United States District Court, S.D. Indiana, Indianapolis Division
OPINION AND ORDER
L. Miller, Jr. Judge.
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.
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
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
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.
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.
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.
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
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.
February 2016, Mr. Mesker provided the completed
questionnaire. Mr. Mesker confirmed taking Stribild for his
HIV infection as ...