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17-1307 - GARNER v. AETNA LIFE INSURANCE COMPANY


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17-1307 - GARNER v. AETNA LIFE INSURANCE COMPANY
February 20, 2018
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ENTRY - Plaintiff Kimberly Garner claims she has been unable to return to work at her job with Amazon since July 2016 due to difficulties with urinary incontinence. In the intervening months, Ms. Garner applied for long term disability benefits ("LTD") through an insurance policy issued to Amazon employees by Defendant Aetna Life Insurance Company ("Aetna"). Aetna twice denied Ms. Garner's claim following reviews by a nurse and a urologist concluding that Ms. Garner is not disabled. Ms. Garner then filed this lawsuit against Aetna under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. ยงยง 1001, et seq., seeking past benefits, future benefits, and attorney's fees. For the reasons set forth in this Order, the Court GRANTS IN PART Ms. Garner's Motion and DENIES Aetna's Motion. The Court agrees with Ms. Garner that Aetna's decision was not supported by substantial evidence, but concludes that remand to Aetna -- rather than an award of benefits -- is the proper remedy in this instance. Aetna's decision to deny Ms. Garner benefits is entitled to deference. But Aetna is not entitled to rely upon critically flawed clinical reviews as the basis for its decision. The Court finds Aetna's denial of benefits to be arbitrary and capricious and therefore GRANTS IN PART Ms. Garner's Motion for Summary Judgment, 19, and DENIES Aetna's Motion for Summary Judgment, 18. Remand, rather than an award of benefits, is the appropriate remedy in this case to allow Aetna to address the procedural errors identified herein. Final judgment will issue accordingly. Pursuant to Federal Rule of Civil Procedure 54(d)(2)(B), the Court ORDERS that Ms. Garner file any petition for attorney's fees on or before March 23, 2018. The Court requests that the Magistrate Judge confer with the parties to discuss the possibility of a negotiated resolution as to the fee issue. (SEE ENTRY). Signed by Judge Jane Magnus-Stinson on 2/20/2018. (APD)