Anderson v. Liberty Mutual Long Term Disability Plan
Docket: Case No. C15-00145RSM
Court: District Court, W.D. Washington; July 27, 2015; Federal District Court
The Court granted Plaintiff Joni Anderson's motion for judgment and denied the Defendants' cross motion for judgment under Federal Rule of Civil Procedure (FRCP) 52 in an ERISA dispute regarding long-term disability (LTD) benefits. Anderson claims total disability due to vertigo and related symptoms while employed as a Books Transfer Account Manager for Liberty Mutual. The Defendants contest her claim, arguing that the medical evidence does not support total disability.
The Court determined that Anderson is entitled to LTD benefits under the Liberty Mutual Long-Term Disability Plan and remanded the matter to LLA-COB for consideration of extending benefits beyond the initial 18-month 'own occupation' period.
Regarding procedural issues, the Court accepted the parties' stipulation for de novo review of the case rather than summary judgment under Rule 56. This decision was based on the Ninth Circuit's allowance for a trial on the administrative record to assess whether Anderson meets the policy's definition of disability, rather than merely determining the existence of material facts. The Court emphasized that under de novo review, it must make factual findings and evaluate the evidence as if conducting a trial.
In trials on the administrative record, judges can assess the credibility of conflicting testimonies and determine which is more credible, particularly in ERISA benefits cases. The de novo standard, which allows the court to make factual findings and evaluate evidence, indicates that a bench trial is the appropriate procedure rather than summary judgment. Summary judgment may be suitable when there is no dispute over the interpretation of the plan, regardless of the review standard applied. In the case at hand, the court has decided to resolve the dispute through a bench trial based on the administrative record.
Key findings include:
1. Plaintiff Joni Anderson has been employed by Safeco since 2000 and has worked as a Books Transfer Account Manager since June 2012, requiring significant computer use.
2. Anderson is eligible for Short Term Disability (STD) and Long Term Disability (LTD) benefits from the Liberty Life Assurance Company of Boston, given her full-time status.
3. The STD Plan defines disability as an inability to perform all material duties of her job due to injury or sickness for a maximum of 182 days.
4. The LTD Plan extends benefits beyond 182 days, defining 'Disabled' as an inability to perform the Material and Substantial Duties of her occupation due to injury or sickness.
5. LTD benefits are capped at 18 months unless the employee can demonstrate an inability to perform any occupation suited for them based on various factors.
6. Anderson experienced symptoms of Meniere’s disease starting in February 2012, which worsened by November 2012, leading her to stop working on December 11, 2012, due to severe fatigue and other debilitating symptoms. She reported her inability to fulfill work responsibilities even when attempting to work from home.
On December 18, 2012, Ms. Anderson applied for short-term disability (STD) benefits, which were granted on January 17, 2013, with LLA-COB acknowledging her disability as starting December 11, 2012. Throughout early 2013, she consulted with Dr. Jay Rubenstein, who identified symptoms suggestive of migraine and prescribed Topamax, which aggravated her condition. In February 2013, Ms. Anderson was advised to attempt working from home, leading to the cessation of her STD benefits.
Subsequent evaluations by neurologist Dr. Michael Chun on February 28 and March 8, 2013, revealed abnormal examination results and a suspected vestibular disorder, despite MRI scans showing no clear cause. In May 2013, neuro-ophthalmologist Dr. Eugene May observed downbeating nystagmus and recommended watchful waiting. By May 13, 2013, Ms. Anderson reported ongoing fatigue and severe vertigo. Dr. Chun later diagnosed her with a presumed chronic vestibular disorder on June 14, 2013.
Ms. Anderson reapplied for STD benefits on July 30, 2013, providing a 'Restrictions Form' from Dr. McClincy indicating her limited work capabilities due to episodic vertigo. LLA-COB denied this application on September 10, 2013, and upheld the denial after Ms. Anderson's appeal on October 14, 2013. She subsequently appealed to the U.S. District Court for the Western District of Washington, resulting in a settlement.
On October 25, 2013, Safeco Insurance requested information from Dr. McClincy, who confirmed that Ms. Anderson’s impairment affected her ability to perform essential job functions, particularly during symptomatic episodes. On December 11, 2013, Ms. Anderson applied for long-term disability (LTD) benefits. In a questionnaire submitted to LLA-COB on January 2, 2014, she detailed her limited physical capabilities, indicating variability in her ability to perform daily activities based on her symptoms.
LLA-COB engaged Dr. Ahmed Robbie to evaluate Ms. Anderson’s medical records, resulting in a report dated February 28, 2014. Dr. Robbie identified Ms. Anderson's conditions as vertigo, dizziness, imbalance, dysequilibrium, and amblyopia, noting a peer discussion with Dr. McClincy who affirmed the legitimacy of her symptoms. However, Dr. Robbie concluded that her symptoms were subjective, lacking objective neurological impairment that would hinder her job performance. Consequently, LLA-COB denied Ms. Anderson’s long-term disability (LTD) benefits on March 18, 2014, citing the absence of objective findings.
On September 2, 2014, Ms. Anderson appealed the denial, submitting over 100 pages of medical documentation, including her declaration about computer use exacerbating her dizziness, and a diagnosis from Dr. Alan Langman, who noted her disequilibrium and its correlation with visual overstimulation. Dr. Langman concluded that her condition prevented her from fulfilling job requirements involving frequent computer use. During the pending appeal, LLA-COB conducted an eight-day surveillance of Ms. Anderson, capturing 35 minutes of footage showing her engaging in activities consistent with her previous statements and those of Dr. Langman.
LLA-COB further consulted Dr. Suzanne Galli, who concurred with Dr. Langman's assessment of disequilibrium, noting that Ms. Anderson's symptoms were episodic and did not render her completely incapacitated. An independent medical examination was performed by Dr. John Rockwell on January 7, 2015, who reviewed extensive medical records and found Ms. Anderson to be in a wheelchair due to foot surgery but not experiencing vertigo or disequilibrium at the time of examination.
Dr. Rockwell's report indicated that the claimant's complaints of vertigo and dysequilibrium were entirely subjective, asserting that patients with such conditions often lead productive lives, including holding office jobs. He characterized Ms. Anderson as a healthy 34-year-old and expressed disagreement with any limitations on her ability to perform sedentary work or use a computer. The court noted that Dr. Rockwell's opinions were inconsistent with Ms. Anderson's previous medical records. On January 28, 2015, LLA-COB denied her appeal for long-term disability (LTD) benefits, citing reports from Dr. Rockwell, Dr. Galli, and surveillance evidence. This led to the current civil action.
Under ERISA, a plan participant can file a federal court action to recover benefits or clarify rights regarding future benefits. The court affirmed that the plaintiff is a qualified participant. Although ERISA does not specify the review standard for benefit eligibility determinations, both parties agreed to a de novo review. This means the court independently assesses whether the claimant has demonstrated disability under the plan's terms, without deferring to the claim administrator's decision. In this review process, the burden of proof lies with the claimant, who must establish entitlement to benefits.
Ms. Anderson is recognized as disabled under the Long Term Disability (LTD) Plan, as both parties agree she was covered. The Plan does not mandate complete incapacitation or permanent disability for qualification. Instead, Ms. Anderson must demonstrate her inability to perform essential job responsibilities due to illness or disease. Evidence indicates her job requires constant computer use, and medical assessments by Dr. McClincy and Dr. Langman confirm that her condition prevents her from fulfilling this critical function, supporting her claim of disability.
Defendants argue Ms. Anderson’s symptoms are subjective, yet fail to provide legal grounds for denying benefits based on a lack of objective symptoms. Conditions such as vertigo, fatigue, and nausea, while subjective, are valid considerations in assessing disability. The law acknowledges that subjective complaints are significant in determining a claimant's disability status, particularly when supported by medical professionals.
Defendants' reliance on surveillance evidence to challenge Ms. Anderson's claims is unsubstantiated; the surveillance failed to capture her performing essential job functions or to disprove her reported symptoms. The Court concludes that, based on the administrative record and the Plan's criteria, Ms. Anderson was disabled during the relevant time frame, and there is no indication that her condition will improve without changes in her medical status.
The Court lacks adequate evidence to determine if Ms. Anderson is unable to perform the essential duties of any occupation for which she is reasonably qualified, as LLA-COB did not address her disability under the Plan. Consequently, the Court remands the matter to LLA-COB for a decision on extending benefits to Ms. Anderson beyond the initial 18-month "own occupation" benefit period. In ERISA cases, a district court may award prejudgment interest to compensate plaintiffs for losses due to nonpayment of benefits, with the decision based on fairness and equitable considerations. Typically, the interest rate for post-judgment interest under 28 U.S.C. § 1961 is applied unless a substantial case-specific reason warrants a different rate. Ms. Anderson is entitled to long-term disability benefits for the entire 18-month period, prejudgment interest on those unpaid benefits at the post-judgment rate, and reimbursement for her attorney's fees and costs under 29 U.S.C. § 1132(g)(1).
1) Defendants’ Motion for Judgment under Federal Rule of Civil Procedure 52 is denied, while Plaintiffs’ Motion is granted in part, entitling Plaintiff to long-term disability benefits for 18 months, pre-judgment interest on unpaid benefits, and attorney’s fees and costs. 2) The issue of extending benefits beyond the 18-month period is remanded to LLA-COB. 3) Plaintiff must file a Motion for Attorney’s Fees within ten days, supported by documentary evidence and legal argument, with Defendants allowed to respond and Plaintiff to reply according to Local Rules. 4) The case is now closed. 5) Defendants recognize objective testing supports Ms. Anderson's claims of vestibular dysfunction but argue there is insufficient evidence linking these symptoms to her inability to perform her occupation. The Court finds that intermittent symptom absence does not negate their regular occurrence, and Ms. Anderson's credible assertions and her medical providers' observations are compelling. The Court notes a procedural violation by LLACOB in relying on surveillance evidence without giving Ms. Anderson a chance to respond, violating ERISA procedures. Defendants’ suggestions that Plaintiff is dishonest about her symptoms are addressed, with the Court stating that it can rule in favor of Plaintiff based solely on the administrative record without needing to consider additional statements from Dr. Langman or the Plaintiff.
