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Abou-Zaki v. Aetna Life Insurance Co.

United States District Court, Ninth Circuit

January 2, 2014

ZENA ABOU-ZAKI (ARMANI), Plaintiff,
v.
AETNA LIFE INSURANCE COMPANY, and BOEHRINGER INGELHEIM, LTD BENEFIT PLAN, Defendants.

FINDINGS OF FACT AND CONCLUSIONS OF LAW

RICARDO S. MARTINEZ, District Judge.

This is an action for long-term disability benefits under the Employment Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. brought by Plaintiff Zena Abou-Zaki against Defendants Aetna Life Insurance Co. ("Aetna") and Boehringer Ingelheim, Ltd Benefit Plan ("Boehringer"). The Court held a bench trial on the administrative record on December 9, 2013. Having reviewed de novo the administrative record, and having considered the pleadings and arguments by counsel, the Court finds in favor of Defendants.

I. FINDINGS OF FACT

"In bench trials, Fed.R.Civ.P. 52(a) requires a court to find the facts specifically and state separately its conclusions of law thereon.'" Vance v. American Hawaii Cruises, Inc., 789 F.2d 790, 792 (9th Cir. 1986) (quoting Fed.R.Civ.P. 52(a)). By identifying the factual basis for its ultimate conclusions, the trial court satisfies an important purpose of Rule 52: "to aid the appellate court's understanding of the basis of the trial court's decision." Id. (citation omitted). The trial court, however, "is not required to base its findings on each and every fact presented at trial." Id. at 792. The Court's findings of fact on the Administrative Record (cited throughout as "R.") are as follows.

A. Aetna's Long-Term Disability Plan

Ms. Abou-Zaki formerly worked as a pharmaceutical sales representative for Boehringer. She was injured while making a doctor visit in September 2008. R. at 000781. She claims to have "felt something pop" along her right arm, neck, and shoulder while lifting a laptop and sample bag out of the back of her vehicle. Id. Ms. Abou-Zaki could not finish work that day and sought treatment two days later, which included several MRIs and physical therapy. Id. Although Plaintiff continued to work for several weeks immediately following the incident, she reported ongoing headaches, dizziness, nausea, vomiting, numbness, and neck pain. R. at 000791. Dr. Ruth Freeman, Plaintiff's primary physician, later diagnosed her with occipital neuralgia and chronic myofascial strain, which rendered her unable to return to work. See R. at 000873. On November 26, 2008, a "Nuclear Medicine Spec Bone Scan" also revealed potential chronic muscle spasm. See R. at 000847. As a result, Plaintiff filed for disability benefits under Boehringer's Long Term Disability Benefit Plan, Policy No. GP-877093 (the "Plan"), which was issued through Aetna. R. at 000057.

The Plan establishes a two-fold test for disability depending on the duration of benefits paid to the participant after the initial injury. See R. at 000087. Until benefits are paid for twenty-four months following the date of disability, a Plan participant is deemed disabled on any day she is:

• not able to perform the material duties of [her] own occupation solely because of: disease or injury; and
• [her] work earnings are 80% or less of [her] adjusted predisability earnings.

R. at 000087 (emphasis in original, indicating defined terms). Following this 24-month period, the Plan participant is deemed disabled on any day she is unable to work at any "reasonable occupation" solely because of:

• disease; or
• injury.

R. at 000087 (emphasis in original, indicating defined terms). After initial approval, disability benefits will end on the first to occur of:

• The date Aetna finds [the participant is] no longer disabled or the date [she] fails to furnish ...

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