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Robison v. Reliance Standard Life Insurance Co.

United States District Court, W.D. Oklahoma

March 10, 2017

CHRIS I. ROBISON, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

          ORDER

          TIMOTHY D. DeGIUSTI UNITED STATES DISTRICT JUDGE.

         Plaintiff Chris Robison (Robison) participated in a short-term disability plan and a long-term disability plan sponsored by her employer, SandRidge Energy, Inc. (SandRidge) and administered by Defendant Reliance Standard Life Insurance Company (Reliance). Both plans were subject to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq. Reliance denied Robison's claim for benefits, which was affirmed in a subsequent administrative appeal. Robison now appeals that denial in this Court under ERISA's civil enforcement provision, 29 U.S.C. § 1132(a)(1). See Petition, ¶ 9 [Doc. No. 1-2]. Before the Court are Robison's Opening Brief on Appeal and Reliance's Motion for Summary Judgment [Doc. Nos. 30, 31]. The matter is fully briefed and at issue.

         BACKGROUND

         Robison was employed by SandRidge as a payroll administrator, where she was enrolled in SandRidge's group short-term disability (STD) plan (Policy No. STD 158778) and long-term disability (LTD) plan (Policy No. LTD 115067). The STD policy pays weekly disability benefits to an insured who is “disabled due to Sickness or Injury.” Under the STD policy, “disabled” means that an insured was “(1) unable to do the material duties of his/her job; and (2) not doing any work for payment; and (3) under the regular care of a physician.” “Injury” means “bodily injury resulting directly from an accident, independent of all other causes. The injury must cause disability which begins while an Insured.”

         The LTD policy, which defines “injury” in substantially the same manner as the STD policy, paid monthly disability benefits following 180 consecutive days of disability (the “Elimination Period”) to an insured who remains “Totally Disabled” as a result of an injury or sickness. Throughout the duration of the Elimination Period and the following twenty-four (24) months, the LTD policy defined “Total Disability” to mean that an insured cannot perform the material duties of her regular occupation, and “Total Disability” was, from that point, defined as the insured's inability to perform the material duties of any occupation for which she is qualified by education, training or experience.

         With respect to submitted claims, the STD policy provided that for any covered loss, written proof must have been sent to Reliance within ninety (90) days. If it was not reasonably possible to provide notice within the prescribed time period, the policy stated the claim was not affected if proof was sent as soon as reasonably possible. In addition, the STD policy provided that no legal action could be brought on the policy within sixty (60) days after written proof of loss had been given, and no action could be brought after three years from the time written proof of loss was required to be given.

         The LTD policy stated that written notice of a claim must be provided to Reliance within thirty-one (31) days after a Total Disability covered by the policy occurred, or as soon as reasonably possible. If a claimant did not receive the claim forms within fifteen (15) days after receiving notice, then proof of Total Disability would be met by giving Reliance a written statement of the type and extent of the Total Disability within ninety (90) days after the loss began. Written proof of Total Disability was to be submitted within ninety (90) days after Total Disability occurred or as reasonably possible. In any event, the LTD policy stated proof of Total Disability must have been provided within one year after Total Disability occurred, unless the insured was legally incapable of doing so. With respect to legal actions, the LTD policy stated no legal action could be brought to recover on the policy within sixty (60) days after written proof of loss had been given, and no action could be brought after three (3) years from the time written proof of loss was received.

         Both the STD and LTD policies stated the following:

Reliance Standard Life Insurance Company shall serve as the claims review fiduciary with respect to the insurance policy and the Plan. The claims review fiduciary has the discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits. Decisions by the claims review fiduciary shall be complete, final and binding on all parties.

         On September 5, 2007, Robison was involved in a car accident in which she sustained several injuries. She returned to work on February 25, 2008 and continued to work until December 14, 2008, when she underwent surgery due to an infection. According to her statement to Reliance, Robison last worked at SandRidge on March 31, 2009, when she worked “about 1/3 of [the] day” but left due to experiencing chronic pain in her back and foot, as well as experiencing cognitive difficulties. Robison stated her reason for leaving SandRidge was due to termination.[1]

         During the course of rehabilitation and treatment, Robison was evaluated by several doctors who monitored her progress. Dr. W. Bentley Edmonds examined Robison and noted she was experiencing only mild pain while in a walking boot. Dr. Edmonds noted Robison's wounds had fully healed and there was no sign of infection. After seeing Robison on follow up appointments, Dr. Edmonds noted Robison was doing well, her pain was reasonably controlled, and she was going to advance her activities and eventually wean off of the boot. Dr. Matthew Diesselhorst also observed that Robison's surgical incisions were healing well, and that although she continued to experience tenderness in her foot, she had good range of motion and was steadily improving. He also recommended that she slowly wean herself from the boot.

         Following another appointment with Robison, Dr. Edmonds observed she was “doing as well as could be expected” from her injuries and would likely need medical management for her pain. Dr. Edmonds referred Robison to Dr. A.J. Bisson for pain management, who also noted Robison's surgical incisions were healing well. Dr. Bisson recommended Robison undergo minimal physical therapy to alleviate a gait in her walk. Dr. Bisson adjusted Robison's medication and noted that Robison “look[ed] to be doing amazingly well.” Dr. Edmonds later observed that Robison displayed good ankle motion without any pain and that she was very happy with her progress. Robison was also examined by Dr. Jeffrey Cruzan for a long history of depression. She was observed as “feel[ing] much better and happier” and exhibited no signs of homicidal or suicidal thoughts.

         Robison subsequently filed for, and received, social security disability benefits from her inability to be gainfully employed in any occupation since April 1, 2009. On December 14, 2012, Robison submitted short term and long term disability claims to Reliance. Reliance classified and evaluated Robison's claim based on her ability to perform sedentary work. On July 13, 2013 and July 15, 2013, Reliance denied Robison's claims on the basis the records did not demonstrate she was “disabled” as those terms were defined under the respective policies. Robison administratively appealed the denial, alleging she was unable to do light duty work without assistance from her co-workers. Robison also submitted a report by Dr. Darren Elenburg that stated (1) she could not alternately stand, sit, walk or drive over an eight-hour day and (2) she had reached maximum medical improvement and could not return to work. Robison also submitted a vocational evaluation performed by Dr. Lon Huff that stated she met the policy definition of “long term disability” on April 5, 2009.

         Reliance conducted a coordinated review of the LTD and STD claim denials and Robison's objections thereto. Its review showed that Dr. Elenburg first observed Robison in 2008. In October 2009, he noted that Robison's fractures had healed, but that her hardware implants were painful and may require removal in the future, but no surgery was planned at the time. In the report cited by Robison, Dr. Elenburg noted that over the course of an 8-hour day, Robison could not alternately stand, sit, walk, or drive. Dr. Elenburg also noted, however, Robison could perform sedentary work in an 8-hour day, and was not limited in her abilities to (1) relate to other people beyond giving and receiving instructions, (2) complete and follow instructions, (3) perform simple and ...


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