United States District Court, N.D. Alabama, Southern Division
MEMORANDUM OF DECISION
JAMES H HANCOCK, Senior District Judge.
The court has before it Cross-Motions for Judgment on the Administrative Record (Docs. # 10 & 12). Pursuant to the court's December 3, 2014 order (Doc. #9), the motions were deemed submitted, without oral argument, on March 31, 2015. After thorough review of the briefs and administrative record, the court concludes that summary judgment is due to be granted in favor of Defendant Aetna Life Insurance Company for the reasons explained below.
I. Procedural History
Plaintiff Thomas Denney commenced this action on August 4, 2014 by filing a Complaint (Doc. #1) in this court against Defendant Aetna Life Insurance Company. Plaintiff's Complaint set forth only one cause of action: wrongful denial of long term disability benefits in violation of the Employee Retirement Income Security Act of 1974, as amended, (ERISA), 29 U.S.C. §§ 1001, et seq. Defendant responded with an Answer (Doc. #4) on August 28, 2014. Pursuant to the court's initial order (Doc. #7), on December 2, 2014, the parties file a Joint ERISA report and the administrative record. (Doc. #8.) Defendant filed its Motion (Doc. #10) for Judgment on the Administrative Record on February 16, 2015, asserting that Aetna's determination that its determination that Plaintiff did not satisfy the Plan's Test of Disability after twenty-four months of long term disability (LTD) payments was correct, and not arbitrary and capricious. Plaintiff's February 17, 2015 Motion (Doc. #12), however, contends that Aetna's determination was both erroneous and unreasonable.
Both parties have filed briefs and jointly submitted the administrative record in support of their respective positions. Defendant submitted a brief (Doc. #11) and additional evidence (Doc. #13) in support of its motion on February 16 and 19, 2015. On March 23, 2015, Plaintiff filed a brief (Doc. #152) in opposition to Defendant's Motion, and on March 31, 2015, Defendant filed a brief (Doc. #16) in reply. On February 17, 2015, Plaintiff submitted a brief (Doc. # 12) in support of his own Motion for summary judgment. On March 23, 2015, Defendant filed a brief (Doc. # 14) in opposition to Plaintiffs's Motion. Although given the opportunity to do so, Plaintiff did not file a brief in reply to Defendant's opposition.
II. Findings of Fact
A. The Plan
LTD benefits under the Plan are funded by Group Policy Number GP-881927 ("the Group Policy") issued by Aetna to Southwest. (Admin. Rec. at 00001-30.) The Group Policy confers Aetna with "discretionary authority to: determine whether and to what extent eligible employees and beneficiaries are entitled to benefits; and construe any disputed or doubtful terms under this policy." (Admin. Red. at 000028.)
LTD benefits are payable under the Plan to eligible participants who are "disabled" as defined by Plan booklet-certificate. (Admin. Rec. at 000040.) The Plan's "Test of Disability is explained as follows:
Own Occupation Period
From the date that you first become disabled; and until Monthly Benefits are payable for 24 months; you will be deemed to be disabled on any day if; solely because of: disease or injury; either of the following applies to you:
you are not able to perform the material duties of your own occupation; or
your earnings from working in your own occupation are 80% or less of: your adjusted predisability earnings.
* * *
Any Reasonable Occupation Period
After the first 24 months that any Monthly Benefit is payable during a period of disability; you will be deemed to be disabled on any day if; solely because of: disease or injury; either of the following applies to you:
you are not able to work at any reasonable occupation; or
your earnings from working in any occupation are 50% or less of: your adjusted predisability earnings....
(Id.) (emphasis in original). "Reasonable occupation" is defined by the Plan booklet-certificate as "any gainful activity for which you are; or may become; fitted by: education; ...