Day v. United Health Group, Inc. Short Term Disability Plan

Filing 18

MEMORANDUM OPINION. Signed by Judge Samuel G. Wilson on 12/13/12. (eot)

CLERK' A CE u.:.DI coUr
S OFFI
SQ
T ROANOKE,VA
FI
LED

I TH E UN I
N
TED STA TES D I
STR ICT CO U R T
FO R T H E W ESTER N D I
STR I O F V I G I I
CT
R N A
R O AN O K E D IV ISIO N
PAT R I I A .D AY ,
C A

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BY:

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LE CLERK
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C i lA ct on N o.7: v00114
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Pl nt f
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M EM O M N D UM O PI I N
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UNI
TED H EALTH GRO UP,I
NC.
SH O R T TER M D ISA BILITY PL AN ,
D efendant.

By:Sam ue G .W is
l
l on
U ni e St e D i t i tJudge
t d at s s r c

Pl i ifPa r c a A .Da brngst sa ton pur ua t t Em pl e Re iem e I om e
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I M a c of201 Day e ba ke on apr r c e s resofdoct viist di nos he
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. 13.

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Au u t ( mi R. 4, No.1 - .
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13)
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The pa int i mor dl obes wih s ve a c
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if r t nwa s b te i c n e t nwihtecam fr n ft. ( n. 1 , No. 1)Ac odn t
n omai s u mitd n o n ci t h li o be ei ' Admi R. 4 ECF 1 . c rig o
o
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I gn a Brmbeo fo J l 2 , 01 Da sjbd s r to a mic l ne u me ia rc r sd tdMa 4
ma ig t a ltn rm uy 0 2 0; y' o eci in;nd sel o s dc le o d ae y ,
p
a
201 ,h o g J l 1 , 01 t mi. 48 ECFNo 1 -.
0 tru h uy 4 2 0. Ad n R. ,
. 13)
1Daycl m st Dr Gil i notadocor buts ha ofe e not ngt s
ai hat . ls s
t , he s fr d hi o uppo tt ta s ri
r ha s e ton.

r c ntr c ds i c t t t s i s he e t unde go a hyser c om y. Pe t
e e e or ndi a e ha he s c dul d o
r
t et
r he
r c ds t s i e
e or , hi s xpec e t ei nae t unde l ng ca e of t chr c io
t d o lmi t he
ryi
us
he oni r n
dek i nc Pr e s whi h we e as i ntfe i ude m or d obe iy a
t e y. oblm , c
r lo de ii d, ncl
bi
st nd
o t uc i s ee a
bsr tve l p pnea. The e a e no r c ds of a r pi a o y c ula i n t
r r
e or
ny es r t r ons t to o
i c e t tt obsnltve see a
ndiat ha he t c i l p pneawoul pr cl s de a y wèr a tviis
d e ude e ntr
k c i te .
A c r a M R1 w ih f tonalas e s e no est tt pa i nthas a qua e l f
a di c
t unc i
s s m nt t ha he te
de t e t

v nrc lree to fa to a dt r i n e d n eo a y c g iiei ar n ,
e tiua j ci n rcin n hee s o vie c f n o ntv mp ime t
whi woul pr cl s den a y wor a tviis She doe ha ge r lz a
ch
d e ude e t r
k c i te .
s ve ne a ied nd
no pecfc mus ul ke eal c
ns ii
c os l t ompl i s but t s alo s d not pr cud
ant,
he e s houl
el e
s n a y a tvii . Dr Gil c imed durng t t l onf r et ta stsa
ede t r c i tes . ls onfr
i he eec e enc ha i/tnd
wor tton woul bea a o it lvelofwo k.
ksa i
d
n ppr pra e e
r

( n. 51 ECFNo.113. Dr Perec l t ttfo a oc upai lmedii
Admi R. ,
- ) . ti oncuded ha,trm n c tona
cne
pe s c i ,doc e ato doe nots
r pe tve
um nt i n s
uppor t e o t bedia e fom he r gulr
the mplyee o
s bl d '
r
re a

l rsrce s d n ayj b. ( mi R. , No 1 - . S d wikr s n e t DrPeres
l etitd e e tr o ' Ad n. 51 ECF . 13) e g c e po d d o . ti'
n
'
r por by a ki hi t s cik q si i e d t clrf whet rDay ha a r titons
e t s ng m wo pe t ue tons nt nde o a iy
he
d ny esrci
o rt ni t wor Dr Perea we ed,G s cii r titonsora omm oda i woul
n eur ng o k. . ti ns r G pe fc esrc i
NO
cc
tons
d

b a p ia l f rti e ly e Th e o e i no ds be fo h rr g lrs d nayj b.
e p lc b e o h s mpo e . e mply e s t ia ld r m e e ua e e tr o '
'
( n. 56, No.11 3.
Admi R. ECF
-)
Shorl a trDr Pe re c ude hi r pol Sed c i or d Da by l te t ti wa
ty fe . ti oncl d s e t
gwi k nf me
y
e tr ha t s
uphol ng t de alofD a sc a m f di a lt be tt . The l te e a ne is r a oni a
di he ni
y' l i or s biiy ne i s
e tr xpl i d t e s ng t

lngh a c l d t t û s d on t si or ton,weha de em i d t tt m e ca
e t nd oncude ha ,i e
Ba
hi nf ma i
ve t r ne ha he di l
i or ton s
nf ma i ubmit doe notde onsr t t tyou a euna et pe f m t m ae i ldute o
ted s
m ta e ha
r
bl o ror he t ra i s f
yo o oc pai ' Thi lws ti t r ul.
ur wn cu ton.' s a ui s he es t
II.

The Pl n' de a of Da scl m hi ed on t r quie en t D a of e a t m e ca
a s ni l
y' ai ng
he e r m t hat y f r c ual di l
e de - no s a e e sofs pt m s
vi nce
t t t m nt
ym o --ofa c ton t tr nde e D a unabl t pe f r he
ondii ha e r d y
e o ro m r

s de a yoc
e ntr cupa i Thoug Dayha c
ton.
h
s ompie a extnsve me c lr cor Sedgwi k c d
ld n e i
di a e d,
c oul
c l t tt r c d i s to s h e de . Gi n t tco l i t doc o s a r nt
onc ude ha he e or s hor n uc vi nce ve ha ncuson, he t r ' ppa e

di t uly i c
fk t n onnec i t e si e de e t D a s c pl i s a t Pl n' di c e i i
tng he xi tng vi nc o y' om a nt , nd he a s s r ton n

m a ng isde son,t c tfndst tt Pl n' de son wa r as bl Ac r ngl t
ki t cii he our i ha he a s cii
s e ona e. co di y, he

c u t lg a t h Pln smo inf rs mma yj g n a d n Da s
o r wil rn t e a ' to o u r ud me t nd e y y'.
W hen a t SA be i pl n ves sw ih t pl n ad i s r t t di c e i r
nt
ERI
neft a
t t he a m ni t a or he s r tona y
a hort t m a elgi lt de e m i tons f be t i r e ,a r vi w i co zte ua est
ut iy o ke i biiy t r na i
or ne k a i s e e ng tr val t he

pl n a nitaorsde son f a e ofdicr ton.'W ila sv. er Lie I . ,609F.
a dmi sr t ' cii or bus
s ei ' lim
M to. f ns Co.
3d

622,629-30(t Ci.201 .Unde t a eofdicei sa r arviwi c ts d
4h r 0)
r he bus
s rton tndad, e e ng our houl
notdit b apln ad i sr t r sdec son i t decson i r as
sur
a m nita o '
ii f he ii s e onabl eve i t c twoul
e, n f he our
d
ha co et a c r r c l i i pe nty. 1 a 630. Ther e ng c ti nott
ve m o onta y oncuson nde nde l d. t
eviwi our s
o

s b ttt iso j d me tn pa eo teplna miitao ' j d me t I I ma igta
u si e t wn u g n i lc f h a d n sr trs u g n . d. n kn h t
u
de e m i ton,co t l t t ei f t s e e a e i 800 h v. a - a tSt e .I
t r na i
ur s ook o he ght ac or num r t d n
t W lM r or s nc.

Aso s He 1 & W efr Pln 2 F.d3 5(t Ci. 0 0 :
s c . at
h
lae a , 01 3 3 4h r 2 0 )
()t lng geoft pln;
1 he a ua
he a
( t pur e a goasoft pln;
2) he pos s nd l he a
()t ade cyoft maerasc i rdt maket decso andt de e
3 he qua
he t il onsdee o
he iins he gre
t whi h t y s
o
c he uppor i;
tt

()whehe t fduca y' i e eai wasco itntwih ohe pr vii i
4
t r he i ir s ntmrtton
nsse t t r o sons n
t pl a wih e riri er e a i oft pl
he an nd t a le nt pr t tons he an;

()whehe t de sonma ngpr s wa r a one andprncpld;
5
t r he cii ki oce s s e s d
iie
()whehe t decson wa consse t wih t pr e al a s t tve
6
t r he ii
s
itn t he oc dur nd ubsani
r quie e sofERI ;
e r m nt
SA

()a e ena sa r r e n t t e r ieofdicein;a
7 ny xtr l tndad elva t o he xe cs
srto nd
()t fducir smoi sa a c lc ofi ees i ma ha .
8 he i ay' tve nd ny ontit ntr t t y ve
W iln ,609F. a 630(ii 800t 201F. a 342 .
lims
3d t
ctng
h,
3d t -43)
l t s case,Sedgw i r i pr m mil on t s
n hi
ck eled i
y
he econd partoft Pl sdi abiiy
he an' s lt

dei to na l t tûl y')Physcan( o de M e ca Evi ncet ts
fniin, mey ha tDa s
ii pr vi ) di l de ha uppors( r
t he)
8

i biiyt pe f m t M ae ilDutesofg r OwnOc upai ' ( n.R. ECFNo.11
na lt o ror he tra i
he)
c ton. Admi 25,
'
'
,

Ad n. 6 ECFNo. 13. I d cdigwh t e tee it me ia e i e c s p o td
mi R. 2,
1 - ) n e i n eh r h xsi
ng d c l v d n e u p re
Da si biiyt pe f m he occ ton,Se
y' na lt o ror
r upa i
dgwik e oye an i pe ntr e ng
c mpl d nde nde eviwi
physcin,Dr Pere, o e
ia
. ti t xmni t e de et tDa ha s
ne he vi nc ha y d ubmit d. The e d ei l d
te
vi enc ncude
pr r s no es x- a ,CT s ns M m s a va i o he t t a l b r por s D r Pe re' tve
og es t , r ys
ca ,
, nd rous t r es s nd a e t . . t i s i -

pager por s
e t howst the e ua e t te de e a no e s ve a m e c lc tonsa
ha
val t d ha vi nc nd t d e r l di a ondii
nd

o g i me ia te t n s b tf t n ti go j ciei iai t tDa sv ro sc n iin
n ong dc lr ame t, u omd oh n b e tv ndc tng ha y' a iu o dto s
w oul a t ly pr ve he fom pe f m i he ço n oc upa i ' Dr Peti t r or
d c ua l e nt r r
r or ng r ç w
c ton.
' . r e he ef e

concude t tt r a oc upa i me cnepe s ci ,doc e a i doe no s po t he
l d ha t om n c tonal dii
f
r pe tve
um nt ton s t up r t

e ly et b d sbldfo h rr g a t e titdsd nayj b' ( mi R. , No
mpo e o e ia e r m e e ulr mrsrce e e tr o . Ad n. 51 ECF .
'
113. Ont tr a oni Se wi de e Da scli Thought c thasnodoub t t
- ) ha e s ng, dg ck nid y' am.
he our
t ha
D a s c pl nt a e ge ne t c t nnots y,bas d on t a i sr tve r cor t t
y' om ai s r nui , he our cn
a
e
he dm ni t a i e d, ha

Se
dgwik unr s na y d i d t tDa sm e ca e de f ie t de o taet ts c d
c
ea o bl ec de ha y' di l vi nce a ld o m nsr t ha he oul
notpe f r he s de a y oc upa i
r o m r e nt r c ton.

Da c e t ti ra 800t f c or f l i he f vor Fis,s a guest tt tDr
y ont nds ha mpo tnt
h a t s al n r a . r t he r
ha ha .

Da to ( e p y iin f u t a s wa dsblda t a Gh ln a eo tepln'Bo t
so r h r h sca ) o nd h t he s ia e nd h tt e a gu g f h a '( oh
t
f t t t ontmpltst tf pupos so s tem dia lt be is t Plnwilrl o
acor wo) t e ae ha or
c
e f hor tr sbiiy neft,he a l ey n

t erp r o 1 o rPh sca s p o t o ia iiyt p ro m yoz o o c p to ' ( e
h e o t f Y u y iin' u p ri f n b l o ef r l wn c u ain. M m.
ve
t
r
'
Supp.M o.Summ . .9,ECFNo.1 (mphassadde .ThePln' defnii ofdia lt doe
t
J
2) e
i
d)
a s
ton
sbiiy s
not ho e r asD a s
, w ve ,
y ugges s ves he tea i phys c a w ih t a hort t de e m i he
t , t r r tng
i i n t he ut iy o t r ne r

dia lt sa us Raher i r quie he teai physcin t pr deme c e i nc t t
s biiy tt . t , t e r s r r tng
i a o ovi
dial vde e ha
ac ua l s ppor sheri lt t per or he occ ton. The aut iy t det r i w he he t
t ly u
t
nabiiy o f m r upa i
hor t o e m ne
t r he

me ia e i e c if c s p o t s c afndn , n t ma et eutmaed sb ly
dc l v d n e n a t u p rs u h i ig a d o k h li t ia ii
t
9

detnni to i Sedgwik'.( eAdmi R.25,ECFNo.11 (ç dg c CM Sdeemi s
e nain,s
c s Se
n.
) fse wik
tr ne

wh t e o n ty uaeDia lda d fn db t ePln'; j=a 1 )Cls d wik h st e
eh r r o o r s b e s eie y h a .) ( .t 1 l e g c j a h
' #
exc usve r g a di cr ton,w ih r pec t c a m s a a
l i i ht nd s e i
t es t o l i nd ppea s t i e r t pl s t r s t
l , o nt m et he an' e m , o

a rit rt pl n' be is t dee mi t a ia ef c sa t a y t pln' tr t
dmilse he a s neft, o tr ne he pplc bl a t nd o ppl he a s e ms o

t efcs' An t n oh n i ( S s g e t t a p a a miitao smu t c o ds e il
h a t.
). d t l ti g n ERI A) u g ss h t ln d nsrt r s a c r p ca
l
d e e t t o ni ofte tng physcins' Blck a De kerDia lt Pln v. d,538
ef r nce o he pi ons r a i
i a .' a nd c
s biiy a Nor

U. 8 S (
S. 22, 31 2003)
.
Se ond, a t ke i s w ih Sedgwi k' e pl ym e ofD r Pe r e hi e l tonsof
c
D y a s s ue t
c s m o nt
. t i , s va ua i

t me c le de sa hi phonecal t o he media pr e sona s Da ar ue t spoi t
he di a vi nce nd s
ls o t r
c l of s i l . y g s hi n

t r800t f t t Cthelng
mde
h acor wo t a uageoft p1n', a et Plnr fr t d l Physcin'
he a ' bec us he a ee s o ç r i a '
)
Yot
a nott n i pe ntphysc a ' Howe r t c t s r not ng i t Pln pr ve i
nd
i nde nde
a
ii n.
'
ve ,he our dice ns hi n he a e ntng
Se
dgwik fom e pl ng a i pe n physc a t e ua et e si me c e de i
c r m oyi n nde nde t
ii n o val t he xitng dial vi nce n

ai ofSedg ck' de ii ( . mi R. ECFNo.11 (çse c ha t rg t
d
wi s cson. Cf Ad n. 47,
) Gl dgwik) s he iht o
r que tt tyou a oryo t Physci n c a i y orve iy t m e c li or a i t tyou oryot
e s ha
nd/
tr
i a lrf
rf he di a nf m ton ha
l
r

Physc a s i.A r que tf c a ii a i orve ii a i may i l i pe ntme ca
ii n ubm t
e s or l rfc ton
rtc ton
ncude nde nde
di l
exn nai ns f nc i lc pact e ua i ,s cond me c lo ni ,pee -o- rr viws
mi to , u tona a iy val tons e
di a pi ons rt pee e e ,

j bst e au to s s r ela c a dohe smia me n .
o ie v lai n , u v iln e n t r i lr a s'
l.
Thid,a fnaly,Da poi st 800t fcorsx( t rt de ii wa consse
r nd i l y nt o
h a t i whehe he cson s itnt

wiht pr e lala s tntverquie ntofERI a t s r aleg dee t i t
t he oc dtr nd ubsa i e r me
SA) nd o eveal l ed fcs n he
Pl n' t e de all ter . She c a m st tt e de e t r nde t l te snonc pla w ih
a s hr e ni e t s
l i ha hes f c s e r he e tr
om i nt t
ER I ' m a t t tde a l te s i ude t s ii r as f t de a a s cii
SA S nda e ha ni l e t r ncl he pec f c e on or he ni l nd pe f c

r ernc t t plnpr sononwhiht de ali ba e Se 29C. R.j25 50 1g) s e
ef e e o he a ovii
c he ni s s d. e
F.
60. 3- ( ; e
alo29U. C.j 11 Ha nge mi dt ltescosl t co ttndst tt yae
s
S.
33. vi xn ne he etr l ey,he ur i ha he r

10

s tnta l c
ubsa ily ompla wih ERI i t tt y c an ç sae e ofr as t t unde t
int t
SA n ha he ont i 1 t tm nt e ons ha ,
a
r he
cr um sa esoft c e, r itd as fc e l cea unde sa ng oft a nita o '
ic t nc
he as pe m te ufi i nty l r
rt ndi
he dmi sr t rs

postont per tefci rvi ' Br nv. l 1 F. 158,1 (t Ci.1 ;s e
ii o mi fe tve e ew. oga Holand, 05 3d
'
65 4h r 997) e

as La s v.Ol Do ni Fr i Li l .277F. x31 321( hCi.2008)
lo ron
d mi on eMht ne.nc,
App' 8, 4t r
.
I a hi t r cor i t s c e s st ta t rm uli e doc orvi isand m y i d
f nyt ng, he e d n hi as how ha f e
tpl
t
st
ra

m e ca t t , y' own doc o ssr ggl d t a ti ehe pa n t a pa tc a me c lfndi
di l ess Da s
t r tu e o trbut r i o ny riul r di a i ng.

( .eg.Admi R. ECFNo.112.( .Dasoornotngt thewasGnotf l c nc d
See . ,
n. 69,
- ) Dr t , i ha
i uly onvi e
t t( y' a mals nalM llwa c usnglhe dic or. Eve i t cour woul have
ha Da s bnor pi
t sa i
r somf t'
). n f he t d
i pe nty c et a c r r c uson r gar ng Day' diabiiy cli Se
nde nde l om o onta y oncl i e di
s s lt a m, dgwik'
c s
dec s on i t s c s w a r as na esa i i no wihi t c tspr vi e t di t b i.
i i n hi a e s e o bl nd t s t t n he our ' o nc o s ur t
1
11.

The c r c l
ou t oncudest tSedg ik' de ii n- a ng pr s wasr s ne a
ha
w c s c so m ki
oce s
ea o d nd
prncpl d,a t tt ma e i l on whih i r le a uael s
i i e nd ha he t ra s
c t e id deq t y uppored isde son. Fo t t
t t cii
r ha
r a o and f rt ot rr s ns s a e t s c ti una e t c l t tSe i k' de a of
e s n,
o he he ea o t t d, hi our s bl o onc ude ha dgw c s ni l

Da ss ttr dia lt cai wasunr s na e.Ac or ngl t c tgr nt t Pl n'
y' hor-e m s biiy l m
ea o bl
c di y,he our a s he a s

moin frs mmayj d me t n d n e Da smoinf rs mma yj d me t
to o u r u g n a d e is y' to o u r u g n .
EN TER :D e e be 1 201
c m r 3, 2.

UNI STATESDI CT J
TED
STRI UDGE