The opinion of the court was delivered by: THOMAS PLATT, JR., Senior District Judge
Before this Court are two motions:
1. Citibank Long Term Disability Plan (the "LTD
Plan"), and Citibank Medical Plan, Citibank Flexible
Benefits Plan, Citibank Dental Plan, Citibank Life
Insurance Plan, Citibank Accident Insurance Plan, and
Citibank Retirement Plan ("Non-LTD Plans"),
(collectively "Defendants"), move for summary
judgment pursuant Fed.R. Civ. P. 56(c); and,
2. George Hachtel ("Plaintiff" or "Hachtel")
cross-moves for summary judgment pursuant to
Fed.R.Civ. P. 56(c).
For the following reasons, both Defendants' and Plaintiff's
motions are DENIED.
Prior to and including November 14, 1994, Plaintiff was
employed as a Systems Programmer in the Information Management
Systems at Citibank. (Defs. 3rd Amend. Rule 56.1 Statement at
¶¶ 23-4; Pl. 2nd Amend. Rule 56.1 Statement at ¶¶ 1-2).
Plaintiff was a covered participant of the LTD Plan by virtue of
his employment with Citibank. The LTD Plan is sponsored and
funded by Citibank and administered by Aetna Life Insurance
Company ("Aetna"). (Defs. 3rd Amend. Rule 56.1 Statement at
¶¶ 16-7; Green Aff., Exh. U). Aetna acts as the LTD Plan
administrator and fiduciary. (Id.) Both the LTD and Non-LTD
Plans are employee pension or welfare benefit plans subject to
the Employee Retirement Income Security Act of 1974 ("ERISA").
(Defs. 3rd Amend. Rule 56.1 Statement at ¶¶ 1-8).
Plaintiff alleges that on or about 1993, he developed a
flu-like illness which caused him to suffer severe sore throat
problems, extreme and debilitating exhaustion, lightheadedness
and dizziness. (Montas Aff., Exh. A at 2). In December of 1993, Plaintiff sought medical treatment for
these symptoms at his HMO medical center. Over the course of the
next year, Plaintiff was seen by several different types of
physicians in diverse areas of practice. (Montas Aff., Exh. A at
Plaintiff alleges that his condition subsequently worsened and
he began to suffer from constant fatigue, weakness and severe
cognitive impairments requiring him to sleep excessively and take
several sick days. Plaintiff's doctors informed him that he could
have chronic fatigue syndrome ("CFS") or major depression.
(Id.) In November of 1994, Plaintiff joined a support group for
CFS, wherein he learned about a specialist in this area by the
name of Dr. Susan Levine ("Dr. Levine"). (Id.) Plaintiff
consulted with Dr. Levine, and she diagnosed him with CFS and
prescribed a treatment regimen of medications and vitamin
injections. (Id.; Hachtel Dep. at 112, 114-5). Despite this
treatment, Plaintiff's symptoms continued to increase in severity
and on November 14, 1994, Plaintiff ceased working. (Montas Aff.,
Exh. A at 2; Hachtel Aff. at 77, 79-82, 126-7).
On November 17, 1994, Plaintiff was evaluated at an HMO medical
center by his own doctor, psychiatrist Dr. Deborah Pfeffer ("Dr.
Pfeffer"). (Defs. 3rd Amend. Rule 56.1 Statement at ¶ 31;
Bonner Aff. Exh. C). Dr. Pfeffer ruled out depression as the
cause of Plaintiff's symptoms and found that Plaintiff had CFS and Adjustment Disorder mixed with "emotional feelings."
Plaintiff notified Aetna of his condition and his absence from
work, indicating that he would first exhaust his sick days, then
his vacation days, as required by the Short Term Disability Plan
("STD Plan") and the LTD Plan. The LTD Plan provides benefits to
disabled employees beginning on the 181st day of disability,
after the employee has received coverage under the STD Plan.
Under the LTD Plan, "disability" is defined, in pertinent part,
a mental or physical condition which the Claims
Administrator/Fiduciary determines: (i) prevents the
Participant from performing each and every material
duty pertaining to his or her regular occupation (and
after 24 consecutive months of such condition
prevents the Participant from engaging in each and
every occupation or employment for wage or profit for
which Employee is reasonably qualified by reason of
education, training or experience or may reasonably
(Green Aff., Exh. A, "LTD Plan").
Likewise, the LTD Plan provides that a Claims
Administrator/Fiduciary may require the employee to undergo an
independent medical examination ("IME") by a doctor designated
by the LTD Plan. (Id.)
Aetna made a decision to deny certification of Plaintiff's
disability pending an IME by a specialist in infectious diseases.
(Defs. 3rd Amend. Rule 56.1 Statement at ¶¶ 26-7). Plaintiff underwent the IME in
December 1994. (Id. at 27; Bonner Aff., Exh. B). Dr. Arthur
Klein ("Dr. Klein"), who performed the IME, disagreed with the
diagnosis of CFS, but found Plaintiff was disabled due to
depression and headaches, secondary to chronic sinusitis. (Id.
at 28). Dr. Klein then recommended that Aetna certify Plaintiff's
disability pending evaluation by a neurologist and psychologist.
(Id. at 29). Following this evaluation, Aetna informed
Plaintiff that it would certify his disability until January 16,
1995. (Montas Aff., Exh. A at 4).
In February 1995, pursuant to Aetna's instructions, Plaintiff
was seen by a neurologist, Dr. Kristina Dahl ("Dr. Dahl"), who
diagnosed Plaintiff again with CFS as well as symptoms associated
with depression. (Bonner Aff., Exh. D). Dr. Dahl indicated that
Plaintiff remained disabled due to his physical and cognitive
disabilities. (Id.) The claim file contains notes from Aetna's
Medical Director, Dr. Joseph Pascuzzo ("Dr. Pascuzzo"), which
stated that no significant physical findings were noted in Dr.
Dahl's report. (Defs. 3rd Amend. Rule 56.1 Statement at ¶
34). Further, the cognitive defect could be on a medical or a
psychiatric level. (Id.) Aetna notified Plaintiff that it would
continue to certify his disability through March 3, 1995. (Id.
at ¶ 33).
On April 12, 1995, however, Aetna declined to certify
additional disability time for Plaintiff until he underwent additional
testing. (Id. at ¶ 45). Pursuant to this requirement, Plaintiff
met with an Aetna rehabilitation nurse, Arlene Mackey ("Nurse
Mackey"), so she could perform a Functional Capacity Evaluation
("FCE"). (Montas Aff., Exh. A at 7). Plaintiff, however, was too
weak to perform the FCE and Nurse Mackey relayed to Aetna that
Plaintiff was not capable of work due to his disability. (Id.)
Aetna then scheduled a medical examination for Plaintiff with a
neuropsychologist, Dr. Avraham Calev ("Dr. Calev"), in May 1995.
(Bonner Aff., Exh. E). Dr. Calev also found that Plaintiff
suffered from CFS and depression, although he made no finding
with regard to Plaintiff's disability. (Id.)
Plaintiff's entire file was then reviewed by one of Aetna's
in-house physicians, Dr. David Erickson ("Dr. Erickson"), who
recommended that Aetna certify the disability. (Montas Aff., Exh.
A at 10-11). Aetna suggested that Plaintiff begin rehabilitation
on June 16, 1995. (Defs. 3rd Amend. Rule 56.1 Statement at ¶
46). Plaintiff began such rehabilitation three times per week,
and Aetna again extended its certification until August 31, 1995.
Plaintiff continued his rehabilitation, and Dr. ...