DUKES v. LIBERTY LIFE ASSURANCE COMPANY OF BOSTON et al

Filing 31

OPINION. Signed by Judge Jose L. Linares on 7/7/15. (DD, )

NOT FOR PUBLICATION
UNITED STATES DISTRICT COURT
DISTRICT OF NEW JERSEY
KAREN DUKES

Civil Action No. 14-cv-00806

Plaintiff,
V.

LIBERTY LIFE ASSURANCE
COMPANY OF BOSTON, et al.,

OPINION

Defendants.

JOSE L. LINARES, U.S.D.J.

This matter comes before the Court upon cross motions for summary judgm
ent. Plaintiff
Karen Dukes (“Plaintiff’) moved for summary judgment on February 20,
2015. (ECF Nos. 14
and 15). On the same day, Defendants Liberty Life Assurance Company
of Boston and Wells
Fargo & Company Group Disability Policy (“Defendants”), also moved
for summary judgment.
(ECF No. 16). Pursuant to Rule 78 of the Federal Rules of Civil Procedure,
no oral argument
was heard. Upon consideration of the Parties’ submissions, and for the
reasons stated below,
Plaintiffs Amended Motion for Summary Judgment, (ECF No.15), is
DENIED, and
Defendants’ Motion for Summary Judgment, (ECF No. 16), is GRANTED.
I.

STATEMENT OF UNDISPUTED FACTS
Defendant Liberty Life Assurance Company of Boston (“Liberty”)
provides claim

administrative services and acts as the insurer of benefits for a Group
Disability Income Policy

(LTD Policy) sponsored by Wells Fargo & Company. (Defendants’
Statement of Undisputed
Material Facts (“SOUF”), ECF No. 16-2, 1). Plaintiff was employ
ed as a Service Manager 1
¶

for Wells Fargo & Company from December 21, 2010 until April 26, 2012. (Id.

¶ 5). Plaintiff’s

job description states that her position required “seldom” lifting of up to ten pounds for thirty
minutes or less within an eight hour workday. (Id.

¶ 8).

Plaintiff left her employment on April 26, 2012 and began receiving short term disability
benefits. (Id.

¶ 9). Plaintiff eventually exhausted short-term disability benefits and applied for

long-term disability (LTD) benefits. (Id.

¶ 10). Liberty reviewed records from Plaintiff’s

various physicians and treatment providers, and found evidence of degenerative disc disease and
multilevel facet arthropathy. (Id.
restrictions form. (id.

¶ 11-15). Liberty asked each medical provider to complete a

¶ 20). Liberty referred Plaintiff’s file to Raymond J. Chagnon, M.D. (Id.

¶ 30). Dr. Chagnon reviewed Plaintiff’s medical records, contacted Plaintiff’s physicians for
peer-to-peer discussions, and furnished Liberty with a report on October 12, 2012. (Id.

¶ 31).

Dr. Chagnon concluded that Plaintiff had lower back pain and radiation to her left leg, and that
she had restrictions which would last three months. (Id.

¶ 37). On October 16, 2012, following a

review of Plaintiffs claim documentation, Liberty determined that Plaintiff was eligible to
received LTD benefits, effective that day. (Id.

¶ 40). Liberty advised Plaintiff that her claim

would be reviewed periodically to determine ongoing eligibility. (Id.

¶ 41).

In February 2013, Dr. Chagnon reviewed additional medical records and contacted
Plaintiffs treatment providers again. (Id.

¶J 43-44). Based on his new findings, Dr. Chagnon

reiterated the restrictions and limitations he had previously recommended, but also conclu
ded
that Plaintiff could return to full-time work within those restrictions. (Id.

¶IJ 54-55). Based on

Dr. Chagnon’ s report and all other relevant information, Liberty sent Plaintiff a letter
on
February 22, 2013 to notify her that her LTD benefits would be discontinued becaus
e she was no
longer “disabled.” (Id.

¶ 56). Liberty concluded that the Plaintiff had not produced evidence

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that she was precluded from performing the “Material and Substantial Duties” of her “Own
Occupation.” (Id.

¶ 57). Liberty notified Plaintiff of her right to appeal its decision. (id. ¶ 58).

Plaintiff, through counsel, formally appealed Liberty’s determination on August 16,
2013. (Id.

¶ 59). Plaintiff argued that she suffered from “unrelenting back pain, which prevents

her from walking, standing, and sitting for [any] long-term period time,” and that this condition
prevented her from performing her occupation. (Id.

¶J 60-6 1). Plaintiffs appeal mainly relied

on two documents: a report from Dr. Daniel I. Richman, M.D., and a letter from Dr. Michael
Coppola. (Id.

¶ 63). Dr. Richman determined that Plaintiff “cannot perform any type of

employment that would require her to sit for any period of time, move around or stand for
any
period of time in particular to lift heavy objects
have to bend at the waist.” (Id.
disabled. (Id.

more than 10 or 15 pounds where she would

¶ 66). Dr. Coppola, her chiropractor, stated that she was totally

¶ 70). Plaintiffs appeal was referred to an independent physician, Dr. Jamie L.

Lewis, for review. (Id.

¶ 74). Dr. Lewis reviewed Plaintiffs medical records, Plaintiffs job

description, and Liberty’s Occupational Analysis, and concluded that Plaintiff could perform
her
own occupation in a full-time capacity with appropriate restrictions and limitations. (Id.

¶J 76-

77). On October 28, 2013, Liberty upheld its decision to deny benefits after completing
a
thorough review of Plaintiffs entire claim file. (Id.

¶ 80).

In light of the foregoing, Plaintiff commenced this action on February 7, 2014. (ECF
No.
1). This Court’s jurisdiction is premised on federal question, 28 U.S.C.

§ 1331, as Plaintiffs

claim arises from the Employee Retirement Security Act of 1974 (“ERISA”). (Cmp.,
¶ 14).
Both Parties moved for summary judgment on February 20, 2015 (ECF Nos.
15 and 16).
11.

LEGAL STANDARD

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Summary judgment is appropriate when, drawing all reasonable inferences in the non
movant’s favor, there exists no “genuine dispute as to any material fact” and the movant is entitle
d
to judgment as a matter of law. See Fed. R. Civ. P. 56(a); Anderson v. Liberty Lobby, Inc.,
477
U.S. 242, 255 (1986).
The moving party is entitled to judgment as a matter of law when the non-moving party
fails to make “a sufficient showing on an essential element of her case with respect to which
she
has the burden of proof.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The Court must,
however, consider all facts and their reasonable inferences in the light most favorable to the
nonmoving party. See Pennsylvania Coal Ass’n v. Babbitt, 63 F.3d 231, 236 (3d Cir. 1995).
If a
reasonable juror could return a verdict for the non-moving party regarding material disputed
factual issues, summary judgment is not appropriate. See Anderson, 477 U.S. at 242-43 (“At the
summary judgment stage, the trial judge’s function is not himself to weigh the evidence and
determine the truth of the matter but to determine whether there is a genuine issue for trial.”)
.
III.

DISCUSSION
A. Plaintiffs Amended Motion for Summary Judgment

Plaintiff seeks summary judgment primarily because Liberty’s decision to terminate
Plaintiffs LTD benefits was “arbitrary and capricious.” (Memorandum of Law in Suppo
rt of
Plaintiff’s Motion for Summary Judgment (“Pl.’s Brief’), ECF No. 15-1, at 19). Plainti
ff first
argues that Liberty’s decision was arbitrary and capricious because there was a structu
ral conflict
of interest given Liberty was “the sole adjudicator of all claims, as well as the sole payor
of all
benefits which might be due and owing to Plaintiff.” (Id. at 21). Plaintiff also argues
that
Liberty’s decision was arbitrary and capricious because Liberty “employed self-se
rving

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selectivity in the use of evidence, relied on self-serving paper reviews, and relied
on the opinions
of non-treating physicians without adequate explanation.

. . .“

(Id. at 24).

B. Defendants’ Motion for Summary Judgment

Defendants seek summary judgment on similar grounds as the Plaintiff, focusin
g on the
standard of review and arguing that Liberty’s decision was not arbitrary and caprici
ous.
(Defendant’s Memorandum of Law in Support of their Motion for Summary Judgm
ent (“Defs.’
Brief’), ECF No. 16-I, at 11). First, Defendants argue that Liberty’s decision to
terminate LTD
benefits was not arbitrary and capricious because the “determination concerning
Plaintiff’s LTD
claim was both reasonable and the result of a well-documented and procedurally
fair review.”
(Id. at 13). Next, Defendants argue that “[P]laintiff has neither alleged nor adduced any
evidence
whatsoever that Liberty’s decision was the result of bias or was tainted by any conflic
t of
interest.” (Id). Finally, Defendants argue that Plaintiff’s claims that she now suffers
from
additional medical issues are inappropriate, as “the sole question for this Court is
whether
Liberty reasonably concluded, based upon the administrative record before it,
that plaintiff had
not met her burden of proving she was Disabled, as that term is defined under
the LTD Policy,
during the administrative review period.” (Id. at 14).
C. Arbitrary and Capricious Standard

The Parties are in agreement that the correct legal standard to be applied to
Liberty’s
decision to terminate Plaintiff’s LTD benefits is whether the decision was “arbitr
ary and
capricious.” (Pl.’s Brief at 19; Defs.’ Brief at 11). The Parties, however, disagre
e as to whether
Liberty’s decision making process meets this standard of review. The Third
Circuit recently held
that “[a]n administrator’s decision is arbitrary and capricious if it is withou
t reason, unsupported
by substantial evidence or erroneous as a matter of law.” Miller v. Ameri
can Airlines, inc., 632

5

F.3d 837, 844-845 (3d Cir. 2011) (citing Abnathya v. Hoffmann—La Roche, Inc., 2 F.3d 40,
45
(3d Cir. 1993). An administrator’s decision is supported by substantial evidence “if there
is
sufficient evidence for a reasonable person to agree with the decision.” Daniels v. Ancho
r
hocking Corp., 758 F. Supp. 326, 331 (W.D. Pa. 1991). The Court must look at a
variety of
factors when analyzing whether an ERISA decision was arbitrary and capricious, includ
ing
procedural concerns about the decision making process and structural concerns about
conflicts of
interest, but the factors will vary and are “case-specific.” Estate ofSchwing v.
Lilly Health Plan,
562 F.3d 522, 526 (3d Circ. 2009) (citing Metropolitan Lfe Ins. Co. v. Glenn, 554
U.S. 105, 128
(2008)). Finally, this scope of review is narrow, and “[r]eview under this standa
rd requires the
challenged decisions to remain intact unless it is not rational.” Lucash v. Strick Corp.,
602 F.
Supp 430, 434 (E.D. Pa 1984) (quoting Federal Communications Commission v. Nation
al
Citizens Cominittee for Broadcasting, 436 U.S. 775, 803, (1978)). Accordingly,
“deference
should be given to the lion’s share of ERISA claims.” Shvartsman v. Long Term
Disability
Income Plan for Choices Eligible Employees ofJohnson & Johnson, No. 11-036
43, 2012 WL
2118126, at *9 (D.N.J. June 11, 2012) (citing Glenn, 554 U.S. at 116-17) (discus
sing Firestone
Tire and Rubber Co. v. Bruch, 489 U.S. 101, 111(1989))).
D. Conifict of Interest

Defendants concede that “a conflict of interest may arise where, as here, the plan
administrator is responsible both for determining eligibility benefits and for
paying those benefits
out of its own funds,” (Defs.’ Brief at 12), but this is only one factor for the Court
to review and
is only important “where there is evidence that the benefits denial was motiva
ted or affected by
the administrator’s conflict.” Glenn, 554 U.S. at 120 (Roberts, C.J., concurring).
This Court
considered a factually analogous case just two years ago in Vander-Leeuw
v. First Unum Life

6

Ins. Co., No. Civ. A. 11-5685, 2013 WL 3479433, at *8 (D.N.J. July 9, 2013). In
that case,
Plaintiff contended that the administrator’s discussions with a financial consul
ting team
constituted a conflict of interest. Id. The existence of a potential conflict of interes
t was not
enough to show the administrator’s decision was arbitrary and capricious, howev
er, as this Court
ruled that “Plaintiff does not point to any evidence that [the administrator] sought
or followed the
advice of financial consultants.

.

.

Therefore, under the facts of this case, the Court finds that

conflict of interest is not a significant factor.” Id. Similarly, in this case Plainti
ff states “[t]here
can be no dispute in this matter that Liberty Mutual was both the sole adjudi
cator of all claims,
as well as the sole payor of all benefits which might be due and owing to Plainti
ff.

.

.

Here, this

factor weights in favor of granting Plaintiff’s Motion for Summary judgment.” (P1.’
s Brief at
21). Plaintiff merely points out the existence of a potential conflict of interes
t, but does not
proffer any evidence that Liberty’s decision to terminate Plaintiff’s LTD benefit
s was influenced
by this conflict or incentivized Liberty to deviate from their normal protocol.
Accordingly, the
Court finds that the potential conflict of interest is not a significant factor here.
E. Liberty’s Procedure for Terminating Plaintiffs LTD Benefits

The second critical dispute at issue in this case is whether Liberty’s review
of Plaintiff’s
claim was procedurally proper. Plaintiff claims that “Liberty Mutual employ
ed self-serving
selectivity in the use of evidence, relied on self-serving paper reviews, and
relied on the opinions
of non-treating physicians over treating physicians without adequate explan
ation.” (Pl.’s Brief at
24). Defendants respond that “Liberty’s review of plaintiff’s claim was
well-documented,
procedurally fair, and free of taint,” and that “Liberty did not ignore the
reports of plaintiffs
treating physicians or her expert.” (Defs.’ Brief at 21). Both Parties acknow
ledge that an
administrator is not required to afford controlling weight to a Patient’s
treating physicians, as set

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out by the United States Supreme Court in Black & Decker Disability Plan
v. Nord, 538 U.S.
822, 834 (2003). Plaintiff contends, however, that Liberty’s decision
was arbitrary and

capricious because in that same case the United States Supreme Court
also held that “[p]lan
administrators, of course may not arbitrarily refuse to credit a claimant’s
reliable evidence,
including the opinions of a treating physician.” Id. Plaintiff relies on Culley
v. Liberty Life
Assurance Co., 339 Fed.Appx. 240 (3d Cir. 2009), where the Third Circui
t stated “[wjhile
Liberty Mutual may freely rely on its consultants, without giving special
deference to the views
of treating physicians, neither may it turn a blind eye to faults in the eviden
ce supporting its
consultants’ opinions.” Id. at 245. In Cuiley, the administrator’s consulting
physician noted that
he was missing some critical information that left him unable to render a clear
opinion and a later
review of the consulting physician’s findings by a case manager found incons
istencies in his
findings, yet Liberty stood by their termination of LTD Benefits. Id. at 244.
Notably, in the present case, Plaintiff cannot point to inconsistencies in
the findings of
Dr. Chagnon or Dr. Lewis, but mainly challenges Liberty’s consultants
based on the fact that
“the consultants reported that the treating physicians allegedly made statem
ents that are in direct
conflict with their written statements.” (Pl.’s Brief at 24). These purpor
ted discrepancies are do
not rise to a level sufficient to cast doubt over the reasonableness of Liberty
’s decision, do not
prove that Liberty’s decision was made without reliable evidence, and
do not show that Liberty’s
decision was incorrect as matter of law. Plaintiff may not agree with
the findings of Liberty’s
experts, but the experts clearly considered the entire administrative record
before them as
required. As such, Liberty’s decision was not arbitrary and caprici
ous and cannot be overturned
bythis Court.
IV. CONCLUSION

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For the reasons set forth above, Plaintiffs Amended Motion for Summary Judgm
ent,
(ECF No.15), is DENIED, and Defendants’ Motion for Summary Judgment,
(ECF No. 16), is
GRANTED. An appropriate Order accompanies this Opinion.

Linares
States District Judge

Date: *,2Ol5

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