United States District Court, E.D. Michigan, Southern Division
K. Majzoub, United States Magistrate Judge.
AND ORDER: (I) GRANTING PLAINTIFF'S MOTION FOR SUMMARY
JUDGMENT  AS TO CLAIMS NOS. 2 AND 3 AND DENYING
PLAINTIFF'S MOTION FOR JUDGEMENT AS TO CLAIM NO. 1; (II)
GRANTING DEFENDANT'S MOTION FOR JUDGMENT ON THE
ADMINISTRATIVE RECORD  WITH RESPECT TO CLAIM NO.1 AND
DENYING DEFENDANT'S MOTION AS TO CLAIMS NOS. 2 AND
GERSHWIN A. DRAIN, United States District Court Judge.
an Employee Retirement Income Security Act
(“ERISA”) case, arising under 29 U.S.C. §
1132(a)(1)(B). Rebecca Filthaut (“Plaintiff”)
filed a complaint on August 13, 2015 against AT&T
Umbrella Benefit Plan No. 3 (“the Plan” or
“Defendant”). Plaintiff alleges that the Plan
wrongfully denied her short-term disability benefits during
three different periods between January and May 2014. The
Plan alleges that the Plaintiff failed to present sufficient
documentation to establish that she was disabled.
the Court is Defendant's Motion for Judgment on the
Administrative Record  and Plaintiff's Motion for
Summary Judgment Granting Plaintiff Short-Term Disability
Benefits . Each motion has been responded to by the
opposing party. Reply briefs have not been filed on either
Motion. Upon review of both motions, the Court finds that
oral argument will not aid in the disposition of this matter.
Accordingly, the hearing is cancelled and the Court will
decide the matter on the submitted brief. See E.D.
Mich. L.R. 7.1(f)(2). For the reasons discussed herein, the
Court will GRANT the Plaintiff's Motion IN PART, and
GRANT the Defendant's Motion IN PART.
is a female service representative with the Michigan Bell
Telephone Company. ECF No. 17-1 at 141 (Pg. ID 191); ECF No.
20 at 11 (Pg. ID 1285). She participated in the AT&T
Midwest Disability Benefit Program, which is a component of
the Plan. ECF No. 7 at 2-3. Though housed within AT&T,
disability benefits are administered by Sedgwick Claim
Management Service, Inc. (“Sedgwick”). ECF No. 20
at 10-12 (Pg. ID 1284-86). The Plan provides both short-term
and long-term benefits if participants meet the Plan's
definition of disabled:
“[i]f the Claims Administrator determines that you are
Disabled by reason of sickness, pregnancy, or an off-the job
illness or injury that prevents you from performing the
duties of your job (or any other job assigned by the Company
for which you are qualified) with or without reasonable
accommodation. Your Disability must be supported by objective
Id. The Plan defines objective Medical Evidence as:
“Objective medical information sufficient to show that
the Participant is Disabled, as determined at the sole
discretion of the Claims Administrator. 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
profession. 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.”
response to kidney issues and chronic back pain that had been
ongoing since at least 2012, Plaintiff applied for short-term
disability benefits. ECF No. 17-4 at 57 (Pg. ID 532). The
Plan granted benefits to the Plaintiff from December 2013 to
early January 2014. ECF No. 20 at 13 (Pg. ID 1287). Amid
continued pain and discomfort, Plaintiff made three
additional claims for short-term disability benefits: January
13 to February 23, 2014 (“Claim No. 1”), March 3
to April 14, 2014 (“Claim No. 2”), and April 16
to May 7, 2014 (‘Claim No. 3”). The Plan denied
disability benefits on all three claims. Id. at 2
(Pg. ID 1276). According to the Plan, the Defendant did not
provide sufficient medical evidence that she was unable to
perform her sedentary job. Id. at 28-32 (Pg. ID
the relevant period, the Plaintiff consulted at least three
treating physicians: Drs. Al Nouri, Kovar and Carley. Dr. Al
Nouri diagnosed the Plaintiff with lumbar degenerative disc
disease and administered a series of steroid injections. ECF
No. 17-1 at 149 (Pg. ID 199). The injections did not
successfully control the Plaintiff's pain. Id.
Dr. Kovar, a neurologist, determined the Plaintiff suffered
from a myofascial strain near her ribs and multiple segmental
somatic dysfunction throughout the Plaintiff's thoracic
region. ECF No. 17-2 at 18 (Pg. ID 240).
Carley, a family care physician, is the most important doctor
to Plaintiff's claims. On March 5, 2014, Dr. Carley's
observed clinical findings noted that the Plaintiff was
“unable to ambulate”. ECF No. 17-5 at 96 (Pg. ID
637). Dr. Carley recommended “no work” as a
functional restriction. Id. On March 11, 2014, Dr.
Carley indicated that if Plaintiff returned to work, she
would require the following restrictions: breaks every five
minutes, no sitting or standing for more than five minutes,
no lifting over two pounds, no reaching over-head, no
bending, no twisting, no kneeling, and no stooping. ECF No.
18-4 at 52-54 (Pg. ID 1139-41). Dr. Carley recommended these
limitations for no more than six months. Id. The
Plaintiff submitted medical information from all three
treating physicians to the Plan.
Plan participants supply medical evidence of a disability,
the Plan contacts physician advisors, who are hired
specialists, to make an independent disability determination.
Generally, one physician advisor will be consulted for the
Plan's initial determination, and two more will supply
their opinion during the appeal of an initial disability
determination. In reviewing Plaintiff's applications for
disability benefits, the Plan consulted seven physicians:
Drs. Robbie, Garcia, Jamie Lee Lewis, Friedman, Rangaswamy,
Grattan, and Moshe Lewis. The contents of these physician
advisors' assessments are discussed below.
Legal Standard to Review a Denial of ...