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Brown v. Life Insurance Company of North America

United States District Court, D. Nevada

March 18, 2014

KIMBERLY BROWN, Plaintiff,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant

For Kimberly Brown, Plaintiff: Julie A. Mersch, Law Office of Julie A. Mersch, Las Vegas, NV.

For Life Insurance Company Of North America, other Four Seasons Hotels Employee Benefits Plan, Defendant: Von S. Heinz, LEAD ATTORNEY, Lewis Roca Rothgerber LLP, Las Vegas, NV.

OPINION

Page 1126

Lloyd D. George, United States District Judge.

ORDER, FINDINGS OF FACT, CONCLUSIONS OF LAW

The plaintiff, Kimberly Brown, sues the defendant, Life Insurance Company of North America (LINA), pursuant to 29 U.S.C. § 1132(a)(1)(B), asserting that LINA wrongfully terminated her benefits under her employer's long-term disability plan. LINA has filed the administrative record (#16). The parties have agreed to present this matter as a summary bench trial, and they have each moved for judgment on the administrative record, submitting opening briefs (## 17, 18), opposing briefs (## 19, 20), and reply briefs (## 21, 22).

While the Court readily concludes from the administrative record that, in general, LINA appropriately administered the determination whether Brown remained eligible for disability benefits in an appropriate manner, the correctness of its determination whether or not she is disabled, as defined by the plan, presents a closer question. Having carefully considered the entirety of the administrative record, paying particular attention to documents generated by Brown, her medical providers, other medical professionals who have evaluated her, the Transferrable Skills Analysis, and LINA's letter determining that Brown was not disabled as defined by the plan, and LINA's letter denying Brown's appeal, the Court cannot agree with LINA's determination on November 10, 2011, that Brown did not meet the plan's

Page 1127

definition for persons disabled from any occupation. Accordingly, the Court will grant Brown's motion and deny LINA's motion for judgment.

The following constitutes the Court's Findings of Fact and Conclusions of Law.

The Court has jurisdiction pursuant to 28 U.S.C. § 1331 and the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(e)(1). Venue is proper in this Court pursuant to 29 U.S.C. § 1132(e)(2).

Brown worked as a reservations manager for VEBA, Inc. According to the Dictionary of Occupational Titles, a " reservations manager" is a sedentary job. She stopped working in late August 2006, to undergo surgery to remove a tumor pressing against her brain stem. After returning to work on February 1, 2007, on a reduced schedule and with restrictions, Brown began suffering an increase in headaches and fatigue, and felt unable to perform her job. She continued working through August 2, 2007, and has not worked since that time in any occupation. In December 2008, Brown underwent gamma knife surgery in a procedure related to the medical condition treated in her 2006 surgery.

While working for VEBA, Brown was eligible to and did participate in the long-term disability benefits plan offered by VEBA. LINA was the Claim Fiduciary for the VEBA plan.

Pursuant to the VEBA plan:

[An] Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:
1. unable to perform the material duties of his or her Regular Occupation; and
2. unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.
...

[LINA] will require proof of earnings and continued Disability.

On August 3, 2007, Brown made a claim for long-term disability benefits, and provided medical records supporting her claim. The Court has reviewed all medical records provided to LINA in support of her initial claim. Among these records was a Medical Request Form completed by Staci Ross, PhD, a neuropsychologist, who diagnosed Brown as having a cognitive disorder secondary to meningioma subsequent to a resection of the meningioma. Additional factors noted by Dr. Ross impacting Brown's return to work were " Adjustment disorder with mixed anxiety/depression secondary to cognitive decline." She noted as restrictions that Brown was " [n]ot able to work in high pressured enviroment in a quick manner. Limiting tasks which require attention to detail, limiting organization, planning, mathematical reasoning, thus impacting mood and ability to work with others." LINA approved Brown's claim, and Brown began receiving disability benefits beginning January 30, 2008.

Pursuant to the VEBA plan, " [LINA] may reduce the Disability Benefits by the amount of such Other Income Benefits." " Other Income Benefits include: . . . 2. any Social Security disability or retirement benefits the Employee . . . on his or her own behalf . . . because of his or her entitlement to such benefits." The VEBA plan further provides:

[LINA] will assume the Employee (and his or her dependents, if applicable) are receiving benefits for which they are eligible from Other Income Benefits. [LINA] will reduce the Employee's Disability Benefits by the amount from Other Income Benefits it estimates are payable

Page 1128

to the Employee and his or her dependents.
[LINA] will waive Assumed Receipt of Benefits, except for Disability Earnings for work the Employee performs while Disability ...

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