United States District Court, E.D. Kentucky, Central Division, Lexington
MEMORANDUM OPINION AND ORDER
C. Reeves, United States District Judge
matter is pending for consideration of the cross-motions for
judgment filed by Plaintiff Tracy Kellar and Defendants Aetna
Life Insurance Company (“Aetna”) and Amazon
Corporate LLC Long Term Disability Plan. [Record Nos. 21, 22]
Kellar challenges Aetna's decision to deny her claim for
long-term disability (“LTD”) benefits under an
employee benefit plan sponsored by her former employer,
Amazon Corporate LLC (“Amazon”), and governed by
the Employee Retirement Income Security Act of 1974
(“ERISA”), 29 U.S.C. § 1001, et
seq. [Record No. 21] Kellar argues that Aetna's
decision was arbitrary and capricious. [Id.]
Conversely, the defendants contend that Aetna's decision
was supported by substantial evidence and should be affirmed.
[Record Nos. 22, 23] The defendants have the winning
arguments and judgment will be entered in their favor.
hired Kellar as a Fulfillment Associate on July 26, 2015.
[Administrative Record (“AR”), p. 11] She became
a participant in Amazon's group LTD plan at that time.
[Id.] Aetna issued the Plan to Amazon, acted as its
claims administrator, and had discretion to interpret the
Plan's terms and to make benefit determinations. [Plan,
Kellar's LTD Plan
Plan pays a monthly benefit if a person covered by the Plan
satisfies the LTD test of disability and the 180 day
elimination period has passed. [Plan, pp. 6, 73] The LTD test
of disability provides as follows:
[Y]ou will be deemed to meet the test of disability on any
- You cannot perform the material
duties of your own occupation
solely because of an illness, injury or
disabling pregnancy-related condition; and
- Your work earnings are 80% or less of your
adjusted predisability earnings.
[Plan, p. 7]
“Material duties” are duties that:
■ Are normally required for the performance of your own
- Cannot be reasonably omitted or modified.
However, to be actively at work in excess of
40 hours per week is not a material duty.
[Plan, p. 27]
Your “own occupation” is:
The work that you are routinely performing when your period
of disability begins. Your occupation will be viewed as it is
normally performed in the national economy instead of how it
- For your specific employer; or
- At your location or work site; and
- Without regard to your specific reporting
relationship. [Plan, p. 28]
The Plan, however, “does not pay benefits for a
disability that is caused, or contributed to, by a
preexisting condition, if the disability starts . . . within
the first 12 months after your coverage goes into effect. . .
.” [Plan, p. 10] According to the Plan:
A preexisting condition is an
illness, injury or disabling
pregnancy-related condition for which, during the 3 months
before your coverage or any increase in your coverage became
- You were diagnosed or treated; or
- You received diagnostic or treatment
- You took drugs that were prescribed or
recommended by a physician.
[Plan, p. 9]
Associate is a medium exertion level position. [AR, pp.
1541-42] A Fulfillment Associate at Amazon must be able to
lift up to 49 pounds with or without reasonable
accommodation; stand/walk for 10-12 hours; frequently push,
pull, squat, bend, and reach; continuously climb and descend
stairs; and work on powered equipment such as a forklift or
cherry picker. [AR, pp. 1545-46]
Kellar's LTD Claim
was injured on August 25, 2015, one month after she began
working for Amazon, when she was struck in the shins by a
flatbed cart being pushed by another associate. [AR, pp.
1497-1502] Both shins appeared to be bruised, an abrasion on
her left shin was bleeding, and she initially reported a pain
level of 8 out of 10. [AR, pp. 1497-99] Kellar was treated
onsite for the injury with ice. [AR, pp. ...