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Realmuto v. Life Insurance Company of North America

United States District Court, D. Maryland

July 24, 2015

MARIO REALMUTO, Plaintiff,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

MEMORANDUM OPINION

GEORGE L. RUSSELL, III, District Judge.

Pending before the Court is Plaintiff's, Mario Realmuto, Motion for Summary Judgment (ECF No. 32) and Defendant's, Life Insurance Company of North America ("LINA"), Motion for Summary Judgment (ECF No. 34).[1] The issues have been fully briefed and no hearing is necessary. See Local Rule 105.6 (D.Md. 2014). For the reasons given below, Realmuto's Motion for Summary Judgment will be denied and LINA's Motion for Summary Judgment will be granted in part and denied in part.

I. BACKGROUND

Beginning in 1988, Realmuto was employed by Arrow Electronics, Inc. ("Arrow") as a staff accountant and was eventually promoted to Financial Systems Manager/Account Finance Manager. His duties included staff management, providing around-the-clock support to hundreds of worldwide users, significant travel, and software analysis and support.

Realmuto stopped working in May 2004 as a result of symptoms associated with Charcot-Marie-Tooth ("CMT") disease, Type IA; an inherited progressive neurological condition with no curative treatment, which causes slow weakening progression that starts at the feet and progresses up the body. Realmuto began to exhibit symptoms of CMT in 1974, at age 18. He describes himself as having enjoyed recreational activities through his thirties. By age forty-four, however, he was wearing leg braces and by May 2004, at age forty-eight, progression of the deformity in his feet, the severity of pain, and the likelihood of major surgery made performance of his occupational duties impossible. Realmuto reported difficulty walking, paresthesia, gait disturbance, muscle weakness, pain of the legs and hands, muscle wasting of the legs and hands, altered nerve sensations in the feet and legs, foot deformity, severe fatigue, and limitations of functional capacity and related physical and functional disabilities.

Realmuto was enrolled in Arrow's long-term disability ("LTD") Plan and Group Disability Insurance Policy LK-030291 (collectively, the "Plan"), which was issued and administered by LINA. An employee is entitled to LTD benefits under the Plan if he meets the provided definition of disability. "Disability" is defined as the inability:

to perform all the material duties of his... regular occupation, or solely due to Injury or Sickness, he... is unable to earn more than 80% of his... Indexed Covered Earnings; and after Disability Benefits have been payable for 24 months, he... is unable to perform all the material duties of any occupation for which he... may reasonably become qualified based on education, training or experience, or solely due to Injury or Sickness, he... is unable to earn more than 80% of his... Indexed Covered Earnings

(Administrative Record ["A.R."] at Realmuto-592). The Plan provides that disability benefits terminate, inter alia, when the insured is no longer disabled, (A.R. at Realmuto-599); and requires continued proof of disability for benefits to continue. (A.R. at Realmuto-1180). Realmuto was approved for disability benefits under the Plan beginning on May 31, 2004. (A.R. at Realmuto-01116) (approval notice for short-term disability); (see also A.R. at Realmuto-01116) (approval notice for long-term disability). Realmuto was also approved for disability benefits by the Social Security Administration ("SSA") under the SSA rules effective May 24, 2004.

Pursuant to the Plan, however, LINA continued to request updated medical records after its initial claim approval. In 2011, LINA claims manager, Kim Jackson, noted certain "red flags" in Realmuto's case file, which promoted her to refer the claim to "Special Investigations" to monitor and investigate Realmuto's activities. Between August 9 and August 12, 2011, 108 hours of surveillance video was taken of Realmuto. The video depicted Realmuto engaging in various physical activities including pushing and pulling a lawn mower, trimming the edges of his lawn, using a leaf blower, riding his bike while simultaneously holding his dog's leash, and playing a round of golf. He performed these activities fluidly, without leg braces, and without signs of any physical limitation or restriction. Based on the activities captured in the surveillance video and a review of the medical information on file, LINA determined that Realmuto sustained functionality that would allow him to return to, at least, a sedentary occupation. (A.R. at Realmuto-292-95). As a result, LINA terminated Realmuto's LTD benefits by letter of September 27, 2011. (Id.).

Realmuto appealed his benefits termination by letter dated February 12, 2012. (A.R. at Realmuto-456-64). He referenced medical reports by Dr. Michael Stanton, Realmuto's treating neurologist; Dr. Michael Foster, Realmuto's primary care physician; Drs. Adolf Flemister and Leon Root, Realmuto's treating orthopedic surgeons; and Dr. Buoye, Realmuto's treating podiatrist, (see id.), as evidence of his disability. To assist in its review of the appeal, LINA obtained an independent medical opinion by Dr. John Mendez, who is board certified in occupational and internal medicine. Dr. Mendez concluded that the medical records failed to document any significant measured physical limitations or functional deficits from October 13, 2011 forward. (A.R. at Realmuto-454-55). Ultimately, after a thorough review of the claim including Dr. Mendez's report, LINA determined that Realmuto's subjectively reported physical limitations were not supported by the evidence. Thus, LINA denied Realmuto's first appeal by letter dated May 3, 2012.

On October 29, 2012, Realmuto filed a second appeal. (A.R. at Realmuto-382-403). Upon the second appeal, LINA undertook another thorough review of the claim including additional comprehensive diagnostic evaluations, pulmonary function tests, and vocational assessments, submitted by Realmuto to further supplement the medical record. LINA again referred the matter to a second independent board certified internist, Dr. DeBerry.

Dr. DeBerry conducted a number of peer to peer telephone calls with Realmuto's treating physicians. (See A.R. at Realmuto-365). Of significance is a conversation with Dr. Michael Stanton, Realmuto's treating neurologist, in which Dr. Stanton indicated that the level of function described in Realmuto's medical chart was not based on objective examination; rather, was based on Realmuto's subjective reporting. (A.R. at Realmuto-368). Further, despite CMT being a progressive condition, Dr. Stanton could not specify any measure of difference in Realmuto's condition between the time of his initial treatment and the present. (Id.). Finally, Dr. Stanton expressed surprise by the level of activity depicted in the surveillance video. (Id.). After a thorough review of the record, Dr. DeBerry opined that while the physical limitations and restrictions noted in the medical documentation alone indicate that Realmuto would not be able to function even at a sedentary occupation, the video revealed no presenting physical limitations or functional deficit that would prevent Realmuto from returning to work. (A.R. at Realmuto-369).

Moreover, as part of its review of the claim and in response to Realmuto's request, LINA also conducted a transferrable skills analysis. (A.R. at Realmuto-355). The analysis considered Realmuto's master's degree in business and historical accounting and managerial positions; and found him to possess mathematical and computer skills, knowledge to design financial record-keeping systems, estimate values, and plan, organize, and direct the work of others. (Id.). Based on these skills, the analysis concluded that Realmuto could perform at least two positions-Manager, Department and Manager, Office-that would meet his Indexed Covered Earnings requirement. (Id.). Based on a complete review of the Administrative Record, on February 14, 2013, LINA again upheld the denial of Realmuto's LTD claim. (A.R. at Realmuto-352).

On April 24, 2014, Realmuto brought this action under the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), 29 U.S.C. ยง 1132(a)(1)(B) (2012), seeking judicial review of LINA's determination that he does not qualify for LTD benefits. On January 30, 2015 and March 2, 2015, the parties moved for summary judgment on ...


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