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Filthaut v. AT&T Midwest Disability Benefit Plan

United States District Court, E.D. Michigan, Southern Division

November 7, 2016

Rebecca Filthaut, Plaintiff,
v.
AT&T Midwest Disability Benefit Plan and AT&T Umbrella Benefit Plan No. 3, Defendant.

          Mona K. Majzoub, United States Magistrate Judge.

         OPINION AND ORDER: (I) GRANTING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT [21] 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 [20] WITH RESPECT TO CLAIM NO.1 AND DENYING DEFENDANT'S MOTION AS TO CLAIMS NOS. 2 AND 3

          HON. GERSHWIN A. DRAIN, United States District Court Judge.

         I. Introduction

         This is 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.

         Before the Court is Defendant's Motion for Judgment on the Administrative Record [20] and Plaintiff's Motion for Summary Judgment Granting Plaintiff Short-Term Disability Benefits [21]. 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.

         II. Factual Background

         Plaintiff 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 Medical Evidence.”

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.”

Id.

         In 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 1302-06).

         Throughout 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).

         Dr. 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.

         After 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.

         III. Legal Standard to Review a Denial of ...


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