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Kerridge v. United of Omaha Life Insurance Co.

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

January 10, 2017




         Plaintiff, Tricia Kerridge, has sued Defendant, United of Omaha Life Insurance Company (United), under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., seeking review of United's decision denying her long-term disability benefits. United has filed the Administrative Record and the parties have filed cross-motions for judgment on the Administrative Record in accordance with the procedures set forth in Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998).

         For the reasons set forth below, the Court will grant United's motion and affirm its decision denying benefits.

         I. Standard Of Review

         The parties agree that the Court must apply the de novo standard in reviewing United's decision to deny Kerridge's claim for benefits. This standard applies to both factual and legal determinations by a plan administrator. Rowan v. Unum Life Ins. Co. of Am., 119 F.3d 433, 435 (6th Cir.1997). “In the ERISA context, the role of the reviewing federal court is to determine whether the administrator or fiduciary made a correct decision, applying a de novo standard.” Perry v. Simplicity Eng'g, 900 F.2d 963, 966 (6th Cir.1990). “This review is limited to the administrative record and the court is obligated to determine whether the administrator properly interpreted the plan and if the insured was entitled to benefits under the plan.” Kaye v. Unum Group/Provident Life & Accident, No. 09-14873, 2012 WL 124845, at *5 (E.D. Mich. Jan.17, 2012) (citing Perry, 900 F.2d at 967). “The administrator's decision is accorded no deference or presumption of correctness.” Hoover v. Provident Life & Accident Ins. Co., 290 F.3d 801, 809 (6th Cir.2002) (citing Perry, 900 F.2d at 966). “When conducting a de novo review, the district court must take a ‘fresh look' at the administrative record but may not consider new evidence or look beyond the record that was before the plan administrator.” Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 616 (6th Cir.1998) (citations omitted).

         II. Background

         Kerridge was employed by SAF-Holland, Inc. as a Business Unit Financial Analyst, a sedentary position that involved sitting and walking. (ECF No. 7-6 at PageID.664.) During her employment with SAF, SAF maintained Group Policy, No. GLTD-AEMS, issued by United, that provided long-term disability (LTD) benefits to eligible SAF employees. (ECF No. 7-1 at PageID.42-71.) The Policy is an “employee welfare benefit plan” within the meaning of § 3(1) of ERISA, 29 U.S.C. § 1002(1), and Kerridge was a participant eligible for coverage under the Policy. (ECF No. 5 at pageID.12.)

         The Policy defines “disability” and “disabled” as:

because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which You are:
(a) prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis; and
(b) unable to generate Current Earnings which exceed 99% of Your Basic Monthly Earnings due to that same Injury or Sickness.
After a Monthly Benefit has been paid for 2 years, Disability and Disabled mean You are unable to perform all of the Material Duties of any Gainful Occupation.[1]
Disability is determined relative to your ability or inability to work. It is not determined by the availability of a suitable position with Your employer.

(ECF No. 7-1 at PageID.68-69.) Material duties are

the essential tasks, functions, and operations relating an occupation that cannot be reasonably omitted or modified. In no event will We consider working an average of more than 40 hours per week in itself to be part of material duties. One of the material duties of Your Regular Occupation is the ability to work for an employer on a full-time basis.

(Id. at PageID.69.) An employee's regular occupation “means the occupation You are routinely performing when Your Disability begins.” (Id. at PageID.70.)

         On April 6, 2014, Kerridge submitted a claim for LTD benefits to United, claiming that she became disabled on October 22, 2013, due to “pass[ing] out unexpectedly, loss of memory, [and] can't function normally.” (ECF No. 7-6 at PageID.662; see also ECF No. 7-2 at PageID.232 (describing passing out suddenly and briefly).) Kerridge identified Dr. Ramona Wallace as the physician who was treating Kerridge for her disability and also indicated that she had received treatment at the Cleveland Clinic from March 26, 2014 to the present.[2] (Id. at PageID.663.) The employer portion of the claim form stated that Kerridge's job required occasional standing and walking (0-33%), continuous sitting (67-100%), and frequent reaching/working overhead (34-66%). (Id. at PageID.669.) The employer portion also stated that reasonable accommodations on a temporary or permanent basis could be made for Kerridge to perform her job. (Id. at PageID.669.) In the Physician's Statement, Dr. Wallace described Kerridge's claimed disability as 9-CM 781.0 (abnormal involuntary movements)[3], dystonia (a movement disorder in which the muscles contract involuntarily, causing repetitive or twisting movements)[4], low Vitamin D, “possible genetic syndrome, ” “chronic condition-idiopathic, ” and “unable to perform [treatment] - etiology[5] unclear.” (ECF no. 7-5 at PageID.525-26.) Dr. Wallace restricted Kerridge from sitting, standing, and walking for more than one hour in an eight-hour workday, driving/operating equipment, lifting/carrying, use of hands in repetitive motions, use of feet in repetitive increments, bending, squatting, crawling, climbing, and reaching above shoulder level. (Id. at PageID.526.)

         A. Medical Evidence

         1.2013 Studies

         In October 2013, Dr. Wallace ordered a Holter monitor recording (a device that monitors a person's heart rhythm).[6] The results were “normal, ” with no evidence of couplets or ventricular tachycardia and “no significant tachy- nor bradyarrhythmias.” (ECF No. 7-5 at PageID.534.)

         On October 22, 2013, an MRI study was performed on Kerridge's brain. The study found “[n]o mass or area of abnormal signal intensity” and “a small cyst in the pineal gland, unchanged from previous studies.”[7] Overall, the study was “[e]ssentially negative.” (Id. at PageID.530.) A second MRI study, performed on December 9, 2013, reported a “[s]table MRI of the brain” with “[n]o discrete sellar [sic] mass . . . identified.” (Id. at PageID.532.)

         2.Dr. Wallace's Office Notes

         Dr. Wallace saw Kerridge six times between the date Kerridge last worked and August 2014-December 19, 2013, January 8, 2014, February 12, 2014, February 28, 2014, and August 18, 2014. (ECF No. 7-2 at PageID.166-190.)

December 19, 2013 Office Visit. In this visit, Kerridge reported that her syncope, or fainting episodes, began one month ago, occurred “daily, ” and were “mild.” Kerridge also reported a history of acne, insomnia/sleep problems, and hyperlipidemia/lipids. Kerridge reported that the symptoms from the insomnia were “worsening, ” and that the fainting symptoms were “moderate” and occurred weekly. Kerridge's medications included Lorazepam (prescribed 4/15/13), Seroquel (prescribed 12/19/13), and Drisdol (prescribed 12/19/13). A review of “systems” was “positive” for fatigue; dizziness, extremity weakness, and memory impairment; anxiety and depression; and muscle weakness.” Dr. Wallace's findings on physical exam were all “normal.” Dr. Wallace reported that the dizziness was attributable to hyperparathyroidism, due to low vitamin D, which, in turn, was secondary to previous bariatric surgery. (Id. at PageID.166-68.)
January 8, 2014 Office Visit. Kerridge reported hyperlipidemia/lipids that was “mild” and “[un]changed” and insomnia/sleep problems, with “improving” symptoms. Kerridge's list of medications remained the same. The review of systems indicated no problems in any category. Dr. Wallace's findings on physical exam were all “normal.” Kerridge reported that her insomnia was improved with the Seroquel and she requested an increase in the dosage to 50 mg. at night. (Id. at PageID.170-72.)
• February 12, 2014 Office Visit. In this visit, Kerridge reported insomnia/sleep problems, with improving symptoms, and nausea that was “mild” and intermittent. Kerridge's medications remained the same. The review of systems indicated no problems except for anxiety, depressed mood, depression, marked diminished interest or pleasure. Dr. Wallace's findings on physical exam were all “normal.” Dr. ...

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