Spears v. Liberty Life Assurance Co. of Bos.

• Decision Date: 31 March 2015
• Docket Number: CIVIL ACTION NO.: 3:11-cv-1807 (VLB)
• Court: U.S. District Court — District of Connecticut
• Parties: HALEY SPEARS, PLAINTIFF, v. LIBERTY LIFE ASSURANCE COMPANY OF BOSTON; THE GROUP LIFE INSURANCE AND DISABILITY PLAN OF UNITED TECHNOLOGIES CORPORATION, aka THE UTC CHOICE INTEGRATED DISABILITY BENEFIT PROGRAM, DEFENDANTS.

HALEY SPEARS, PLAINTIFF, v. LIBERTY LIFE ASSURANCE COMPANY OF BOSTON;

THE GROUP LIFE INSURANCE AND DISABILITY PLAN OF UNITED TECHNOLOGIES

CORPORATION, aka THE UTC CHOICE INTEGRATED DISABILITY BENEFIT PROGRAM, DEFENDANTS.

CIVIL ACTION NO.: 3:11-cv-1807 (VLB)

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

March 31, 2015

MEMORANDUM OF DECISION GRANTING, IN PART, [82] PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT, GRANTING [94] PLAINTIFF'S MOTION TO SUBMIT EVIDENCE OUTSIDE THE ADMINISTRATIVE RECORD, AND DENYING [85] DEFENDANTS' MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD, AND REMANDING TO THE PLAN ADMINISTRATOR FOR FURTHER PROCEEDINGS

This is an appeal of a denial of short and long-term disability benefits brought by the Plaintiff, Haley Spears ("Spears"), against the United Technologies Choice Integrated Disability Benefit Program (the "Plan"), sponsored by her former employer, United Technologies Corporation (UTC), and the plan administrator, Liberty Life Assurance Company of Boston ("Liberty"), acting pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA").¹ Spears alleges that the Defendants improperly denied her claim for Long Term Disability ("LTD") benefits under the Plan, in violation of the provisions of 29C.F.R. § 2560.503-1, which governs processing and handling of claims for ERISA plan benefits.

On March 1, 2013, Spears and the Defendants, respectively, filed motions for summary judgment and for judgment on the administrative record. [Dkt. ## 51, 54]. That day, Spears also filed a motion to submit evidence outside the administrative record. [Dkt. #55]. However, the parties' filings failed to comply with Local Rule of Civil Procedure 56, and on March 21, 2014, the Court denied them without prejudice to refiling in compliance with this Rule. [Dkt. #80].

On April 28, 2014, the parties refiled their motions for summary judgment and for judgment on the administrative record, and on June 13, 2014, Spears refiled her motion to submit evidence outside the administrative record. [Dkt. ## 82, 85, 94].

After consideration of the record, for the reasons stated hereinafter, the Court GRANTS, in part, Spears' Motion for Summary Judgment, DENIES Defendants' Motion for Judgment, and GRANTS Spears' Motion to Submit Evidence Outside the Administrative Record.

Background Facts²

a. Spears Applies For And Receives Short-Term Disability Benefits From October 8, 2008 Through February 8, 2009

Spears worked as an executive administrative assistant at Pratt & Whitney, a division of UTC. [Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 18; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 18]. Spears' job responsibilities included making travel arrangements, filing documents, and assisting in preparing, gathering and maintaining expense reports. [Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 4; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 4].³ Spears asserts, and the Defendants do not dispute, that, prior to the onset of her symptoms, Spears was a dedicated and bright employee who worked hard and was able to handle a range of job responsibilities. [AR 481, 487, 489; Dkt. #82-5,P.'s Local Rule 56(a)(1) Statement, at ¶¶ 9-10; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶¶ 9-10].

Beginning in the spring of 2008, Spears began to experience symptoms of ill health. [AR 484; Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 11; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 11]. On April 8, 2008, she saw Dr. James O'Brien for nausea, abdominal pain and frequent diarrhea. [AR 2034-36; Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 12; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 12]. During this visit, she was diagnosed with unspecified gastritis, gastroduodenitis, and regional enteritis of the large intestine. [Id.].

In the summer of 2008, Spears began to suffer from migraines and associated symptoms, including blurred vision and an inability to focus. [AR 484-85; Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 12; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 12]. Later that summer, on August 28, 2008, Spears went to the St. Francis Hospital emergency room for a migraine headache. [AR 1429-43; Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 12; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 12]. While there, Spears underwent a CT scan which revealed "[l]ow attenuation changes in the white matter of the right temporal lobe" of her brain. [AR 1409]. The examining doctor concluded that they "may represent gliosis⁴ or edema."⁵ [Id.]. As a result, the doctor recommended "[a]follow[-]up brain MRI." [Id.]. Spears underwent her first of two MRIs, on September 2, 2008. [AR 1410; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 12]. This first MRI revealed a "lobulated lesion" but "no associated edema." [AR 1410]. Instead, the doctor surmised that the lesion "may represent an inactive demyelinating plaque," and that "[a] low-grade glioma [wa]s less likely." [Id.]. Accordingly, the doctor recommended a follow-up MRI with contrast in 3 months. [Id.].

Spears' migraines and related symptoms persisted, and shortly after this MRI, in September 2008, Spears stopped working and applied for short term disability ("STD") benefits. [Dkt. #82-5, P.'s Local Rule 56(a)(1) Statement, at ¶ 14; Dkt. #90, D.'s Local Rule 56(a)(2) Statement, at ¶ 14]. Based upon these persistent migraine headaches and related symptoms, Liberty approved the payment of benefits, effective October 4, 2008. [Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 21; AR 69 at Claim Note 2; AR 68 at Claim Note 2]. This initial approval was through October 8, 2008. [AR 68 at Claim Note 6]. Liberty explained to Spears that in order to receive an extension of her benefits, she would have to request records forms from her treating doctors. [AR 67-68, Claim Note 7].

On October 6, 2008, Spears underwent a second MRI. This MRI confirmed the presence of "white matter lesions in the right temporal lobe" but concluded that they were "stable," "not enhance[d]," that there were "no new lesions" and "no associated edema." [AR 2181]. The examining doctor further concluded thatthe "diagnosis favors demyelinating plaque over a low grade glioma" but recommended "a repeat MRI in 6 months." [Id.]. Spears provided these results to Liberty on October 16, 2008. [AR 67, Claim Note 10]. Liberty also received Restrictions Forms from two of Spears' treating physicians. [Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶¶ 23-24; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶¶ 23-24]. Dr. Evan Schiff, a doctor of internal medicine, submitted his form on October 10, 2008, which stated that Spears had "severe migraines," but deferred to Spears' neurologist, Dr. Barry Gordon, as to when she would be able to return to work. [AR 2189; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 23; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 23]. Three days later, on October 13, 2008, Dr. Gordon submitted a Restrictions Form which stated that Spears did not have any physical, mental, or cognitive restrictions that corresponded to Spears' migraine diagnosis. [AR 2178; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 24; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 24]. After receiving this information, on October 16, 2008, Liberty extended its approval of STD benefits through November 1, 2008. [AR 67 at Claim Note 11].

As a result of her migraines and related symptoms, Spears continued to see doctors throughout November and December 2008. See [AR 62-64]. During this period, she submitted reports from her treating doctors and scheduled additional medical procedures. [Id.]. For instance, on November 11, 2008, a different neurologist who examined Spears, Dr. Silvers, prepared a Restrictions Form in which he diagnosed Spears with a migraine and encephalopathy, and stated that she could perform a sedentary occupation on a full-time basisbeginning on January 8, 2009. [AR 2112; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 25; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 25]. Plaintiff's neuro-oncologist, Dr. Joachim Baeringer, also submitted a Restrictions Form, dated December 11, 2008, in which he stated that Spears exhibited an "abnormal brain scan," but he did "not assess[]" any related physical, mental, or cognitive restrictions, because he was "only seeing [Spears] for [the] MRI scan abnormality." [AR 2135; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 26; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 26]. After receiving these reports, Mary Hayden, a Liberty Disability Case Manager ("DCM"), referred Spears' claim to Dr. Potts, a neurologist, for a peer review. [AR 2137; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶¶ 27-28; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶¶ 27-28]. As part of his evaluation, Potts contacted Drs. Gordon and Silvers regarding any restrictions or impairments from which Spears was presently suffering. [AR 2115, 2117; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 29; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 29]. Both doctors reported that Spears suffered from severe and persistent headaches with accompanying symptoms, which led Dr. Potts to conclude in his December 18, 2008 report that Spears "appears to have nearly daily headaches, the severity of which is likely to preclude her from working." [AR 2116; Dkt. #85-7, D's Local Rule 56(a)(1) Statement at ¶ 32; Dkt. #91-1, P's Local Rule 56(a)(2) Statement at ¶ 32]. However, during follow-up discussions with Drs. Gordon and Silvers, Dr. Gordon told Dr. Potts that he had not placed any restrictions or limitations on her work capacity and had not recommended she stay out of work. [AR 2115]. Dr. Silvers stated hisopinion that Spears would be able to return to work by January 7, 2009. [Id.]. Based on Spears' records and Dr. Potts' December 18 and 23 report and addendum, Liberty extended its approval of STD benefits...