Pettit v. Unumprovident Corp..

774 F.Supp.2d 970

Margaret PETTIT, Plaintiff,

v.UNUMPROVIDENT CORPORATION, d/b/a Unum Group, d/b/a Unum Group Corporation, Defendant.

No. 4:10–cv–00021–JEG.

United States District Court, S.D. Iowa, Central Division.

Feb. 16, 2011.

Christopher D. Spaulding, Berg Rouse Spaulding & Schmidt PLC, Des Moines, IA, for Plaintiff.Michael W. Thrall, Nyemaster Goode West Hansell & O'Brien PC, Des Moines, IA, for Defendant.

ORDER

JAMES E. GRITZNER, District Judge.

Plaintiff Margaret Pettit (“Pettit”) filed this action under the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. §§ 1001–1461, seeking judicial review of an appeal from the denial of long-term disability benefits by Defendant UnumProvident Corporation (“Unum”). Pettit further seeks review of Unum's calculation of benefits made payable as a result of her mental disability. The matter is submitted without oral argument on the administrative record and the briefs of the parties.

I. BACKGROUND

Pettit was hired by Great River Health Systems, Inc. (“Great River”), on August 12, 1999. As a Great River employee, Pettit was eligible for coverage under Great River's long-term disability plan (the “Plan”). The Plan is part of an “employee welfare benefit plan” covered by ERISA. 29 U.S.C. § 1002(1).

The Plan names Great River as the Plan administrator “with authority to delegate its duties.” A.R. 29. The Plan designates Unum as a claims fiduciary, providing that Unum, as the administrator's designee, “has discretionary authority to determine ... eligibility for benefits and to interpret the terms and provisions of the [Plan].” A.R. 11, 34. A participant is deemed disabled under the Plan when Unum determines that the participant (1) is “limited from performing the material and substantial duties of [his/her] regular occupation due to [his/her] sickness or injury;” and (2) has “a 20% or more loss in [his/her] indexed monthly earnings due to the same sickness or injury.” A.R. 15. After twenty-four months of payments, however, a participant is deemed disabled only if Unum determines “that due to the same sickness or injury,” the participant is “unable to perform the duties of any gainful occupation” for which the participant is “reasonably fitted by education, training or experience.” Id.

During her employment with Great River, Pettit worked as a surgical technician in the Digestive Health Center and later as a Certified Registered Nurse (“CRN”) in the Acute Care Unit. A.R. 80. In the course of her employment, Pettit was responsible for cleaning medical equipment with a chemical called Cidex. Pettit began to experience adverse reactions to Cidex while working with this chemical. Specifically, Pettit experienced “problems with her eyes burning, coughing, sneezing, nose plugging and running whenever she went into [a] room where Cidex was.” A.R. 568. On at least one occasion, Pettit presented to the emergency room with “coughing, [and] burning swollen eyes” after being exposed to Cidex. A.R. 314, 225. The attending physician diagnosed Pettit with “bronchiospasms [secondary] to chemical exposure.” A.R. 313.

Pettit has a history of problems with allergies. She received treatment for her allergies while employed with Great River on numerous occasions. On March 28, 2006, Thomas Boyd, D.O., Pettit's primary physician, examined Pettit and noted that she was “having a lot of problems with allergies” and was “reacting to the chemicals used to clean instruments at her job.” A.R. 732. Pettit was referred to David Wegner–Keller, M.D., an allergy specialist, who diagnosed Pettit with latex allergy, contact metal sensitivity, “perennial allergic rhinitis and seasonal rhinitis as well as chronic cough.” A.R. 733, 567. Dr. Wegner–Keller also opined that Pettit was intolerant to Cidex and recommended that she wear a charcoal mask around this chemical or avoid contact with it completely. On or about October 30, 2006, after Pettit presented to Dr. Boyd with watery eyes, a runny nose and cough, Dr. Boyd made a diagnosis of “[a]llergic rhinitis with Cidex intolerance” and recommended that Pettit “consider rotating every 2 to 3 days to other work stations, to avoid Cidex exposure.” A.R. 204.

Pettit also treated with Ravinder Agarwal, M.D., an allergy specialist, who confirmed the diagnosis of chronic rhinitis and also diagnosed Pettit with allergies to dust mites, cat, ragweed and latex. Dr. Agarwal recommended that Pettit undergo desensitization therapy to help control her symptoms. Pettit appears not to have received such therapy, however, due partially to her lack of resources.

Pettit was directed to visit Great River's occupational medicine provider as a result of the problems she was experiencing with her allergies while at work. On February 6, 2007, Pettit saw Patrick Bredar, PA–C, for “an evaluation secondary to chronic recurrence of shortness of breath, coughing, sneezing and breaking out in hives.” A.R. 289. Mr. Bredar noted that Pettit appeared to develop “an asthmatic reaction with [a] runny nose, [and] shortness of breath” when exposed to Cidex. Id. Mr. Bredar recommended that Pettit “be placed on restricted duty from the use only of the Cidex chemical” but indicated she could return to work A.R. 290.

Pettit saw Ricky Garrels, M.D., another occupational medicine provider for Great River on February 8, 2007, with “complaints of respiratory issues related to Cidex exposure.” A.R. 288. Dr. Garrels observed congestion in Pettit's upper airways, provided an assessment of allergies and rhinitis, and placed Pettit “on restrictions to avoid exposure to all chemicals, mist, vapors, and odors.” Id.

On March 8, 2007, Dr. Garrels saw Pettit for a follow up examination. In his notes, Dr. Garrels reported that Pettit was missing a substantial amount of work. Dr. Garrels noted that Pettit has “significant environmental allergens including household dust, corn smut, and cats” and indicated that Pettit was complaining of increased nasal symptoms with “any exposure to dust, mist, vapor, chemical, or odor.” A.R. 286. Following his examination, Dr. Garrels opined, “At this point, I do not think there is anything more that I can offer her other than to suggest that she have a permanent restriction for avoiding exposure to all chemicals, dust, mist, vapors, or odors.... She is at maximal medical improvement.” Id. Dr. Garrels also discussed “the idea of disability” with Pettit based upon his impression that “the number of problems that she is having are essentially adding up to a situation where she is not able to be at work the majority of the time.” Id. Dr. Garrels did advise Pettit to return to work, however.

In addition to her allergies, Pettit has a history of anxiety and depression. On March 29, 2006, Gary Szymula, Ph.D., with Great River Mental Health Care Associates, examined Pettit and noted that she was “having severe problems at work related to depression and anxiety,” and that she was “having panic attacks which intensified after the threat of being fired” due to excessive absences from work. A.R. 1435. Following his evaluation, Dr. Szymula diagnosed Pettit with major depressive disorder and panic disorder without agoraphobia and explained that he would document Pettit's concerns to “protect her from possible early termination.” A.R. 1436. Pettit's panic attacks persisted despite recommendations from Dr. Szymula for reducing stress.

On March 3, 2007, Pettit treated with Robert Strayhan, M.D., for mental health issues. Pettit reported that she was experiencing “almost constant anxiety” with “3–4 major panic attacks per week.” A.R. 954. The panic attacks made Pettit fearful of leaving home, and the most severe attacks required her to be placed on oxygen in the emergency room. Dr. Strayhan opined, “The patient appears at times to have an increased focus on somatic concerns and fears of illness due to chemical exposure. It does appear that the concerns about respiratory status result in precipitation of respiratory stress.” A.R. 956. Dr. Strayhan diagnosed Pettit with major depression and panic disorder with agoraphobia.

On March 21, 2007, Pettit's employment with Great River was terminated. Thereafter, on July 22, 2007, Pettit filed a claim with Unum for disability benefits under the Plan. Pettit claimed that she was unable to work as a result of chronic allergies and specifically noted problems with Cidex exposure in her claim.

Dr. Boyd authored a letter in support of Pettit's claim for long-term disability benefits on September 6, 2007. In this letter, Dr. Boyd explained that, while he “would not consider himself a medical expert in allergies or disability,” it was his opinion that Pettit “suffered a great deal with her acquired allergies which have made it nearly impossible for her to function in the work environment for which she is trained and experienced.” A.R. 946.

Unum granted Pettit's application for disability benefits on December 6, 2007, under a Reservation of Rights, explaining that “payment cannot be construed as an admission of past, present or future liability and we reserve our right to enforce any and all provisions of the policy.” A.R. 1009. Unum indicated that it was “in the process of obtaining additional information from [Great River] to determine if [Pettit's] lost time at work prior to March 21, 2007 was due to [her] medical condition or scheduling issues.” Id. Unum also explained that its medical department was “in the process of reviewing the medical information in [Pettit's] claim file,” and that Pettit would “be notified once the review is completed and the final determination has been made.” Id. Thereafter, Pettit began to receive monthly benefit payments from Unum in the amount of $1,410.24.

On or about January 30, 2008, Lawrence Broda, M.D., an internist working as a medical consultant for Unum, attempted to contact Dr. Boyd by letter to discuss his interpretation of the available medical data concerning Pettit's...