-8). He remained at the
bar during the afternoon, exiting intermittently to smoke cigarettes and converse with
individuals. (Doc. 14-7 at 7-8).
On the third day, Goros was seen driving the sports car to a doctor’s office, and
then to a pharmacy. (Doc. 14-7 at 9). After driving the sports car back to his home, he
rode as a passenger to the same bar he had frequented on previous dates. (Doc. 14-7
at 9). He was again observed leaving the bar intermittently to smoke cigarettes, converse
with individuals, and at one point, he was seen squatting to pick up a cigarette from the
ground. (Doc. 14-7 at 9).
On the fourth day, Goros was seen driving an SUV to a pharmacy and returning to
his residence. (Doc. 14-7 at 10-11). And while he remained in his home for the remainder
of the day, on the fifth day he was observed walking around his neighborhood carrying
poster board, and then driving his sports car back to the same bar he had frequented on
prior occasions, exiting intermittently to smoke cigarettes and converse with other
individuals, but otherwise remaining there until the late afternoon. (Doc. 14-7 at 11-12).
Then, on the last day, Goros was seen conducting a garage sale at his home, wherein he
bent at the waste, leaned forward, carried items, smoked several cigarettes and lifted a
wheeled seat above the level of his shoulders. (Doc. 14-7 at 14-15).
Sun Life also obtained Goros’ updated medical records. Among such records were
those of five visits to Dr. Kunz, which indicated an improvement in Goros’ condition,
including a noticeable decrease in pain and a lessening in stiffness. (Doc. 14-6 at 100-
103, 104-107, 108-113, 114-118, 119-123). In addition, records indicated that Goros also
saw Dr. Aaron Coleman, M.D. for right foot pain, and while being evaluated, Goros stated
that he enjoyed “power walking” as many as 2.5 miles a day. (Doc. 14-7 at 70). Goros
also repeated this interest when seeing Dr. Erika S. Blank, M.D., when he reported that
he walked 2 miles at 3.9 mph and a 5% incline every day. 3 (Doc. 14-7 at 98).
Sun Life then procured an independent review of Goros’ medical file by Dr. Richard
S. Corzatt, M.D.
(Doc. 14-8 at 4-9).
After examining Goros’ files and the video
surveillance, Dr. Corzatt opined that although the medical records supported a diagnosis
of ankylosing spondelitis, Goros had responded well to treatment, his condition was better
than when he stopped working in November 2012, and that the surveillance indicated that
Goros’ activities were compatible with a light occupation. (Doc. 14-8 at 9). Dr. Corzatt
opined that Goros “should be able to sit frequently changing positions every 45 minutes
as needed, [to] stand and walk frequently [for] no more than an hour at a time, [to]
occasionally lift [up] to 20 pounds, and [to] keyboard on a frequent basis.” (Doc. 22-1 at
Given the benefit of the independent medical report, the surveillance tapes, the
updated medical information, and the other information in the claim file, Sun Life
concluded that Goros was not entitled to continued Disability Benefits and ceased
distribution of same as of August and September 2014. (Doc. 14-8 at 12-14, 19-24).
Dr. Coleman ultimately performed a cheilectromy on Goros after his visit to Dr. Blank,
which is a procedure to remove a bone spur that has formed on a toe. (Doc. 14-7 at 7375). Marc First MTP Cheilectomy, AMERICAN ORTHOPEDIC FOOT & ANKLE SOCIETY,
accessed on August 21, 2017).
Goros then sought administrative review of Sun Life’s determination. (Doc. 14-8 at 2728).
During that process, Sun Life obtained another independent peer review of Goros’
medical records by Dr. Dennis Payne, Jr., M.D. (Doc. 14-11 at 40-45). Dr. Payne found
that while the diagnosis of ankylosing spondylitis had been established by the information
in the claim file, the video surveillance data indicated that Goros had “no restrictions or
limitations whatsoever.” (Doc. 14-11 at 43). On this basis, in July of 2015 Sun Life
affirmed its decision to terminate the Disability Benefits. (Doc. 14-11 at 50-63, 72-97).
Thereafter, on March 25, 2016, Goros filed the Complaint seeking a determination
that the Disability Benefits should be reinstated and seeking the recovery of any unpaid
benefits. (Doc. 1). Goros and Sun Life have submitted cross motions for summary
judgment. (Docs. 19, 22).
ERISA benefit denial cases present a unique scenario to courts where the
standard summary judgment considerations do not apply. Hert v. Prudential Ins. Co. of
Am., 650 F. Supp. 2d 1180, 1190 (M.D. Fla. 2009). “[W]here the decision to grant or deny
benefits is reviewed for abuse of discretion, a motion for summary judgment is merely the
conduit to bring the legal question before the district court and the usual tests of summary
judgment . . . do not apply.” Crume v. Metro. Life Ins. Co., 417 F. Supp. 2d 1258, 1272
(M.D. Fla. 2006) (quoting Bendixen v. Standard Ins. Co., 185 F.3d 939, 942 (9th
Cir.1999)). In substance then, a district court reviewing such a motion for summary
judgment sits more as an appellate tribunal than as a trial court. See Curran v. Kemper
Nat. Servs., Inc., 2005 WL 894840, *7 (11th Cir.2005) (unpublished per curiam opinion)
(quoting Leahy v. Raytheon Co., 315 F.3d 11, 17–18 (1st Cir.2002)); see also Crume,
417 F. Supp. 2d at 1272.
“It does not take evidence, but, rather, evaluates the
reasonableness of an administrative determination in light of the record compiled before
the plan fiduciary.” Id. As such, “the pertinent question is not whether the claimant is
truly disabled, but whether there is a reasonable basis in the record to support the
administrator's decision on that point.” Crume, 417 F. Supp. 2d at 1273.
A plaintiff must prove his entitlement to contractual benefits. Horton v. Reliance
Standard Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir. 1998). “This is true regardless of
whether the claim denial was from the onset of the claimed disability or whether the claim
denial was a termination of benefits that had been paid before the denial.” Walker-Hall v.
Am. Int'l Life Assur. Co. of New York, 788 F. Supp. 2d 1355, 1358 (M.D. Fla. 2011).
“ERISA itself provides no standard for courts reviewing the benefits decisions of
plan administrators or fiduciaries.” Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350,
1354 (11th Cir. 2011) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109
(1989)). The Eleventh Circuit, though, has laid out a multi-step framework to guide courts
in reviewing such a decision. Blankenship, 644 F. 3d at 1354. These steps are:
(1) Apply the de novo standard to determine whether the
claim administrator's benefits-denial decision is “wrong”
(i.e., the court disagrees with the administrator's decision);
if it is not, then end the inquiry and affirm the decision.
(2) If the administrator's decision in fact is “de novo wrong,”
then determine whether he was vested with discretion in
reviewing claims; if not, end judicial inquiry and reverse the
(3) If the administrator's decision is “de novo wrong” and he
was vested with discretion in reviewing claims, then
determine whether “reasonable” grounds supported it
(hence, review his decision under the more deferential
arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the inquiry and
reverse the administrator's decision; if reasonable grounds
do exist, then determine if he operated under a conflict of
(5) If there is no conflict, then end the inquiry and affirm the
(6) If there is a conflict, the conflict should merely be a factor
for the court to take into account when determining
whether an administrator's decision was arbitrary and
Id. at 1355.
“A pertinent conflict of interest exists where the ERISA plan administrator both
makes eligibility decisions and pays awarded benefits out of its own funds.” Id. In such
an event, “the burden remains on the plaintiff to show the decision was arbitrary; it is not
the defendant's burden to prove its decision was not tainted by self-interest.” Id. (internal
quotations omitted). Even where a conflict of interest exists, “courts still owe deference
to the plan administrator’s discretionary decision making as a whole. Id. (citing Doyle v.
Liberty Life Assur. Co. of Boston, 542 F.3d 1352, 1363 (11th Cir. 2008)). “Courts must
account for a structural conflict of interest, when one exists, as “a factor” in the analysis:
but the basic analysis still centers on assessing whether a reasonable basis existed for
the administrator's benefits decision.” Id. (citing Conkright v. Frommert, 559 U.S. 506,
After conducting a careful and complete review, a district judge “may accept, reject,
or modify . . . the findings or recommendations made by the magistrate judge.” See 28
U.S.C. § 636(b)(1). The district judge “shall make a de novo determination of those
portions of the report or specified proposed findings or recommendations to which
objection is made.” Id. And “[t]he judge may also receive further evidence or recommit
the matter to the magistrate judge with instructions.” Id.
The Report and Recommendation recommends granting Sun Life’s Motion for
Summary Judgment and denying Goros’ Motion for Summary Judgment. (Doc. 29 at 4142). Goros lodges four main objections to that conclusion, arguing: (1) Judge Mirando
erred by finding that Dr. Corzatt’s opinion did not contradict the Occupational Analysis
and supports Sun Life’s decision because Goros is unable to perform out of state travel
or to sit for more than 45 minutes at a time; (2) Judge Mirando erred by finding that Goros
did not present any evidence that the missing page of Dr. Corzatt’s opinion was not before
Sun Life when Sun Life terminated his benefits; (3) Judge Mirando erred by finding that
the surveillance videos, as well as Dr. Corzatt’s and Dr. Payne’s opinions, provided a
reasonable basis to support Sun Life’s decision to terminate benefits; and (4) Judge
Mirando erred by finding that no facts support Goros’ assertion that Sun Life’s short-term
monetary gain led it to negotiate toward a settlement with Goros regarding his Disability
Benefits, and when those advances were rebuffed, to investigate him. (Doc. 30). But
these arguments merely regurgitate the precise contentions already asserted and
considered in the briefing on the motions for summary judgment. Having undertaken an
independent review of the record, the Court finds that except for two small additions by
the Court regarding Goros’ first and second objection, Goros’ objections were adequately
addressed by the Report and Recommendation. Consequently, the Court will accept and
adopt the Report and Recommendation in its entirety and include the following additional
DR. CORZATT’S LIMITATIONS
Goros’ first objection argues that Judge Mirando erred by finding that Dr. Corzatt’s
opinion did not contradict the Occupational Analysis because it did not take into account
the demands of his job. (Doc. 30 at 1). Specifically, Goros avers that when working for
United Plastic, he spent as many as 72 days a year traveling out of state in 2011. He
reasons that if those demands were to hold true in the future, such activity would be
impossible under Dr. Corzatt’s limitations, which he contends allows for him to sit for no
more than 45 minutes at a time. He argues that Sun Life’s decision to terminate benefits
was arbitrary. The Court disagrees.
First, the correct lens to determine the congruence of Dr. Corzatt’s opinion is not
the previous demands of Goros’ employment at United Plastic, but, as the Policy
provides, the “usual and customary employment, business, trade, profession or vocation
that the [e]mployee performed as it is generally recognized in the national economy
immediately prior to the first date [t]otal or [p]artial [d]isability began.” (Doc. 14-1 at 5354). Crucially, the Policy provides that such analysis “is not limited to the job or position
the Employee performed for the [e]mployer or performed at any specific location.” (Doc.
14-1 at 54). With this in mind, the Occupational Analysis determined that Goros’ position
as the Executive Vice President of Manufacturing Operations is properly classified in the
general economy at the light exertion level. (Doc. 14-2 at 126). Notably, light work in the
general economy requires “occasional traveling.” (Doc. 14-2 at 126). The pertinent issue
is whether Dr. Corzatt’s limitations are consistent with the demands of occasional
Second, it tackling that question, Goros commingles the concept of remaining
seated in the same position with that of sitting while changing positions. Contrary to
Goros’ argument, Dr. Corzatt’s opinion does not limit him to 45 minutes in a seated
position. Instead, it allows for him to “sit frequently changing positions every 45 minutes
as needed, [and to] stand and walk frequently [for] no more than an hour at a time.” (Doc.
22-1 at 7). Though Dr. Corzatt does not precisely define what he means by the phrase
“changing positions,” its natural meaning conjures the mere alteration in overall body
posture while seated. The Court is unaware of any form of travel that would prohibit such
a basic human movement.
What’s more is that Dr. Corzatt’s opinion also allowed for standing and walking for
up to an hour. (Doc. 22-1 at 7). If, in the course of his employment, Goros were to travel
by automobile, he would possess the unfettered autonomy to stop, stand, stretch and
walk at his discretion. Even if Goros were required to travel via airplane from one location
to another, it is reasonable to assume that he would not be completely barred from
standing to stretch in the aisle or from walking to the men’s room during the course of the
Finally, the Eleventh Circuit has previously upheld an administrative claim denial
where evidence indicates that shifting positions would enable a claimant to perform
clerical work. See Turner v. Delta Family-Care Disability & Survivorship Plan, 291 F.3d
1270 (11th Cir. 2002). In Turner, the claimant’s disability benefits were terminated, and
the administrator’s decision was subsequently upheld, after she received medical
approval to perform clerical activities so long as she could change positions as needed,
she could refrain from lifting, twisting or bending, and the claimant was not required to lift
more than ten pounds. Id. at 1273. Similar to Turner, the Court finds no reason that
Goros cannot perform the duties of his occupation here, so long as the limitations outlined
by Dr. Corzatt are allowed. And because those limitations may be observed by Goros
while traveling, the Court finds that Dr. Corzatt’s opinion does not contradict the
DR. CORZATT’S FULL OPINION
Second, Goros argues Judge Mirando erred by finding he presented no evidence
the missing page of Dr. Corzatt’s opinion was not before Sun Life when it terminated his
Disability Benefits. (Doc. 30 at 2). Instead, Goros argues he did so by pointing out that
Sun Life failed to outline the limitations in Dr. Cozatt’s opinion when explaining the
termination of the Disability Benefits in letter form. Additionally, Goros argues evidence
that Sun Life considered less than the entirety of Dr. Corzatt’s opinion can be discerned
by the fact that Sun Life’s internal notes do not mention Dr. Corzatt’s limitations. Goros’
Though the fact that Dr. Corzatt’s opinion was not expressly mentioned by Sun
Life constitutes circumstantial evidence it was not considered, the Court is not prepared
to accept Goros’ otherwise unbridged conclusion. For starters, Sun Life – the plan
Goros’ claim that he cannot function within these parameters is further undermined by
the fact that during the time he claimed to be disabled, and just months after his in-person
interview with a Sun Life representative where he tearfully contemplated permanently
foregoing motorcycle riding, social media accounts place him on a 300 mile, five hour
motorcycle cruise. (Doc. 14-6 at 52). Similarly, Goros’ ability to take a Christmas drive
“down the coast,” as represented on social media, is indicative of an ability to perform
occasional travel. (Doc. 14-6 at 55).
administrator – contends that it considered Dr. Corzatt’s entire medical review, including
the last page, which lists Goros’ medical limitations. (Doc. 26 at 10). Additionally, Sun
Life’s attorney maintains in an affidavit that the omission on the record was merely a result
of an error in scanning and uploading the document. (Doc. 27-1 at ¶ 6).
Nothing about the omission would lead to the conclusion that Sun Life did not
consider the entirety of the evidence in rendering its decision. The denial letter simply
stated that an orthopedic surgeon found that the video surveillance indicated that Goros’
activities appeared to be compatible with a light occupation. (Doc. 14-8 at 13). It did not
conclude that the evidence cited constituted the entire cited medical opinion, nor did it
make any unequivocal statements about Goros’ abilities. (Doc. 14-8 at 13). Moreover,
the denial letter is not contradicted by Dr. Corzatt’s limitations. To the contrary, given that
Dr. Corzatt opined Goros’ activities appeared to be compatible with a light occupation,
(Doc. 14-8 at 3), and the Court has already found the restrictions imposed by Dr. Corzatt
do not contradict the Occupational Analysis, the contents of the denial letter are precisely
in line with the thrust of the facts.
By the same token, although Sun Life’s internal notes do not mention Dr. Corzatt’s
limitations, they do not mention Dr. Corzatt’s opinion by name at all. (Doc. 14-1 at 6).
Instead, Sun Life’s internal notes comprise short, cursory, entries that mark events
including (1) the provision of Goros’ medical file to Dr. Corzatt; (2) a “medical review” in
which Goros was deemed capable of performing light work; and (3) that a claim denial
was sent. (Doc. 14-1 at 6). The context of the record provides the clear inference that
the “medical review” was that of Dr. Corzatt, but Goros does not indicate why he would
expect to find a specific reference to Dr. Corzatt’s limitations in such a format. Upon
consideration, it seems that such an in-depth entry into the substance of the medical
opinion would exceed the surface level specificity with which the other notes were kept.
Consequently, the fact Dr. Corzatt’s limitations were not found in Sun Life’s internal notes
is not a strong indicator they were not considered.
At base, Goros’ argument is flawed because it hinges on the presumption that
every specific consideration be spelled out in every decisional manifestation. Such a
result would be absurd and unwieldy. In the eyes of the Court, Sun Life’s denial letters
would indicate that it had considered the entire information at hand.
Accordingly, it is now
1. Magistrate Judge Carol Mirando’s Report and Recommendation (Doc. 29) is
ACCEPTED and ADOPTED and the findings incorporated herein.
2. Sun Life’s Motion for Summary Judgment (Doc. 19) is GRANTED.
3. Goros’ Motion for Summary Judgment (Doc. 22) is DENIED.
4. The Clerk is DIRECTED to enter judgment accordingly, terminate any pending
motions and deadlines, and to close the file.
DONE and ORDERED in Fort Myers, Florida this 28th day of August, 2017.
Copies: All Parties of Record
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