United States District Court, W.D. Missouri, Western Division
ORDER GRANTING DEFENDANTS' SUMMARY JUDGMENT
KAYS, CHIEF JUDGE UNITED STATES DISTRICT COURT
ERISA action arises from Defendant Prudential Insurance
Company of America's (“Prudential”) decision
to terminate Plaintiff John Johnston's
(“Plaintiff”) long-term disability benefits under
a policy purchased by Defendant Commerce Bancshares, Inc.
(“Commerce”). Plaintiff alleges Prudential and
Commerce improperly terminated benefits to which he was
entitled under the policy.
before the Court are the parties' cross motions for
summary judgment. Holding that Commerce is not a proper party
to this lawsuit because it had no involvement in any decision
to grant or deny benefits to Plaintiff, and that
Prudential's decision to deny Plaintiff benefits under
the policy was not an abuse of discretion, Prudential and
Commerce's motions are GRANTED (Docs. 55, 57) and
Plaintiff's motion is DENIED (Doc. 59).
moving party is entitled to summary judgment “if the
movant shows 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). The movant bears
the initial responsibility of explaining the basis for its
motion, and it must identify those portions of the record
which demonstrate the absence of a genuine issue of material
fact. Torgerson v. City of Rochester, 643 F.3d 1031,
1042 (8th Cir. 2011).
Court finds the material, undisputed facts to be as
employed Plaintiff in its computer department as an
Enterprise Storage Engineer. As part of his compensation
package, Commerce provided him with a long-term disability
insurance policy (“the Plan”) which it purchased
Plan states that Prudential is the claims administrator, and
Prudential “as Claims Administrator has the sole
discretion to interpret the terms of the Group Contract, to
make factual findings, and to determine eligibility for
benefits. The decision of the Claims Administrator shall not
be overturned unless arbitrary and capricious.”
Administrative Record (“R.”) at 100 (Doc. 54).
Plan defines disability as when: “ you [the
claimant] are unable to perform the material and substantial
duties of your regular occupation due to sickness or injury;
 you are under the regular care of a doctor; and  you
have a 20% or more loss in your monthly earnings due to that
sickness or injury.” R. at 69. Prudential determines
whether a claimant meets the definition of disability. R. at
69. It provides Prudential may stop sending payments if the
claimant fails “to submit proof of continuing
disability satisfactory to Prudential.” R. at 78. The
Plan also provides,
[Prudential] may request that you send proof of continuing
disability, satisfactory to Prudential, indicating that you
are under the regular care of a doctor. . . . Prudential will
deny your claim or stop sending you payments if the
appropriate information is not submitted.
R. at 90.
illness and the initial claim approval.
14, 2013, Plaintiff stopped working because of
hydrocephalus which, doctors later learned, was caused
by a colloid cyst in the third ventricle of his brain. The
hydrocephalus, in turn, caused Plaintiff to develop
unknown exactly when Plaintiff began experiencing changes in
his health attributable to the cyst. Plaintiff's wife
reports his behavior began changing in 2007, when he started
becoming increasingly angry. Sometime after 2010, the family
began seeking mental health treatment because of his behavior
change, which the family attributed to depression and
Plaintiff not sleeping well due to sleep apnea. In June of
2012, Plaintiff began losing control over his urine, and
shortly after that, his stool. He also began experiencing
problems with his gait. He was eventually referred to a
neurologist who could not find anything wrong and referred
him back to a psychiatrist.
a subsequent visit with a psychiatrist, Plaintiff's wife
interjected that he was having serious problems and requested
an MRI because she feared he may have had a stroke. The
psychiatrist then ordered an MRI which revealed a colloid
cyst and enlarged ventricles in his brain.
of 2013, Plaintiff underwent brain surgery to remove the cyst
and relieve the pressure on his brain. Following the surgery,
a neurologist, psychologist, and physical medicine and
rehabilitation doctor all treated Plaintiff.
filed his claim for long-term disability benefits on October
8, 2013. The rehabilitation doctor submitted a statement on
October 10, 2013, in which he opined Plaintiff was
permanently disabled with moderate to severe cognitive
impairments and decreased memory, judgment, attention, and
October 24, 2013, a Prudential team comprised of team lead
Kellie Tattersall, clinician Laurel Cox, R.N., vocational
rehabilitation specialist David Carey, and disability claims
manager Justin Huth, discussed Plaintiff's claim. Ms. Cox
noted Plaintiff had undergone two rounds of
neuropsychological testing, most recently in October 2013,
and that it would be helpful to have the results of that
testing in determining the severity and prognosis of
Plaintiff's illness. Ms. Cox noted it did not appear
necessary to obtain the raw data underlying the
neuropsychological testing at that time.
the Court can determine, during this meeting Prudential
decided to approve Plaintiff's claim for long-term
disability benefits, at least through the duration of his
physical therapy. On November 7, 2013, Prudential sent
Plaintiff a letter stating:
We have approved your LTD claim. We have reviewed the medical
information provided by your treating physician and have
determined that you are currently disabled from your regular
occupation as defined in the enclosure. This letter outlines
some of the programs and benefits that are available.
Whenever possible, we want to work with you on your return to
. . .
To be eligible to receive benefits, you must be continuously
disabled from performing the material and substantial duties
of your regular occupation through the entire elimination
period. Since you have met this requirement, your LTD claim
has been approved and benefits begin effective December 12,
. . .
At this time we have requested the results of your two
Neuropsychological examinations from Patrick Caffrey, Ph.D.
and Eric Eckhmd-Johnson, Ph.D. Please contact these providers
to obtain the medical records and advise of our request. This
information is needed for the ongoing review of your claim
and benefits beyond December 31, 2013.
R. at 761-62.
subsequent denial of the claim.
point, it is unclear when,  Prudential received the results
of the July 2013 and October 2013 neuropsychological testing.
Mr. Huth and Ms. Cox discussed the October results. Mr. Huth
noted the results were not considered valid due to
Plaintiff's inconsistent performance. It appeared from
the neuropsychological testing that Plaintiff had some
cognitive impairment, but it could not be determined how
much. Mr. Huth also noted that with cognitive therapy and
behavioral health counseling, at “least partial
improvement would be expected.” R. at 823. Mr. Huth and
Ms. Cox agreed that Plaintiff would not have sustained
capacity for work at the time, but that Mr. Huth would follow
up with Plaintiff in two to three months after he had
obtained therapy and counseling.
in March of 2014, Plaintiff underwent another surgery to
place a shunt in his brain because the ventricles in his
brain had not returned to their normal size after the prior
surgery to remove the cyst.
March 11, 2014, Linda Gasowski discussed the claim with Mr.
Huth, Ms. Cox, and Mr. Carey. They decided to refer
Plaintiff's file to a physician for review because of the
claim's multiple ...