United States District Court, E.D. Arkansas, Western Division
KATHERINE KOCHANEK, on behalf of herself and all others similarly situated PLAINTIFF
AETNA LIFE INSURANCE CO. and HOME DEPOT U.S.A., INC. DEFENDANTS
Katherine Kochanek appeals the termination of her short-term
disability (“STD”) benefits under the Employee
Retirement Income Security Act (“ERISA”).
Defendant Aetna Life Insurance Company's
(“Aetna”) decision to terminate Kochanek's
benefits is affirmed, judgment is entered for Aetna and
defendant Home Depot U.S.A., Inc. (“Home Depot”),
and this case is dismissed with prejudice.
Kochanek is a former employee of Home Depot who received
insurance coverage through the Home Depot Welfare Benefits
Plan. Administrative Record (“AR”) at 69, 81, 83,
85, 384-91, 501, 737-39, 747, Doc. No. 17. The plan includes
STD benefits insured through Aetna under a group policy
issued to Home Depot. See Id. It defines the
eligibility requirements for STD benefits and designates
Aetna to serve as the claims administrator. Id. at
89, 385-86, 501. This means that Aetna has the sole authority
to determine whether and to what extent an insured is
entitled to receive STD benefits. See Id. at 79,
391, 471, 499, 501. The plan permits Aetna to interpret its
terms and decide all claims and appeals, and it confers broad
discretion on Aetna in making all of these determinations.
Id. at 79, 391, 471, 499.
plan defines a “disability” as an illness,
injury, or pregnancy-related condition that precludes an
individual from performing the material duties of her job.
Id. at 89. An individual is not performing the
material duties of her job if (1) she is only performing some
of the material duties of her job; and (2) her income is 80%
or less of her predisability earnings solely because of an
illness, injury, or a disabling pregnancy-related condition.
Id. The plan defines “illness” as a
“[a] pathological condition of the body that presents a
group of clinical signs and symptoms and laboratory findings
peculiar to it and that sets the condition apart as an
abnormal entity differing from other normal or pathological
body states.” Id.
applied for STD benefits on April 29, 2014, id. at
517, because she was being treated for splenomegaly, an
abnormal enlargement of the spleen, and for Epstein-Barr
virus (“EBV”). Id. at 727-28. Kochanek
provided authorization to Aetna to obtain her medical
information so that it could evaluate her claim. Id.
at 530-31. Aetna requested that her primary care physician,
Dr. Derek Bryant, complete a statement concerning
Kochanek's health and send supporting records and other
medical documentation. Id. at 525-35, 537-41. Dr.
Bryant sent Aetna a statement indicating that Kochanek had
splenomegaly and EBV; that Kochanek reported abdominal
swelling, fever, and fatigue beginning around January 30,
2014; and that she had “[n]o ability to work”
between April 24, 2014, to July 1, 2014. Id. at
727-28. Dr. Bryant, however, did not submit any supporting
medical records or physical examination findings-he simply
stated that Kochanek was awaiting an appointment with a
point, Aetna suspended its claims investigation and informed
Kochanek that Dr. Bryant's statement was insufficient to
support her claim. Id. at 542. It advised her that
it would need medical notes with objective physical
examination findings that demonstrate that Kochanek would be
unable to perform core elements of her job. Id. On
May 20, 2014, Dr. Bryant sent the following medical
documentation to Aetna: (1) a CT scan from February 28, 2014,
showing “[m]ild fatty infiltration of the liver and
mild splenomegaly, ” (2) an Anti-Nuclear ABS test,
which detected elevated EBV levels, (3) records from a visit
on April 7, 2014, in which Kochanek complained about an
enlarged spleen, EBV, diabetes, fatigue, stomach pain,
diarrhea, and general pain; and (4) records from a visit on
April 24, 2014, in which Kochanek complained about heart
palpitations, nausea, bloating, stomach acid, EBV, and
generally feeling unwell. Id. at 706-08, 712-13,
714-19. It appears that Dr. Byrant referred Kochanek to a
gastroenterologist, Dr. Angelo Coppola, and prescribed
Valtrex, Carafate, Prilosec, and Zantac. Id. at 706.
reviewing these records, Aetna's staff recommended
denying Kochanek's claim after finding that “the
medical data received does not support a functional
impairment. We did not find specific physical examination
findings which would preclude the associate from performing
the core elements of her own job.” Id. at 628,
769. Aetna, however, ultimately approved the claim through
June 5, 2014, following a consultation with Dr. Coppola and
further review of Kochanek's job requirements.
Id. at 773-75. It informed Kochanek that her
benefits would not be extended past June 5, 2014, without
additional medical information supporting her claim.
Id. at 543.
then sought additional documentation from Dr. Bryant, who
forwarded a report from Dr. Coppola dated June 5, 2014,
concerning an esophagogastroduodenoscopy procedure.
Id. at 702. Dr. Coppola found that Kochanek had
antral gastritis, which he treated with increased doses of
previously prescribed proton pump inhibitor drugs.
Id. Based on this report, Dr. Bryant reported that
Kochanek would not be able to return to work until August 1,
2014, because of nausea and weakness. Id. at 703.
When asked about specific restrictions, Dr. Bryant responded
that he was waiting for further results, but he did not
identify any specific limitations on Kochanek's daily
activities. Id. Kochanek also reported that she had
appointments with her doctors on June 9, 2014, and July 2,
2014, for a repeat CT scan and a colonoscopy. Id. at
13, 2014, Aetna decided to continue paying STD benefits to
Kochanek through July 6, 2014, but it informed her that
continued benefits past that date were contingent on the
submission of objective evidence supporting her disability
claim. Id. at 552. Because Kochanek was still
waiting for the results of diagnostic testing, it again
agreed to continue her benefits until August 4, 2014.
Id. at 574.
August 19, 2014, Aetna denied Kochanek's claim for
benefits, effective August 5, 2014. Id. at 583. It
did so after receiving documentation from Drs. Bryant and
Coppola which, according to Aetna, failed to support her
disability claim past August 5, 2014. Id. at 673-89.
In particular, Dr. Coppola released Kochanek to return to
work as early as July 3, 2014, and reported that she was able
to perform “[h]eavy work activity” without
restrictions or limitations. Id. at 675, 687.
Although Dr. Bryant submitted a contrary opinion, he was
unable to identify any specific restrictions or limitations
that would prevent Kochanek from returning to work.
Id. at 689. Further, he did not send any medical
documentation supporting his opinion. Id.
appealed Aetna's denial of her STD benefits through its
internal appeals process. Id. at 585. Aetna referred
her file to Dr. Edward Klotz, an internal medicine physician,
for review. See Id. at 836. Dr. Klotz found no
functional impairment and concluded that Kochanek was not
disabled. Id. at 651-52. Following a conversation
with Dr. Bryant, who reported that there were no objective
findings supporting his opinion and the he did not know
whether Kochanek's conditions affected her daily living
activities, Klotz reaffirmed his conclusion. Id. at
640-41. It appears that Aetna denied Kochanek's appeal on
this basis. Kochanek then filed this lawsuit, pursuant to 29
U.S.C. section 1132(a)(1)(B), to reinstate her benefits.
Class Action Compl. ¶¶ 6-8, Doc. No. 2.
Standard of Review
parties dispute the applicable standard of review. When an
ERISA benefits plan gives an administrator
“discretionary authority to determine eligibility for
benefits, ” the administrator's decision is
reviewed for an abuse of discretion. Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). Here,
various plan documents indisputably confer broad
discretionary authority on Aetna to determine whether and to
what extent claimants ...