PHILADELPHIA – Aetna Life Insurance Company recently won a motion for summary judgment in federal court, versus a Federal Express employee who filed suit to challenge the denial of his long-term total disability benefits.
On Feb. 2, Judge Gene E.K. Pratter of the U.S. District Court for the Eastern District of Pennsylvania ruled to grant defendant Aetna’s motion for summary judgment, and deny a cross-motion for summary judgment filed by plaintiff Yuri Sirko.
Sirko was employed by FedEx as a Ramp Transport Driver, a physically demanding position. As a FedEx employee, Sirko was a participant in FedEx’s short- and long-term disability plans. Aetna determines eligibility for benefits and reviews benefit denials and the plan grants Aetna discretionary authority to interpret the plan’s provisions relating to eligibility.
Sirko first sought disability benefits in 2011 in order to assist in treating his multiple back conditions, including spinal stenosis, multi-level lumbar degenerative disk disease and lumbar spine facet syndrome, along with back and shoulder pain.
Sirko underwent spinal fusion surgery in 2012 and shoulder surgery in 2013, plus physical therapy and epidural injections, among other treatments, to remedy these conditions. Throughout Sirko’s medical records, his range of motion is listed at varying levels of impairment – with some physicians believing he would be to sustain his job’s levels of physicality and others disagreeing on this point.
From November 2011 to April 2014, Sirko received benefits under FedEx’s short and long-term disability benefit plans, but in order to receive these benefits for more than that time period, Sirko needed to be labeled as “Totally Disabled”. Per the plan criteria, that means a medically-determinable condition would prevent him from working for 25 hours in a given week, supported by objective findings of that same condition.
When Aetna denied Sirko’s application for long term disability benefits in April 2014, it cited “a lack of significant objective findings” supporting Sirko’s claim. Mr. Sirko then filed the instant lawsuit, alleging that Aetna’s decision to deny benefits was “arbitrary and capricious” and seeking benefits under the Employee Retirement Income Security Act of 1974 (ERISA). The parties filed cross-motions for summary judgment.
Pratter said Sirko “does not cite to any case law regarding what weight should be given to the opinions of treating physicians”, while Aetna “cites to precedential opinions holding that a plan administrator need not accord special deference to the opinion of treating physicians.”
“Given the thorough review of medical records that each of the two non-examining physicians conducted and the conflicting information about Mr. Sirko’s functional capacity found in those records, the Court cannot say that Aetna acted arbitrarily or capriciously in crediting the opinions of those non-examining experts,” Pratter said.
Pratter also pointed out Sirko’s argument that Aetna ignored his continued inability to perform his job’s essential functions did not take into account the plan’s definition of both disability and total disability.
“Mr. Sirko’s argument…wholly ignores the clear language of the plan’s definition of ‘Total Disability’ as not being tied to the ability to perform an employee’s former occupation but to the ability to perform any compensable employment for at least 25 hours a week,” Pratter stated.
Pratter said Sirko’s medical records showed he could sit for 4-5 hours at a time, which corresponds “very closely to a 25-hour work week at a sedentary job.”
“While the Court sympathizes with Mr. Sirko’s ongoing health struggles, nothing in the record suggests that Aetna denied him benefits arbitrarily or capriciously. For the foregoing reasons, the Court will deny Mr. Sirko’s motion for summary judgment and grant Aetna’s,” Pratter said.
The plaintiff is represented by Brandon A. Swartz, Larissa K. Staszkiw, and Scott Eric Diamond of Swartz Culleton, in Newtown.
The defendant is represented by Barak J. Babcock and Ashley Satterfield Patterson of Federal Express Corporation’s Legal Department, in both Moon Township and Memphis, Tenn., respectively.
U.S. District Court for the Eastern District of Pennsylvania case 2:15-cv-00021
From the Pennsylvania Record: Reach Courts Reporter Nicholas Malfitano at nickpennrecord@gmail.com