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Phillips v. Charter Communications, Inc.

United States District Court, E.D. Missouri, Eastern Division

February 28, 2019

KIMBERLY PHILLIPS Plaintiff,
v.
CHARTER COMMUNICATIONS, INC. WELFARE BENEFIT PLAN, Defendant.

          MEMORANDUM AND ORDER

          STEPHEN N. LIMBAUGH, JR. UNITED STATES DISTRICT JUDGE

         This matter comes before the Court on plaintiff's motion for summary judgment (#22) and defendant's cross-motion for summary judgment (#26). Those motions have been fully briefed. For the reasons set forth below, the Court will DENY plaintiff's motion and GRANT defendant's motion.

         I. BACKGROUND

         Plaintiff filed this action seeking to overturn a denial of short-term disability benefits under defendant's self-funded “Welfare Benefits Plan.” Claims for short-term disability are evaluated by a claims administrator, Sedgwick Claims Management Services, Inc. Sedgwick is the “sole authority to determine benefit claims under the terms of the Short-Term Disability Program.” Sedgwick determines “in its discretion” whether the “applicant is entitled to [benefits under the Plan].” Defendant is a telecommunications company providing cable, pay TV, telephone, and high-speed internet services. Plaintiff has been an employee of defendant since 2010. Her position as a “community sales specialist” requires, among other things, an ability to read, write, persuade, clearly communicate, build relationships, deal with the public, and maintain confidentiality.

         Plaintiff has been treated for bipolar disorder since 2012 and generalized anxiety disorder since 2015. On March 31, 2017, plaintiff contacted Sedgwick claiming “stress” and “bipolar disorder” caused her to experience disabling symptoms that required her to miss work. That same day, plaintiff was seen at Central Texas Mental Health for a follow-up visit regarding her bipolar and anxiety disorders. A physician's assistant, Julie Williams, noted in plaintiff's medical chart that she exhibited no motor abnormalities, had “linear, coherent thought, ” no “psychotic thoughts, ” “good judgment, ” intact memory, and “fair concentration.” However, plaintiff was also noted as being “anxious, stressed, weepy, and [exhibiting a] labile affect.”

         On April 3, 2017, Sedgwick explained by letter that “medical documentation to support [plaintiff's] claim” would need to be received on or before April 23, 2017. Two days later, Williams completed a “concurrent disability and leave statement of incapacity, ” whereby Williams indicated plaintiff was able to concentrate for five-to-ten minute timespans, was exhibiting reasoning and judgment within normal limits, and was not delusional or suffering from hallucinations. Nonetheless, Williams stated plaintiff was unable to perform “all” of her job functions. Based upon this record, Sedgwick preliminarily approved plaintiff for short-term disability benefits on April 11, 2017, for a duration beginning April 22, 2017, through May 1, 2017. However, plaintiff was instructed to provide additional medical documentation by May 8, 2017, should she require an extension of her short-term disability benefits.

         Plaintiff was seen by Williams for another follow-up visit on April 18, 2017. Williams' notes were substantially identical to plaintiff's earlier visit. On April 26, 2017, Williams completed a second disability and leave statement, which noted a “minimal[] improve[ment] from the prior visit, ” and, based upon this statement, Sedgwick extended plaintiff's short-term disability through May 14, 2017. Once again, Sedgwick stated that additional medical documentation would be required to further extend plaintiff's short-term disability.

         Plaintiff reported for a third follow-up visit with Williams on May 11, 2017. Once again, Williams' notes were substantially identical to the March 31st and April 18th visits. A third disability and leave statement was completed by Williams-again, largely similar to the first two statements-and, through it, Sedgwick extended plaintiff's short-term disability benefits through June 2, 2017.

         Plaintiff reported for a fourth follow-up visit with Williams on June 2, 2017. This time, while plaintiff's complaints were largely the same, she also reported suicidal ideations without an intent or plan. Williams' notes mostly mirrored her prior notes, except for an additional indication that plaintiff had “overinclusive, blocking thought processes” and “psychotic thought content.” Plaintiff requested that she be permitted to extend her disability through approximately October 27, 2017.

         On June 13, 2017, Sedgwick-by letter-denied plaintiff of further short-term disability benefits, indicating such benefits would cease as of June 3, 2017. For its reason, Sedgwick indicated “medical stated referral to therapist but no therapist notes were provided. It is not clear why you are unable to return to work at this time.” Sedgwick also explained

“A claim of total disability or partial disability cannot be based solely on self-reported symptoms. Total disability and partial disability must be based at least in part on objective evidence, which means … diagnosis determination by the physician by use of tests, imaging, clinical studies, medical procedures and other physical evidence[, ] intensity and frequency of treatment[, ] and presence of other health conditions, injuries, and illness.”

         Sedgwick then informed plaintiff of her appeal rights and noted that she may “submit additional medical information, and any facts, data, questions, or comments you deem appropriate for use to give your appeal proper consideration.”

         Plaintiff initiated an appeal on June 15, 2017. The next day, plaintiff submitted an e-mail to Connie Wulf (a disability administrator) stating, among other things, that “my physician and I are unable to determine what additional information Sedgwick may require to approve a continuation of my short-term disability benefits.” During the several extensions that took place before Sedgwick's initial denial, Wulf has repeatedly asked plaintiff for “any testing you can provide.” And administrative notes indicate plaintiff was repeatedly told that the provided medical records do not support an ongoing disability beyond the June 2nd date of termination.

         Nonetheless, what plaintiff provided on appeal was additional medical treatment notes without objective clinical testing. These new treatment notes include those from Brittney Jones, a therapist at Austin Anxiety and Behavioral Health Services, PLLC., who determined over several visits that plaintiff was able to “identify many of her automatic thoughts” but would nonetheless need to “continue to actively work on these skills in order to maintain her gains.” Plaintiff also provided a fourth disability and leave statement from Williams that contained the same basic information as the other statements except for changes to certain medication dosages. Meanwhile, with a medical authorization in ...


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