United States District Court, D. Minnesota
Jacob R. Jagdfeld, Esq. and Johnson Becker PLLC, 33 South Sixth Street, Suite 4530, Minneapolis, MN 55402, counsel for plaintiff.
S. Russell Headrick, Esq. and Lathrop & Gage LLP, 2344 Grand Boulevard, Suite 2200, Kansas City, MO 64108, counsel for defendant.
DAVID S. DOTY, District Judge.
This matter is before the court upon the cross-motions for summary judgment by plaintiff Jennifer Jueneman and defendant Union Security Insurance Company d/b/a Assurant Employee Benefits (USIC). Based on a review of the file, record, and proceedings herein, and for the following reasons, the court grants the motion by defendant.
This insurance benefit dispute arises out of USIC's denial of long-term disability benefits to Jueneman. In 2008, Jueneman was a personnel recruiter for Flagship Marketing, Inc. Her position entailed screening job candidates, referrals, and clients, and required sedentary to light exertion. Admin. R. at 2143-44. Jueneman had disability insurance through USIC policy number G 5, 295, 764 (Policy) provided through her employer. Id. at 1. The Policy expressly grants USIC the "authority to determine eligibility for participation or benefits and to interpret the terms of the policy." Id. at 25.
On August 16, 2008, Jueneman suffered a shoulder injury for which she sought medical attention a few days later. Id. at 330, 2584. Jueneman was initially treated by Dr. Worenzoff at Tria Orthopaedic Center, who diagnosed her with a shoulder contusion and referred her to a chiropractor. Id. at 2584, 2604. After a few weeks without improvement, Dr. Worenzoff referred Jueneman to Dr. Braman, a shoulder specialist at Tria. Id. at 2582. Dr. Braman recommended physical therapy, which also did not help Jueneman's pain. Id . Jueneman was then referred to Dr. Nadine Maurer, a chronic pain specialist with Park Nicollet. Id. at 2602. Dr. Maurer noted the impression of shoulder pain, right upper extremity, and myofascial pain syndrome (MPS). Id . She prescribed physical therapy and neurontin for nerve pain. Id . Dr. Maurer also prescribed stellate injections, but Jueneman reported no resulting improvement. Id . Jueneman continued to work during this time.
In January 2009, Jueneman filed a claim for short-term disability benefits, claiming that she was unable to work due to the limited use of her right arm and shoulder. Id. at 346. Dr. Maurer supported the claim, diagnosing Jueneman with complex regional pain syndrome (CRPS) (also referred to as RSD), cervical and shoulder pain, and MPS. Id. at 339. Dr. Maurer recommended full medical disability for three months followed by an evaluation of Jueneman's ability to return to work. Id . USIC paid Jueneman short-term benefits based on Dr. Maurer's recommendation. Id. at 341. Jueneman remained on disability past the three-month period and her claim transferred to USIC's long-term disability department. Id. at 348-50. USIC informed Jueneman that it would continue to monitor her claim and would require her to provide updated medical records as proof of continuing disability. Id. at 349.
Jueneman continued treatment with Dr. Maurer, who prescribed medication for the pain and physical therapy. Id. at 2335. In June 2009, Jueneman's physical therapist noted "[i]mproved tolerance" and "good response" to treatment. Id. at 2337. On June 19, 2009, Dr. Maurer noted normal strength in the upper extremities. Id. at 2335.
In December 2009, a consulting physician reviewed Jueneman's file on behalf of USIC and concluded that Jueneman's "pain complaints are out of proportion to her physical findings." Id. at 2192. The physician recommended a functional capacity evaluation (FCE) to determine Jueneman's residual work capabilities. Id. at 2193. Dr. Maurer reported to USIC that Jueneman was medically stable and capable of participating in the FCE. Id. at 373.
USIC contacted Jueneman and requested that she participate in the FCE. Id . USIC also informed Jueneman that Dr. Maurer believed that she was capable of participating in the FCE. Id . Jueneman reportedly became upset at the prospect of the FCE and expressed concern that Dr. Maurer had made "too many mistakes." Id. at 373, 377. Jueneman indicated, for the first time, that she wanted to replace Dr. Maurer with another physician. Id. at 377.
The FCE took place on January 4-5, 2010. See id. at 2197-222. The FCE examiners concluded that Jueneman was capable of performing light work given her ability to lift and carry 15 pounds, with frequent sitting and occasional standing. Id. at 2207, 2211. The examiners further concluded that Jueneman was "capable of sustaining the Light level of work for an 8-hour day/40-hour week." Id. at 2207. USIC sent the FCE to Dr. Maurer and asked her to review the results. Id. at 685. Dr. Maurer was no longer Jueneman's physician, however, and she did not respond to the request. Id.
In February 2010, Jueneman began treatment with Dr. Margaret Guthrie at United Pain Center. Id. at 1984. Dr. Guthrie diagnosed Jueneman with unspecified myalgia, myostosis, and RSD in the upper and lower limbs. Id. at 1992. In March 2010, Jueneman was in a car accident, which worsened her symptoms. Id. at 1993.
After learning that Jueneman was now being treated by Dr. Guthrie, USIC sent the FCE to Dr. Guthrie for review and comment. Id. at 685. On June 15, 2010, Dr. Guthrie responded by indicating that she agreed with the FCE's determination that, although Jueneman could not work full-time right away, she could ultimately do full-time work at light and sedentary levels. Id . In July 2010, Jueneman became "quite hostile" because Dr. Guthrie had not contradicted the FCE. Id. at 2010. Jueneman told Dr. Guthrie that she should inform USIC that she is totally disabled. Id . When Dr. Guthrie declined to designate her as disabled, Jueneman became angry and told Dr. Guthrie that she wanted a new doctor. Id. at 2011. Dr. Guthrie consulted with two colleagues, both of whom agreed that designating Jueneman as completely disabled would be tantamount to fraud in light of the FCE. Id . Dr. Guthrie reported this conversation to Jueneman, who remained hostile and continued to demand a disability designation. Id . Dr. Guthrie then told Jueneman that she could no longer treat her due to her hostility and rudeness, which violated her patient contract with United Pain Center. Id . Jueneman began seeing Dr. Kenneth Britton in October 2010. Id. at 1719. Dr. Britton concluded that Jueneman suffered from RSD and recommended continued physical therapy, chiropractic care, pain medication, and psychological therapy to help with pain management. Id. at 1722. Dr. Britton did not place any restriction on Jueneman's ability to work. See id. at 1698-726. After consulting with Dr. Britton, USIC proposed a return-to-work program for Jueneman under the Policy's Quality of Care provision. Id. at 557-58, 1699. On July 29, 2011, USIC sent a letter to Jueneman explaining the ...