United States District Court, S.D. Ohio, Eastern Division
STANLEY A. HAGERMAN, Plaintiff,
AMERICAN ELECTIC POWER SERVICE CORPORATION, Defendants.
OPINION AND ORDER
C. SMITH, JUDGE
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
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
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).
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).
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).
Hagerman's medical conditions
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.
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).
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
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
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.).
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.).
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
Initial denial of disability benefits
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.).
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 ...