Nunnelly v. Life Ins. Co. of N. Am., Case No. 4:19-cv-01383-HNJ

TERRY NUNNELLY, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

Case No. 4:19-cv-01383-HNJ

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ALABAMA MIDDLE DIVISION

July 7, 2021

MEMORANDUM OPINION

This action proceeds before the court on Plaintiff Terry Nunnelly's Motion for Judgment on LTD Benefits for Inability to Perform Own Occupation, (doc. 31), and Motion to Strike Affidavit and Portions of Affidavit of Richard Lodi, (doc. 45); and Defendant Life Insurance Company of North America's Motion for Summary Judgment. (Doc. 35). Nunnelly filed this action pursuant to the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. ("ERISA"), seeking long-term disability benefits under an employee welfare benefit plan provided by his employer, Honeywell International, Inc. ("Honeywell"), and insured by Life Insurance Company of North America ("LINA"). Nunnelly beseeches the court to reverse LINA's adverse decision denying his claim for long-term disability benefits. LINA bids the court to affirm its decision.

Because the evidence fails to depict Nunnelly sustained a continuous disability during the pertinent period, LINA properly determined he did not establish an entitlement to long-term disability benefits. The court therefore DENIES Nunnelly's Motion for Judgment on LTD Benefits for Inability to Perform Own Occupation and GRANTS LINA's Motion for Summary Judgment. The court further GRANTS IN PART and DENIES IN PART Nunnelly's Motion to Strike Affidavit and Portions of Affidavit of Richard Lodi.

STANDARD OF REVIEW

The general principle of Federal Rule of Civil Procedure 56 - that summary judgment is proper "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law" - has limited application in an ERISA case, as the district court "sits more as an appellate tribunal than as a trial court" and "evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary." Curran v. Kemper Nat'l Servs., Inc., No. 04-14097, 2005 U.S. App. LEXIS 29623, *18-19 (11^th Cir. Mar. 16, 2005) (unpublished per curiam opinion) (quoting Leahy v. Raytheon Co., 315 F.3d 11, 18 (1^st Cir. 2002)).

To that end, the Eleventh Circuit's six-step sequential framework for reviewing ERISA benefit denials guides the court:

(1) Apply the de novo standard to determine whether the claim administrator's benefits-denial decision was "wrong" (i.e., the courtdisagrees with the administrator's decision); if it is not, then end the inquiry and affirm the decision.

(2) If the administrator's decision in fact is "de novo wrong," then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.

(3) If the administrator's decision is "de novo wrong" and he was vested with discretion in reviewing claims, then determine whether "reasonable" grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).

(4) If no reasonable grounds exist, then end the inquiry and reverse the administrator's decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest.

(5) If there is no conflict, then end the inquiry and affirm the decision.

(6) If there is a conflict, the conflict should merely be a factor for the court to take into account when determining whether an administrator's decision was arbitrary and capricious.

Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1355 (11^th Cir. 2011). The court undertakes the review by considering "the material available to the administrator at the time it made its decision." Id. Moreover, the claimant sustains the burden of proving entitlement to ERISA benefits. Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241, 1248 (11^th Cir. 2008).

FACTUAL BACKGROUND

A. The Benefits Policy

LINA insures the long-term disability ("LTD") component of Honeywell'semployee welfare benefit plan ("the Plan") via Group Policy No. VDT-980084 (the "Policy"). (Doc. 36 at 2). LINA issued the Policy to the Trustee of the Group Insurance Trust for Employers in the Manufacturing Industry, to which Honeywell subscribes. (Id.) Honeywell constitutes the Plan Administrator, (AR 0085),¹ and LINA constitutes the claims administrator that adjudicates benefit claims. (Doc. 36 at 3).²

The Policy provides:

[LINA] will pay Disability Benefits if an Employee becomes Disabled while covered under [the] Policy. The Employee must satisfy the Elimination Period . . . and meet all the other terms and conditions of the Policy. He or she must provide [LINA], at his or her own expense, satisfactory proof of Disability before benefits will be paid. . . .

(AR 0022). The Elimination Period constitutes "the period of time an Employee must be continuously Disabled before Disability Benefits are payable." (Id.) As relevant here, the Policy prescribed a twenty-six week Elimination Period for benefits claims. (AR 0006).

The Policy defines "Disability" as follows:

The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:

1. unable to perform the material duties of his or her Regular Occupation; and

2. unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.

After Disability Benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is:

1. unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and

2. unable to earn 80% or more of his or her Indexed Earnings.

(Id.)

Further, pursuant to the Plan:

[Honeywell] . . . appointed [LINA] as the named fiduciary for adjudicating claims for benefits under the Plan, and for deciding any appeals of denied claims. [LINA] shall have the authority, in its discretion, to interpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact. All decision made by [LINA] shall be final and binding on Participants and Beneficiaries to the full extent permitted by law.

(AR 0086).

B. Claim History

Honeywell employed Nunnelly as a Mechanic III until he ceased working on January 18, 2017. (AR 0753). Adopting the standards set forth in the Dictionary of Occupational Titles, Honeywell classified the Mechanic III position as a "Medium Work level occupation." (AR 1185). Medium Work entails occasionally exerting twenty to fifty pounds of force to move objects; and/or frequently exerting ten to twenty-five pounds of force to move objects; and/or constantly exerting up to ten pounds of force to move objects. (Id.)

Nunnelly telephonically applied for LTD benefits on November 14, 2017.³ (AR 0765). On November 20, 2017, LINA sent Nunnelly a letter acknowledging hisapplication, and requesting that he complete a Disability Questionnaire and Activities of Daily Living Form. (AR 0811-13). The letter further stated that LINA would contact Nunnelly's psychiatrist to obtain pertinent medical records, and notified Nunnelly that he remained "responsible for ensuring [LINA] receive[d] the requested information within 45 days of the request." (AR 0811). Nunnelly did not respond to LINA's request, and, on December 13, 2017, and January 11, 2018, LINA sent him additional letters requesting medical records and other supporting documents vis-à-vis his claim. (AR 1036-37, 1134-35). In addition, LINA directly contacted Nunnelly's care providers on multiple occasions to request medical records. (AR 0866-67, 0874-75, 0885, 1048-49, 1054-55, 1142-43).

On January 8, 2018, Nunnelly completed a paper application for LTD benefits. (AR 1126-27). He did not specify any disabling impairments on the application, and identified only his psychiatrist as a treating physician. (AR 1126). LINA effected review of medical records it obtained from Nunnelly's care providers via two of its employees: Shadrach H. Jones, IV, M.D., an Associate Medical Director for LINA board certified in internal medicine with a specialty in occupational and environmental medicine, (AR 1148-50), and Licensed Professional Counselor Brandi Mitchell, who specializes in behavioral health. (AR 0319). After reviewing Nunnelly's medical records - including those pertaining to his STD claim - portraying treatment for bipolar disorder, anxiety,depression, migraines, and neck pain, LINA denied Nunnelly's LTD claim on January 26, 2018.⁴ (AR 1184-88).

On July 23, 2018, Nunnelly appealed LINA's denial. (AR 1210, 1213-14, 1223). On August 23, 2018, Nunnelly submitted additional medical records and notified LINA he had "no [further] medical evidence to submit."⁵ (AR 1245). In addition, he informed LINA he could not afford medical treatment due to a lack of income. (Id.)

On appeal, LINA effected review of Nunnelly's medical records by engaging third-party consultants M. Antoinette Acenas, M.D., board certified in psychiatry, (AR 1235-37), and Dr. Leonid Topper, M.D., board certified in neurology. (AR 1240-43). On September 20, 2018, after consideration of Nunnelly's medical records and the opinions of the independent medical reviewers, LINA upheld the denial of LTD benefits.⁶ (AR 1291-94).

On March 11, 2019, Nunnelly submitted additional medical records depictingpsychiatric treatment during the period June 2018 to February 2019. (AR 1302-25). A cover letter prefacing the submission states, "Mr. Nunnelly has not been awarded Social Security disability benefits. This week [he] received the enclosed records from [psychiatric practice] Grayson & Associates, P.C. for visits on 6/6/18, 6/13/18, 8/18/18, 11/7/18, and 2/4/19. [He] [has] no additional records to submit." (AR 1302). On March 20, 2019, LINA notified Nunnelly it would not regard the submission as a second appeal request because he did not furnish "a formal written request to...