David Phillips, Plaintiff,
v.
Aetna Life Insurance Company, Defendant.
Civ. No. 20-2048 (PAM/DTS)
United States District Court, D. Minnesota
November 22, 2021
MEMORANDUM AND ORDER
Paul A. Magnuson, United States District Court Judge.
This matter is before the Court on the parties' cross-Motions for Summary Judgment. For the reasons that follow, Defendant's Motion is granted and Plaintiff's Motion is denied.
BACKGROUND
Plaintiff David Phillips worked for more than twenty years as a systems engineer at the Boeing Company in Missouri. In March 2019, Phillips was assaulted, suffering serious injuries that required hospitalization. He was eventually transferred to St. Louis University Hospital, where he was diagnosed with a subdural hematoma in his brain as well as an intraventricular hemorrhage in his right frontal lobe, in addition to physical injuries such as facial and rib fractures.
Shortly after the incident, Phillips applied for and received short-term disability benefits through the Boeing-sponsored short-term-disability plan, which is not administered by Defendant Aetna Life Insurance Company. In August 2019, Phillips applied for long-term-disability benefits from Boeing's Aetna-administered long-term-disability plan. According to Phillips, he continues to suffer from memory issues and
cognitive impairment that preclude him from returning to his job as a systems engineer.
The plan provides monthly benefits to participants who are “disabled and unable to work because of: [a]n illness; [a]n injury; or [a] disabling pregnancy-related condition.” (Admin. R. (Docket No. 27) at 36.)[1] Disability for the first 24 months of the long-term coverage requires that the participant be unable to “perform the material duties of [his] own occupation.” (Id. at 90.) The plan also provides that a participant will be considered no longer disabled when he either does not meet the disability test (i.e., he can return to his own occupation) or when he is “no longer under the regular care of a physician” or the date the participant refuses to participate in an Aetna-requested medical examination. (Id. at 38.) The participant must establish that he is disabled within the meaning of the plan throughout the “elimination period, ” which is the first 26 weeks after the injury or illness. (Id. at 36, 66.)
In June 2019, Phillips' treating neurosurgeon, Dr. Richard Bucholz, cleared Phillips to return to work as of June 24, 2019. (Id. at 378-79.) Indeed, after a June 20, 2019, CT scan showed “complete resolution” of the subdural hematoma and hemorrhage, Phillips was discharged from the neurology clinic altogether. (Id. at 369-70.) Dr. Bucholz noted in another form dated July 17, 2019, that there were no “symptoms/functional impairments that would prevent [Phillips] from returning to work.” (Id. at 377.) In a conversation with an Aetna representative in late September 2019, Phillips conceded that he had not
been under the care of any physician since his last neurologist appointment at the end of June.
After receiving Aetna's decision denying his application (id. at 466-69), Phillips sought additional medical treatment. The family-medicine physician who examined Phillips on October 29, 2019, opined that Phillips could not return to his previous employment because of cognitive impairment, memory loss, and other issues. (Id. at 355.) Aetna then requested that Phillips undergo the neuropsychological testing that this physician recommended. But despite mailing Phillips a letter about the scheduled test and attempting to reach him at least three times by phone, Phillips did not attend the test, nor did he respond to Aetna's contacts. Aetna once again denied Phillips's benefits application. (Id. at 513-15.)
Phillips appealed, sending Aetna a letter from the family-medicine physician who examined him in October 2019. (Id. at 151.) This letter noted that the physician had examined Phillips twice, and recommended neuropsychological testing to measure the extent of Phillips's impairment. (Id.) The physician had not performed nor ordered such testing, however. Phillips also submitted records from a July 2020 office visit with a neurologist. (Id. at 123-30.) The neurologist noted that Phillips denied difficulty with routine daily activities and that, although he complained about headaches, those usually...
