IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF TEXAS

SAN ANTONIO DIVISION

DOUGLAS MANN,

Plaintiff

VS.

LIFE INSURANCE COMPANY OF 

NORTH AMERICA,

Defendant.

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§ Civil Action No._____________

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ORIGINAL COMPLAINT

Douglas Mann (“Plaintiff” or “Mann”) files this Complaint against Life Insurance 

Company of North America (“LINA”).

I.

PARTIES

1. Plaintiff, Douglas Mann, is an individual and resident of Wilson County, Texas.

2. LINA is an insurance company licensed to do business in Texas and is incorporated 

under the laws of the State of Pennsylvania with its principal place of business in Philadelphia, 

Pennsylvania. LINA can be served with citation by serving its Attorney for Service, C T 

Corporation System, by certified mail, return receipt requested, at 1999 Bryan St., Suite 900, 

Dallas, Texas 75201.

II.

JURISDICTION AND VENUE OF ERISA CLAIMS

3. This action against LINA arises under the Employee Retirement Income Security 

Act of 1974 (“ERISA” or the “Act”), 29 U.S.C. §1001 et. seq.

4. This Court has jurisdiction over the action pursuant to 29 U.S.C. § 1132(e)(1).

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5. Venue is proper in this district pursuant to 29 U.S.C. § 1132(e)(2) because the 

breach occurred in this district.

III. 

FACTUAL BACKGROUND

A. Mann Ceased Working and LINA Approved His Claim for STD Benefits. 

6. BBA Aviation Shared Services, Inc. (“BBA”) employed Mann as a Field Service 

Representative/Mechanical Technician, which LINA erroneously defined as a medium-duty

physical demand level occupation. Mann’s job description from BBA defined it as a heavy duty

physical demand level job due to (1) BBA’s lifting requirements outlined for the position—the 

ability to lift up to 70 pounds, (2) the requirement Mann walk, sit, drive, or stand for various 

periods of time, and (3) the ability to operate hoists, heavy parts, chemicals and fluids with the use 

of precision instruments, stringent housekeeping, and work area safety regulations and practices. 

In addition, the most analogous job description in the Dictionary of Occupational Titles (“DOT”) 

also defined the occupation as heavy duty. 

7. Mann began his employment at BBA on July 25, 2011. As a BBA employee, Mann 

was a participant in BBA’s health and welfare benefit plan (the “Plan”) that provided group shortand long-term disability (“LTD”) and group life insurance with life premium of waiver (“LWOP”) 

benefits to its employees. 

8. The Plan paid short-term disability benefits (“STD”) and LTD benefits to qualified 

BBA employees through a group disability policy issued by LINA (the “Disability Policy”) and 

life insurance benefits through a group life insurance policy also issued by LINA (the “Life 

Policy”).

9. While insured under the Disability and Life Policies, Mann experienced severe left 

leg and lower back pain and significant numbness and tingling in his extremities. The pain and 

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neuropathy significantly affected his ability to sleep and he began to suffer disabling symptoms 

caused by his various diagnoses, including lumbar post laminectomy syndrome, lumbosacral

radiculitis, idiopathic peripheral neuropathy, and lumbar spinal stenosis. Mann underwent surgery 

for a left lumbar laminectomy on November 12, 2015 and lumbar interbody fusion at the left side 

of L4-5 with pedicle screws on February 16, 2016.

10. As a result of his lumbar laminectomy, Mann was forced to cease working on 

November 11, 2015. Thereafter, he submitted a claim for STD benefits to LINA.

11. On December 11, 2015, LINA approved Mann’s claim for STD benefits effective 

November 19, 2015 because it concluded he could not perform the material duties of his own 

occupation. The amount of his STD benefit was $1,280.40 per week. After approving his claim, 

LINA constantly reinvestigated Mann’s eligibility for STD benefits, but based on Mann’s solid 

medical evidence, LINA was forced to pay Mann STD benefits for the entire eligibility period—

until May 8, 2016.

12. During the period LINA paid Mann his STD benefits, LINA regularly requested 

medical records from Mann’s physicians, including Dr. Machelle Williams, his family practitioner, 

and Dr. Guy Fogel, the orthopedic surgeon who performed Mann’s November 2015 and February 

2016 surgeries.

B. LINA Investigated Mann’s Eligibility for LTD Benefits and Reviewed His Medical 

Records. 

13. Before Mann’s STD benefits expired, Ashley Flood, a LINA claims representative,

spoke to Jamie Mann, Mann’s wife, and erroneously advised her LINA did not have any 

information to suggest Mann had enrolled or was eligible for LTD benefits. Flood promised 

Mann’s wife she would investigate whether Mann had been enrolled in LTD so that LINA could 

begin processing Mann’s LTD claim. Laura Ngyugen from BBA’s human resources department 

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called LINA regarding Mann’s enrollment in the LTD Plan. LINA advised Ngyugen Mann was 

not eligible for LTD benefits, but Ngyugen insisted he was and said she would send proof he

enrolled in the LTD Plan. The proof she sent expressly indicated Mann had been enrolled in the 

LTD portion of the Disability Plan since January 1, 2013. In other words, LINA’s first crack at 

attempting to avoid paying Mann’s benefits failed miserably.

14. In April 2016, shortly before Mann’s STD benefits were scheduled to end, LINA

requested that Dr. Fogel, Mann’s orthopedic surgeon, fill out a Medical Request Form, which he 

returned on May 6, 2016. In the form, Dr. Fogel indicated the factors preventing Mann from 

returning to work were post-operative recovery from surgery Mann underwent on February 18, 

2016, continued pain in his lower back and extremities, and his inability to recover from his 

November 2015 lumbar fusion surgery. Dr. Fogel opined that Mann was unable to perform any of 

his job functions and at home he could not lift greater than 10 pounds and he could never bend, 

twist, bend at waist, or climb stairs. 

15. Nyugen, a human resources representative for BBA, contacted LINA by email on 

April 28, 2016 to implore LINA to expedite its decision regarding Mann’s eligibility for LTD 

benefits since his STD benefits had expired almost six weeks prior and Mann was experiencing a

lapse in coverage. Ashley McCoy, a group claims associate, responded she would ensure LINA

would move quickly to make a determination regarding his eligibility for LTD benefits. 

16. LINA subsequently began an investigation to determine if Mann was eligible for 

LTD benefits, but did not make an effort to render a decision quickly as McCoy promised. After 

reviewing Mann’s medical records, LINA finally approved his LTD claim on June 6, 2016—many 

months after Mann initially sought the benefits. As a result of the approval, LINA automatically 

investigated whether he was eligible for life waiver of premium (“LWOP”) benefits—the waiver 

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of the payment of his premiums while he was disabled—under his Life Policy. His LWOP benefits 

were approved on June 7, 2016. 

17. In order for a BBA employee to be eligible to participate in the LTD Plan, they

must meet the definition of “Disability/Disabled,” which means the “Employee is considered 

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

Definition of Disability/Disabled

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% of more of his or her Indexed Earnings from 

working in his 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 may reasonably become, qualified based on 

education, training, or experience; and

2. Unable to earn 60% or more of his or Indexed Earnings.”

18. To receive LWOP benefits under the Life Plan, “Disability/Disabled” means

“because of Injury or Sickness an Employee is unable to perform the material duties of his or her 

Regular Occupation, or is receiving disability benefits under the Employer’s plan during the initial 

9 months of Disability. Thereafter, the Employee must be unable to perform the material duties 

of any occupation which he or she may reasonably become qualified based on education, training, 

or experience, or is subject to the terms of a Rehabilitation Plan approved by the Insurance 

Company.”

19. Mann’s occupation required him to be responsive to field service activities on gas 

turbine powered aircraft, perform technical troubleshooting, solve problems, perform engine 

changes, and make engine repairs in the field. The essential functions of the occupation (1) were

to perform inspections, conduct airframe interface, perform ground operations, trouble-shoot, 

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implement the adjustment and repair of engines and related accessories; (2) conform results to the 

manufacturer’s approved modification specifications in engines and related accessories; (3) 

monitor tooling calibrations for any equipment used to perform designated tasks; (4) perform any 

appropriate inspection he was certified to perform following completion of engine repairs and 

modifications and the inspections of powerplants following their installation into the aircraft for 

release to service; and (5) make airworthiness determinations and provide suitable certification for 

the work performed, including the final inspection and release to service of any work accomplished 

within the repair station’s rating either at the repair station or at any other location. To qualify for 

the occupation, Mann had to have the following cognitive abilities: (1) the ability to express or 

exchange ideas verbally with peers and clients; (2) the ability to get along with co-workers; (3) 

have effective written and communication skills; (4) express or exchange ideas by means of spoken 

word to impart oral information to convey detailed spoken instructions to other workers, customers 

or agents, accurate, loudly or quickly; and (5) possess a valid driver’s license. The mandatory 

physical demands of Mann’s occupation included (1) active work in field locations, both in hangars 

and on ramps; (2) exerting up to 50-70 pounds of force occasionally to lift, carry, push, pull or 

otherwise move objects; (3) the ability to walk, sit, drive or stand for various periods of time; and 

(4) reach by extending hands and arms in any direction. and (4) express or exchange ideas by 

means of spoken word to impart oral information to convey detailed spoken instructions to other 

workers, customers or agents, accurate, loudly or quickly. Finally, the work environment for 

Mann’s occupation required that he travel between 70-90% of the time (usually by driving), the

ability to work in hangars, ramps and engine shop environments, including, handling hoists, heavy 

parts, chemicals and fluids with use of precision instruments, stringent housekeeping and work 

area safety regulations and practices to observe and maintain.

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20. After approving Mann’s claim for LTD benefits, LINA regularly reinvestigated 

whether Mann remained disabled pursuant to the definition of disability under his LTD policy.

21. On August 23, 2016—only 10 weeks after LINA approved Mann’s benefits—it 

referred Mann’s claim to Alletrice Gilliam, BNS, RN, to determine Mann’s functional capacity. 

22. In her August 24, 2016 report, Gilliam concluded Mann’s updated medical records 

supported restrictions and limitations preventing him from returning to work in his own 

occupation, mainly due to his severe pain and limited range of motion in his lumbar spine. 

C. LINA Misrepresents and Ignores the Content of Mann’s Medical Records.

23. Upon LINA’s approval of Mann’s STD benefits, LINA retained Allsup on Mann’s 

behalf to apply for Social Security Disability Insurance (“SSDI”). As part of his application, Mann 

underwent an internal medicine consultative examination with Dr. Yu-Jie “Jack” Kuo on 

December 6, 2016. Dr. Kuo observed Mann was only able to walk without assistance for about 

30 yards before he had to stop and lean on something, he could not lift or carry more than 8 pounds, 

he could only stand for 5 minutes, and he could only sit for 5 minutes without having to change 

positions—i.e., he could not perform a sedentary occupation.

1

24. In January 2017, Dr. Williams referred Mann for physical therapy at Momentum 

Physical Therapy. On January 17, 2017, Mann had an initial evaluation performed by physical 

therapist Kara Goode. Goode noted in her report that Mann complained of difficulty walking for 

more than minimum distances, engaging in prolonged sitting and standing, that he had experienced 

a loss of function, and experienced symptoms of numbness, pain, stiffness, tingling and weakness. 

He described his own occupation as an aircraft mechanic, a job that required him to frequently 

1 The DOT provides a definition of a sedentary occupation, which requires exerting up to 10 pounds occasionally

(up to 1/3 of a workday) and a negligible amount frequently (from 1/3 to 2/3 of a workday, sitting most of the time 

during the workday, and walking and standing for brief periods of time. 

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travel by car and airplane to trouble-shoot and repair different aircraft throughout the United States, 

Canada, and Mexico. To perform his occupation, he had to lift greater than 75 pounds or greater 

occasionally, move and handle tools, operate heavy equipment, bend, stoop, maneuver in varied 

positions to work on all areas of an airplane or parts, drive a forklift, climb ladders, climb on top 

of airplanes, and travel by car and airplane at least 70% of the time. 

25. Upon examination, Goode noted Mann’s pain was aggravated with upright sitting, 

stationary standing, and forward bending and that his pain was only relieved when he reclined or 

laid flat. She provided the following functional impairments for Mann: he was unable to bend, he 

could lift objects with a maximum weight of 10 pounds, he could sit and stand for only 15 minutes 

at a time, and he could walk in the grocery store for a maximum of 20 minutes as long as he leaned 

on the shopping cart. Goode stated that Mann’s lumbar spine was hypermobile at L3-L4 and

hypermobile and painful at L4-L5 and L5-S1. Further, she stated Mann had limited range of 

motion, decreased hip and lower extremity flexibility, decreased strength in his core and hip/lower

extremity musculature, and decreased functional endurance. Finally, she noted that Mann greatly 

desired to return to work, but he was absolutely unable to perform the requirements of his 

occupation.

26. On the same date as her initial evaluation of Mann, Goode completed a form 

entitled “Medical Opinion Re: Ability to Do Physical Activities,” in which she noted Mann had 

participated in physical therapy on and off since 2015, he suffered from severe low back pain, and 

his prognosis was poor due to chronic pain. She also noted Mann could only walk 4 blocks without 

rest, he could only continuously stand or sit for 15 minutes at a time, he could only sit for a total 

of less than 2 hours of an 8-hour workday, and he could only stand for 2 hours total during an 8-

hour workday. She further stated Mann needed a job that would allow him to change positions 

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from sitting, standing and walking at will and he would allow him to take unscheduled breaks 

throughout an 8-hour workday, which Goode estimated would occur every 30-45 minutes. She

stressed that Mann had “good days” and “bad days” and if he returned to work he would likely be 

absent at least several times a month.

27. Goode performed another evaluation of Mann on February 8, 2017 after he had 

undergone surgery for a transforaminal lumbar interbody fusion (“TLIF”) with Dr. Fogel. Mann 

complained of continued pain after the surgery, including pain shooting down his left lower 

extremity to his feet and toes, as well as numbness and tingling at the top of his left foot, pain in 

his lumbar spine and lower back that radiated into his left hip and sometimes on his right hip. 

Although Mann previously experienced improvement in mobility and ease of walking due to 

physical therapy he engaged in in the past, Dr. Williams referred him for physical therapy again 

to address his pain, stiffness, and loss of function. In describing Mann’s functional activity, Goode

opined Mann could only sit for 45 minutes continuously, he could not bend and he could only lift 

or carry light objects, he had insomnia, and he could not drive. Goode observed that Mann’s 

posture consisted of stiffened/guarded movements and protective posturing while changing 

positions and his gait showed decreased pelvic rotation and general stiffened body with mobility 

or ambulation. Upon testing Mann’s active range of motion in his lumbar spine, she noted he had 

active range of motion of 40 percent in flexion, 10 percent in extension, 50 percent in side bending

to the left and 3/5 gross strength in all those areas. Upon testing Mann’s muscle strength in his 

right abdominals, lower abdominals and paraspinals, she noted he had 3/5 strength and in his right 

gluteus medius he had 4/5 strength. On his left side he had no muscle strength in his abdominals 

and lower abs, 3/5 strength in his paraspinals and 4/5 strength in his iliopsoas, gluteus medius, and 

gluteus maximus. Goode also tested his joint mobility, which was firm at L1, L2, and his sacroiliac

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joint was hypermobile at L4 and L5, all of which showed an increase in his stiffness since Goode 

last evaluated him. Goode recommended that Mann set a goal to be able to increase his sustained 

sitting tolerance to one hour to improve his ability to possibility return to some type of work in the 

future and to be able to tolerate sustained standing for 30 minutes to improve tolerance to upright 

activities in his home. She stressed these goals were “long term.”

28. In February 2017, as part of its continuing investigation as to whether Mann was 

disabled, LINA asked Dr. Williams to produce medical records and to complete a Physical Ability 

Assessment form. In her form dated February 1, 2017, she indicated Mann could only sit, stand, 

and walk for less than an hour a day, he could only reach overhead, to desk level, or below his 

waist for only 2 hours a day, and he could only lift, push, or pull objects weighing 10 pounds for 

less than an hour a day.

29. Dr. Williams submitted medical records to LINA revealing the results of Mann’s

office visits. During Mann’s appointment with Dr. Williams on April 4, 2017, he reported he 

needed a referral to a spinal surgeon because his February 2016 TLIF surgery on his lumbar spine 

had been unsuccessful and he was in constant pain which was only treating with pain management, 

which included taking Tramadol, Oxycodone, and Gabapentin—all of which caused him cognitive 

deficits and prevented him from driving. Mann also told her it was difficult for him to do almost 

anything other than normal activities of daily living due to pain and left leg weakness, which made 

walking difficult and painful. He also told Dr. Williams his pain was at its worst with prolonged 

sitting and standing and he only got relief from being in a supine position. He further told her his 

pain was the worse on his left side, which he described as a constant burning ache with weakness 

in his leg. 

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30. During a June 13, 2017 office visit with Dr. Williams, Mann complained walking 

even short distances was painful and he was not able to sit for more than brief periods without 

having to stand up. He also reported that his pain medication prevented him from driving and 

affected his ability to concentrate. Upon examination, Dr. Williams noted he had weakness in his 

left leg, chronic pain in his lumbar spine, parathesias to his anterior left lower extremities, and 

sedation and difficulty concentrating due to his pain medication. 

31. In a January 9, 2018 office visit with Dr. Williams, Mann reported he still had 

debilitating pain and had scheduled an appointment with a surgeon to see if there were any other 

surgical options available to him to ameliorate his chronic back pain. He also advised her he 

continued to have days when he could not get out of bed or had to use a cane to walk. Upon 

examination, Dr. Williams reported Mann had decreased range of motion in rotation and forward 

bending, 2/5 muscle strength in his left lower extremities, and a gait with a limp.

32. LINA also requested Dr. Fogel’s medical records for Mann, which ranged in date 

from October 28, 2015 to August 21, 2018. In his office visit note from October 28, 2015, Dr. 

Fogel listed Mann’s diagnoses of displacement of intervertebral disc without myelopathy, spinal 

stenosis of lumbar region at left L4-L5, and lumbosacral radiculitis at left L4-L5. Upon physical 

examination, Dr. Fogel noted Mann had ankle dorsiflexion tibialis anterior 4/5, great toe extension 

extensor hallucis longus 4/5, no reflex in his left ankle, and decreased sensation on the lateral leg

and dorsum of the foot. Dr. Fogel also reviewed the results of Mann’s recent lumbar MRI, which 

showed he had a L4-L5 disc herniation in the left foramen that likely compressed the L5 nerve 

roof in the lateral recess. Based on his examination, Dr. Fogel recommended Mann get a nerve 

root block of the L5 nerve root on the left. If that didn’t work, he recommended Mann undergo 

laminotomy surgery at L4-L5 to decompress the L4-L5 lateral recess stenosis on the left. 

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33. Pursuant to Dr. Fogle’s recommendation, Mann underwent a L4-5 laminotomy on 

November 12, 2015. During a follow-up visit, Mann reported he did pretty well for a while after 

the surgery, but then gradually the tingling and painful sensation and dysesthesias returned in his 

left leg. Mann expressed anxiety about whether he would ever be able to return to work. 

34. During a December 23, 2015 appointment with Dr. Fogle, Mann expressed he still 

had pain in his left extremities. Additionally, on January 16, 2016, Mann had another follow-up 

appointment with Dr. Mann and complained the surgery had not relieved his pain and sensory loss. 

Dr. Fogel opined Mann had some far lateral foraminal stenosis that might be impinging on the L4 

nerve root. 

35. Mann saw Dr. Fogel again on February 5, 2016. Dr. Fogel noted Mann’s symptoms 

were severe and Mann had lost his ability to perform most of his normal activities of daily living. 

Dr. Fogel recommended Mann undergo a TLIF to the left and discussed the possibility of also 

performing a laminotomy if he found residual sciatic pain from unrelieved stenosis. Dr. Fogel also 

recommended Mann have an EMG.

36. On February 18, 2016, while Mann was still receiving STD benefits, Dr. Fogel 

performed a post-laminectomy, L4-5 spondylolisthesis and stenosis operation on Mann. Dr. 

Fogel’s office visit notes after the surgery showed Mann had lumbar post-laminectomy syndrome 

at L4-5; idiopathic peripheral neuropathy with chronic L2-4 quadriceps weakness; displacement 

of lumbar intervertebral disc; spinal stenosis of his lumbar region at L4-5; transforaminal lumbar 

interbody fusion at L4-L5 on the left; and lumbar radiculitis and left EMG chronic L2-4 quadriceps

weakness. 

37. On March 24, 2016, Mann saw Dr. Fogel for a follow-up from his surgery. Dr. 

Fogle reviewed the results of Mann’s most recent lumbar CT scan and concluded there had been 

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a buildup of bone at the left side at L4-L5 that had caused some acute irritation of his L5 nerve 

root. Dr. Fogel stressed most of Mann’s symptoms were all in the L5 nerve root and caused him 

stinging, shocking pain into his leg and numbness in his foot—symptoms that had obviously 

worsened over time. Dr. Fogel recommended Mann have a further decompression of his 

laminotomy on the left at L4-5 and remove Mann’s left-sided screws because the fusion was 

complete and the screws could be connected to his current L5 radiculopathy. Dr. Fogle also 

discussed the possibility of expanding the laminectomy down along the course of the L5 nerve 

root which could give him some relief from his acute inflammation. 

38. On May 6, 2016, Dr. Fogel reviewed the EMG results with Mann, which showed 

he had chronic radiculopathy in his left thigh. Dr. Fogel recommended treating Mann’s continuing 

pain by using a spinal cord stimulator. Upon physical examination, Dr. Fogel noted Mann had a 

mild forward list, dyskinesis of his lumbar spine motion, increased pain with forward flexion of 

the back, and increased pain with hyperextension and AP thrust. Dr. Fogel also reported that 

Mann’s range of motion showed his forward flexion was limited to 60 degrees and extension was

15 degrees, lateral flexion was 15 degrees on the left and right, and deep tendon reflexes were 

diminished at his knee and ankle. 

39. On August 12, 2017, per LINA’s request, Dr. Fogel completed a PAA in which he 

indicated Mann was completely functionally impaired from performing his job due to his 

diagnoses of post laminectomy syndrome, acute low back pain, lumbar spinal stenosis, and lumbar 

radiculopathy. He stated his opinions were based on his regular physical examinations of Mann.

40. During an October 28, 2017 office visit with Dr. Fogel, Mann complained he was 

suffering from severe back pain and left buttock pain that was similar to his preoperative pain in 

November 2015. He reported he was trying to walk every day, but it caused him to become very 

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stiff and he walked with a marked limp due to pain. Dr. Fogel’s physical examination of Mann 

was virtually identical to his May 6, 2016 appointment. 

41. At his January 10, 2018 office visit, Dr. Fogel noticed that Mann moved very 

poorly, he still limped when he walked, and it was difficult for him to move from a sitting to 

standing position. Mann reported his pain and radiculopathy were getting worse and his pain 

radiated down his left leg to his foot, which Dr. Fogel thought might be a combination of his 

polyneuropathy as well as L5 radiculopathy. Dr. Fogel’s physical examination revealed symptoms 

similar to those he found in Mann’s last two appointments. 

D. LINA’S Unreasonable and Arbitrary and Capricious Handling of Mann’s Claim.

42. On June 3, 2016, LINA’s vocational department considered what occupation in the 

national economy was most analogous to Mann’s occupation at BBA using the DOT. LINA

concluded Mann’s occupation was similar to an Airframe and Power Plant Mechanic Field Service 

Representative. As with Mann’s own occupation, LINA’s vocational department considered the 

DOT position to be a medium physical demand level occupation, even though through the tasks 

listed for the position would have required Mann to sit, stand, walk, crawl, climb, stoop, crouch, 

reach, and kneel—all activities his treating physicians either opined he could never do or was 

significantly impaired in his ability to perform them. In addition, the DOT occupation was not 

similar to Mann’s own occupation for the following reasons: it did not require him to lift up to 70 

pounds occasionally, the ability to walk, sit, drive or stand for various periods of time required to 

work on equipment attached on or to be attached to aircraft and travel 70-90% of the time, either 

by driving or by airplane. The DOT position did not include these physical demands and it was a 

blatant error for LINA to deem the two occupations sufficiently analogous in considering Mann’s 

eligibility for benefits.

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41. In March 2017, LINA asked Mann to have his treating physical fill out another

PAA form for purposes of LINA’s investigation of his LTD benefits. In his March 20, 2017 PAA, 

Dr. Fogel indicated Mann could not lift anything heavier than 8 pounds and stressed Mann had no 

functional ability to return to work. 

42. In response to LINA’s request for a PPA, Dr. Williams faxed a letter to LINA in 

which she confirmed that Mann’s “specific limitations on his activity [were] provided on your 

provided form,” that he had “difficulty ambulating” because he could only walk less than 50 feet 

without an assistive device, “he [was] unable to sit in a comfortable exam chair for the duration of 

an office visit, which is 15 minutes,” and he was forced to change positions every 15 minutes and 

he could not stand for the rest of the visit without sitting again.

43. On March 8, 2017, Dr. Holger Skerhut, an orthopedic surgeon drafted a letter to 

Dr. Williams to advise her that a recent MRI of Mann’s lumbar spine showed the left facet was 

loose post-operatively and that his symptoms had not changed from his first pre-operative visit. 

He stated there was some calcification within the neuroforamina which happened post-operatively 

and that Mann’s symptoms had not changed much after his surgery and he suspected Mann 

received some sort of injury to his sensory ganglion during his later disc herniation. He also stated 

he was pessimistic that a foraminotomy would improve his condition and would likely threaten 

the damaged nerve further. 

44. On May 3, 2017, Courtney Willis, a claims examiner assigned to Mann’s LWOP 

claim, conducted a telephone interview with Mann who informed Willis that none of his medical 

providers had released him to work part or full-time. He advised Willis he had discussed the 

possibility of undergoing another surgery with Dr. Fogel in January 2018 due to his severe back 

pain and leg numbness. He also complained he suffered from brain fog, depression and side effects 

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due to his narcotic pain medication. Mann told Willis he had performed the same occupation for 

20 years and had an Associate’s Degree and a certificate from a technical school to work as an 

aircraft mechanical technician.

45. On that same day, LINA referred Mann’s LWOP and LTD claims to Perry Glaze, 

one of its rehabilitation specialists, to perform a transferable skills analysis (“TSA”) to determine 

if there were lighter duty jobs Mann could perform that met the LWOP and LTD wage 

requirement. Glaze could only identify one occupation that met these requirements—a material 

scheduler—a sedentary occupation. Glaze expressly stated he relied upon the restrictions and 

limitations Dr. Jacobson provided for Mann and did not consider the restrictions and limitations 

Mann’s own physicians had given him, review Mann’s medical records, or speak to Mann or his 

treating physicians. Glaze stated Mann’s restrictions and limitations precluded him from 

performing activities at a physical demand level greater than exerting up to 10 pounds of force 

occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise 

move objects and more than occasional waking or standing for brief periods of time. Glaze 

concluded Mann was able to perform the occupation of a material scheduler, a sedentary 

occupation, even though it would require Mann to sit for most of the day—a requirement that was 

contradicted by all of Mann’s medical providers’ conclusions that he could only sit for brief 

periods of time during a workday.

46. On May 11, 2017, LINA referred Mann’s claim to Helena Allen and Mandy White, 

RN for a file review. After reviewing Mann’s records, they concluded Mann’s medical records, 

particularly his doctors’ physical examination findings, supported that he was disabled under his 

Disability Policy. They recommended that LINA review Mann’s return to work status again in 

November 2017.

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47. On the other hand, LINA terminated Mann’s LWOP benefits on June 8, 2017—an 

obvious sign LINA intended to terminate Mann’s LTD benefits after the definition of disability 

changed under the Disability Policy. In its letter explaining the bases for its decision, it listed the 

following reasons: (1) Dr. Williams’ PPA form purportedly noted Mann could sit, stand, walk, lift 

and carry up to 10 pounds and push and pull for less than an hour, but it completely ignored the 

strict limitations Dr. Williams gave to Mann for sitting, standing, and walking; (2) in Dr. Fogel’s 

office visit note from February 1, 2017, despite Mann’s physical complaints and Dr. Fogel’s 

findings upon examination, LINA erroneously stated the “neurology exam did not document 

abnormal findings”; and (3) Dr. Fogel completed a PPA form and stated Mann could not handle 

any items exceeding 8 pounds and that he had no work function at the time.

48. LINA’s reasons for terminating Mann’s LWOP benefits obviously supported he 

was entitled to those benefits and did not provide a basis for terminating them, especially given 

the fact that Dr. Williams had concluded Mann could not sit for more than two hours a day—a 

restriction that precluded him from performing a sedentary occupation.

48. Mann appealed LINA’s decision to terminate his LWOP benefits and included 

letters from his wife, his son, his in-laws, and Dr. Williams, as well as updated medical records. 

On September 20, 2017, LINA acknowledged its receipt of Mann’s appeal. LINA informed Mann 

it was sending his file to its Disability Appeals Team for a supposed “independent” review. 

49. Dr. Williams stated in her letter that based on her physical examinations of Mann, 

he had difficulty ambulating for more than 50 feet, he was unable to sit in an exam chair for a 15-

minute office visit without having to stand up several times, and that the narcotic pain medication 

Mann was prescribed precluded him from driving and impaired his concentration and attention.

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50. In her September 11, 2017 letter, Mann’s wife wrote LINA a letter to explain her 

husband’s disabling condition and his inability to perform most of the activities he could perform 

prior to the development of his lower back pain and his first surgery. She stressed that Dr. 

Williams’ April 6, 2017 letter detailed Mann’s psychical limitations, including the inability to sit, 

stand, or walk for any significant length of time. She explained that Mann spent a minimum of 

one-third of his day in a supine position because he was unable to sit or stand for long periods 

without uncontrolled pain. Although he was capable of minimal light physical activities in short 

spurts, when he did so, he had to lie back down again due to pain. She also advised LINA that 

Mann frequently had days when he could not get out of bed at all. She also included records from 

HEB pharmacy listing the medications Mann’s doctors prescribed him. Many of those 

medications are known to cause side effects such as brain fog, difficulty concentrating, and an 

inability to drive due to drowsiness and dizziness caused by taking narcotic pain medication. 

51. Mann’s son, Waylon Mann, also wrote a letter on his father’s behalf. He stated his 

father experiences heavy breathing when he walked and was in severe pain. He also advised LINA

that when his father attempts to try to engage in activities, he could not do it for long and he would 

be unable to get out of bed the next day. 

52. On October 4, 2017, Nancy Lesher, RN, created a nurse case manager plan, in 

which she indicated Mann had physical and cognitive symptoms and the primary symptom 

impacting his functionality was pain. She concluded Mann’s claim should be referred to an 

occupational medicine specialist to determine his functional abilities and any restrictions and 

limitations he had that would prevent him from working a sedentary occupation in connection with 

his LWOP claim.

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53. On that same date, LINA advised Mann it was going to send his LWOP appeal to 

one of its employee Medical Directors for a purportedly “objective and independent review of the 

original claim decision.” 

54. Dr. Roger Belcourt was assigned to perform the medical records review and he 

created a report dated October 10, 2017. He only reviewed medical records and did not speak to 

Mann or any of his medical providers. After reviewing the office visit notes from Mann’s various 

medical providers, he unsurprisingly and speciously concluded their opinions that Mann could not 

return to work were not well supported by medically acceptable clinical or laboratory diagnostic 

techniques and were inconsistent with the other substantial evidence in the claim file because: (1) 

the results of Mann’s March 7, 2017 CT of his lumbar spine was inconsistent with Dr. Williams’ 

physical examination findings that Mann had 3/5 left lower extremity weakness and Dr. Fogel’s 

February 22, 2017 examination in which he documented full, normal, and symmetrical motor 

strength and negative bilateral straight leg test even though he failed to describe how the CT results 

were inconsistent with the physicians’ findings; (2) there was purportedly no documentation of 

medication side effects including physical or cognitive examinations; (3) Dr. Fogel’s March 24, 

2017 office visit note indicated Mann’s condition was not emergent indicating a stable surgical 

condition even though Mann was considering further surgery to his lumbar spine; despite the 

evince to the con and allegedly there was no documentation of decreased range of motion, strength, 

sensation, or reflexes of the upper extremities, vision or hearing, or consistent documentation of 

the inability to sit that would preclude the claimant from a sedentary level of activity—evidence 

that had no relevance to Mann’s diagnoses. Based on his unsupported findings, Dr. Belcourt 

concluded Mann could sit constantly with the ability to change positions for comfort and 

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occasionally stand, walk, and lift, carry, push and pull up to 10 pounds. Dr. Belcourt completely 

ignored the opinions of Dr. Williams and Dr. Fogel that Mann could not work in any capacity. 

55. In October 2017, LINA referred Mann’s claim to Randy Norris, a vocational 

specialist, to perform another TSA related to his LWOP claim. Norris based his restrictions and 

limitations solely upon Dr. Belcourt’s report, in which Dr. Belcourt stated Mann could sit 

constantly, stand and walk occasionally, reach constantly, lift, carry, push, and pull up to 10 pounds 

occasionally. Norris also stated that Mann did not require any medically necessary restrictions 

and limitations due to his complaints of pain. Norris concluded there were two sedentary jobs 

Mann could perform—a batch records clerk and an industrial order clerk—both of which required 

prolonged sitting, which Mann was unable to do. 

56. On that same date, LINA sent Mann a letter to advise him it was starting an 

investigation to determine whether he would be entitled to LTD benefits as of May 8, 2018, the 

date on which the definition of disability under the Disability Policy changed to the inability to 

perform the material duties of any occupation for which he is or may reasonably become, qualified 

based on education, training, or experience. 

57. On October 18, 2017, LINA referred Mann’s claim to Young Chang, another 

vocational specialist, who performed a new TSA related to Mann’s appeal of the denial of his 

LWOP benefits. Based on Dr. Belcourt’s report, Chang concluded Mann was capable of 

consistently and reliably performing work activities for 8 hours per day, 5 days per week, for 40 

hours per week with the following medically necessary work restrictions: sit constantly, with the 

ability to change positions for comfort and occasionally stand, walk, lift up to 10 pounds, climb 

stairs, stoop, kneel, crawl and use lower extremities on the left only. He concluded Mann did not 

require any medically necessary restrictions or limitations due to complaints of pain. He also 

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opined Mann could perform the sedentary occupations of batch-records clerk and industrial order 

clerk. 

58. LINA told Mann on October 20, 2017 that his appeal of the termination of his 

LWOP benefits had been denied based on the opinions of its Medical Director, its Vocational 

Rehabilitation Counselor, its Senior Appeal Specialist and its Appeals Specialist. In particular, 

LINA focused on the opinions of Dr. Belcourt who opined Mann could occasionally stand, walk, 

lift, carry, push and pull 10 pounds, climb stairs, stoop, kneel, crawl and use lower extremities 

with the left foot for foot controls. He also opined Mann could be able to constantly reach, fine 

manipulate, simple and firm grasp, see, and hear. He allegedly based these conclusions on Dr. 

Williams’ and Dr. Fogel’s office visit notes which purportedly did not support restrictions and 

limitations preventing Mann from performing a sedentary occupation—which they definitely did 

not.

59. On November 20, 2017, LINA’s referred Mann’s LTD claim for a behavioral 

health review by K. Johnson, a licensed professional counselor, and Cecilia Valena, a RN, for a 

nurse case manager review. 

60. Valena completed a NCM Case Plan Documentation form, in which she stated 

Mann did not have a projected return to work date and recognized that Mann’s back pain and left 

leg weakness with a limping gait were symptoms that impacted Mann’s functionality. More 

importantly, she stated Mann was unable to sit for 15 minutes without changing positions and 

could not stand, even though she claimed there was a difference of opinion among Mann’s medical 

providers. She referred Mann’s claim to LINA’s behavioral health services and to an occupational 

medicine physician to determine if Mann’s updated medical records changed Dr. Belcourt’s 

previous opinions.

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61. Although Johnson was instructed to speak to Dr. Williams, she merely reviewed 

Mann’s medical records and did not attempt to contact Dr. Williams. Johnson concluded Mann’s

medical records did not support any psychiatric or cognitive functional impairments. She based 

this decision solely upon reviewing Mann’s office visit notes from Dr. Williams. She never spoke 

to Dr. Williams as instructed.

62. Based on Valena’s recommendation, Mann’s claim was referred to Gitry 

Heydebrand, Ph.D., an in-house medical director, to determine whether Mann’s medical records 

supported a conclusion of functional limitations related to cognitive or psychological/psychiatric 

impairment. Dr. Heydebrand only reviewed office visit notes from Dr. Williams, and based on that 

review, he concluded Mann did not have any neuropsychological or psychiatric conditions that 

caused him to have restrictions or imitations. Although he acknowledged Dr. Williams had opined 

Mann’s narcotic pain medication impaired his concentration and attention, he speciously claimed 

there were no clinical findings reflecting these deficits. He also opined that Mann was only 

receiving low intensity treatment from Dr. Williams, which indicated he did not need more intense 

mental health treatment, and he stressed Mann had never been referred for a neuropsychological 

evaluation to determine the extent of any cognitive deficits. 

63. LINA then referred Mann’s LTD claim to Cindy Herzog, a rehabilitation specialist, 

to perform two separate TSAs based on Dr. Heydebrand’s conclusions regarding Mann’s cognitive 

impairments and mental illness and Dr. Belcourt’s opinions regarding Mann’s physical restrictions 

and limitations. 

64. Herzog performed her TSA relating to Mann’s cognitive and mental deficits based 

solely upon Dr. Heydebrand’s report and the DOT. She expressly stated her TSA focused solely 

upon Mann’s cognitive restrictions and limitations and not his physical limitations. Based on Dr.

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Heydebrand’s opinion that Mann had no medically necessary activity restrictions based on the 

clinical evidence in his medical records from a neuropsychological, psychiatric or psychological 

perspective, Herzog considered Mann’s skills and abilities and identified two occupations from 

the DOT she believed he could perform—an airframe power plant mechanic—a medium duty 

occupation—and an avionics technician—a light duty position. Other than Herzog’s TSA, there 

is absolutely no evidence in the administrative record that Mann could perform a light or medium 

physical demand level occupation.

65. In her November 30, 2017 TSA relating to Mann’s physical restrictions and 

limitations, Herzog based her conclusions upon the conclusions of Dr. Belcourt and the DOT. 

Herzog relied heavily upon Dr. Belcourt’s opinions, including, but not limited to, Mann’s 

purported ability to consistently and reliably perform work activities for 7 hours per day, 5 days 

per week, for 40 hours per work week with the following medically necessary work activity 

restrictions: (1) Mann’s purported ability to engage in constant sitting; (2) occasional standing and 

walking; (3) an ability to lift, carry, push and pull only up to 10 pounds; (4) using his lower 

extremities for foot controls on the left only; and (4) pain did not preclude Mann to have any 

restrictions and limitations preventing him from returning to work. Based on these conclusions, 

Herzog concluded Mann could perform the duties of a material scheduler, which required him to 

sit constantly—again a physical task all of his medical providers concluded he could not do.

66. On December 8, 2017, LINA conducted a forum review of Mann’s disability claim 

related to his psychiatric diagnoses and cognitive deficits. The forum members noted that although 

Dr. Williams diagnosed Mann with severe depression, she noted that his anxiety was under control. 

Dr. Williams also purportedly failed to specify any tasks Mann could not perform as a result of his 

mental diagnoses, including his complaints of deficits in concentration and attention. The forum 

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recommended that one of its occupational medicine medical directors perform another medical 

records review.

67. LINA referred Mann’s claim to Dr. Stephen Jacobson, an occupational medicine 

specialist, for a medical records review. Dr. Jacobson, who only reviewed Mann’s medical records

and did not speak to Mann or his medical providers, mysteriously stated in his report that the 

“determination of whether an individual can or cannot perform an occupation is not a medical 

determination and is a vocational decision.” Despite that statement, Dr. Jacobson went on to opine 

whether Mann could perform any occupation. He opined there was no documentation of cognitive 

deficits to support cognitive restrictions and limitations from Mann’s medication and his chronic 

pain. Dr. Jacobson concluded that Mann had the following restrictions and limitations based on 

his medical records: exerting up to 10 pounds of force occasionally and/or a negligible amount of 

force frequently to lift, carry, push, pull or otherwise move objects and standing and walking on 

more than an occasional basis. Dr. Jacobson did not comment upon Mann’s ability to sit for most 

of a workday—an absolutely necessary ability in order to perform a sedentary occupation.

68. On December 18, 2017, LINA notified Mann that it had terminated his LTD 

benefits effective May 8, 2018 because he lacked evidence he was unable to perform the material 

duties of any occupation for which he was, or may reasonably become qualified based on his 

education, training or experience. LINA again based its decision upon cherry-picked statements 

contained in Mann’s medical records and ignored evidence supporting Mann’s disability. LINA

based its decision on (1) the fact that the results from Mann’s March 7, 2017 lumbar CT scan were 

allegedly inconsistent with Dr. Fogel’s March 20, 2017 PAA, which indicated Mann was totally 

restricted from returning to work; (2) the lumbar CT scan was also allegedly inconsistent with Dr. 

Williams physical examinations which she noted showed Mann had 3/5 motor strength in his left 

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lower extremity and leg weakness; (3) LINA’s “expert resource group” reviewed Mann’s medical 

records and concluded there was not any consistent documentation of physical deficits in the upper 

extremities or his inability to sit for more than brief periods (even though Mann’s physicians 

observed first-hand his difficulty sitting for longer than short periods of time); (4) Mann’s medical 

records supported that he could frequently lift, carry, push, and pull and occasionally exert up to 

10 pounds of force and walk or stand for brief periods of time—again a conclusion contrary to Dr. 

Williams’ conclusions; and (5) the report of Dr. Heydebrand, LINA’s medical director for 

neuropsychology and psychology, purportedly showed that Mann only had occasional insomnia, 

his anxiety was controlled with medication, and his depression was stable but not improved. Based 

on these reasons, LINA frivolously concluded there was no evidence that Mann had functional 

limitations due to cognitive or physical impairments.

69. On November 1, 2018, the undersigned attorney appealed the denial of Mann’s 

LTD benefits on his behalf. As part of the appeal, Mann submitted updated medical records, a 

letter drafted by Dr. Fogel, a letter drafted by Ms. Goode, a letter drafted by Mann’s in-laws, the 

Social Security Administration’s approval of Mann’s disability claim, the SSA’s physical 

examination of Mann, and a Functional Capacity Examination (“FCE”) performed by Dr. Marcus 

Hayes at Alivio Rehabilitation.

70. Mann submitted medical records from Kara Goode, a physical therapist, who 

performed extensive physical examinations of Mann. In January 2018, Dr. Williams referred 

Mann to Goode for an initial evaluation for physical therapy. Based on her review of Mann’s 

medical history, his subjective complaints, and her physical examination, Goode concluded Mann 

had the following restrictions and limitations: (1) unable to bend; (2) no lifting of objects weighing 

more than 10 pounds; (3) sitting and standing for only 15 minutes at a time; (3) chronic insomnia; 

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and (4) he was unable to perform work activities. She also examined Mann’s lumbar spine and 

concluded his flexion was limited to 25%, his extension was limited to 10% due to severe pain, 

his right side bending was limited to 50% due to pain, his left side bending was limited to 60% 

due to stiffness and soreness, and he was moderately restricted in his flexibility in his hamstring, 

hip flexors, piriformis, iliotibial band, rectus femoris, quadratus, and lumbar paraspinals. Goode 

also noted that throughout her evaluation of Mann that he had to frequently change positions from 

sitting to standing due to pain and observed that his posture consisted of a forward head, rounded 

shoulders, and decreased lumbar lordosis. Upon examination of Mann’s joint mobility in his 

lumbar spine, Goode found he was hypermobile at L3-L4 and hypermobile and had pain at L4-5 

and L5-S1.

71. Goode also filled out a form entitled “Medical Opinion Re: Ability to do Physical 

Activities.” In the form, she stated Mann could only sit and stand for 15 minutes at a time for a 

total of approximately two hours total in an eight-hour workday. She also stated Mann would need 

to take unscheduled breaks during the workday every 30-45 minutes and the rest period would 

need to be for 30 minutes while Mann laid flat for pain relief. She further concluded Mann could 

never bend or twist at the waist and that his disability would require him to miss work more than 

twice a month. Mann submitted Goode’s records as part of his appeal of the termination of his 

LTD benefits.

72. Also on that day, Mann submitted a letter written by his father and mother-in-law, 

Judy and Paul Wiggington, in support of his appeal. They emphasized that before Mann began 

experiencing severe pain in his lower back, he had a strong work ethic, was an active and engaged

parent, would help his in-laws fix damaged items in their house and work on their cars, and was 

involved in many sporting activities, including riding jet skis, boating, golfing swimming, and 

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sightseeing. The Wiggingtons advised LINA that prior to the onset of his back pain, he would 

travel a majority of the time for work. However, they explained that once Mann began suffering 

back and leg pains and underwent surgery that only increased his symptoms, he was no longer able 

to perform any of the activities he engaged in before the onset of his problems. They stated that 

Mann spent a good portion of his time in bed, particularly if he overexerted himself on a previous

day when his symptoms were not as severe as usual. 

73. Mann also submitted updated medical records from Dr. Fogel. On July 27, 2018, 

Dr. Fogel filled out a Restrictions and Limitations form for Mann. He noted that Mann could only 

occasionally (up to 33% of the day) sit, stand and walk as long has he could change positions every 

10 to 15 minutes, never drive, kneel, crawl, or lift or carry more than 10 pounds. 

74. During an August 15, 2018 office visit, Dr. Fogel noted he had not seen Mann in 

several months because Mann temporarily lost his health insurance, but had obtained insurance 

again and was interested in pursuing surgery. Dr. Fogel stressed Mann needed to undergo a 

laminectomy on the left at L4-5 because he continued to have significant L5 radiculopathy as well 

as chronic upper lumbar neuropathy. Dr. Fogel discussed the results of a February 21, 2018 MRI 

of Mann’s lumbar spine, which showed a buildup of bone at the left side at L4-5 where he inserted 

the cage. Dr. Fogel believed this was causing some acute irritation of his L5 nerve root. He stated 

that all of Mann’s symptoms are in the L5 nerve root with stinging, shocking pain into the leg and 

numbness in the foot which had worsened since Dr. Fogel last saw Mann. 

75. Upon physical examination, Dr. Fogel reported Mann’s gait had a mild list to the 

right, mild scoliosis, flattening of the lumbar spine, dyskinesis of the lumbar spine motion, 

increased pain with forward flexion of the back, and increased pain with hyperextension and AP 

thrust. Mann’s range of motion was 70 degrees with forward flexion, 25 degrees with extension, 

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and 25 degrees lateral flexion on the left and right. He also observed Mann’s deep tendon reflexes 

were diminished at his left ankle, his left knee, and his right ankle. He also had left weakness of 

ankle dorsiflexion and numbness of L5 distribution. 

76. Mann also submitted updated records from Goode, his physical therapist. During 

an April 18, 2018 office visit, Goode noted Mann continued to see his pain management doctor 

and his current medications helped improve his pain only if he avoided certain positions and 

activities. She also reported that Mann’s laminectomy and lumbar fusion did very little to improve 

his functional status. Her physical examination of Mann revealed he had decreased range of 

motion in rotation and forward bending in his back and 2/5 muscle strength in his left lower 

extremity. 

77. Further, Mann provided another letter authored by Goode, in which she stated she 

intended to present LINA with objective and subject evidence of Mann’s disability. Her physical

evidence stemmed from her frequent examinations of Mann, which revealed he had 25% of normal 

range of motion (“ROM”) in his lumbar spine upon forward flexion, he was limited by pain and 

stiffness caused by his last surgery, he also had limited extension (backward bending) by 90%, and 

side bending by about 50% of normal ROM. 

78. She stressed Mann’s pain was located in his lower back and radiated down his left 

leg down to his foot. This pain was aggravated with upright sitting, standing stationary, walking 

and with forward bending and his pain was only relieved by reclining or lying flat. She also 

stressed Man could only tolerate sitting in a straight back chair or standing for 15 minutes. Goode

also advised LINA Mann had an Oswestery Low Back Disability Index Score of 78%, which meant 

he had a significantly reduced ability to perform daily and functional tasks.

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79. Goode concluded that not only could Mann not perform his previous own 

occupation, but that he could not perform any sedentary occupation either. She based this opinion 

on the fact that her physical examinations of Mann showed: (1) he could only sit for 5-10 minutes 

at a time for a total of 1 1⁄2 hours a day; (2) he could not stand for 5-10 minutes at a time for a total 

of 1 1⁄2 hours a day; (3) he could walk for 10 minutes at a time for 1 1⁄2 hours a day; (4) he could 

lift a five pound object occasionally; and (5) he would not be able to tolerate positional changes 

for an entire 9-hour work day because he must recline or lay flat throughout the day in order to 

decrease his pain levels. All of these restrictions and limitations prevented Mann from returning 

to any capacity 

80. Mann also submitted the results of a Physical Performance Evaluation performed 

by Dr. Marcus Hayes from Alivio Rehabilitation on August 29, 2018. Based on his lengthy

examination of Mann, Dr. Hayes concluded Mann could only lift 8 pounds from the floor and from 

the floor to his shoulder infrequently and 5 pounds occasionally, he could only lift 5 pound objects 

from the floor to overhead pounds infrequently and 3 pounds occasionally, and he could push and 

pull objects weighing 10 pounds infrequently and 5 pounds occasionally. He also concluded Mann 

could only sit infrequently for 20 minutes at a time, stand for 8 minutes infrequently, and walk for 

6 minutes infrequently. He also opined Mann could never climb, squat, kneel or crawl. Further, 

he noted Mann had a left antalgic gain and lumbar flexion limited to 30 degrees. Based on his 

findings, Dr. Hayes concluded Mann performed at a sub-sedentary physical demand level and was 

precluded from performing sedentary work. 

81. On March 13, 2018, LINA unsurprisingly denied Mann’s appeal despite the

substantial evidence in his file supporting his disability as defined in the Disability Policy. In its 

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letter explaining the bases for its decision, LINA advised Mann it referred his claim for a so-called 

“independent medical review” by an orthopedic surgeon and a psychiatrist.

82. According to LINA, the orthopedic surgeon purportedly reviewed all of the medical 

records in Mann’s claim file, but, based on information and belief, he did not speak to Mann or his 

medical providers.. In his report, he dismissed the results of Dr. Hayes’s FCE because he claimed 

the results of the FCW were contradicted by Mann’s radiologic studies or the physical 

examinations performed by his treating physicians and because the PPA did not indicate whether 

Mann’s functional limitations were caused purely by physical discomfort or visible physical 

weakness. The orthopedic surgeon acknowledged Mann’s medical providers had repeatedly 

documented Mann had experienced a decrease in his ROM involving the lumbar spine in lumbar 

flexion and extension, gait alteration, and weakness and numbness involving the left lower 

extremity. He also acknowledged that these conditions impacted his ability to engage in prolonged 

sitting, standing, walking, reaching below his waist, repetitive lifting, carrying, pushing, pulling, 

kneeling, crouching, crawling, or engaging in repetitive use of his left extremity for foot controls.

83. Despite acknowledging these facts, the orthopedic surgeon frivolously concluded 

that Mann’s most recent medical records purportedly showed he could frequently sit and 

occasionally walk and stand, but that he needed to have frequent position changes as needed. He 

also opined Mann could frequently lift, carry, push and pull up to 10 pounds and occasionally push 

and pull up to 20 pounds. 

84. The psychiatrist LINA hired to perform a medical review opined that Dr. Williams’

conclusion that Mann had cognitive deficits as a result of his medication was allegedly not 

supported by medically acceptable clinical diagnostic techniques, including mental status 

examinations, psychological and/or neuropsychological testing and was inconsistent with other 

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information in his claim file. He also noted even though Mann had been diagnosed with depression 

and anxiety, Dr. Williams’s office visit notes purportedly reflected Mann had appropriate mood 

and affect, did not document observations of tearfulness or other dysfunction related to psychiatric 

symptoms, and reflected his symptoms of anxiety and depression were stable. The psychiatrist 

further reported that the intensity of treatment for Mann’s mental illnesses and cognitive 

difficulties was inconsistent with would have been expected in an impairing psychiatric conditions. 

Based upon information and belief, the psychiatrist only reviewed Mann’s medical records and 

did not attempt to speak with his medical providers.

85. In its denial letter, LINA conceded Mann had been approved for Social Security 

Disability Insurance benefits, but it speciously contended that the SSA’s judgment was 

inconsistent with its findings from Mann’s claim file. 

86. LINA’s decision to terminate Mann’s LTD benefits was utterly unreasonable and 

is not supported by the great weight of evidence in his claim file, including the language of the 

Disability and Life Policies. As a result of LINA’s unsubstantiated decision, Mann was forced to 

hire the undersigned attorney to appeal LINA’s decision to terminate his benefits and to file this 

Complaint. In addition, Mann’s medical records unequivocally show his physical impairments are 

getting worse, not better.

87. Due to LINA’s unreasonably and egregious conduct in terminating Mann’s LTD 

benefits, he is entitled to receive the amount of this benefits from the date they were terminated to 

the present, interest, and attorney’s fees. 

IV. 

COUNT ONE

Breach of the Plans and Policy Provisions Claim

88. Pursuant to 29 U.S.C. § 1132 (a)(1)(B), Mann is entitled to life waiver of premium 

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and long-term disability benefits under the Disability Policy and Life Policy because he meets the 

applicable definitions of disability included in the Policies.

89. Mann has complied with his obligation to make proofs of claims in accordance with 

the Policies’ requirements and he has exhausted his remedies under the Policies.

90. Mann is entitled to have the Court conduct a trial de novo of the issues stated herein 

because LINA operated under a conflict of interest and it failed to conduct a full and fair review 

of Mann’s claims.

91. In the alternative, LINA’s decision to deny Mann’s benefits was arbitrary and 

capricious.

92. Mann is entitled to life waiver of premium and long-term disability benefits because 

LINA’s evaluations were so flawed and self-interested that its decisions to deny Mann benefits 

was unreasonable. 

93. The Disability Policy provides that in the instance where Mann is t disabled—and 

therefore unable to perform any occupation—then he is entitled to LTD benefits under the policy.

94. The Life Policy provides that if Mann meets the definition of disability, which 

meant he was unable to perform the material duties of any occupation which he or she may 

reasonably become qualified based on education, training, or experience, then he is entitled to 

those benefits.

95. Mann’s claim files provide substantial evidence that he met the definition of 

disability under both Policies.

96. LINA failed to consider much of Mann’s medical evidence and thus it failed to 

provide Mann a full and fair review of his claims that took into account all comments, documents, 

records, and other information submitted to it by Mann and his medical providers.

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V. 

COUNT TWO

Reasonable and Necessary Attorney’s Fees

97. Pursuant to 29 U.S.C. § 1132(g)(1), Mann seeks an award for his reasonable and 

necessary attorney’s fees in connection with the prosecution of this action.

PRAYER

WHEREFORE, Mann requests that the Court order: 

1. LINA to pay Mann the full employee benefits incurred and unpaid at the time of 

trial; 

2. LINA to restore Mann’s employee benefits;

3. LINA to pay Mann’s reasonable attorney’s fees incurred in pursuit of recovery of 

the benefits owed to Mann; 

4. LINA to pay Mann pre-judgment and post-judgment interest; and,

5. Mann recover the cost of this action and such other further relief, as the Court may 

deem proper under the circumstances.

Respectfully Submitted, 

THE LAW OFFICE OF JESSICA TAYLOR

14100 San Pedro, Suite 602

San Antonio, Texas 78232

(210) 402-4022 (Telephone)

(210) 402-1225 (Fax)

By: /s/ Jessica Taylor

JESSICA TAYLOR

Texas State Bar No. 24013546

 jessica@jtaylorlaw.com

ATTORNEY FOR PLAINTIFF

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