United States District Court, D. Minnesota
R. Strand, Esq., Thomas J. Beedem, Esq. counsel for
G. Lipschultz, Esq. and Littler Mendelson, PC, counsel for
S. Doty, Judge
matter is before the court upon the cross-motions for summary
judgment by plaintiff Jeremy Braden and defendant AT&T
Umbrella Benefit Plan No. 3. Based on a review of the file,
record, and proceedings herein, and for the following
reasons, the court grants defendant's motion.
insurance benefit dispute arises out of the Plan's denial
of short-term disability benefits to Jeremy Braden. From July
14, 2008, to June 2, 2015, Braden was employed at AT&T as
a Business Customer Service Specialist II. Braden's
position required him to use problem solving and
troubleshooting skills to assist AT&T's internal
customer service representatives and business clients with a
variety of cellular network and billing issues. Admin. R. at
277-78. The position was sedentary; it consisted of using a
telephone and computer while sitting. Id. at 1.
Braden had disability benefits through the AT&T Mobility
Benefits Program (Plan). Under the Plan, AT&T delegated
its discretionary authority to make all benefit
determinations to Sedgwick Claims Management Services, Inc.
See id. at 725, 727. A claimant filing for
disability benefits under the Plan must provide Sedgwick with
“satisfactory Medical Evidence of [his] Disability from
[his] Physician.” Id. at 703. The Plan defines
“medical evidence” as:
Objective medical information sufficient to show that the
Participant is Disabled, as determined at the sole discretion
of [Sedgwick]. Objective medical information includes, but is
not limited to, results from diagnostic tools and
examinations performed in accordance with the generally
accepted principles of the health care profession. In
general, a diagnosis that is based largely or entirely on
self-reported symptoms will not be considered sufficient to
support a finding of Disability. For example, reports of
intense pain, standing alone, will be unlikely to support a
finding of Disability, but reports of intense pain
associated with an observable medical condition that
typically produces intense pain could be sufficient.
Id. at 725 (emphasis added).
January 15, 2015,  Braden stopped working due to back pain,
and, on January 23, applied for short-term disability
benefits. See id. at 1, 4, 38. On January 29, Braden
submitted a form completed by his physician, Dr. Thomas
Kiefer. See id. at 85. Kiefer stated that Braden
suffered from “pain and immobility” due to
“lumbar disc syndrome.” Id. Due to this
condition, Kiefer stated that Braden would need “days
off work intermittently” and that his current
functional restrictions were “limited lifting or
bending.” Id. Based on this information,
Sedgwick approved disability benefits through January 22.
Id. at 92.
February 5, Braden sent Sedgwick a progress report from a
February 3 follow-up visit with Kiefer, in which Kiefer
discussed Braden's history of lumbar disc syndrome
including two previous lumbar surgeries completed in December
2013 and June 2014. Id. at 94-95. Kiefer reported
that Braden appeared in “moderate distress, ” had
“difficulty walking, ” had a poor range of
motion, and could not “bend forward very much.”
Id. at 94. Kiefer also discussed the results of a
February MRI, which showed that Braden had bulging discs, and
that he did not know when Braden could return to work.
Id. at 95.
Plan sought an independent review of Braden's medical
records, and on February 12, Dr. Xico Garcia, a family
practice physician, concluded that the evidence supported a
claim for disability starting January 26 and that Braden
could reasonably be expected to return to work by February 16
if his symptoms improved. Id. at 97-99. Based on
Garcia's review, the Plan approved Braden's
disability claim through February 16. Id. at 356.
did not return to work on February 17, and, on February 20,
the Plan denied disability benefits for February 17 forward
because “the medical documentation did not clearly
address the severity of [Braden's] condition.”
Id. at 358. The denial letter informed Braden that
he needed to provide “clear documentation from [his]
current treating provider(s) of why [he was] not able to
perform the essential duties of [his] occupation.”
Id. at 359. Further, the documentation would need to
state “[his] functional impairments as they relat[ed]
to [his] diagnosis and provide a treatment plan that
addresses plans for [his] return to work with or without
reasonable restrictions with a reasonable duration.”
response, on March 13, Braden submitted a report from a
February 25 follow-up visit with Kiefer, in which Kiefer
observed that Braden experienced pain from bending forward,
had difficulty sleeping because of the pain, and had a
positive straight leg exam. Id. at 101-02. Kiefer
also stated that Braden should continue to be off work and
that and Braden “knows he cannot sit or stand for very
long.” Id. The Plan again denied disability
benefits from February 17 forward for the same reasons
provided in the previous denial letter. See id.
March 27, Braden submitted a note from Kiefer stating that he
had been disabled due to lumbar disc syndrome but could
return to work on March 30 for 4 hours per day, 5 days per
week. Id. at 125. The return-to-work note stated
that Braden could not lift more than ten pounds, climb
ladders, or squat, and that he may need to change positions
every half-hour. Id. On April 2, Braden submitted
another note dated April 1, in which Kiefer reiterated that
Braden could not sit for over thirty minutes without standing
or walking. Id. at 127.
returned to work on March 30, but he stopped working again on
April 6 due to back pain. Id. at 406. On April 22,
Braden submitted an April 21 physician statement from Kiefer
stating that Braden had lumbar pain with immobility.
Id. at 497.On April 30, Dr. Katherine Duvall, a
physician specializing in occupational medicine, spoke with
Kiefer by telephone and reviewed the physician statement.
Id. Kiefer informed Duvall that, based on the
February MRI, Braden had mild stenosis and a bulging disc,
but that “the MRI did not show a ‘terrible
problem.'” Id. He also stated that Braden
had a decreased range of motion but no neurological deficits
and that he wanted to keep Braden off work completely until
he met his physical therapy goals. Id. Based this
information, Duvall concluded there was insufficient
objective medical evidence to support a claim for disability.
Id. at 498. On May 6, the Plan denied disability
benefits from April 6 forward. See id. at 504-06.
Again, the denial letter informed Braden that he should
submit documentation showing how his condition rendered it
impossible for him to work. See id. at 505.
1, Braden submitted physical therapy notes from Dr. Frank
Wei, a physician specializing in physical medicine and
rehabilitation. See id. at 522-32. Wei recommended
physical therapy two days per week for four weeks.
Id. at 531. After a review of this additional
information, the Plan informed Braden that it would not alter
its previous denial. See id. at 533. Braden then
submitted a May 15 procedure report and a June 1 progress
note from Wei on June 19. See id. at 209, 512. The
procedure report indicated that Braden received an epidural
injection in his back on May 15 and that Braden reported low
back pain as “4/10" pre-procedure and
“2-3/10" post-procedure. Id. at 512. In
the progress note, Wei reported that Braden continued to have
back and leg pain, “move[d] about the room stiffly,
” a straight leg test was positive, and was “not
improving significantly with non-operative care.”
Id. at 209. On June 24, the Plan informed Braden
that the new information did not alter its decision.
Id. at 542-43.
than appeal, on July 10, Braden submitted notes from a June
12 visit with Dr. John Mullan, a spine specialist. See
id. at 135-36. Mullan stated that Braden had a history
of lower back pain and that Braden felt he was disabled and
unable to work. Id. at 135. Mullan observed that
Braden was “in no acute distress, ” had a normal
gait, his “motor strength [was] 5/5 in all muscle
groups, ” he had no sensory loss in the lower
extremities, and a straight leg test was negative.
Id. Mullan discussed the possibility of back surgery
with Braden, and Braden agreed to the surgery. Id.
September 14, Braden, through counsel, appealed the denial of
short-term disability benefits. See id. at 145. In
support of his appeal, Braden submitted: (1) Garcia's
February 12 medical review; (2) Keifer's February 25
progress notes; and (3) Mullan's June 12 follow-up visit
notes. Id. This information was the same information
Braden had earlier submitted. See id. at 146. ...