United States District Court, D. Colorado
ORDER AFFIRMING DENIAL OF BENEFITS
BROOKE JACKSON UNITED STATES DISTRICT JUDGE.
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
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.
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.
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.
the Plan, "Disability/Disabled" is defined as
You are considered Disabled if, solely because of Injury or
Sickness, you are:
(1) unable to perform the material duties of your Regular
(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 ...