Waldrip v. Reliance Standard Life Insurance Company
3:21-cv-05602
W.D. Wash.Apr 26, 2023Background
- Plaintiff Christa Waldrip (born 1973) has a history of multiple sclerosis and spinal/carpal tunnel surgeries; she worked as a Production Supervisor and was covered by Reliance Standard Life’s group LTD policy.
- Policy: benefits paid for Total Disability; after 24 months the standard shifts from inability to perform Regular Occupation to inability to perform Any Occupation (defined by education/training/experience). Elimination period satisfied Jan 22, 2019.
- Reliance initially approved LTD benefits, later terminated them in April 2020, then reopened and paid through Jan 22, 2021; Reliance then determined Waldrip could perform full-time sedentary work and terminated benefits effective Jan 22, 2021.
- Medical record conflict: treating providers (e.g., Dr. North, FNP Davies) and a physical-therapy PWPE reported significant functional limitations (very limited sitting, need to lie down, frequent breaks, poor dexterity); Reliance’s IME neurologist (Dr. Greenberg) found normal exam features, pain but mostly preserved function, and concluded Waldrip could perform full-time sedentary work though his sitting estimate was "frequent" (≈2.7–5.3 hrs), not expressly ≥4 hrs.
- Administrative vocational analysis identified transferable skills for sedentary jobs; plaintiff obtained Social Security disability benefits under a different standard. The court reviewed the LTD denial de novo and awarded LTD benefits from Jan 22, 2021 until termination under the Policy (directing the parties to present a judgment calculation).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review / burden | De novo review applies; Waldrip bears burden to prove disability after 01/22/2021 | Agreed de novo (no discretionary grant to administrator) | Court applied de novo; claimant bears burden to prove inability to perform Any Occupation after 01/22/2021 (Muniz/Abatie) |
| Whether Waldrip was "Totally Disabled" under Any Occupation as of 01/22/2021 | Waldrip cannot sit/concentrate more than 4–5 minutes; treating opinions and PWPE show she cannot sustain full-time sedentary work | Reliance relied on Dr. Greenberg IME and vocational analysis concluding capability of full-time sedentary work | Court found Waldrip met her burden: she could not reliably perform full-time sedentary work as of 01/22/2021 and is entitled to LTD benefits from that date forward |
| Weight of treating opinions versus IME/consultants | Treating opinions establish severe limitations | Reliance: IME and reviewers are persuasive; treating opinions contain inconsistencies | Court noted treating opinions are not presumptively controlling under ERISA (Nord); some treating opinions were inconsistent; nevertheless, on the record the claimant carried her burden despite IME’s thoroughness |
| Role of objective evidence / subjective pain and other limitations (medication side effects, falls, incontinence, absenteeism) | Reliance failed to meaningfully consider medication effects, falls, GI/incontinence and therefore undervalued limitations; objective proof is not required | Reliance: policy requires "satisfactory" medical documentation and its IME showed capacity for sedentary work | Court held Policy does not mandate objective-only proof; subjective pain and related limitations can be credited (Saffon/Salomaa); Reliance did not investigate some issues at IME stage and plaintiff proved inability to meet sedentary-work sitting requirement (4 hours) |
Key Cases Cited
- Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006) (de novo is default where plan gives no discretion to administrator)
- Muniz v. Amec Constr. Mgmt., Inc., 623 F.3d 1290 (9th Cir. 2010) (claimant bears burden under de novo review)
- Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869 (9th Cir. 2004) (medical diagnosis alone does not establish disability)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) (treating physician opinions not entitled to special ERISA deference)
- Pannebecker v. Liberty Life Assurance Co. of Boston, 542 F.3d 1213 (9th Cir. 2008) (interpretation of "any occupation" standard)
- McKenzie v. Gen. Tel. Co. of Cal., 41 F.3d 1310 (9th Cir. 1994) (discussion of "any occupation"/vocational proof)
- Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863 (9th Cir. 2008) (subjective pain may be credited; objective measures not always possible)
- Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011) (conditioning awards on objective evidence that cannot exist is arbitrary)
- Armani v. Nw. Mut. Life Ins. Co., 840 F.3d 1159 (9th Cir. 2016) (for "sedentary" work claimant must be able to sit at least four hours in an eight-hour day)