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Graham v. First Reliance Standard Life Insurance Co.

July 31, 2007


The opinion of the court was delivered by: Naomi Reice Buchwald United States District Judge


Donald Graham ("plaintiff" or "Graham"), a 67 year old man with Parkinson's Disease, brings this action against First Reliance Standard Affirmative Life Insurance Company ("First Reliance") and Penn Maritime Group Long Term Disability Insurance Plan (collectively, "defendants") to challenge the denial of disability pension benefits under an employee benefit plan governed by the Employment Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. Graham contends that he was "totally disabled" at the time he ended his employment with Penn Maritime, Inc. ("Penn Maritime") on October 30, 1999, and thus is entitled to Long Term Disability plan benefits.

After defendants' earlier motion for summary judgment was denied on August 10, 2006, Graham v. First Reliance Standard Life Ins. Co., No. 04 Civ. 9797 (NRB), 2006 WL 2372244, at *1 (S.D.N.Y. Aug. 10, 2006), plaintiff moved to expand the administrative record. Based on plaintiff's three previous opportunities to expand the record during his administrative review prior to this litigation, we found an absence of good cause and denied plaintiff's motion on November 22, 2006. Graham v. First Reliance Standard Life Ins. Co., No. 04 Civ. 9797 (NRB), 2006 WL 3408548 (S.D.N.Y. Nov. 22, 2006). Plaintiff now moves for a judgment on the merits.*fn1 For the reasons below, we find in favor of the defendants.


I. Legal Framework

A. Standard of Review

A court's review of a decision to deny a claimant disability benefits is de novo "unless the benefit plan gives the administrator . . . discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). As First Reliance has not argued that it possessed any discretionary authority, our review of the record will be de novo. See Kinstler v. First Reliance Standard Life Ins. Co., 181 F.3d 243, 249 (2d Cir. 1999) ("The plan administrator bears the burden of proving that the arbitrary and capricious standard of review applies, since the party claiming deferential review should prove the predicate that justifies it.") (internal quotation omitted).

B. Burden of Proof

Plaintiff bears the burden of proving that he is totally disabled within the meaning of the plan by a preponderance of the evidence. Paese v. Hartford Life Accident Ins. Co., 449 F.3d 435, 441 (2d Cir. 2006). To qualify for Penn Maritime's Long Term Disability ("LTD") plan benefits, plaintiff's "[i]njury or [s]ickness" must render him unable to "perform the material duties of [his] regular occupation" during the Elimination Period (a period of 180 consecutive days, starting on the first day of disability claimed, during which no benefit is payable under the plan) and the first 60 months thereafter during which a monthly benefit is payable. AR 150-51. Even if a worker "is capable of only performing the material duties on a part-time basis or part of the material duties on a full-time basis," he is still considered totally disabled and hence qualified for LTD.*fn3 Id. Thus, in order to meet his burden, plaintiff must present evidence that he suffered symptoms from his Parkinson's Disease which rendered him incapable of performing the material elements of his job since October 29, 1999, the day he ended his employment with Penn Maritime.

We will first review the physicians' opinions found in the record. We will then turn to evidence of specific functional limitations. Finally, we will discuss plaintiff's objections to First Reliance's reviews of his claim.

C. Evaluating Treating Physicians' Opinions

Although plan administrators cannot arbitrarily refuse to credit a claimant's reliable evidence, including the opinions of a treating physician, "courts have no warrant to require administrators automatically to accord special weight to the opinions of claimant's physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation." Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003). In fact, a court may "evaluate [a treating physician's] opinion in the context of any factors it considers relevant, such as the length and nature of their relationship, the level of the doctor's expertise, and the compatibility of the opinion with the other evidence." Connors v. Connecticut General Life Ins. Co., 272 F.3d 127, 135 (2d Cir. 2001). A physician's opinion is more credible when supported by medical and vocational evidence of contemporaneous functional limitations. Thus, we will consider the treating physicians' opinions by taking into account the degree to which they are supported by other evidence in the record.

II. Evidence in the Record

A. Requirements of Plaintiff's Job

Graham served as a Chartering Representative at Penn Maritime for 35 years until October 29, 1999, AR 348, scheduling vessels for fueling and transport of supplies. AR 130. The entry for plaintiff's job in the Dictionary of Occupational Titles ("DOT")*fn4 lists his duties as including "[d]etermin[ing] the number and kind of barges and lighters needed to transport cargo," "[c]oordinat[ing] movement of vessels to ensure most efficient service," "[a]assign[ing] barges and lighters to individual haulage jobs and issu[ing] orders to [tugboat captains]," and "[c]ompil[ing] or direct[ing] activities of workers engaged in compilation of periodic reports on freight tonnage transported and cost of operations." AR 132. He occasionally was required to lift up to 10 pounds and frequently had to lift "negligible" amounts of weight. AR 133. According to the DOT Occupational Requirements of Graham's job, while the general learning aptitude and verbal aptitude demanded were frequently relatively high (67-89 percent, or 2 out of 5 on the DOT scale), the levels of motor coordination and finger dexterity required were low (10-33 percent, or 4 out of 5 on the DOT scale), and the necessary levels of manual dexterity and eye-hand-foot coordination were very low (below 10 percent, or 5 out of 5 on the DOT scale). Id. According to Graham's office manager, Graham's job's physical requirements included continuous sitting and occasional walking, standing, stooping, kneeling, crouching, and reaching ...

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