Prezioso v. Prudential Ins. Co. of Am., Inc., Civil No. 12–1055 ADM/JSM.

• Decision Date: 28 February 2013
• Docket Number: Civil No. 12–1055 ADM/JSM.
• Citation: 927 F.Supp.2d 693
• Parties: Michael PREZIOSO, Plaintiff, v. PRUDENTIAL INSURANCE COMPANY OF AMERICA, INC., Defendant.
• Court: U.S. District Court — District of Minnesota

927 F.Supp.2d 693

Michael PREZIOSO, Plaintiff,

v.PRUDENTIAL INSURANCE COMPANY OF AMERICA, INC., Defendant.

Civil No. 12–1055 ADM/JSM.

United States District Court, D. Minnesota.

Feb. 28, 2013.

Denise Yegge Tataryn, Esq., and KrisAnn Norby–Jahner, Esq., Hellmuth & Johnson PLLC, Edina, MN, on behalf of Plaintiff.

Emily S. Costin, Esq., Alston & Bird LLP, Washington, D.C.; and Corey J. Ayling, Esq., McGrann Shea Carnival Straughn & Lamb, Chtd., Minneapolis, MN, on behalf of Defendant.

MEMORANDUM OPINION AND ORDER

ANN D. MONTGOMERY, District Judge.

I. INTRODUCTION

On December 18, 2012, the undersigned United States District Judge heard oral argument on Plaintiff Michael Prezioso's and Defendant Prudential Insurance Company of America, Inc.'s (“Prudential”) cross-motions for summary judgment [Docket Nos. 26, 31]. Prezioso claims Prudential improperly denied him long-term disability benefits under the Employee Retirement and Income Security Act (ERISA) for an on-the-job injury. Prudentialargues that its decision to deny Prezioso benefits was not an abuse of its discretion, and thus should be upheld. For the reasons set forth below, Prudential's motion for summary judgment is granted, and Prezioso's motion for summary judgment is denied.

II. BACKGROUND

A. Prezioso's Employment and Injury

In October 2003, Michael Prezioso began working for Vertis, Inc. (“Vertis”), a Maryland corporation that sells advertising and other marketing materials. See Aff. Emily Costin [Docket No. 34] Ex. 1 (“Admin. Record”) at D000976. Prezioso worked out of Vertis' Minnesota office and received several promotions in his first few years. By May 2006, Prezioso was Vice President of Regional Sales. Id. In this capacity, Prezioso managed a staff tasked with selling advertising materials to corporate customers, including to Target Corporation, a major client. Id. at D000977.

In 2009, however, Target discontinued its relationship with Vertis, forcing Vertis to significantly downsize its Minnesota operations. Id. In October 2009, Vertis concluded Prezioso was not satisfying its sales expectations and placed him on a 90–day performance improvement plan. Id. at D000408–09. Vertis later determined that Prezioso had not met the expectations of this plan. Id. at D000413.

By April 2010, Vertis demoted Prezioso to Sales Representative, leaving him as Vertis' last sales employee in Minnesota. Id. at D000977. As an advertising sales agent, Prezioso negotiated sales from Vertis' office in Minnesota as well as by traveling to meet clients. See id. at D0001190. A significant amount of Prezioso's job included communicating with staff and negotiating with clients in person, by phone, or over email. See id. at D000566–67, 1190. Prezioso was also occasionally required to lift light objects, such as when he visited clients to display sample advertisements or art. See id. Prezioso was occasionally required to lift objects up to 20 pounds in weight. Id.

On April 2, 2010, Vertis placed Prezioso on a second performance improvement plan, citing a failure to meet sales goals. The plan warned Prezioso that if he did not meet expectations by May 2, 2010, Prezioso faced “further disciplinary action up to and including [ ] termination.” Id. at D000406. Prezioso argues that the performance improvement plans placed “unrealistic” expectations on him and measured revenue, a benchmark that was beyond his control. Pl.'s Mem. in Opp. Summ. J. [Docket No. 44]. Nevertheless, about a month later, Vertis determined that Prezioso had not made “material progress” toward its expectations. Admin. Record at D000413. Vertis thus issued a “Request for Termination,” concluding that Prezioso had again failed to meet sales goals and should be terminated. Id. at D000413–14.

On May 10, 2010—shortly after Vertis decided to terminate Prezioso but before it communicated the decision to him—Prezioso injured himself while lifting a 15–pound art portfolio onto a customer's counter. See id. at D000426, D000977. Prezioso informed a human resources employee at Vertis of his injury and his inability to work for the remainder of the day. Id. at D000978. He also informed Vertis that he had scheduled a doctor's appointment for the following day. Id.

This was not Prezioso's first back injury. In 1981, before his employment with Vertis, Prezioso had back surgery for a ruptured spinal disk but returned to work afterwards. Id. at D000977. In May 2009, Prezioso also suffered a back injury in the course of his employment for Vertis. Id. After that injury, Prezioso received two steroid injections and anti-inflammatory medication, and was able to return to work on a full-time basis. See id.

At his appointment on May 11, 2010, Dr. John Dowdle diagnosed Prezioso with mechanical lower back pain, degenerative disk disease of the lumbar spine, ¹ and “acute exacerbation of low back pain.” Id. at D000507. Dr. Dowdle advised Prezioso to return for an appointment in one week, writing, “I would anticipate that he should be dramatically better when he is seen in 1 week.” Id. The doctor also completed a report stating Prezioso was unable to work until May 18, 2010. Id. at D000506. Prezioso faxed this report to Vertis. Id. at D000318–20.

A few hours later, still on May 11, 2010, Vertis met with Prezioso and terminated his employment. Id. at D000978. After his termination, Prezioso continued to see doctors in connection with his back injury. On May 18, 2010, Dr. Dowdle performed an examination in which he observed Prezioso as “well groomed, well nourished, in no acute distress, [and] pleasant and cooperative.” Id. at D001073. However, Dr. Dowdle noted that Prezioso was “tender to palpation of lumbar spine” and had “some paraspinal muscle spasm,” which limited his range of motion. Id. An MRI scan of Prezioso's lumbar spine was ordered to “find out why [Prezioso] has such [an] increase in his symptoms.” Id.

Dr. Dowdle's clinic performed the MRI on May 26, 2010. Upon review, Dr. Dowdle concluded that the MRI showed a “degenerative disk at the L4–L5 level with moderate degenerative disk disease.” Id. at D001081. Prezioso's diagnosis was “mechanical low back pain with recurrent episodes of back and leg pain due to a degenerative disk at the L4–L5 level.” As initial treatment, Dr. Dowdle ordered an “active exercise program” at Physicians Neck and Back Clinics (“PNBC”), and wrote that if Prezioso did not improve, he might be a candidate for spinal fusion. Id. In addition, Dr. Dowdle noted that Prezioso was “not able to walk a distance because of persistent continued back pain,” and that “[a]t this point, it is my opinion he is not able to work.” Id.

On June 8, 2010, Dr. Katherine L. Anglin of PNBC conducted an initial examination of Prezioso. See id. at D001085. Dr. Anglin observed Prezioso moving “fairly easily about the room” with a normal gait, although he complained of lower back pain and had a limited range of motion due to this pain. Id. at D001087. Dr. Anglin diagnosed Prezioso with chronic, recurrent low back pain, lumbar disc syndrome, non-specific thoracic pain, and, in particular, deconditioning syndrome. Id. at D001088. In terms of treatment, Dr. Anglin recommended that Prezioso begin PNBC's rehabilitation program. She stated that the goals were to “avoid surgery, speed healing, return to activities, and, most importantly, to prevent recurrence.” Id. At this time, Prezioso's prognosis was “fair,” and she expected Prezioso to largely recover in 9–12 weeks. Id. at D001089.

On July 21, 2010, at the recommendation of Dr. Dowdle, Prezioso underwent a discography. Id. at D000736. The procedure indicated that Prezioso had “abnormal disc morphology” at the L4–5 and L5–S1 discs. Id. at D000737. At a meeting with Dr. Dowdle on August 3, 2010, the doctor noted that Prezioso had participated in physical therapy at PNBC and was “not making any progress, in fact getting worse.” Id. at D000748. Dr. Dowdle decided to present Prezioso's “case and films” for consideration of a spinal fusion at the L4–5, L5–S1 level. Id. at D000749. Prezioso's diagnosis was still mechanical low back pain and degenerative disc disease. Id. Dr. Dowdle also recorded a normal range of motion in the thoracic spine and lumbar spine. Id. at D000748.

On August 17, 2010, upon the referral of Dr. Dowdle, Prezioso went to the Midwest Spine Institute, LLC, for a second opinion. Id. at 000753. Dr. Stefano M. Sinicropi observed partial sacralization at the L5–S1 disc segment. Id. at D000757. Dr. Sinicropi theorized that this disc may not have troubled Prezioso in the past, but Prezioso's “injury overcame this and clearly this disc has become painful after his work-related injury given the positive concordant discography.” Id. at D000757–758. Dr. Sinicropi ordered a CT scan and reviewed the results on October 12, 2010. The CT scan showed “fair significant distortion of the left facet joint,” along with “some protrusion into the canal of this region,” which suggested nerve impingement. Id. at D001114. Dr. Sinicropi recommended surgical fusion, noting that Prezioso was “certainly miserable with his symptoms,” and that surgery had an “excellent chance” of improving his pain symptoms. Id. at D001115.

The next day, on October 13, 2010, Prezioso was in an automobile accident. A semitrailer truck backed into Prezioso's vehicle, leaving Prezioso complaining of numbness in his left hand, neck pain, and continued lower back pain. Id. at D001112. On October 26, 2010, Dr. Sinicropi concluded that the accident both aggravated Prezioso's existing disc problems but also likely caused a cervical spine injury. Id. at D001113. The doctor also noted that “[g]rossly, [Prezioso] was neurologically intact,” and that Prezioso's “[s]ensation was intact.” Id. On February 8, 2011, Dr. Sinicropi concluded that Prezioso had “[t]raumatic C5–C6 disc injury” as a result of his accident. Id. at D000153. In particular, Prezioso had a 25% range of motion in all directions of his cervical...