Jalowiec v. Aetna Life Ins. Co.

155 F.Supp.3d 915

William Jalowiec, Plaintiff,

v.Aetna Life Insurance Company, Defendant.

Civil No. 14-4332 (DWF/LIB)

United States District Court, D. Minnesota.

Signed December 21, 2015

KrisAnn Norby-Jahner, Esq., Brian R. Christiansen, Esq., and Denise Yegge Tataryn, Esq., Hellmuth & Johnson PLLC, counsel for Plaintiff.

Eric P. Mathisen, Esq., Colton D. Long, Esq., and Hal A. Shillingstad, Esq., Ogletree, Deakins, Nash, Smoak & Stewart, PC, counsel for Defendant.

MEMORANDUM OPINION AND ORDER

DONOVAN W. FRANK, United States District Judge

INTRODUCTION

This matter is before the Court on cross-motions for summary judgment brought by Plaintiff William Jalowiec (“Jalowiec”) (Doc. No. 27) and Defendant Aetna Life Insurance Company (“Aetna”) (Doc. No. 23). For the reasons stated below, the Court grants Plaintiff's motion in part and denies Defendant's motion.

BACKGROUND

In November 2006, Jalowiec was hired as a Design Documentation Control (“DDC”) Supervisor at TEAM Industries, Inc. (“Team Industries”). (Doc. No. 33, Declaration of Lina M. Camacho (“Camacho Decl.”) ¶ 8, Ex. B (Administrative Record (“AR”)) at 36, 392-93.) In this position, Jalowiec supervised employees, coordinated employee efforts to maintain consistency of processes, resolved problems, and provided technical advice. (AR at 392.) In February 2012, Jalowiec ended his employment at Team Industries due to the onset of daily debilitating headaches that “impacted [his work duties] to a very large degree.” (AR at 36, 481.)

Prior to the onset of this disabling condition, Jalowiec enjoyed boating, yard work, attending school events, camping, exercising, and Tae Kwon Do. (AR at 37.) After the condition began, however, Jalowiec was rarely able to engage in these activities due to pain and the effects of his medications. (Id. ) Jalowiec sought short-term disability (“STD”) and long-term disability (“LTD”) benefits under a plan sponsored by his employer and underwritten by Aetna. (See Camacho Decl. ¶ 6, Ex. A (Plan Documents (“PD”)) at 2, 29; AR at 293.) Although Aetna awarded Jalowiec STD benefits (AR at 293), it denied Jalowiec's claim for LTD benefits (AR at 778-80). Jalowiec now challenges Aetna's denial under the Employee Retirement Income Security Act of 1974 (“ERISA”).

I. Jalowiec's Position at Team Industries

As a DDC Supervisor at Team Industries, Jalowiec was responsible for supervising a group of personnel, coordinating employees to maintain consistent processes, providing direction to employees in their daily assignments, and ensuring the integrity of CAD models and component prints to meet defined standards. (See AR at 392.) His duties included coordinating and facilitating staff training, providing feedback, reviewing and writing reports, coordinating recruitment of new employees, and conferring with peers to solve problems and provide technical advice. (See id. ) Other duties identified by his employer included design/print review meetings, conducting presentations at Design and Drafting “Best Practices” meetings, attending to designer and drafter problems on a daily basis at various work stations in the department, traveling to colleges for recruitment presentations, traveling to required software conferences, presenting training to groups in various Team Industries locations, and leading the interview process for prospective new drafters. (AR at 1280.) Jalowiec's job description listed the following “Essential Functions” of the job:

• Communicates appropriately by listening to others, processes information, and communicates effectively ... • Must be able to frequently lift up to 25 pounds and occasionally up to 50 pounds.

• Capable of riding ATV's, snowmobiles, motorcycles, tractors, etc.

• Write reports and effectively present information to teams and/or supervisor...

• Occassional [sic] travel required

• Must be able to sit and work while modeling up to 8 hours per day

(AR at 393.) In a work history questionnaire completed for Aetna, Jalowiec noted that he worked a ten-hour work day, sat eight hours per day, stood one hour per day, and walked one hour per day. (AR at 36.) He indicated that his position required him to bend/stoop, crawl, reach above his shoulders, kneel, push/pull, and lift up to 50 pounds or more occasionally. (Id. )

II. The Plan

Jalowiec's employment with Team Industries entitled him to certain benefits, including short-term and long-term disability insurance. Team Industries' group long-term disability plan (“LTD Plan”) is underwritten by Aetna, and is governed by ERISA. (See PD at 2, 29, 56.) The LTD Plan provides, in relevant part: “This Plan will pay a Monthly Benefit for a period of total disability caused by a disease or accidental bodily injury.” (PD at 3.) The LTD Plan then provides the following definition of total disability: “You are deemed to be totally disabled if you are not able, solely because of injury or disease, to perform the material duties of your own occupation. ...” (Id. ) The LTD Plan clarifies this provision, stating:

You will not be deemed to be performing the material duties of your own occupation or working at a reasonable occupation on any day if:

• you are performing at least one, but not all, of the material duties of your own occupation or you are working at any occupation (full-time or part-time); and

• solely due to disease or injury, your income from either is 80% or less of your adjusted pre-disability earnings.

(Id. ) The LTD Plan provides a list of circumstances under which a period of total disability will be deemed to end, including the following relevant provisions:

• The date you are not totally disabled....

• The date you fail to give proof that you are still totally disabled.

(PD at 4.) Under a provision labeled, “How and When To Report Your Claim,” the LTD Plan states, “[y]our claim must give proof of the nature and extent of the loss.” (PD at 14.) In addition, the LTD Plan states, “Aetna may require copies of documents to support your claim,” and “[y]ou must furnish such true and correct information as Aetna may reasonably request.” (Id. )

III. Jalowiec's Medical History

In February 2011, Jalowiec was involved in a Tae Kwon Do event during which he suffered a “blow to the back of his head.” (AR at 381.) Jalowiec's medical difficulties began around this same time when he began experiencing chronic headaches coupled with symptoms of dizziness. (AR at 379.) During a July 2011 visit to his primary care clinic, Corinne Dargus, A.P.R.N., B.C., P.A.-C (“Dargus”) described Jalowiec's “[c]hronic problems with insomnia and fatigue as well as headaches.” (AR at 425.) Dargus noted that Jalowiec “just does not seem to improve at all” despite various treatment attempts. (Id. ) In October 2011, Dargus met Jalowiec again for his “severe headaches” which were presenting “every 2 or 3 days” and lasting up to “a couple of days.” (AR at 433.) On November 15, 2011, Jalowiec met with his primary care physician, Charles Winjum, M.D. (“Dr. Winjum”) due to worsening headache symptoms. (AR at 436.) Dr. Winjum noted “[t]he frequency ... and ... intensity of these headaches are increasing,” but described Jalowiec to be “in no acute distress.” (AR at 436-37.) Dr. Winjum referred Jalowiec to be seen by a neurologist the following day. (AR at 437.) On November 16, 2011, Jalowiec was seen by Shaun K. Christenson, M.D. (“Dr. Christenson”) for a neurological consultation. (AR at 473.) Dr. Christensen's CT of the head and neck did not reveal abnormalities. (AR at 530, 532-35, 1104-10.)

On December 20, 2011, Jalowiec went to the emergency room for a headache accompanied by symptoms of nausea and light sensitivity, exacerbated by movement. (AR at 367.) At this emergency room visit, Jalowiec's heart rate and rhythm and neurological functions appeared normal. (AR at 368.) In early 2012, Jalowiec visited the emergency room on more occasions, presenting similar symptoms. (AR at 519-20 (Jan. 22, 2012 visit); 517-18 (Jan. 30, 2012 visit); 515-16 (Feb. 12, 2012 visit).) On February 27, 2012, Jalowiec visited Dr. Winjum for his headaches which “continued to bother him” and caused him to miss “a lot of work.” (AR at 461; see also AR at 488 (describing Jalowiec's work absences as “missing ³/₅ days of work per week”).) Due to these work difficulties, Jalowiec elected to take a twelve-week leave of absence from work. (See id. ) February 24, 2012 would end up being Jalowiec's last day of work at Team Industries. (See AR at 481.) Jalowiec's headaches persisted. (See, e.g. , AR at 463, 465, 467.)

On March 7, 2012, Jalowiec saw John Tulloch, M.D. (“Dr. Tulloch”), a neurologist, and received a Botox injection for the treatment of his migraine headaches. (Id. at 500-07.) On March 13, 2012, Jalowiec went to the Sanford Neuroscience Clinic for a consultation with Cynthia Knutson, M.D. (“Dr. Knutson”). (AR at 487-91.) At this visit, Jalowiec described his headaches as “continuous ... since February 27, 2012.” (AR at 488.) Dr. Knutson noted Jalowiec's symptoms as “photophobia, phonophobia, nausea, difficulty thinking, dizziness, nausea rarely.” (Id. ) She did not complete a physical exam, noting that “[a] recent neurological exam with Dr. Tulloch ... was normal.” (AR at 490.)

On May 24, 2012, Jalowiec had a neuropsychology consultation with Gregory Hauge, Ph.D. (“Dr. Hauge”) to address his “chronic headache pain which ha[d] not responded to interventions.” (AR at 379.) Dr. Hauge noted Jalowiec's cognitive difficulties, stating “[h]e feels that it takes increased effort to calculate, retrieve words and names and recall day-to-day events.” (Id. ) As with prior visits, Jalowiec's symptoms included dizziness and photophobia. (AR at 380.) Dr. Hauge noted, “[w]ife notes progressively worse headaches which are daily...[and] [h]e is unable to ... perform physical activities.” (AR at 380.) Dr. Hauge observed Jalowiec “ambulating independently” and described him to be “oriented to time and location and not acutely confused.” (Id. ) Dr. Hauge administered thirteen tests...