Rupprecht v. Reliance Standard Life Ins. Co.
| Docket Number | Civil Action 1:21-cv-01260 (AJT/JFA) |
| Decision Date | 26 August 2022 |
| Parties | WALTER RUPPRECHT, Plaintiff, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Eastern District of Virginia |
Walter “Sonny” Rupprecht (“Plaintiff” or “Rupprecht”) and Reliance Standard Life Insurance Company (“Reliance” or “Defendant”) have filed cross-motions for summary judgment (each respectively “Plaintiff's Motion” and “Defendant's Motion”; collectively the “Motions”) with respect to Plaintiff's claim for long term disability benefits under Reliance's employee benefits plan subject to the Employee Retirement Income Security Act of 1974 (“ERISA”), codified as amended at 29 U.S.C. §§ 1001, et seq. Based on the following, the Plaintiff's Motion for Summary Judgment is GRANTED, [Doc. No. 9] and the Defendant's Motion is DENIED [Doc. No. 7].
Reliance provided group long term disability insurance (the “Plan”) to Plaintiff and others through his employment with Sharp Electronics Corporation (“Sharp”).[1] [Doc. No. 8-1] (“Administrative Record” or “AR”) at 1-36 (text of the Plan). Plaintiff was injured in November 2017 in a work-related accident and subsequently filed claim for disability benefits. Id. at 140.
It appears his initial request[2] for Long Term Disability (LTD) benefits was delayed and initially denied due to an error on behalf of his employer. AR at 140-44 (original denials), 209-30.[3]Reliance reversed the denial on July 21, 2020, id. at 145 (reversal), and referred the claim to its Long Term Disability department. Id. at 145. This letter advised Plaintiff that he “may be required to provide Reliance [] periodic proof of continuing Total Disability and . . . may be required to undergo an Independent Medical Evaluation ....” AR 145. On September 14, 2020, the Long Term Disabilities Department then approved his claim, providing him benefits from May 27, 2018 through February 27, 2020.[4] Id. at 159-60. But beyond 24 months, i.e., after May 27, 2020, the letter informed Plaintiff that he “must be totally disabled from performing the material duties of Any Occupation.” Id. Reliance informed him that “[a]n investigation will begin prior to this date in order to gather the necessary information to determine your continued eligibility for LTD benefits.” Id. at 160.
On October 12, 2020, Plaintiff was advised his benefits were being terminated because Matrix (the claim administrator) did not receive the necessary and requested information from Plaintiff's doctors. Id. at 163. Matrix informed Plaintiff that it notified Plaintiff it needed this information on July 23, 2020, August 25, 2020, and September 11, 2020. Id. Matrix also informed Plaintiff that if the medical records were received within 180 days, it could continue to process his request. Id. at 164. Plaintiff subsequently provided this information to Matrix in February 2021, including a medical diagnosis from Dr. Yu stating Plaintiff “remained permanently disabled” based on a November 3, 2020 doctor visit. Id. at 513, 516-17. Dr. Yu also stated that Plaintiff experienced “significant chronic pain” and was directed to “avoid prolonged sitting and standing to help control the pain.” Id. In Dr. Yu's opinion, Plaintiff's condition was not expected to improve and surgery was not an option. Id. Plaintiff appears to have previously provided medical diagnoses from Dr. Patel to Matrix, stating in the February 2021 letter that “[t]here are no updated records to send from” him. Id. Dr. Patel filled out a Reliance “attending physician” form on May 16, 2019 stating that Plaintiff could not perform 1-3 hours of standing, sitting, walking or driving in an eight-hour period, even with two breaks and lunch and really could not perform these activities “at all.” Id. at 184-85.
On May 27, 2021, after receiving the requested information, Reliance informed Plaintiff that it reviewed his file and determined that he no longer met the definition of Total Disability according to his employer's group policy (“May 2021 Letter”) and so terminated benefits after May 27, 2020, i.e. after 24 months and the elimination period. Id. at 166. Specifically, the letter pointed to the language of Sharp's policy that for the first 24 months, an individual had to be unable to perform his or her regular occupation but that after 24 months, the standard for total disability meant that the insured cannot perform “the material duties of Any Occupation.” Id. at 167 (emphasis added). The letter noted that based on Matrix's vocational staff's review of all Plaintiff's available medical information and information on his education, training, and experience, he was able to perform and would qualify for a number of “sedentary” positions including, for example, an informational clerk role. Id. at 167; see also 532-41 (residual employability analysis). The corresponding analysis by nurse Renee Phillips states that Plaintiff would be capable of performing a variety of “sedentary” position in which he was “[m]ostly sitting.” Id. at 536-41. This formed the basis of the subsequent April 2021 review by Matthew Bolks who was the “Senior Vocational Rehabilitation Specialist.” Id. at 532-33. The May 2021 letter informed Plaintiff that he could request a review of the decision. Id. at 167-68.
Plaintiff appealed the decision on September 20, 2021, citing the May 2021 Letter's failure to specify why Plaintiff was being denied benefits and claiming the vocational review was flatly contradicted by the submitted opinions of Plaintiff's treating physicians and did not explain to him what information would be needed on appeal to “perfect the decision” as required under law. Id. at 545-77.
In response to his appeal, Reliance stated in an October 14, 2021 letter that it received Plaintiff's appeal[5] and after review, determined Plaintiff would need to undergo an independent medical examination “prior to the close of [Reliance's] review.” Id. at 170. The October 2021 letter also informed Plaintiff that Reliance would take beyond the 45-day appeal period, which was set to conclude on November 4, 2021, because it needed to “await the completion of the above-mentioned IME and/or the receipt of above requested information.” Id. at 171. Reliance stated that it was allowed the additional 45 days whenever “circumstances do not permit us to make a final determination in the initial . . . time frame allotted.” Id. at 171.
Plaintiff responded to the letter on November 1, 2021 asking for all future correspondence to be faxed. Id. at 603-06. Plaintiff objected to Reliance taking an additional 45 days to render a decision, stating that scheduling an IME after a denial of benefits was not permitted by law and, as such, Plaintiff would not undergo an IME.[6] Id. at 604-06. Plaintiff further raised a variety of concerns with the chosen doctor to conduct the IME. Id. Reliance wrote back on November 12, 2021 stating that the November 8, 2021 IME was rescheduled to December 3, 2021 due to Plaintiff's concern with the originally scheduled IME provider. Id. at 173. It appears Reliance mailed instead of faxed the November 12, 2021 letter. Plaintiff filed suit on November 15, 2021. [Doc. No. 1] (“Compl.”). Reliance and Plaintiff both filed for summary judgment on April 15, 2022. See [Doc. Nos. 7, 9].
Under Federal Rule of Civil Procedure 56, summary judgment is appropriate only if the record shows that “there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.P. 56(c); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986); Evans v. Techs. Apps. & Serv. Co., 80 F.3d 954, 958 (4th Cir. 1996). The party seeking summary judgment has the initial burden to show the absence of a material fact. Bouchat v. Baltimore Ravens Football Club, Inc., 346 F.3d 514, 522 (4th Cir. 2003). A genuine issue of material fact exists “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson, 477 U.S. at 248. Once a motion for summary judgment is properly made and supported, the opposing party has the burden of showing that a genuine dispute exists. Bouchat, 346 F.3d at 522. To defeat a properly supported motion for summary judgment, the non-moving party “must set forth specific facts showing that there is a genuine issue for trial.” Anderson, 477 U.S. at 247-48 () (internal quotations and citation omitted). Whether a fact is considered “material” is determined by the substantive law, and “[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.” Id. at 248.
The facts shall be viewed, and all reasonable inferences drawn, in the light most favorable to the non-moving party. Id. at 255; see also Lettieri v. Equant Inc., 478 F.3d 640, 642 (4th Cir. 2007). “When faced with cross-motions for summary judgment,” as is the case here, “the court must review each motion separately on its own merits to determine whether either of the parties deserves judgment as a matter of law.” Rossignol v. Voorhaar, 316 F.3d 516, 523 (4th Cir. 2003)
ERISA is a “comprehensive and reticulated statute” and is “the product of a decade of congressional study of the Nation's private employee benefit system,” governing most active employee benefit plans in the United States. See Mertens v. Hewitt Assocs., 508 U.S. 248 251 ...
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