Opinion
CV 99-09548 RSWL (Ex).
December 16, 2005
RULING
Before the Court are Plaintiff Donald Jebian's claims against Defendant Hewlett-Packard Company Employee Benefits Organization Income Protection Plan for breach of contract regarding disability coverage. Plaintiff seeks this Court order Defendant to (1) pay his past benefits plus interest; (2) reinstate all other relevant ERISA plans to which disabled employees are entitled, including contributions to pension plans; and (3) award reasonable attorney's fees and costs.
The Court has carefully reviewed and considered all of the documentary evidence presented in this trial.
THE COURT NOW FINDS AND RULES AS FOLLOWS:
Plaintiff prevails in this action.
The Court conducted a de novo review of Voluntary Plan Administrators, Inc.'s ("VPA") denial of Plaintiff's claim for long-term disability, because administrative discretion was not exercised when Plaintiff's benefits application was "deemed denied" because of time expiration. Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income Protection Plan, 349 F.3d 1098, 1102-03 (9th Cir. 2003).
In conducting this review, the Ninth Circuit instructed this Court not to apply the "treating physician rule," but enabled this Court to afford Plaintiff's treating physicians' opinions whatever weight they might merit. Id. at 1109 n. 8. This Court complied with this direction.
This Court finds that Plaintiff has successfully met his burden establishing that he is "totally disabled" for the purpose of qualifying for long-term disability coverage under Defendant's Employee Benefits Organization Income Protection Plan. This Court finds that Plaintiff has demonstrated that he is continuously unable to perform any occupation for which he is or may be qualified, by reason of his education, training, or experience.
This Court reviewed the following records:
(1) Dr. Lu Medical Report — June 25, 1997
(2) Dr. Lu Physician Certification of Disability Form — September 3, 1997
(3) Dr. Lu Attending Physician Statement of Disability — January 30, 1998
(4) Dr. Oslund Medical Report — May 5, 1998
(5) Health South report — May 5, 1998
(6) Health South report — June 8, 1998
(7) Rehab West Employability Assessment Report — June 25, 1998
(8) Dr. James W. Landes letter — October 14, 1998
(9) Dr. James Stark letter — November 30, 1995
(10) Dr. Lacy Medical Report — September 24, 1996
(11) Dr. Franzino Medical Report — October 31, 1996
(12) Dr. Lu Medical Report — July 23, 1996
(13) Dr. Lacy Medical Report — August 21, 1996
(14) Rehab West Employability Assessment Report — March 15, 1996
Plaintiff's medical reports reflect a history of degenerative back problems dating back to 1995, when he underwent two back surgeries. These surgeries were then followed by two shoulder surgeries in 1996. Plaintiff's doctors state in their medical records that, in their medical opinions, Plaintiff was disabled and unable to tolerate the sitting, standing, and reaching required at work.
Defendant Hewlett-Packard places great weight in the June 25, 1998 Rehab West report prepared by Jodelle Florentine, which suggested four alternative occupations available to Plaintiff Jebian. Specifically, those occupations of User Support Analyst, Data Processing Auditor, Sales Representative, Computers and EDP Systems, and Technical Training Instructor. Although Defendant contends that this report establishes that Plaintiff was capable of performing other occupations even if he was incapable of working as a Software Engineer, the evidence presented to this Court indicates otherwise. All four of the alternative occupations listed in Rehab West's report call for physical work requirements similar to those of a Software Engineer, including sitting, standing, and reaching.
The Ninth Circuit noted in its review of the Summary Judgment that VPA did not have Plaintiff Jebian examined by a doctor.Jebian, 349 F.3d at 110. Nor did VPA have Plaintiff Jebian's medical records reviewed by a doctor. Id. The only assessments requested by VPA were the Health South assessment conducted by physical therapists and the Rehab West report prepared by a Jodelle Florentine, "vocational consultant." Id. All of these facts remain unchanged. Defendant has provided no medical evidence or opinion to contradict or draw into doubt the assessments made by Plaintiff's doctors as to his inability to work due to chronic pain.
The June 25, 1998 Rehab West suggesting the four alternative occupations is especially problematic. As an initial matter the June 25, 1998 Rehab West report is identical to the Rehab West report issued on March 15, 1996. This is disconcerting considering that (1) Plaintiff had two shoulder surgeries in the time intervening between the issuance of these two reports, and (2) no mention of which medical records were reviewed accompanies the reports. The fact that the later report appears to be a carbon copy of the first reduces any persuasiveness it might carry.
Additionally, unlike the doctors who actually examined Plaintiff Jebian, Ms. Florentine never met with or observed Plaintiff. And unlike the medical doctors that examined and observed Plaintiff Jebian, there exists no explanation of Ms. Florentine's academic background or credentials qualifying her as a Vocational Consultant.
But more importantly, Ms. Florentine's report states that medical reports were reviewed. The medical reports provided by Plaintiff's treating physicians indicate that Plaintiff suffers from chronic back pain and is unable to sit or stand for periods of time exceeding thirty minutes. It is clear from the medical records that Plaintiff was physically unable to continue his "usual occupation" as a Software Engineer. As the alternative positions require similar physical requirements, he must be equally unable to perform the alternative occupations suggested by Ms. Florentine in the Rehab West report. But, Defendant provided no evidence and no discussion is included in Ms. Florentine's report explaining how she reached an assessment contradictory to the recommendations of Plaintiff Jebian's physicians as included in their reports.
Given the apparent inconsistencies in the documents relied upon by VPA, this Court finds that the opinions of Plaintiff's treating physicians have greater credibility and are afforded more weight than the reports issued by Health South and Rehab West, and especially the report prepared by Jodelle Florentine. Plaintiff's treating physicians had a greater opportunity to know, observe, and treat Plaintiff as a patient. As such, their medical diagnoses and conclusions regarding Plaintiff's inability to work are much more persuasive than those provided by the vocational consultant. Plaintiff's medical reports demonstrate a history of chronic pain over a period of years that was present and continuous upon the expiration of his short-term disability.
Therefore, this Court finds that Plaintiff has successfully met his burden of establishing that he is "totally disabled" for the purposes of long-term disability coverage under Defendant's Employee Benefits Organization Income Protection Plan.
Plaintiff is entitled to:
(1) past long-term disability benefits plus interest in the amount of 10%, as set by California Insurance Code § 10111.2;
(2) reinstatement of the benefits he is entitled to receive under the ERISA plans for disabled Hewlett-Packard employees; and
(3) reasonable attorney's fees and costs to be approved by the Court.