Lester v. Liberty Life Assurance Company of Boston
- Edward Chen
- 3:19-cv-01490
- U.S. District Court · Northern District of California
- 20
In Lester v. Roche, Judge Chen upheld ending Lester’s disability benefits, denied her judgment motion, and granted Roche’s motion after finding the decision reasonable.
Tajamala Lester’s long-term-disability benefits were terminated, and U.S. Roche Health and Welfare Benefits VEBA Plan obtained judgment in its favor.
What happened
In Tajamala Lester v. U.S. Roche Health and Welfare Benefits VEBA Plan, Lester sued after Liberty ended her long-term-disability benefits, finding she was no longer disabled under the plan. She argued that the plan required an impossible medical standard and that Liberty’s reviewers mishandled her cognitive-impairment evidence.
The court applied a deferential standard because the plan gave Liberty discretion to decide benefit claims. It found that Liberty reasonably relied on medical records and reviewer opinions, and that Lester’s doctors had not conclusively said she could not work in her occupation. The court also found that Lester showed some financial conflict involving one reviewer, but that this did not make Liberty’s decision unreasonable.
Judge Edward M. Chen denied Lester’s motion for judgment and granted Roche’s cross-motion for judgment. The court concluded that ending Lester’s benefits was not arbitrary and capricious and was supported by a reasonable basis.
The detailed version
- Lester v. Liberty Life Assurance Company of Boston · No. 3:19-cv-01490
- Edward Chen
- June 23, 2020
Background
Tajamala Lester brought an Employee Retirement Income Security Act (ERISA) claim concerning long-term-disability benefits under the U.S. Roche Health and Welfare Benefits VEBA Plan. Liberty Life Assurance Company of Boston administered the plan. After Lester went on leave because of depression, anxiety, and cognitive problems, the plan paid her short-term-disability benefits from October 2, 2017, through March 5, 2018, and then paid long-term-disability benefits.
Liberty later determined that Lester was no longer disabled under the plan and stopped her long-term benefits retroactively from September 30, 2018. Liberty upheld that decision on appeal. Lester then sought judgment in her favor under Federal Rule of Civil Procedure 52, and Roche filed a cross-motion for judgment.
Arguments
Lester argued that Liberty applied an impossible definition of disability by effectively requiring a newer neuropsychological examination. She also argued that Liberty’s medical reviewers were biased and did not properly evaluate her cognitive impairment, including because they reviewed records instead of examining her in person and did not contact all of her treating physicians.
Roche argued that Liberty did not require a repeat examination and instead relied on the complete medical record. Roche also argued that Lester’s treating physicians had not conclusively found that she could not work in her own occupation, while Liberty’s reviewers reasonably found that she could work.
Court’s analysis
The court explained that ERISA review ordinarily is based on the plan’s terms, but that the plan gave Liberty discretion. Because the parties agreed there was no structural conflict involving Liberty, the court reviewed the benefits decision under an abuse-of-discretion standard. Under that standard, the decision could stand if it had a reasonable basis and was not illogical, implausible, or unsupported by the record.
The court rejected Lester’s argument that the plan or Liberty required an impossible medical examination. Nothing in the plan or Liberty’s decisions indicated that benefits depended on submitting a repeat neuropsychological examination within a period that made the examination impossible.
The court found that Lester’s treating physicians’ opinions were not conclusive. Dr. Nancy Canning documented cognitive symptoms and recommended additional evaluation and a gradual return to work, but did not definitively state that Lester could not work. Dr. Nishi Bhopal recommended a reduced schedule and later a return to work, possibly in a different business-oriented role. The court concluded that these opinions were ambiguous about whether Lester could work without accommodations.
The court also found that Liberty’s reviewers had a reasonable basis for concluding that Lester was not disabled under the plan. Dr. Pei Nie reviewed medical records, compared Lester’s cognitive abilities with her job duties, and spoke with Dr. Bhopal. Dr. Vikram Garg found no internal-medicine restriction on full-time work. Dr. H. Daniel Blackwood found no support for a mental-illness impairment preventing work and noted that Lester scored 27 out of 30 on a Montreal Cognitive Assessment, which the court viewed as relevant because it was closer in time to the benefits termination. Dr. Yong-Sung Chyun likewise found no internal-medicine impediment to full-time work.
Lester showed evidence that Dr. Blackwood had reviewed approximately 1,000 claims for Liberty, so the court treated his report with skepticism because of a possible financial conflict. But Lester did not provide comparable evidence of bias involving the other reviewers. The court further held that a paper review, without an in-person examination, did not automatically make a benefits decision unreasonable under ERISA.
Disposition
The court concluded that Roche did not abuse its discretion and that Liberty’s decision to terminate Lester’s benefits was grounded in a reasonable basis. Judge Edward M. Chen denied Lester’s motion for judgment and granted Roche’s motion for judgment. The order disposed of Docket Nos. 38 and 39.
Read the full 20-page opinion on CourtListener, the free public archive maintained by the Free Law Project.