United States District Court, C.D. California
FINDINGS OF FACT AND CONCLUSIONS OF LAW
MICHAEL W. FITZGERALD United States District judge.
Orly Haber brings this action against Defendant Reliance
Standard Life Insurance Company for recovery of long-term
disability benefits under the Employee Retirement Income
Security Act of 1974 (“ERISA”). This matter came
on for trial before the Court sitting without a jury on April
5, 2016. The parties did not present any additional evidence
at trial but argued from the Administrative Record and
supplemental evidence filed with the Court. The Court
admitted the Administrative Record and Exhibit 1 to the
Declaration of Robert F. Keehn in Support of
Plaintiff’s Initial Trial Brief (Docket No. 21).
Following the parties’ arguments, the Court took the
matter under submission.
carefully reviewed the record and the arguments of counsel,
as presented at the trial and in their written submissions,
the Court now makes the following findings of fact and
reaches the following conclusions of law under Rule 52 of the
Federal Rules of Civil Procedure. Any finding of fact that
constitutes a conclusion of law is also hereby adopted as a
conclusion of law, and any conclusion of law that constitutes
a finding of fact is also hereby adopted as a finding of
FINDINGS OF FACT
Plaintiff Orly Haber is an individual and citizen of the
State of California.
Defendant Reliance Standard is a corporation duly organized
and existing pursuant to the laws of the State of Illinois
with its principal place of business located in Philadelphia,
Between 2000 and 2011, Haber worked as a salesperson for
Neiman Marcus (“NM”). Haber’s work required
a certain level of physical exertion, including being able to
continuously stand and walk for approximately 67-100% of the
an NM employee, Haber was insured as a member of a group
short-term disability (“STD”) policy as well as
group long-term disability policy (“LTD Policy”).
The LTD Policy
Under the LTD Policy, Reliance Standard pays a monthly
benefit to “an [insured employee who] (1) is Totally
Disabled as the result of a Sickness or Injury covered by
this Policy; (2) is under the regular care of a Physician;
(3) has completed the Elimination Period; and (4) submitted
satisfactory proof of Total Disability.”
Class 2 employees like Haber, the Policy considers an insured
employee “Totally Disabled” if s/he “cannot
perform the material duties of his/her Regular
Occupation” “during the Elimination Period and
for the first 24 months for which a Monthly Benefit is
payable.” The Policy has a 180-day Elimination Period.
An employee’s “Regular Occupation” is
“the occupation the [employee] is routinely performing
when Total Disability begins.” The first 24 months for
which a Monthly Benefit is payable is known as the
“Regular Occupation” period of the LTD Policy.
After the Regular Occupation period, the Policy considers an
insured employee “Totally Disabled” if the
employee “cannot perform the material duties of Any
Occupation.” “Any Occupation” is defined as
“an occupation normally performed in the national
economy for which [the employee] is reasonably suited based
upon his/her education, training or experience.” The
period following the Regular Occupation period is known as
the “Any Occupation” period of the LTD Policy.
Haber’s History of Illness, Medical Treatment, and
January 2011, Haber stopped working at NM. She submitted a
claim for STD benefits based on reported symptoms of neck,
shoulder, and back pain.
same month, Haber complained of back pain to her primary
physician, Dr. Amanuel Sima. Dr. Sima referred Haber to
physical therapy and ordered an MRI of Haber’s lumbar
spine. The MRI came back normal. Dr. Sima extended
Haber’s time off from work, ordered her to continue
with physical therapy, and referred her to Dr. Neel Anand, a
spine surgeon who recommended surgery to the cervical spine.
Between February and April 2011, Haber continued seeing Dr.
Sima and reported continued pain in her neck, back, and arm,
as well as associated numbness in her arms. Dr. Sima’s
records consistently reported that a physical examination of
Haber revealed “upper extremity numbness with neck
[range of motion].”
June 2011, Haber underwent cervical spine surgery.
Following the surgery, Haber’s STD claim was approved
and paid through the maximum 180-day STD period, from January
2011 through July 2011.
the months immediately following the surgery, Haber continued
to see Dr. Sima and complain of pain in her neck, back, and
arm, as well as associated numbness in her arms. Dr.
Sima’s records beginning June 2011 and through April
2013, however, no longer reported any upper extremity
numbness revealed by a physical examination. Dr. Sima’s
August 2011 records also indicated that he expected Haber to
make a “full recovery” in less than 12 months.
August 2011, Haber submitted a claim for LTD benefits based
on the reported pain in her back, shoulder, neck, arms, and
Between August 2011 and May 2012, Dr. Sima’s records
indicated that Haber’s “Chief Complaint”
was limited to persistent neck and upper back pain. Between
September 2011 and March 2012, Dr. Sima’s records
indicated that Haber herself denied “any upper
March 2012, Reliance Standard notified Haber that her LTD
claim had been approved and that she would receive LTD
benefits beginning (retroactively) July 2011. Haber’s
LTD benefits were thus paid under the policy’s
“Regular Occupation” 24-month period of
disability, from July 2011 to July 2013. Reliance Standard
explained that Haber would reach the end of the 24-month
Regular Occupation period in July 2013, before which
Defendant would begin to ...