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Cooper v. Intel Corporation Long Term Disability Plan

United States District Court, D. Oregon

August 8, 2014

TRICIA Z. COOPER, Plaintiff,
v.
INTEL CORPORATION LONG TERM DISABILITY PLAN, Defendant.

Richard H. Rizk, Jerome P. Larkin, Richard Rizk, Attorney at Law, Portland, OR, Attorneys for Plaintiff.

Nancy B. Pridgen, Monnolly Pridgen LLP, Atlanta, GA, Sarah J. Ryan, Jackson Lewis LLP, Portland, OR, Attorneys for Defendant.

OPINION & ORDER

MARCO A. HERNNDEZ, District Judge.

Plaintiff Tricia Cooper brings this ERISA action under 29 U.S.C. § 1132(a) against Defendant Intel Corporation Long Term Disability Plan for the denial of long term disability benefits. Before me are Plaintiff's motion for summary judgment [17] and Defendant's cross-motion for summary judgment [18]. I find that Defendant's denial of long term disability benefits was not an abuse of discretion. Therefore, I deny Plaintiff's motion and grant Defendant's motion.

BACKGROUND

Plaintiff worked as a Project/Program Coordinator at Intel and was a participant in Intel's long term disability ("LTD") plan. Compl. ¶¶ 5, 9; Answer ¶¶ 5, 9. Plaintiff stopped working for Intel around January 12, 2010 due to chronic low back pain, spondylosis, and fibromyalgia.[1] Admin. R. ("AR") 399. Plaintiff received short-term disability benefits from January 13, 2010 through January 9, 2011. Compl. ¶ 11; Answer ¶ 11. Plaintiff applied to Reed Group for LTD benefits in January 2011. AR 456. Reed Group is a third-party claims administrator for Defendant. Id . Plaintiff received LTD benefits for six months, but then Reed Group notified Plaintiff that the LTD benefits would be discontinued on July 11, 2011 because Plaintiff did not have a qualifying disability within the meaning of the LTD plan. AR 619-22.

Under Intel's LTD plan, "disability" is defined as "any illness or injury that is substantiated by Objective Medical Findings and which render a Participant incapable of performing work." AR 13. Additionally, because 18 months had passed since Plaintiff's initial claim for disability, "a Participant must be unable to perform the work of any occupation for which he or she is or becomes reasonably qualified for by training, education or experience." AR 13-14. "Objective Medical Findings" is defined as

a measurable, independently-observable abnormality which is evidenced by one or more standard medical diagnostic procedures including laboratory tests, physical examination findings, X-rays, MRI's, EEG's, ECG's, "Cat scans" or similar tests that support the presence of a disability or indicate a functional limitation.... [T]ests that depend on Participant self-reports, such as trigger point/tender point tests, are not considered objective[.] Tests whose results vary depending on the Participant's expenditure of effort... likewise are not considered objective[.]

AR 14. Furthermore, "Objective Medical Findings do not include physicians' opinions... based on the acceptance of subjective complaints (e.g. headache, fatigue, pain, and nausea)[.]" Id . In Plaintiff's case, Reed Group found there was a lack of "Objective Medical Findings" to support proof of disability. AR 620.

Plaintiff appealed and Reed Group affirmed the denial on January 27, 2012. AR 608. Plaintiff then opted for a voluntary appeal to Claim Appeal Fiduciary Services, Inc. ("CAFS"). AR 373. CAFS is an "independent fiduciary" retained by Intel to review LTD plan claim appeal denials. AR 11. In August 2012, CAFS upheld the denial of LTD benefits. Id . CAFS concluded that "[t]he objective medical findings do not support the existence of any medical or psychiatric diagnoses which render [Plaintiff] "Disabled" as defined in the LTD policy." AR 28.

STANDARDS

Traditionally, summary judgment is appropriate if there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(a). However,

Traditional summary judgment principles have limited application in ERISA cases governed by the abuse of discretion standard. Where, as here, the abuse of discretion standard applies in an ERISA benefits denial case, a motion for summary judgment is, in most respects, merely the conduit to bring the legal question before the district court and the usual tests of summary judgment, such as whether a genuine dispute of material fact exists, do not apply.

Stephan v. Unum Life Ins. Co. of Am. , 697 F.3d 917, 929-30 (9th Cir. 2012) (citations, quotation marks omitted). In addition, "judicial review of benefits determinations is limited to the administrative record-that is, the record upon which the plan administrator relied in making its benefits decision[.]" Id. at 930 (internal quotation marks omitted). "[W]hen a court must decide how much weight to give a conflict of interest under the abuse of discretion standard[, ]... the court may consider evidence outside the [administrative] record." Abatie v. Alta Health & Life Ins. Co. , 458 F.3d 955, 970 (9th Cir. 2006) (en banc). In considering "evidence outside the administrative record to decide the nature, extent, and effect on the decision-making process of any conflict of interest[, ]" id., traditional rules of summary judgment apply, and "summary judgment may only be granted if after viewing the evidence in the light most favorable to the non-moving party, there are no genuine issues of material ...


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