United States District Court, E.D. Michigan, Southern Division
K. Majzoub, U.S. Magistrate Judge
ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY
JUDGMENT ; DENYING PLAINTIFF'S MOTION FOR SUMMARY
J. Tarnow, Senior United States District Judge
James Wilson is a 55-year-old resident of Ann Arbor,
Michigan. He suffers from a malignant cancer (lymphoma) of
the spine, HIV, gastroesophageal reflux disease, and
hypertension. He challenges the decision by Defendant
Reliance Standard Life Insurance Company to deny his claim
for Long Term Disability (“LTD”) benefits issued
under an ERISA-governed employee benefit plan (“the
Plan”) to his employer, RCF Information Systems.
Plaintiff's claim falls under 502(a)(1)(B) of ERISA, 29
U.S.C. § 1132(a)(1)(B).
reasons stated below, Defendant's Motion for Summary
Judgment  is GRANTED. Plaintiff's
Motion for Summary Judgment  is DENIED.
Terms of the Insurance Policy
2011, Defendant issued to RCF a group LTD policy that
provides coverage to active, full time RCF employees. Under
that policy, “Totally Disabled” and “Total
Disability” mean, that as a result of an Injury or
(1) during the Elimination Period and for the first 24 months
for which a Monthly Benefit is payable, an Insured cannot
perform the material duties of his/her Regular Occupation;
(a) “Partially Disabled” and “Partial
Disability” mean that as a result of an Injury or
Sickness an Insured is capable of performing the material
duties of his/her Regular Occupation on a part-time basis or
some of the material duties on a full-time basis. An Insured
who is Partially Disabled will be considered Totally Disabled
except during the Elimination Period;
(b) “Residual Disability” means being Partially
Disabled during the Elimination Period. Residual Disability
will be considered Total Disability; and
(2) after a Monthly Benefit has been paid for 24 months, an
Insured cannot perform the material duties of Any Occupation.
We consider the Insured Totally Disabled if due to an Injury
or Sickness he or she is capable of only performing the
material duties on a part-time basis or part of the material
duties on a Full-time basis.
Plaintiff's Medical and Claims History
was in the U.S. Air Force from 1981 through 1991. From July
1, 2011 through December 13, 2014, Plaintiff worked as an IT
Programmer/Systems Analyst (a sedentary occupation) for RCF
Information System, a defense contractor. Plaintiff was
living in Ohio at this time. RCF purchased group disability
coverage from Defendant effective June 1, 2011. (AR001).
November 2014, Plaintiff was briefly hospitalized at Wright
Patterson Air Force Base Hospital, where he was diagnosed
with malignant cancer (lymphoma) of the spine. (AR215).
Plaintiff applied for Short Term Disability
(“STD”) benefits in December 2014. (AR211). Dr.
Nicholas Conger, M.D. completed an Attending Physician's
Statement in which he diagnosed Plaintiff with
“inflammatory mass of the lumbar spine” and
indicated that Plaintiff was unable to perform his job.
(AR209). On December 28, 2014, Dr. Borislav Hristov, Chief of
Radiation Oncology, recommended that Plaintiff “be off
of work” while he received intensive radiation therapy.
(AR215). Defendant promptly approved Plaintiff's STD
benefits claim. (AR53-76).
received radiation therapy from December 30, 2014 through
January 2, 2015. Shortly thereafter, he began chemotherapy.
He received his final chemotherapy on April 20, 2015.
(AR269). Shortly thereafter, Lieutenant Colonel Roger A.
Wood, Chief of Hematology/Oncology, indicated that Plaintiff
cares for himself, but was “[u]nable to carry on normal
activity or to do active work.” (AR266). Wood also
stated that Plaintiff “[r]equires occasional assistance
but is able to care for most personal needs.”
Id. Plaintiff also “[r]equires considerable
assistance and frequent medical care.” Id.
appears that Defendant approved Plaintiff's claim for
Long Term Disability (“LTD”) benefits in May
2015. (AR124-26). Wood twice extended Plaintiff's leave
until approximately August or November 2015. (AR265, 266).
treated with a number of doctors throughout the summer and
fall of 2015. He saw Dr. Niklas Mackler, M.D. on June 16,
2015. Dr. Mackler noted that Plaintiff was “steadily
improving his strength” and that there was “no
clinical evidence to suggest relapse” of Burkitt's
lymphoma. (AR 349-50). A few days later, Dr. Roger Chen, M.D.
evaluated Plaintiff. Plaintiff told Dr. Chen that “his
coughing has improved.” (AR469). Plaintiff denied chest
pain or wheezing and had no fever or chills. Id.
1, 2015, Plaintiff returned to Dr. Mackler, who found that
Plaintiff was “making a steady recovery with improving
appetite and energy.” (AR343). Plaintiff had
“established care with an infectious disease
doctor” and had started antiviral therapy. Id.
Dr. Mackler again noted that Plaintiff presented with
“no evidence to suggest relapse” of Burkitt's
saw Dr. Neelay Kothari, M.D. on July 16, 2015. At this point,
Plaintiff was taking Triumeq for his HIV, which he tolerated
well. (AR420). Plaintiff suffered no adverse side effects
from the Triumeq. Id. Plaintiff felt “well
overall” and told Dr. Kothari that his energy level had
29, 2015, Plaintiff returned to Dr. Mackler, who said that
Plaintiff had “[n]o new complaints” and was
“[f]eeling well.” (AR504). On that same date, Liz
Kirshner, NP, and Dr. Mark Weiner, M.D. evaluated Plaintiff
for his leg, knee, and back pain, substance abuse, and
suspected mood disorder. Plaintiff reported that his leg pain
was “4-5/10.” (AR527).
treated with Nurse Kirshner and Dr. Weiner several times
throughout the summer of 2015. Their notes indicate that
Plaintiff's level of pain continued to decrease. On
August 5, 2015, for example, Plaintiff reported
“suboptimal pain management at 4-5/10.” (AR526).
On September 9, 2015, Plaintiff rated his pain level at
¶ 4/10 and at ¶ 2-3/10. (AR523). Finally, on
September 17, 2015, Plaintiff reported no side effects from
the pain medication and stated that his pain “has gone
from a 5/10 down to 2/10.” (AR522). He was also
sleeping better. Id.
followed up with Dr. Kothari on September 3, 2015. Plaintiff
continued feeling better overall, including
“improvement in energy levels and overall
strength.” (AR410). Plaintiff had no “recent
fever or chills, ” nor did he suffer from “cough
or respiratory symptoms.” Id. Plaintiff
continued to tolerate the Triumeq and did not notice any
“significant side effects.” Plaintiff returned to
Dr. Mackler on ...