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Kellar v. Aetna Life Insurance Co.

United States District Court, E.D. Kentucky, Central Division, Lexington

February 5, 2018

TRACY KELLAR, Plaintiff,
v.
AETNA LIFE INSURANCE COMPANY, et al., Defendants.

          MEMORANDUM OPINION AND ORDER

          Danny C. Reeves, United States District Judge

         This 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.

         I.

         Amazon 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, p. 70]

         A. Kellar's LTD Plan

         The 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 day that:
- 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 occupation; and
- 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 is performed:
- 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 effective:
- You were diagnosed or treated; or
- You received diagnostic or treatment services; or
- You took drugs that were prescribed or recommended by a physician.
[Plan, p. 9]

         Fulfillment 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]

         B. Kellar's LTD Claim

         Kellar 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. ...


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