United States District Court, D. Colorado
HAROLD E. MASON, Plaintiff,
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.
ORDER ON ADMINISTRATIVE RECORD
S. Krieger Chief Judge
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).
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).
RECORD AND PROCEDURAL HISTORY
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
Mr. Mason's relevant work and medical history
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.
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
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.
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.
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.
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.
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.
Reliance's review on remand
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.
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 ...