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Uquillas v. Unum Life Insurance Co. of America

January 21, 2010


The opinion of the court was delivered by: Margaret M. Morrow United States District Judge


Plaintiff Janis Uquillas filed this action on January 23, 2007, against UNUM Life Insurance Company of America ("UNUM") and Parexel International Corporation Long Term Disability Plan (the "Plan"). Uquillas alleges that she was denied long-term disability benefits to which she was entitled under the Plan, a disability benefit plan established by her employer Parexel International Corporation ("Parexel"), and insured by UNUM. Uquillas contends that UNUM's decision to terminate her benefits was an abuse of discretion. After reviewing the administrative record and considering the parties' trial briefs, the court makes the following findings of fact and conclusions of law.


A. The Plan

1. The Plan is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"), because it is an employee benefit plan funded by plaintiff's employer.*fn1

2. UNUM was the Plan Administrator. 3. Under the Plan, an employee is considered disabled and entitled to payments when the employee is "limited from performing the material and substantial duties of [her] regular occupation due to [her] sickness or injury," and experiences "a 20% or more loss in [her] indexed monthly earnings due to that sickness or injury."*fn2

B. Uquillas' Employment

4. Uquillas was employed as a Senior Manager in Parexel's "Clinical Process Management and Training Group."*fn3 Her position was largely a "desk job" that required lifting less than ten pounds "on occasion."*fn4 Its responsibilities included overseeing "clinical and technical training and development for clinical staff" in connection with Parexel's research studies on behalf of pharmaceutical companies seeking FDA approval for new drugs.*fn5

C. Onset of Uquillas' Symptoms and Initial Claim

5. Uquillas' disability claim arises out of increased symptoms of pain that began some time in December 2003. Uquillas' representations regarding the onset of the increased pain are inconsistent. Prior to the onset of the symptoms, in 2002, Uquillas had been treated by Dr. Charles Jablecki, a neurologist.*fn6

6. On December 24, 2003, Uquillas initially told Jablecki that the increased pain began on December 14, 2003, when "she arose from a couch and felt some pain in her left low back and buttock area."*fn7

7. Later, on January 15, 2004, Uquillas, apparently for the first time, "raised the possibility" that "her problem with her left low back and pain m[ight], in fact, be work related."*fn8 She stated that "heavy lifting associated with the moving of her office took place for a period of about a week" coincident with the time her pain appeared on December 14, 2003.*fn9 On February 3, 2004, she told Jablecki that "several weeks of repetitive lifting at work" preceded the appearance of the symptoms on December 14, 2003.*fn10 On her application for disability benefits, Uquillas stated that the claim was based on an injury that occurred on December 2, 2003 when she was moving office furniture and boxes.*fn11 On an application for workers' compensation benefits, Uquillas stated that the her injury resulted from an accident on December 3, 2003.*fn12

8. Uquillas first sought treatment for the pain on December 18, 2003. That day, she went to the emergency room because the pain, as she later told Jablecki, had become "intolerable." Uquillas left the emergency room when she was told there would be a two-hour wait, and took prescription painkillers she had at home. She reported that these did not relieve the pain.*fn13

9. Uquillas returned to the emergency room on December 21, 2003, and was admitted. She was given IV Dilaudid and Valium for pain and Phenergan for vomiting. The physicians contacted Jablecki, who recommended that Dr. Paul Raffer, a neurologist with privileges at the hospital, evaluate Uquillas. Raffer conducted an MRI scan of Uquillas' spine, which "showed only mild degenerative changes with no disk protrusion."*fn14 Jablecki considered the MRI "normal."*fn15 Uquillas reported a slight improvement after bed rest and taking Solumedrol.*fn16 A CT scan was performed on December 24, and Uquillas was discharged to see Jablecki.*fn17

10. Uquillas first saw Jablecki for the symptoms in question on December 24, 2003.*fn18 As noted, Uquillas stated at that time that the pain began when she got up from her couch on December 14, 2003. She reported that the pain was constant but was worse if she tried to extend her leg while seated.*fn19 She was not taking any medications at the time of the visit.*fn20 Jablecki conducted "[l]imited EMG studies of the left lower extremity," which he reported were "abnormal" and "compatible with acute nerve pathology affecting the left L5 nerve root."*fn21 Jablecki noted that his "clinical examination suggest[ed] that there [was] compression of a nerve root as a cause of [Uquillas'] symptoms."*fn22 He prescribed OxyContin for pain control.*fn23

11. On December 26, 2003, Uquillas was admitted to UCSD Medical Center, and seen by neurology, neurosurgery, and pain management specialists.*fn24

12. On December 29, 2003, Jablecki performed "EMG and nerve conduction studies of the lower left extremity," which he again found to be "abnormal" and "compatible with acute nerve pathology affecting the left L5 nerve root.*fn25 He prescribed an MRI for further analysis.*fn26 Uquillas also received a steroid injection from Dr. Mark Wallace on December 29 and 30.*fn27

13. Dr. William Ladd performed an MRI of Uquillas' lumbar spine on December 30, which was "negative."*fn28

14. Jablecki saw Uquillas again on January 5, 2004. He noted that her problem had "evolved in a favorable way," and that she was able to walk without a cane, although he noted that she continued to require pain management for severe, constant pain.*fn29 It is unclear what, if any, medication Uquillas was taking at the time.*fn30 Jablecki prescribed Zofran to relieve the nausea Uquillas experienced with OxyContin and Fentanyl; Uquillas had these drugs, but had not been taking them due to side effects.*fn31 Uquillas also received another steroid injection from Wallace on January 5.*fn32

15. From January 7 to 9, 2004, Uquillas returned to her job and worked at the office. From January 10 through 20, she worked from home part-time.*fn33 Uquillas told UNUM that her doctors "made her stop" working part-time.*fn34 However, there is nothing in the doctors' records to support this. Rather, on January 15, Uquillas told Jablecki that she had tried to return to work, but stopped going to the office because she "had too much pain."*fn35

16. Jablecki saw Uquillas on January 15, 2004; at that point, she was taking Elavil to help her sleep, and continued to be able to walk without a cane.*fn36 She was not taking any analgesics. Jablecki noted that the problem continued to evolve favorably, but concluded that Uquillas would not be able to return to work until March 1, 2004 "given the slow rate of progress of her problem and the severity of the current pain."*fn37 Uquillas also received a third steroid injection from Wallace on January 15.*fn38

17. Jablecki again saw Uquillas on January 26, 2004. He noted that she was still taking only Elavil, as "[t]he pain has not been sustained or great enough to have to take narcotic analgesics."*fn39 He reported that Uquillas had undergone three steroid injections; the first resulted in improvement in her condition, but there was "minimal improvement" following the next two.*fn40 Jablecki indicated that he was still unable to diagnose the cause of Uquillas' condition. He recommended a CT myelogram; because of Uquillas' concerns regarding complications related to the procedure, however, Jablecki decided to proceed with a CT scan of her lumbosacral spine.*fn41 Uquillas was able to drive herself to the appointment.*fn42

18. Jablecki saw Uquillas again on February 3, 2004. She was still taking only Elavil and was able to walk and drive.*fn43 Her pain continued to improve and was "usually [at] a 4-5/10" level.*fn44 Jablecki noted that the CT scan was "normal," as were "blood studies [designed] to evaluate [her] for systemic disorders [that might be] the cause of a radiculopathy."*fn45

Jablecki concluded: "I remain optimistic that [Uquillas] will be able to return to work, at least part-time, on March 1, 2004."*fn46

19. During the February 3, 2004 visit, Jablecki helped Uquillas fill out a worker's compensation claim. According to Jablecki, "[t]he basis for filing the claim was that the symptoms began [on December 14, 2003] when she simply turned over at home on a couch after carrying out several weeks of repetitive lifting activity at work"; the lifting at work, "if not the proximate cause, [was] an aggravating factor, which led to the development of radiculopathy."*fn47

20. Jablecki saw Uquillas again on February 17, 2004. Uquillas was taking only Elavil on a regular basis; she reported that she took Motrin or Aleve when the pain increased, but that "[t]he pain ha[d] not been so great that she ha[d] needed to take narcotic analgesics."*fn48

Jablecki again performed EMG and nerve conduction studies; once again, he found them "abnormal" and "compatible left L5 radiculopathy." He observed that "[c]ompared to the study performed [on] December 29, 2003, there is no evidence of new nerve pathology."*fn49

He noted that Uquillas planned to attempt to resume working part-time from home on March 1, and expressed agreement with this plan.*fn50 Uquillas was able to walk without a cane and drive herself to the appointment.*fn51

21. Uquillas did not return to work on March 1; on March 9, she again saw Jablecki, reporting that the pain was "somewhat worse."*fn52 She continue to take only Elavil on a regular basis and Motrin and Aleve if she experienced a "flare-up" of pain. Jablecki reported that Uquillas also took Vicodin on occasion.*fn53 He noted that Uquillas had "discuss[ed] the possibility of doing a few hours of work at home, but this [was] not acceptable to her employer. She is now considering taking a job . . . close to home so she would not have to make a two hour drive everyday which she currently would have to do."*fn54

22. On March 16, 2004, Uquillas saw Dr. Larry Dodge "to determine if her. . . problem [was] work-related."*fn55 Dodge took radiographs, which indicated "no instability."*fn56

23. At a March 24, 2004 appointment with Jablecki, Uquillas reported that her condition was worse. She was taking Elavil regularly and Aleve for "flare-ups." Jablecki also noted that Uquillas had taken Vicodin "probably twice since she was last seen.*fn57 Uquillas told Jablecki that while at Dodge's office, she had seen "a note on the desk from the insurance carrier which indicated that she was misrepresenting information." She said this "upset her very much."*fn58

24. In his records of the March 24 appointment, Jablecki noted three available options for treatment: (1) continued rest and medication "with the hope that her problems will improve"; (2) additional steroid injections; and (3) a CT myelogram "with the hope that a surgically correctable problem can be identified."*fn59 He stated that Uquillas was "temporarily and totally disabled form her full work . . . because the work requires prolonged sitting and this activity aggravates the left buttock and leg pain."*fn60 He noted that Uquillas had decided not to accept the position closer to home that had been discussed at the previous appointment.*fn61

25. On April 5, 2005, Uquillas filed a claim for disability benefits.*fn62 In Uquillas' application, Jablecki indicated that she could not bend, stoop or lift more than five pounds; kneel or squat; drive more than twenty minutes at a time once a day; stand more than two minutes at a time; or sit more than five minutes at a time.*fn63

26. At an April 5 appointment, Jablecki considered Uquillas' condition "relatively stable" but "worsening," and again urged her to consider the myelogram.*fn64 Uquillas reported the same taking the same medications as she had been at the time of the previous appointment.*fn65 She was able to walk without assistance.*fn66 Jablecki concluded that Uquillas would be unable to work through July 30, 2008.

27. On April 8, 2004, Uquillas' worker's compensation claim was denied.*fn67 The reasons for the denial are not in the record. Uquillas later told an UNUM employee, however, that the claim was denied because a co-worker told an investigator that she did not move furniture. Uquillas asserted that this was a lie and said that the co-worker was trying to "get back" at her because Uquillas had been accumulating information to support terminating the co-worker for incompetence.*fn68

D. Increased Symptoms and Prescription for Bed Rest

28. On the evening of April 12, 2004, Uquillas reported an increase in pain, and went to an urgent care facility where she was seen by a Dr. Cochrane. Uquillas was given Tigan and morphine, and ...

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