The opinion of the court was delivered by: Michael A. Telesca United States District Judge
Plaintiff Tammy Morse ("plaintiff" and/or "Morse"), former employee of Corning Incorporated brings this action against the defendant Corning Incorporated Pension Plan For Hourly Employees ("defendant" and/or "Corning") pursuant to the Employee Retirement Income Security Act ("ERISA") claiming that the defendant wrongfully denied her application for total and permanent disability benefits.
Defendant moves pursuant to Rule 56 of the Federal Rules of Civil Procedure for summary judgment on grounds that the Plan Administrator's decision to deny benefits was neither arbitrary nor capricious and thus, the decision is entitled to deference from the Court. Plaintiff cross-moves for summary judgment.
Plaintiff's complaint alleges a violation of ERISA in connection with the defendant's decision to deny plaintiff disability benefits under the Corning Pension Plan for Hourly Employees (the "Plan"). Under the Plan, Corning provides a disability pension to employees who become totally and permanently disabled ("TPD benefits"). On June 12, 2006, Corning filed a motion for summary judgment against Morse. On August 3, 2003, Morse filed a cross motion for summary judgment.
A. Corning's Pension Plan
The Plan provides pension benefits to retired Corning employees and TPD benefits to those employees who can satisfy the eligibility requirements. Article 4.3 of the Plan states that an employee is deemed to be totally and permanently disabled "when on the basis of medical evidence satisfactory to the Pension Committee he is found to be unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or to be of long, continued and indefinite duration."
Article 5.9 of the Plan states that the Pension Committee has "the discretion to ... determine all questions relating to ... the eligibility of persons to receive benefits hereunder." Corning states that the Pension Committee was subsequently renamed the Benefits Committee under an amendment to the Plan. Plaintiff however, argues that the amendment merely indicates "that there is hereby created a Benefits Committee" and the Plan does not state that the Pension Committee was renamed the Benefits Committee. Moreover, the Summary Plan Description ("SPD") states that "[t]he plan administrator has been delegated exclusive authority to review and administer benefit claims appeals. The plan administrator has the right to interpret the provisions of the plan and the administrator's decisions are final and conclusive." The SPD also states that the plan administrators for all of Corning benefit plans "have the complete authority, in their sole and absolute discretion,... to decide the eligibility for, and the extent of, benefits under the Plans..."
Article 5.12(b) of the Plan states that "named fiduciaries ... shall have the right to designate persons other than named fiduciaries to carry out fiduciary responsibilities ... under the Plan." On July 13, 2001, the Benefits Committee unanimously approved the delegation of its duties as claims administrator for TPD benefits under the Plan to CORE, INC. ("CORE"). CORE's duties as claims administrator were performed by its Peer Review Analysis ("PRA") division. Corning claims that on October 10, 2002, MCMC, LLC ("MCMC") acquired PRA from CORE and became the Plan's claim administrator for TPD benefits. Plaintiff argues that absent a specific delegation in accordance with the underlying Plan documents by the Benefits Committee, not CORE, all determinations made by MCMC are subject to de novo review.
The amendment to the Standard Services Agreement ("SSA") entered into between Corning and CORE dated January 1, 2002 provides that, "CORE hereby agrees to act as fiduciary under the specific employer Plan...,to make findings of fact, and to decide all issues presented. It is intended that, in carrying out its duties under the preceding sentence, CORE will have complete and Unfettered discretion, and that any determination ... by CORE may be reversed or overruled ... only if such determination ... is arbitrary and capricious. The independent specialist physician(s) will be selected by CORE. Such physician(s) will be employed by, or under contract with, CORE... C. The independent specialist(s) ... will review documentation received with the case... F. Should additional information be needed, CORE's reviewer may contact the patient's provider to request the additional information where CORE considers such information necessary or potentially useful... G. The independent specialist(s)... will review available medical records, will review any additional information obtained from patient's provider, and will write an independent rationale in support of his/her final decision... H. A determination letter will be written and mailed by CORE to the Plan participant or beneficiary. The letter will include the final decision, the specific reasons for the final decision written in a manner calculated to be understood by the claimant, as well as specific references to any Plan provisions on which the decision is based...."*fn1
B. Denial of Morse's Application
Corning employed Morse from March 1979 through November 21, 2003 as a Material Control Operator. In connection with her employment, Morse is a participant in the Plan. Morse submitted a Statement of Claim for Total and Permanent Disability Benefits dated March 17, 2004 ("Statement of Claim") to Corning. In her Statement of Claim, Morse indicated that she stopped working on November 21, 2003, the same day she claims she became totally disabled and unable to work. Further, Morse stated that she was being treated by Dr. Richard Kowalski. Other than stating she had an "illness," Morse did not identify her disability in her application. However, Morse's application included an Attending Physician's Statement of Functional Capacity signed by Dr. Kowalski and Linda Riner, a Social Worker indicating that Morse had decreased energy and "difficulty focusing [and] concentrating" and that she was unable to work "due to mental health diagnosis."
The report further showed that based on the physician's findings according to the DMS-III multiaxial classification, plaintiff's primary diagnosis was bipolar II disorder (269.89) and secondary diagnoses were panic disorder without agoraphobia (300.01) and depressive disorder NOS (311). Alcohol dependence (303.90) was stated to be in "remission." The report concluded that Morse was totally disabled from any occupation and that she would never be able to resume work activities. Furthermore, Morse wrote in a personal profile accompanying her application that she was taking Prozac (40 mg per day), Risperdal (10 mg per day), and Buspar (10 mg twice per day).
MCMC assigned Dr. Jean Dalpe, a board certified psychiatrist and neurologist, to determine whether Morse qualified for TPD benefits under the Plan. Dr. Dalpe prepared a case report dated April 2, 2004 in which he listed the materials he reviewed and stated that he spoke to Dr. Kowalski as part of his review. In the section of his report entitled "Clinical Summary," Dr. Dalpe stated that Morse was diagnosed with "Major Depressive Disorder, recurrent in remission, Panic Disorder without agoraphobia, and Alcohol Dependence."*fn2 Dr. Dalpe reported that Dr. Kowalski informed him that he had been seeing Morse for those conditions since 2001 and that Morse was also being treated by Ms. Riner. In addition, Dr. Dalpe asked Dr. Kowalski why Morse stopped working and quoting from his notes, Dr. Kowalski replied that she has a "continued conflict with [her] superiors at work" and "is angry, feels attacked" and was "concerned about how she is treated on the job." Dr. Dalpe also noted that "[t]he only disabling symptoms [Dr. Kowalski] cited were that Morse 'can't concentrate and now [had] more anxiety attacks.'"
Dr. Dalpe concluded that Morse was not eligible for TPD benefits because there was "no medical justification" for her alleged disability.
He further noted that there was no "medical documentation" showing that Morse had any "functional incapacity" and her anxiety appeared to be solely the result of conflict with her supervisor. As a result, MCMC advised Morse that her application for TPD benefits was denied since "there was no medical documentation provided that would indicate functional incapacity" and there was "no medical justification" for the disability. Plaintiff argues that although Dr. Dalpe's report contains no such conclusions, the denial letter asserts "there is residual work capacity to perform any substantial work activities." Defendant concedes that Dr. Dalpe did ...