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Culver v. NXP USA Inc. Long Term Disability Insurance Plan

United States District Court, D. Arizona

May 22, 2019

Nathan Culver, Plaintiff,
v.
NXP USA Incorporated Long Term Disability Insurance Plan, et al., Defendants.

          ORDER

          Dominic U. Lanza United States District Judge.

         Pending before the Court is Plaintiff Nathan Culver's (“Culver”) motion to supplement the administrative record or remand (Doc. 59), which Defendants oppose (Doc. 62). Neither party has requested oral argument. As explained below, the motion will be granted to the extent it seeks a remand.

         BACKGROUND

         Culver is a former employee of Defendant NXP USA, Inc. (“NXP”) who, after becoming disabled in October 2014, sought benefits under NXP's Long Term Disability Insurance Plan. NXP self-funded this plan and hired a pair of third-party companies-first Aetna and then Prudential-to serve as plan administrators.

         In April 2015, Aetna denied Culver's initial application for long-term disability (“LTD”) benefits. (Doc. 62-2 at 24-26.)

         In September 2015, Culver appealed this decision. (Doc. 62-2 at 18.)

         On August 16, 2016, Aetna reversed its previous decision and granted Culver's application for LTD benefits. (Doc. 59-1.) However, Aetna also sent a separate letter to Culver on that date in which it explained that its definition of disability would be changing in November 2016 and thus asked Culver to submit an array of additional medical information. (Doc. 59-3 at 3.)

         On August 22, 2016, Aetna sent another letter to Culver encouraging him to apply for Social Security disability benefits. (Doc. 59-2.) This letter explained that, “[a]lthough your [LTD] benefit would be reduced by any Social Security disability benefits you may receive, you and your family still stand to gain some very significant financial advantages by obtaining a Social Security award . . . .” (Id.) In response, Culver faxed a letter to Aetna confirming that he'd already submitted such an application. (Doc. 62-2 at 9.)

         During September and October 2016, Aetna made repeated requests to Culver's attorney to supply additional medical information, but these requests were either ignored or inadequately addressed. (Doc. 59-3 at 3; Doc. 62-2 at 42-45.)

         On October 15, 2016, Culver executed a consent form that authorized Aetna to obtain his “entire Social Security file including all medical records, Financial records, consultations, reviews, exams, etc.” from the Social Security Administration (“SSA”). (Doc. 59-5.)

         On November 1, 2016, Aetna terminated Culver's LTD benefits and sent Culver a letter explaining that this decision was based on his failure to provide requested medical information. (Doc. 59-3.)

         In April 2017, Culver appealed this decision and submitted some additional medical records in support of his appeal. (Doc. 62-2 at 2-3.)

         In August 2017, Prudential (which had now replaced Aetna as the claims administrator) upheld the November 2016 termination of LTD benefits. (Doc. 62-2 at 63-68.)

         In February 2018, Culver appealed this decision. (Doc. 62-2 at 21.) In support of this appeal, Culver informed Prudential that “he has now been determined to qualify for Social Security Disability Insurance. Although he has not yet received the final written decision, we have included a letter from Mr. Culver's Social Security Disability attorney outlining the current status of his ...


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