United States District Court, E.D. Louisiana
TOMMY W. SENEGAL
RELIANCE STANDARD LIFE INSURANCE COMPANY
ORDER AND REASONS
ANN VIAL LEMMON UNITED STATES DISTRICT JUDGE
IS HEREBY ORDERED that Tommy W. Senegal's Motion
to Supplement Administrative Record (Doc. #13) is
IS FURTHER ORDERED that Tommy W. Senegal's
Motion Strike Portions of the Administrative Record (Doc.
#13) is DENIED.
IS FURTHER ORDERED that Reliance Standard Life
Insurance Company's Motion for Summary Judgment (Doc.
#11) is DENIED.
IS FURTHER ORDERED that Tommy W. Senegal's
Motion for Judgment Based on the Administrative Record (Doc.
#12) is DENIED.
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.
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.
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.
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.
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
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.
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. ...