The opinion of the court was delivered by: Hurd, U.S. District Judge.
MEMORANDUM-DECISION AND ORDER
Plaintiff moves for partial summary judgment as to her first and second
causes of action, which seek monetary and injunctive relief for the
wrongful denial of benefits under Section 502(a)(3) of ERISA,
29 U.S.C. § 1132(a)(3). Defendants have moved for summary judgment
dismissing all ERISA and state law causes of action. Oral argument was
heard on September 8, 2000, in Utica, New York. Decision was reserved.
This action arises out of the termination of long-term disability
benefits to Sparkes by the defendant Northwestern Mutual Life Insurance
Company ("Northwestern"), pursuant to a clause in the defendant Morrison
& Foerster Long-Term Disability Plan (the "Plan") which limited receipt
of benefits for disability due to mental illness to two years. The
following are the undisputed facts in this case.
Sparkes was employed by defendant Morrison & Foerster LLP ("Morrison &
Foerster"), a large international law firm, as a word processor and
administrative assistant. Sparkes worked in the firm's New York office.
During the relevant time period, the firm maintained a group long-term
disability insurance plan with Northwestern. The Plan provided long-term
disability benefits for eligible employees of the firm, subject to the
terms and conditions of the Plan. As an employee of the firm, plaintiff
was a participant in the Plan.
Under the terms and conditions of the Plan, an insured employee was
entitled to long-term disability benefits, following a 90-day elimination
period, if the insured was disabled from her own occupation for a 24-month
period. After the 24-month period expired, benefits would be paid only if
the employee was disabled from all occupations. All benefits under the
Plan were subject to a mental disorder limitation which provided that
"[p]ayments of [long-term disability] benefits is limited to 24 months
for each period of Disability caused or contributed to by a Mental
Disorder. . . . Mental Disorder means: a mental, emotional or behavioral
disorder." See Ex. "F" to Siegel Affidavit at 8.
On December 27, 1991, Sparkes became disabled and was unable to work.
She was subsequently diagnosed by her own doctors with Chronic Fatigue
Syndrome ("CFS"). Following a 90-day elimination period, she began to
receive benefits pursuant to the terms of the Plan effective March 28,
1992. On May 18, 1994, Northwestern notified her that it was making an
exception to continue her benefits while it investigated the potential
applicability of the mental health limitation to her claim.
On or about November 8, 1994, Sparkes was given a psychological
examination by Dr. Jacqueline Bashkoff in regard to her application for
Social Security disability benefits. Dr. Bashkoff did not attribute
plaintiffs CFS symptoms to depression, or to any other mental health or
personality disorder. She subsequently began to receive Social Security
benefits on or about July 1, 1996.
A moving party is entitled to summary judgment "if the pleadings,
depositions, answers to interrogatories, and admissions on file, together
with the affidavits, if any, show that there is no genuine issue as to
any material fact and that the moving party is entitled to a judgment as
a matter of law." Fed.R.Civ.P. 56(c). The ultimate inquiry is whether a
reasonable jury could find for the nonmoving party based on the evidence
presented, the legitimate inferences that could be drawn from that
evidence in favor of the nonmoving party, and the applicable burden of
proof. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct.
2505, 91 L.Ed.2d 202 (1986). In determining a motion for summary
judgment, all inferences to be drawn from the facts contained in the
exhibits and depositions "must be viewed in the light most favorable to
the party opposing the motion." United States v. Diebold; Inc.,
369 U.S. 654, 655, 82 S.Ct. 993, 8 L.Ed.2d 176 (1962); Hawkins v.
Steingut, 829 F.2d 317, 319 (2d Cir. 1987). Nevertheless, "the litigant