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