Braden v. AT&T Umbrella Benefit Plan No. 3
ORDER denying 16 Motion for Summary Judgment; granting 18 Motion for Summary Judgment(Written Opinion) Signed by Senior Judge David S. Doty on 3/17/2017. (DLO)
UNITED STATES DISTRICT COURT
DISTRICT OF MINNESOTA
Civil No. 16-729(DSD/HB)
AT&T Umbrella Benefit Pan No. 3,
Alesia R. Strand, Esq., Thomas J. Beedem, Esq. and Beedem Law
Office, 222 South Ninth Street, Suite 1600, Minneapolis, MN
55402, counsel for plaintiff.
Noah G. Lipschultz, Esq. and Littler Mendelson, PC, 80 South
8th Street, Suite 1300, Minneapolis, MN 55402, counsel for
This matter is before the court upon the cross-motions for
summary judgment by plaintiff Jeremy Braden and defendant AT&T
Umbrella Benefit Plan No. 3.
Based on a review of the file,
record, and proceedings herein, and for the following reasons, the
court grants defendant’s motion.
This insurance benefit dispute arises out of the Plan’s denial
of short-term disability benefits to Jeremy Braden.
From July 14,
2008, to June 2, 2015, Braden was employed at AT&T as a Business
Customer Service Specialist II.
Braden’s position required him to
use problem solving and troubleshooting skills to assist AT&T’s
internal customer service representatives and business clients with
a variety of cellular network and billing issues.
Admin. R. at
The position was sedentary; it consisted of using a
telephone and computer while sitting.
Id. at 1.
disability benefits through the AT&T Mobility Benefits Program
(Plan). Under the Plan, AT&T delegated its discretionary authority
to make all benefit determinations to Sedgwick Claims Management
See id. at 725, 727.
A claimant filing for
disability benefits under the Plan must provide Sedgwick with
“satisfactory Medical Evidence of [his] Disability from [his]
Id. at 703.
The Plan defines “medical evidence” as:
Objective medical information sufficient to show that the
Participant is Disabled, as determined at the sole
discretion of [Sedgwick]. Objective medical information
includes, but is not limited to, results from diagnostic
tools and examinations performed in accordance with the
generally accepted principles of the health care
In general, a diagnosis that is based
largely or entirely on self-reported symptoms will not be
considered sufficient to support a finding of Disability.
For example, reports of intense pain, standing alone,
will be unlikely to support a finding of Disability, but
reports of intense pain associated with an observable
medical condition that typically produces intense pain
could be sufficient.
Id. at 725 (emphasis added).
On January 15, 2015,1 Braden stopped working due to back pain,
and, on January 23, applied for short-term disability benefits.
See id. at 1, 4, 38.
On January 29, Braden submitted a form
completed by his physician, Dr. Thomas Kiefer.
See id. at 85.
Unless otherwise noted, all events occurred in 2015.
Kiefer stated that Braden suffered from “pain and immobility” due
to “lumbar disc syndrome.”
Due to this condition, Kiefer
stated that Braden would need “days off work intermittently” and
that his current functional restrictions were “limited lifting or
Based on this information, Sedgwick approved
disability benefits through January 22.
Id. at 92.
On February 5, Braden sent Sedgwick a progress report from a
February 3 follow-up visit with Kiefer, in which Kiefer discussed
Braden’s history of lumbar disc syndrome including two previous
lumbar surgeries completed in December 2013 and June 2014.
distress,” had “difficulty walking,” had a poor range of motion,
and could not “bend forward very much.”
Id. at 94.
discussed the results of a February MRI, which showed that Braden
had bulging discs, and that he did not know when Braden could
return to work.
Id. at 95.
The Plan sought an independent review of Braden’s medical
records, and on February 12, Dr. Xico Garcia, a family practice
physician, concluded that the evidence supported a claim for
disability starting January 26 and that Braden could reasonably be
expected to return to work by February 16 if his symptoms improved.
Id. at 97-99. Based on Garcia’s review, the Plan approved Braden’s
disability claim through February 16.
Id. at 356.
Braden did not return to work on February 17, and, on February
20, the Plan denied disability benefits for February 17 forward
because “the medical documentation did not clearly address the
severity of [Braden’s] condition.”
Id. at 358.
The denial letter
informed Braden that he needed to provide “clear documentation from
[his] current treating provider(s) of why [he was] not able to
perform the essential duties of [his] occupation.”
Id. at 359.
Further, the documentation would need to state “[his] functional
impairments as they relat[ed] to [his] diagnosis and provide a
treatment plan that addresses plans for [his] return to work with
or without reasonable restrictions with a reasonable duration.”
In response, on March 13, Braden submitted a report from a
February 25 follow-up visit with Kiefer, in which Kiefer observed
that Braden experienced pain from bending forward, had difficulty
sleeping because of the pain, and had a positive straight leg
Id. at 101-02.
Kiefer also stated that Braden should
continue to be off work and that and Braden “knows he cannot sit or
stand for very long.”
The Plan again denied disability
benefits from February 17 forward for the same reasons provided in
the previous denial letter.3
See id. at 104-05.
A positive straight leg exam may indicate that a patient has
a herniated disc.
This denial letter did not specifically address the February
25 follow-up report, but the Plan later informed Braden in a March
On March 27, Braden submitted a note from Kiefer stating that
he had been disabled due to lumbar disc syndrome but could return
to work on March 30 for 4 hours per day, 5 days per week.
The return-to-work note stated that Braden could not lift
more than ten pounds, climb ladders, or squat, and that he may need
to change positions every half-hour.
On April 2, Braden
submitted another note dated April 1, in which Kiefer reiterated
that Braden could not sit for over thirty minutes without standing
Id. at 127.
Braden returned to work on March 30, but he stopped working
again on April 6 due to back pain.
Id. at 406.
On April 22,
Braden submitted an April 21 physician statement from Kiefer
stating that Braden had lumbar pain with immobility.
Id. at 497.4
On April 30, Dr. Katherine Duvall, a physician specializing in
occupational medicine, spoke with Kiefer by telephone and reviewed
the physician statement.
Kiefer informed Duvall that, based
on the February MRI, Braden had mild stenosis and a bulging disc,
but that “the MRI did not show a ‘terrible problem.’”
29 letter that the newly submitted information did not alter the
previous denial. See id. at 114.
Neither party cites to Kiefer’s physician statement in the
record, and it appears that it was not provided to the court. The
court, therefore, relies on Dr. Katherine Duvall’s April 30 review
of the physician statement.
See id. at 497.
challenges Duvall’s conclusion, it appears neither party argues
that Duvall’s summary of the physician statement was inaccurate.
neurological deficits and that he wanted to keep Braden off work
completely until he met his physical therapy goals.
this information, Duvall concluded there was insufficient objective
medical evidence to support a claim for disability.
Id. at 498.
On May 6, the Plan denied disability benefits from April 6 forward.
See id. at 504-06.
Again, the denial letter informed Braden that
he should submit documentation showing how his condition rendered
it impossible for him to work.
See id. at 505.
On June 1, Braden submitted physical therapy notes from Dr.
Frank Wei, a physician specializing in physical medicine and
See id. at 522-32.
Wei recommended physical
therapy two days per week for four weeks.
Id. at 531.
review of this additional information, the Plan informed Braden
that it would not alter its previous denial.
See id. at 533.
Braden then submitted a May 15 procedure report and a June 1
progress note from Wei on June 19.
See id. at 209, 512.
injection in his back on May 15 and that Braden reported low back
pain as “4/10" pre-procedure and “2-3/10" post-procedure.
In the progress note, Wei reported that Braden continued to
have back and leg pain, “move[d] about the room stiffly,” a
significantly with non-operative care.”
Id. at 209.
On June 24,
the Plan informed Braden that the new information did not alter its
Id. at 542-43.
Rather than appeal, on July 10, Braden submitted notes from a
June 12 visit with Dr. John Mullan, a spine specialist.
See id. at
Mullan stated that Braden had a history of lower back pain
and that Braden felt he was disabled and unable to work.
Mullan observed that Braden was “in no acute distress,” had
a normal gait, his “motor strength [was] 5/5 in all muscle groups,”
he had no sensory loss in the lower extremities, and a straight leg
test was negative.
Mullan discussed the possibility of back
surgery with Braden, and Braden agreed to the surgery.
On September 14, Braden, through counsel, appealed the denial
of short-term disability benefits.
See id. at 145.
In support of
his appeal, Braden submitted: (1) Garcia’s February 12 medical
review; (2) Keifer’s February 25 progress notes; and (3) Mullan’s
June 12 follow-up visit notes.
This information was the same
information Braden had earlier submitted.
See id. at 146.
then requested time to submit additional materials, and the Plan
granted the request.
See id. at 147, 369.
On November 11, Braden submitted information in support of his
appeal consisting of all the information previously submitted in
addition to (1) a July 15 follow up report from Wei; (2) a
questionnaire completed by Kiefer; (3) letters from family and
describing his own symptoms on video.
See id. at 668-86.
In the questionnaire, Kiefer stated that Braden had been in
“almost constant lumbar pain with spasms of severe pain.”
He further noted that Braden’s gait was “slow and guarded,”
his “range of motion is limited,” and “he should not be working
without extensive rehab or surgery.”
When asked whether
Braden’s symptoms were supported by objective findings, Kiefer
responded, “Not really.
He has mild disc buldges on MRI.”
Kiefer also noted several work restrictions such as no
lifting, no bending or crouching, and that sitting, standing, and
walking was limited to fifteen to thirty minutes before Braden
required a change in position.
Id. at 682-83.
Braden was taking sedating medications.
Kiefer noted that
Id. at 684.
Wei, in his July 15 progress report stated that Braden’s pain
ranged from three or four out of ten to as high as five or seven
out of ten as the day progressed.
Id. at 210.
He opined that
Braden is was not “very employable even in a sedentary duty
He would have to change positions at least every hour
and given his discomfort he would not be very productive ....” Id.
Wei also stated that he would take Braden off of work for sixmonths with “the assumption that he probably will end up having
The Plan requested that Dr. Daniel Gutierrez, a neurosurgeon,
and Dr. Heidi Klingbeil, a physician in physical medicine and
rehabilitation, independently review Braden’s appeal materials. On
December 8, Gutierrez submitted a review that considered Braden’s
February MRI, his two prior surgeries, his appointments with
Kiefer, Wei, and Mullan, his medications, and the requirements of
See id. at 231-33.
Of specific note, Gutierrez reviewed
the MRI and noted that there were no “concerning findings to the
extent that [Braden] would be considered disabled.”
Id. at 232.
Gutierrez concluded that there was insufficient objective evidence
to support a claim for disability from February 17 through March
29; April 6 through May 14; and May 18 forward.
Klingbeil also submitted a review dated December 8.
Like Gutierrez, Klingbeil considered Braden’s two
surgeries, all of his appointments, his medications, and the
requirements of his job.
Klingbeil concluded that there
was “insufficient objective evidence to support that [Braden] was
reasonably restricted from his ... occupation.”
Id. at 238.
Klingbeil and Gutierrez submitted revised reports after Braden
submitted additional evidence for his appeal on November 11, and
they both concluded that the additional information did not alter
their previous opinions.
See id. at 255, 263.
granting Braden’s appeal.
See id. at 265.
The Plan approved
short-term disability benefits for the period of February 17
through March 29 and May 15-17.
It denied benefits from April
6 through May 15 and from May 18 through December 14.
On March 22, 2016, Braden filed this suit under 29 U.S.C.
§ 1132(a)(1)(B) alleging that the Plan wrongfully refused to pay
Standard of Review
“The court shall grant summary judgment if the movant shows
that there is no genuine dispute as to any material fact and the
movant is entitled to judgment as a matter of law.”
Fed. R. Civ.
P. 56(a); see Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986).
A fact is material only when its resolution affects the outcome of
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
A dispute is genuine if the evidence is such that it could
cause a reasonable jury to return a verdict for either party.
id. at 252.
On a motion for summary judgment, the court views all evidence
and inferences in a light most favorable to the nonmoving party.
See id. at 255.
The nonmoving party, however, may not rest upon
mere denials or allegations in the pleadings but must set forth
specific facts sufficient to raise a genuine issue for trial.
Celotex, 477 U.S. at 324. A party asserting that a genuine dispute
exists — or cannot exist — about a material fact must cite
“particular parts of materials in the record.”
Fed. R. Civ. P.
If a plaintiff cannot support each essential element
of a claim, the court must grant summary judgment because a
necessarily renders all other facts immaterial.
Celotex, 477 U.S.
Under ERISA, a plan participant may bring a civil action to
“recover benefits due to him under the terms of his plan.”
U.S.C. § 1132(a)(1)(B).
Because the Plan gave Sedgwick discretion
to construe the terms of the Plan, its decision is reviewed under
the abuse of discretion standard.
Ortlieb v. United HealthCare
Choice Plans, 387 F.3d 778, 781 (8th Cir. 2004).
Braden argues that the Plan’s decision should be evaluated
under a less deferential standard of review because of an alleged
conflict of interest.
Braden claims that Sedgwick is not truly
independent because correspondence to Sedgwick is addressed to the
AT&T Integrated Disability Service Center and callers to Sedgwick
are “thanked for calling the AT&T Disability Service Center, as
administered by Sedgwick.”
ECF No. 24, at 21.
nothing in the record supporting these assertions, and, even if
true, these claims do not establish that Sedgwick is incapable of
making an independent decision.
Under the Plan, there is a clear
separation of Sedgwick’s authority to decide the claims and AT&T’s
responsibility to fund the claims; therefore, there is no potential
conflict of interest.
See Metro. Life Ins. Co. v. Glenn, 554 U.S.
105, 108 (2008) (“[When] the entity that administers the plan ...
both determines whether an employee is eligible for benefits and
pays benefits out of its own pocket ... this dual role creates a
conflict of interest ....”).
As a result, an abuse of discretion
Under the abuse of discretion standard, the court will uphold
the benefits decision if it was supported by substantial evidence.
McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 924 (8th
“Substantial evidence means such relevant evidence as
Id. (citation and internal quotation marks omitted).
The court will not disturb a decision supported by substantial
evidence even if a different, reasonable decision could have been
administrator who has discretion under an ERISA-regulated plan, a
reviewing court must focus on the evidence available to the plan
administrators at the time of their decision and may not admit new
evidence or consider post hoc rationales.”
King v. Hartford Life
& Accident Ins. Co., 414 F.3d 994, 999 (8th Cir. 2005) (citation
and internal quotation marks omitted).
Denial of Benefits
The Independent Reviews
Braden argues that Gutierrez’s and Klingbeil’s reviews did not
discretion by relying on them.
See Jalowiec v. Aetna Life Ins.
Co., 155 F. Supp. 3d 915, 944 (D. Minn. Dec. 21, 2015) (“[I]t is an
abuse of discretion for an insurer to rely on an independent
reviewer’s report that reflects an incomplete, selective review of
the medical evidence.”) (citation and internal quotation marks
First, Braden asserts that Gutierrez and Klingbeil
ignored relevant information.
He specifically argues that (1)
Klingbeil ignored his two previous back surgeries; (2) Klingbeil
ignored evidence of limited range of motion in concluding that
there was no evidence of a severe loss of motion; and (3) Gutierrez
and Klingbeil ignored the sedating effects of his medication.5
These claims are contradicted by the record; Braden’s surgeries,
limited range of motion, and medication were fully considered by
Gutierrez and Klingbeil.
See Admin. R. at 231-33, 236-38, 255-57,
Braden next claims that because the MRI showed two-level
degenerative disc disease, Gutierrez incorrectly concluded that it
did not show “any concerning findings to the extent that [Braden]
would be considered disabled form his normal occupation.”
However, Kiefer stated that the MRI “did not show a terrible
Braden’s argument that the Plan ignored the mental
requirements of his job is also unsupported by the record. A full
job description, which included the mental requirements of Braden’s
job, was provided to Gutierrez and Klingbeil. See Admin. R. at
277-78. Further, to the extent that the denial was focused on the
physical requirements of his job, it was because Braden submitted
medical records that overwhelmingly focused on his physical
symptoms and noted his medications only in passing.
problem” and it only showed “mild disc bulges.”
Id. at 497, 681.
It was not unreasonable, therefore, for Gutierrez to conclude that
the MRI did not show a serious problem such that Braden was unable
perform his sedentary job.
Finally, Braden argues that it was unreasonable for Gutierrez
and Klingbeil to conclude that Braden was not disabled because
Kiefer, Wei, and Mullen agreed that Braden suffered from lumbar
pain and degenerative disc disease.
But Gutierrez and Klingbeil
did not deny Braden’s condition; rather, they concluded that there
was insufficient objective evidence to establish that the severity
of the condition prevented Braden from working. This conclusion is
supported by substantial evidence.
For example, the MRI only
showed mild disc bulges; Kiefer concluded that the MRI did not show
“a terrible problem and that there was “not really” any objective
evidence supporting Braden’s symptoms; and Mullen reported that
Braden was “in no acute distress,” his gait was normal, and he had
full motor strength in all muscle groups.
See Groves v. Metro.
Life Ins. Co., 438 F.3d 872, 875 (8th Cir. 2006) (“[I]t is not
unreasonable for a plan administrator to deny benefits based upon
a lack of objective evidence.”) (citation and internal quotation
Although Wei and Kiefer opined that Braden should
be off work, the Plan was entitled to rely on the opinions of
Gutierrez and Klingbeil because their reviews, as discussed above,
were based on a full review of the record.
See Black & Decker
Disability Plan v. Nord, 538 U.S. 822, 834 (2003) (“[C]ourts have
special weight to the opinions of a claimant’s physician; nor may
explanation when they credit reliable evidence that conflicts with
a treating physicians evaluation.”); Midgett v. Wash. Grp. Int’l
Long Term Disability Plan, 561 F.3d 887, 897 (8th Cir. 2009)
(“[T]reating physicians are not automatically entitled to special
Weidner v. Fed. Express Corp., 492 F.3d 925, 930 (8th Cir. 2007)
(upholding a determination that the plaintiff was not disabled even
though the parties agreed that she had multiple sclerosis and her
primary physician had concluded that she was “fully disabled”).
Although the diagnosis of degenerative disc disease was agreed
on by each physician, it does not automatically follow that Braden
was unable to perform his sedentary job.
Based on a thorough and
substantial evidence supports the Plan’s denial of Braden’s claim
for short-term disability benefits.
Braden next claims that the Plan’s denial was arbitrary and
supported approval from April 6 forward.
This partial approval is
not logically inconsistent
The Plan reasonably concluded that
Braden was unable to perform his job from May 15-17 because of his
May 15 epidural injection.
Additionally, the denial of April 6
forward was based on evidence that Braden’s symptoms had, as of
March 30, improved enough to return to work.6
Although parts of
the record indicate that Braden’s symptoms had continued, see
Admin. R. 209 (noting that Braden experienced some discomfort
during a straight leg raise exam on June 1), it is unclear whether
the symptoms were so severe Braden could not work.
is evidence that Braden’s symptoms had not worsened since his
experienced no discomfort in the straight leg exam, that his motor
strength was five out of five, and he appeared to be in no acute
In light of this information, the Plan’s denial for the
period after March 30 was not unreasonable.
Adequate Explanation of Denial
Braden next argues that the Plan’s decision was arbitrary and
capricious because its denial of benefits did not adequately inform
Braden of the reasons for denial.
See King, 414 F.3d at 999 (“An
administrator with discretion under a benefit plan must articulate
its reasons for denying benefits when it notifies the participant
Braden claims that he only returned to work because of
Regardless of Braden’s motive, the Plan
reasonably relied on Kiefer’s representation that Braden had
improved enough to return to work.
or beneficiary of an adverse decision ....”). Specifically, Braden
claims that the Plan never informed him that it was denying
benefits because of a lack of objective medical evidence and that
this is a post hoc rationale that the court must ignore.
The Plan’s denial letters stated that the benefits were denied
because “[t]he medical documentation did not clearly address the
severity of your condition.”
Admin. R. at 104.
The letters also
For your claim to qualify for benefits, AT&T ... would
need clear documentation form your current treating
provider(s) of why you are not able to perform the
essential duties of your occupation.
provider(s) would need to document your functional
impairments as they related to your diagnosis .... This
information may be included in the following: chart or
progress notes, specialist’s evaluations, physical
therapy notes, diagnostic test results, operative
report(s), or any other clear observable medical
Admin. R. at 105(emphasis added). The letters adequately addressed
the reasons for denial and informed Braden of what information was
Further, these are the same reasons stated in the Plan’s
final denial letter, see id. at 651-52, and on which the Plan now
relies; they are not post hoc rationales.
Full and Fair Review
Finally, Braden argues that the Plan’s appeal process did not
afford him a full and fair opportunity to respond to Klingbeil’s
and Gutierrez’s reviews. See Abram v. Cargill, Inc., 395 F.3d 882,
886 (8th Cir. 2005) (holding that the plaintiff should have been
permitted to review and respond to the report by an independent
reviewer). But this argument has since been rejected by the Eighth
Circuit. See Midgett, 561 F.3d at 893-96 (distinguishing Abram and
opportunity for the plaintiff to review and rebut the reports of
independent reviewers plaintiff did not deny her a full and fair
Indeed, “requiring a plan administrator to grant a
claimant the opportunity to review and rebut medical opinions
generated on administrative appeal would set up an unnecessary
cycle of submission, review, re-submission, and re-review.” Id. at
896 (citation and internal quotation marks omitted).
As a result,
Braden was not denied a full and fair review of his disability
Accordingly, based on the above, IT IS HEREBY ORDERED that:
The motion for summary judgment by defendant [ECF No. 18]
The motion for summary judgment by plaintiff [ECF No. 16]
is denied; and
The case is dismissed.
LET JUDGMENT BE ENTERED ACCORDINGLY.
Dated: March 17, 2017
s/David S. Doty
David S. Doty, Judge
United States District Court
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?