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Moldovan v. Wells Fargo Co.

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

March 6, 2019

JANE MOLDOVAN, Plaintiff,
v.
WELLS FARGO COMPANY, et al., Defendants.

          MEMORANDUM AND ORDER

          CHARLES A. SHAW UNITED STATES DISTRICT JUDGE

         This matter is before the Court on cross-motions for summary judgment filed by plaintiff Jane Moldovan and defendants Wells Fargo & Company[1] (“Wells Fargo”) and Wells Fargo & Company Short Term Disability Plan Life Insurance Company (the “Plan”), collectively referred to as “defendants.” Plaintiff filed this action challenging the denial of short-term disability benefits under her employer Wells Fargo's welfare benefit plan. The Plan is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq. The motions are fully briefed and ready for decision. For the following reasons, the Court will grant defendants' motion for summary judgment and deny plaintiff's motion for summary judgment.

         I. Summary Judgment Standard

         The Eighth Circuit Court of Appeals has explained the applicable standards relating to summary judgment as follows:

Summary judgment is proper if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law. The movant bears the initial responsibility of informing the district court of the basis for its motion, and must identify those portions of the record which it believes demonstrate the absence of a genuine issue of material fact. If the movant does so, the nonmovant must respond by submitting evidentiary materials that set out specific facts showing that there is a genuine issue for trial. On a motion for summary judgment, facts must be viewed in the light most favorable to the nonmoving party only if there is a genuine dispute as to those facts. Credibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the facts are jury functions, not those of a judge. The nonmovant must do more than simply show that there is some metaphysical doubt as to the material facts, and must come forward with specific facts showing that there is a genuine issue for trial. Where the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no genuine issue for trial.

Torgerson v. City of Rochester, 643 F.3d 1031, 1043 (8th Cir. 2011) (en banc) (internal citations and quotation marks omitted).

         Where parties file cross-motions for summary judgment, as here, each summary judgment motion must be evaluated independently to determine whether a genuine dispute of material fact exists and whether the movant is entitled to judgment as a matter of law. See, e.g., Wermager v. Cormorant Twp. Bd., 716 F.2d 1211, 1214 (8th Cir. 1983). The denial of one motion does not necessitate the grant of the other. M. Snower & Co. v. United States, 140 F.2d 367, 369 (7th Cir. 1944).

         II. Facts

         Plaintiff was employed by Wells Fargo beginning November 11, 2008 as a project manager.

         Wells Fargo describes plaintiff's job responsibilities as follows:

Responsible for leading project teams and managing activities associated with projects that are typically longer-term, multiple-department or organizational entity-wide and moderate in risk, scope and complexity. Consults with business partners to clarify and define project requirements and business case, including development of a statement of work. Develops and revises complex project plans and budgets, works with users to understand complex problems and focuses on bringing issues to resolution, escalating as necessary to meet timelines. Interacts and negotiates with mid to senior level management on behalf of project team. Develops and implements complex project communication plans. Creates and delivers presentations to mid-senior level management on project goals and plans, including progress reports. May be responsible for sourcing, negotiating and managing outside vendors. May manage a group of projects associated with a specific business function. May directly manage project staff, including selection, training and conducting performance evaluations.

Doc. 17-2, Wells Fargo-Moldovan 602. Plaintiff's position requires face-to-face, telephonic, and e-mail contact with customers, working overtime, and meeting productivity quotas. Id. 603. Plaintiff's position requires frequent sitting, and seldom requires lifting, carrying, or other dynamic movements.

         Plaintiff is a participant in Wells Fargo's Short Term Disability Plan (“STD Plan”), a welfare benefit plan under the Employee Retirement Income Security Act of 1974 (“ERISA”). Wells Fargo is the plan administrator and sponsor for the STD Plan, funds the STD Plan, and is ultimately responsible for paying benefits. Liberty Life Assurance Company of Boston (“Liberty”) is the Claims Administrator for the STD Plan. The STD Plan provides that “Liberty has full discretionary authority to administer and interpret the STD Plan.” Wells Fargo-Moldovan 56.

         To be considered disabled under the STD Plan, a participant “must have a medically certified health condition that lasts longer than the [seven-day] STD waiting period and prevents you from performing the essential duties of your job.” Id. 60. The STD Plan defines a “medically certified health condition” as follows:

For purposes of the STD Plan, a medically certified health condition is generally defined as a disabling injury or illness that:
• Is documented by clinical evidence as provided and certified by an approved care provider. Clinical evidence may include medical records, medical test results, physical therapy notes, mental health records, and prescription records.
• Prevents you from performing the essential functions of your own job as regularly scheduled for longer than the STD waiting period.

Id. 60.

         Plaintiff filed a claim for STD benefits in early June 2017, which stated that her last day of work would be June 30, 2017. Plaintiff's claim was denied as premature on June 8, 2017, and plaintiff was advised to file her claim closer to her last day of work. Plaintiff re-applied for short-term disability benefits later in June 2017, with a disability date of July 1, 2017.[2] Plaintiff's last day of work was on June 30, 2017.

         In support of her STD benefits application, plaintiff submitted medical records from her primary care physician, Dr. Michael Schoenwalder, which consisted of notes from a May 30, 2017 office visit. Dr. Schoenwalder's notes list the following “problems” for plaintiff:

E03.8 Other specified hypothyroidism
E06.3 Autoimmune thyroiditis
N95.1 Menopausal and female climacteric states
G47.00 Insomnia, unspecified
R53.82 Chronic fatigue, unspecified
F34.8 Other persistent mood [affective] disorders

         Wells Fargo-Moldovan 549. Dr. Schoenwalder's notes show a “Problem List” including “Chronic fatigue, unspecified, ” “Other chronic pain, ” and “Insomnia, unspecified.” Id. 549-50. Under the general heading of “Exam, ” the Mental Status Exam entry was left blank. Id. 551.

         Dr. Schoenwalder's notes include an “Assessment” that lists:

R53.82 Chronic fatigue, unspecific
F34.8 Other persistent mood [affective] disorders
N95.1 Menopausal and female climacteric states
G47.00 Insomnia, unspecified
E03.8 Other specified hypothyroidism
E06.3 Autoimmune thyroiditis

Id. 551.

         Dr. Schoenwalder's notes state that plaintiff was compliant with medications and “has hypothyroidism. Thyroid disease related review: Complains of fatigue, heat/cold intolerance, bowel/skin changes, uncontrolled on meds.” and that Plaintiff “still [had] chr[onic] fatigue.” Id. 549.

         Under the heading “Behavioral visit/mtgfr, ” Dr. Schoenwalder's notes state that plaintiff

presents with Pt co anxiety / panic attacks, Feels down, sad, blue, crying spells or feels like crying for no apparent reason, trouble with focus. concentration, finishing a task, irritable, mood swings, edgy, tense all the time, cannot fall asleep, then keeps waking up with difficulty returning to sleep, early morning awakening, tired upon rising, tired, lethargic, apathetic. Symptoms have Stable. over last few months, on methy[l] ¶ 12 and methy[l] folate.

Id.

         Dr. Schoenwalder's notes state: “[W]ent into depth on root cause of her [symptoms] related to chronic life long stress [and] her current work environment is a culprit as well.” Id. 551. The notes state that plaintiff was looking into ending her job and claiming disability; “spent majority of time in cou[ns]eling on this chr[onic] issues [from] e[mo]tional trauma.” Id.

         On June 6, 2017, “Denise T” added the following note, signed by Dr. Schoenwalder the same date, which states:

I recommend that Jane takes leave from work with an approximate start date 7/1/17 and will re-evaluate in September's follow up appointment (9/1/17), with an estimated possible return to work date of 10/1/17 pending re-evaluation. Due to increased stress and emotional trauma from work it is impacting her physical health. She needs to avoid stressful environments such as her workplace. Jane would benefit from short term disability at this time. She has tried treatments such as massage therapy, counseling, physical therapy, and chiropractic treatments, with little to no improvement. At this time, the best treatment for her is to rest and take leave from work.

Id. 552.

         On August 8, 2017, Liberty sent a letter (“Initial Denial Letter”) to plaintiff stating it reviewed her STD benefit claim and determined that benefits were not payable, quoting the STD Plan's definition of medically certified health condition. Wells-Moldovan 545. The Initial Denial Letter stated that plaintiff submitted a “claim for mood disorder and chronic fatigue” and the claim file contained as medical documentation Dr. Schoenwalder's notes from the May 30, 2017 office visit. The Initial Denial Letter stated that a nurse case manager at Liberty reviewed the medical records and found:

You saw Dr. Schoenwalder on 5/30/17 reporting fatigue, hot/cold intolerance, anxiety, panic attacks, feeling down, sad and blue, crying spells or feeling like crying, trouble with focus and concentration, irritable, mood swings, edgy, tense all the time, sleep disturbances, lethargic, apathetic, and trouble finishing a task. You reported symptoms are stable. Exam was normal. Diagnoses given are chronic fatigue, persistent mood (affective) disorders, insomnia, hypothyroidism, and autoimmune thyroiditis. Dr. Schoenwalder discussed with you the need to work on improving health and root causes of her symptoms to include current work environment and chronic life stress. You were looking into job ending and possible disability. There is a note from Dr. Schoenwalder dated 6/6/17 recommending you take a leave from work starting 7/1/17-10/1/17 due to increased stress and emotional trauma from work impacting her ...

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