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McAlister v. Liberty Life Assurance Company of Boston

United States District Court, E.D. Kentucky, Southern Division, at London

July 27, 2015

YULUNDA KAREN MCALISTER, Plaintiff,
v.
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, Defendant.

MEMORANDUM OPINION AND ORDER

DAVID L. BUNNING, District Judge.

Plaintiff Yulunda McAlister brings this action against Defendant Liberty Life Assurance Company of Boston pursuant to the Employee Retirement Income Security Act of 1974 (ERISA). 29 U.S.C. ยง 1132. The parties have filed cross-motions for judgment on the record that are fully briefed and ripe for review. (Docs. 15, 16, 18, 19). McAlister argues that her benefits should not have been terminated because her mental impairment has an organic cause, as opposed to a psychiatric or psychological one. Because McAlister has not shown that Liberty's decision to terminate her long term disability benefits was arbitrary and capricious, the Court will enter judgment for Liberty.

I. FACTUAL AND PROCEDURAL BACKGROUND

McAlister was employed as a claims manager with Allstate Insurance Company. (Doc. 16 at 2). As part of her employment, she enrolled in short term disability (STD) and long term disability (LTD) insurance coverage. ( Id. ). Defendant Liberty is the claim administrator for those plans. (Docs. 16 at 2; 18 at 4). The LTD policy, which is at issue in this case, defines "disability" in the following manner:

i. [D]uring the Elimination period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of h[er] Own Occupation; and
ii. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation

(AR 7).

Relevant here, the policy has a two-year limitation on benefits related to a Mental Illness diability. (AR at 21). "Mental Illness" is defined as "a psychiatric or psychological condition classified as such in the most current edition of the Diagnostic and Statistical manual of Mental Disorders (DSM) regardless of the underlying cause of the Mental Illness." (AR 9).

In April 2010, McAlister applied for STD. (AR 1060). In order to evaluate McAlister's claim, Liberty requested her medical records. (1022). McAlister's treating psychiatrist, Dr. Angela Burt, submitted treatment notes from May 20, 2010, wherein she opined that McAlister had "[s]erious cognitive [symptoms] of depression." (AR 1018). She also completed a June 21, 2010 Restrictions Form that stated McAlister was "currently suicidal" and "depressed." (AR 1021). Jessie Singleton, a social worker at Gulf Oaks Psychiatric Services, also submitted treated notes dated May 7, 2010, that indicated McAlister was having "depressive episodes, " "thoughts of suicide, " and "extreme outbursts of anger." (AR 1004). Liberty approved McAlister for STD through August 12, 2010, and for LTD beginning on August 13, 2010. (AR 990). In a letter confirming its approval of LTD benefits, Liberty advised McAlister that the benefits were "payable up to a maximum of 24 months, or August 11, 2012...." (AR 983).

After approving McAlister for disability benefits, Liberty continued to receive updated medical information. In March 2011, Dr. Burt reported that McAlister's diagnosis remained Major Depression, Borderline Personality Disorder, and Obsessive Compulsive Personality Disorder. (AR 817). Dr. Burt further noted that McAlister's symptoms included "rage episodes" and "suicidal indeation, " and that she could not "tolerate stress, frustration, [or] pressure of any kind." ( Id. ).

Liberty also requested a peer review from Dr. Gregory Barclay, Board Certified in Psychiatry. In a July 5, 2011 report, he opined that the medical evidence did not support McAlister's current impairment. (AR 700-02). Specifically, he noted that there was a "lack of objective evidence of cognitive impairment" and that he could not "consider [McAlister's] self-report as a reliable measurement of impairment due to evidence in the records that she has been dishonest and minimized problems, suggesting she is also prone to symptom exaggeration...." ( Id. ).

Based in part on Dr. Barclay's report, Liberty denied McAlister's claim for benefits effective July 27, 2011. (AR 667-69). McAlister appealed, and in support submitted additional medical records from Neurologist Dr. Abha Mishra. Those records contain results from a December 2011 EEG and MRI Without Contrast. The EEG results were "[a]bnormal... due to intermittent left frontotemporal spike and wave discharges suggestive of epileptiform dicharges." (AR 429). Meanwhile, the MRI stated that McAlister had "[s]mall asymmetric focus of abnormal signal at the left parietal white matter on the T2weighted images potentially representing some mild chronic small vessel ischemic changes or possibly some gcoliosis." (AR 167). Dr. Mirsha suspected that McAlister had vascular dementia. (AR 433).

Liberty then requested and received peer review reports in March 2012 from Drs. Michael A. Rater and Joshua A. Alpers, both Board Certified in Psychiatry. Dr. Rater opined that McAlister would be a "danger to herself and others in the workplace because of her reactivity and composure." (AR 400). He also stated that she "would experience problems with cognition when her emotional condition was exacerbated." ( Id. ). Dr. Alpers indicated that McAlister's symptoms included "headaches, cervical radiculopathy, and possible epilepsy." (AR 402). He also stated that "though diagnosed with vascular dementia' by Dr. Mishra, this diagnosis is not supported given the lack of vascular disease on MRI of the brain." (AR 403). After reviewing these reports, Liberty decided to reinstate McAlister's LTD benefits. (AR 394).

On July 26, 2012, Liberty informed McAlister that due to the 24-month Mental Illness limitation, her LTD benefits would expire on August 12, 2012. (AR 201). Liberty also advised McAlister that "to remain eligible for benefits... which are not related to a Mental Illness, [she] must be physically disabled from Any Occupation." (AR 202). McAlister appealed her benefit denial on January 22, 2013. (AR 189). McAlister did not initially provide medical ...


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