Anderson v. Sun Life Assurance Co. of Can.

• Decision Date: 19 November 2013
• Docket Number: No. CV-12-00145-TUC-CKJ,CV-12-00145-TUC-CKJ
• Parties: Diana C. Anderson, Plaintiff, v. Sun Life Assurance Co. of Canada; and CHS/Community Health Systems, Inc., Defendants.
• Court: U.S. District Court — District of Arizona

Diana C. Anderson, Plaintiff, v. Sun Life Assurance Co. of Canada; and CHS/Community Health Systems, Inc., Defendants.

No. CV-12-00145-TUC-CKJ

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA

Dated: November 19, 2013

ORDER

Pending before this Court are several motions.On March 21, 2013, DefendantSun Life Assurance Co. of Canada ("Sun Life") filed a Motion for Summary Judgment on All Plaintiff's Claims.(Doc. 65).Plaintiff filed her Response on April 24, 2013.(Doc. 82).Sun Life filed a Reply on May 22, 2013.(Doc. 95).

On March 21, 2013, Plaintiff filed a Motion for Summary Judgment.(Doc. 67).On April 18, 2013, DefendantCHS/Community Health Systems, Inc.("CHS") filed a Response.(Doc. 78).Sun Life filed a Response on April 22, 2013.(Doc. 80).Plaintiff filed her Reply on May 21, 2013.(Doc. 94).

On March 21, 2013, Defendant CHS filed a Motion for Summary Judgment on All of Plaintiff's Claims.(Doc. 69).Plaintiff filed her Response on April 25, 2013.(Doc. 84).On May 9, 2013, CHS filed its Reply.(Doc. 92).

Finally, on April 10, 2013, Sun Life filed a Motion to Dismiss for Failure to State a Claim.(Doc. 76).Plaintiff filed her Response on April 29, 2013.(Doc. 87).On May 2, 2013, Sun Life filed its Reply.(Doc. 89).The Court heard oral argument on October 7, 2013.(Doc. 104).

I.Factual Background¹

Plaintiff began her employment as a Registered Nurse at Northwest Medical Center on April 4, 1993.(Administrative Recordat 862-868)("AR").As a Registered Nurse, Plaintiff's salary was $39.55 per hour.(ARat 2).On July 15, 2008, Plaintiff suffered a work related injury.(ARat 827-828).Plaintiff's disability insurance carrier at that time was Aetna.(Plaintiff's Statement of Facts at ¶67)(Doc. 68).

Shortly after suffering her injury, Plaintiff continued working as a Registered Nurse.(Doc. 68 at ¶6).However, beginning on December 10, 2008, Plaintiff was unable to continue her duties as a Registered Nurse due to the July 15, 2008 injury.(ARat 867-868).On December 16, 2008, Plaintiff returned to Northwest Medical Center.She began performing clerical work to accommodate for her injury, without a reduction in salary.(ARat 14-15).Since December 10, 2008, Plaintiff has been medically restricted form working as a Registered Nurse in patient care.(ARat 576-578, 1228-1330).

On January 1, 2009, the long term and short term disability coverage for Northwest Medical Center employees transitioned from Aetna to Sun Life.(ARat 1014-1062).Sun Life became the claims administrator for the disability insurance plan and CHS was the plan administrator.(Sun Life's Statement of Facts at ¶2)(Doc. 66).

Officially, Plaintiff was on a leave of absence from her position as a Registered Nurse at Northwest Medical Center from December 10, 2008 through June 10, 2009.(ARat 826).However, on April 17, 2009, Plaintiff was approved for a temporary pilot program as a Patient Satisfaction Representative, to accommodate for her disability.(ARat 2042).Initially, Plaintiff worked in the pilot program without a reduction in salary.(ARat 2042).On May 5, 2009, Northwest Medical Center advised Plaintiff that her leave of absence from her position as a Registered Nurse would expire on June 10, 2009 and if she was unable to return to her position as a Registered Nurse by that date, she would be terminated.(ARat 826).

On May 19, 2009, Plaintiff contacted Sun Life to apply for disability benefits.(ARat 862-868).She told Sun Life about her July 2008 injury and that since December 10, 2008, she has been unable to perform her duties as a Registered Nurse.(ARat 862-868).She further informed Sun Life that her position was going to be terminated on June 10, 2009.(ARat 862-868).Plaintiff contends that she believed she was filing a claim for short term and/or long term disability benefits.(ARat 862-868).

On June 18, 2009, Sun Life admitted that Plaintiff's medical disability was founded but denied Plaintiff's claim for short term disability benefits based on an exclusion for work related injuries.(ARat 1102-1105).Sun Life's claim file indicates that Plaintiff was eligible for long term disability.(ARat 14).Sun Life did not inform Plaintiff that the exclusion for work related injuries did not apply to her long term disability coverage.(Doc. 68 at ¶62).

On July 15, 2009, Plaintiff sent an email to Sun Life providing a timeline for her injury and noting that she believed she was entitled to short term and long term disability benefits.(ARat 1117-1119).She also requested copies of all documents, records, and other information relevant to her claim for benefits.(ARat 576-578).On July 29, 2009, Plaintiff wrote to Sun Life regarding the denial of her disability claim arguing that other employees have received worker's compensation and short term/long term disability for work related injuries.(ARat 1198-1203).Despite Plaintiff's repeated referrals to short term and long term disability coverage, Sun Life did not process Plaintiff's claim for long term disability benefits at that time.(ARat 7).Instead, Sun Life interpreted Plaintiff's protests as an appeal of the denial of short term disability benefits.(ARat 79).

Plaintiff's temporary position as a Patient Satisfaction Representative wassubsequently made permanent.(ARat 176).On August 2, 2009, Plaintiff was officially hired as a Patient Satisfaction Representative and her salary was reduced to $12.83 per hour.(ARat 176).This position required a light level of physical exertion.(ARat 1529-1535).

Plaintiff stopped working as a Patient Satisfaction Representative on June 20, 2010.(ARat 1653-1655).On November 11, 2010, Plaintiff submitted a claim for long term disability insurance benefits with Sun Life.(ARat 1653-1655).Plaintiff requested that Sun Life consider her date of disability as of December 10, 2008.(ARat 1653-1655).

On March 9, 2011, Sun Life denied Plaintiff's long term disability claim based on her occupation as a Patient Satisfaction Representative.(ARat 87-93).Sun Life explained that her coverage under the disability insurance policy terminated when she resigned from her employment on June 20, 2010.²(ARat 1014-1062).However, according to Northwest Medical Center's November 10, 2010 employer statement to Sun Life, Plaintiff's employment had not been terminated as of November 10, 2010.(ARat 1674-1677).Plaintiff had been employed as a Patient Satisfaction Representative for one year and three months as of November 10, 2010.(ARat 1674-1677).

On May 20, 2011, Plaintiff's counsel sent a letter to Sun Life requesting documentation including the short term disability file and other documents.(ARat 806-808).On June 22, 2011, Plaintiff's counsel sent a letter to Sun Life advising them to notify the long term disability department reviewing Plaintiff's claim that an error had been made and Plaintiff's claim for long term disability benefits should have been evaluated in 2009.(ARat 135-137).Sun Life denied Plaintiff's appeal of the denial of her short term disability benefits on June 24, 2011.(Doc. 66 at ¶41A).

Plaintiff's Medical Disability

On March 25, 2009, Dr. Joel Thompson found that as a result of Plaintiff's July 15, 2008 injury, her work should be limited.(ARat 2027-2029).Additionally, he found that Plaintiff was in no condition to lift more than five pounds and could not do any overhead activity.(ARat 2027-2029).This diagnosis was confirmed by Dr. Jon T. Abbott on July 13, 2009.(ARat 400-408).On August 12, 2009, Sun Life's nurse consultant Marie Gluszak explained that Plaintiff's medical file reasonably supports the diagnosis and physical impairment class stated as light with no heavy lifting.(ARat 1228-1230).

Additionally, the Industrial Commission of Arizona found that as a result of Plaintiff's July 15, 2008 shoulder injury, she is disabled from performing the duties of a Registered Nurse.(ARat 827-831).However, her medical limitations would not preclude her from performing the duties of a Patient Satisfaction Representative.(ARat 827-831).³

On July 12, 2010, Plaintiff visited Dr. Robert Pedowitz who diagnosed her with left shoulder impingement syndrome.(ARat 1750-1751).Additionally, Dr. William Sniger reviewed Plaintiff's medical file on behalf of Sun Life.Dr. Sniger noted that Plaintiff had arthroscopic surgery on her left shoulder on July 16, 2010 and was temporarily restricted from performing the duties of her position as a Patient Satisfaction Representative for a three to four month period after her surgery.(ARat 1533-1534).Prior to July 16, 2010, there were no restrictions or limitations on Plaintiff's ability to perform the material and substantial duties of a Patient Satisfaction Representative.⁴(Doc. 66 at ¶¶27, 40).

On June 2, 2011, Dr. Richard D. Corzatt reviewed a list of Plaintiff's medicalrecords from 2008 through 2011 and concluded that as a result of her July 2008 shoulder injury, Plaintiff would be precluded from returning to work in a medium occupation.(ARat 1450-1454).However, she was not totally impaired and could perform a light occupation.(ARat 1450-1454).A June22, 2011 MRI of Plaintiff's shoulder revealed a partial rotator cuff tear.(ARat 810-811).On August 2, 2011, Plaintiff underwent surgery to repair her rotator cuff tear.(Doc. 68 at ¶20).

II.Procedural Background

On February 28, 2012, Plaintiff filed a two count Complaint.Count One was a Declaratory Judgment claim for benefits pursuant to 29 U.S.C. §1132(a)(1)(B) against DefendantSun Life.(Doc. 1).Count Two was a claim for statutory damages against DefendantSun Life and Community Health Systems for violating 29 U.S.C. §1132(c)(1).(Doc. 1).

On June 26, 2012, Plaintiff filed a Motion for Leave to File a First Amended Complaint.(Doc. 29).In her Motion, Plaintiff sought leave to correct the name of Defendant CHS in the caption and to add CHS as a defendant in her declaratory judgment...