Tekmen v. Reliance Standard Life Ins. Co.

55 F.4th 951

Anita TEKMEN, Plaintiff – Appellee,

v.RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant – Appellant.

No. 20-1510

United States Court of Appeals, Fourth Circuit.

Argued: September 14, 2022

Decided: December 16, 2022

ARGUED: Joshua Bachrach, WILSON ELSER MOSKOWITZ EDELMAN & DICKER L.L.P., Philadelphia, Pennsylvania, for Appellant. Glenn R. Kantor, KANTOR & KANTOR, LLP, Northridge, California, for Appellee. ON BRIEF: Richard Dennis Carter, RICHARD D. CARTER PLLC, Annapolis, Maryland, for Appellee.

Before WYNN and HARRIS, Circuit Judges, and KEENAN, Senior Circuit Judge.

Affirmed by published opinion. Judge Wynn wrote the opinion, in which Judge Harris and Senior Judge Keenan joined.

WYNN, Circuit Judge:

Reliance Standard Life Insurance Company denied Anita Tekmen's claim for long-term disability benefits after concluding that she was not "Totally Disabled" as defined by her disability insurance plan. Tekmen brought this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), arguing that the denial of benefits violated that Act. After conducting a bench trial under Federal Rule of Civil Procedure 52, the district court awarded judgment to Tekmen. Reliance appeals.

On appeal, we affirm that the district court appropriately resolved the matter under Rule 52 and did not clearly err in its factual findings. We also affirm that Tekmen was entitled to long-term disability benefits under the terms of the plan.

I.

In October 2013, Tekmen, while employed as a Financial Analyst for Adsum, Inc., performed financial management services, including analyzing complex financial management systems, maintaining knowledge of business processes and financial software, and conducting technical evaluations and reports. The position required reasoning, cognitive exertion, and the ability to hear and understand easily. Through her employment with Adsum, Inc., Tekmen received coverage under a long-term disability insurance policy provided by Reliance.

Tekmen was involved in a rear-end car accident on October 24, 2013. At an urgent-care facility several hours later, she reported experiencing neck and lower-back pain, dizziness, headache, and wooziness. The treating provider wrote a letter indicating that Tekmen could return to work four days later. Tekmen did so.

Shortly after returning to work, Tekmen was treated by Dr. Frederick W. Parker III, a Family Medicine physician, who diagnosed that she had a concussion. At that time, Tekmen reported experiencing dizziness and headaches. She continued to report significant symptoms three weeks after the accident, including dizziness, sensitivity to light and noise, and difficulty concentrating. She also reported vestibular symptoms,¹ including unsteadiness and difficulty with balance. Tekmen began participating in vestibular therapy, and by late December 2013, her symptoms had begun to improve.

In January 2014, however, Tekmen reported to Dr. Parker that she had developed "an exaggerated auditory response to light vibration, motion and noise." J.A. 618.² This new sensitivity to sound and vibration—called "hyperacusis"—caused Tekmen "extreme distress." Id. At this time she also reported experiencing tinnitus³ and difficulty concentrating.

By March 2014, Tekmen's symptoms had worsened; she continued to experience heightened sensitivity to vibration, light, and noise. Tekmen reported that her sensitivity to sound and vibration made her unable to tolerate being near a running microwave, flushing toilet, or passing truck. Dr. Parker indicated that these symptoms rendered Tekmen unable to concentrate or perform her job duties.

In April 2014, Tekmen again began to improve following rest and time off from work through a medical leave of absence. She used headphones and ear plugs and avoided the stimuli that triggered her symptoms. She returned to work, first part-time, and then full-time by July 2014.

But in January 2015, Tekmen's hyperacusis drastically worsened when her employer moved her work location to a new building, Tower 1. Dr. Parker noted that the heightened symptoms appeared to be triggered by "generators in the lower floors and basement" of the new building, which caused "a low-grade vibration throughout the office." J.A. 461. Tekmen catalogued her symptoms as including the following: "Heavy head dull pressure headache, severe vibration and noise sensitivity induced vertigo," "feel dizzy drunk hungover, woozy, unstable, off balance," "severe cognitive dysfunction and mental fatigue," "confused, disoriented, CAN NO LONGER THINK OR FUNCTION." J.A. 1688.

Tekmen's employer moved her to a different building in February 2015, but in June 2015, Tekmen told Dr. Parker that her hyperacusis had been worsening over the preceding months and that she was using headphones and cotton in her ears to deaden sound. In August 2015, Dr. Parker noted that Tekmen had an episode involving slurred speech, unstable gait, and problems with motor function, among other symptoms. He recommended that Tekmen take a two-week leave of absence from work.

Tekmen attempted to return to work on August 31, 2015, but she had to leave after two hours due to her symptoms. She saw Dr. Parker the following day, and he recommended that Tekmen take a four-to eight-week leave of absence. Tekmen filed a claim for short-term disability benefits with Reliance on September 16, 2015, which was granted. Two months later, she sought to convert her short-term disability benefits into long-term disability benefits, which are the subject of this appeal.

From the time of her accident in October 2013 until she filed the claim for long-term disability benefits in November 2015, Tekmen saw many specialists and received multiple possible explanations for her symptoms. She was examined numerous times by Dr. Ruben Cintron, a neurologist who began treating Tekmen in May 2014 for her hyperacusis and balance problems. She also sought treatment from other physicians, including neurologists, neurotologists, vestibular therapists, and head injury specialists. She was diagnosed with post-concussion syndrome, hyperacusis, endolymphatic hydrops, tinnitus, and vestibular dysfunction, among other possible diagnoses. Tekmen also underwent several tests, including MRIs, EEGs, and CT scans, as well as tests of cognitive function and hearing ability. The results of many of these tests were normal or otherwise failed to fully explain her reported symptoms.

In reviewing Tekmen's application for long-term disability benefits, Reliance hired two independent physicians—Dr. Julius Damion and Dr. Leonid Topper—to review Tekmen's medical records and determine whether she was totally disabled. Dr. Damion concluded that Tekmen had "work capacity on a full time consistent basis on or around the 09/01/2015 Date of Loss and forward, with the stipulation that a quiet work environment in which there is no ambient vibration be provided for her." J.A. 4076. Dr. Topper found that there was "no evidence of any objective neurological illness affecting the claimant" around September 1, 2015; that her clinical history could not be explained by "any recognizable neurological diagnosis"; and that, "[i]n the absence of specific diagnosis, there is no evidence of impairment." J.A. 4057.

Reliance denied Tekmen's claim for long-term disability benefits on May 2, 2016. In support of its determination, Reliance explained that Dr. Topper noted that "sensitivity to noise" like that experienced by Tekmen "is not expected from the neurological point of view in cases of concussion" and that "while concussion and whiplash injury" from the car accident were "believable," the symptoms "would not increase over time, or be subject to new symptoms months later." J.A. 90. And, Reliance explained, "Dr. Topper further notes that there is no conclusive evidence to establish any neurological diagnoses to explain [Tekmen's] physical symptoms on or around 09/01/2015." Id.

Reliance acknowledged Dr. Damion's findings that Tekmen "may have symptoms of hyperacusis and tinnitus." J.A. 91. Nevertheless, Reliance concluded that those conditions did not "prevent [Tekmen] from working full-time in [her] Regular Occupation"⁴ because "Dr. Damion state[d] that [Tekmen] did not have any medical testing that would support that vibratory stimuli would preclude [her] ability to work in an office setting." Id.

Additionally, Reliance noted that, although Tekmen was receiving treatment for her hyperacusis and tinnitus symptoms, demonstrated mild to moderate hearing loss, and showed an abnormal gait and unsteadiness in some examinations, other tests—including MRIs and neuropsychological evaluations—were normal. According to Reliance, those results belied Tekmen's claim of "Total Disability." Reliance concluded that the exacerbation of hyperacusis and tinnitus symptoms in early 2015 was due to "building-specific" noise and vibration. J.A. 92. Reliance acknowledged that Dr. Damion stated that Tekmen should have a quiet work environment with no ambient vibration but concluded that this "minor work-site provision" was "location-specific and building-specific" and "not applicable to [Tekmen's] Regular Occupation in the national economy." Id.

Therefore, Reliance concluded that Tekmen did not have an impairment that precluded her continued employment, stating: "We believe ... that actual examination findings and the results of diagnostic studies fail to support the level of impairment that you are claiming. Rather, we find the opinions provided by independent physicians Dr. Damion and Dr. Topper, as portraying a more accurate depiction of your physical ability to perform the material duties of your Regular Occupation." Id.

Tekmen filed an appeal, which was referred to Reliance's Quality Review Unit for independent review. In evaluating the appeal, Reliance hired two additional independent examiners to review Tekmen's file. Dr. David Foyt, an otolaryngologist, noted that although there is "really no...