Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Green v. Life Insurance Co. of North America

United States District Court, D. Colorado

September 29, 2017

MICHAEL GREEN, Plaintiff,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

          ORDER AFFIRMING DENIAL OF BENEFITS

          R. BROOKE JACKSON UNITED STATES DISTRICT JUDGE.

         This case arises under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. It is a review of Defendant Life Insurance Company of North America's denial of Plaintiff Michael Green's claim for long-term disability benefits. After considering the arguments, applicable law, and administrative record, the Court affirms LINA's denial of benefits for the reasons stated herein.

         BACKGROUND

         A. Facts.

         Mr. Green was a truck driver employed by McLane Company, Inc. (“McClane”). In December 2014, Mr. Green began experiencing cloudy vision. Admin. Rec. at 238. He visited Dr. Kenneth Van Amerongen at Van's Eyecare on December 4th, 2014, and was diagnosed with posterior vitreous detachment (“PVD”). Id. PVD is generally a benign and asymptomatic condition that occurs when the vitreous gel that fills the eye separates from the retina. Id. at 1159. Dr. Amerongen noted that there were no bleeds or tears on Mr. Green's eyes, but recommended that Mr. Green seek out a retinal specialist if his symptoms worsened or failed to improve. Id.

         On February 25, 2015, Mr. Green sought treatment with Dr. Justin Kanoff at Eye Care Center of Northern Colorado. Id. at 909. Dr. Kanoff diagnosed Mr. Green with a macula-off retinal detachment of the right eye. Id. Mr. Green underwent three surgeries over the course of six months to treat his right eye, but he ultimately suffered permanent vision loss. See id. at 216-221, 425-428, 909, and ECF No. 26 at 5. This vision loss renders him unable to work as a truck driver. ECF No. 36.

         McClane provided its employees with a group disability benefits plan (“the Plan”). Mr. Green was covered under Policy No. VDT-0980073. Id. at 7. The Plan was administrated by Life Insurance Company of North America (“LINA”), and McClane appointed LINA “as the designated fiduciary for the review of claims for benefits under the Plan.” Admin. Rec. at 38. This gave LINA the “authority, in its discretion, to interpret the terms of the Plan; to decide questions of eligibility for coverage or benefits under the Plan; and to make any related findings of fact.” Id.

         Under the Plan, "Disability/Disabled" is defined as follows:

You are considered Disabled if, solely because of Injury or Sickness, you are:
(1) unable to perform the material duties of your Regular Occupation; and
(2) unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.

Id. at 21. A "Sickness" is defined as "a physical or mental illness." Id. at 23. The Plan promises the following:

We will pay Disability Benefits if you become Disabled while covered under this Policy. You must satisfy the Elimination Period, be under the Appropriate Care of a Physician, and meet all the other terms and conditions of the Policy. You must provide to us, at your own expense, satisfactory proof of Disability before benefits will be paid.

Id. at 12. The Plan's Pre-Existing Condition limitation, which is central to this case, states:

We will not pay for benefits for any period of Disability caused or contributed to by, or resulting from, a Pre-existing Condition. A 'Pre-existing Condition' means any Injury or Sickness for which you incurred expenses, received medical treatment, care or services including diagnostic measures, or took prescribed drugs or ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.