United States District Court, E.D. Kentucky, Northern Division, Ashland
MEMORANDUM OPINION AND ORDER
R. Wilhoit, Jr. United States District Judge.
matter is before the Court upon the parties' cross
Motions for Summary Judgment [Docket Nos. 14 and 15]. For the
reasons set forth below, the Court finds that Defendant
AT&T Services, Inc. is entitled to judgment as a matter
Brock filed this civil action against her employer, AT&T
Services, Inc. (hereinafter "AT&T") pursuant to
29 U.S.C. § 1132(A)(1)(B), challenging the denial of her
application for short-term disability benefits.
Judith Brock ("Brock") worked for AT&T Mobility
Services, LLC ("AT&T") as a Clerk from October
10, 2001 through November 21, 2015 [Docket No. 12-1,
Administrative Record 000059]. As an AT&T employee, Brock
was an eligible employee in the AT&T Mobility Disability
Program ("DP"), which is regulated by the Employee
Retirement Income Security Act, 29 U.S.C. §1001 et.
seq. ("ERISA"). [Docket No. 12-5, Plan 087].
The short-term disability ("STD") portion of the DP
provides for benefits for up to 26 weeks after an eligible
employee has been determined to be partially or totally
disabled. [Docket No. 12-3, Plan 056].
the terms of the DP, disability determinations are made by a
third-party Claims Administrator, Sedgwick Claims Management
Services, Inc., through the Integrated Disability Service
Center ("IDSC"), which Sedgwick operates. [Docket
No. 12-1, AR 000172]. The Claims Administrator is the only
entity which determines whether or not a participant is
disabled and is granted complete discretion to make such a
decision. [Docket No. 12-5, Plan 068]. The plan participant
must be under the care of a physician, provide their medical
providers with a release and ensure that they submit medical
information to the Claims Administrator in a timely manner.
Id. at 067. After a review of the medical
information, if the Claims Administrator denies the claim,
the participant must be provided with an explanation as to
the reason for denial of disability benefits. Id. at
084. A plan participant has the right to appeal the denial
and can file a lawsuit if the claim is denied on appeal.
Id. The Claims Administrator is granted complete
discretion to grant or deny appeals for disability benefits
under the Plan. Id. As with the initial claim
decision, on appeal, the Claims Administrator must provide
the participant with specific reasons why the disability
benefits claim is denied. Id.
was employed by AT&T as a Clerk from October 1, 2001
until November 22, 2015. [Docket No. 12-1, AR 000059]. Her
job was essentially sedentary and included filing, answering
the phone, typing, precessing mail and providing general
office support. Id. at 000012 and 000068.
AT&T employee, Plaintiff was a participant in the DP,
described supra. During her tenure at AT&T,
Plaintiff was diagnosed as having restless leg syndrome,
essential tremors and mild carpal tunnel syndrome [Docket No.
12-1 AR 000091, 000093].
April 2, 2014, Plaintiffs treating physician, Dr. Suresh
Kumar, saw the Plaintiff for her history of essential tremors
and peripheral neuropathy which she indicated were made worse
with stress or loud music. During that visit, he refilled her
medication and told her to follow up in four - six months.
[Docket No. 12-2, AR 000147-148].
Dr. Kumar a little over two weeks later, August 20, 2014. She
told Dr. Kumar that medication was controlling her restless
syndrome and tremors. He, again, recommended a follow up
visit in four-six months. Id. at 000143-144.
saw Dr. Kumar again, about seven months later on May 5, 2015,
for a follow up of her restless leg syndrome and tremors. His
prescription at that time was for an over the counter
medication and he advised Plaintiff to continue the
medication. He recommended a follow up in six months.
Id. at 000140.
November 16, 2015, Sedgwick, through the AT&T Integrated
Disability Center, opened a disability claim for the
Plaintiff. Id. at 000152-153.
to Plaintiffs authorization, Sedgwick received the Initial
Physician Statement ("IPS") which Dr. Kumar,
Plaintiffs treating physician, completed on November 16, 2015
in which he stated that Plaintiff had been diagnosed with
essential tremors which were "exacerbated with loud
noise". He noted that he had increased the dosage on
Plaintiffs medication which was expected to improve her
functioning and suggested that Plaintiff be allowed to work
away from loud noise "if possible". [Docket No.
12-1, AR 00016]
initial review of Plaintiff s claim on November 23, 2015
indicated that the medical information did not support ...