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Mesker v. Reliance Standard Life Insurance Co.

United States District Court, S.D. Indiana, Indianapolis Division

August 2, 2018

MICHAEL MESKER, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

          OPINION AND ORDER

          Robert L. Miller, Jr. Judge.

         In 2010, Michael Mesker was forced to stop working at the Indiana State Teacher's Association due to complications from HIV/AIDS. Mr. Mesker applied for and was awarded a long-term disability insurance policy issued by Reliance Standard Life Insurance Company ("Reliance"). Five years later, Reliance terminated Mr. Mesker's claim and affirmed that decision in its administrative appeals process.

         Mr. Mesker brought this suit and challenged the timeliness of Reliance's decision. The late Judge Larry McKinney held that the applicable standard of review is arbitrary and capricious, because Reliance substantially complied with the ERISA's procedural regulations and didn't render an untimely decision. The parties' cross-motions for summary judgment are now before the court. For the reasons stated below, the court denies Mr. Mesker's motion and grants Reliance's motion.

         I. Background

         In October 2010, Mr. Mesker submitted a claim for long term disability benefits to Reliance, and was approved for long term disability benefits effective December 14, 2010. The policy promised payment to Indiana State Teacher's Association employees of long term disability benefits under the following conditions:

INSURING CLAUSE: We will pay a Monthly Benefit if an Insured:
(1) is Totally Disabled as the result of a Sickness or Injury covered by this policy;
(2) is under the regular care of a Physician;
(3) has completed the Elimination Period; and (4) submits satisfactory proof of Total Disability to us.
"Totally Disabled" and "Total Disability" mean, that as a result of an Injury or Sickness:
(1) during the Elimination Period and for the first 60 months for which a Monthly Benefit is payable, an Insured cannot perform the material duties of his/her Regular Occupation;
(2) after a Monthly Benefit has been paid for 60 months, an Insured cannot perform the material duties of Any Occupation. We consider the Insured Totally Disabled if due to an Injury or Sickness he or she is capable of only performing the material duties on a part-time basis or part of the material duties on a Full-time basis. . . .
"Any Occupation" means an occupation normally performed in the national economy for which an Insured is reasonably suited based upon his/her education, training or experience.

         In October 2010, infectious disease specialist Dr. Steven Norris completed an attending physician's statement in support of Mr. Mesker's long-term disability benefits claim in which he stated that Mr. Mesker had been diagnosed with HIV/AIDS, was unable to sit, stand, walk, or drive for more than an hour over the course of an eight-hour workday, and was therefore unable to return to work. Dr. Norris also indicated that Mr. Mesker had reached maximum medical recovery and wasn't expected to improve over time.

         Reliance approved Mr. Mesker's claim on January 24, 2011, with a gross monthly benefit amount of $2, 666.64 payable retroactively to December 14, 2010. Mr. Mesker applied for social security disability income benefits as a result of his HIV/AIDS, peripheral neuropathy, chronic fatigue syndrome, and fibromayalgia in July 2010. Mr. Mesker's social security benefit claim was initially denied. Upon review, administrative law Judge Stephen E. Davis rendered a favorable decision, and Mr. Mesker was awarded full benefits.

         Dr. Norris's February 2015 office visit note documented a normal physical examination negative for fever, chills, weight loss, malaise and fatigue, congestion, sore throat, nausea, vomiting, diarrhea, back pain, tremors, seizures, depression and memory loss among others. Mr. Mesker reported preferring Stribild to Atripla and having "no trouble" with it. Mr. Mesker 's CD4 count was 546 and his viral load less than 20. Dr. Norris's impression was that Mr. Mesker was ''doing well, '' and had no new HIV symptoms.

         On July 29, 2015, Reliance informed Mr. Mesker that it had began its review of his eligibility for continued benefits under the policy and requested completion of several forms. It followed up on the requested information on August 13 and 28. On or about August 27, 2015, Dr. Norris completed the attending physician's statement for continued benefits and reported that Mr. Mesker was now treated with Stribild for his HIV infection and ''experienced declining health.''

         In January 2016, Reliance provided further notice about the change of definition of disability under the policy, invited Mr. Mesker to submit any medical or vocational information he wanted Reliance to consider in its review of his continued eligibility for benefits, and requested completion of several forms including an activities of daily living questionnaire.

         In February 2016, Mr. Mesker provided the completed questionnaire. Mr. Mesker confirmed taking Stribild for his HIV infection as ...


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