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Baker v. Broadspire National Services

January 25, 2007

MARCIA BAKER, PLAINTIFF,
v.
BROADSPIRE NATIONAL SERVICES, INC., F/K/A KEMPER NATIONAL SERVICES, INC., ET AL., DEFENDANTS.



The opinion of the court was delivered by: William M. Skretny United States District Judge

DECISION AND ORDER

I. INTRODUCTION

In this action, Plaintiff Marcia Baker seeks to recover long term disability benefits under a group disability insurance policy sponsored by her former employer. Plaintiff asserts her claim pursuant to 29 U.S.C. § 1132(a)(1)(B), a provision of the Employee Retirement Income Security Act of 1974 ("ERISA"). Presently before this Court is Defendants' Motion for Summary Judgment.*fn1 For the reasons that follow, Defendants' Motion is granted.

II. BACKGROUND

The following facts are undisputed for purposes of the instant Motion. Plaintiff is a former Document Review Specialist for Defendant HSBC Bank, USA ("HSBC"). During her employment, Plaintiff was covered under a long term disability plan ("the Plan") sponsored by HSBC, issued by Defendant Lumbermens Mutual Casualty Insurance ("Lumbermens"), and administered by Defendant Broadspire Services, Inc. ("Broadspire") (collectively "Defendants"). (Defs' State., ¶ 4). In relevant part, the Plan provides that an eligible employee is entitled to benefits, if he can establish that he is "disabled," as that term is defined by the Plan. Specifically, the Plan states:

Disabled/Disability means our determination that a significant change in your physical or mental condition due to:

1. Accidental injury;

2. Sickness;

3. Mental Illness;

4. Substance Abuse; or

5. Pregnancy; began on or after your Coverage Effective Date and prevents you from performing, during the Benefit Qualifying Period and the following 12 months, the Essential Functions of your Regular Occupation or of a Reasonable Employment Option offered to you by the Employer, and as a result you are unable to earn more than 70% of your Pre-disability Monthly Income. After that, you must be so prevented from performing the Essential Functions of any Gainful Occupation that your training, education and experience would allow to perform.

(Defs' State., ¶ 5; Gerber Dec., Exh. C, p. 7). The Plan also vests Broadspire with the authority to:

1. Resolve all matters when a review has been requested;

2. Establish and enforce rules and procedures for the administration of the Group Policy and any claim under it;

3. Determine your eligibility for coverage; 4. Determine whether proof of your loss is satisfactory for receipt of benefit payments according to ...


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