Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

CASEY v. FIRST UNUM LIFE INSURANCE CO.

March 31, 2004.

KATHERINE O. CASEY, Plaintiff,
v.
FIRST UNUM LIFE INSURANCE COMPANY, Defendant



The opinion of the court was delivered by: FREDERICK SCULLIN, Chief Judge, District

I. INTRODUCTION

Plaintiff Katherine O. Casey commenced this action by filing a summons and complaint in state court on January 5, 2000. Defendant First UNUM Life Insurance Company ("First UNUM") removed the action to this Court on February 18, 2000, on the ground that "[t]his action is governed by ERISA." See Notice of Removal at ¶ 5.

  Defendant subsequently filed a motion for summary judgment. By Memorandum-Decision and Order dated September 5, 2001, this Court granted Defendant's motion with respect to Plaintiff's breach of contract claim because, as Plaintiff's counsel conceded, ERISA preempted Page 2 that claim. See Memorandum-Decision and Order, dated September 5, 2001, at 7 n.3. The Court, however, denied Defendant's motion with respect to Plaintiff's claim that Defendant wrongfully terminated her disability benefits pursuant to ERISA. The Court remanded the case to Defendant with instructions to consider all relevant evidence, to apply the appropriate standards, and to reach a determination as to whether Plaintiff is, in fact, disabled within the meaning of the Plan. See id. at 15. The Court further instructed Plaintiff that she was to inform the Court in writing of the result of Defendant's review process, including appeals, and the effect of that result on the continued viability of her action. See id. at 16.

  Upon completion of the review process, Plaintiff moved for summary judgment on her ERISA claim and Defendant moved for judgment on the administrative record. The Court will address each of these motions in turn.

  II. BACKGROUND

  In October 1994, Defendant issued Group Long Term Disability Policy No. 457187 (the "Policy") to Jowonio School, Plaintiff's former employer. The Policy is an employee benefits plan within the meaning of the Employment Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"), and was designed to provide long term disability income benefits to eligible employees. See Declaration of Bruce Dominick, sworn to March 26, 2001 ("Dominick Decl.," at ¶ 3.

  In September 1995, Plaintiff began working as a full-time employee at Jowonio School as an Administrative/Accounting Assistant. Her job duties included maintaining staff records, therapist time sheets, child attendance records, billing for all special needs children, interaction Page 3 with employees regarding benefits, input of financial data to the general ledger, reconciliation of bank statements, tracking accounts receivable and accounts payable, typing, and, when the secretary was absent, office coverage, which included reception of visitors, answering phones, copying and filing. See Declaration of Walter Kogut, dated May 17, 2001, Exhibit "A" (Transcript of the Deposition of Katherine O. Casey, dated January 16, 2001 ("Casey Tr.")), at 18. After the birth of her first child, Plaintiff requested, and was granted, permission to work three days per week. See Casey Tr. at 20, 22. Her duties remained the same. See id. at 19.

  In January 1997, Ms. Casey fell down some stairs in her home and injured her back. Although she experienced some pain after the fall, she did not immediately see a doctor or miss time from work. However, on July 2, 1997, Plaintiff sought treatment from Dr. Greenky, an orthopedist, whose notes indicate a diagnosis of a herniated disk. See Dominick Decl., Exhibit "A," at 33. On that same day, on Dr. Greenky's advice, Plaintiff left work on short term disability because of her back pain.

  On October 10, 1997, Ms. Casey filed an application for long-term disability benefits under the Policy. See Dominick Decl., Exhibit "A," at 17-19. At that time, Ms. Casey was working part-time, twenty-one hours per week. By letter dated November 7, 1997, Defendant approved her application and began paying her benefits. See id., Exhibit "A," at 20.

  From November 1997 until January 1999, Defendant continued to pay Plaintiff disability benefits under the Policy. See Dominick Decl. at ¶¶ 10-11. In addition, Defendant attempted to collect additional information about Plaintiff's claim. See id. at ¶¶ 12-22. On August 26, 1998, Defendant wrote to Dr. Yuan, Plaintiff's treating physician, requesting copies of his treatment notes and test results and requesting that Dr. Yuan complete a "Physical Capacities Form," which Page 4 was enclosed with the letter. See id. at ¶ 13 and Exhibit "A" at 68. Dr. Yuan returned the Physical Capacities Form on September 14, 1998, but he did not complete the form and he did not include copies of his medical records. See id. at 14. Thereafter, by letter dated September 28, 1998, Defendant wrote to Plaintiff, advising her, among other things, that Dr. Yuan had neither provided copies of his medical records nor completed the Physical Capacities Form. See id. at ¶ 15 and Exhibit "A" at 77-78. Defendant also advised Plaintiff that it needed proof of her on-going disability and that, if it did not receive that information within thirty days, it would conclude that she was no longer pursuing disability benefits and would close her claim. See id. at ¶ 15.

  On October 29, 1998, Defendant's claim representative spoke with Plaintiff about her current condition. See id. at ¶ 17. Plaintiff told the claim representative that she had seen Dr. Yuan on October 5, 1998, and that he had performed an MRI. See id. That same day, Defendant wrote to Dr. Yuan requesting his office notes and requesting that he complete the Physical Capacities Form. See id. at ¶ 18 and Exhibit "A" at 88. Although Dr. Yuan provided a copy of his notes, he did not complete the form. See id., Exhibit "A," at 97-100.

  Thereafter, Eileen Mayo, RN CCM, reviewed Plaintiff's file for Defendant. Ms. Mayo also called Dr. Yuan's office and received a return call from Pat Lampert, a registered nurse practitioner in Dr. Yuan's office. See id. at ¶ 20 and Exhibit "A" at 104-05. Ms. Lampert advised Ms. Mayo that Dr. Yuan did not complete forms outlining physical limitations and restrictions. See id.

  On December 21, 1998, Ms. Mayo wrote to Dr. Yuan summarizing her review: Page 5

 
Based on review of the available information and attempts to obtain further information from you, we have concluded that Ms. Casey would minimally be able to perform part-time work at a sedentary level. It is reasonable that she would require the ability to change positions, alternate sit/stand every half hour or so. It is also reasonable that she would be capable of a 20 hour/week at this level. If you disagree with the above, please forward your response within 14 days to my attention. Please include specific restrictions and limitations, and the basis for each. . . . If I do not hear from you ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.