Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_16-cv-01348/USCOURTS-cand-3_16-cv-01348-2/pdf.json

Parties Involved:
Edward Elliott
Plaintiff
Life Insurance Company of North America, Inc.,
Defendant

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United States District Court

Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

EDWARD ELLIOTT,

Plaintiff,

v.

LIFE INSURANCE COMPANY OF 

NORTH AMERICA, INC.,

Defendant.

Case No. 16-cv-01348-MMC 

ORDER GRANTING PLAINTIFF'S 

MOTION FOR JUDGMENT; DENYING 

DEFENDANT'S CROSS-MOTION FOR 

JUDGMENT; FINDINGS OF FACT 

AND CONCLUSIONS OF LAW

Re: Dkt. No. 56

Before the Court are (1) plaintiff Edward Elliott's ("Elliott") "Rule 52 Motion for 

Judgment," filed October 2, 2018, and (2) defendant Life Insurance Company of North 

America's ("LINA") "Cross-Motion for Judgment Under F.R.C.P. Rule 52," filed October 

29, 2018. The motions have been fully briefed. Having read and considered the parties' 

respective arguments as well as the applicable administrative record, the Court rules as 

follows.1

BACKGROUND2

Elliott was formerly employed as a Vice President with BTIG LLC ("BTIG"), a 

brokerage firm. (Administrative Record ("AR") 1074, 1328-1329.)

3

 Through his 

employer, Elliott was a participant in a "Group Policy" issued by LINA that provides for 

payments to participants who become "Disabled" within the meaning of the policy. (AR 

 

1By order filed January 28, 2019, the Court took the matters under submission.

2This section and the following sections constitute the Court's findings of fact and 

conclusions of law. See Fed. R. Civ. P. 52(a)(1).

3The Administrative Record was filed August 31, 2018.

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1008-1033.) In September 2014, Elliott submitted to LINA a claim for disability benefits 

(AR 233, 273), in which he listed September 5, 2014, as his last day of work and stated 

he was unable to return to work due to a "nerve condition – severe face pains – twitching 

in the face" (AR 333). Thereafter, in support of his claim, he submitted, inter alia, a letter 

from his treating physician, who provided a diagnosis of "trigeminal neuralgia." (AR 233, 

429).

LINA initially approved Elliott's claim as one for "Short Term Disability (STD)

benefits" under a separate policy (AR 314) and paid benefits for approximately three 

months, after which the claim was denied (AR 271).

4

 With respect to Elliott's claim for 

"Long Term Disability (LTD)" benefits, said claim was denied on February 26, 2015 (AR 

232), after which, on June 9, 2015, and, again, on January 14, 2016, the denial was 

upheld (AR 210-211, 229).

On March 21, 2016, Elliott filed the instant action pursuant to the Employee 

Retirement Income Security Act ("ERISA"), seeking judicial review of the denial of his 

claim for LTD benefits and requesting an award of such benefits or, in the alternative, an 

order remanding his claim to the plan administrator for further proceedings.

Thereafter, on October 20, 2016, Elliott filed with the Social Security 

Administration ("SSA") an application for disability benefits, in which he alleged an 

"inability to function and/or work" as a result of the following impairments: "trigeminal 

neuralgia; chronic migraine headaches; severe facial pain; poor sleep; [and] difficulty 

talking due to trigeminal neuralgia." (AR 790.) On February 26, 2017, the SSA granted 

Elliott's application, finding he was disabled (AR 837), based on its determination that he 

was "[u]nable to sustain work due to pain from trigeminal neuralgia" and his medication's 

 

4Although that decision and the other decisions referenced herein were made in 

written letters issued on the letterhead of Cigna Group Insurance (see, e.g., AR 210, 

314), Elliott has named only LINA as a defendant, both parties, in their respective 

motions, refer to LINA as the entity that made the decisions here at issue, and LINA, in its 

answer, states it was the entity that "administered" Elliott's claim (see Answer ¶ 10). 

Accordingly, for purposes of the instant motions, the Court considers LINA the plan 

administrator.

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"side effects of sedation and cognitive slowing" (AR 796).

On March 23, 2017, the Court approved the parties' stipulation to stay the instant 

action to afford LINA, in light of the SSA's decision, the opportunity to conduct further 

administrative proceedings. Thereafter, Elliott, in addition to submitting to LINA the 

SSA's decision and documents the SSA had considered in making its determination, 

provided LINA with his updated medical records and other evidence. (See Joint Status 

Report, filed June 21, 2017, at 2:10-13; AR 181, 195, 390, 835.) On July 6, 2017, LINA 

advised Elliott that its prior denial of his claim for LTD benefits was "unchanged" (AR 

196), and, on April 10, 2018, upon reconsideration, upheld its decision not to reconsider 

said denial (AR 181).

On May 29, 2018, the Court, upon joint request of the parties, lifted the stay, and 

the parties subsequently filed the instant motions for judgment.

LEGAL STANDARD

Under ERISA, a plan participant may bring a civil action "to recover benefits due to 

him under the terms of his plan," see 29 U.S.C. § 1132(a)(1)(B), in which action the 

plaintiff has the burden to establish his entitlement to benefits, see Muniz v. Amec 

Construction Management, Inc., 623 F.3d 1290, 1294 (9th Cir. 2010).

Where, as here, a court's review of a decision to deny benefits is de novo,5

disputes of fact are "resolved by trial." See Kearney v. Standard Ins. Co., 175 F.3d 1084, 

1094 (9th Cir.), cert. denied, 528 U.S. 964 (1999). "Although Rule 43(a) requires that 

'testimony' be taken in open court, the record [in an ERISA case] should be regarded as 

being in the nature of exhibits, which are routinely a basis for findings of fact even though 

no one reads them out loud." Id. Specifically, the district court tries the case "on the 

record that the administrator had before it." Id. at 1095. "In a trial on the record, ... the 

judge can evaluate the persuasiveness of conflicting [evidence] and decide which is more 

 

5On July 5, 2016, the Court approved the parties' stipulation that the appropriate 

standard of review is de novo.

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likely true." Id. In so doing, the district court "consider[s] anew both the legal and factual 

aspects of [the plaintiff's] claim." See Thomas v. Oregon Fruit Products Co., 228 F.3d 

991, 995 (9th Cir. 2000). In other words, the district court "does not give deference to the 

claim administrator's decision, but rather determines in the first instance if the claimant 

has adequately established that he or she is disabled under the terms of the plan." See

Muniz, 623 F.3d at 1295-96.

DISCUSSION

In his motion for judgment, Elliott states he seeks an order "overturn[ing] [LINA's] 

denial of his short term disability, long term disability, and life insurance waiver of 

premium benefit claims." (See Pl.'s Mot., first unnumbered page at line 21.) As LINA 

points out, however, Elliott's complaint only seeks relief with respect to the denial of 

benefits under the LTD policy and, further, that Elliott has not alleged he exhausted his 

administrative remedies as to any claim other than the claim for LTD benefits. See

Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir. 2008) 

(holding "an ERISA plaintiff claiming a denial of benefits must avail himself or herself of a 

plan's own internal review procedures before bringing suit in federal court") (internal 

quotation and citation omitted).6 Consequently, any challenge to the termination of 

Elliott's claim for short-term disability benefits, as well as any challenge to any decision by 

LINA regarding life insurance premiums,

7

is not properly before the Court and will not be 

further addressed herein.

//

 

6Moreover, in the "Facts" section of the parties' Joint Case Management 

Statement, filed June 9, 2016, the only claim discussed is Elliott's claim for LTD benefits. 

(See Joint Case Management Statement at 2:9-15.)

7

In his reply, Elliott asserts that, in the event the Court were to find he is entitled to 

LTD benefits, he would be entitled to "ancillary benefits such as the Life Insurance 

Waiver of Premium benefit." (See Pl.'s Reply at 1:23.) Elliott, however, has not cited any 

provision in the Group Policy, or in any other document in the administrative record, 

addressing the circumstances under which a plan participant may be entitled to any such 

ancillary benefit.

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The Court next turns to the issue before it, i.e., whether Elliott is entitled to LTD 

benefits and/or an order remanding his claim for such benefits to LINA for further

consideration.

The Group Policy, i.e., the policy that sets forth the circumstances under which a 

plan participant is entitled to LTD benefits, defines "Disability/Disabled" as follows:

The Employee is considered Disabled if, solely because of Injury or 

Sickness, he or she is:

1. unable to perform the material duties of his or her Regular Occupation;

 and

2. unable to earn 80% or more of his or her Indexed Earnings from

 working in his or her Regular Occupation.

After Disability Benefits have been payable for 24 months, the Employee is 

considered Disabled if, solely due to Injury or Sickness, he or she is:

1. unable to perform the material duties of any occupation for which he or

 she is, or may reasonably become, qualified based on education,

 training or experience; and

2. unable to earn 80% or more of his or her Indexed Earnings.

(AR 1011.)

The Group Policy further provides that, to be entitled to LTD benefits, the 

"Employee must satisfy the Elimination Period" of "180 days," which "is the period of time 

an Employee must be continuously Disabled before Disability Benefits are payable." (AR 

1011, 1016.)

Here, because the date as of which Elliott assertedly could no longer work is

September 6, 2014, the Elimination Period ended March 4, 2015. (AR 210.) 

Consequently, to be entitled to LTD benefits, Elliott bears the burden to show he has 

been continuously disabled, from September 6, 2014, through whatever date beyond 

March 4, 2015, he claims such benefits are owed.

The Court next turns to whether Elliott has made such a showing and, at the 

outset, whether he has an "Injury or Sickness." (AR 1011.)

As noted, Elliott states he ceased working for BTIG as a result of pain that his 

treating physician attributed to a condition known as trigeminal neuralgia. LINA contends 

the record lacks objective indicia to support a diagnosis of trigeminal neuralgia. 

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According to the National Institute of Health ("NIH"), trigeminal neuralgia "is a 

chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most 

widely distributed nerves in the head," see Johnson v. Life Insurance Company, 2017 WL 

4180328, at *11 (D. Colo. September 21, 2017) (citing NIH "Trigeminal Neuralgia Fact 

Sheet"), and "causes extreme, sporadic sudden burning or shock-like facial pain that 

lasts from a few seconds to two minutes per episode," see Karns v. Colvin, 2017 WL 

119585, at *3 (D. Kan. January 12, 2017) (citing NIH Trigeminal Neuralgia Fact Sheet). 

Similarly, Stanford Health Care, on its website, states trigeminal neuralgia "is 

characterized by sudden attacks of severe, shooting pain in the face" that "typically lasts 

anywhere from a few seconds to a few minutes." See https://stanfordhealthcare.org/ 

medical-conditions/brain-and-nerves/trigeminal-neuralgia.html.

8

Elliott's last day of work with BTIG was September 5, 2014, a Friday. The 

following Tuesday, September 9, 2014, Elliott was seen by Aimee C. Chagnon, M.D. ("Dr. 

Chagnon"), a board-certified neurologist, at which appointment Elliott reported he had 

missed two days of work, i.e., Monday, September 8 and Tuesday, September 9, due to 

pain he described as a "sharp jabbing pain in the right temple." (AR 559.) On 

September 23, 2014, during a subsequent appointment, Elliott reported to Dr. Chagnon 

that he remained unable to work "due to the pain," as well as that he felt "too dizzy and 

sedated and confused" due to his taking oxcarbazepine and tizanidine, two medications 

Dr. Chagnon had prescribed at the prior appointment. (AR 434.) In October 2014, Elliott 

reported to Dr. Chagnon that he had begun to experience pain in his left temple and that 

he continued to have the same side effects from his medications. (AR 430.) In 

November 2014, Elliott reported to a dental specialist, to whom he had been referred by 

 

8

In their respective briefs, the parties have cited specific webpages found on the 

websites of several medical providers, such as Stanford Health Care and the Mayfield 

Clinic. The Court understands such citations to set forth what the parties believe are 

generally known facts about trigeminal neuralgia. As neither party has objected to the 

other party's citations of this nature, the Court has considered the parties' respective 

citations.

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Dr. Chagnon, that, on a daily basis, he experienced facial pain (AR 598), that his chief 

complaint was "sharp shooting pain in [his] face and head region" (AR 606), and that the 

pain was "debilitating." (AR 606). Thereafter in December 2014, as well as throughout 

2015 and 2016, Elliott reported to Dr. Chagnon, as well as to other medical providers, 

that he experienced ongoing and at times worsening facial pain, as well as a continuance 

of serious side effects from prescribed medications. (See, e.g., AR 423 (reporting in 

March 2015 that "his facial pain has continued to worsen" and "[t]he right and left 

temporal pain is essentially equal"); AR 413 (reporting in July 2015 "explosions of 

electrical pain in the right side of the mouth"); AR 636 (reporting in October 2015 he 

experienced "some psychosis" as a result of taking Tegretol); AR 532 (reporting in April 

2016 he was experiencing "significant sedation and cognitive slowing with most of the 

medications being used for the pain"); AR 715 (reporting in October 2016 he "has had an 

increase in his facial pain"); see also AR 416, 420, 427, 528-531, 534, 646-648, 719).

In early December 2014, Dr. Chagnon diagnosed Elliott with trigeminal neuralgia 

(AR 428-49), having ruled out a considerable number of other possible causes for Elliott's 

pain.

9

 That diagnosis was later supported by Jaimie M. Henderson, M.D. ("Dr. 

Henderson"), a neurological surgeon with Stanford Health Care, who, after having 

evaluated Elliott in October 2015, found Elliott's symptoms to be "consistent" with 

trigeminal neuralgia, noting Elliott had "some classical elements" of such impairment (see

AR 635, 638). Additionally, H. Pham, M.D., who, in January 2017, reviewed Elliott's 

application for SSA benefits, agreed that Elliott had trigeminal neuralgia, "given 

supporting ME [medical evidence] from this [claimant's] records." (AR 796-797.)

//

 

9Possible causes for the pain that were ruled out were a "musculoskeletal/ 

craniofacial" impairment (AR 428), "temporal arteritis, infection, or autoimmune disease" 

(AR 1055), Lyme disease (AR 1056), "demyelination" (AR 411), a "mass lesion or 

vascular lesion" (id.), and "degenerative changes" to the "C spine" (AR 422). Also ruled 

out was the possibility that the pain was a side effect of dental work Elliott had undergone 

shortly before he began experiencing the pain. (AR 561, 1056.)

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In support of its argument as to the asserted insufficiency of such evidence, LINA 

points to Dr. Chagnon's report that the results of a magnetic resonance angiography

("MRA") "failed to show any vascular loop" (AR 413); in addition, LINA relies on the 

reports of physicians who reviewed the file for LINA and opined there was an absence of 

objective evidence showing a cause for Elliott's pain. (AR 342-51 (report by Stephen M. 

Selkirk, M.D.) at 347 (stating "there is no clinical data to support the presence of a 

neurological impairment"; noting "MR imaging of his brain and cervical spine . . . failed to 

identify [any] significant underlying pathology"); AR 917-27 (report by David Burke, M.D.) 

at 926 (stating "numerous tests failed to identify a tangible cause" for Elliott's pain 

symptoms); AR 84-87 (report by Richard Hall, M.D.) at 85 (stating record is "devoid of 

any documented, significant, quantified, positive, neuromuscular or clinical finding"); AR 

1044-51 (report by David Ross, M.D.) at 1050-51 (stating there "were no abnormalities or 

findings on clinical examination").)

LINA fails, however, to explain the relevance of any such lack of objective 

evidence. First, as a contractual matter, the LTD defines "Sickness" as "[a]ny physical or 

mental illness" (AR 1027); it includes no requirement limiting the scope of covered 

conditions to illnesses that can be documented objectively. Further, as a medical matter, 

although trigeminal neuralgia "can sometimes be traced to a physiological abnormality 

such as a blood vessel compressing the trigeminal nerve," it is "frequently a diagnosis of 

exclusion after various other potential causes of facial pain are ruled out." See Johnson, 

2017 WL 4180328, at *11 (citing NIH Trigeminal Neuralgia Fact Sheet).10 Here, as set 

forth above, the diagnosis of trigeminal neuralgia was not made in the first instance, but, 

rather, after numerous other potential causes were ruled out. Moreover, contrary to 

LINA's argument that Elliott's "doctors were conflicted" as to whether a diagnosis of 

trigeminal neuralgia was proper (see Def.'s Cross-Mot. at 15:17-18), there is nothing in 

 

10The Trigeminal Neuralgia Fact Sheet on the NIH's website was cited by Elliott

and, as noted, no objection thereto has been made by LINA. 

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the record indicating any physician who examined or consulted with Elliott disagreed with 

Dr. Chagnon's diagnosis of trigeminal neuralgia.

Accordingly, the Court finds Elliott has a "Sickness," specifically, trigeminal 

neuralgia, a condition that, as set forth above, can cause acute pain.

The Court next considers whether, as a result of trigeminal neuralgia, Elliott has 

been unable to perform the material duties of his "Regular Occupation" (AR 1011)

beginning September 6, 2014, and through a date beyond March 4, 2015.

Elliott's position as a Vice President for BTIG "required a merging of both the 

financial and IT worlds, as he managed developers who tested and built software to 

process large financial transactions for his employer." (AR 1074.) Specifically, Elliott 

was the "Lead/Project Manager" of eight "software developers who created software for 

various internal business units [of BTIG]." (AR 487.) There is no dispute that the position 

"required prolonged periods of focused attention" (id.) and was "very cognitively 

demanding and involved high levels of stress" (AR 1074).

Elliott's treating physician, the State of California, and the SSA each concluded 

Elliott is unable to perform the duties associated with his prior position. Dr. Chagnon, the 

treating physician, has opined that Elliott has been unable to return to his work beginning 

in September 2014 through at least March 2018, the date of the most recent report 

included in the administrative record, basing her opinion on, inter alia, her observations of 

Elliott and, as set forth in more detail above, Elliott's descriptions of the frequency and 

nature of his pain, as well as the types of side effects he experienced from his taking 

prescribed medications. (AR 362, 428, 430, 531, 533-534, 1105.) The State of 

California, based on Elliott's medical records, found Elliott was entitled to disability 

benefits beginning in September 2014, and that he was "unable to perform his . . . regular 

or customary work" due to a "physical or mental condition," see Cal. Unemp. Ins. Code

§ 2626(a), through September 25, 2015, the date on which his state benefits were 

"exhausted." (AR 400-401, 403-404.) The SAA found Elliott has been unable to work as 

of September 2014 (AR 837), and, in particular, that he is unable to perform his "past 

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relevant work" as a "Vice President" (AR 797);11 its record included Elliott's medical 

reports and Elliott's statements that he has experienced "random frequent bouts of 

intense pain" that "causes [him] to not be able to complete common tasks like sitting, 

standing or bending" (AR 499) and that eight medications he takes cause "side effects" of 

"sedation," "mental confusion," and/or "nausea" (AR 506).

Although, for purposes of ERISA, the opinion of a treating physician "gets no 

special weight," see Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 

869, 879 (9th Cir. 2003), and findings by government agencies that a claimant is disabled 

"do not bind plan administrators," see Salomaa v. Honda Long Term Disability Plan, 642 

F.3d 666, 679 (9th Cir. 2011), such opinions and findings nonetheless constitute 

evidence that the claimant is unable to work, see id. at 676, 679.

Dr. Chagnon's opinion is, as are the findings made by the State of California and

the SSA, based in large part on each such individual or entity's accepting as credible 

Elliott's statements describing the frequency and intensity of the attacks of pain in his 

face as well as the side effects, such as sedation and mental confusion, from prescribed 

medications.

12 LINA argues Elliott is not credible, and, consequently, that Dr. Chagnon's 

opinion and the government agencies' findings do not support Elliott's claim. Accordingly, 

the Court next considers the question of Elliott's credibility.

As noted, Dr. Chagnon, Elliott's treating physician who has had the opportunity to 

work with and observe Elliott for several years, has found him credible. A court may 

"take cognizance of the fact (if it is a fact in a particular case) that a given treating 

physician has a greater opportunity to know and observe the patient than a physician 

retained by the plan administrator." See Jebian v. Hewlett-Packard Co. Emp. Benefits 

 

11The SSA's disability determination, issued February 26, 2017, is subject to 

review in "5 to 7 years." (AR 837, 840.)

12Where a claimant credibly reports he is experiencing side effects from 

medications taken in an effort to alleviate pain, the side effects are considered in 

determining whether the claimant is disabled. See Demer v. IBM Corp. LTD Plan, 835 

F.3d 893, 904-906 (9th Cir. 2016).

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Org. Income Protection Plan, 349 F.3d 1098, 1109 n.8 (9th Cir. 2003) (internal quotation

and citation omitted). Here, the Court takes cognizance of such fact, as Dr. Chagnon has 

set forth her observations and findings in a series of detailed notes, written over a period 

of several years in which she has provided medical care to Elliott, whereas none of the 

physicians retained by LINA examined Elliott, although, under the terms of the Group 

Policy, they could have done so. (AR 1022 (providing LINA has "the right to examine any 

person for whom a claim is pending as often as it may reasonably require").)

Additionally, the type and frequency of pain Elliott has described is consistent with 

the medical literature's descriptions of symptoms usually experienced by persons who 

have trigeminal neuralgia. See, e.g., Karns, 2017 WL 119585, at *3 (citing statement, in 

NIH Trigeminal Neuralgia Fact Sheet, that trigeminal neuralgia "causes extreme, sporadic 

sudden burning or shock-like facial pain that lasts from a few seconds to two minutes per 

episode"). Also, to the extent the administrative record includes documents setting forth 

known side effects of medications Elliott has taken, his reported side effects are 

consistent therewith. (See, e.g., AR 1161 (Drugs.com webpage stating "more common" 

side effects of baclofen include "confusion" and "drowsiness"); AR 1247 (Drugs.com 

webpage stating "more common" side effects of Vimpat include "sleepiness or unusual 

drowsiness").)

Further, Elliott's history of consistent employment beginning in 1999, while he was 

in college (AR 439, 486),

13 and continuing thereafter despite, at some point prior to March 

2012, the onset of "chronic headaches" (AR 563), as well as during what appears to have 

been an approximately two-week period following the onset of "severe facial pain"

symptomatic of trigeminal neuralgia (AR 333), supports a finding that his cessation of 

work after September 5, 2014, was due to an inability to perform his duties for BTIG 

rather than to a lack of motivation. See Schaal v. Apfel, 134 F.3d 496, 502 (2nd Cir. 

 

13The record does not include evidence pertaining to his work history prior to 

college.

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1998) (observing "a good work history may be deemed probative of credibility"); see also

Pearsall v. Massanari, 274 F.3d 1211, 1218 (8th Cir. 2001) (noting “lack of work history 

may indicate a lack of motivation rather than a lack of ability”).

Moreover, although, as noted, LINA now argues Elliott is not credible, LINA itself 

found Elliott was disabled, for purposes of its policy governing STD disability benefits, 

beginning September 6, 2014 through December 17, 2014 (AR 271, 314), even though 

such finding was dependent on Elliott's credibility, and neither in its decision terminating 

STD benefits nor in its papers filed in support of its cross-motion has LINA pointed to any 

evidence indicating Elliott's condition has improved. See Montour v. Hartford Life & Acc. 

Ins. Co., 588 F.3d 623, 635 (9th Cir. 2009) (discussing lack of improvement as factor 

bearing on disability assessment).

LINA does point out that, when provided with a surgical option in 2015, Elliott 

declined it, which declination, LINA asserts, supports a finding he is not experiencing pain 

of the magnitude he indicates.

14 The surgical option, offered by Dr. Henderson at 

Stanford Hospital, is microvascular decompression (AR 637-638), a form of "brain 

surgery," see https://mayfieldclinic.com/pe-mvd.htm, which procedure, according to Dr. 

Henderson, would require a hospital stay of "3-4" days and would have a "chance of long 

term relief . . . somewhere in the 60% range." (AR 638.)15 Given the invasive nature of 

the procedure, see https://www.ninds.nih.gov/Disorders/ Patient-Caregiver-Education/

Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet (referring to microvascular decompression 

 

14Although LINA also asserts Elliott "did not follow through on his referral to the 

trigeminal neuralgia clinic" (see Def.'s Cross-Mot. at 1:23), LINA offers no support for 

such assertion and the record is to the contrary. In particular, the record indicates Dr. 

Chagnon referred Elliott to the UCSF Trigeminal Neuralgia Clinic (AR 429), that Dr. 

Chen, a neurosurgeon at said Clinic, advised Dr. Chagnon "he felt it was useless for Mr. 

Elliott to be seen there" (AR 423), that Dr. Chen believed "the most appropriate person 

for Mr. Elliott to see" was Charles McNeill, D.D.S. ("Dr. McNeill"), the Director of UCSF's 

Center for Orofacial Pain (AR 423, 648), and that Elliott then did consult with Dr. McNeill 

(AR 646-648).

15Dr. Henderson did state that, where there is "radiographic evidence" of 

compression, the chance of long-term relief would be 80%. (Id.) Such evidence was not, 

however, observed in Elliott's case.

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as the "most invasive of all surgeries" for trigeminal neuralgia), which involves drilling a 

hole in the occipital bone, removing the bone, exposing the brain, and, after the 

procedure is complete, replacing the hole with a titanium plate, see https://mayfieldclinic.

com/pe-mvd.htm, coupled with possible side effects, which range from the more 

"common" effects of "decreased hearing" and "dizziness/nausea" to the less common 

effects of "coma" or "death" (AR 638), the Court declines to find Elliott's decision not to 

undergo such brain surgery is indicative of a lack of credibility.

In light of the circumstances described above, the Court finds Elliott's statements 

as to the frequency and intensity of the attacks of pain in his face and side effects from

his medications are credible.

As noted, Elliott's position as a Vice President was "very cognitively demanding" 

and "required prolonged periods of focused attention." (AR 487, 1074.) For the reasons 

set forth above, the Court finds Elliott has shown he was unable to perform the material 

duties of his Regular Occupation, beginning September 6, 2014, through the 24-month

period beginning March 5, 2015, and, accordingly, is entitled to LTD benefits 

corresponding to said period.

16

The Court next addresses Elliott's claim for LTD benefits under the "any 

occupation" provision. (AR 1011.) As noted, Elliott, in his complaint, seeks either an 

award of such benefits or, alternatively, an order remanding the matter to the plan 

administrator for further proceedings.

Where, as here, a court has found a plan administrator erred in determining that a 

claimant is unable to perform his regular occupation, district courts commonly have found 

it appropriate to remand the matter to the plan administrator to determine whether the 

claimant is entitled to benefits under an "any occupation" provision. See Lavino v. 

Metropolitan Life Ins. Co., 2010 WL 234817, at *13 (C.D. Cal. January 13, 2010) (holding,

 

16LINA does not dispute that, in the event Elliott was unable to perform the material 

duties of his Regular Occupation, he was also unable to "earn 80% or more of his 

Indexed Earnings from working in his . . . Regular Occupation." (AR 1011.)

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where plan administrator erroneously terminates LTD benefits under "own occupation" 

provision, "[r]emand is proper" for determination of whether claimant satisfies "anyoccupation standard" in plan); Minton v. Deloitte & Touche USA LLP Plan, 631 F. Supp. 

2d 1213, 1221 (N.D. Cal. 2009) (holding, where plan administrator erroneously finds

claimant ineligible for LTD benefits under "own occupation" provision, claimant's claim for 

benefits under "any occupation" provision is properly remanded to plan administrator for 

consideration).

Similarly, in this instance, the Court finds it appropriate to remand the matter to 

LINA for a determination of whether Elliott can demonstrate he is entitled to LTD benefits 

under the "any occupation" provision of the Group Policy, particularly given the absence 

of any significant evidence from a medical provider for the period following the expiration 

of the Regular Occupation period.17

Lastly, the Court addresses Elliott's claim, made in his complaint and reiterated in 

his motion for judgment, that he is entitled to an award of prejudgment interest. In his 

motion, Elliott does not set forth any argument as to why he is entitled to such award; 

rather, Elliott requests he be allowed to address the matter in a motion for fees and costs

he intends to file. As LINA does not object to Elliott's request to defer briefing on said 

issue, the Court makes no determination at this time as to Elliott's entitlement, if any, to 

prejudgment interest.

//

//

//

//

 

17The only evidence presently in the administrative record from a medical provider 

and addressing said period is a letter to LINA from Dr. Chagnon, dated March 22, 2018, 

in which she reports she has "followed" Elliott "through the present." (AR 360.) The 

balance of the letter responds to comments made by one of LINA's record reviewers and 

does not indicate any particular observations made after March 5, 2017, or treatments 

rendered after said date, other than to note that Elliott is "still on modafinil." (AR 363.)

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CONCLUSION

For the reasons stated above:

1. Elliott's motion for judgment is hereby GRANTED, and the matter is 

REMANDED to LINA to (a) determine the amount of LTD benefits to which Elliott is 

entitled under the "Regular Occupation" provision for the 24-month period beginning 

March 5, 2015, and (b) consider whether Elliott is entitled to benefits under the "any 

occupation" provision.

2. LINA's cross-motion for judgment is hereby DENIED.

IT IS SO ORDERED.

Dated: July 9, 2019

MAXINE M. CHESNEY

United States District Judge

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