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Senegal v. Reliance Standard Life Insurance Co.

United States District Court, E.D. Louisiana

January 17, 2017

TOMMY W. SENEGAL
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY

         SECTION "S"

          ORDER AND REASONS

          MARY ANN VIAL LEMMON UNITED STATES DISTRICT JUDGE

         IT IS HEREBY ORDERED that Tommy W. Senegal's Motion to Supplement Administrative Record (Doc. #13) is GRANTED.

         IT IS FURTHER ORDERED that Tommy W. Senegal's Motion Strike Portions of the Administrative Record (Doc. #13) is DENIED.

         IT IS FURTHER ORDERED that Reliance Standard Life Insurance Company's Motion for Summary Judgment (Doc. #11) is DENIED.

         IT IS FURTHER ORDERED that Tommy W. Senegal's Motion for Judgment Based on the Administrative Record (Doc. #12) is DENIED.

         IT IS FURTHER ORDERED that this matter is REMANDED to the Plan Administrator for reconsideration within 90 days of Tommy W. Senegal's claim. This case is STAYED pending that review. The parties may reinstate this case to the active docket by filing an appropriate motion within 14 days after the plan administrator concludes its review.

         BACKGROUND

         This matter is before the court on cross-motions for summary judgment. Defendant, Reliance Standard Life Insurance Company, argues that it is entitled to summary judgment based on the administrative record because its discontinuance of plaintiff's long-term disability payments was made in accordance with the policy language. Plaintiff, Tommy W. Senegal, argues that he is entitled summary judgment finding that he is awarded to long-term disability payments under the Reliance policy because Reliance's decision to terminate his benefits was arbitrary and capricious.

         Senegal was employed by Cequel III, LLC as a field service engineer supervising cable installation. His job required climbing ladders, crawling in tight spaces, completing paperwork, scheduling jobs, managing employees and lifting up to 85 pounds. Senegal is insured under Cequel's group long-term disability policy issued by Reliance. Senegal left Cequel on December 14, 2011, due to disability caused by severe back, knee and neck pain, post-traumatic stress disorder and anxiety. Reliance approved Senegal's initial disability claim and paid benefits.

         On May 15, 2013, an Administrative Law Judge (“ALJ”) at the Social Security Administration (“SSA”) determined that Senegal was disabled from December 14, 2011, through the date of the decision. Specifically, the ALJ found that Senegal had severe impairments from disorders of the back, osteoarthriosis and allied disorders, affective disorder and anxiety disorders. After reviewing records from Senegal's treating physician, Dr. R. Dale Bernauer, and social worker, Eddie Windham, LCSW, the ALJ found that Senegal was disabled. Further, based on the testimony of a vocational expert, the ALJ found that there were no jobs in the national economy that Senegal could perform.

         On January 27, 2014, Reliance wrote to Senegal to inform him that his long-term disability benefits would be terminated on March 14, 2014, because he no longer met the policy's definition of “totally disabled.” Reliance explained that, for the first 24 months in which a claimant receives benefits, “totally disabled” means that the claimant cannot perform the material and substantial duties of his regular occupation. However, after the first 24 months, “totally disabled” means that the claimant cannot perform the material and substantial duties of any occupation. Reliance stated that it reviewed Senegal's medical records and determined that he was capable of performing sedentary work. A vocational expert employed by Reliance determined that based on the medical information and Senegal's training, education and experience he could perform the occupations of protective signal operator, service dispatcher and industrial order clerk.

         In the same letter, Reliance also concluded that Senegal was no longer eligible for benefits because of the policy's mental or nervous disorder limitation, which states that:

Monthly Benefits for Total Disability caused or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months unless the Insured is in a Hospital or Institution at the end of the twenty-four (24) month period. The Monthly Benefit will be payable while so confined, but not beyond the Maximum Duration of Benefits. Mental or Nervous Disorders include depressive and anxiety disorders.

         The letter noted that Reliance would consider the SSA's determination of benefits, but that such determination was not binding because it may be based on different guidelines that could lead to different conclusions. ...


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