United States District Court, D. Arizona
G. MURRAY SNOW, District Judge.
Pending before the Court is Melissa Chavez's appeal of Defendant Reliance Standard Life Insurance's ("Reliance") determination that she does not qualify for long-term total disability benefits. (Docs. 25, 27, 28.) For the following reasons, the Court affirms the determination of Reliance.
Chavez worked as a Senior Long Term Disability Claims Manager for Defendant Matrix Absence Management, Inc. ("Matrix"), which provided disability benefits to its employees under its Absence Management Employee Benefit Plan (group policy number LTD 099765) (the "Plan"). According to the Plan, employees were eligible for short-term benefits for up to ninety days, long-term benefits for up to twenty four months if they could not perform the occupation for which they were hired ("own occupation benefits"), and long-term benefits past twenty four months if they could not perform any occupation ("any occupation benefits").
Chavez first became disabled on July 8, 2008. She received both short-term and long-term own occupation benefits until she returned to work in October 2008. During this first period of disability, doctors discovered white matter lesions in Chavez's brain.
In May 2010, she again applied for short-term disability benefits. Later that same year, she applied for long-term benefits, and on September 16, 2010, she began to receive long-term own occupation benefits with a monthly allocation of $2558.40. As part of the process for applying for and receiving disability benefits under the Plan, Chavez indicated that she was diagnosed with rheumatoid arthritis, Sjogren's disease, and hypothyroidism. She also frequently complained of migraine headaches.
Chavez continued to receive long-term own occupation benefits until 2012. On March 12, 2012, Reliance sent a letter to Chavez informing her that the period for own occupation benefits was ending soon and that Reliance would be "gathering information concerning [her] medical condition, education, training and experience" and that this review "could potentially lead [Reliance] to conclude that" Chavez would not be eligible for any occupation benefits. (Doc. 23, Ex. 7.)
In August 2012, Reliance received an anonymous phone call, stating that Chavez was not disabled. In September and in October 2012, Reliance paid Chavez any occupation benefits under the Plan. On September 27, 2012, Dr. Debra Rowse performed an independent medical examination ("IME") of Chavez in which Dr. Rowse physically examined Chavez and also reviewed Chavez's medical history related to Chavez's 2010 disability claim. Dr. Rowse noted Chavez's diagnosed illnesses, but noted that the rheumatoid arthritis "has been quiescent over the past few years, " that the Sjogren's disease is "treated systematically, " and that the hypothyroidism is "controlled on medication." (Doc. 23, Ex. 12, p. 4.) Dr. Rowse also noted that Chavez "may have migraine headaches, " but concluded that Chavez's failure to receive treatment "raises many questions." ( Id. ) Nevertheless, because Dr. Rowse did not review the medical records pertaining to Chavez's 2008 claim, she did not review the MRI that showed white matter in Chavez's brain. Dr. Rowse also opined that, although Chavez complained of other symptoms, there was no "objective evidence to support diagnoses of cervical radiculopathy, low back pain, multiple sclerosis, fibromyalgia or carpal tunnel syndrome" and that "[t]he level of pain and the severity of disease that Ms. Chavez alleges is not supported by the objective findings." ( Id. )
Reliance concluded, based on Dr. Rowse's findings, that Chavez was capable of performing sedentary level work, performed a Residual Employability Analysis ("REA") on Chavez, and concluded that she could perform her prior work as a claims examiner, as well as other occupations, such as a contract representative, a customer complaint clerk, or a policyholder-information clerk. Reliance discontinued benefits to Chavez on November 8, 2012.
Chavez appealed Reliance's decision on November 20, 2012, and Reliance requested a review of Chavez's medical record by Dr. Manoj Moholkar as part of the appeals process. Dr. Moholkar made findings, similar to Dr. Rowse, that all of Chavez's diagnosed illnesses were either stable or treatable and that Chavez's non-compliance with treatment contributed to many of her symptoms. Dr. Moholkar concluded that Chavez could perform work at a sedentary level.
On June 13, 2013, Chavez submitted additional medical records, which Reliance forwarded to Dr. Moholkar for review. The additional records included the information about the white matter lesions that doctors had discovered when Chavez had initially applied for short-term benefits in 2008, updated reports from two doctors who examined Chavez in 2013, including an MRI of the lesions, more information about Chavez's migraines, and claims of memory problems. Dr. Moholkar stated that the new medical evidence did not change his earlier conclusion because the migraines did not appear to be debilitating, Chavez's claims of memory problems were not supported by objective evidence, and there was no diagnosis of demyelinating disease, a serious disease associated with white matter lesions, from the MRI taken in 2013. Reliance conducted a second REA, which confirmed the results of the earlier REA based on Dr. Rowse's findings, and on July 12, 2013, Reliance upheld its decision to discontinue benefits.
On December 11, 2013, Chavez filed the present action under section 502 of ERISA, claiming that Reliance committed several procedural errors and incorrectly interpreted the Plan in denying her benefits.
I. Legal ...