DAVID C. KEESLER, Magistrate Judge.
Plaintiff Nathaniel Cannon ("Plaintiff" or "Cannon") was employed by Charter Communications ("Charter") as an Order Management Representative on or about January 6, 2012. (Document No. 17-1, pp. 1, 3) (citing Administrative Record, governing Charter Communications Short Term Disability Plan (the "Plan") documents, and records related to Plaintiff's pre-existing Americans with Disabilities Act ("ADA") claims — Document Nos. 20, 20-1, 20-2, 20-3 and 20-4 (Bates numbered Charter 000001 through Charter 002075) — (all together, the "Record" or "R.") 803, 904);
(Document No. 17-1, p. 3);
Charter is a cable provider that offers video, telephone, and high-speed internet services. (Document No. 19-1, p.6). Charter Communications Short Term Disability Plan (the "Plan" or "Defendant") is a self-funded benefit plan organized and existing pursuant to 29 U.S.C. § 1132. (Document No. 1, p. 1; Document No. 19-1, p. 6). The Plan provides short-term disability ("STD") benefits to eligible participants employed by Charter.
(Document No. 19-1, pp.6-7).
Plaintiff's first absence from work in connection with the underlying disability claim was August 31, 2017. (Document No. 19-1, p. 7) (citing R. 904). On that date, Plaintiff was seen by Gbenga Aluko, M.D. ("Dr. Aluko"), an internal and family medicine physician.
Plaintiff returned to Dr. Aluko on September 7, 2017. (Document No. 17-1, pp. 3-4; Document No. 19-1, pp. 7-8). Dr. Aluko then completed a "Concurrent Disability And Leave Statement Of Incapacity/Attending Physician Statement" (R. 736-38).
Also on September 7, 2017, Plaintiff contacted Sedgwick Claims Management Services, Inc. (the Plan's "Claims Administrator" or "Sedgwick") an independent third-party claims administrator to provide notice of his absence due to a claimed disability related to his blood pressure, a pacemaker, and vertigo. (Document No. 19-1, pp. 5, 7) (citing R. 904, 953). The Claims Administrator apparently informed Plaintiff on September 11, 2017, that there were no exam findings as to why he could not perform his job duties, that driving was not part of his job duties, there was conflicting information as to the off work dates of September 7 and March 30, 2017, and that exam findings and a treatment plan were needed to support why he could not perform his job functions. (Document No. 19-1, p. 8) (citing R. 945-46).
Dr. Aluko revised his ". . .Statement" on September 14, 2017, changing the period of disability from August 31, 2017 to February 28, 2018, and checking a box indicating that Plaintiff was not able to perform his job functions. (Document No. 19-1, p. 8) (citing R. 826). Dr. Aluko also provided a letter on Plaintiff's behalf stating:
(R. 829);
On September 18, 2017, the Claims Administrator informed Plaintiff that his claim was being reviewed by a clinical specialist pursuant to the Plan, and that he was required to submit additional medical information supporting his disability claim by September 27, 2017. (Document No. 19-1, p. 9; R. 820). On or about September 19, 2017, the Claims Administrator's clinical specialist issued the following request for objective medical evidence or documentation:
(R. 811, 817);
On September 21, 2017, the Claims Administrator sent a letter to Plaintiff noting that it had made unsuccessful attempts to reach him and that if sufficient information was not provided in a timely manner his disability request may be denied, and requesting that he "[p]lease contact us immediately." (Document No. 19-1, p. 9; R. 812). Plaintiff was also informed by the Claims Administrator in a telephone call that the currently provided records did not support disability. (Document No. 19-1, pp. 9-10; R. 933).
On or about September 25, 2017, Dr. Aluko responded to the Claim Specialist's questions listed above. (R. 809, 817; Document No. 17-1, p. 4; Document No. 19-1, p. 10). Dr. Aluko referenced the records he had already provided and stated that he recommended that Plaintiff work from home.
The Claims Administrator denied Plaintiff's STD benefits on October 3, 2017. (R. 1047-1048; Document No. 17-1, p. 4; Document No. 19-1, p. 10). It was determined based on review of the documents provided by Dr. Aluko that Plaintiff did not qualify for STD benefits under the Plan.
Plaintiff appealed the initial denial of benefits on October 5, 2017. (R. 958-963, 2019-2023; Document No. 17-1, pp. 4-5; Document No. 19-1, p. 10). Plaintiff's appeal includes a letter stating that he disagreed with the denial of benefits and that he had sought STD benefits because he was no longer being permitted to work from home.
On October 10, 2017, the Claims Administrator acknowledged Plaintiff's request for additional time to submit medical records and agreed to suspend its review for 14 days. (R. 1024; (Document No. 17-1, p. 5; Document No. 19-1, p. 11). The Claims Administrator noted that the remaining 41 days of the 45-day determination period would commence on October 24, 2017.
Plaintiff concedes that on or about October 12, 2017, "
Neil Gupta, M.D. ("Dr. Gupta"), board certified in internal medicine, reviewed Plaintiff's medical file on or about October 19, 2017. (R. 1056-1060; Document No. 17-1, p. 5; Document No. 19-1, p. 11). Dr. Gupta determined that clinical evidence did not support a functional impairment during the August 31, 2017 to present time frame.
Mark Reploeg, M.D. ("Dr. Reploeg"), board certified in neurology and sleep medicine, also reviewed Plaintiff's file on or about October 19, 2017. (R. 1062-1065; Document No. 17-1, pp. 6-7; Document No. 19-1, pp. 11-12). Dr. Reploeg opined that "from a Neurology and Sleep Medicine perspective the claimant is not impaired during the time period under review."
On October 20, 2017, the Claims Administrator completed its review and denied Plaintiff's appeal. (R. 1076-1078; Document No. 17-1, p. 7; Document No. 19-1, p. 12). The final denial letter noted that Plaintiff's medical records had been reviewed by two different independent and board certified doctor/specialists.
The Claims Administrator then advised Plaintiff that he had the right to bring a civil action under the Employee Retirement Income Security Act of 1974 ("ERISA"). (R. 1078).
Plaintiff initiated this action with the filing of his "Complaint" against Defendant Charter Communications Short Term Disability Plan pursuant to 29 U.S.C. § 1132(a)(1)(B), on January 26, 2018. (Document No. 1). Plaintiff seeks a declaration that he is entitled to STD benefits, as well as attorney's fees and costs. (Document No. 1, p. 3). "Defendant's Answer And Affirmative Defenses" (Document No. 4) was filed on February 27, 2018.
On March 19, 2018, the parties filed a "Joint Rule 26(f) And LCvR 16.1(b) Report" (Document No. 10) and a "Joint Stipulation of Consent To Exercise Jurisdiction by a United States Magistrate Judge" (Document No. 11). The parties further agreed that:
(Document No. 10, p. 1).
The undersigned issued a "Pretrial Order And Case Management Plan" (Document No. 12 on April 5, 2018. The ". . .Case Management" includes the following deadlines: discovery completion — May 11, 2018; ADR report — June 11, 2018; motions deadline — July 11, 2018; and trial — January 7, 2019. (Document No. 12, p. 1). Mediator M. Ann Anderson filed a report on June 11, 2018, stating that the parties attempt to resolve this dispute had reached an impasse. (Document No. 13).
Following amendment to the case deadlines, the parties' pending dispositive motions were filed on August 8, 2018. (Document Nos. 17 and 19). The parties also filed a "Joint Stipulation" (Document No. 19-2) agreeing that "the Court may dispose of this claim based on this document, the attachments hereto, the parties' cross-memoranda in support of judgment, and any oral argument thereon." (Document No. 19-2) (citing Document Nos. 20, 20-1, 20-2, 20-3 and 20-4 (Bates numbered Charter 000001 through Charter 002075)).
The parties' responses were then filed on August 22, 2018. (Document Nos. 23 and 24). Defendant filed a timely reply brief on August 29, 2018; however, Plaintiff failed to file a reply brief, or notice of intent not to reply, as required by Local Rule 7.1(e).
This matter is now ripe for review and disposition.
The standard of review here is familiar. Summary judgment shall be granted "if the movant shows 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(a). The movant has the "initial responsibility of informing the district court of the basis for its motion, and identifying those portions of the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, which it believes demonstrate the absence of a genuine issue of material fact."
Once the movant's initial burden is met, the burden shifts to the nonmoving party.
When considering cross-motions for summary judgment, a court evaluates each motion separately on its own merits using the standard set forth above.
As an initial matter, the undersigned notes that the parties agree that pursuant to the Plan, the Claims Administrator here had discretionary authority to make eligibility determinations, and that
(Document No. 17-1, p. 9) (quoting
Plaintiff first argues that Defendant abused its discretion by "ignoring Plaintiff's request for documents upon which the denial was based." (Document No. 17-1, p. 9). Plaintiff contends that in his October 5, 2017 letter he had "requested that Defendant send him each and every document upon which the denial of his claim was based." (Document No. 17-1, p. 11). Plaintiff concludes that Defendant's failure to process his request for documents until October 26, 2017, was an abuse of discretion that denied him a reasonable opportunity to respond. (Document No. 17-1, p. 12) (citing 29 C.F.R. § 25630.503-1(h)(2)(iii) ("a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits")).
In response, Defendant notes that Plaintiff did not include this alleged violation of 29 C.F.R. § 25630.503-1(h)(2)(iii) in his Complaint. (Document No. 23, p. 10) (citing Document No. 1) and (
Defendant further notes that Plaintiff did not ask to toll the appeal while waiting for receipt of the records; to the contrary, Plaintiff expressly advised the Claims Administrator that all relevant records were in its possession and that it could begin its review. (Document No. 23, p. 10) (citing R. 906-907);
Defendant goes on to assert that the "minimal delay" in producing the requested records was harmless because: (1) most of the documents were treatment records from Plaintiff's own physician; and (2) Plaintiff had been informed — in detail — as to the content of the requested documents.
Defendant concludes that a delay in furnishing the records here does not warrant overturning or remanding the Claims Administrator's sound decision, especially since Plaintiff has failed to identify any defect with the records or with the decision to deny benefits. (Document No. 23, p. 11).
Plaintiff failed to file a reply brief that might have rebutted Defendant's arguments or attempted to distinguish
Next, Plaintiff argues that Defendant abused its discretion by engaging in an unreasonably hasty appeal process and ignoring and/or failing to obtain medical information related to Plaintiff's appeal. (Document No. 17-1, pp. 12-20). Plaintiff contends that Defendant's review was "clearly deficient, and was not the result of a `deliberate, principled reasoning process.'" (Document No. 17-1, p. 13).
Specifically, Plaintiff suggests that Defendant made no effort to review records related to treatment he received on October 10, 12, and 18, 2017. (Document No. 17-1, pp. 13-14). In addition, Plaintiff contends that Defendant could not adequately review its physician's reports received on October 19, and then issue a denial on October 20, 2017. (Document No. 17-1, p. 16). Plaintiff further contends that Dr. Reploeg's opinion was flawed because he did not allow a reasonable time to speak to Plaintiff's treating physician before rendering an opinion. (Document No. 17-1, pp. 18-20).
In response, Defendant asserts that Plaintiff does not claim an inability to perform any of his essential job duties and concedes that driving (his only arguable limitation) is not one of his essential duties. (Document No. 23, p. 11). Defendant contends that this fact alone is enough to end the Court's inquiry.
Addressing Plaintiff's arguments, Defendant first notes that Plaintiff had told Defendant that Dr. Aluko was his only medical provider and that on October 13, 2017, Plaintiff had reported that all documentation had been submitted and that the review process should go forward. (Document No. 23, p. 12) (citing R. 906-909). Moreover, Plaintiff has acknowledged that it was his burden to provide relevant information and substantiate disability. (Document No. 23, p. 13). Defendant argues that Plaintiff has not identified any contrary information that was actually ignored.
Defendant next asserts that Plaintiff had repeatedly represented that his file was complete and that its reviewing physicians considered all of Plaintiff's medical records before issuing their decisions. (Document No. 23, p. 14). Defendant notes that Plaintiff has not alluded to any evidence that would have changed the benefits determination — and that Dr. Aluko and Plaintiff concede that he can fulfill all his essential job duties.
Finally, Defendant observes that Dr. Gupta did have a peer-to-peer conversation with Dr. Aluko, and that Dr. Reploeg's attempts to do the same went unanswered. (Document No. 23, p. 15). Defendant contends that Dr. Reploeg's attempts were sufficient, and went beyond what is required under relevant Fourth Circuit caselaw. (Document No. 23, pp. 15-16) (citations omitted).
The undersigned again finds Defendant's argument in response most persuasive.
In support of its motion for summary judgment, Defendant focuses on arguments that the Claims Administrator's decision was the product of a deliberate, principled reasoning process that was based on substantial evidence. (Document No. 19-1, pp. 15-19). Defendant notes that the Claims Administrator had a clinical specialist review the claim prior to initially denying the request for benefits, and that its decision was upheld on appeal after referring the claim to two independent physicians who found no evidence that Plaintiff was unable to perform his job duties. (Document No. 19-1, p. 16) (citing
Defendant further notes that both Dr. Gupta and Dr. Reploeg opined that Plaintiff was not functionally impaired. (Document No. 19-1, p. 17). Defendant asserts that, as in Havens, the Claim Administrator here properly determined that: (1) Plaintiff's symptoms were within normal limits; (2) no objective clinical findings demonstrating functional limitations were observed; and (3) there was a lack of definitive objective evidence that would preclude Plaintiff from performing his occupation.
Finally, Defendant argues that the only limitation identified by Plaintiff's own physician, Dr. Aluko, was an inability to drive. (Document No. 19-1, p. 18) (citing R. 962). However, that limitation is irrelevant here because driving was not one of Plaintiff's essential job duties.
In response, Plaintiff argues that Defendant did not allow sufficient time for him to submit additional information to support his claim. (Document No. 24, pp. 1-2). Plaintiff further argues that Defendant's memorandum wholly ignores that Plaintiff's limitations had been accommodated for years by allowing him to work from home. (Document No. 24, pp. 2-3). Plaintiff then suggests that Defendant's failure to consider Plaintiff's restriction to work from home shows that Defendant's review process was flawed.
Defendant filed a timely ". . .Reply In Support Of Summary Judgment" (Document No. 25). In that reply, Defendant again contends that Plaintiff was provided ample time to submit all relevant records, and that Plaintiff had informed the Claims Administrator that all documentation had been submitted. (Document No. 25, p. 1);
Regarding accommodations, Defendant argues that Plaintiff is missing the point.
Contrary to Plaintiff's suggestions, it appears that Defendant's decision to deny STD benefits was "`the result of a deliberate, principled reasoning process' and `supported by substantial evidence.'"
