Meyer v. Group Long Term Disability Plan

          ORDER AND OPINION

          JAMES E. SHADID, UNITED STATES DISTRICT JUDGE

         Now before the Court are cross-motions for summary judgment. Plaintiff has filed a Motion (D. 34^[1]) for Summary Judgement. Defendants filed a collective Response (D. 38) in Opposition to Plaintiff's Motion for Summary Judgment and Plaintiff replied (D. 39). Defendants have also collectively filed a Motion (D. 35) for Summary Judgment. Plaintiff filed a Response (D. 37)^[2] to Defendants' Motion for Summary Judgment and Defendants replied (D. 40). For the reasons set forth below, Plaintiff's Motion is DENIED and Defendants' Motion is GRANTED.

         Background

         Plaintiff Sherry Meyer (“Plaintiff” or “Meyer”) brought this action after Defendants denied her claim for long-term disability benefits. Defendant Group Long Term Disability Plan for Employees of Edward D. Jones & Co., L.P. (the “Plan”) is an employee welfare benefit plan sponsored by Edward D. Jones & Co. and governed by the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1001 et. seq. Defendant Hartford Life and Accident Insurance Company (“Hartford”) issued an insurance policy (the “Policy”) to Edward D. Jones & Co. to fund long-term disability benefits under the Plan.

         The following facts are from the administrative record. D. 23. Meyer has worked for Edward D. Jones & Co. as a financial advisor since 1992. D. 23-10, at 8. Meyer stopped working full time for Edward D. Jones & Co. in November 2013. D. 23-1, at 99. As a participant in the Plan, Meyer submitted a claim in early-2014 under the Policy for mental illness disability. Id. at 169. Hartford approved Meyer's claim for long term disability benefits May 1, 2014. Id. at 130.

         On July 11, 2014, Meyer began receiving chiropractic care for pain in her neck, shoulder, and lower back. D. 23-7, at 72. Meyer received thirty-four chiropractic treatments for neck and lower back pain from July 11, 2014 through May 14, 2015. Id. at 21-89. Beginning September 19, 2014, Meyer told her chiropractor, Dr. Kramer, that she experiences numbness, radiating pain, stiffness, and throbbing in her neck that radiates to both arms and hands. Id. at 21. She also described dull ache, radiating pain, and stiffness in her lower back. Id. Meyer told Dr. Kramer the symptoms occurred 76%-100% of the day and rated the symptoms no lower than a seven on a zero-ten scale. Id.

         Meyer began seeing a rheumatologist, Dr. Santoro, on November 26, 2014. D. 23-7, at 12. On that date, Dr. Santoro ruled out a diagnosis of fibromyalgia due to the absence of tender points, hyperalgia and allodynia. Id. at 16. He suggested her symptoms may be due to soft tissue rheumatism and ordered a sleep study to explore her reported un-refreshed sleep. Id.

         Pursuant to a regularly conducted review to determine whether Meyer can return to fulltime work, Hartford sent a letter to Meyer's psychiatrist, D r. K yle, in March 2015 inquiring whether Meyer had been cleared to work full time from a psychiatric standpoint. D. 23-7, at 104. D r. K yle responded that Meyer was able to work up to, but no more than, 40 hours per week. Id. at 107. D r. Kyle noted Meyer generally worked 30 hours or less each week because Meyer became fatigued to the point where the quality of her work suffered. Id. D r. Kyle went on to say, “Realistically she is not able to work more hours and her schedule will probably stay as it is. Again, it comes with the definition of what is full time or not. She is certainly able to work but not at the pace she did when she was younger.” Id. at 108. Dr. Kyle wrote that Meyer told her on their last visit that “the most [Meyer] can do is 40 hours” Id. at 109.

         On May 7, 2015, Hartford sent a letter to Meyer stating she no longer qualified for long-term benefits due to her mental illness. D. 23-1, at 97. Hartford lacked medical information necessary to determine whether Meyer met the Policy's definition of disability due to a physical condition and Meyer had two options to challenge the claim denial: 1. perfect her claim by providing specific documents to the claim analyst, Penny Mccormick; or 2. submit an appeal to Hartford's appeal unit. Id. The letter acknowledged Meyer recently began seeing a rheumatologist. Doc. 23-1, at 100. To perfect her claim, Meyer was advised to submit an Attending Physician Statement (“APS”) completed by a physician who was restricting Meyer from working full-time, as well as all medical records supporting her physical disability from July 1, 2014 to present time. Id. Alternatively, Meyer could appeal the claim denial by sending a signed, dated letter within 180 days clearly stating her position. Id. at 101. Meyer could also submit written comments, documents, records and other information related to her claim as part of her appeal. Id.

         On June 2, 2015, Meyer sent the following letter to Hartford: “Hi - Enclosed are my medical records and claim forms from two doctors. Please advise regarding my disability income asap. EDJ [employer] still has me on part-time, irregular schedule [sic] leave of absence. My rheumatologist only wants me to work 28 or less hours a week.” Doc. 23-6, at 55. Meyer enclosed medical records from her rheumatologist, D r. Santoro, as well as records from her current and former chiropractors, Dr. Kramer and Dr. Trotter. Id. The letter was sent to the attention of Penny Mccormick; however, it was addressed to the appeals department. Id.

         On August 11, 2015, Penny Mccormick sent another denial of disability benefits. Doc. 23-1, at 82. Meyer did not meet the Policy's definition of “disability” for a physical condition because she had not shown that she was unable to perform the duties of her occupation. Id. at 84. The essential duties of her occupation included meeting with clients, managing client finances, and establishing new business. Id. To perform said duties, Meyer “must be able to frequently sit with occasional walking, standing and lift/carry [sic] up to 25 pounds.” Id. The decision to deny Meyer's claim was based on a full review of all the documents in her file, including medical records and APS forms. Id. Hartford had also sought an independent review of her file from D r. Aayar, who was board certified in occupational medicine. Id. Dr. Aayar had attempted several times to contact Meyer's treating physicians for clarification on the restrictions placed on her work hours. Id. at 85. Dr. Aayar had been unsuccessful in contacting Dr. Santoro and his conversation with Dr. Kramer did not change his assessment that Meyer could work full-time. Id. Meyer was again informed of her appeal rights.

         Meyer also called and spoke to Penny Mccormick on August 11, 2015. D. 23-1, at 1. Mccormick explained the lack of medical evidence to support her claim based on a physical disability and to support the restrictions on her work hours. Id. Mccormick explained how Dr. Aayar spoke to Dr. Kramer, but he was unsuccessful in attempts to contact Dr. Santoro. Id. Mccormick advised Meyer of her rights to appeal Hartford's denial of her claim. Id. Meyer did not appeal the August 2015 claim denial and filed the instant action almost one year later. D. 34, at 15.

         Legal Standard

         Summary judgment is proper where the materials in the record demonstrate that there is “no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56. The role of the judge in resolving a motion for summary judgment is not to weigh the evidence for its truth, but to determine whether sufficient evidence exists for a jury to return a verdict in favor of the non-movant. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). The Court will construe the record “in the light most favorable to the non-movant” in deciding whether the case involves genuine issues of fact requiring a trial. Payne v. Pauley, 337 F.2d 767, 770 (7th Cir. 2003). By filing cross-motions for summary judgment, each movant must show he has met the traditional standards necessary to obtain judgment as a matter of law. United Transp. Union v. Illinois ...