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McIntyre v. Reliance Standard Life Insurance Co.

United States District Court, D. Minnesota

May 28, 2019

MELISSA A. MCINTYRE Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY Defendant.

          Katherine L. MacKinnon and Nicolet Lyon, for plaintiff.

          Leah N. Kippola-Friske and William D. Hittler, NILAN JOHNSON LEWIS PA, for defendant.

          MEMORANDUM OPINION AND ORDER GRANTING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT

          JOHN R. TUNHEIM CHIEF JUDGE

         Plaintiff Melissa A. McIntyre brought this Employee Retirement Income Security Act (“ERISA”) claim against Defendant Reliance Standard Life Insurance Company (“Reliance”). McIntyre received long-term disability benefits from Reliance for approximately four years. Reliance terminated those benefits after review of McIntyre's case and determination that she no longer qualified as disabled. McIntyre appealed, and Reliance upheld its denial of McIntyre's benefits. McIntyre then brought the instant action for denial of her appeal and benefits under an ERISA plan. The Court will apply a de novo review to Reliance's denial of McIntyre's appeal. Because the evidence supports a finding of disability, the Court will grant McIntyre's Motion for Summary Judgment and deny Reliance's Motion for Summary Judgment.

         BACKGROUND

         McIntyre was employed by Mayo Clinic Health System as a nurse at a Mayo Hospital starting from December 2003. (Compl. ¶ 10 at 3, Nov. 16, 2017, Docket No. 1.) As part of her employment, McIntyre participated in an employer-sponsored long-term disability plan (the “Plan”) funded by a group long-term disability insurance policy administered by Reliance. (Aff. of William D. Hittler (“Hittler Aff.”) ¶ 3, Oct. 1, 2018, Docket No. 19, Exs. 1-26 (“Hittler Exs.”) at 1, Oct. 1, 2018, Docket No. 19-1.) The Plan is governed by ERISA. (Compl. ¶ 7, Nov. 16, 2017, Docket No. 1; Answer ¶ 7, Dec. 21, 2017, Docket No. 4.)

         By July 2011, McIntyre's worsening health rendered her unable to work. (Compl. ¶ 14.) McIntyre has suffered from Charcot Marie Tooth Syndrome (“CMT”) her entire life. (Id. ¶ 11.) CMT is a neurological condition that affects peripheral nerves and can result in the loss of sensation and atrophy of muscles in the feet, legs, and hands. (Compl. ¶ 12.) In July 2011, McIntyre left her position as a Registered Nurse because her CMT caused her to have difficulty performing her job duties. (Hittler Aff. ¶ 51; Ex. 26C (“Ex. 26C”) at 33-35, 118, Oct. 1, 2018, Docket No. 22.) Specifically, McIntyre had trouble balancing, ambulating to patient rooms, and with fatigue that required frequent naps. (Ex. 26C at 33-35.)

         McIntyre applied for and received short-term disability benefits for her entire short-term disability eligibility period. (Compl. ¶ 15.) The Plan provided for two types of long-term disability benefits: (1) Regular Occupation, an employee is unable to perform the duties of their regular occupation due to his or her disability; and (2) Any Occupation, an employee is unable to perform the duties of any occupation due to his or her disability. (Hittler Aff. ¶ 51; Ex. 26A (“Ex. 26A”) at 11, Oct. 1, 2018, Docket No. 20.) An insured may receive disability benefits for the first twenty-four months of their disability under the Regular Occupation benefit, but after twenty-four months, the benefit converts to Any Occupation, and an insured must then qualify for benefits under that definition. (Ex. 26A at 12.)

         On September 27, 2011, McIntyre applied for long-term disability benefits with Reliance. (Compl. ¶ 16.) Reliance approved McIntyre's benefits retroactive to October 18, 2011-the day after McIntyre's short-term disability benefits expired. (Id. ¶ 17.) Through a third party, Reliance also helped McIntyre apply for and obtain Social Security Disability Insurance benefits that Reliance used to offset the benefits it was required to provide to McIntyre. (Ex. 26C at 97.)

         Reliance initially determined that McIntyre qualified for Regular Occupation benefits because she had less than sedentary restrictions. (See Hittler Aff. ¶ 6, Hittler Exs. at 49.) In 2013 Reliance began evaluating whether McIntyre qualified for Any Occupation benefits. (Hittler Aff. ¶ 6, Hittler Exs. at 67-68.) In a letter dated February 5, 2016, Reliance notified McIntyre that because she was capable of performing sedentary and light work activity she was not entitled to receive Any Occupation benefits beyond December 1, 2015. (Hittler Aff. ¶ 36, Hittler Exs. at 165.)

         On May 31, 2016, McIntyre appealed Reliance's termination decision through her attorney, Jerold M. Lucas. (Hittler Aff. ¶ 51; Ex. 26E (“Ex. 26E”) at 79, Oct. 1, 2018, Docket No. 24.) In her appeal, McIntyre included a letter from Dr. Vanessa Tseng, McIntyre's treating neurologist, opining that McIntyre was unable to engage in any gainful employment, even in a sedentary position; an employment evaluation report dated May 6, 2016 and prepared by Kate Schrot, a Qualified Rehabilitation Consultant; a letter from McIntyre; and seven testimonial letters from witnesses regarding McIntyre's disability. (Id. at 79-80.)

         On June 22, 2016, Susan Strickler, a Senior Benefit Analyst with Reliance, responded by letter to Lucas informing him that Reliance was seeking further medical records from Dr. Mankato, Dr. Stevens, and Dr. Tseng. (Hittler Aff. ¶ 51; Ex. 26B (“Ex. 26B”) at 200-01, Oct. 1, 2018, Docket No. 21.) Strickler also informed Lucas that the statutory period for processing an appeal would be tolled until Reliance received the requested information from McIntyre. (Id. at 200.) McIntyre asserts that a Dr. Mankato does not exist and thus records from Dr. Mankato could not be provided.

         After nearly a month passed without receiving a response to its request for records from Dr. Tseng and Dr. Mankato, Reliance followed up by sending a letter to Lucas advising him that Reliance had not received a response and requesting Lucas's assistance in obtaining the records. (Ex. 26B at 207.) Dr. Tseng responded on July 25, 2016. (Ex. 26E at 131.) Dr. Tseng provided the medical records, noting that the records had already been released to Reliance previously. (Id.)

         Reliance then continued to wait for records from Dr. Mankato. On August 10, 2016, Reliance sent another letter to Lucas informing him that it had not yet received records from Dr. Mankato and again requesting those records. (Ex. 26B at 208.)

         Then, on August 25, 2016, Reliance sent a letter to Lucas informing him that it had received and reviewed the medical records. (Ex. 26B at 209.) Based on this review, Reliance required McIntyre to undergo an independent medical examination (“IME”). (Id.) The letter stated that Reliance's “request for an IME will toll the statutory time frames for reaching an appeal determination, from the time of our request until such time as we receive the independent physician's report.” (Id.)

         By letter dated September 8, 2016, Reliance informed Lucas that an IME had been scheduled for September 20, 2016, and that McIntyre was required to attend the appointment. (Id. at 211.) The IME, however, was canceled the day before the appointment by the doctor due to a conflict of interest. (Hittler Aff. ¶ 51; Ex. 26F (“Ex. 26F”) at 53, Oct. 1, 2018, Docket No. 25.) Reliance re-scheduled the IME for October 22, 2016 in Alexandria, Minnesota. (Ex. 26E at 207.) Lucas objected to this because the location required three hours of travel one way, and the IME was scheduled for a day when McIntyre was unavailable. (Ex. 26F at 2-3.) Lucas also noted that Reliance had already delayed a decision on the appeal too long. (Id.) Reliance replied in three letters, one dated October 20, 2016, and two dated October 25, 2016, informing Lucas that Reliance was “required to make a decision within 45 days of the date of [McIntyre's] appeal but [was] allowed an additional 45 days if circumstances do not permit us to make a decision within the initial 45 day time frame, ” and that those letters served as “notice of our intention to take beyond 45 days to make a final decision.” (Ex. 26B at 213-218.) The October 22, 2016 appointment was cancelled on October 20, 2016 due to Lucas's concerns. (Ex. 26F at 84).

         Although the second IME appointment had been cancelled on October 20, 2016, another IME was not re-scheduled until November 9, 2016. (See Ex. 26F at 82.) Reliance failed to promptly reschedule the IME because of an internal failure of communication and follow-up by the employee assigned to review McIntyre's appeal. (See Ex. 26F at 82-88.) The IME was then scheduled for December 3, 2016, in Burnsville, Minnesota with Dr. Khalafalla Bushara. (Ex. 26F at 6.) McIntyre attended the IME with her parents. (Ex. 26F at 10.) Dr. Bushara prepared a report dated December 16, 2016. (Ex. 26F at 9-16.) The report noted McIntyre's symptoms and ultimately concluded that McIntyre was capable of performing sedentary jobs, such as office work. (Id. at 16.) After review of the report, Reliance upheld its decision to terminate McIntyre's benefits by letter dated December 21, 2016. (Ex. 26F at 42-46.)

         The administrative record contains opinions regarding McIntyre's ability to work from Debra Thompson, Dr. Tseng, Dr. Bushara, Ms. Schrot, and McIntyre's friends and family. Dr. Tseng, starting in 2011, evaluated and treated McIntyre for her CMT and held the opinion that McIntyre could not work full time due to her CMT. (See Ex. 26C at 79-82; Hittler Aff. ¶ 51; Ex. 26D (“Ex. 26D”) at 44, 46-47, 125-26, Oct. 1, 2018, Docket No. 23; Ex. 26E at 47-48, 81.) Dr. Tseng's latest opinion, made in March 2016, was that McIntyre could not work full time because McIntyre could not stay in one position or perform one task for greater than thirty minutes due to her pain and fatigue. (Ex. 26E at 81.) Debra Thompson, an occupational medicine registered nurse, also evaluated McIntyre starting in 2011 and provided the opinion that McIntyre could not work due to her CMT. (See Ex. 26C at 7, 33-35, 60, 114; Ex. 26D at 37-38, 98-99.) In May 2016, Ms. Schrot reviewed McIntyre's medical records, performed an interview, and evaluated McIntyre for an employment report and provided the opinion that McIntyre could not work full-time. (See Ex. 26E at 82-87.) In December 2016, Dr. Bushara reviewed McIntyre's medical records and evaluated ...


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