Daniliauskas v. Reliance Standard Life Insurance Company

Filing 55

OPINION and Order. Signed by the Honorable Charles R. Norgle, Sr on 3/14/2018. Mailed notice (ew, )

IN THE UNITED STATES DISTRICT COURT FOR
THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
JONAS DANILIAUSKAS,

Plaintifl
Case

No. 1:16-cv-9278

v.

RELIANCE STANDARD LIFE
INSURANCE COMPANY,

Hon. Charles R. Norgle

Defendant.

OPINION AND ORDER
Plaintiff Jonas Daniliauskas ("Plaintiff') brings his claim against Defendant Reliance Standard

Life Insurance Company ("Defendant") pursuant to the Employee Retirement Income Security
Act ("ERISA") seeking a judicial determination that he is due long-term disability benefits under
the Group Long Term Disability Insurance Program ("Contract"). Before the Court are cross-

motions for entry of judgment pursuant to Fed. R. Civ. P.

52. For the following

reasons,

Plaintiff s motion for judgment is denied and Defendant's motion for judgment is granted.
BACKGROUND
Plaintiff, who suffers from a number of ailments,l is a former plan administrator with
Alliance Pension Consultants, LLC. ("Alliance"), a subsidiary of Miller Cooper & Co. Ltd. As

Miller Cooper & Co. employee he was eligible for long and short-term disability

a

through

Defendant. On October 27, 2015, Plaintiff ceased working and was placed on short-term
disability. On January 26,2016, Plaintiff s long-term disability was scheduled to begin, but on
February 19, 2016, Defendant denied Plaintifls claim

for long-term disability

' Plaintiff has: human immunodeficiency virus (HIV), prostate cancer; and mental deficits

benefits.

Following the denial

of

benefits Plaintiff exercised his administrative remedies and on

September 12,2016, he received a letter upholding Defendant's initial determination.

^.

Findings of Fact2
The question before the Court is whether Plaintiff s ailments are sufficient to find that he

is due long-term disability compensation under Contract's definition of disability. The Contract
defines totally disabled as:

"Totally Disabled" and "Total Disability" mean, that as a result of an injury or
Sickness:

(1) during the Elimination Period and for the ftst24 months for which a Monthly
Benefit is payable, an insured cannot perform the material duties of his/her
regular occupation...
"(2) after a Monthly Benefit has been paid for 24 months, an Insured cannot
perform the material duties of any occupation. Any occupation is one that the
Insured's education, training or experience will reasonably allow. We consider the
Insured Totally Disabled if due to an Injury or Sickness he or she is capable of
only performing the material duties on a part - time basis or part of the material
duties on a full - time basis."
Statement of Facts in Supp. Pl.'s Mot. for Entry of J. fl 5 [hereinafter, Plaintiff s SoF] (citing,

Reliance Standard

Life

Insurance Company, Group Long Term Disability Insurance Non-

Participatin g, p. 2.1).

In his application Plaintiff alleged that he was unable to perform his duties "due to HIV

infection, prostate cancer, urinary incontinence, anxiety and depression, and cognitive
impairments." Plaintiff s SoF, t|

6.

In his motion, Plaintiff argues that all of his ailments

contribute to his status as disabled.

Plaintiff is a pension administrator with Alliance. As a pension administrator Plaintiff
must, inter alia, maintain client relationships; prepare accountings of trust accounts; determine
contributions due; prepare management reports; and perform compliance testing. Administrative

2

The Court takes the facts from the parties' Statements of Facts and relies on the Administrative Record
(maintained by Defendant and heavily cited by Plaintiffl as well as other evidence presented by the Parties

Record,

p. 105. In order to successfully perform his duties Plaintiff must

possess excellent

verbal and written skills, strong problem solving and analytical skills, attention to detail,
developed interpersonal skills, and self-motivation. Id. at 105.

Plainriff's HIV

It is uncontested that Plaintiff is HIV Positive. He has lived with HIV since 2005

and at

present his HIV is controlled by a regimen of medication administered and overseen by his
primary care physician, Dr. Robert T. Hargan. Plaintiff is routinely examined by Dr. Hargan and
the most recent records indicate that his HIV is managed by the new regimen of medication. See

Pl.'s Resp. to Statement of Facts in Supp. Def.'s Mot for Entry of J. and Add'I. Facts in Supp. of

Pl.'s Mot for Entry of J., !f 20-22 [hereafter, 'oPl.'s Resp. to SOF"]; see also Administrative
Record, pp. 242, 244, 246, 248, 250, and

252. In the records before the Court, Dr. Hargan

indicates that Plaintiff s HIV is well managed and has not resulted in any secondary infections or
complications.

Dr. Hargan does note, however, that beginning in late September 2015, Plaintiff began to
experience some depression as related to his

work. Administrative Record, p.248. Dr. Hargan

observes Plaintiff s depression through the most recent records before the Court, May 3, 2016.

Id. at pp. 241-2. These observations are undercut by recent observations that Plaintiff

oohas

a

normal mood and affect." Id. at pp.241,243, and245.

Accordingly, the Court finds that Dr. Hargan's care of Plaintiff is primarily related to his

HIV diagnosis and other general issues. As a result the Court places considerable weight in his
determination that Plaintiffls HIV is well managed by his current medication.

Plainti/f's Prostate Cancer
Plaintiff was diagnosed with prostate cancer,

ooa

low risk adenocarcinoma[,]" in 2014. Id.

at 218-9. In mid-March 2015, Plaintiff was treated, without incident or abnormality, via
CyberKnife by Dr. Dicker. The follow-up letters from Dr. Dicker indicate that Plaintiff
recovered from his surgery without any significant issues. However, Plaintiff did suffer two
episodes of incontinence in September 2015. Id. at 361.

The Court finds that Dr. Dicker is the physician treating Plaintiffls prostate cancer and as
a result gives considerable weight to the evidence presented from his treatment. The Court also

finds that Plaintiffls cancer has been treated and according to the evidence before the Court, he
"continues to do

3.

well." Id. at 361.

Plaintiff's Myriad Mental Health Ailments
Plaintiff suffers from a number of mental defects and deficiencies. For several years

Plaintiff has been treated by Jeff Levy,

a Licensed

Clinical Social Worker. Mr. Levy reports that

Plaintiff has been dealing with depression and anxiety and from 2015 his depression, anxiety,
and feelings of isolation have increased. Mr. Levy reports that, eventually, the combined stress

of Plaintiff s HIV, prostate cancer, and professional responsibilities led to worsening depression
and eventually disability. Administrative Record, pp. 150-151. Plaintiff remained highly
anxious and continued to deal with issues relating to his depression and anxiety through Mr.

Levy's reporting period. Id. at 443-444.
In addition to Mr. Levy, Plaintiff was treated by Richard Abrams, M.D., S.C. Before the
Court are Dr. Abrams treatment notes for Plaintiff. They contain session notes wherein the

Plaintiff

s mental status is evaluated. In the notes Dr. Abrams acknowledges several instances

of

mental impairment as indicated by mistakes in a serial 7 test (counting backwards from 100 by

7s), some impaired concentration, anxiety, panic, and depression. However, in most of the notes

from 2016 Dr. Abrams reports "no deficiencies in calculation, serial 7's, fund of knowledge,
orientation, memory, ability to abstract, similarities, posture, grooming or dress." Id. at 355; see
Id. at352-356.
Lastly, Andrew Suth, Ph.D., examined and evaluated the Plaintiff s neurobehavioral and

emotional functioning. Dr. Suth conducted a battery

of test focused on Plaintiffs

mental

abilities and intellectual capacity. The "Global Cognition" tests indicate Plaintiffs IQ is
average, his individual index scores were: verbal comprehension index, high average; perceptual

reasoning index, average; working memory index, low average; processing speed index, average;

full scale IQ, average. Administrative Record, p.377. Dr. Suth's report states "[Plaintiffs]
general abilities scores indicate robust intellectual capacity and premorbid functioning, testing
revealed areas of specific weakness concentrated on frontal lobe functions." ld. at 317 .

Dr. Suth's report goes on to discuss a number of different areas of cognitive functioning
through the administration of a battery of cognitive tests. Discussed at length within his report
are Plaintifls memory, working memory, attention, and executive function. Dr. Suth made
numerous conclusions, including: that Plaintiff suffers from cognitive challenges associated with

attention and memory functions, Id. at 318-321; Plaintifls learned memory is largely intact,

albeit delayed, Id. at 323; and Plaintiff has difficulties with registering and learning new
information,

Id.

Ultimately, Dr. Suth diagnosed Plaintiff, according to the Diagnostic and

Statistical Manual of Mental Disorders, 5th Edition, with: Mild Neurocognitive Disorder due to
an unspecified origin; Major Depressive Disorder, Recurrent, Moderate; Generalized Anxiety
Disorder; Post Traumatic Stress Disorder. ld. at325.

Accordingly, the Court finds that Plaintiff suffers from myriad neurological and
psychological deficiencies. Plaintiff suffers from depression, anxiety, and panic disorders

as

well as neurological deficits associated with frontal lobe functions, i.e. memory and attention.

ANALYSIS
Standard of Decision
"[Federal Rule of Civil Procedure] 52 allows this Court to conduct a trial on the papers
and to resolve factual disputes[.]" Halley v. Aetna

Ill. 2015). Unlike

a motion

Life Ins. Co., 141 F. Srpp. 3d 855, 8s7 (N.D.

for summary judgment the court can weigh the evidence presented,

make conclusions, and resolve factual disputes. Fed. R. Civ. P. 52(aX1). ERISA claims are

"well-suited" to review pursuant to Rule

52.

Fontaine v. Metro. Life Ins. Co., 800 F.3d 883,

885-86 (7th Cir. 2015).
Claims under ERISA are typically reviewed de novo by the district court. However, "the

district courts are not reviewing an1'thing; they are making an independent decision about the
employee's entitlement to benefits." Diaz v. Prudential Ins. Co. of Am. , 499 F.3d 640, 643 (7th
Cir. 2007). "[W]hen de novo consideration is appropriate in an ERISA case... the court can and
must come to an independent decision on both the legal and factual issues that form the basis
the

claim." ld. at 643 (citing Patton v. MFS/Sun Life Financial Distributors. Inc., 480 F.3d

of

478,

485-86 (7thCir.2007)). The party seeking enforcement of the plan bears the burden of proving
his position under the contract by a preponderance of the evidence. Ruttenberg v. U.S. Life Ins.
Co. in City of New York. a subsidiary of Am. Gen. Corp., 413 F.3d 652,663 (7th Cir. 2005); see
also Fontaine, 800 F.3d at 886.

Both parties acknowledge that a motion for judgment pursuant to Rule 52 is essentially a

trial on the papers and given the substantive issue-ERlSA-the Court will make

an

independent decision as to Plaintiffs disability under the Contract. Yet, both Parties instead
devote considerable time discussing the initial determination by Defendant and the subsequent
appeal by

Plaintiff.

Because review of the

initial determination is inappropriate given the motion

before the Court, the Court ignores these arguments and makes an independent determination of

Plaintifls disability under the Contract.

Plaintiffs Total Disability Claim
Here, Plaintiff is asking the Court to find he is due disability benefits under the Contract.

The total disability provision of the Contract is articulated as being unable to perform the
material duties of, here, Plaintiffls regular occupation or "la)ny occupation." Plaintiff s SoF !f

5

(citing Contract,2.l). Any occupation is defined as one the Plaintiffs "education, training or
experience will reasonably allow." Id.

Plaintiff, as articulated above, suffers from myriad ailments: HIV, prostate

cancer,

depression, and neurocognitive issues. As the Court found above Plaintiff is HIV positive, but

his virus is well controlled through the administration of medication and is overseen by his
internist, Dr. Hargan. Dr. Hargan's reports indicate that Plaintiffs HIV is well managed and

Plaintiff admitted that his HIV is well managed and that there are no secondary infections or
complications resulting from Plaintiff s HIV. Pl.'s Resp. to SoF at fllf 20, 21. PlaintifPs prostate
cancer is similarly well controlled. Plaintiff responded well to CyberKnife treatment save some
side effects secondary to the treatment (urinary and fecal urgency and occasional incontinence).
What remains is Plaintifls mental defects.

While the Court considers the totality of Plaintiffls ailments in making a determination of

disability, Plaintifls mental health complaints are the major motivation for his disability claim.
This statement is echoed by Plaintiffls primary care physician, Dr. Hargan, his Psychotherapist,

Mr. Levy, and Dr. Suth. Since 2075, Plaintiffs depression and anxiety have increased. Recent
tests indicate that Plaintiff also suffers form decreased frontal lobe functioning resulting in
decreased memory and attention.

These ailments, however, are not sufficient to prevail under the high bar set by the

Contract. The Contract clearly sets out provisions wherein a claimant can receive disability

as

the result of mental or nervous disorders. Among the enumerated mental and nervous disorders
are depressive and anxiety disorders, Pl.'s Resp. to SoF at

fl

ll,

both of which affect Plaintiff.

The standard set by the Contract is weather the claimant can perform either his own occupation

or

afiy other occupation commensurate with his skills and experiences.

In McFarland v. Gen. Am. Life Ins. Co., the Seventh Circuit interpreted the language of
an occupational disability insurance policy with a definition of total disability similar to the
definition contained in the Contract at issue here. 149 F.3d 583, 586 (7th Cir. 1998). The policy

in McFarland defined total disability
substantial duties

as when the insured is "unable to perform the material and

of [his or her] regular occupation." Id. The court held that the definition of

total disability was unambiguous and that the insured would be totally disabled under the policy

when he "cannot perform a sufficient number

of his material and substantial duties and is

therefore precluded from continuing the employment he undertook before the disability." Id. at
587.

Further, the court stated that "[t]he policy language could be interpreted reasonably to
cover both qualitative and quantitative reductions in one's performance as a result of an injury or

sickness." Id. at 588. A qualitative reduction would be one where the insured is "no longer able
to perform one core and essential aspect of his job. . . as a result of an injury."

Id.

For instance, a

shortstop, who could no longer perform the core and essential duty of throwing a baseball due to

his disability, but could still run, hit, and catch, would be totally disabled due to a qualitative
reduction in his performance. Id. In contrast, "a quantitative performance reduction would be
one in which the injury or sickness would not physically prevent an employee from performing
any given task, but the injury instead renders the person unable to perform enough ofthe tasks or

to perform for a long enough period to continue working at his regular occupation." Id.
Here, the Contract would be limited to qualitative reductions in perforrnance. By virtue

of the "any occupation" provision of the disability definition Defendant has limited Plaintiff

s

ability to claim disability where his overall reduction in performance would prohibit him from
holding his original position where another similar, yet less demanding position, was available.

Plaintiffs duties, as articulated above, encompass a range of intellectual and interpersonal requirements and there is no dispute that Plaintiff has been effected by the litany of

ailments he suffers. However, Plaintiffs doctors have not identified any specific job
requirements that he is unable to perform. The evidence before the Court allows the Court to
conclude that Plaintiff is suffering from some limitations to his problem solving, self-motivation,
and analytical skills. However, none of these skills are so impaired that he is unable to perform
an essential element of his

job.

See also Cheney

v. Standard Ins. Co.,831 F.3d 445,451 (7th

Cir. 2016) (highlighting that "doubts or gaps" in the evidence should be resolved against the
insured because they bear the burden of demonstrating policy coverage.)(citing Ruttenberg v.
U.S. Life Ins. Co., 413 F.3d 652,663 (7th Cir. 2005)).

Moreover, even

if Plaintiff was to show that his disability

reached the level that would

preclude him from holding his original position; he would need to show that he is disabled from
any other occupation commensurate with his skills and education. While Plaintiff argues that he

is not be able to

handle the stress and mental demands

of his

occupation as a pension

administrator he may be suited to a number of other positions-Defendant analyzed Plaintiffs
claim in light of his aptitude as a Benefits Clerk. Statement of Facts in Supp. Pl.'s Mot for Entry

ofJ. fl

10.

Plaintiffs Social Security Award

In his reply, Plaintiff

argues that

the Social Security Administration's ("SSA")

determination of disability is further reinforcement of Plaintiff s disability and urges the Court to
consider its finding. He argues that because the SSA is a neutral and objective agency with more

stringent criteria

for

evaluating disability, considerable weight should

be given to

its

determination.

"An administrator is not forever bound by a Social Security determination of disability,
but an administrator's failure to consider the determination in making its own benefit decisions
suggests arbitrary decision

making." Holmstrom v. Metro. Life Ins. Co., 615 F.3d 758,772-73

(7th Cir. 2010) (citing Metro. Life Ins. Co. v. Glenn,554 U.S. 105, 118 (2008)). While
Defendant could not have considered the SSA's decision in its own decision making processthe SSA rendered its determination after the instant suit was

filed-the Court

does.

The SSA considers an applicant's: "age, education, and work experience, [and ability to]
engage in any other kind

of substantial gainful work which exists in the national economy[.]"

42 U.S.C. $ 423 (d)(2XA). The Agency's determination rests on the application of a medical

vocational grid. In the SSA's determination Plaintiff was found to be moderately limited in his

ability to carry out detailed instructions; maintain attention and concentration for
periods of time; and to complete a normal work

extended

day. Moreover, the agency determined that

Plaintiff does not have transferable skills and that Plaintiff could only perform simple

10

and

unskilled tasks. These findings are contrary to the weight of the evidence as laid out by the
Court above.
Remand to the Administrator

Plaintiff askes the Court to award benefits and make a determination without remanding
the matter to Defendant. The Seventh Circuit has stated that

"[i]t would be a terribly unfair and

inefficient use ofjudicial resources to continue remanding a case to the Committee to dig up new
evidence until

it found just the right support for its decision to deny an employee her benefits."

Dabertin v. HCR Manor Care" Inc. ,373 F.3d 822, 832 (7th Cir. 2004) (citing Vega v. Nat'l Life
Ins. Servs.. Inc., 188 F.3d 287,302n. 13 (5th Cir.1999) (en banc) (parties must make their full
records before coming to the federal courts as "allowing the case to oscillate between the courts

and the administrative process prolongs a relatively small matter that, in the interest of both
parties, should be quickly decided.")).

Accordingly, the Court finds that Plaintiff has not satisfied his burden of proving
disability by a preponderance of the evidence. Plaintiff is not disabled from his occupation as a
pension administrator and is not due disability benefits under the Contract.

IT IS SO ORDERED.
ENTER:

CHARLES RONALD N
United States District Court

DATE: March 14,2078

l1