Schuman v. Aetna Life Ins. Co.

          RULING ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

          Stefan R. Underhill United States District Judge.

         On July 1, 2015, Jeff Schuman filed this action against three defendants-Ahold USA's Master Welfare Benefit Plan, the Administrative Committee of Ahold USA as Plan Administrator, and Aetna Life Insurance Co. (“Aetna”) as Claims Administrator-alleging that they violated the Employee Retirement Income Security Act (“ERISA”) by denying him long-term disability benefits. See Compl., Doc. No. 1; Am. Compl., Doc. No. 32-1. On March 20, 2017, I issued a ruling on the parties' cross-motions for summary judgment (doc. nos. 36 and 37), in which I granted in part and denied in part the defendants' motion and denied Schuman's motion in its entirety. See Schuman v. Aetna Life Ins. Co., 2017 WL 1053853, at *1 (D. Conn. Mar. 20, 2017) (hereinafter “Schuman I”). In light of various inadequacies in the record, however, I ordered that the case be remanded to the claims administrator for a correct evaluation of Schuman's long-term disability claim. Id. at *12. Specifically, I directed the defendants to complete another vocational evaluation that would determine “whether Schuman is or may become fitted to perform any type of work that actually exists in the economy and whether he is vocationally qualified to obtain such employment, and to earn a reasonably substantial income from it.” Id. at *18 (internal quotations omitted).

         Aetna denied Schuman's renewed disability claim on August 4, 2017. See Supplemental Administrative Record (“SAR”) at 1668. Schuman appealed that decision September 1, 2017. Id. at 1675. On October 31, 2017, I granted Schuman's motion to reopen the case (doc. no. 102) and noted that the case was “remanded to permit Aetna to complete the administrative appeal process. Aetna shall decide the administrative appeal within fourteen days of the date of this order. Failure to issue a decision within that deadline will be treated as a denial of the appeal.” Doc. No. 104. Aetna upheld its denial decision on appeal in a letter dated November 10, 2017. SAR at 1754. On April 23, 2018 the parties again filed cross-motions for summary judgment (doc. nos. 113 and 115).

         After a review of the record and supplemental briefing, I deny both motions.

         I. Standard of Review

         A. Summary Judgment

         Summary judgment is appropriate when the record demonstrates that “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256 (1986) (plaintiff must present affirmative evidence in order to defeat a properly supported motion for summary judgment).

         When ruling on a summary judgment motion, the court must construe the facts of record in the light most favorable to the nonmoving party and must resolve all ambiguities and draw all reasonable inferences against the moving party. Anderson, 477 U.S. at 255; Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986); Adickes v. S.H. Kress & Co., 398 U.S. 144, 158-59 (1970); see also Aldrich v. Randolph Cent. Sch. Dist., 963 F.2d 520, 523 (2d Cir. 1992) (court is required to “resolve all ambiguities and draw all inferences in favor of the nonmoving party”). In the context of cross-motions for summary judgment, the same standard is applied. See Scholastic, Inc. v. Harris, 259 F.3d 73, 81 (2d Cir. 2001). However, in deciding each motion, the court must construe the evidence in the light most favorable to the non-moving party. Id.

         “Only when reasonable minds could not differ as to the import of the evidence is summary judgment proper.” Bryant v. Maffucci, 923 F.2d 979, 982 (2d Cir. 1991); see also Suburban Propane v. Proctor Gas, Inc., 953 F.2d 780, 788 (2d Cir. 1992). If the nonmoving party submits evidence that is “merely colorable, ” or is not “significantly probative, ” summary judgment may be granted. Anderson, 477 U.S. at 249-50.

The mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact. As to materiality, the substantive law will identify which facts are material. Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment. Factual disputes that are irrelevant or unnecessary will not be counted.

Id. at 247-48. To present a “genuine” issue of material fact, there must be contradictory evidence “such that a reasonable jury could return a verdict for the non-moving party.” Id. at 248.

         If the nonmoving party has failed to make a sufficient showing on an essential element of his case with respect to which he has the burden of proof at trial, then summary judgment is appropriate. Celotex, 477 U.S. at 322. In such a situation, “there can be ‘no genuine issue as to any material fact,' since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial.” Id. at 322-23; accord Goenaga v. March of Dimes Birth Defects Found., 51 F.3d 14, 18 (2d Cir. 1995) (movant's burden satisfied if he can point to an absence of evidence to support an essential element of nonmoving party's claim). In short, if there is no genuine issue of material fact, summary judgment may enter. Celotex, 477 U.S. at 323.

         B. ERISA

         “When an ERISA plan participant challenges a denial of benefits, the proper standard of review is de novo ‘unless the benefit plan gives the administrator or fiduciary discretionary authority' to assess a participant's eligibility.” Thurber v. Aetna Life Ins. Co., 712 F.3d 654, 658 (2d Cir. 2013), abrogated on other grounds by Montanile v. Bd. of Trustees of Nat. Elevator Indus. Health Benefit Plan, 136 S.Ct. 651 (2016) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). “If the plan does reserve discretion, the denial is subject to arbitrary and capricious review and will be overturned only if it is without reason, unsupported by substantial evidence or erroneous as a matter of law.” Id. (internal quotation marks and citation omitted). The Second Circuit held in Halo v. Yale Health Plan, however, that the denial of a claim under a plan including discretionary authority is not entitled to the great deference afforded by the arbitrary and capricious standard if the denial procedure failed to comply with the Department of Labor's claims-procedure regulation, 819 F.3d 42, 56 (2d Cir. 2016). The Halo Court further stated that “the plan bears the burden of proof on this issue since the party claiming deferential review should prove the predicate that justifies it.” Id. (internal quotation marks and citation omitted).

         I previously held that Schuman's plan granted Aetna discretionary authority, subject to arbitrary and capricious review. See Schuman I at *14. Despite the plan's adequate grant of discretion, Schuman identified several potential violations of the claims-procedure regulations that would trigger Halo's de novo review. Those violations included Aetna failing to consider the vocational report of Erin Bailey when making its appeal determination, failing to identify Joseph Thompson as a vocational expert, and failing to provide Schuman with ...