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Mathews v. Northwestern Mutual Life Insurance Co.

United States District Court, W.D. Wisconsin

October 29, 2019



          WILLIAM M. CONLEY, District Judge.

         Plaintiff Catherine A. Mathews claims that The Northwestern Mutual Life Insurance Company denied her request for short-term disability insurance benefits in violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Pending before the court are the parties cross-motions for judgment as a matter of law.[1] For the reasons that follow, the court finds that defendant wrongfully denied her claim for short-term disability insurance benefits. Accordingly, the court will grant plaintiff's motion and enter judgment in her favor pursuant to ERISA § 502(a)(3).


         A. Overview

         Mathews was a participant in short-term and long-term disability plans issued by Northwestern Mutual to its policyholder, Aztalan Engineering, Inc., Mathews' former employer, referred to by Northwestern as the “STD” and “LTD” Plans. Both are employee welfare benefits plants subject to ERISA, and Northwestern Mutual is also the claims administrator contracted by Aztalan Engineering to administer claims for benefits arising under the plans.

         Mathews is 55 years old. In addition to earning her high school diploma, she also completed a Certified Nursing Assistant program. In 1997, Mathews began working at Aztalan Engineering, a manufacturing company, and at least by April 2015, she was working as a Packager & Administrator. According to Aztalan's job description for a Packager & Administrator, the material duties included “cleaning and packaging parts, inspecting parts, and performing assembly operations, ” and the job required “the ability to occasionally lift up to 50 pounds.” (Pl.'s PFOFs (dkt. #17) ¶ 14.) Northwestern Mutual does not dispute that this accurately reflects the duties of a Packager & Administrator, but contends that “from May 4, 2015, until she ceased work more than a year later, ” Mathews was performing the work of a Finishing Inspector, a light strength level occupation.

         Mathews was employed at Aztalan until she was terminated on June 24, 2016, because she maintains, her “myofascial pain syndrome, chronic fatigue, and chronic neck, right arm, and low back pain” precluded her from working. (Id. ¶ 13.) Northwestern Mutual disputes that she suffered from fatigue, and it also disputes that Mathews' other medical conditions precluded her from working.

         B. Plaintiff's Job Duties and Accommodations

         In 1997, Mathews was injured at work when an object struck her right hip. Mathews contends that this injury subsequently caused chronic low back pain. In 2002, Mathews suffered another accident at work. In a 2014 medical record, Mathews reported that the second accident occurred as “she was loading baskets with some metal parts, and accidentally hurt her right arm and shoulder.” (AR 258; see also AR 371 (another medical record noted “[s]econd accident occurred 2001/2002 when pt was lifting; resulting in R neck and shoulder pain”).)[3] Medication helped Mathews manage the pain from these injuries, and she was able to maintain full-time employment. Also, at some unknown time, she was diagnosed with myofascial pain disorder.[4]

         As time went on, however, the lifting requirements of Mathews' job exacerbated her pain, causing it to radiate around her upper abdomen to her belly button. She also reported being unable (1) to drive to work because of the sedating effects of her medication and (2) to perform the lifting and repetitive tasks required of her job. By 2010, her coworkers also began noticing a decrease in her performance. Northwestern Mutual would dispute both characterizations since medical records from 2015 and 2016, at times, describe her reported pain symptoms as “stable” and “well controlled by medication, ” indicating generally that there were “no substantial adverse effects related to the medication, ” and stating specifically that she can drive an automatic vehicle. (Def.'s Resp. to Pl.'s PFOFs (dkt. #25) ¶ 19.)

         However, there is no dispute that in early 2015, Mathews sought an accommodation from her employer to perform her work duties, and in response, Aztalan requested that Mathews' doctor complete a “Fitness for Duty” form, which Dr. Milford, Mathews' primary care provider, completed on April 21, 2015. (AR 382-83.) Dr. Milford responded that Mathews is not able to return to work full-time without restrictions, and indicated that she was fully restricted from lifting over 10 pounds and climbing, and had “partial restrictions” for sedentary-lifting 0 to 10 pounds; pulling/pushing, carrying; stopping; kneeling; and operating a motor vehicle, crane, tractor, etc. (indicating that he restricted her driving to “in town only”). (Id.)

         Based on Dr. Milford's response, Aztalan further determined that she was unable to perform her essential job functions as a Packager & Administrator and transferred her to the position of Material Handler, effective May 4, 2015, although the listed duties for Material Handler are essentially the same as that for Packager & Administrator. Specifically, the Material Handler position's duties included “inspecting parts, cleaning and packaging parts to specifications, and performing assembly operations, ” and the position required “standing, walking, bending, crouching, or stopping, and occasionally lifting heavy objected weighing up to 50 pounds.” (AR 522.) Defendant does not dispute that she was transferred to this position or that the position involved those duties and required physical demands, but contends that her “actual work duties differed from the duties identified in Aztalan's ‘Material Handler' job description.” (Def.'s Resp. to Pl.'s PFOFs (dkt. #25) ¶ 22.)

         Not surprisingly, given the similarity in the two positions, Mathews was not able to perform the duties of the Material Handler position without accommodations, including the assistance of her coworkers. Northwestern Mutual does not dispute this, but contends that because Mathews was not performing the Material Handler job, Aztalan had effectively created a new position for Mathews by limiting her duties in certain respects and taking some tasks away from other workers in order to form a job for her. Aztalan's HR Manager informed Northwestern that in this position,

[Mathews] spent time doing hand written inspection reports, and doing data entry after packaging. She would do some packing of small items only, and would clean items that had come back from outside vendors, before packaging them in a particular way as requested by the customer. She did the final inspection of parts before they were packaged and sent to the shipping department.

(AR 522.)

         For approximately one year, Mathews worked in this new position, which Aztalan identified as a “Material Handler, ” but Northwestern claims is more accurately “defined by the STD Plan” as a “Finishing Inspector, a light strength level occupation.” During this year, Mathews contends she continued to struggle with myofascial pain syndrome, fatigue and chronic neck, right upper extremity and low back pain. Northwestern Mutual again disputes the extent of her pain symptoms, pointing to medical records showing that her pain was “stable” and “well controlled, ” as described in more detail below.

         In early 2016, new management took over Aztalan, and in May 2016, Mathews was required to complete an updated Fitness for Duty form. Peter Silvers, PAC, completed that form on June 22, 2016. (AR 158-59.) Consistent with the prior form, Silvers indicated that she was not able to work full-time without restrictions, again limiting her to lifting no more than 10 pounds and stating that this could be on an “infrequent basis if work is within 12 inches of body and below shoulder level, ” but otherwise, she was limited to 5 pounds on an occasional basis. Silvers also indicated that “pulling” was fully restricted, while “partial restrictions” were necessary for pushing/ carrying, stooping, kneeling, repeated bending and climbing (limiting her to climbing to reach 8-10 feet, but no work at or above shoulder height when climbing).

         Because Aztalan was not able to accommodate Mathews' restrictions, it terminated her employment effective June 24, 2016, and encouraged her to apply for disability. Before her termination, Mathews was earning $37, 440 annually, or $18.00 per hour.

         C. Plaintiff's Medical History

         1. Overview

         Mathews' diagnosed medical conditions include myofascial pain syndrome, hyperlipidemia[5] and hypothyroidism. Northwestern Mutual does not dispute this, but contends that there are no identified work-related restrictions with respect to the latter two diagnoses. More specifically, Mathews claims that her myofascial pain syndrome causes fatigue and chronic, neck, right arm and low back pain. As noted above, Northwestern Mutual contends that the medical record does not reflect that Mathews suffered from fatigue and also points to records describing her pain as “stable” and “well controlled.” (Def.'s Resp. to Pl.'s PFOFs (dkt. #25) ¶ 36.)

         Over the years, Mathews has undergone numerous treatments in an attempt to manage her pain, including physical therapy, acupuncture, injection treatments, transcutaneous electrical nerve stimulation, prolotherapy and pain medication. However, she claims that none of these treatments have provided meaningful relief. Mathews also contends that she suffers from sedating side effects caused by pain medication that she is on, but for support, she points to a medical record from May 2017, almost a year after the end of her employment. Northwestern Mutual also points out that her treatment records from October 6, 2016, December 1, 2016, and January 27, 2017, state that “there are no substantial adverse effects related to the medication.” (Def.'s Resp. to Pl.'s PFOFs (dkt. #25) ¶ 38 (citing AR 172, 168, 116).) Nonetheless, Mathews identifies prior complaints by her coworkers that noticed her “doz[ing] off” while on the job and expressed concerns about her safety given that her functions were so impaired. (Pl.'s PFOFs (dkt. #17) ¶ 39.)

         2. 2013-2015

         Mathews walks through her medical records in detail, dating back to early 2013. At that point, Mathews' treating physician Dr. Jeffrey Paterson, D.O., noted she presented with neck and back pain. He also noted that her medication makes her “fuzzy, ” resulting in errors at work. The medical note further indicated that morphine helped “considerably” with her pain, but that the fentanyl patch “was too much for her and made her dopey.” (Pl.'s PFOFs (dkt. #17) ¶ 41 (citing AR 203); Def.'s Resp. to Pl.'s PFOFs (dkt. #25) (citing AR 319, 331).) As a result, Mathews discontinued the fentanyl patch but continued on the morphine.

         In 2013, Mathews also was seen by Dr. James Conniff on four occasions to address ongoing pain and fatigue complaints. In his medical notes, Conniff described Mathews' pain as “stable” or “steady, ” though still recognized that she was suffering from pain, and also noted that her pain was “a little worse recently” or had “worsened.” (AR 289, 298, 311.) Mathews continued to see Dr. Conniff in 2014. In an August 14 note, Conniff explained that Mathews was attending physical therapy, though she “doesn't notice any overall improvement.” (AR 267.) In a September 16 appointment, Conniff similarly noted “muscle tenderness - cervical and lumbar on deep palpation, ” and pain with movement of her right shoulder, though Conniff also noted that she was alert and not in acute distress, though “tearful with recall of previous injuries.” (AR 372.)

         In 2014, Mathews also began treatment with her current, primary care provider, Dr. James A. Milford. In an October 2014 medical note, Dr. Milford noted that Mathews presented with decreased range of motion in her neck, coupled with tenderness and rigidity, and that she had limited range of motion in her back, back muscle spasms, muscle tenderness and low back pain. Mathews also saw Dr. Anil Dogra in November and December 2014 for pain management. (AR 257, 258.)

         On January 26, 2015, Dr. Milford noted that Mathews had seen pain management, apparently in reference to her appointments with Dr. Dogra, who believed that her “current medicines [were] appropriate and should continue.” (AR 222.) Dr. Milford also stated that “[w]ithout medication her ADLs [activities of daily living] are impaired.” (Id.) A few days later, in a January 29 note, Dr. Agril found tenderness in Mathews' low back, but also stated that “[o]verall, [Mathews] thinks that her pain is under good control now” and that she reported her pain level was 5 out of 10. (AR 256.) In an October 12, 2015, medical note, Dr. Milford further wrote that Mathews required transportation to her appointment, that “[p]ain medication is controlling her pain adequately although it's not completed relieved, ” and that “[s]he is able to perform most ADLs.” (AR 350.)

         3. 2016-2017

         On January 14, 2016, Mathews saw a new pain specialist, Dr. Donatello, who noted that Mathews had chronic back pain and had experienced “sudden onset of right arm shoulder and neck pain after engaging in repetitive lifting at work.” (AR 253.)[6] Dr. Donatello's physical exam also revealed limited range of motion, and specifically that her “spine range of motion restricted with 0 of extension of cervical segment.” (Id. at 255.) While Donatello noted that Mathews would continue to treat her symptoms with medication, he also “referred her for a cervical spine MRI imaging study given the new cervical symptoms.” (Id.) A May 10, 2016, MRI further showed “[s]mall C6-7 focal disc in the midline, however no significant central spinal canal stenosis on this study, ” and “[a] small 3mm nerve root sleeve cyst in the right foramen at ¶ 6-7.” (AR 136.) Defendant maintains that this MRI was essentially unchanged from a February 2012 MRI, which found “mild midline disk bulge which lateralizes to the right at ¶ 6-7, but does not produce any significant encroachment on the spinal cord or the neural foramen.” (AR 186.)[7]

         At an April 25, 2016, appointment, Dr. Milford similarly noted that:

Overall her pain condition has been stable. She has ongoing low back pain. Recently however her right upper extremity pain has been increasing. She described pain at the base of her neck and then extending down to her right shoulder and then down her right arm. This does limit her functional ability.

(AR 240.) Milford further noted that Mathews was experiencing “ongoing fatigue which has been getting worse over the past year.” (Id.) His physical exam also revealed “pain with palpation over her right trapezius, ” which “seems to stem from the base of her neck.” (Id.) Accordingly, Milford increased ...

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