Aisenberg v. Reliance Standard Life Ins. Co.
| Decision Date | 15 November 2022 |
| Docket Number | Civil Action 1:22cv0125 (TSE/JFA) |
| Parties | MICHAEL AISENBERG, Plaintiff, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Eastern District of Virginia |
REPORT AND RECOMMENDATION
This matter is before the undersigned magistrate judge for a report and recommendation pursuant to 28 U.S.C. § 636(b)(1)(B) on cross-motions for summary judgment. (Docket nos. 10, 13). This action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C § 1001 et seq., arises from defendant Reliance Standard Life Insurance Company's (“RSL” or “defendant”) denial of plaintiff Michael Aisenberg's (“Aisenberg” or “plaintiff') application for long-term disability (“LTD”) benefits. The parties disagree as to whether Aisenberg was entitled to receive LTD benefits after January 13,2021 under the terms of the employee benefit plan administered and insured by RSL. For the reasons stated below, the undersigned recommends that plaintiffs motion for summary judgment be granted, and defendant's motion for summary judgment be denied.
In September 2020, plaintiffs employer submitted an application and supporting information to RSL concerning LTD benefits for plaintiff. (Administrative Record (“AR”) 216- 288). The application listed the date plaintiff last worked as June 29, 2020. (AR 217). In October 2020, plaintiff provided RSL with additional information concerning his disability claim. (AR 290-296). Based on a review of the medical records, on November 20, 2020, RSL found that starting on June 29, 2020, plaintiff was precluded from engaging in any sustained work function on a frequent and consistent basis due to surgery and recovery from his double coronary artery bypass graft and completion of cardiac rehabilitation. (AR 61). However, RSL later determined that plaintiff was not entitled to any LTD benefits from the policy, finding that plaintiffs impairment did not continue beyond January 12,2021. (AR 182-184). On July 2, 2021, plaintiff appealed RSL's denial of LTD benefits. (AR 1704-85). On December 10, 2021, RSL largely upheld its prior decision to deny benefits. (AR 2351-57). RSL determined that plaintiff was not totally disabled as of January 13, 2021, but he was entitled to one day of LTD benefits under the terms of the policy (from the conclusion of the elimination period on January 12, 2021 to January 13, 2021). (Id.).
On February 4, 2022, plaintiff filed this civil action seeking judicial review of RSL's decision denying LTD benefits pursuant to the provisions of ERISA. (Docket no. 1). Both plaintiff and defendant filed their motions for summary judgment on June 24, 2022, and they were originally noticed for a hearing before the District Judge on July 29, 2022. (Docket nos. 10, 13, 15, 16). Each party then filed their memoranda in opposition on July 8, 2022 and replies to the memoranda in opposition on July 14, 2022. (Docket no. 17, 18, 21, 22). On July 13, 2022, an order was entered by the District Judge moving the hearing on the motions for summary judgment to August 12, 2022. (Docket no. 20). On August 3, 2022, the District Judge entered an order cancelling the scheduled hearing on the pending motions for summary judgment and referred the case to the undersigned “for preparation of a prompt report and recommendation.”
(Docket no. 23).[1] Pursuant to 28 U.S.C. § 636(b)(1)(B), the parties will have an opportunity to file objections to these proposed findings and recommendations and the District Judge will then need to make a de novo determination as to those portions of the proposed findings and recommendations to which an objection has been made.
“[W]hen a plaintiff challenges the denial or termination of benefits under an ERISA plan, the reviewing court must apply a ‘de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.'” Griffin v. Hartford Life & Accident Ins. Co., 898 F.3d 371, 378 (4th Cir. 2018) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). “Under the abuse of discretion standard, the administrator's decision will not be disturbed if it ‘is the result of a deliberate, principled reasoning process and if it is supported by substantial evidence.'” Elliott v. Sara Lee Corp., 190 F.3d 601, 605 (4th Cir. 1999) (quoting Brogan v. Holland, 105 F.3d 158, 161 (1997)). Substantial evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Mastro v. Apfel, 270 F.3d 171, 176 (4th Cir. 2001) (quoting Richardson v. Perales, 402 U.S. 389,401 (1971)). It is “more than a mere scintilla of evidence but may be somewhat less than a preponderance.” Id. Here, the parties agree that RSL serves as a claims review fiduciary as it relates to the policy at issue. (Docket no. 11 at 10; Docket no. 14 at 12). Therefore, RSL's decision denying LTD benefits to plaintiff must be reviewed under the abuse of discretion standard.
Since 2005, RSL has administered a disability insurance policy for certain employees of The MITRE Corporation (“MITRE”). (AR 1). This policy is governed by the laws of Massachusetts and/or ERISA, and it “provides income replacement benefits for Total Disability from Sickness or Injury.” (Id.). As it relates to LTD benefits under the policy, RSL will pay a monthly benefit to the insured if the insured: “(1) is Totally Disabled as the result of a Sickness or Injury covered by this Policy; (2) is under the regular care of a Physician; (3) has completed the Elimination Period; and (4) submits satisfactory proof of Total Disability to us.” (AR 21). This monthly benefit will cease at the earliest of: “(1) the date the Insured ceases to be Totally Disabled; (2) the date the Insured dies; (3) the Maximum Duration of Benefits, as shown on the Schedule of Benefits page, has ended; or (4) the date the Insured fails to furnish the required proof of Total Disability.” (AR 22).
The elimination period is defined in the policy as (AR 11). It ends at the greater of “180 consecutive days of Total Disability or the end of The MITRE Corporation's continuation program.” (AR 9). Monthly benefits will be paid at the end of the elimination period so long as the other criteria for the monthly benefits are met. (AR 21). In this case the maximum duration of benefits would be 21 months since plaintiff was 68 years old when he discontinued working at MITRE. (AR 9).
The policy provides that a claimant is totally disabled when, as a result of injury or sickness, “during the Elimination Period and for the first 24 months for which a Monthly Benefit is payable, an Insured cannot perform the material duties of his/her regular occupation.” (AR 12). A claimant who is partially disabled, meaning that “an Insured is capable of performing the material duties of his/her regular occupation on a part-time basis or some of the material duties on a full-time basis,” is considered totally disabled, except during the elimination period. (Id.). After the first 24 months of the monthly benefit being paid, total disability continues only when “an Insured cannot perform the material duties of any occupation.” (Id.).
Plaintiff was 68 years old on June 29, 2020, his last day of work at MITRE. (AR 61, 311). Plaintiff received his B.A. from the University of Pennsylvania and J.D. from the University of Maine School of Law. (AR 368). Plaintiff is a member of the District of Columbia Bar. (Id.). Prior to his job at MITRE, he worked for the Federal Communications Commission, Digital Equipment Corporation, VeriSign, Inc., and Electronic Warfare Associates-Information & Infrastructure Technologies, Inc. (Id.). Plaintiff also has experience in academia, serving as a lecturer in communications law at the University of Maryland and an adjunct professor in the technology ethics program at the University of Fairfax, as well as having been appointed a senior fellow of the George Washington University Center for Cyber and Homeland Security in 2015 and a fellow of the Institute for Critical Infrastructure Technologies. (Id.).
At MITRE, plaintiff served as principal cyber security counsel in the Center for National Security of MITRE's Defense and Intelligence Federally Funded Research and Development Center. (Id.). In this role, plaintiff was responsible for providing strategic policy advice and analysis in support of MITRE's systems engineering work for federal agencies in defense, intelligence, and homeland security. (Id.). Plaintiff holds Top Secret clearances from the Department of Defense (DoD), Department of Homeland Security (DHS), and the U.S. Intelligence Community. (Id.). His supervisor described plaintiff's role as constantly (almost hourly) working with senior leadership at the DHS Cybersecurity and Infrastructure Security Agency, the Director of National Intelligence, or the DoD Chief Information Officer either on the phone, in high level virtual meetings, or traveling around the Washington, DC metro area to meet in person with senior personnel prior to COVID-19. (AR 132-133). Plaintiff s job was very demanding and stressful with short deadlines and frequent and unexpected changes in the requirements from the various agencies. (Id.). In June 2020, plaintiff was earning $15,083 per month from MITRE. (AR 262).
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