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Hagerman v. American Electric Power Service Corp.

United States District Court, S.D. Ohio, Eastern Division

February 22, 2018

STANLEY A. HAGERMAN, Plaintiff,
v.
AMERICAN ELECTIC POWER SERVICE CORPORATION, Defendants.

          Jolson Magistrate Judge.

          OPINION AND ORDER

          GEORGE C. SMITH, JUDGE

         Plaintiff Stanley A. Hagerman brings this action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. § 1132. On August 25, 2017, Hagerman and Defendants American Electric Power Service Corporation and AEP Long-Term Disability Plan (collectively, “AEP”) each moved for judgment on the administrative record. (Docs. 22 and 24). Responses have been filed and these motions are now ripe for review. For the following reasons, Hagerman's motion is DENIED and AEP's motion is GRANTED.

         I. BACKGROUND

         Plaintiff Stanley Hagerman was employed as a senior generation dispatcher by Defendant American Electric Power Service Corporation (“AEP”) until February 23, 2015. (Doc. 23, Administrative Record (“AR”) 4, 94-98). His position included the following responsibilities:

Dispatching AEP's generation assets; communication with power plant operators, and other personnel; monitor, record, and report on emission information; directing power plant control room operators to take appropriate action to ensure units are operated to support reliable operation of the Bulk Electric System.

(AR 660).

         Hagerman was a participant in the long-term disability plan (the “Plan”) offered by AEP. The Plan was administered by AEP and Prudential Insurance Company of America (“Prudential”) performed claims administration services for AEP's Plan. The relevant provisions of the Plan are set forth in the AEP Long-Term Disability Plan in the Administrative Record (“AR”), pages 101 through 120. Under the terms of the Plan, long-term disability benefits become available after a participant has been disabled for 1, 040 hours of regularly scheduled work (this waiting period is called the “elimination period”), until 24 months following the date of disability, if the participant can establish that she had “an illness or injury that requires the regular treatment of a duly qualified physician that may reasonably be expected to prevent you from performing the material duties of your own occupation with AEP” (the own occupation standard). (Doc. 23, AR 106). If the employee continues to be disabled after the first 24 months (the conclusion of the Plan's “own occupation” period), to continue receiving long-term disability benefits, the Plan requires the participant to establish that he had “an illness or injury that requires the regular treatment of a duly qualified physician and that may reasonably be expected to prevent you from performing the duties of any occupation for which you are reasonably qualified by your education, training and experience” (the any occupation standard). (AR 107).

         Pursuant to the Plan, it is Plaintiff's burden to provide proof of his disability. (AR 113) (“When you apply for benefits, you must provide proof of your disability.”). The Plan requires “satisfactory, written proof of objective medical information relating to [the applicant's] illness or injury which supports a functional impairment that renders [the applicant] to be disabled.” (Id. at 111).

         The Plan sets forth the rights and responsibilities of Prudential, as the claims administrator responsible for determinations under the Plan's claims and appeals procedures, which include reviewing and processing LTD claims by eligible participants. (AR 113). As claims administrator, Prudential's decisions are final and binding. (AR 117).

         A. Hagerman's medical conditions

         Hagerman suffered a traumatic head injury in a motor vehicle accident in 1984 when he was 18 years old. (AR 311). He had a seizure shortly following the accident, but was able to prevent further seizures with medication (Tegretol) for about twenty years. (AR 311-12). He experienced a handful of seizures during 2010-13, and then in December 2014, he requested to change to an extended release form of his medication. (AR 126). Hagerman suffered another seizure in January 2015 and was admitted to Mount Carmel East Hospital for several days in February 2015 for Tegretol toxicity resulting from his medication change. (AR 430). Hagerman has not returned to work since his hospital admission on February 23, 2015.

         From then on, Hagerman has not experienced any further seizures, but has “zoning out” or “staring” spells and reports problems with his memory. (AR 343). Hagerman has several other chronic conditions, including diabetes, hyperthyroidism, obstructive sleep apnea, epilepsy, and facial swelling and hives caused by allergic reactions. (AR 127, 265).

         On March 12, 2015, Hagerman was seen by his primary care physician, Dr. Randolph Schultz, whose progress notes indicate that Hagerman was “to return to work pending next Tegretol level being in therapeutic range. Patient agrees with plan.” (AR 358). However, on March 24, 2015, Dr. Schultz issued an Attending Physician's Statement (“APS”) stating that Hagerman was disabled for the period of March 23-May 25, 2015, due to “mild cognitive impairment since 2 seizures Feb 2015.” (AR 100). In the space for the date Hagerman was released to return to work, Dr. Schultz wrote “N/A.” (Id.).

         Dr. Schultz referred Hagerman for a neurological assessment of his epilepsy. (AR 342). The neurological assessment was completed by Dr. Imad Najm on May 11, 2015. (Id.). Dr. Najm noted Hagerman's history of seizures and staring spells, describing the latter as “zones and stares off with no associated [loss of consciousness], he can still hear and see what is going on around him and is unable to respond.” (AR 343). Dr. Najm's notes also indicate that Hagerman's seizures were now well-controlled with medication, and that “[a]s for the zoning out spells, we are at this time unclear of the etiology of these events. They could be dialeptic seizures, or possibly brief microsleep episodes as a result of his sleep apnea.” (AR 346). The staring spells were occurring every day. (Id.). Dr. Najm instructed Hagerman not to drive until he was seizure-free for at least six months, and that he should not engage in unsupervised bathing or swimming, use of heavy machinery, or use of sharp moving objects. (AR 346-47).

         Hagerman also underwent EEG monitoring for several days from May 7 to May 12, 2015, under the supervision of Dr. Andreas Alexopoulos. (AR 125). During this period, he reported experiencing three seizures, but no change in EEG activity was observed. (AR 128). Hagerman also underwent an MRI, the results of which were normal. (AR 131). In his discharge instructions, Dr. Alexopoulos stated, “[Hagerman] was not cleared to return to work.” (Id.).

         On June 9, 2015, Susan Rojc, PA-C, issued an APS stating that Hagerman was disabled for the period of May 7-August 20, 2015, “at least, ” and that his return to work date would be determined after an upcoming follow up appointment with Dr. Najm on August 20, 2015. (AR 99). Ms. Rojc left blank the section of the form to explain the reasons for Hagerman's work restrictions, but noted a primary diagnosis of “spells” and a subjective finding of “seizures.” (Id.).

         Hagerman saw Dr. Najm for a follow up appointment on August 20, 2015, at which time Hagerman reported continued staring spells and speech problems. (AR 298). Dr. Najm discussed with Hagerman the possibility that his symptoms were caused by conversion disorder. (Id.). Dr. Najm also recommended that Hagerman be seen by the Center for Brain Health for further evaluation. (Id.).

         B. Initial denial of disability benefits

         Prudential's claims manager referred Hagerman's file to Dr. Jonathan Mittelman, a board-certified specialist in occupational and environmental medicine, for review on September 25, 2015. (AR 667-69). Dr. Mittelman reviewed the medical records that had been provided to Prudential at that time: records from his February 2015 hospitalization at Mount Carmel East for Tegretol toxicity; Dr. Schultz's progress notes and March 2015 APS; Dr. Najm's May 2015 neurological assessment; records from Dr. Alexopoulos's EEG monitoring in May 2015; Rojc's June 2015 APS; Dr. Najm's notes from the August 2015 follow up appointment. (Id.).

         Dr. Mittelman concluded that standard post-seizure diagnosis restrictions (including no unsupervised bathing or swimming, no use of heavy machinery, no use of sharp moving objects, and avoidance of heights) were supported by Hagerman's currently available medical records; but the same did not disclose any cognitive testing that would speak to Hagerman's self-reported cognitive changes. (Id.). Dr. Mittelman determined that Hagerman's physicians' basis for keeping Hagerman off work was the unclear cause of Hagerman's staring or zoning out spells. (AR 669). In Dr. Mittelman's opinion, Hagerman would be limited in performing his job duties only during his brief staring spells, and although these spells are unpredictable in their frequency, it was ...


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