Majeske v. Quicken Loans and Affiliated Companies Welfare Benefits Plan

          MONA K. MAJZOUB U.S. MAGISTRATE JUDGE.

          OPINION AND ORDER GRANTING [20] DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND DENYING [19] PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT

          Arthur J. Tarnow Senior United States District Judge.

         Plaintiff, Jill Majeske, brings this suit against her employee welfare benefit plan to recover short term disability benefits. Defendant, the Quicken Loans and Affiliated Companies Welfare Benefits Plan (“the Plan”), is subject to the Employee Retirement Income Security Act of 1974 (“ERISA”). Plaintiff brings this action under 29 U.S.C. § 1132(a)(1)(B). The Administrative Record has been filed with the Court [Dkt. # 18], and both parties now seek summary judgment. Because Plaintiff has not shown that Defendant acted arbitrarily or capriciously when it denied her claim for benefits, Defendant's motion will be granted and Plaintiff's will be denied.

         Factual and Procedural Background

         Plaintiff is a loan underwriter at Quicken Loans, Inc. Defendant is an ERISA Employee Benefits Plan sponsored by Quicken Loans, Inc. and administered by Liberty Mutual Group.

         Ms. Majeske sought treatment at Bio Energy Medical Center on May 22, 2017. She complained about a wide range of health problems, including chronic fatigue. On June 15, 2017, Ms. Majeske underwent laboratory work testing for Lyme Disease. She was tested according to Western Blot IgM method. (Administrative Record, HA0140-41). The Western Blot test measures the presence of certain antibodies against Lyme Disease and assigns their presence in various bands. (Id.). The three such bands that were positive from Ms. Majeske blood sample were sufficient to trigger a positive result for Lyme disease according to the laboratory's criteria, but not for those of the Center for Disease Control (“CDC”). (Id.). Thus, on June 30, 2017, the laboratory, IGeneX, issued a report showing that Ms. Majeske tested positive for Borreliosis, or Lyme Disease, according to the IGeneX criteria, but negative for the disease according to the CDC/NYS criteria. (Id.).

         Ivy Carson, N.P., on an August 21, 2017 consultation, found that Ms. Majeske suffered from fatigue that was “[l]ikely related to a host of factors, including nutritional deficiencies, Hashimoto's hypothyroidism, digestive imbalances, Lyme disease, [and] Epstein Barr reactivation.” (HA 0175). The next day, August 22, 2017, Ms. Carson wrote a letter “to whom it may concern” opining that it was in Ms. Majeske's best interest to take 90 days off work to pursue treatment for these ailments. (HA 0128). Ms. Carson reiterated her position in a second letter on September 14, 2017. (HA0177). A third letter, dated November 9, 2017, expanded the list of symptoms and opined that “[e]xtensive labwork performed has included the IgM Western Blot which was positive for Borreliosis, as well as labwork confirming her autoimmune thyroiditis, multiple nutritional deficiencies, dysbiosis, and immunodeficiency…” (HA0178). She added that external stressors exacerbate symptoms and slow recovery, and that Ms. Majeske's time off work was necessary for her recovery. On November 27, 2017, the Bio Energy Medical Center Medical Director, James. R. Neuenschwander, M.D. opined that the IgeneX positive markers, along with a “non existent CD57 (activated natural killer cell) count, ” indicated chronic Borreliosis. (HA0179).

         Dr. Neuenschwander continued to describe the indications of chronic Borreliosis as follows,

Jill has the classic pattern of normal lymphocyte count and IP flow. Positive IgM with negative IgG western blot along with a low CD57 (in the absence of other immunodeficiency). Jill also had an elevated C-reactive protein, an indicator of inflammation, along with a high TPO antibody level indicating her hypothyroidism is due to Hashimoto's, an autoimmune disease. Based on this evidence, Jill was diagnosed with chronic Borreliosis (I am differentiating this from the acute/subacute form of Borrelia commonly known as Lyme disease) and was treated with three months of a standard oral Borrelia protocol-Doxycycline and Hydroxychloroquine. This treatment resulted in a significant increase in her symptoms (typically seen with antibiotic treatment of chronic infections and known as the Jarisch/Herxheimer reaction). These symptoms included significant increase in fatigue and brain fog, hypersomnolence, and joint pain. These symptoms resulted in the necessity for short term disability. Due to the chronicity of her symptoms, she likely needs a longer course of treatment, but is unable to pursue this at this time due to her work situation. Given the symptom complex and biochemical evidence to support her diagnosis along with the classic response to antibiotic treatment, she deserves to qualify for short term disability payment for the three months that she was under treatment.” (HA0179).

         Ms. Majeske filed her initial application for short term disability on August 23, 2017. (HA0106). A disability nurse manager concluded that based on the evidence before her-Ivy Carson's office notes from 8/21/2017 visit by Ms. Majeske and the aforementioned letter from Ivy Carson-restrictions and limitations were not supported “due to lack of medical evidence that would indicate a level of impairment. (Id.). Defendant received Ms. Majeske's first letter of appeal on September 14, 2017. (HA0107). The appeal included a summary of care and a lab order from Ms. Carson, dated 5/22/2017, lab reports dated 6/15/2017, summary of care dated 8/21/2017, and the letter dated 9/14/2017 from Ms. Carson. Ms. Majeske's claim was then reviewed by an independent physician, Dr. Sara Keiler.

         Dr. Keiler spoke with Ms. Carson about Ms. Majeske's worsening symptoms, including fatigue, and joint pain. (HA0115-16). Ms. Carson told Dr. Keiler that she believed that Ms. Majeske's symptoms were caused by her Lyme disease and the treatment thereof, in addition to a history of mold exposure. (Id.). She disputed Ms. Carson's Lyme disease diagnosis on the grounds that Ms. Majeske tested negative according to the CDC standard for Lyme disease diagnosis. (HA0117). She also found that EBV serologies were more consistent with a past infection than a current infection. Dr. Keiler also noted that Ms. Majeske's hypothyroidism was under control with medication. Finally, Dr. Keiler also found that mold inhalation has not been linked in medical literature to fatigue, so it was a dubious explanation for Ms. Majeske's fatigue. (Id.).

         Defendant received Ms. Majeske's second level of appeal on December 1, 2017. (HA0108). That appeal considered the November 9, and November 27, 2019 letters from Ms. Carson and Dr. Neuenschwander respectively. Ms. Carson also provided notice after the second level appeal was denied of a “new diagnosis of an autoimmune condition (Hashimoto's thyroid).” (Id.) Ms. Majeske's second level appeal was reviewed by an independent physician, Dr. Jeffrey Sartin. Dr. Sartin opined that Ms. Majeske's file lacked documentation from psychiatric providers as to whether her depression and anxiety was disabling, that it lacked documentation of physical examinations that would indicate impairing diagnoses, and that it lacked evidence of reported or observed cognitive or physical side effects to Ms. Majeske's medications. (HA0123). Dr. Sartin noted that,

In evaluating complaints of cognitive disfunction, in particular where anxiety and depression are involved, one would generally need input from the neurological and psychiatric perspective, as well as detailed neurocognitive testing and brain imaging. These are lacking in medical evidence. (Id.).

         Dr. Sartin also observed that Ms. Majeske's Lyme disease testing was negative according to CDC criteria for both IgM and IgG. Dr. Sartin placed several phone calls to Dr. ...