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Moody v. Liberty Mutual Life Assurance Co. of Boston

United States District Court, W.D. Kentucky, Louisville Division

June 19, 2018

CHERYL MOODY, Plaintiff,
v.
LIBERTY MUTUAL LIFE ASSURANCE COMPANY OF BOSTON, Defendant.

          MEMORANDUM OPINION AND ORDER

          David J. Hale, Judge United States District Court

         Plaintiff Cheryl Moody brings this action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., seeking review of Defendant Liberty Life Assurance Company of Boston's decision to deny her claim for long-term disability benefits. (See Docket No. 1-2) This matter is currently before the Court on the parties' cross-motions for judgment on the administrative record. (D.N. 21; D.N. 22) For the reasons discussed below, the Court will deny Moody's claim and grant Liberty's motion for judgment on the administrative record.

         I. Background

         Cheryl Moody is a former employee of Wal-Mart Stores, Inc., in Louisville, Kentucky. (D.N. 1-2, PageID # 9) On January 2, 2015, Moody suffered a work-related injury while attempting to lift a tray of meat. (D.N. 13, PageID # 171) Over a year after her injury, Moody submitted a claim for LTD benefits under a policy provided by Wal-Mart and administrated by Liberty. (Id., PageID # 91) After receiving the application, Liberty advised Moody that it needed “[m]edical records from all physicians including treatment notes, diagnostic test results, therapy notes, procedure reports and hospital discharged reports.” (Id., PageID # 293) Liberty thereafter requested that Moody's treating physician, Dr. Raymond Shea, submit all “[o]ffice treatment notes, test results, prescription histories, and treatment plans” regarding Moody. (Id., PageID # 286)

         Liberty received medical records from Dr. Shea, which detail Moody's visits to his office between January 16, 2015 and February 6, 2016. In his notes regarding her early visits, Dr. Shea indicated Moody's “acute pain and discomfort in the neck” (id., PageID # 266), her inability to work (id., PageID # 263), her “progressively more severe” neck pain (id., PageID # 262; see also id., PageID # 259-60), and her “loss of motion in flexion and extension of the cervical spine” (id., PageID # 284). In notes dated June 25, 2015, Dr. Shea stated that “[Moody] is permanently and totally disabled.” (Id.) However, Dr. Shea later opined that while the range of motion of Moody's neck was limited, “there [was] no neurologic deficit and [she had] good strength in her hand.” (Id., PageID # 275) Liberty also received information regarding several MRIs Moody had undergone during her treatment from Dr. Shea. An MRI of Moody's spine dated January 17, 2015, showed only “[m]ild degenerative change . . . but no cord compression at any level.” (Id., PageID # 270) An MRI dated March 31, 2015, showed only “[m]ild lower lumbar degenerative change with areas of minimal foraminal narrowing.” (Id., PageID # 268)

         Following receipt of Moody's medical records from Dr. Shea, Liberty submitted a request for a file review to consulting physician Kirsten D'Amore. (Id., PageID # 257) After reviewing Moody's medical records, Dr. D'Amore diagnosed Moody with “[c]ervical sprain/strain, cervical [degenerative disc disease]/spondylosis, [and] neck pain.” (Id., PageID # 253) Based on that assessment, D'Amore estimated Moody's restrictions to be “no lifting/carrying over 25 pounds, ” and indicated that the usual recovery time for Moody's primary impairing condition was “[w]eeks/months with conservative treatment.” (Id., PageID # 253-54)

         Liberty next referred Moody's claim to a Liberty consulting physician for a full file review. (Id., PageID # 252) In his report, consulting physician Shilpa Kasuganti stated that “[t]he clinical history suggests that initial trauma resulted in the acute strain/sprain injury of [Moody's] cervical spine and lumbar spine which has now transitioned to . . . chronic cervical and lumbar spondylosis that are within the norm for her age and are not causing any neurologic deficit.” (Id., PageID # 243) Based on his assessment, Dr. Kasuganti recommended the following restrictions for Moody: “up to frequent walking and standing; unlimited sitting with the ability to change positions as needed; occasional lifting/carrying/pushing/pulling up to 25 lbs.; occasional bending and twisting; no climbing ladders, crawling; occasional kneeling, stooping, [and] squatting.” (Id.) He also indicated his efforts to consult with Dr. Shea regarding Shea's diagnosis of Moody as “still disabled”-a diagnosis that Dr. Shea's secretary relayed to Kasuganti over the phone: “I asked [the secretary] whether she could clarify with Dr. Shea [regarding Moody's] physical deficits on exam and what prevented [her] from being able to sustain some level of sedentary or light activity . . . . I have yet to receive a reply.” (Id., PageID # 242)

         On March 22, 2016, based on the records provided by Dr. Shea and the reviews conducted by its consulting physicians, Liberty provided Moody an initial approval for LTD benefits. (Id., PageID # 231-33) The approval followed from the fact that Moody merely needed to show an inability to perform her prior position at Wal-Mart to initially qualify for benefits. (Id., PageID # 55) Specifically, Liberty found that Moody was eligible for LTD benefits effective July 13, 2015. (Id., PageID # 232) Under the terms of the Policy, Moody was entitled to benefits for the 12 months following that date so long as she was unable to perform her prior occupation at Wal-Mart. (Id., PageID # 55) After the 12-month period, to qualify for continued benefits, Moody would have to demonstrate an inability to perform “any occupation.” (Id.) Meanwhile, Liberty continued its efforts to communicate with Dr. Shea. Liberty sent Dr. Shea a letter listing Dr. Kasuganti's recommended limitations and asking him “whether or not [he] agree[d] with the . . . restrictions as well as the[ir] duration.” (Id., PageID # 209) Shortly thereafter, Liberty received a fax from Dr. Shea, signed on April 8, 2016, on which he placed a check-mark next to “Agree.” (Id., PageID # 167)

         The initial 12-month benefits period ended on July 12, 2016. Beginning on that date, in order to be entitled to continued benefits, Moody would have to show that she was unable to perform “any occupation.” (Id., PageID # 55) The Policy defines “any occupation” as “any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.” (Id., PageID # 54) Based on the consulting physicians' recommendations and Dr. Shea's agreement with the recommendations, Liberty case manager Rebecca Turner listed several occupations that were within Moody's physical capacities for work and which qualified as “Any Occupation” under the Policy. (Id., PageID # 157-58) The occupations include badge checker, information clerk, cashier, assembler/small parts, customer service representative, order clerk, and retail salesperson. (Id.)

         Liberty therefore informed Moody that she no longer qualified for LTD benefits because she did not meet the Policy's definition of “disabled.” (Id., PageID # 147-50) Liberty also advised Moody of her appeal rights and instructed her to attach “updated medical information, . . . . [including] any new office visit notes, test results, [etc.]” in the event of an appeal. (Id., PageID # 149) On November 12, 2016, Moody informed Liberty of her decision to appeal. (Id., PageID # 130) In her communication with Liberty, Moody included a letter from Dr. Shea dated March 16, 2016. (Id., PageID # 131) Attached to the letter is one page of undated handwritten notes, which state: “1) sit 2 hrs., 2) stand 2 hrs., 3) [l]ift [less than] 10 lbs., 4) [b]reaks 4-5 hrs., (5) [m]iss 4-5 days.” (Id., PageID # 132) Immediately to the right of the notes is another handwritten notation which states, “Based on our [appointment] today. But you're the doctor!” (Id.) Moody also included a Social Security claim form signed by Dr. Shea and dated April 25, 2016-two weeks after Dr. Shea's fax to Liberty in which he agreed with Dr. Kasuganti's recommended limitations. (Id., PageID # 134) In the form, Dr. Shea recommends that Moody can sit for a total of 15 minutes in an 8 hour workday, stand for a total of 15 minutes in an 8 hour workday, lift and carry less than 5 pounds, never use her right arm to work, and use her left arm to work 0-33% of the day. (Id.)

         On February 16, 2017, Liberty informed Moody of its decision to affirm its denial of LTD benefits. (Id., PageID # 104-09) For the basis of its decision, Liberty cited Dr. Kasuganti's report, the communications between Dr. Kasuganti and Dr. Shea's office, Dr. Shea's April 8, 2016 agreement with Dr. Kasuganti regarding Moody's restrictions and their duration, and the results of Moody's MRIs. (Id., PageID 106-08) Specifically, Liberty noted that

[d]uring the review of your appeal, Ms. Moody's entire claim file was reviewed. The additional medical documentation submitted on appeal was relatively unchanged from prior office visits. The medical [evidence] continued to indicate that Ms. Moody was unable to carry out activities of daily living, reported continued pain and discomfort and indicated deficits in cervical range of motion. The additional information submitted on appeal did not provide significant changes in her examination findings that would alter the supported restrictions and limitations outlined by Dr. Kasuganti and agreed upon by Dr. Shea.

(Id., PageID # 108)

         In April 2017, Moody filed this action seeking review of Liberty's decision to deny her claim for LTD benefits. (See D.N. 1-2) Moody and Liberty now each move for ...


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