ROBERT D. MARIANI, District Judge.
Presently before the Court are cross-motions for summary judgment filed by Plaintiff Jason Jabara (Doc. 35) and by Defendant Aetna Life Insurance Company ("Aetna") (Doc. 33). Plaintiff filed this action under Section 1132(a) of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001 et seq., seeking reinstatement of long-term disability benefits. (Compl., Doc.1, at ¶4). By Memorandum (Doc. 31) and Order (Doc. 32) dated December 1, 2014, this Court has previously determined that the arbitrary and capricious standard of review applies to Plaintiffs claims that Defendant improperly terminated his long-term disability benefits and improperly denied reinstatement of those benefits.
At the outset, the Court will dispense with Plaintiffs Cross Motion for Summary Judgment (Doc. 35). Because Plaintiff failed to follow the Middle District of Pennsylvania Local Rules that govern the filing of this Motion and its supporting documents, Plaintiffs Motion is hereby deemed withdrawn. Under Local Rule 7.5, Plaintiff had fourteen days after the filing of his motion in which to file a brief in support of said Motion. The Rule states that, "[i]f a supporting brief is not led within the time provided in this rule the motion shall be deemed to be withdrawn." Plaintiff filed his Motion on February 3, 2015. On March 6, 2015, more than 30 days after the Motion was filed, Plaintiff a filed a document styled "Brief in Opposition to Defendant's Motion for Summary Judgment and in Support of Plaintiffs Motion for Summary Judgment" (Doc. 38). To the extent that this document constitutes an opposition brief to Defendant's Motion for Summary Judgment, it was timely under Local Rule 7.6. Combining a Brief in Support with a Brief in Opposition, however, does not allow Plaintiff to escape the bounds of Local Rule 7.5, to wit: the requirement that a supporting brief must be filed within fourteen days of the filing of the relevant Motion. Thus, the Court will deem Plaintiffs Cross Motion for Summary Judgment withdrawn.
Before relating the undisputed, material facts of this case, the Court is compelled by the state of the filings it received on this point to remark on what it expects of the parties — and indeed, what the Federal and Local Rules require of them — at the summary judgment stage of proceedings. Local Rule 56.1, "Motions for Summary Judgment," reads as follows:
"The purpose of this rule is to `structure a party's summary judgment legal and factual theory into a format that permits and facilitates the court's direct and accurate consideration of the motion.'" Hartshorn v. Throop Borough, No. 3:07-CV-01333, 2009 WL 761270, at *3 (M.D. Pa. Mar. 19, 2009) (quoting Gantt v. Absolute Machine Tools, Inc., No. 1:06-CV-1354, 2007 WL 2908254, at *3 (M.D. Pa, Oct. 4, 2007). Here, neither party has presented the Court with Local Rule 56.1 papers that facilitate the Court's consideration of Defendant's Motion for Summary Judgment. With respect to the moving party, the Defendant, the Court wishes to make clear that in a statement of facts for a motion for summary judgment where the arbitrary and capricious standard is to be applied, it does not expect to see again paraphrases, summaries, characterizations, or interpretations where the reports are available and may be quoted verbatim. And with respect to the nonmoving party, the Court notes that the Plaintiff went to great lengths to avoid admitting or denying the specific assertions of fact made by Defendant and engaged in many of the same approaches of Defendant, to wit, providing characterizations and interpretations of medical reports rather than providing the text itself. Plaintiff avoided admitting and denying factual assertions apparently in an effort to avoid admitting material facts harmful to his position, something that is absolutely impermissible in responding to a Local Rule 56.1 Statement of Material Facts and which represents a singular abuse of the summary judgment process.
The following represents the undisputed material facts that the Court sifted from the parties' papers:
Plaintiff was hired by Defense Support Services, LLC as an electrician on January 1, 2010. (SMF, Doc. 34 ¶1; Response to SMF, Doc. 37 ¶1). His position "often required extremely heavy lifting," though it was at some point post-hire classified as a medium physical demand occupation. Id. Plaintiff was an eligible participant in Defense Support Services, LLC's employee welfare benefit plan ("Plan"), which offered long-term disability ("LTD") benefits. Id. at ¶2. The Plan was subject to ERISA. Id. Defendant was the underwriter of the Plan and administered LTD claims under it. Id. at ¶¶3-4. Defendant is a fiduciary pursuant to Section 503 of ERISA. Id. at ¶5, The Plan documents provide that Defendant has "complete authority to review all denied claims for benefits under this policy" and has "discretionary authority to determine whether and to what extent employees and beneficiaries are entitled to benefits and to construe any disputed or doubtful terms of this Policy, the Certificate, or any other document incorporated herein."
Plaintiffs last day of work with Defense Support Services, LLC was August 5, 2010 due to back problems described as a "diagnosis of displacement of lumbar intervertebral disc without myelopathy and a herniated disc." Id. at ¶9. Defendant initially approved Plaintiffs LTD benefits claim on March 29, 2011.
On November 29, 2012, Defendant sent a letter to Dr. Roberts requesting release of Plaintiff to sedentary activity with the ability to change from sitting to standing and walking as needed. (Doc. 34 at ¶14; Doc. 37 at ¶14). Dr. Roberts signed the letter on January 8, 2013 and returned it to Defendant.
On February 11, 2013, after receipt of the termination letter, Plaintiff submitted to Defendant a report from Dr. Janerich.
After Defendant received Dr. Janerich's letter, an Aetna nurse reviewed it. (Doc. 34 at ¶25). Defendant then issued a letter to Plaintiff stating that, notwithstanding Dr. Janerich's letter, the termination decision had not changed.
Defendant referred Plaintiffs appeal file out to board certified physicians for independent medical reviews and peer-to-peer consultations.
By May 24, 2013, Defendant concluded its appellate review of its decision to terminate benefits; the decision was upheld. Id. at ¶41. Defendant addressed a termination letter to Plaintiffs counsel. Id. at ¶42.
Through summary adjudication, the Court may dispose of those claims that do not present a "genuine dispute as to any material fact." Fed. R. Civ. P. 56(a). "As to materiality,. . . [o]nly disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).
The party moving for summary judgment bears the burden of showing the absence of a genuine issue as to any material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). Once such a showing has been made, the non-moving party must offer specific facts contradicting those averred by the movant to establish a genuine issue of material fact. Lujan v. Natl Wildlife Fed'n, 497 U.S. 871, 888 (1990). Therefore, the non-moving party may not oppose summary judgment simply on the basis of the pleadings, or on conclusory statements that a factual issue exists. Anderson, 477 U.S. at 248. "A party asserting that a fact cannot be or is genuinely disputed must support the assertion by citing to particular parts of materials in the record . . . or showing that the materials cited do not establish the absence or presence of a genuine dispute, or that an adverse party cannot produce admissible evidence to support the fact." Fed. R. Civ. P. 56(c)(1)(A)-(B). In evaluating whether summary judgment should be granted, "[t]he court need consider only the cited materials, but it may consider other materials in the record." Fed. R. Civ. P. 56(c)(3). "Inferences should be drawn in the light most favorable to the non-moving party, and where the non-moving party's evidence contradicts the movant's, then the non-movant's must be taken as true." Big Apple BMW, Inc. v. BMW of N. Am., inc., 974 F.2d 1358, 1363 (3d Cir. 1992), cert, denied 507 U.S. 912 (1993).
By Memorandum (Doc. 31) and Order (Doc. 32) dated December 1, 2014, this Court has previously determined that the arbitrary and capricious standard of review — rather than a de novo standard — applies to Plaintiffs claims that Defendant improperly terminated his long-term disability benefits and improperly denied reinstatement of those benefits. A decision is arbitrary and capricious if "it is without reason, unsupported by substantial evidence or erroneous as a matter of law." Fleisher v. Standard Ins. Co., 679 F.3d 116, 121 (3d Cir. 2012). Under the arbitrary and capricious standard, "[c]ourts defer to an administrator's findings of facts when they are supported by `substantial evidence,' which [is] `defined as such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Fleisher, 679 F.3d at 121 (citation omitted). "The scope of this review is narrow, and `the court is not free to substitute its own judgment for that of the defendants in determining eligibility for plan benefits.'" Doroshaw v. Hartford Life & Accident Co., 574 F.3d 230, 234 (3d Cir. 2009) (quoting Abnathya v. Hoffman-La Roche [Hoffmann], Inc., 2 F.3d 40, 45 (3d Cir. 1993), abrogated on other grounds by Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 112 (2008)). Defendant's decisions, then, will be upheld unless they are "clearly not supported by the evidence in the record." Michaels v. Equitable Life Assur. Soc'y, 305 Fed. App'x. 896, 901 (3d Cir. 2009) (citing Smathers v. Multi-Tool, Inc., 298 F.3d 191, 199-200 (3d Cir. 2002)). That is, so long as there were reasonable bases for Defendant's decisions, a reviewing court will not disturb those decisions. Id.
Plaintiff challenges Defendant's decisions to terminate his LTD benefits and to uphold that termination on administrative appeal, arguing that Defendant "abuse[d] its discretion in denying and then in failing to reinstate Plaintiffs LTD benefits." (Brief in Opposition, Doc. 38 at 6). Review of the administrative record
In evaluating Plaintiffs claim that Defendant's actions at termination and on administrative appeal were arbitrary and capricious, the Court is mindful that the Plan itself put the burden of proving disability on the Plaintiff at both of those points. (See Benefit Plan, Doc. 34, Ex. 1, at 10) (listing "the date you fail to provide proof that you meet the LTD test of disability" as one of several points at which a Plan participant will "no longer be considered as disabled nor eligible for long term monthly benefits."). Thus, at the "test change" period, when Plaintiffs disability status was measured against not his "own occupation" as an electrician, but rather against "any reasonable occupation," Plaintiff was required to demonstrate to Defendant that Plaintiffs condition under the new test continued to warrant the payment of benefits. This fact is unremarkable in the context of the insurance industry. See, e.g., Mitchell v. Eastman Kodak Co., 113 F.3d 433, 439 (3d Cir. 1997) ("LTD benefits under the [Kodak] Plan are not automatic, and a claimant bears the burden of demonstrating that he qualifies for benefits."), abrogated on other grounds as stated in Miller v. Am. Airlines, Inc., 632 F.3d 837, 847 (3d Cir. 2011).
The Court's careful review of the administrative record indicates that Plaintiff provided very little information to Defendant about the time period relevant to its decisions. Much of the information with which Plaintiff came forward was outdated information drawn from or submitted in conjunction with the initial twenty-four month period of LTD benefits, which was measured by the "own occupation" test for disability. For instance, Dr. Janerich's letter to Plaintiffs Counsel dated February 1, 2013, recounted five visits by Plaintiff to Dr. Janerich's office, all occurring on or before June 25, 2009 — that is, over a year before Plaintiffs last day of work. (Doc. 34, Ex. 6 at 12-14). In the section of the letter discussing Plaintiffs January 23, 2013 visit, the objective medical tests referenced by Dr. Janerich, namely electromyograms (EMG), nerve conduction studies (NCV), and MRIs, were performed in 2009 and in 2010. Id. at 14-15. Dr. Janerich did not review Plaintiffs more recent December 5, 2012 MRI, and though Dr. Janerich recommended a new "EMG/NCV of the upper and lower extremities" be done, id. at 15-16, there is no indication of the results in the administrative record, if indeed such a study was ever conducted.
Similarly, Plaintiffs arguments before this Court rely heavily on outdated medical records related the "own occupation" period of LTD benefits. For instance, Plaintiff claims that one of Defendant's independent medical reviewers, Dr. Cohan, "erroneously set[] aside Dr. Janerich's restriction because of [Plaintiffs medication therapy contending there is no evidence of impairment from the medications written in the records." (Doc. 38 at 20). Plaintiff goes on to state that u[t]his is simply untrue, as discussed above, Dr. Butcofski[]. . . specifically noted the medication therapy made [Plaintiff] sleepy." Id. Plaintiff provides no record citation to Dr. Butcofski's note, but the Court has discerned that on Dr. Butcofski's Attending Physician Statement dated March 28, 2011, the word "sleepy" is written on the line next to "[impairment from medication effects." (Doc. 34, Ex. 5 at 90-91). But Dr. Cohan was asked by Defendant if there were "any physical or cognitive examination findings of any functional impairment suggesting that the claimant's ability to work has been directly impacted by an adverse medication effect during the time period from 02/02/2013 through 05/31/2013." (Doc. 34, Ex. 5 at 51). Plaintiffs suggestion that a single report of a subjective complaint documented nearly two years before the "test change" is enough to render Dr. Cohan's response that "[t]here is no evidence in the medical record to indicate that the claimant's work functionality has been adversely affected by medications," id., "erroneous" given the question asked of him smacks of a lack of understanding of the standards involved in this case.
The Court's review of the administrative record convinces it that Plaintiff failed to meet his burden of demonstrating disability under the "any reasonable occupation" standard, and thus, that Defendant did not act in an arbitrary and capricious nature in its handling of Plaintiffs claim. Indeed, the record also reveals that Defendant made the effort to extract from Plaintiff and his doctors, specifically Dr. Roberts and Dr. Janerich, information that might potentially have supported his claim under the "any reasonable occupation" standard and his appeal of the termination of LTD benefits. The information requested was simply never provided. For instance, Dr. Rubin, one of Defendant's independent medical consultants, attempted to reach Dr. Janerich by telephone several times in the course of conducting his review of the claim file. (Doc. 34, Ex. 5 at 58). According to the record, Dr. Janerich never responded to Dr. Rubin's calls. Furthermore, on May 20, 2013, a Senior Appeal Specialist employed by Defendant sent a letter to Dr. Janerich asking him to review Dr. Rubin's report and requesting that, if he disagreed with the report's conclusion, he "respond by indicating which areas of the attached report [he] agree[s] with, which areas [he] disagree[s] with, and any clinical evidence or observations in support of that opinion that have not already been provided . . . ." (Doc. 34, Ex, 5 at 55). It is undisupted that Dr. Janerich never responded. See supra, at 9-10. And in the narrative letter that Dr. Janerich did provide Defendant on appeal, he makes reference to diagnostic studies that do not appear in the record that was before Defendant at the time. Indeed, Defendant made efforts to obtain these medical records at the beginning of Plaintiffs award of LTD benefits, well before the test change. (See Doc. 34, Ex. 2 at 28-29 (March 2011 claim note expressing desire to obtain copy of an MRI referenced by Dr. Janerich)); (Doc. 34, Ex. 2 at 44 (claim note documenting ParaMeds' repeated attempts in April 2011 to obtain records from Dr. Janerich)).
With respect to Dr. Roberts, Defendant sent him a letter dated November 29, 2012 (Doc. 34, Ex. 4, at 100) asking Dr. Roberts to sign and return the letter if he agreed with the assessment that Plaintiff had "full time sedentary functional capacity," as defined in the letter. Id. The letter directed Dr. Roberts to provide his "clinical rationale with test results and any other evidence that would help [Defendant] understand what would prevent [Plaintiff's level of full time functional capacity" if he did not agree with the assessment. Id. The letter additionally asked Dr. Roberts if there were "any other tests that [he felt] would be helpful in assessing [Plaintiff's current functional status" and provided a fax number to which Dr. Roberts could send his response. Id. Instead of providing information that may have altered Defendant's assessment that Plaintiff had sedentary work capacity, Dr. Roberts responded with a signed copy of the letter by fax on January 8, 2013. (Doc. 34, Ex. 6 at 4).
These above vignettes are representative of the administrative record's overall inability to prove the claims Plaintiff has placed before this Court. The upshot of this case is that there is substantial evidence in the record to support Defendant's actions. Plaintiffs scattershot approach to this lawsuit, which has included avoidance of his obligations under Local Rule 56.1, see supra, at 2-4, mischaracterizing a rather straightforward document,
Based on the foregoing, Plaintiffs Cross Motion for Summary Judgment (Doc. 35) will be deemed withdrawn and is otherwise denied and Aetna's Motion for Summary Judgment (Doc. 33) will be granted.
A separate Order follows.
