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Mason v. Reliance Standard Life Insurance Co.

United States District Court, D. Colorado

March 22, 2017

HAROLD E. MASON, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

          ORDER ON ADMINISTRATIVE RECORD

          Marcia S. Krieger Chief Judge

         THIS MATTER comes before the Court for review of Reliance Standard Life Insurance Company's denial of long term disability benefits to Plaintiff Harold E. Mason under an insurance plan governed by the Employment Retirement Income Security Act of 1974, 28 U.S.C. § 1001, et seq. (“ERISA”). The parties filed an Administrative Record (# 30) and a joint motion for a ruling on that Record (# 37) which reflected the parties' agreement that the matter should be determined on the briefs (# 31, 32, 36).

         JURISDICTION

         The parties agree that the Plaintiff's claim is governed by ERISA and the Court exercises subject matter jurisdiction pursuant to 29 U.S.C. § 1132(a)(1)(B).

         ADMINISTRATIVE RECORD AND PROCEDURAL HISTORY

         LSI Corporation (LSI) was Mr. Mason's employer. LSI provided Mr. Mason with long-term disability and life insurance through a policy (“the Policy”) issued by Reliance Standard Life Insurance Company (“Reliance”). Under the terms of the Policy, Mr. Mason is eligible for long-term disability benefits if, due to injury or sickness, he cannot perform his “regular occupation.” However, the Policy delays the onset of benefits for a 364-day “Elimination Period, ” during which Mr. Mason must remain “totally disabled.”

         A. Mr. Mason's relevant work and medical history

         Mr. Mason's job at LSI was as the Director of Industry Marketing. According to the position description, he was required to represent LSI in meetings and public fora, support marketing efforts, exhibit leadership in promoting LSI products, maintain membership in over fifty groups, lead funding for research programs, forecast budgets, and communicate and speak at industry events. Approximately 50-80% of Mr. Mason's job involved traveling. For example, in 2007, Mr. Mason travelled in excess of 66, 000 miles. Mr. Mason's job required only minimal physical activity, but considerable mental and cognitive abilities.

         Beginning in 2007, Mr. Mason was diagnosed with viral hepatitis (hepatitis B) and chronic cirrhosis of the liver. In mid to late 2008, Mr. Mason's doctor noted that Mr. Mason also showed signs of coronary artery disease. In 2009, Mr. Mason experienced fevers, coughs, abdominal pain, pleural effusion, and other complications from the liver cirrhosis. These symptoms as well as diarrhea, nausea and vomiting continued through at least 2011 resulting in multiple hospitalizations. In 2011, his treating physician, Dr. Karen Cesario, noted that it was likely that Mr. Mason would ultimately need a liver transplant.

         Due to his health condition, Mr. Mason stopped working on July 26, 2012 and applied for benefits under the Policy. This triggered the advent of the 364-day Elimination Period. Mr. Mason states that he was no longer able to perform his job due to fevers, nausea, diarrhea, fatigue, and inability to concentrate or manage stress.

         After the Elimination Period concluded, Reliance determined that Mr. Mason had not demonstrated that he had been totally disabled during it (July 26, 2012 - July 26, 2013). As a consequence, Reliance denied Mr. Mason's claim. Mr. Mason appealed the denial, and Reliance referred his appeal to its Quality Review Unit for a review by Dr. Manoj Mehta.

         Dr. Mehta reviewed Mr. Mason's medical records but did not perform an in-person medical evaluation. Dr. Mehta opined that Mr. Mason was not totally disabled as of July 26, 2012. According to Dr. Mehta, aside from his portal hypertension, Mr. Mason was asymptomatic. He could travel and his medical condition did not affect his cognitive abilities. Consequently, Reliance also denied Mr. Mason's appeal.

         B. First lawsuit

         Mr. Mason sought judicial review of Reliance's denial of his long term disability benefits in case 14-cv-01415-MSK-NYW. Upon review of the record, the Court reversed and remanded directing Reliance (1) to resolve an ambiguity in the meaning of “total disability” under the Policy and (2) to consider all of the medical evidence readily available to Reliance pertinent to the Elimination Period between July 2012 to July 2013.

         As to the second issue, the Court found that Reliance had not considered all of the evidence available to it, and specifically found that substantial evidence did not support three findings: (1) that Mr. Mason's medical condition did not affect his cognitive abilities because there was no apparent consideration of Dr. Cesario's August 21, 2012 report stating that Mr. Mason suffered from hepatic encephalopathy/slowed thinking or letters from Mr. Mason's colleagues that he suffered from cognitive difficulties before he stopped working; (2) there was no consideration of treatment notes reflecting Mr. Mason's frequent nausea, severe leg swelling, and suppressed immune system, as well as the collective effect of the multiple symptoms, in so far as they impacted his ability to stand, walk, make speeches, and promote LSI products; and (3) that Reliance's finding that Mr. Mason was able to travel was based entirely on a singular, vague treatment note in December 2012 that stated that Mr. Mason “has been travelling quite extensively” that was contradicted by other evidence of record.

         C. Reliance's review on remand

         After the remand, Reliance referred the matter to Dr. Mehta, the same doctor who had conducted the earlier record review. On this second go round, it does not appear that Dr. Mehta was provided or considered the Court's opinion pointing out the inadequacy of the prior assessment. Consequently, it is unsurprising that Dr. Mehta again opined, based on a record review, that Mr. Mason's medical condition during the Elimination Period did not affect his cognitive abilities. In addition, Dr. Mehta stated that during such period, Mr. Mason had “essentially had no complaints aside from a hernia.” And, based entirely on the vague December 2012 treatment note, Dr. Mehta again opined that during such period Mr. Mason was able to travel.

         Based on Dr. Mehta's second report, Reliance again denied Mr. Mason's claim. Reliance clarified the Policy ambiguity as to the meaning of “total disability”. It stated:

Mr. Mason would have been considered Totally Disabled if he were Partially Disabled during Elimination Period, in accordance with the Policy provision regarding Residual Disability. For example, if Mr. Mason were unable to perform some of the duties of his Regular Occupation during the Elimination Period, he would have been Partially Disabled ...

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