United States District Court, N.D. California
For Steven Polnicky, Plaintiff: Corinne Chandler, LEAD ATTORNEY, Kantor & Kantor, Northridge, CA; Beth Davis, Glenn R. Kantor, Peter Steffens Sessions, Kantor and Kantor LLP, Northridge, CA.
For Liberty Life Assurance Company of Boston, Wells Fargo & Company Long Term Disability Plan, Defendants: Blake J Russum, Pamela E. Cogan, LEAD ATTORNEYS, Ropers Majeski Kohn & Bentley, Redwood City, CA.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
SUSAN ILLSTON, United States District Judge.
On June 9, 2014, the Court held a hearing on cross-motions for judgment filed by plaintiff Steven Polnicky and defendants Liberty Life Assurance Company of Boston (" Liberty Life") and Wells Fargo & Company Long Term Disability Plan (" the Plan"). Plaintiff brings this action under the Employee Retirement Income Security Act of 1974 (" ERISA"), 29 U.S.C. § 1001 et. seq . to recover long-term disability (" LTD") benefits due to him under the terms of the Plan. On motion brought by plaintiff, this Court previously determined that the proper standard of review in this case is de novo . Docket No. 39, Order Grant. Pl.'s Mot. Summ. J. Nov. 18, 2013.
This order constitutes this Court's findings of fact and conclusions of law in accordance with Federal Rule of Civil Procedure 52(a). For the reasons set forth below, the Court GRANTS plaintiff's motion for judgment and DENIES defendants' motion for judgment.
FINDINGS OF FACT
1. Plaintiff Steven Polnicky, now thirty-three years old, was employed as a Reverse Mortgage Consultant with Wells Fargo & Company (" Wells Fargo"). Docket No. 47-2, Paula McGee Decl., Ex. B, CF 0025-26. Plaintiff's resume states that he was the number one producer in the entire Wells Fargo Western Division and that he received top honors and awards for funding an average of thirteen loans per month for three million dollars in volume. CF 0973.
2. Plaintiff suffers from back and neck pain in connection with an injury he suffered as a teenager. CF 0672, 0988. Plaintiff has since been diagnosed with spondylolisthesis, chronic lumbago, hamstring contractures, and generalized anxiety and mood disorders. CF 0672, 0932, 1026.
3. Defendant Plan is an " employee welfare benefit plan" under 29 U.S.C. § 1002(1). The Plan is established and sponsored by Wells Fargo for the benefit of its employees. Docket No. 26-1, Paula McGee Decl., Ex. A, P 0001-44.
4. Defendant Liberty Life insures LTD benefits provided by the Plan under a group disability income policy (" the Policy"), effective as of January 1, 2010. P 0001-44. Liberty Life is also the claim administrator responsible for administering, processing, and paying claims for LTD benefits under the Plan. Id.
5. Plaintiff was a covered participant in the Plan. CF 0025-26. Pursuant to the Policy, plaintiff began receiving LTD benefits from defendant on September 28, 2011, after submitting an LTD claim of work incapacity due to back pain. CF 0025. On June 1, 2012, Liberty Life terminated plaintiff's LTD benefits after determining that plaintiff was not disabled under the terms of the Policy. CF 0658-63.
6. Plaintiff appealed Liberty Life's denial of benefits. CF 0333-39. On February 19, 2013, Liberty Life sent a letter to plaintiff denying the appeal and upholding its prior determination that plaintiff was not entitled to LTD benefits under the Policy. CF 0034-46.
7. On April 2, 2013, plaintiff filed a complaint against defendants alleging a cause of action under 29 U.S.C. § 1132(a)(1)(B) to recover LTD benefits under the terms of the Plan. Docket No. 1, Compl.¶ 1.
B. Relevant Insurance Policy Provisions
8. The Policy provides that Liberty Life will pay a monthly benefit to an employee insured under the Plan if, in relevant part, Liberty Life receives proof of continued disability after a six-month " Elimination Period." P 0022. The monthly benefit ceases if the employee fails to provide proof of continued disability. P 0030.
9. The Policy defines " Disability" to mean " that during the Elimination Period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness,  is unable to perform the Material and Substantial Duties of his Own Occupation." P 0008. After the 24-month period, the Covered Person is disabled if he or she " is unable to perform, with any reasonable continuity, the Material and Substantial Duties of Any Occupation." Id. Plaintiff's LTD benefits were terminated within the 24-month period. CF 0025.
10. The Policy defines " Material and Substantial Duties" to mean " responsibilities that are normally required to perform the Covered Person's Own Occupation, or any other occupation, and cannot reasonably be eliminated or modified." P 0011.
11. The Policy defines " Own Occupation" to mean the claimant's occupation " that he was performing when his Disability or Partial Disability began. For purposes of determining Disability under this policy, Liberty Life will consider the Covered Person's occupation as it is normally performed in the local economy." P 0012.
C. Plaintiff's Occupation
a. Wells Fargo Job Description
12. A job description provided by Wells Fargo to Liberty Life during its short-term disability (" STD") claim investigation described plaintiff's occupation as " Reverse Mortgage Consultant." CF 1177. The description stated the following: the job was an eight-hour per day, forty-hour per week position, and job responsibilities included " soliciting reverse mortgages from various sources including realtors, builders, financial professionals, past customers and other nontraditional sources." Id. The job required constant (six to eight hours per day) repetitive hand use; frequent (three to six hours per day) sitting and grasping; occasional (thirty minutes to three hours per day) walking, standing, bending, and fine hand manipulation; and seldom (up to thirty minutes per day) squatting, twisting, pushing, pulling, and reaching. Id. The employee ...