Applegate v. Liberty Life Assurance Co. of Bos.

ROBERT APPLEGATE, Plaintiff, v. LIBERTY LIFE ASSURANCE COMPANY OF BOSTONand PARKER HANNIFIN CORPORATION, Defendants.

Case No: 2:17-cv-130-FtM-99MRM

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA FORT MYERS DIVISION

July 24, 2018

REPORT AND RECOMMENDATION¹

Pending before the Court are: Defendant's Motion for Final Judgment on the Administrative Record, filed on January 12, 2018 (Doc. 41); Plaintiff's Response thereto, filed on February 16, 2018 (Doc. 46); Plaintiff's Motion for Judgment on the Record, filed on January 16, 2018 (Doc. 44); and Defendant's Memorandum in Response thereto, filed on February 16, 2018 (Doc. 45). For the reasons stated below, the Court respectfully recommends that Defendant's Motion for Final Judgment on the Administrative Record (Doc. 41) be GRANTED and Plaintiff's Motion for Judgment on the Record (Doc. 44) be DENIED.

I. Background

This is an action brought pursuant to the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. (Doc. 29 at 1 ¶ 1). Plaintiff Robert Applegate alleges that Defendants Liberty Life Assurance Company of Boston ("Liberty Life") and Parker Hannifin Corporation ("Parker Hannifin") wrongfully terminated his benefits under a long-term disability insurance policy ("LTD"). (Doc. 29 at 6 ¶¶ 31, 32). Defendants claim that Plaintiff failed to exhaust his administrative remedies and, further, that the decision to deny Plaintiff's LTD benefits was correct and reasonably supported by substantial evidence of record. (See generally Doc. 41).

A. Procedural History

Parker Hannifin employed Plaintiff from February 1, 1993 through September 26, 2012. (AR at 1).² During his last years of employment, Plaintiff worked as an Inspector Technician. (Id. at 1, 550-51). At times while employed, Plaintiff participated in Parker Hannifin's LTD group plan issued by Liberty Life and sponsored by Parker Hannifin. (Id. at 846). Plaintiff suffered from low back pain that gradually worsened with pain radiating to the lateral aspects of Plaintiff's right leg and foot. (Id. at 631). Plaintiff sought a spinal cord stimulator on September 27, 2012. (Id. at 631-32).

Plaintiff applied for and began receiving Short Term Disability benefits, beginning on September 27, 2012, and ending on March 27, 2013. (Id. at 490). When these benefits expired, Plaintiff applied for and began receiving LTD benefits on March 26, 2013. (Id. at 519).

The LTD plan provides:

During the first two years after you qualify for LTD benefits, you are considered to have a qualifying disability if your medical condition prevents you from performingthe essential functions of your occupation, even with job accommodations Parker makes for you. This means you are unable to perform the functions normally required of your occupation in the national economy.

(Id. at 793 (emphasis in original)). Thus, Liberty Life approved LTD benefits "based on [Plaintiff's] inability to perform the duties of his occupation." (Id. at 519). The LTD plan paid Plaintiff 66 2/3% of his pre-disability earnings less benefits from other income. (Id.).³

Issues arose after the first two years ended. The LTD plan provides:

After two years of eligibility for LTD benefits, your disability is considered to be a qualifying disability only if you are unable to perform the essential functions of your occupation or any other occupation for which you are or could, with minimal training, become qualified. In determining if you are able to engage in any other occupation, the claims administrator considers your:

• Education (level and type of education required to perform the occupation),

• Training (fully trained or only in need of the training normally provided to a qualified individual entering this position as a new hire or internal transfer),

• Experience (relevant work experience that equals or exceeds the occupation requirements), and

• Medical ability (ability to perform the essential functions of the occupation with, or without, reasonable accommodation).

(Id. at 793 (emphasis in original)).

On February 11, 2015, Liberty Life notified Plaintiff by letter that it completed a thorough review of his eligibility for benefits and decided that he was no longer eligible for LTD benefits beyond March 27, 2015. (Id. at 156). Liberty Life considered office visit notes from Dr. Richard Hood dated April 24, 2013 through October 15, 2014, as well as office visit notes from Dr. Dean Lin dated October 4, 2012 through October 25, 2012. (Id. at 157).

Liberty Life then referred Plaintiff's file to an independent physician for review who found Plaintiff capable of performing full-time work with certain restrictions and limitations.(Id.). Liberty Life also referred Plaintiff's file to a Vocational Specialist to conduct a vocational analysis of Plaintiff's abilities. (Id.). The Vocational Specialist determined that Plaintiff was capable of performing the following occupations: Assembler, Small Parts; Assembler, Electromechanical, Small Parts; Security Reception/Badge Checker; Cashier; and Information Clerk. (Id. at 158). Liberty Life informed Plaintiff that he may "request a review of this denial by writing" to Liberty Life within 180 days from receipt of the February 11, 2015 letter, and must state the reasons Plaintiff felt the claim should not have been denied along with documentation to support his assertions. (Id. at 158-59).

By letter dated August 6, 2015, Plaintiff appealed the February 11, 2015 decision to deny benefits. (Id. at 146). The August 6, 2015 letter states:

Please accept this letter as the appeal of Mr. Applegate's LTD claim, which was denied on February 11, 2015. I would also like to request that you delay reviewing Mr. Applegate's claim until approximately August 28, 2015, while I am trying to obtain additional medical information from Mr. Applegate's treating physician. If you have any questions, please do not hesitate to contact me. Thank you.

(Id.). Plaintiff submitted office visit notes dated March 18, 2015 through July 9, 2015 from Dr. Hood. (Id. at 79). Plaintiff also submitted an office visit note dated September 12, 2015 and a medical source statement dated October 12, 2015 from Dr. Alan Tannenbaum. (Id.).

On November 5, 2015, Liberty Life sent Plaintiff's counsel a letter stating that it reviewed Plaintiff's request for "reconsideration of Robert Applegate's claim for Long Term Disability ("LTD") benefits and [has] maintained the decision to deny benefits beyond March 27, 2015." (Id. at 78). In this letter, Liberty Life stated that it had referred Plaintiff's file to an independent physician, Dr. Howard Grattan, for review. (Id. at 79-80). Dr. Grattan determined that Plaintiff "would have the capacity to maintain full-time employment within the restrictions and limitations outlined above." (Id. at 80 (emphasis omitted)). After Dr. Grattan's medicalreview, Liberty Life also engaged a vocational consultant to review Plaintiff's claims. (Id. at 81). This vocational consultant "confirmed that the previously identified occupations remained viable alternatives based on the capacities outlined by Dr. Grattan." (Id.). Liberty concluded that "[h]aving carefully considered all of the information submitted in support of Mr. Applegate's claim, our position remains that proof of his continued disability in accordance with the Plan provisions after March 27, 2015 has not been provided, and our original decision to deny benefits beyond that date is therefore upheld." (Id.).

The November 5, 2015 letter set forth procedures to request a review of the denial if Plaintiff disagreed with the decision. (Id. at 82). Specifically, this letter provided: "If Mr. Applegate disagrees with this denial, he may make a written request to Liberty Life Assurance Company of Boston. He may submit any additional information or comments he deems pertinent for review. All requests must be made in writing within 60 days of the date of this letter." (Id.).

On January 4, 2016, Plaintiff's counsel sent a letter to Liberty Life stating the following: "This letter is in response to your denial letter dated November 5, 2015. The letter provides that additional information pertinent to review maybe [sic] submitted within 60 days of the denial letter. I would like to request [an] additional 10 days to submit additional evidence from Mr. Applegate's treating physician, Richard Hood, M.D." (Id. at 64). Liberty Life wrote a letter in response dated January 13, 2016. (Id. at 47). In this letter Liberty Life stated the following: "Please be advised that the LTD plan under which Mr. Applegate is covered is a self-insured plan sponsored by his employer, Parker Hannifin Corporation, for which Liberty Life Assurance Company of Boston ("Liberty Life") provides administrative services only. We have confirmedwith Parker Hannifin Corporation that they will not permit the extension requested in your January 4, 2016 letter." (Id.).

Plaintiff sent a second Letter dated January 14, 2016. (Id. at 49). In this Letter, Plaintiff requested a second extension of twenty (20) days to submit additional evidence, stating the following:

Please grant our office a second extension of time in which to submit additional evidence in this case. We previously requested our first extension on 01/04/16. We are still waiting for Dr. Hood's office to send us the additional evidence. We are keeping this in strict follow up. [sic] Please grant and [sic] additional twenty (20) days to submit additional evidence. This will make our new deadline February 3, 2016 to submit our additional evidence in this case.

(Id.). On January 15, 2016, Liberty Life responded stating that it was unable to grant Plaintiff's request for a second extension of time to submit additional evidence. (Id. at 45). Liberty Life also stated, "[a]s outlined in our January 13, 2016 letter (copy attached), Parker Hannifin Corporation, the self-insured Plan Sponsor, will not permit an extension." (Id.).

On January 29, 2016, Plaintiff sent another letter...