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Kemathe v. Reliance Standard Life Insurance Co.

United States District Court, District of Columbia

February 1, 2019



          TREVOR N. McFADDEN, U.S.D.J.

         Josephine Kemathe seeks to recover benefits under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq., claiming that Reliance Standard Life Insurance Company (“Reliance”) improperly terminated her disability benefits. Ms. Kemathe overlooks that to qualify for the disability benefits that she seeks, she must prove that she cannot perform the material duties of any occupation, not just her old one. She did not do so, so the Defendant's Motion for Summary Judgment will be granted.


         Ms. Kemathe was a respiratory care practitioner at a hospital, but she stopped working in 2014 because of asthma. A.R. 269. She submitted a claim to Reliance for “Total Disability” benefits, and Reliance approved the claim and paid her benefits. Compl. ¶ 18, 20, ECF No. 1. Under Ms. Kemathe's policy, there are two definitions of “Total Disability.” A.R. 14. For the first two years when a benefit is payable, the insured is “totally disabled” if she “cannot perform the material duties” of her regular job. Id. But after the insured has received benefits for two years, she is “totally disabled” only if she “cannot perform the material duties of Any Occupation.” Id. In other words, the disability bar is raised after two years.

         After paying benefits for two years, Reliance concluded that Ms. Kemathe was no longer “totally disabled” under the policy because she could perform the “material duties” of another job, so Reliance discontinued her benefits as of November 2016. A.R. 246-51. Ms. Kemathe administratively appealed Reliance's decision. A.R. 1404-06. Reliance upheld its decision. A.R. 258-68. Reliance explained that while Ms. Kemathe may have persistent symptoms from asthma, it believed that “the level of severity specific to this condition does not preclude [Ms. Kemathe] from sedentary work function.” A.R. 266. For instance, Reliance proposed that Ms. Kemathe could work as a telemetry technician, blood bank booking clerk, admissions clerk, information clerk, or appointment clerk. A.R. 1599.

         Ms. Kemathe sued Reliance, alleging that its denial of her benefits violated ERISA.[1]Compl. ¶ 1. Reliance now moves for summary judgment. Mem. of Law ISO Mot. for Summ. J. (“Def.'s Mem.”), ECF No. 25-2. Naturally, Ms. Kemathe opposes. Mem. in Opp. (“Pl.'s Opp.”), ECF No. 30.


         Summary judgment is appropriate when “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). “A fact is material if it ‘might affect the outcome of the suit under the governing law,' and a dispute about a material fact is genuine ‘if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.'” Steele v. Schafer, 535 F.3d 689, 692 (D.C. Cir. 2008) (quoting Anderson, 477 U.S. at 248).

         The Court must view the facts in the light most favorable to the non-moving party, but her opposition must consist of more than mere unsupported allegations or denials, and it must be supported by affidavits, declarations, or other competent evidence setting forth specific facts showing that there is a genuine issue for trial. See Fed. R. Civ. P. 56(e); see also Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986). The non-moving party must provide evidence that would permit a reasonable factfinder to find in her favor. Laningham v. U.S. Navy, 813 F.2d 1236, 1242 (D.C. Cir. 1987). A “mere . . . scintilla of evidence” in support of the non-movant's position cannot defeat a motion for summary judgment. Anderson, 477 U.S. at 252.

         Because Ms. Kemathe's policy does not grant discretion to Reliance, the parties agree that the Court should review the denial of benefits under a de novo standard, not the deferential arbitrary and capricious standard sometimes applicable in ERISA cases. See Pettaway v. Teachers Ins. & Annuity Ass'n of Am., 644 F.3d 427, 433 (D.C. Cir. 2011).


         Ms. Kemathe first asks the Court to consider two documents outside the administrative record: (1) her August 25, 2017 Social Security Administration decision; and (2) her affidavit describing her “Independent Medical Examination.” Pl.'s Opp. at 4. She claims that both are relevant to whether Reliance provided her “a full and fair review of her claims.” Id.

         According to the parties, the D.C. Circuit has not determined whether district courts should admit evidence outside the administrative record under de novo review. See Def.'s Reply at 3, ECF No. 31; Pl.'s Mem. at 3. Regardless, these items do not create a genuine issue of material fact about whether Reliance erred in denying her benefits.

         First, the Social Security Administration issued its decision after Reliance made its final benefits decision. “Courts review ERISA-plan benefit decisions on the evidence presented to the plan administrators, not on a record later made in another forum.” Block v. Pitney Bowes Inc., 952 F.2d 1450, 1455 (D.C. Cir. 1992) (giving no weight to a Social Security Administration determination made after the defendant's decision). The Social ...

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