Taylor v. Smithkline Beecham Corp.
| Decision Date | 26 June 2009 |
| Docket Number | No. 2:07-cv-0809-FMC-JTLx.,2:07-cv-0809-FMC-JTLx. |
| Parties | Janice TAYLOR, Plaintiff, v. SMITHKLINE BEECHAM CORPORATION, a GlaxoSmithKline Company Long Term Disability Plan, Defendant. |
| Court | U.S. District Court — Central District of California |
Brent Dorian Brehm, Corinne Chandler, Glenn R. Kantor, Kantor and Kantor LLP, Northridge, CA, for Plaintiff.
Cynthia L. Sands, Gonzalez Saggio & Harlan LLP, Irwin S. Evans, Atkins & Evans, Los Angeles, CA, for Defendant.
ORDER ON ADMINISTRATIVE REVIEW
The matter is before the Court on administrative review. The Court has read and considered the parties' briefs and the administrative record. As explained herein, and in the manner set forth below, the Court reviews the administrative decision under an abuse of discretion standard and concludes that Plaintiff Janice Taylor is entitled to benefits under the LTD Plan.
This case arises out of Plaintiff Janice Taylor's claim for long term disability benefits governed by the Employee Retirement Income Security Act ("ERISA"). Plaintiff is a former employee of GlaxoSmithKline, and was a plan participant of Defendant SmithKline Beecham Corporation, A GlaxoSmithKline Company Long Term Disability Plan ("SmithKline" and "LTD Plan"). (Compl. 2-3.) The LTD Plan is self-funded by SmithKline, which also acts as the Plan Administrator and possesses discretionary authority to review claims and interpret claim provisions. (GSK 023.) SmithKline delegates the task of claims administration to a third party. For the time period relevant to the Court's administrative review, claims administration was performed by Hartford-Comprehensive Employee Benefit Service Company ("Hartford"). The Administration Agreement provides that Hartford will perform an initial claim review and if requested by the plan participant, Smith-Kline will perform a final review. (Chandler Decl., Ex. F.)
Plaintiff was employed as a phlebotomist for SmithKline. After developing carpal metacarpal instability in her left hand Plaintiff filed a long term disability claim with SmithKline in November of 1995. Plaintiff began receiving disability benefits in July 1996. At the time, SmithKline delegated claims administration to ITT Hartford Life Insurance Company, who determined that Plaintiff was eligible for LTD benefits. (GSK 1066.) During the course of her claim and receipt of LTD benefits, the claims administrator changed several times. In 1998, UnumProvident Corp. ("Unum") began to provide claims administration services to SmithKline. In December 1999, Unum asked Plaintiff to submit proof of continued disability. (GSK 447.) Plaintiff submitted an Attending Physician's Statement and Physical Abilities Form in February 2000 and May 2000 from her treating hand physician, Dr. Kendrick Lee. Unum also received a statement from Dr. William Lowrey in February 2001. These documents indicated Plaintiff could lift or carry 20 pounds frequently, 30 pounds occasionally, had limited sitting and stooping/bending, and could perform simple grasping, fine manipulation, pushing, pulling and repetitive motion with the left hand for up to two-thirds of a workday. (GSK 320, 381, 439.)
On this basis, Unum conducted an Employability Assessment, determined Plaintiff could perform eleven occupations including her former position as Phlebotomist, and denied her benefits in April 2002. (GSK 362-364.) Plaintiff appealed Unum's decision, and submitted additional reports from Dr. Lee dated October 2002 and findings of an Administrative Law Judge granting her Social Security disability benefits in December 2002. In addition to left hand pain and limited thumb and wrist mobility, these documents showed Plaintiff suffers from seizures, protein-S deficiency, and has a history of deep venous thrombosis. These ailments cause distorted vision, impaired consciousness, and pain and blood clots in her right leg, preventing her from sitting for long periods of time. (GSK 343-346.) With this information, Unum's reviewing physician added restrictions of no repetitive movement with the thumb and no pinching or grasping activities. A second Employability Analysis revealed that the additional restrictions eroded the job base by 90%, and found only one acceptable occupation— gate guard. (GSK 334.) With these results, Unum reversed its prior decision, and reinstated Plaintiff's disability benefits on January 27, 2003. (GSK 320-323.)
On January 1, 2004, Hartford-Comprehensive Employee Benefit Service Company ("Hartford") replaced Unum as the claims administrator for the LTD Plan. Soon thereafter, on February 19, 2004, Hartford decided to reassess Plaintiff's eligibility for benefits, which is permitted by the LTD Plan on an annual basis. (GSK 018; H 027.) Hartford asked that Plaintiff submit proof of ongoing disability, including an Attending Physician Statement ("APS") from her treating physician within twenty-one (21) days. (GSK 266.) Plaintiff called Hartford on March 19, 2004 to explain her medical condition and her planned visit with a hematologist in May 2004. Hartford stated it would follow up with her in mid-June. (H 026.) Hartford sent additional requests for an APS in March, June, and July 2004. On July 20, 2004 and August 4, 2004, Plaintiff's daughter called Hartford to explain that Plaintiff was in South America on a family emergency and would not be back until August 19, 2004. Hartford responded that it could not provide an extension past July 31st. (H 026.) On August 5, 2004, Hartford received an APS faxed from Dr. Lee's office. However, the APS was based upon an examination date of October 23, 2002, and Dr. Lee had not examined Plaintiff since. Hartford rejected the APS and wrote to Plaintiff explaining that she had to submit an APS based on a current exam, because the policy requires that she be under the regular care of a physician. (GSK 262.) Hartford sent additional notices requesting an APS in October and November 2004, and a final notice on January 7, 2005, giving Plaintiff 21 days to return the requested information. After returning from South America, Plaintiff informed Hartford in several phone calls that she was having trouble getting her Workers Compensation to approve a visit with her treating physician, and that she suffered a stroke in November 2004, was hospitalized for two weeks, and was getting treatment for possible thyroid cancer. (H 024-025.)
On January 27, 2005, Hartford received the requested documents, and an APS from Dr. Lee's office, Plaintiffs treating hand physician, based on an exam conducted on October 25, 2004. The APS, signed December 13, 2004, indicated Plaintiffs status was unchanged and her thumb pinching restriction was permanent. (GSK 254-255.) Plaintiff also described her other ailments in a Claimant Questionnaire. (GSK 249-252.) However, on January 25, 2005, Hartford initiated the termination process and generated a letter terminating Plaintiffs benefits on the basis of failing to provide documentation of ongoing disability. (H 023.) Hartford signed and issued the termination letter on January 28, 2005, 21 days after its final notice dated January 7, 2005. (GSK 256-258.)
Having received the requested documentation, Hartford decided to conduct an Employability Analysis ("EA") prior to reopening Plaintiffs claim. The only restriction considered by the EA was pinching activities performed by the left thumb, as noted in Dr. Lee's recent APS. The EA also considered that Plaintiff had been able to attend Mills College to earn a Bachelor's degree in May 1999. The EA concluded Plaintiff could work in seven (7) occupations that are prevalent in the economy. From these results, Hartford decided to deny Plaintiffs claim on the merits, and issued a denial letter on March 3, 2005. Plaintiff was given 180 days to appeal the decision. (GSK 214-217.)
On August 15, 2005, Plaintiff sent a letter to Hartford's Appeals Unit, appealing the decision to deny and terminate benefits. Plaintiff described her hand limitations, protein S deficiency, seizure disorder, and venous insufficiency of lower extremities. Plaintiff objected to Hartford's EA, because it changed Plaintiffs ability to handle objects from occasionally to constantly, even though handling objects requires Plaintiff to both pinch and grip. Plaintiff attached documentation of her hospitalization in November 2004 at the Alta Bates Medical Center for her stroke, treatment in March 2005 for her hands at a Hand Therapy & Acupuncture center, and documents already in Hartford's possession, such as the ALJ decision to award her Social Security disability benefits in December 2002. Plaintiff also requested an extension of time to submit additional medical records, as she was once again having difficulty securing approval to visit her treating physician from her workers' compensation carrier.
In a letter dated September 1, 2005, Hartford denied Plaintiffs request for an extension, and informed her she would have to send her completed appeal to Hartford by November 1, 2005, pursuant to the 180-day deadline. Plaintiff requested another extension on October 30, 2005, because her next appointment with Dr. Lee was scheduled for December 5, 2005. Hartford called Plaintiff on November 14, 2005 and informed her that no additional medical information would be considered or sent to the independent physician consultant at University Disability Consortium ("UDC"), because the review is based on Plaintiffs condition as of January 2005, the date benefits were denied, and because her appeal was complete as of November 1, 2005. The only opportunity for the independent consultant to consider additional information would his telephone consultations with Plaintiffs treating physicians. (GSK 046.)
Meanwhile, at some point in November 2005, Hartford sent all of Plaintiffs medical records in its possession as of November 1, 2005 to Dr. Beth Aaronson of UDC for an...
To continue reading
Request your trial
-
Blankenship v. Metropolitan Life Ins. Co.
... ... 394 (N.D.Ill. 2009); Taylor v. SmithKline Beecham Corp., 629 F.Supp.2d 1032 (C.D.Cal.2009); Santos ... ...