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Guest-Marcotte v. Life Insurance Co. of North America

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

July 17, 2018


          Patricia T. Morris Magistrate Judge



         Plaintiff Kimberly J. Guest-Marcotte filed her complaint on February 27, 2015 asserting a claim for short term disability (“STD”) benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”), as well as a claim for disability discrimination under the Michigan Persons with Disability Civil Rights Act (PWDCRA), MCL 37.1101, et seq., against her former employer, Metaldyne Powertrain Co., and her former employer's ERISA Plan administrator, Life Insurance Co. of North America (“LINA”). ECF No. 1. On April 1, 2015, all pretrial matters were referred to Magistrate Judge Morris. ECF No. 9. Defendants filed a motion to dismiss, an answer, and a counterclaim on April 24, 2015. ECF Nos. 11, 12. Plaintiff then filed an answer to Defendants' counterclaim on May 13, 2015. ECF No. 17. On June 22, 2015, Magistrate Judge Morris issued a report recommending that the Court grant Defendants' motion to dismiss, to which Plaintiff filed objections on July 2, 2015. ECF No. 20, 21. The court ultimately issued an order overruling Plaintiff's objections, adopting the Magistrate Judge's report, and dismissing Plaintiff's PWDCRA claim. ECF No. 28.

         Following supplemental briefing, Plaintiff filed a motion for leave to file a first amended complaint on November 20, 2015. ECF No. 35. The Magistrate Judge issued a report, ECF No. 40, which the Court adopted, granting Plaintiff's motion to amend in part and confirming the standard of review as arbitrary and capricious. ECF No. 42. Plaintiff then filed an amended complaint on April 19, 2016. ECF No. 44. After filing of the administrative record and pertinent plan documents (ECF Nos. 49, 50), Plaintiff moved for judgment on August 5, 2016. ECF No. 54. Defendants moved for dismissal of Plaintiff's case and judgment on the counterclaim. ECF No. 55. On December 1, 2016, Magistrate Judge Morris issued a report recommending that the court deny Plaintiff's motion and grant Defendants' motion, noting that “[t]ime and again, this Circuit has held that “it is entirely reasonable for an insurer to request objective evidence of a claimant's functional capacity.'” Rep. & Rec. at 25, ECF No. 63 (quoting Rose v. Hartford Financial Services Group, Inc., 268 Fed.Appx. 444, 453 (6th Cir. 2008)). On January 6, 2017, the Magistrate Judge's report was adopted, and Plaintiff's claims were dismissed with prejudice. ECF No. 67. Plaintiff timely appealed the decision. ECF No. 75. The Court of Appeals for the Sixth Circuit issued its opinion on March 30, 2018, reversing the dismissal of Plaintiff's claims and remanding the matter for a full and fair review of Plaintiff's condition and her application for STD benefits. ECF No. 81. Judgment was entered in favor of Plaintiff on April 27, 2018. ECF No. 84. On May 21, 2018, Plaintiff filed a motion for attorney fees and costs. ECF No. 85. For the following reasons, that motion will be denied.


         It is undisputed that Plaintiff has been diagnosed with and suffers from Ehlers-Danlos Syndrome Type III (“EDS”), a hereditary disease characterized by loose connective tissue and frequent joint dislocations. It is medically known that EDS can cause chronic pain. On the recommendation of her primary care physician, Dr. Kadaj, and an expert in EDS, Dr. Tinkle, Plaintiff sought a disability leave of absence in June 2013. Adm. Record at 102-03, ECF No. 49-1. Soon thereafter, Plaintiff applied for short-term disability benefits through Defendant Life Insurance Company of North America (“LINA”). In support of her application, Dr. Kadaj submitted a medical request form, in which he concluded that Plaintiff should not return to work, even if significant accommodations were made. Dr. Tinkle also submitted a medical request form. Dr. Tinkle concluded that Plaintiff could return to work if she did not lift objects heavier than five pounds, did not engage in any repetitive motions, and took frequent breaks. Id. at 59. Plaintiff was initially denied benefits in August 2013. Id. The denial was based on a review of the notes from Plaintiff's office visits, medical request forms from both Dr. Kadaj and Dr. Tinkle, and a clarification request from Dr. Tinkle. Id. Before making its determination, LINA followed up with both treating doctors and Plaintiff on several occasions. Adm. Record at 154, 162, ECF No. 49-2; Adm. Record at 49, ECF No. 49-5. The medical evidence was reviewed by Nurse Case Manager Sarah Drudy and Dr. Paul Seiferth. Adm. Record at 74, ECF No. 49-6. LINA denied the claim for the reasons explained in Judge Morris's report:

Ultimately, July 3, 2013 commentary from a physician reviewer, Paul D. Seiferth, M.D., notes that Dr. Tinkle's findings, which explicitly indicate Ehlers-Danlos Syndrome with joint pain and laxity, “are remarkable for TMJ [temporomandibular joint] crepitation, normal extremity range of motion, and strength, hyper-mobility of joints on the Beighton scale 5/9.” (Doc. 49-6 at 74). He continued to note that imaging showed “central cervical spine stenosis at ¶ 4-5 with no clinically correlated signs, ” and no signs that Plaintiff's condition “worsened at incur” as she was “functional at a sedentary demand level” since her original diagnosis in 2005. (Id.). Later, on July 22, 2013, an updated review of medical evidence submitted by Dr. Kadaj failed to support Plaintiff's inability “to perform prolonged sitting, standing, [or] lifting greater than 10 pounds or pushing/pulling activities” with “diagnostic testing results indicating [the] nature and presence of functional loss.” (Doc. 49-6 at 67). Her initial claim was denied on these grounds, and indicated that while LICNA/CIGNA was “in no way stating [that Plaintiff's] symptoms do not exist, . . . there [was] no documentation or a functional deficit” and “no diagnostic testing on file to support [Plaintiff's] diagnosis.” (Doc. 49-1 at 60).

Rep. & Rec. at 13.

         Plaintiff appealed the denial of benefits in September 2013. Id. at 95-96. Her appeal contained supplemental medical information, including notes from additional office visits; letters from Dr. Kadaj, Dr. Tinkle, Sheila Isles-Truax (Plaintiff's physical therapist), Dr. Wilkinson (Plaintiff's acupuncturist), and Dr. Deitrick (Plaintiff's therapist); x-ray results; lab work results; and notes from physical therapy sessions. Id. Before making a determination on Plaintiff's appeal, LINA requested follow-up information several times. Adm. Record at 14, ECF No. 49-3. Plaintiff's appeal, and all included medical information, was reviewed this time by an additional physician, Dr. Nick Ghaphery. Adm. Record at 34, ECF No. 49-6. In November 2013, LINA rejected Plaintiff's appeal and affirmed the denial of benefits on the same grounds. Adm. Record at 96, ECF No. 49-1. Gena Morton, writing for LINA, provided an explanation which was summarized in Judge Morris's report:

She observed that “the medical information on file did not identify any significant clinical findings to demonstrate a functional impairment.” (Doc. 49-6 at 34). She noted that lab results revealed no “significant abnormalities that would preclude functional demands, ” and that despite office notes from Dr. Kadaj indicating “limited right shoulder motion in abduction, and abnormal joint palpitation, there are no quantified measurable strength or functional deficits documented” to support these alleged limitations. (Id.). Plaintiff's EMG, for instance, did not “demonstrate evidence of radiculopathym myopathy, or peripheral neuropathy, ” and her MRI- which did reveal “moderate central canal stenosis at ¶ 4- C5”-nevertheless “would not preclude functional demands.” (Id.)

         Plaintiff filed her final internal appeal in July 2014, which included the following additional medical information: statements from Dr. Kadaj and Dr. Tinkle; Dr. Tinkle's curriculum vitae; office notes from a Dr. Bergeon; a healthcare provider questionnaire; letters from Dr. Deitrick, Dr. Kadaj, Dr. Wilkinson, and Dr. Tinkle; results from a nerve conduction study; physical therapy notes; x-ray of Plaintiff's shoulder and lumbar spine; MRI of Plaintiff's cervical spine; sleep study results; and medical request forms. Adm. Record at 4-5, ECF No. 49-5. Plaintiff's second appeal, and all medical information, was reviewed by a third physician, Dr. Shadrach Jones. Adm. Record at 15, ECF No. 49-6. Plaintiff's final appeal was denied in October 2014, for the reasons explained in Judge Morris's report:

         In consultation with reviewing physician Shadrach H. Jones, IV, M.D., Appeal Assignee Elizabeth Palmer noted that “the current objective or quantifiable clinical examination, clinical diagnostic testing, or imaging documentations do not support a significant ongoing physical functional impairment which would preclude [Plaintiff] from performing her own occupational duties on a full time basis.” (Doc. 49-6 at 15) (emphasis added). She observed that Dr. Tinkle's medical genetics analysis “did not document any specific physical findings or impairments that would preclude the required occupational functional abilities, ” that his suggested limitations were “not supported by documented impairment, ” that Dr. Kadaj's physical examination was “normal” and presented no musculoskeletal or neurologic exam findings, that Dr. Bergeon's notes found “no focal weakness or other neurological abnormalit[ies], ” and that Dr. Bergeon did not suggest any work limitations, though he “encouraged active independent exercise.” (Id.) (emphasis added).

         Plaintiff commenced this action on February 27, 2015.


         Plaintiff seeks attorney fees and costs, contending that she has had success on the merits and that the King factors weigh in favor of such an award. Sec'y of Dep't of Labor v. King, 775 F.2d 666, 669 (6th Cir. 1985).[1] Specifically, Plaintiff argues that the Sixth Circuit's finding that LINA's conduct in denying her benefits was arbitrary and capricious and the Court's order remanding the case for a full and fair review establish the propriety of a fee award. Mot. at 1-2, ECF No. 85. Plaintiff also argues that Defendants are financially capable of satisfying a fee award, that such an award would deter similarly-situated plan administrators from behaving arbitrarily in addressing applications for benefits, and that Plaintiff's success confers a common benefit for other participants in the ERISA plan. Id. at 9-11.

         Defendants argue that a fee award is not supported by the King factors in this case. Specifically, they argue that a finding of “arbitrary and capricious” is not the same as a finding of culpability or bad faith, and that they are not culpable. Resp. at 5, ECF No. 86. Defendants do not contest that they are financially capable of satisfying an award, but they do argue that the conduct that resulted in the denial of Plaintiff's claims was not rooted in bad faith; instead, Defendants contend that the denial was rooted at most in an honest mistake concerning the necessity of a physical examination of the Plaintiff, and that a fee award will not have a deterrent effect. Id. at 8. Additionally, Defendants argue that Plaintiff's action sought a private benefit, and that it will not- nor was it ...

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