Searching over 5,500,000 cases.

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Westfall v. Liberty Life Assurance Company of Boston

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

February 28, 2018



          Benita Y. Pearson, United States District Judge

         Plaintiff Shelley Westfall commenced this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., against Defendant Liberty Life Assurance Company of Boston. Plaintiff challenges the administrator's decision denying her long-term disability benefits. Pending before the Court are briefs as contemplated by Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 619 (6th Cir. 1998) (Gilman, J., concurring). Plaintiff has filed an opening brief. ECF No. 16. Defendant has filed a brief in response, which it styles as a motion for judgment on the merits. ECF No. 17. Defendant also filed proposed findings of fact and conclusions of law.[1] ECF No. 18. Plaintiff then filed a response in support of her position. ECF No. 19. For the reasons that follow, the Court denies Defendant's motion and remands the case to the plan administrator to conduct a new review, taking into account Dr. Kissinger's identification of emotional lability as a symptom that Plaintiff suffered.

         I. Background

         Plaintiff works in asset protection at a WalMart distribution center. ECF No. 13-1 at PagelD #: 231. Plaintiffs son died while working at the same WalMart distribution center in April 2015. Id. at PagelD #: 321. Plaintiff last worked on April 20, 2015. Id. at PagelD #: 128. Plaintiff received long-term disability benefits from November 2, 2015 through January 14, 2016, but benefits beyond January 14, 2016 were denied. Id. at PagelD #: 144. Plaintiff appealed Defendant's decision, but Defendant maintained its original decision. Id. at PagelD #: 144-48.

         Due to the denial of long-term disability benefits, Plaintiff filed this action. ECF No. 1.

         A. Initial Application for Benefits

         After her son's death, Plaintiff went on short-term disability leave, which ended November 1, 2015. ECF No. 13-1 at PagelD #: 317. In a letter dated September 4, 2015, Defendant informed Plaintiff that her short-term disability benefits were going to expire, and therefore, she would have to apply for long-term disability benefits to continue receiving benefits. Id. Plaintiff complied with this instruction and applied for long-term benefits.

         On September 8, 2015, Defendant acknowledged that it had received Plaintiffs request for consideration of long-term disability benefits. Id. at PagelD #: 316. In an activities questionnaire form Plaintiff completed in conjunction with the request, she wrote a note stating she was not suffering from a physical disability, but rather, her heart was broken. Id. at PagelD #: 319. The form included a list of tasks that individuals routinely complete, such as bathing, grocery shopping, and vacuuming, and the applicant had to indicate who in their life performs those tasks. Id. at PagelD #: 320. For every task on the list, Plaintiff indicated that she performed the task on her own without any assistance. Id. The form also asked the applicant to describe their purported disability in their own words. Id. at PagelD #: 321. Plaintiff wrote that her son died in her workplace, she could not bring herself to go back to that site, and she did not want to speak to people who asked her so many questions. Id

         B. Office Visits & Defendant's Initial Review

         Since her son's death, Plaintiff has paid office visits to two different doctors: Dr. Mark Kissinger, her primary care physician, and Dr. Prabnjot Deol, a psychiatrist. Plaintiff met with Dr. Kissinger on April 17, 2015, May 21, 2015, July 7, 2015, August 10, 2015, September 21, 2015, October 19, 2015, November 23, 2015, and March 2, 2016. She met with Dr. Deol on at least four occasions: October 23, 2015, November 30, 2015, January 6, 2016, and April 20, 2016. Dr. Kissinger reported that Plaintiff considered herself "down, but not depressed, " at her April 17, 2015 appointment. Id. at PagelD #: 276. At her six-week followup with Dr. Kissinger, Plaintiff indicated mild improvement, but that she was still "emotionally distraught" with "great sadness, " although she had not yet started to take previously-prescribed medication. Id. at PagelD #: 273. The notes from Plaintiffs July 7, 2015 visit with Dr. Kissinger stated that Plaintiff had attempted to go back to work, but was unable to do so, due to the emotional effects of returning. Id. at PagelD #: 271. During the August 10, 2015 visit, Dr. Kissinger's nurse practitioner recommended referring Plaintiff for a psychiatry evaluation, and Dr. Kissinger agreed with the recommendation. Id. at PagelD #: 267. On September 21, 2015, Dr. Kissinger again referred Plaintiff to a psychiatrist Plaintiff had previously scheduled an appointment with Dr. Deol for October 23, 2015, but she had to cancel due to the birth of her granddaughter. Id. at PagelD #: 264-65. Dr. Kissinger's notes from the meeting indicate that Plaintiff had feelings of hopelessness and did not feel stable enough to return to work. Id. at PagelD #: 265. Plaintiff also reported that marital discord had arisen since her last visit. Id.

         Defendant had Dr. Scott Lurie, a board-certified psychiatrist, review Plaintiffs medical records, and Dr. Lurie drafted a memorandum summarizing his findings. Id. at PagelD #: 256-58. Dr. Lurie's assessment included notes from all meetings with Dr. Kissinger between Plaintiffs April 17, 2015 visit through her October 19, 2015 appointment. Id. Dr. Lurie concluded that the record before him demonstrated "limitations on [Plaintiffs] ability to perform tasks at the location of her employment (and the site of her son's death)." Id. at PagelD #: 256. He found the record before him supported a six-week limitation from the original date of Plaintiffs initial appointment with Dr. Deol, October 23, 2015, with a possibility for a six-week extension. Id. Dr. Lurie also concluded that Plaintiff "might be able to function in a different area of the distribution center but that cannot be determined unless the claimant is given a transfer to another area." Id. at PagelD #: 257. He further concluded that Plaintiffs symptoms supported a diagnosis of depression NOS. Id. Dr. Lurie also stated that "[t]he available record does not document any psychiatric reason that the claimant could not be allowed to attempt to return to work in a different area of the distribution center or in a different location for her employer." Id

         After Dr. Lurie's memorandum, Plaintiff continued to see Dr. Kissinger and began to see Dr. Deol. Plaintiff had her first appointment with Dr. Deol on October 23, 2015. Id. at PagelD #: 183. Dr. Deol's notes indicated that he viewed Plaintiff as suffering from major depression, single episode. Id. After this initial appointment with Dr. Deol, Plaintiff had a November 23, 2015 appointment with Dr. Kissinger, and the notes for that appointment reveal that Plaintiff had separated from her husband. Id. at PagelD #: 192. Dr. Kissinger also noted that Plaintiff suffered days when her sadness rendered her unable to get out of bed, but such events occurred less often then they had previously. Id. Plaintiff had a follow-up appointment with Dr. Deol on November 30, 2015, and at this meeting, she reported weight gain, suffering from panic almost daily, and being angry with WalMart. Id. at PagelD #: 182.

         Dr. Lurie drafted an addendum to his memorandum, and he issued the addendum on December 29, 2015. In his addendum, he concluded that Plaintiff suffered from major depression and complicated grief. Id. at PagelD #: 211-12. That said, however, Dr. Lurie concluded that the record before him did not document sufficiently frequent and severe symptoms or corroborating mental status findings to support a finding of ongoing impairment. Id. atPageID#:211.

         Following Dr. Lurie's addendum, Defendant sent a letter to Plaintiff, dated January 15, 2016, informing Plaintiff that she did not qualify for long-term disability benefits. Id. at PagelD #: 207. Defendant claimed that, based on Dr. Lurie's review, Plaintiffs condition no longer met the definition of "disability." Id. at PagelD #: 208.

         After Defendant denied Plaintiff long-term disability benefits, Plaintiff retained counsel and filed an appeal. Id. at PagelD #: 204.

         On March 2, 2016, Plaintiff had a three-month follow-up with Dr. Kissinger. Id. at PagelD #: 194. During this meeting, Plaintiff reported feeling anxiety. Id. Additionally, even though her long-term disability benefits had ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.