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Keskeny v. United of Omaha Life Insurance Co.

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

April 20, 2017

JEAN KESKENY, Plaintiff,


          THOMAS L. LUDINGTON United States District Judge

         On April 14, 2016 Plaintiff Jean Keskeny initiated the above-captioned matter against Defendant United of Omaha Life Insurance Company pursuant to the civil enforcement provision of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 11322(a). Plaintiff alleges that Defendant wrongfully denied her long term disability benefits. See Compl., ECF No. 1. The matter was referred to Magistrate Judge Patricia T. Morris for pretrial management. See ECF No. 6. On September 23, 2016 Plaintiff and Defendant each filed a motion for declaratory judgment on the administrative record. See ECF Nos. 10, 11. On February 24, 2017 the magistrate judge issued her report, recommending that Defendant's motion be granted and Plaintiff's motion be denied. See ECF No. 18. Plaintiff filed objections on March 8, 2017. See ECF No. 19. For the reasons stated below, Plaintiff's objections will be overruled and the report and recommendation will be adopted.


         Plaintiff Keskeny is a licensed Practical Nurse, and was employed as a Charge Nurse by MediLodge beginning on January 5, 2009. At the time of the relevant events, MediLodge sponsored a Group Disability Plan (the “Plan”), which was issued and administered by Defendant United of Omaha Life Insurance Company. Under the Plan, Defendant agreed to pay certain short-term disability benefits (“STD benefits”) and long-term disability benefits (“LTD benefits”) to covered, eligible persons who established a qualifying disability. For the purpose of LTD benefits, the Plan defined disability as follows:

         Disability and Disabled means that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which You are:

. prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis; and
. 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 24 months, Disability and Disabled mean You are unable to perform all of the Material Duties of any Gainful Occupation.
Disability is determined relative to Your ability to work. It is not determined by the availability of a suitable position with Your employer.

See Tr. 000013, ECF No. 9-1.

         Plaintiff ceased working on February 4, 2013. In March of 2013, Plaintiff filed a claim with Defendant for STD benefits, claiming that the nature of her illness was “head & neck pain.” See Tr. 001111. The request was supported by documentation from Plaintiffs treating neurologist, Doctor Steven Beall, who found that Plaintiffs activities were limited by an inability to bend, squat, stoop, or lift or carry any weight. Tr. 001115-16. Dr. Beall concluded that Plaintiff “should not work til condition healed.” Id. Defendant approved Plaintiffs request for STD benefits beginning on February 11, 2013. Tr. 001013-14. Defendant ultimately extended Plaintiff's STD benefits through August 11, 2013, at which time Plaintiff's STD benefits under the Plan were exhausted. Tr. 000957-58.

         After exhausting her STD benefits, Plaintiff sought and obtained LTD benefits from Defendant commencing on August 12, 2013. Tr. 000863-68. In approving the LTD benefits, Defendant relied upon Plaintiff's STD claim, as well as on medical records obtained from North Ridge Family Practice, Doctor Steven Beall, and Nurse Practitioner Beth Weaver. Plaintiff proceeded to collect LTD benefits for 24 months. Therefore, to continue receiving monthly benefits under Defendant's Plan after August 11, 2015, Plaintiff was required to demonstrate that she was “unable to perform all of the Material Duties of any Gainful Occupation.” Tr. 000013 (emphasis added).

         By a letter dated June 25, 2015, Defendant informed Plaintiff that her request for LTD benefits beyond August 11, 2015 was denied. Tr. 00483-91. The denial was based upon Defendant's finding that Plaintiff was able to perform the material duties of gainful occupations requiring only light or sedentary work, such as a manicurist, phlebotomist, hospital-admitting clerk, and appointment clerk. Tr. 000488. Defendant rejected Dr. Beall's suggestion that Plaintiff's medical records demonstrated that multiple sclerosis prevented her from performing such work, noting that “[t]he examinations that we received from Dr. Beall's office include checklists without comprehensive examinations, impressions or plans.” See Tr. 000487. Defendant further noted that recent medical imaging of her cervical and lumbar spine “showed degenerative changes without significant stenosis, disc herniation or cord compromise, ” and that “examinations did not show any significant strength, sensation, motion or coordination abnormalities.” Tr. 000487. Defendant also observed that Plaintiff had continued to consume alcohol and smoke cigarettes on a daily basis in contravention of medical advice. Tr. 000485-87. Finally, Defendant found that Plaintiff had not established that her other chronic conditions of obesity, hypertension, GERD, anxiety, COPD/asthma, sleep apnea, gastritis and hair loss caused significant physical functional impairment.

         Plaintiff appealed. In conducting its review of the appeal, in January of 2016 Defendant retained neurologist Robert L. Marks, M.D., to conduct a medical record review. After reviewing all of the relevant records, Dr. Marks concluded that, “although it is very possible that demyelinating disease such as MS is a correct diagnosis, it cannot be considered an absolutely definitive diagnosis. Time will eventually provide verification.” See Tr. 000079. Dr. Marks also noted that he “could not find substantiation that the claimant was unable to arise from a chair to stand and walk, although an assistive device may be necessary. Basic functional use of the upper extremities, possibly with some weakness, appeared to be present.” See Tr. 000080. While agreeing that “restrictions and limitations are appropriate in this case, ” Dr. Marks warned that “caution is needed to avoid relying too much on purely ...

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