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Radsvick v. United of Omaha Life Insurance Co.

United States District Court, N.D. Ohio

August 21, 2019

KENNETH RADSVICK, Plaintiff,
v.
UNITED OF OMAHA LIFE INSURANCE CO., Defendant.

          OPINION & ORDER [RESOLVING DOCS. 13, 14]

          JAMES S. GWIN, UNITED STATES DISTRICT JUDGE

         This case concerns a disability insurance dispute controlled by the Employment Retirement Income Security Act (“ERISA”).

         Plaintiff Kenneth Radsvick worked as a heating and air conditioning servicer.[1]Through his employment, Defendant United of Omaha Life Insurance Co. (“Omaha”) covered Radsvick under a disability insurance policy. Omaha also administered the insurance plan.[2]

         On April 12, 2016, Radsvick suffered a heart attack.[3] Radsvick underwent a successful cardiac catherization and stent placement.[4] After a second procedure on July 5, 2016, Radsvick's heart problems largely resolved.[5]

         However, shortly after the heart attack, Radsvick reported cognitive decline, short-term memory loss, and confusion-which continues to today.[6] Doctors have been unable to determine the cause of Plaintiff's cognitive ailments.

         In July 2016, Radsvick applied for long term disability benefits with Omaha, claiming that he was disabled since his April heart attack.[7] Omaha denied that application initially and on reconsideration.[8]

         Plaintiff then brought this ERISA action, challenging Omaha's determination and claiming breach of fiduciary.[9] Both parties now move for judgment on the administrative record.[10] For the following reasons, the Court GRANTS judgment for Defendant and DENIES judgment for Plaintiff.

         I. Disability Benefits Claim

         To qualify for long term disability under the plan, Radsvick generally had to show that he suffered from an illness that prevented him from performing at least one of his material duties for ninety days.[11] Plaintiff's ninety-day clock started with his April 12, 2016 heart attack, running through July 11, 2016.[12]

         However, Defendant Omaha determined that Plaintiff's disability ended by July 10, 2016 rendering him ineligible. Omaha essentially concluded that Plaintiff's cardiac issues ended after his July 5 catherization and that his claimed cognitive difficulties were not supported by the medical records.

         An ERISA-governed disability-plan beneficiary may challenge an administrator's denial of benefits under 29 U.S.C. § 1132(a)(1)(B). Where, as here, the insurance plan gives the administrator interpretative discretion, the Court considers only whether the administrator's decision was arbitrary or capricious.[13] Under this forgiving standard, the Court will uphold the decision so long as “it is the result of a deliberate, principled reasoning process and [] is supported by substantial evidence.”[14]

         Radsvick claims long-term disability from mental problems and (maybe) heart problems. The Court considers both in turn.

         A. Plaintiff's Heart Problems

         Plaintiff Radsvick suffered a minor heart attack on April 12, 2016. He was discharged from the hospital two days later after a successful cardiac catherization and stent placement. Afterwards, Radsvick began rehabilitation, which went well.

         Plaintiff suffered additional chest pain on July 5, 2016. A second catherization revealed minimal coronary artery disease and a widely patent stent. He was discharged from the hospital on July 7, 2016. Although Radsvick continued cardiac rehabilitation for some continuing months, the records do not indicate any continuing significant cardiac issues after this date.

         Defendant Omaha retained board-certified cardiologist Dr. Jonathon McAllister to review Radsvick's medical records.[15] Dr. McAllister concluded that Radsvick had no cardiac-related work restrictions after July 10, 2016.

         Accordingly, Omaha's decision to deny long-term disability benefits from a cardiac perspective was neither arbitrary nor capricious.[16]

         B. Plaintiff's ...


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