United States District Court, D. Colorado
MICHAEL J. PAQUFN, an individual, Plaintiff,
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, a New Jersey for-profit corporation, Defendant.
BROOKE JACKSON UNITED STATES DISTRICT JUDGE
case, which arises under the Employee Retirement Income
Security Act of 1974, 29 U.S.C. § 1001 et seq., is a
review of defendant Prudential Insurance Company of
America's termination of plaintiff Michael J.
Paquin's long-term disability benefits. After considering
the arguments, applicable law, and administrative record, the
Court reverses the termination of Mr. Paquin's benefits
for the reasons stated herein, and therefore GRANTS Mr.
Paquin's motion for summary judgment, ECF No. 48.
Factual and Procedural Background.
Michael Paquin contracted encephalitis from a mosquito
infected by the West Nile virus. He sustained brain damage
and cognitive difficulties that interfered with his ability
to continue his employment as a Business Development Director
for Transistor Devices, Inc. ("TDI"). TDI offered
an employee benefits plan which was insured and administrated
by Prudential Insurance Company of America. The plan states,
in relevant part:
You are disabled when Prudential determines that:
• you are unable to perform the material and substantial
duties of your regular occupation due to your sickness or
• you have a 20% or more loss in your indexed monthly
earnings due to that sickness or injury.
24 months of payments, you are disabled when Prudential
determines that due to the same sickness or injury, you are
unable to perform the duties of any gainful occupation for
which you are reasonably fitted by education, training, or
experience . . .
and substantial duties means duties that:
• are normally required for the performance of your
regular occupation; and
• cannot be reasonably omitted or modified, except that
if you are required to work on average in excess of 40 hours
per week, Prudential will consider you able to perform that
requirement if you are working or have the capacity to work
40 hours per week.
• gainful occupation means an occupation, including
self-employment, that is or can be expected to provide you
with an income equal to at least 60% of your indexed monthly
earnings within 12 months of your return to work.
Prudential approved Mr. Paquin for short-term disability
benefits in 2003. In 2004 Mr. Paquin's employment ended,
and he applied for long-term disability ("LTD")
benefits under the company's employee benefits plan.
Prudential approved his application and provided him LTD
benefits beginning in April 2004. R. 1803. However, when Mr.
Paquin attempted (unsuccessfully) to go back to work for a
trial period, Prudential terminated Mr. Paquin's LTD
benefits in May 2004. Mr. Paquin appealed this decision, and
after reviewing his file Prudential reversed its
determination in 2006, reinstated Mr. Paquin's benefits,
and paid back Mr. Paquin's benefits from May 2004 through
January 2006 until January 7, 2015-roughly eleven
years-Prudential paid Mr. Paquin LTD benefits. It regularly
reviewed Mr. Paquin's file throughout the years, and each
time it determined that Mr. Paquin's disability warranted
on January 8, 2015 Prudential terminated Mr. Paquin's LTD
benefits, due in large part to one independent
neuropsychological test ("NPT") and
Prudential's conclusion that there was no valid evidence
of a continuing impairment that would prevent Mr. Paquin from
performing the duties of his regular occupation. Two internal
appeals of that decision were unsuccessful. On August 24,
2016 Mr. Paquin filed this suit challenging the denial of his
LTD benefits under the Employee Retirement Income Security
Act of 1974, or ERISA. Now before the Court is Mr.
Paquin's motion for summary judgment. ECF No. 48. The
motion has been fully briefed and is ripe for this
Medical Evidence in the Administrative
following is a summary of the medical evidence that was
before Prudential when it decided to terminate Mr.
Paquin's LTD benefits and when it denied Mr. Paquin's
• September 2003: Neurologist Janice Miller, MD, treats
Mr. Paquin for viral encephalitis and meningitis after
exposure to West Nile virus. During this hospital stay, Mr.
Paquin is also seen by infectious disease physician Nelson
Ganz, MD. R. 22, 117.
• November 2003: Upon referral by Dr. Miller, Mr. Paquin
visits Mapletown Rehabilitation Center for cognitive therapy
and evaluation. Medical records from these visits indicate
notable cognitive impairments. R. 12, 29-65.
• November 21, 2003: Speech language pathologist Melissa
Hundley, MS, evaluates Mr. Paquin for neurotrauma speech and
language therapy, and she notes that he has "a variety
of cognitive deficits which include: decreased short term
recall, impaired word finding, impaired processing, impaired
executive functioning and an inability to complete multiple
tasks." R. 36.
• February 2003: Treating neurologist Michelle Ferguson,
MD, certifies Mr. Paquin's West Nile virus exposure as
encephalitis. R. 12.
• June 2004: Dr. Ferguson again notes "[p]ersistent
and worsening cognitive problems after West Nile encephalitis