Roebuck v. Usable Life

          OPINION AND ORDER

          Kristine G. Baker, United States District Judge

         This is an action filed under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), by plaintiff Karen Roebuck (Dkt. No. 1). Defendant USAble Life (“USAble”) filed an answer to Ms. Roebuck's complaint (Dkt. No. 6), and the parties submitted an administrative record (Dkt. No. 12). Ms. Roebuck then filed a motion for summary judgment (Dkt. No. 15). USAble responded, and Ms. Roebuck replied (Dkt. Nos. 18, 19).

         Although Ms. Roebuck's motion is styled as one for summary judgment, she does not cite Federal Rule of Civil Procedure 56 in either her motion or brief in support (Dkt. Nos. 15, 16). Furthermore, USAble's response asks the Court to affirm USAble's disability benefits determination (Dkt. No. 18, at 15). Accordingly, the Court treats Ms. Roebuck's motion for summary judgment as a motion for judgment on the administrative record.

         Having considered the parties' respective positions regarding Ms. Roebuck's entitlement to disability benefits, the Court finds that Ms. Roebuck's claim should be dismissed with prejudice (Dkt. Nos. 15, 18, 19). The relief requested by Ms. Roebuck is denied.

         I. Background

         A. The Policy

         USAble issued a long-term disability insurance policy (the “Policy”) to Arkansas Blue Cross and Blue Shield (Dkt. No. 12-10, at 108). The Policy states that, if a policyholder “become[s] disabled while insured under the policy, we will pay long term disability insurance benefits after you satisfy the elimination period.” (Id., at 140). The Policy contains a clause that authorizes USAble to “have the sole discretionary authority to determine eligibility for participation or benefits and to interpret the terms of the policy.” (Id., at 131).

         The Policy defines “disabled” as satisfying the “Occupation Test, ”^[1] which is defined as follows:

         Occupation Test

1. During the elimination period [sic] the first 24 months and of a period of disability, an injury, sickness, or pregnancy requires that you be under the regular care of a physician, and prevents you from performing all of the material duties of your regular occupation with reasonable accommodations; and

2. After 24 months of disability, an injury, sickness, or pregnancy prevents you from performing all of the material duties of any gainful occupation with reasonable accommodations for which your education, training, and experience qualifies you.

(Id., at 122). The effective date of the Policy is January 1, 2011, the renewal date is January 1, 2012, and the “anniversary date” of the Policy is “January 1, 2011[, ] and [e]ach [s]ucceeding January 1.” (Id., at 108, 110). The Policy defines the “elimination period” as 180 days (Id., at 121).

         B. Ms. Roebuck's Initial Claim

         Ms. Roebuck worked as a registered nurse who evaluated insurance claims for Blue Cross Blue Shield from October 2012 until December 28, 2015 (Dkt. No. 12-9, at 6-7). Ms. Roebuck was involved in a motor-vehicle collision on December 21, 2013 (Dkt. No. 12-6, at 19). At the hospital following the accident, Ms. Roebuck complained of neck pain, lower back pain, and soreness in her chest (Id.). She received treatment as a result of her injuries (Id.).

         Although Ms. Roebuck initially continued to work after the 2013 accident, eventually, she quit working. Ms. Roebuck's last day of work was December 23, 2015, and she filed an application for long-term disability income benefits under her employer's long-term disability plan, which is issued by USAble, on June 29, 2016 (Dkt. Nos. 12-9, at 7-9; 12-11, at 102). In her application, she cited her symptoms as “low back pain, neck/[left] arm and shoulder pain, bilateral wrist pain/numbness . . . .” (Dkt. Nos. 12-9 at 6; 12-11, at 111).

         The administrative record includes medical evidence, including but not limited to the following. On February 3, 2014, Ms. Roebuck had an MRI performed on her lumbar spine (Dkt. No. 12-10, at 87). This procedure revealed the following:

At L4-L5, there is small central disc protrusion. In conjunction with facet overgrowth and ligamentum flavum thickening, this results in mild spinal canal narrowing. The disc protrusion measures 4 mm anterior to posterior. Spinal canal is narrowed to a minimum dimension of 11 x 14 mm. There is some crowding of the nerve roots but no high grade effacement of the thecal sac. These changes result in mild narrowing of subarticular recesses bilaterally, but no high-grace impingement of the descending nerve roots identified. The neural foramina are patent.

(Id.).

         Another MRI was performed on Ms. Roebuck on February 3, 2014, this time on her cervical spine. This MRI revealed the following:

L paracentral disc extrusion C5-6 resulting in mild spinal canal narrowing and contacts and flattens the anterior L aspect of the spinal cord. No. signal abnormalities. Mild L neural foraminal encroachment. L Paracentral disc protrusion C6-7 without sig stenosis. Mild L neural foraminal encroachment.

(Dkt. No. 12-1, at 189).

         On January 15, 2015, Dr. Kenneth Rosenzweig performed a “lumbar facet joint inflection-fluoroscopic guided” procedure on Ms. Roebuck (Dkt. No. 12-3, at 13). On January 29, 2015, he performed a “[r]adiofrequency denervation” procedure on Ms. Roebuck (Id., at 11). On February 12, 2015, he performed another “radiofrequency denervation” on Ms. Roebuck (Id., at 9). On June 18, 2015, he performed a “[f]luoroscopically guided SI joint injection, right and left” on her (Id., at 7). He performed another “[f]luoroscopic SI joint injection, left and right” on her on September 10, 2015 (Id., at 5).

         On October 1, 2015, Ms. Roebuck had another cervical spine MRI performed (Dkt. No. 12-11, at 31). This MRI revealed the following:

At C2-C3 and C3-C4, no significant disc bulge or herniation or evidence for neural compromise is seen.

At C4-C5, a minimal central focal disc bulge present with no evidence for neural compromise.

At C5-C6, there is a mild to moderate left paracentral disc herniation which extends minimally into the left foramen with very mild cord flattening to the left [of] the midline and mild left foraminal stenosis.

At C6-C7, there is a mild posterior disc protrusion with left paracentral predominance extending slightly into the left foramen and with extrusion and subligamentous inferior extension below the disc level in the left paracentral/central distribution approximately three fourths of the height of the C7 vertebral body. There is mild to moderate left foraminal ...