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.

Russo v. Continental Casualty Company

April 11, 2006

DANIEL RUSSO, PETITIONER,
v.
CONTINENTAL CASUALTY COMPANY, SHORT TERM DISABILITY PLAN FOR EMPLOYEES OF ESTEE LAUDER, LONG TERM DISABILITY PLAN FOR EMPLOYEES OF ESTEE LAUDER, BASIC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR EMPLOYEES OF ESTEE LAUDER, AND VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR EMPLOYEES OF ESTEE LAUDER, RESPONDENT.



The opinion of the court was delivered by: Hon. Harold Baer, Jr., District Judge

OPINION & ORDER

On June 20, 2005, plaintiff, Daniel Russo, filed this action against above-named defendants, Continental Casualty Company ("CNA"), Short Term Disability Plan ("STD"), Long Term Disability Plan ("LTD"), Basic Accidental Death and Dismemberment Plan ("Basic AD&D"), and Voluntary Accidental Death and Dismemberment Plan ("Voluntary AD&D ") (collectively "Estee Lauder Plans"). In that complaint, plaintiff alleges that defendants wrongfully denied him disability benefits. Defendants move for summary judgment. For the reasons set forth below, the motion for summary judgment is GRANTED as to all defendants.

I. BACKGROUND

Plaintiff, Daniel Russo, began employment with Estee Lauder Companies as the manager of retail accounting around July 1997. He was terminated from his job on January 9, 2003 but continued to receive paychecks until on or about February 13, 2003.*fn1 On approximately June 2, 2003, Continental Casualty Company ("CNA"), the administrator of the Plan, received a claim for long term disability benefits from the plaintiff. The plaintiff's basis for coverage was, inter alia, his underlying metastatic colon cancer.*fn2

By letter dated September 12, 2003, CNA denied plaintiff's claim for long term disability benefits having found that plaintiff was ineligible since his last day of work was January 9, 2003 and under the plan, you must be employed to participate. Plaintiff appealed CNA's denial by letter dated September 17, 2003. As requested, he submitted written opinions from his treating physicians in order to establish his date of disability as being October 2002, prior to his termination from Estee Lauder. In a letter to the plaintiff, the administrator wrote that plaintiff was not eligible to receive benefits under the plan as his medical documentation failed to establish he was totally disabled at the time he was terminated on January 9, 2003.

A. Estee Lauder Disability Plans

Estee Lauder is the sponsor of the employee welfare benefit plans --Short Term Disability Plan ("STD"), Long Term Disability Plan ("LTD"), Basic Accidental Death and Dismemberment Plan ("Basic AD&D"),*fn3 and Voluntary Accidental Death and Dismemberment Plan ("Voluntary AD&D ")*fn4 (collectively "Estee Lauder Plans") -- at issue in this case. All plans are governed by the Employee Retirement Income Security Act of 1974 ("ERISA") and are fully insured and administered by defendant CNA. These plans confer upon CNA "the sole discretionary authority to determine [plan participants'] eligibility for benefits and to interpret the terms and provisions of the policy." Exhibit "B" to Troxell Affidavit ("Troxell Aff."), RUSSO 000047. Here, the plaintiff asserts claims for disability benefits under the LTD Plan and continuing coverage under the AD&D and Voluntary AD&D Plans.*fn5

Pursuant to the terms of the LTD Plan, CNA, the claims administrator, first determines if the employee is eligible for coverage then ascertains whether the employee satisfies the "total disability" standard under the Plan. Eligible employees are defined as:

All active, regular full time exempt and non-exempt employees including in-store employees.

Active, regular full time means an employee who works at least 30 hours per week . . . Part time, temporary or seasonal employees are not eligible. Exh. "A" to Troxbell Aff., RUSSO 00009.

The LTD Plan defines "total disability" for purposes of a LTD benefit claim as the inability to do the following for six continuous months due to injury or sickness:

1. Continuously unable to perform the substantial and material duties of the employee's regular occupation,

2. Under the care of a licensed physician, and

3. Not gainfully employed in any occupation for which the employee is or becomes qualified by education, training or experience. Exh. ...


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.