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Meiman v. Aetna Life Insurance Co.

United States District Court, E.D. Kentucky, Northern Division, Covington

November 5, 2019

LISA MEIMAN PLAINTIFF
v.
AETNA LIFE INS. CO. DEFENDANT

          MEMORANDUM OPINION AND ORDER

          William O. Bertelsman United States District Judge.

         Plaintiff, Lisa Meiman, filed suit against Defendant, Aetna Life Insurance, under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq., after Aetna terminated the long-term disability benefits it had been paying her for over ten years. Meiman seeks to recover the denied benefits, plus prejudgment interest, and asks the Court to clarify her rights to future benefits. (Doc. 1, ¶¶ 5, 30).

         This matter is now before the Court on Plaintiff's Motion for Judgment on the Administrative Record. (Doc. 45). Deciding that Motion requires the Court to determine whether Aetna correctly found that Meiman could perform a “reasonable occupation” as defined by the terms of the Disability Plan. Considering the medical evidence's consensus that she can perform sedentary work with minor accommodations and a 2016 transferable skills analysis that provides examples of sedentary occupations that meet the Plan's wage requirements, the Court concludes that Aetna was correct in denying benefits and finds that Plaintiff's Motion should be DENIED.

         I. Factual and Procedural Background

         Lisa Meiman, now fifty-four years old, was employed with Delta Airlines for around fifteen years until multiple knee injuries forced her to take long-term disability. (AR 607, 703, 740, 1674). Meiman first injured her right knee in 2003 and underwent a partial medial meniscectomy soon after the injury and an osteochondral autograft transfer procedure in March 2005. (AR 670, 718, 731-32, 848, 970, 1002). Meiman then injured her left knee in late-November 2005 while assisting a customer in a wheelchair. (AR 731-32). After her left-knee injury, a doctor restricted Meiman to sedentary work activity. (AR 629-31). Aetna approved Meiman's initial disability claim in June 2006 when it found that she could not perform the demands of her “own occupation” as a ticket agent (medium work). (AR 349).

         Ongoing treatment for those knee injuries led Aetna to conclude on multiple occasions between December 2006 and October 2016 that Meiman could not perform “any reasonable occupation” as defined by the terms of the Plan. In March 2006, orthopedic surgeon Dr. Angelo J. Colosimo diagnosed joint space narrowing, otherwise known as osteoarthritis, in Meiman's right knee. (AR 859). About a year later, Meiman had a third surgery on her right knee. (AR 732, 1002). In a September 2007 follow-up visit, Dr. Colosimo noted that Meiman would remain restricted to working four to six hours per day until she had a left-knee arthroscopy as her left knee was also showing signs of osteoarthritis. (AR 848).

         Shortly after the September follow up, Aetna conducted its first transferable skills analysis to find examples of sedentary jobs that Meiman could perform that also paid a wage greater than sixty percent of Meiman's adjusted pre-disability earnings. (AR 1628-30).[1] While the transferable skills analysis identified potential jobs, a subsequent labor market survey indicated that the available jobs failed to meet the Plan's wage requirement. (AR 1622). As such, Aetna again found Meiman disabled. (Id.).

         Dr. Colosimo continued to deem Meiman disabled, but in late-September 2007 and October 2007, she saw two doctors who both found that she could perform light work. (AR 718-27, 731-35). Accordingly, Aetna conducted a second transferable skills analysis in February 2008 to identify potential jobs. (AR 1613-17). Aetna identified one such example occupation. (AR 1613, 1615-16). But a subsequent labor market survey concluded that the potentially available positions did not meet the Plan's wage requirements, so Aetna again found Meiman disabled. (Id.).

         Meiman underwent the left-knee arthroscopy procedure in November 2008. (AR 806-07). And in November 2009, Dr. Colosimo indicated that Meiman could perform most of the physical requirements of sedentary work for up to six hours per day. (AR 592). An administrative law judge for the Social Security Administration felt differently and in April 2013 found that Meiman could perform full-time sedentary work with a few additional restrictions. (AR 1501-11). In July 2013, Dr. Colosimo noted that Meiman had received injections in her knees due to reported swelling, pain, and weakness, but he also noted that her radiographs “did not look horrible.” (AR 1470, 1522-23). While he found that Meiman could perform the physical requirements of sedentary work, he without explanation concluded that she was still disabled. (Id.). Shortly after this visit, an internal nurse reviewer for Aetna reviewed the records and determined that Meiman could work full time. (AR 305).

         As a consequence, Aetna conducted a third transferable skills analysis in February 2014 to identify potential occupations. (AR 132-35, 1430-32). The analysis identified four sample occupations that Meiman could possibly perform that also met the Plan's wage criteria. (AR 1431). The sample occupations were, however, considered only fair or potential matches for Meiman. (Id.). Aetna therefore continued to pay disability benefits and did not conduct a labor market survey as it had done in the past. (Id.).

         In October 2015, a new claim representative took over Meiman's claim. The new representative contacted Meiman, and while he noted that Aetna had not yet identified alternative gainful occupations she could perform, he discussed a more favorable July 2015 attending physician statement from Dr. Colosimo with her. (AR 68). That attending physician statement found that Meiman could perform the physical requirements of sedentary work with some additional restrictions, but again, and without explanation, insisted that she was permanently disabled. (AR 68, 1022-23).

         Dr. Colosimo's practice of issuing cursory disabling opinions continued, and in a capabilities and limitations worksheet from January 2016, he once again indicated without explanation that Meiman could perform the physical requirements of sedentary work for only six hours per day. (AR 1305). An internal nurse reviewer for Aetna who examined the worksheet felt that there was no medical evidence suggesting that Meiman could not work a full eight hours. (AR 166). In March 2016, Meiman's claim representative contacted her and informed her that Aetna was unsure as to why Dr. Colosimo had limited her to only six hours of work and explained to her that if Aetna could determine that she could work eight hours and identify gainful employment, then she would no longer be eligible for benefits. (AR 66). During this conversation, Meiman revealed that she could lift items like a gallon of milk and that she helped with her kids, cooked dinner, and that she had been asked by her town's mayor to serve on the city board for code adjustment appeals. (Id.).

         Shortly after this conversation, Aetna conducted two rounds of surveillance on Meiman. Surveillance from April 19 through April 21, 2016, revealed that Meiman neither moved in a guarded manner nor used any visible assistive devices. (AR 1221-22). She was seen walking up and down the stairs of her deck, walking her dog, walking around her backyard, and watering her plants using a hose. (Id.). Meiman was also seen bending to pick up items from the ground, wheeling the garbage bin to the end of the driveway, and driving to pick-up takeout food. (Id.). The second round of surveillance from June 6, 8, and 9, 2016, showed Meiman driving, walking to her mailbox, sitting on her front porch steps, and walking with her child to a nearby elementary school. (AR 1212-13).

         Soon after the surveillance, in July 2016, Meiman underwent an independent medical examination with Dr. V. James Sammarco, a board-certified orthopedic surgeon. (AR 1205-1210). Dr. Sammarco found that her knee arthritis was the only ailment affecting her ability to work. (Id.). After reviewing the surveillance video, Dr. Sammarco stated that Meiman's reported symptoms were in “stark contrast” to what she was seen doing in the video. (AR 1208-09). Dr. Sammarco concluded that Meiman could perform the physical requirements of medium work and could work a full eight-hour day. (AR 1208-10). Aetna then commissioned a fourth transferable skills analysis based on Dr. Sammarco's findings. (AR 1202-03). This 2016 analysis identified five potential occupations that Meiman could perform that also met the adjusted wage requirements. (Id.). Three of the example occupations were ...


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