Wible v. Aetna Life Ins. Co.

• Citation: 375 F.Supp.2d 956
• Decision Date: 20 June 2005
• Docket Number: No. CV 04-4219 DT (MCX).,CV 04-4219 DT (MCX).
• Court: U.S. District Court — Central District of California
• Parties: Dennis WIBLE, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, the Boeing Company Long Term Disability Plan and the Boeing Company Life Insurance Plan, Defendants.

375 F.Supp.2d 956

Dennis WIBLE, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, the Boeing Company Long Term Disability Plan and the Boeing Company Life Insurance Plan, Defendants.

No. CV 04-4219 DT (MCX).

United States District Court, C.D. California.

June 20, 2005.

COPYRIGHT MATERIAL OMITTED

Corinne Chandler, Glenn R. Kantor, Kantor & Kantor, Northridge, CA, Russell G. Petti, Russell G. Petti Law Offices, La Canada, CA, for Plaintiff.

Ronald K. Alberts, Berger Kahn, Amber M. McGovern, Maria del Rey, CA, Courtney C. Hill, Stephan, Oringher, Richman and Theodora, Los Angeles, CA, for Defendants.

ORDER AND OPINION DENYING DEFENDANTS AETNA LIFE INSURANCE COMPANY AND THE BOEING COMPANY GROUP LIFE AND LONG TERM DISABILITY PLAN'S MOTION TO STRIKE PORTIONS OF PLAINTIFF'S EXHIBITS IN THE DECLARATIONS OF RUSSELL G. PETTI AND GLENN R. KANTOR; AND GRANTING PLAINTIFF DENNIS WIBLE'S MOTION FOR SUMMARY ADJUDICATION ON THE PROPER STANDARD OF REVIEW

TEVRIZIAN, District Judge.

I. Background

This action is brought by Plaintiff Dennis Wible ("Plaintiff") against Defendants Aetna Life Insurance Company, The Boeing Company Long Term Disability Plan and The Boeing Company Life Insurance Plan (collectively, "Aetna") for breach of the Employee Retirement Income Security Act of 1974 ("ERISA") and seeking recovery of disability and life benefits, prejudgment and postjudgment interest and attorneys' fees and costs. Plaintiff is trustee of the estate of Marianne Wible ("Ms.Wible"), and currently before this Court is Plaintiff's Motion for Summary Adjudication on the Proper Standard of Review relating to the denial of disability benefits to Ms. Wible.

A. Factual Summary

The following facts are found to be undisputed¹:

The Group Life and Long Term Disability Insurance Policy ("Policy") in this matter was issued by Defendant Aetna Life Insurance Company to The Boeing Company. The Policy provides discretionary authority through the following language:

For the purpose of Section 503 of Title 1 of the Employee Retirement Income Security Act of 1974, amended (ERISA), Aetna is a fiduciary with complete authority to review all denied claims for benefits under this discretionary authority to:

determine whether and to what extent employees and beneficiaries are entitled to benefits; and construe any disputed or doubtful terms of this policy.

The Policy states that Aetna is obligated to exercise this discretion for the benefit of claimants such as Ms. Wible. Specifically, the Plan recognizes that ERISA fiduciaries "have an obligation to administer the Plan prudently and to act in the interest of you and other Plan participants and beneficiaries."

Under the Policy, for the first 30 months of benefits (6months of short term benefits, and 24 months of long term benefits), Ms. Wible would be disabled if, because of an "accidental injury or illness" she was unable to perform "the material duties of [her] own occupation or other appropriate work the Company makes available." However, after 30 months, Ms. Wible would only be entitled to further benefits if she were disabled "from working at any reasonable occupation for which [she] may be fitted by training, education, or experience."

As of February 12, 2001, Ms. Wible was a fifty-six year old registered nurse, with a regular work history in that occupation. She was then working for Boeing in its "Health Service Unit", providing medical care to Boeing employees. In 1990, Ms. Wible suffered from an unknown illness, which included symptoms of "joint aches, chest pain, fatigue, and severe headaches."

In November of 1990, she experienced a "witnessed grand mal seizure," which led to her being referred to Dr. Daniel Wallace. According to Plaintiff, Dr. Wallace is a nationally recognized Lupus expert, who has authored the definitive clinical reference work as well as leading popular book on the disease, and who, as Clinical Chief of Rheumatology at Cedars-Sinai Medical Center, had been appointed an independent medical expert by Judge Stephen Wilson. Dr. Wallace diagnosed Ms. Wible as suffering from systemic lupus erythematosus ("SLE" or "Lupus") and assumed Ms. Wible's regular care for her condition.

Dr. Wallace began treating Ms. Wible with Prednisone, a steroid, which caused problems with toxicity and also with Ms. Wible's mental acuity. When Dr. Wallace was able to remove Ms. Wible from the steroids, her "cognitive functions" improved, and Ms. Wible became concerned about her ability to return to work. Eventually, with appropriate care, Ms. Wible was able to manage her symptoms and return to full time employment as a nurse, and Dr. Wallace continued to monitor and manage her Lupus. Ms. Wible continued to work, although with occasional flare-ups, in spite of her many documented medical problems which included hypertension, hypothyroidism, rhinitis and reflux disease.

Early in 2000, Ms. Wible began experiencing labored, difficult breathing. She was referred to Dr. Robert N. Wolfe, a pulmonary disease expert. In short order, she underwent a pulmonary function test, a chest CT scan, a biopsy, and a fiberoptic scan of her lungs and airways.

On February 14, 2001, Ms. Wible went on short-term disability. On March 5, 2001, Ms. Wible's STD claim was approved. In explaining why she was unable to work, Ms. Wible explained as follows:

Due to the shortness of breath, I cannot respond to emergencies. I must walk slow and short distances [sic]. My thought process is not functioning well and making numerous decisions and keeping up with the demand is difficult. Stress aggravates my shortness of breath as well as my forgetfulness and disorganization I am having.

Ms. Wible concluded that "[i]t has been a challenge to do my job for the past several years while the SLE was in remission. It is now impossible."

On April 19, 2001, Dr. Wallace provided an Attending Physician Statement. Dr. Wallace opined that Ms. Wible was disabled from her Lupus. He stated that she suffered from shortness of breath and stated as an "objective finding" that Ms. Wible's lung biopsy had shown "interstitial pneumonitis." Dr. Wallace also indicated that Ms. Wible was limited because of "steroid psychopathiogy," which he explained somewhat in a treatment note written that same day. "Patient has been on steroids for six weeks at 60 mg a day and is much better. However, the steroids are making her very toxic and it's hard for her to concentrate." He said Ms. Wible was "very cushingoid" (facial features associated with Lupus). Dr. Wallace also indicated in the treatment note that Ms. Wible suffered from a wide range of conditions, including SLE, hypertension, hypothyroidism, reflux and fibromyalgia, as well as the lymphocyctic intestitial pneumonitis. He opined that Ms. Wible was disabled and would never recover sufficiently to return to work.

On June 13, 2001, with her STD benefits nearing an end, Ms. Wible was evaluated for Long Term Disability ("LTD") benefits. On June 26, 2001, Dr. Wallace submitted another APS, affirming that Ms. Wible continued to be unable to work. Ms. Wible submitted a Claim Questionnaire and provided a list of medications she was currently taking for her condition, which included Synthroid, Protonix, Imuran, Prometium, Elavil and Prednasone. Aetna was also provided with a pathology report (from Ms. Wible's biopsy), which confirmed interstitial pneumonia. After a review of Ms. Wible's records, on July 31, 2001, Ms. Wible's claim for LTD benefits was approved.

Shortly after Ms. Wible's claim was approved, her file was sent to Dr. Brent T. Burton, an in-house physician. Dr. Burton reviewed the medical records and spoke with Dr. Wallace. He confirmed Dr. Wallace's opinion that Ms. Wible was disabled both because of her pulmonary problems as well as the cognitive impact of the drugs she was taking. However, he concluded that "there is no objective data contained in this file that document either sufficient respiratory impairment or cognitive dysfunction that would render her unable to work as a registered nurse." He further concluded that "the subjective data reported by Ms. Wible is not supported by objective documentation of impairment that would render her incapable of working as a registered nurse in at least a sedentary or light capacity."

Ms. Wible was informed that an independent medical examination ("IME") would be required. Ms. Wible questioned the need for the examination, suggesting that it was in response to a number of Boeing disability claims which had come in due to layoffs at that company. In response to her inquiry, Aetna informed Ms. Wible, in a telephone call, that it had made the decision that she was disabled from her own occupation, but that it needed to determine her "total work capacity" for when the definition of disability changed to "any occupation." Ms. Wible also suggested, based on her experience with Boeing, why she was being sent for an IME. She believed that Boeing had ordered Aetna to "crack the whip" and start terminating some claims because of all the LOA's and upcoming layoffs.

Ms. Wible was scheduled for an IME with Dr. Pradeep Damle, an expert in Pulmonary Medicine. After conducting his examination, Dr. Damle — a physician selected by Aetna — gave an unqualified opinion that Ms. Wible was indeed disabled from any possible occupation. Dr. Damle confirmed the diagnosis of lymphocytic interstitial pneumonia through that biopsy. He confirmed that Ms. Wible had CT scans which "showed interval increase in the pulmonary nodules and also what appears to be alveolitis involving the right mid lung zones." He also noted the pulmonary function tests which demonstrated her diminished lung functions. Dr. Damle also took into account Ms. Wible's numerous other medical problems, including her fibromyalgia, her seizure disorder and her gastrointestinal problems. Dr. Damle indicated that Ms. Wible's interstitial pneumonia was "moderately severe" and was supported by objective medical...