With De Novo Review Court Should Conduct Bench Trial on The Record

Case Name: Rose Bigham v. Liberty Life Assurance Company of Boston

Court: United States District Court for the Western District of Washington at Seattle.

Type of Claim: Long Term Disability.

Insurance Company: Liberty Life Assurance Company of Boston a/k/a Liberty Mutual Insurance Company (hereinafter “Liberty Life”).

Claimant’s Employer: Amazon, LLC.

Claimant’s Occupation / Job Position: Security Technical Program Manager.

Disabilities: chronic intractable pain, fibromyalgia, seronegative spondyloarthropathy, cervical and lumbar  degenerative disc disease, and related conditions.

Definition of Disability: Under the LTD Plan, benefits are awarded beyond the 25-week window. Under this plan, “Disabled” is defined as when the employee “as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation.” “Sickness” is defined as “illness, disease, pregnancy or complications of pregnancy.” The Plan defines “Material and Substantial Duties” as “responsibilities that are normally required to perform the Covered Person’s Own Occupation, or any other occupation, and cannot be reasonably eliminated or modified.”

LTD Plan benefits are limited to 24 months unless the employee can show that she “is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.” “Any Occupation” is defined as “any
occupation that the [employee] is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.”

Benefits Paid? Liberty Life granted LTD benefits with a reservation of rights. Several months later Liberty Life terminated the Plaintiff’s benefits.

Procedural history: The Plaintiff appealed the termination of benefits. Liberty Life denied that appeal, and the Plaintiff filed a lawsuit.

Issues: (1) Whether Ms. Bigham’s condition qualifies as a disability under the LTD Plan. (2) Liberty Life contends that Ms. Bigham’s symptoms are purely subjective, and cites to Jordan v. Northrup Grumman, 370 F.3d 869 (9th Cir 2004) for the proposition that it is “appropriate for an administrator to require objective evidence of functional restrictions.” (3) Whether the surveillance footage is “inconsistent” with Ms. Bigham’s self-reporting of her pain physical capabilities, and whether “plaintiff in fact does suffer from debilitating pain and fatigue sufficient to preclude her from performing her own occupation…”. (4) Whether the claim should be remanded to Liberty Life for the issue of extending benefits to Ms. Bigham beyond the 24-month period prescribed for “own occupation” benefits under the Plan. (5) Whether it is appropriate to resolve this case on the parties’ cross motions for judgment under Rule 52 as opposed to summary judgment under Rule 56.

Holdings: (1) “It is clear from the record that Ms. Bigham’s job required her to be able to focus her thoughts and interact with others for long periods of time on a daily basis. Doctors who personally examined Ms. Bigham, including Dr. Neiman, Dr. Girolami, and Dr. Goodman, concluded that Ms. Bigham’s condition made it impossible to for her to reliably perform this essential job function. This evidence alone is persuasive that Ms. Bigham is disabled under the Plan.” (2) “However, this citation does not convince the Court that purely subjective symptoms doom Ms. Bigham’s claim for two reasons. First, unlike the Court here, the court in Jordan was reviewing the plan administrator’s decision for abuse of discretion, not de novo review. The Court here is not required to grant any deference to Liberty Life’s previous decisions. Second, the court in Jordan did not rule that subjective symptoms are insufficient evidence of disability, it found that the plaintiff in that case failed to provide sufficient medical documentation of functional restrictions.” (3) “After reviewing the surveillance footage and the rest of the record, the Court disagrees with Liberty Life’s analysis and conclusions. The surveillance footage neither proves nor disproves that Ms. Bigham’s documented chronic intractable pain, fibromyalgia, seronegative spondyloarthropathy, cervical and lumbar degenerative disc disease, and related conditions prevent her from doing her job.” (4) “The Court does not have sufficient evidence or argument before it determine whether Ms. Bigham is ‘unable to perform, with reasonable continuity, the Material and Substantial Duties of…. any occupation that the [employee] is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.'” For these reasons, the Court remanded to Liberty Life the issue of extending benefits into the “own occupation” period. (5) “The answer depends on what standard of review the court applies. … Thus, when applying the de novo standard in an ERISA benefits case, a trial on the
administrative record, which permits the court to make factual findings, evaluate credibility, and weigh evidence, appears to be the appropriate proceeding to resolve the dispute. … Given the above law, and the clear intent of the parties, the Court will resolve the parties’ dispute in a bench trial on the administrative record rather than on summary judgment. Therefore, the court issues the following findings and conclusions, pursuant to Rule 52.”

Other Interesting Comment: “The LTD Plan does not require Ms. Bigham to be completely incapacitated. The Plan does not discuss intermittent disability or provide a threshold frequency of disabling symptoms. Instead, Ms. Bigham will qualify as disabled under the Plan if she can establish that she is unable to perform, as a result of illness or disease, the responsibilities that she is normally required to perform in her occupation, which cannot otherwise be reasonably eliminated or modified.”

Summary: “Plaintiff’s Motion for Judgment under Federal Rule of Civil Procedure 52 (Dkt. #10) is GRANTED. Plaintiff is entitled to receive long-term disability benefits from the beginning of her eligibility through the 24-month period prescribed in the LTD Plan, to recover pre-judgment interest on those unpaid benefits, and to recover attorney’s fees and costs. However, the Court REMANDS to Liberty Life the issue of extending benefits to Ms. Bigham beyond the 24-month period prescribed for own occupation benefits under the LTD Plan.”

Disclaimer: This was not a case handled by disability attorney Nick A. Ortiz. The court case is summarized here to give readers a better understanding of how Federal Courts decide long term disability ERISA claims.
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