United States District Court, D. Colorado
ORDER VACATING DENIAL OF BENEFITS AND REMANDING FOR
William J. Martinez United States District Judge.
case brought pursuant to 29 U.S.C. § 1132(a) of the
Employee Retirement Income Security Act of 1974
(“ERISA”), Plaintiff Julia Mark
(“Mark”) challenges the decision of Defendant
Aetna Life Insurance Company (“Aetna”) to
terminate Mark's short-term disability benefits. After
completion of briefing, the parties filed a Joint Motion for
Determination. (ECF No. 38.) The Court referred the matter to
United States Magistrate Judge Michael J. Watanabe (since
retired) for a report and recommendation. (ECF No. 43.)
Watanabe issued his report and recommendation on April 25,
2018 (“Recommendation”), recommending that
Aetna's decision be vacated and remanded for further
consideration. (ECF No. 44.) Aetna timely objected (ECF No.
45) and Mark responded to that objection (ECF No. 46). The
Court has now reviewed the Recommendation, Aetna's
objection, Mark's response, as well as the parties'
pre- Recommendation briefing (ECF Nos. 29, 33, 37) and many
portions of the Administrative Record (ECF No. 25, cited
below as “R.”).
reasons explained below, the Court adopts the Judge
Watanabe's recommended disposition, although for reasons
somewhat different than those expressed by Judge Watanabe.
Aetna's termination of benefits is therefore vacated and
remanded for further consideration.
RULE 72(b) STANDARD OF REVIEW
magistrate judge issues a recommendation on a dispositive
matter, Federal Rule of Civil Procedure 72(b)(3) requires
that the district court judge “determine de novo any
part of the magistrate judge's [recommendation] that has
been properly objected to.” Fed.R.Civ.P. 72(b)(3). In
conducting its review, “[t]he district court judge may
accept, reject, or modify the recommendation; receive further
evidence; or return the matter to the magistrate judge with
instructions.” Id. An objection is proper if
it is filed within fourteen days of the magistrate
judge's recommendations and is specific enough to enable
the “district judge to focus attention on those
issues-factual and legal-that are at the heart of the
parties' dispute.” United States v. 2121 East
30th Street, 73 F.3d 1057, 1059 (10th Cir. 1996)
(internal quotation marks omitted).
timely objected to the Recommendation with sufficient
specificity. (See ECF No. 45.) Accordingly, the
Court reviews this matter de novo.
party has objected to Judge Watanabe's factual summary
(ECF No. 44 at 2- 7), and so the Court adopts it as if set
forth herein. The Court repeats the following to provide
context for its resolution.
fell on a sidewalk and injured her left knee, as well as one
of her ankles, her neck, and back. (ECF No. 44 at 2; see
also ECF No. 29 at 2; ECF No. 33 at 4.) The parties
point to nothing in the record showing the precise date of
the injury, but it happened on or before March 10, 2016,
which was Mark's last day of work with her employer,
FedEx Office. (ECF No. 44 at 2.) Mark's job required her
to stand for her entire shift, move and lift 55 pounds, and
consistently bend and twist at the waist and the knees.
(Id. at 2-3.) Her injury prevented her from
performing these tasks and so she was placed on leave.
24, 2016, Mark applied for short-term disability benefits
through the FedEx Office and Print Services, Inc. Short Term
Disability Plan (“Plan”). (R. at 782.) The Plan
applies where an injury prevents an employee “from
performing the material and substantial duties of his or her
regular occupation.” (R. at 5.) But the Plan requires,
among other things, that the alleged disability be
“substantiated by significant objective findings which
are defined as signs which are noted on a test or medical
exam and which are considered significant anatomical,
physiological or psychological abnormalities which can be
observed apart from the individual's symptoms.” (R.
which administers the Plan for FedEx Office (R. at 4),
decided on May 31, 2016 that Mark qualified for short-term
disability payments from March 11 through May 26 of that
year. (R. at 230-31.) The letter announcing the benefits
award further stated, “If you need to stay out beyond
May 26, 2016, send current medical information from your
doctor to us for review.” (R. at 230.) The parties do
not describe what Mark did in reaction to this letter.
However, Aetna soon sent another letter, dated June 8, 2016,
announcing that it was “no longer approving”
short-term disability benefits “starting on May 27,
2016.” (R. at 245.) The letter stated that, on May 31,
2016 (the date Aetna initially approved benefits), Aetna had
requested “[a]dditional medical information supporting
your claim . . . from Dr. Chang [who was regularly treating
Mark for her injuries], ” but the information received
from Dr. Chang “provides a diagnosis only and fails to
provide physical examination findings, diagnostic test
results, or any evidence of your inability to perform the
essential functions of your own occupation.”
(Id.) Thus, said Aetna, “It has been
determined that there are insufficient clinical exam findings
to support your [disability claim].” (Id.)
letter provided instructions on how to appeal. (R. at
245-46.) Mark initiated a timely appeal on August 30, 2016.
(R. at 312.) Aetna received numerous additional medical
records from Mark and her treating providers, and affirmed
its termination of benefits by letter dated November 16, 2016
(“Appeal Decision”). (R. at 391.) The Appeal
Decision summarized the medical records, including the
• “PT [i.e., physical therapy]
reevaluation on 06/21/16 . . . [included] a functional report
of antalgic gait and an impaired ability to ambulate long
distances. On exam, you had significant left knee swelling;
an increased, rigid arch in your right foot and multilevel
thoracic mechanical dysfunction. Range of motion was 95
percent bilaterally in the knees. Strength was within
functional limits with pain inhibition in the left
quadriceps. Reflexes and sensation were intact.”
• “PT reevaluation dated 07/20/16 advised of a
functional report of antalgic gait and an impaired ability to
ambulate long distances. On exam, you had significant left
knee swelling; an increased rigid arch in your right foot and
multilevel thoracic mechanical dysfunction. Range of motion
was 95% bilaterally in the knees. Overall strength was
improving. You ...