Opinion ID: 855794
Heading Depth: 2
Heading Rank: 1

Heading: Neaton’s Claim for LTD Benefits

Text: On his last day of work, September 5, 2007, Neaton had been working for Navy Federal for 32 years. Neaton worked as an LCR Counselor, Navy Federal’s term for a debt collector, “recovering outstanding debts, negotiating repayments with att[orneys], maintain[ing] records chronologically[,] and handl[ing] settlement offers.”3 Neaton was diagnosed with Gorlin’s Syndrome in the fourth grade. Gorlin’s is a rare genetic defect that causes Neaton to develop numerous basal-cell carcinomas (skin cancers), cysts, and other lesions. Those cancers, unlike most basal-cell carcinomas, are prone to metastasizing and are 1 Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. 2 It is unreasonable to find that a claimant ceases to be disabled absent a change in the underlying medical condition. See Walke v. Group Long Term Disability Ins., 256 F.3d 835, 840 (8th Cir. 2001) (overturning plan administrator’s termination of benefits where nothing in record demonstrated medical improvement or change in circumstances to warrant termination of benefits). 3 Neaton was highly compensated, earning $16,432.62 ($4,099.92 in salary plus $12,332.80 in commissions) per month on average prior to disability. -2- removed by one of two methods: curettage and cautery (“scooping or scraping” and “burning”)4 or Moh’s surgeries.5 Moh’s surgeries are necessary when the cancers have progressed too far to be removed by curettage and cautery and are more invasive, sometimes requiring skin grafts. The day after his last day of work, September 6, 2007, Neaton was scheduled for a curettage and cautery procedure to remove fourteen skin lesions. Neaton claimed he could not work because he could no longer “handle” the number of surgeries and recovery periods. Through the Plan, Neaton was insured against long-term disability by Hartford.6 Believing that he was now unable to work, Neaton filed for LTD benefits. Neaton’s dermatologist, Jeffrey 4 Neaton described the curettage and cautery procedures as “sometimes involv[ing] fifteen or twenty cancer lesions removed during one procedure. This would cause tremendous pain, stress and anxiety. I would leave the doctor office soaked in sweat. Even these surgeries were very painful and made it difficult to sleep.” 5 Neaton described the effects of the Moh’s surgeries: The day after a Mohs surgery there is tremendous swelling and a lot of pain which causes me to take pain pills. By the second day the pain and swelling are so bad I can not sleep or function at all. If the surgery was on my head or face by the third day my eyes swell shut for about five days. ... The pain is bad enough to require pain medication that affects my functioning. Also, because of pain and the discomfort of the large bandaging, it makes it impossible to sleep. ... The Mohs surgeries I have are so large that the recuperation time can go weeks and sometimes months. Right now I am still feeling effects of the past 3 surgeries which were months ago. 6 The parties do not dispute the terms of the Plan, which contained a fairly common provision defining disability during the first twelve months after the elimination period as the insured’s inability to perform the “material and substantial duties” of his regular occupation and, after that twelve months, as the inability to perform any occupation. Material and substantial duties are those “which cannot be reasonably omitted or altered.” The parties’ dispute turns on a factual issue regarding whether Neaton was capable of performing his former job. -3- Schuldenfrei, M.D., provided a letter describing the treatment and limiting Neaton to “no work.”7 Specifically, Dr. Schuldenfrei explained that Neaton should avoid exposure to sunlight and fluorescent lighting. Because Neaton had been suffering from Gorlin’s for some time, Hartford contacted him in order to ascertain the “reason for stopping work now.” Neaton informed Hartford he needed Moh’s surgeries “every month” because cancer was coming back in places it had previously been removed.8 Hartford was aware, as early as November 2007, that Gorlin’s syndrome is progressive: as patients age, the number of skin cancers increase and are made worse by exposure to sunlight. Because Neaton was commuting an hour to work each day, presumably with the attendant exposure to sunlight, a Hartford claims examiner recommended that his LTD claim be approved. That recommendation was “deferred” pending the receipt of updated treatment notes from Dr. Schuldenfrei, which stated that Neaton underwent another curettage and cautery procedure on November 1, 2007, and was to follow up with Dr. Schuldenfrei every month. Hartford decided to wait for information regarding whether Neaton’s condition could be accommodated before making a benefits decision. On December 10, 2007, Hartford interviewed Neaton to inquire about the effect of his surgeries on his ability to work. Neaton told the interviewer he was scheduled for yet another 7 Hartford maintains that Neaton requested that Dr. Schuldenfrei limit him to “no work.” (Doc. 26 at 5). Neaton acknowledged that he told Dr. Schuldenfrei he could not work anymore, but instead of providing a “no work” letter, Dr. Schuldenfrei advised Neaton to seek counseling. Neaton was still working when those counseling sessions began. 8 Neaton also explained that his “nerves [we]re shot” due to embarrassment about his physical appearance and anger at his boss, who had accused him of having pornography on his computer in some sort of “joke.” Hartford concluded Neaton did not have any work restrictions resulting from a mental condition, but noted that his physical condition might well cause psychological symptoms. Neaton does not attribute his disability to a mental condition in his motion for judgment on the pleadings. -4- surgery on December 13, 2007, and that he was “needing more s[urgeries]” as his condition progressed. Neaton also explained that he needed “time to recoup” after surgeries because of his “nerves,” embarrassment, depression, facial swelling, pain medication, bandaging, and bleeding. Neaton appeared to attribute some of his work limitations to difficulties associated with physically attending work rather than performing work tasks. For example, Neaton was afraid to drive because of sun exposure, and he believed coworkers were talking about his appearance. When the interviewer broached the possibility of Neaton working from home, Neaton did not offer any reason that he could not, but stated that he did not believe his employer would allow it.