United States District Court, D. Columbia.
KELLY FOSTER, Plaintiff: Denise Marie Clark, LEAD ATTORNEY,
CLARK LAW GROUP, PLLC, Washington, DC.
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Commissioner for
the District of Columbia, SUN TRUST BANK SHORT AND LONG TERM
DISABILITY PLANS, Sun Trust Bank In-House Counsel,
Defendants: James Taylor Heidelbach, LEAD ATTORNEY, GEBHARDT
& SMITH LLP, Baltimore, MD; Gregory L. Arbogast, PRO HAC
VICE, GEBHARDT & SMITH LLP, Baltimore, MD.
E. BOASBERG, United States District Judge.
Kelly Foster, a former employee of Sun Trust Bank, brought
this action under the Employee Retirement Income Security Act
of 1974, claiming that Defendants Sedgwick Claims Management
Services, Inc. and the Bank's Short-Term and Long-Term
Disability Plans improperly denied her disability benefits.
She asserts that she submitted sufficient medical evidence of
conditions -- including fibromyalgia, fatigue, and anxiety
disorder -- that render her " totally disabled"
within the meaning of the Plans, and she further maintains
that she has satisfied all of the Plans' other
preconditions for receiving benefits.
with Foster's contentions, Defendants have filed a Motion
for Summary Judgment. They first point out that the
Short-Term Disability Plan is not even governed by ERISA.
They also argue that the denial of long-term benefits was
appropriate in light of the aggregate medical evidence and
the eligibility requirements of the Plans.
that Defendants are entitled to judgment, the Court will
grant their Motion.
Trust Bank automatically enrolls all of its employees in the
company's Short-Term Disability (STD) and Long-Term
Disability (STD) Benefits Plans after six months of
employment. See Mot., Exh. 2 (STD Benefits Handbook) at 1.
Plaintiff, formerly a Mortgage Loan Closer at Sun Trust, was
enrolled in both Plans. See Mot., Exh. 5 (STD Claim File) at
1. Sun Trust retains Sedgwick as the claims administrator for
both of its Disability Benefits Plans. See Mot., Exh. 4
Anna M. Grant) at 1. The claims administrator " make[s]
a determination regarding whether your medically-documented
claim entitles you to a Long-Term Disability [or Short-Term
Disability] benefit." Mot., Exh. 3 (LTD Plan) at 11.
employees are eligible for STD benefits if the claims
administrator determines that for more than five consecutive
business days, the employee is " not able, solely
because of disease or injury, to perform the material duties
of their own occupation and are under the regular care of a
physician." STD Benefits Handbook at 2. This
determination is to be based on " [o]bjective medical
documentation supporting the employee's claim.'"
Id. at 1.
employee is eligible for LTD benefits, conversely, if, after
180 consecutive calendar days of total disability, he or she
remains disabled. See LTD Plan at 4. During the entirety of
this 180-day " waiting period," the employee must
be entitled to STD benefits or Workers Compensation, see id.,
the latter of which is not at issue here. The waiting period
commences on the first day the employee is absent from work
as a result of his or her disability, and it is broken (and
must be restarted) if the employee returns to work for more
than 30 days. Id. These requirements are laid out in
the Plan documents and are discussed in more detail in the
Analysis. See infra Section III.B.1.
to Foster, she suffers from a series of disabling conditions,
including fibromyalgia and fatigue. See STD Claim File at 1,
23. She filed her first claim for disability benefits under
Sun Trust's STD Plan in January 2012. See Mot., Exh. 7
(Claim Log I) at 36. Sedgwick conditionally approved
Plaintiff's claim but later discontinued her benefits the
following month, after she failed to provide medical support
for a continuing disability. See Mot., Exh. 8 (Letter
Discontinuing Temporary Benefits) at 1.
then filed another STD benefits claim -- the claim at issue
in this action -- on August 20, 2012. See STD Claim File at
1. On two occasions after the filing of this claim, Sedgwick
notified Plaintiff that she had to file medical documentation
in support of her claim before September 7, 2012. See id. at
4, 15. After Foster failed to do so, Sedgwick denied her
claim on September 10, 2012. See id. at 18. Five days after
the deadline, Dr. Robert Mayfield submitted an Attending
Physician Statement in support of Plaintiff's claim, in
which he reported that she suffered from fibromyalgia, dry
eyes, and anxiety. See id. at 20-22 (Statement of Dr.
Mayfield). His diagnosis cited an MRI performed in 2011, and
he noted that further objective findings would require
additional testing. See id. at 23. Finding that this
Statement did not constitute " satisfactory"
objective medical documentation of Plaintiff's
disability, Sedgwick again denied her STD claim on September
13, 2012. See Mot., Exh. 13 (Claim Log II) at 46-47; STD
Claim File at 26-27.
September 25, 2012, Sun Trust terminated Foster's
employment as a result of her absence from work. See Grant
Aff. ¶ 4. On that same day, a second physician, Dr.
James Sutherland, submitted an Attending Physician Statement
on her behalf. See Mot., Exh. 14 (Statement of Dr.
Sutherland). Although this Statement confirmed many of Dr.
Mayfield's diagnoses, it also indicated that
Plaintiff's physical condition did not functionally limit
her activities of daily living and did not merit driving
restrictions. See id. at 2.
through counsel, formally appealed the denial of her claim
for STD benefits, which she was permitted to do even after
her termination. See STD Claim File at 28. After additional
including consultation with independent physicians, Sedgwick
upheld this denial on March 29, 2013. See Mot., Exh. 16 (STD
next filed a claim for benefits under Sun Trust's LTD
Plan on October 31, 2013. See Claim Log II at 4. Sedgwick
denied this claim on November 8, on the basis that Foster had
not established that she was entitled to STD benefits or
Workers' Compensation for the duration of the 180-day
waiting period. Mot., Exh. 17 (LTD Denial Letter). Plaintiff
appealed the denial of her claim for LTD benefits on January
10, 2014, but Sedgwick upheld it on January 27. See Claim Log
II at 2.
then filed this action on July 21, 2014, seeking to clarify
and enforce her rights under the benefits plans, as permitted
by ERISA. See 29 U.S.C. § 1132(a).