This is the property of the Daily Journal Corporation and fully protected by copyright. It is made available only to Daily Journal subscribers for personal or collaborative purposes and may not be distributed, reproduced, modified, stored or transferred without written permission. Please click "Reprint" to order presentation-ready copies to distribute to clients or use in commercial marketing materials or for permission to post on a website. and copyright (showing year of publication) at the bottom.

Insurance
Coverage Denied
Disability Insurance Benefits

Natasha Hall v. Aetna Life Insurance Company

Published: Jul. 16, 2021 | Result Date: Jun. 23, 2021 | Filing Date: Mar. 17, 2020 |

Case number: 20-cv-01863-RS Summary Judgment –  Defense

Judge

Richard Seeborg

Court

USDC Northern District of California


Attorneys

Plaintiff

Paul R. Noah
(Law Office of P. Randall Noah)


Defendant

Karen T. Tsui
(Maynard, Cooper & Gale LLP)

Michael B. Bernacchi
(Burke, Williams & Sorensen LLP)


Facts

Natasha Hall worked as a Bank Relationship Manager for City National Bank. She has had a long history of back pain and two back surgeries. CNB refused to accommodate her at its San Francisco location. In 2015, she requested a formal FMLA leave of absence and applied for state disability. In November, she consulted with Dr. Kenneth Light who recommended pain relievers, potentially an epidural, and a possibility of surgery. Aetna Life Insurance Company approved Hall's disability benefits until January 9, 2019 and reinstated them on January 24, 2019. Around April 2019, Dr. Light indicated that she will have surgery in May 2019. In May 2019, Dr. Light called Aetna to inform them he was no longer certifying Hall's disability. Aetna investigated the claim and attempted unsuccessfully to follow up with Dr. Light. Soon thereafter, Aetna terminated Hall's finding she was no longer impaired. Hall brought an action against AETNA under the Employee Retirement Income Security Act, arising from the termination of benefits.

Contentions

PLAINTIFF'S CONTENTIONS: Plaintiff contended that she has had a long history of back pain. Plaintiff contended Dr. Light intended to communicate that he was no longer her doctor only because she briefly lost her health insurance. Plaintiff contended there is no document that indicates Dr. Light changed his opinion about her disability status. Plaintiff contended defendant had medical records showing her condition had not improved. Plaintiff contended that someone from Dr. Light's office had written, "Please reverse prior notification of disability information. Patient will be continued to be seen by Dr. Light. Patient is not released back to work." Therefore she is still entitled to her benefits. Moreover, plaintiff was granted Social Security Disability before Aetna's final denial of long term disability benefits.

DEFENDANT'S CONTENTIONS: Defendant denied all of the contentions. Defendant contended plaintiff is no longer disabled because she got married, gave birth to two children, purchased and operated a yoga studio, and filed a lawsuit against CNB for wrongful termination. Defendant contended in plaintiff's lawsuit against CNB, she admitted she could perform her job even with back issues. Defendant contended it paid plaintiff benefits on the assumption she would undergo surgery.

Result

Defendant's cross motion for summary judgment was granted and plaintiff's motion for summary judgment was denied.


#137433

For reprint rights or to order a copy of your photo:

Email jeremy@reprintpros.com for prices.
Direct dial: 949-702-5390