United States District Court, D. Minnesota
MELISSA A. MCINTYRE Plaintiff,
RELIANCE STANDARD LIFE INSURANCE COMPANY Defendant.
Katherine L. MacKinnon and Nicolet Lyon, for plaintiff.
N. Kippola-Friske and William D. Hittler, NILAN JOHNSON LEWIS
PA, for defendant.
MEMORANDUM OPINION AND ORDER GRANTING PLAINTIFF'S
MOTION FOR SUMMARY JUDGMENT
R. TUNHEIM CHIEF JUDGE
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.
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.)
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.)
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.)
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.)
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
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.
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.
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.
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.)
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.)
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).
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.)
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