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Krysztofiak v. Boston Mutual Life Insurance Co.

United States District Court, D. Maryland

December 4, 2019




         Presently pending and ready for resolution in this case brought pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq., alleging the wrongful termination and denial of disability benefits, are the motion for summary judgment filed by Plaintiff Dana Krysztofiak, (ECF No. 15) and the cross motion for summary judgment filed by Defendant Boston Mutual Life Insurance Co. (ECF No. 17). The issues have been fully briefed, and the court now rules, no hearing being deemed necessary. Local Rule 105.6. For the following reasons, Plaintiff's motion for summary judgment will be granted and Defendant's cross motion for summary judgment will be denied.

         I. Background

         Dana Kysztofiak (“Ms. Krysztofiak” or “Plaintiff”) is a registered nurse. Before the events of this case, she worked as a Clinical Coordination Manager for HomeCare Maryland, LLC. In late 2016, Ms. Kyrsztofiak stopped working due to, among other things, diagnoses of psoriatic arthritis and fibromyalgia. (ECF No. 11-19, at 103). Ms. Krysztofiak first claimed disability benefits under a Boston Mutual Life Insurance Co. (“Boston Mutual” or “Defendant) Long Term Disability policy (“the Policy”) as of December 29, 2016. Id. About four months later, on April 13, 2017, Boston Mutual began paying Ms. Krysztofiak regular disability benefits of $4, 377.50 per month. (ECF No. 1, at 2).

         In the spring of 2018, Boston Mutual's claims administrator, Disability Reinsurance Management Services, Inc. (“DRMS”), determined that Ms. Krysztofiak was no longer disabled. (ECF No. 11-20, at 54). Her disability income benefits were terminated as of May 29, 2018. Her administrative appeal was denied on March 20, 2019, and this case was filed on March 25, 2019. Plaintiff seeks a declaration that she is entitled to the payment of disability income benefits, a reinstatement of benefits going forward so long as she remains disabled, an award of benefits accrued since termination, prejudgment interest, costs, and attorneys' fees.

         Just before benefits were terminated, Ms. Krysztofiak's treating physician, Dr. Tazeen Rehman, concluded that psoriatic arthritis was no longer the cause of Ms. Krysztofiak's disability. Her report is dated May 18, 2018, and she reports that Plaintiff recently has been on Cimzia which results in “good control” of the psoriatic arthritis. (ECF No. 11-1, at 34). Dr. Rehman concluded instead that “[h]er limitations are due to fibromyalgia.” (Id.). The denial letter recounts some of Plaintiff's history concerning treatment for psoriatic arthritis during 2017 and early 2018. (ECF No. 11-20 at 54-57). Defendant argues that, once Plaintiff's psoriatic arthritis was under control, she ceased meeting the definition of disability based on fibromyalgia alone. (ECF No. 17-1, at 8).

         The administrative record is replete with descriptions and analyses of Ms. Krysztofiak's fibromyalgia, but the most thorough are in her own words in an affidavit executed in December 2018:

I experience constant generalized pain, swelling, and stiffness throughout my entire body. The severity of pain ranges from moderate to excruciating. On a 1-10 scale, my pain averages 6-7 on a daily basis. The pain is deep, penetrating, throbbing, and stabbing. It feels like bones are breaking. The pain is exacerbated by anything that touches me, or any kind of bodily movement, including sitting down, standing up, walking, reaching, bending, and turning. When pain levels become unbearable, I need to lie down until the pain subsides. When walking, I use a cane or walker. The pain is often distracting to the point that it impairs my ability to focus on anything other than the pain. The pain often keeps me up at night when I am trying to sleep. I have panic attacks and anxiety because the pain never stops.

(ECF No. 11-19, at 153).

         In order to assess Ms. Krysztofiak's condition as part of the review process, DRMS had her participate in a functional capacity evaluation (“FCE”) on October 2, 2017.[1] (ECF No. 11-5, at 21). During the FCE, Ms. Krysztofiak “refused Floor to Waist and Waist to Shoulder lifts, and carry task” and “refused to try filing, typing and assembly tasks.” Id. The FCE administrator was careful to note that “[t]he results of this evaluation were limited, ” “should be considered to be a minimal representation of her functional ability, ” and that the evaluation was “unable to determine her physical demand level[, ]” because “[d]uring various components of the evaluation, claimant demonstrated lack of effort[.]” (Id. at 21, 22).

         Seemingly at odds with those caveats, however, the FCE states that “[b]ased on the results of this evaluation, claimant would not be able to perform the job functions of Clinical Coordinator Manager, due to claimant not being able to perform frequent fingering, modifications required with walking, sitting limitations, and not being able to demonstrate productive functional reach pattern.” (Id. at 21). The FCE also noted that Ms. Krysztofiak was “consistent throughout both days of the evaluation[, ]” and that she needed “positional changes on both days (sit to supine), which would make it difficult for claimant to perform modified or light duty work.” (Id. at 21, 22).

         Because of the equivocal results of the FCE, Boston Mutual arranged for an in-person examination with Dr. John Parkerson on February 13, 2018. (ECF No. 11-1, at 23). In relevant part, Dr. Parkerson's report concluded:

On a physical basis, she does not present as having any physical limitations or restrictions. Her reported limitations present as psychological or based on fibromyalgia. . . Fibromyalgia is a condition defined only by subjective complaints. The person must report pain and symptoms of severity. There is no objective test known or physical finding required. The diagnosis is made simply on the person's complaints. Therefore, there is no objective finding of limitation or restriction based on this diagnosis. The diagnosis also requires the exclusion of other reasonable causes of the complaints. In this particular case, she has other diagnoses that reasonably explain her complaints including but possibly not limited to her bipolar depressive disorder, endocrinopathy, and opioid dependence. A diagnosis of fibromyalgia does not present her with any physical limitations or restrictions.

(Id., at 28-29). Dr. Parkerson also concluded that Ms. Krysztofiak did not exhibit any “symptom magnification disorder[.]” In other words, Dr. Parkerson thought she was truthful about the severity of her symptoms. (Id. at 27).

         Unlike Dr. Parkerson, Ms. Krysztofiak's doctors did diagnose her with fibromyalgia. On February 10, 2017, Pamela Lentz, CRNP, found “18 out of 18 tender points, ” a common test for fibromyalgia. (ECF No. 11-9, at 25). Dr. Rehman likewise concluded that Ms. Krysztofiak “suffers from fibromyalgia which severely limits her activities of daily living[, ]” (ECF No. 11-10, at 74), and that her “limitations are mainly due to fibromyalgia, ” (ECF No. 11-19, at 128).

         Following Dr. Parkerson's report, DRMS had Stewart Russell, D.O., review all of Ms. Krysztofiak's medical records. Dr. Russell concluded that “the insured likely has fibromyalgia[.]” (Id., at 110). Dr. Russell nonetheless found “no support for an inability to perform at least a minimum of full-time sedentary activity[, ]” and that “self-reports of the insured are not consistent with the overall medical information.” (Id.). Dr. Russell also disagreed with the treatment Ms. Krysztofiak was then undergoing, noting that the opioids she had been prescribed were inappropriate for a fibromyalgia patient. (ECF No. 11-20, at 105).

         The course of opioid treatment which Dr. Russell took issue with had been ongoing since June 2014. (ECF No. 11-6, at 54). In that year, Ms. Krysztofiak began seeing Dr. Norman Rosen for pain treatment related to a number of ailments. On June 30, 2017, the Maryland Board of Physicians reprimanded Dr. Rosen for over-prescription of opioids. (ECF No. 11-20, at 52). According to media reports, on February 27, 2018, federal agents raided Dr. Rosen's clinic as part of an ongoing investigation. (ECF No. 11-1, at 106). By July of 2018, Plaintiff reported to Dr. Rehman that she had weaned herself from opioids and was instead relying on medical marijuana to treat her fibromyalgia, and Plaintiff attested in a December 2018 affidavit submitted as part of her appeal review process that she “no longer use[s] opioid medications.” (ECF No. 11-19, at 156).

         Dr. Russell's review occurred in March 2019 and includes nothing which refutes Plaintiff's and Dr. Rehman's timeline of Ms. Krysztofiak's opioid use. Rather, Dr. Russell appears to have considered Dr. Rehman's July 2018 report that Ms. Krysztofiak was “off all of her pain medications and is taking medical marijuana which seems to be helping the fibromyalgia symptoms.” (Id., at 109). Dr. Russell nonetheless addressed his criticism of Ms. Krysztofiak's treatment specifically and exclusively to her use of opioids for fibromyalgia, writing that “[t]he prescribed opiate ...

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