Zimmer v. Delta Family-Care Disability & Survivorship Plan

JERRI ZIMMER, Plaintiff, v. DELTA FAMILY-CARE DISABILITY AND SURVIVORSHIP PLAN, Defendant.

Case No. 19-CV-1693 (PJS/DTS)

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

February 5, 2021

ORDER

Alesia R. Strand and Thomas J. Beedem, III, BEEDEM LAW OFFICE, for plaintiff.

Jason R. Carruthers and John T. McDonald, THOMPSON HINE LLP, and William D. Hittler, NILAN JOHNSON LEWIS PA, for defendant.

Plaintiff Jerri Zimmer brings this action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), claiming that defendant Delta Family-Care Disability and Survivorship Plan ("the Plan") wrongly terminated her long-term-disability ("LTD") benefits. This matter is before the Court on the parties' cross-motions for summary judgment. ECF Nos. 34, 38. For the reasons that follow, the Plan's motion is granted, and Zimmer's is denied.

I. BACKGROUND

A. Medical and Employment History

Zimmer has a long history of mental illness, dating back more than 25 years.¹ See Administrative Record ("AR") 2332-35, 4602-03. Zimmer's diagnoses have included generalized anxiety disorder, panic disorder, obsessive-compulsive disorder ("OCD"), and chronic depression. See AR 2334-37, 2626. Zimmer has been treated by a number of mental-health providers, including her longtime psychologist Dr. Kim Baldwin, whom Zimmer has been seeing for almost 25 years. AR 0011, 2332-35. Zimmer's mental-health providers have long recommended that she use medications to manage her conditions, but Zimmer has refused, citing a phobia about taking medications. See AR 0011-12, 2334.

Zimmer started working for Delta Air Lines, Inc. ("Delta") in 1997, performing billing and accounting services.² AR 2333. In 1999, Zimmer began working as a customer-service agent, and she remained in that job until 2014 or 2015, when she was transferred to a new position as a customer-care specialist (also referred to as a"reservation agent" or "reservationist").³ Customer-care specialists are responsible for responding to and resolving customer complaints and for entering customer data into Delta's database. AR 1694-95. Zimmer felt that the training and support that she received in this new position were inadequate, and the fact that she was expected to do a job for which she was not adequately trained or supported caused Zimmer to experience stress and anxiety. AR 0013, 2333. Zimmer stopped working due to that stress and anxiety in October 2016. AR 2333.

In addition to her employment with Delta, Zimmer also worked—and continues to work—about 20 hours per week for her brother's company. AR 2333. Zimmer is responsible for billing, accounting, and payroll. AR 2333. She ensures the accuracy of records, prepares reports upon request, and works on "last minute projects" on an as-needed basis. AR 2030. Zimmer does most of this work from her home and reports directly to her brother and to the company's general manager. AR 2030. Zimmer began working for her brother in 2007, and, as noted, she has continued with this part-time employment since leaving Delta in 2016. AR 2333, 4604.

B. Disability Benefit Claims

As a Delta employee, Zimmer had short- and long-term disability coverage under the Plan, which is an employee welfare benefit plan subject to ERISA. See ECFNo. 40-1 at 3. The Plan grants the plan administrator discretionary authority to make benefit determinations, and the plan administrator has delegated that authority to Sedgwick Claims Management Services ("Sedgwick"). Id. at 52-53, 279-80, 288.

Zimmer first applied for short-term disability ("STD") benefits. Her application was approved, and she was paid STD benefits for the maximum period allowed under the Plan. AR 3950. Two weeks before her STD benefits were set to expire, Zimmer applied for LTD benefits. AR 2345-46. In a letter dated April 12, 2017, Sedgwick notified Zimmer that her claim for LTD benefits had been approved through May 31, 2017. AR 2468. The letter further stated that Zimmer's "eligibility for LTD benefits" would be "periodically review[ed]" and that "[t]he next scheduled review" would occur around May 31, 2017. AR 2468.

Sedgwick's letter also summarized the definition of "disability" under the Plan: For the first six months of the disability period (which is the only period at issue for purposes of the parties' cross-motions), a claimant is "disabled" if she is "unable to perform [her] customary occupation" as a result of a demonstrable injury or disease. AR 2468; see also ECF No. 40-1 at 21. A claimant's "customary occupation" is the "type of work" the claimant engaged in before taking disability leave. ECF No. 40-1 at 21.

As part of the "scheduled review" mentioned in Sedgwick's initial approval-of-benefits letter, Zimmer underwent an independent psychological evaluation conductedby Dr. Gregg Eichenfield, a psychologist. Dr. Eichenfield reported that Zimmer is "depressed," suffers from "severe, underlying anxiety," and presents symptoms that "reflect obsessive thinking and possible Obsessive Compulsive Disorder." AR 2336-37. Dr. Eichenfield concluded, however, that no occupational restrictions were necessitated by Zimmer's condition. AR 2338. Dr. Eichenfield cited the fact that Zimmer had no difficulty performing her duties for her brother's company, and that Zimmer's purported inability to return to work for Delta was based on what she perceived as a lack of training and a stressful work environment, rather than her inability to perform any work-related task. AR 2338.

On May 9, 2017, Sedgwick denied Zimmer's claim for LTD benefits from June 1, 2017 forward, citing Dr. Eichenfield's report in support of its conclusion that Zimmer was no longer "disabled" within the meaning of the Plan.⁴ AR 2453.

1. First Appeal

Zimmer filed her first appeal of Sedgwick's adverse benefits determination on November 2, 2017. AR 2315-20. In support of her appeal, Zimmer submitted medical records and letters from her treating physicians, who opined that Zimmer was disabled and unable to return to work. See, e.g., AR 3063-64, 3077-79. To assist in evaluating Zimmer's first appeal, Sedgwick retained a slate of independent physicians to review Zimmer's medical records, including Dr. Patrick Young (a psychiatrist). Dr. Young reviewed Zimmer's medical records and found "no evidence that she [is] unable to work" in her customary occupation. AR 2010. Dr. Young found Zimmer's symptoms to be "mild to moderate" and observed that Zimmer's "memory[,] concentration and cognition were grossly intact." AR 2010. Dr. Young acknowledged that Dr. Baldwin (Zimmer's longtime psychologist) believed that Zimmer was disabled, but found that Dr. Baldwin's opinion was not supported by the medical evidence. AR 2010.

On December 28, 2017, Sedgwick upheld its previous decision to terminate Zimmer's LTD benefits, concluding that Zimmer's "medical records did not reveal objective, clinical medical evidence substantiating a physical or psychological impairment that would restrict or limit [Zimmer's] functionality or preclude her from performing her own customary occupation as defined under the Plan." AR 2664.

2. Second Appeal

Zimmer filed a second appeal on March 27, 2018, and submitted additional medical records and correspondence from her treating physicians.⁵ To assist in evaluating Zimmer's second appeal, Sedgwick retained a new slate of independent medical reviewers, including Dr. Hope Beatte (a psychologist). Dr. Beatte found that although Zimmer's records indicated a "longstanding issue with anxiety," the records did not suggest "an acute condition preventing working." AR 0052. Dr. Beatte further noted that Zimmer had refused to take the medications recommended by her providers, and that there had been no escalation of care, which one would expect to see if Zimmer truly suffered from a debilitating condition. AR 0052. Dr. Beatte updated her report three times as Zimmer continued to submit additional medical records and letters from her treating physicians. AR 4581-89. In each instance, Dr. Beatte explained that the new information did not alter her conclusion that Zimmer is not functionally impaired. AR 4581-89.

Before issuing a final decision on Zimmer's second appeal, Sedgwick retained yet another medical expert—Dr. Thomas Gratzer, a psychiatrist—to examine Zimmer and review her medical records. Dr. Gratzer examined Zimmer on January 23, 2019, and concluded, like Drs. Eichenfield, Young, and Beatte before him, that the medical evidence did not support a finding of functional impairment.⁶ AR 4601, 4611-12. Dr. Gratzer's report noted Zimmer's "longstanding psychiatric difficulties," including anxiety, panic disorder, OCD, and chronic depression. AR 4602, 4611. Dr. Gratzer also acknowledged that Zimmer became "unable to do her job when she was reassigned from customer service to a reservation agent," as Zimmer felt that she was not "properly supported." AR 4611. Dr. Gratzer concluded, however, that Zimmer's "inability to do her job is separate from a psychiatric impairment." AR 4611. During the course of Dr. Gratzer's in-person examination, Zimmer "present[ed] with a normal mental status exam," presented no "evidence of acute depression or acute anxiety," anddid not present symptoms indicative of a disabling condition. AR 4611. Dr. Gratzer thus concluded that Zimmer was not functionally impaired.

On April 15, 2019, Sedgwick denied Zimmer's second appeal and upheld its previous denial of LTD benefits. AR 4549-57. Echoing the conclusions of its four independent medical reviewers, Sedgwick found that Zimmer's inability to perform her duties at Delta was due to inadequate training and workplace-specific stressors, rather than due to a psychiatric impairment. AR 4555-56. In support, Sedgwick cited the lack of medical evidence substantiating any functional impairment, the fact that Zimmer expressed a willingness to return to her previous job at Delta as a customer-service agent, and the fact that Zimmer reported no difficulty performing her...