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Berkoben v. Aetna Life Ins. Co.

United States District Court for the Western District of Pennsylvania

February 21, 2014, Decided; February 21, 2014, Filed

Civil Action No. 2:12-cv-1677

Opinion

 [*694]  REPORT AND RECOMMENDATION

I. RECOMMENDATION

It is respectfully recommended that Plaintiff's Motion for Summary Judgment (ECF No. 21) be granted in part and denied in part. It is recommended that Plaintiff's Motion for Summary Judgment be denied to the extent it seeks reversal and retroactive reinstatement of his long-term disability benefits, and be granted in all other respects. It is further recommended that Defendant's Motion for Summary Judgment (ECF No. 22) be denied. It is further recommended that Aetna's decision to terminate Plaintiff's long-term  [*695]  disability benefits be vacated and the case remanded to the plan administrator for further consideration in light of this Report and Recommendation.

II. REPORT

Currently before the Court for disposition are cross-motions for summary judgment in this ERISA action brought under 29 U.S.C. § 1132(a)(1)(B) for  [**2] review of a termination of long-term disability benefits. This Court has subject matter jurisdiction over this action pursuant to 28 U.S.C. §1331 and 29 U.S.C. §1132(e). Venue in this District is proper pursuant to 28 U.S.C. §§1391(b)(1) & (c)(2).

A. STATEMENT OF RELEVANT FACTS 1

Plaintiff, Jason Berkoben, was employed by Dell, Inc. as a computer programmer. As an employee of Dell, Berkoben was a participant in a long-term disability plan ("Plan"), which was insured by an insurance policy ("Policy") issued to Dell by Defendant, Aetna Life Insurance Company ("Aetna"). The Plan grants Aetna discretionary authority to "determine whether and to what extent eligible employees and beneficiaries are entitled to benefits and to construe any disputed or doubtful terms under this Policy, the Certificate or  [**3] any other document incorporated herein." (Berkoben Policy 074.) The Policy and Plan further provide that Aetna "shall be deemed to have properly exercised such authority unless we abuse our discretion by acting arbitrarily and capriciously." Id. Aetna also reserved the "right to adopt reasonable policies, procedures, rules, and interpretations of this Policy to promote orderly and efficient administration." Id.

Berkoben commenced employment with Dell on or about May 2, 2007, and at all material times, was a covered beneficiary under the Plan. On or about March 3, 2010, Berkoben ceased working due to Schizoaffective Disorder and Bipolar Disorder. (LTD 36-37, 322.)2 His treating psychiatrist at the time, Dr. Lekhwani, recommended that he stay home from work due to a "psychiatric illness." (STD 170.)3 Berkoben informed Dell that his "illness is mental in nature." (STD 166.)

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8 F. Supp. 3d 689 *; 2014 U.S. Dist. LEXIS 39385 **

JASON BERKOBEN, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, Defendant.

Subsequent History: Adopted by, Summary judgment granted, in part, summary judgment denied, in part by, Remanded by Berkoben v. Aetna Life Ins. Co., 8 F. Supp. 3d 689, 2014 U.S. Dist. LEXIS 38957 (W.D. Pa., Mar. 25, 2014)

Motion granted by, Costs and fees proceeding at Berkoben v. Aetna Life Ins. Co., 2014 U.S. Dist. LEXIS 97664 (W.D. Pa., July 18, 2014)

CORE TERMS

benefits, disorder, schizophrenia, brain, brain damage, schizoaffective, disability, termination, claimant, bipolar disorder, nervous condition, mental health, biological, conditions, nervous, opined, medical literature, disease, submits, mental illness, diagnosis, procedural irregularity, conflicting interest, disabling condition, illness, decision to terminate, summary judgment, documentation, recommended, symptoms