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Robilotta v. Fleet Boston Financial Corp. Group Disability Income Plan

March 31, 2008


The opinion of the court was delivered by: Hurley, Senior District Judge


This action arises out of a claim by plaintiff Linda Robilotta ("Plaintiff" or "Robilotta") for long term disability benefits ("LTD benefits") under a Group Disability Income Policy ("Policy") issued by defendant Liberty Life Assurance Company ("Liberty") to Plaintiff's employer FleetBoston Financial Corporation ("Fleet") (Liberty and Fleet as collectively referred to as "Defendants"). The Policy funds the LTD benefits provided under an employee benefit plan established by Fleet and for which Fleet is the Plan Administrator. The Fleet plan and the benefits at issue are governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. Section 1001, et seq. After Liberty denied Plaintiff's claim for LTD benefits, Plaintiff commenced this action to recover those LTD benefits, together with attorneys' fees. Presently before the Court are Defendants' motion and Plaintiff's cross motion for summary judgment. For the reasons set forth below, Defendants' motion is granted and Plaintiff's cross-motion is denied.


The following material facts, drawn from the parties' summary judgment submissions, are undisputed unless otherwise noted.

The Parties

Plaintiff was born in December 1951 and resides in Nesconset, New York. At the time she stopped working in May 2001, Robilotta was employed by Fleet as a Branch Operations Supervisor at Fleet's Hauppauge, New York branch and was covered by the Policy. Fleet is the designated Plan Administrator and agent for service of process. Liberty is the insurer and claims administrator; it pays the benefits provided by the Policy.

The Policy and Summary Plan Description

The Policy provides that Liberty has discretion to interpret the Policy. It states:

Liberty shall possess the authority, in its sole discretion, to construe the terms of this policy and to determine benefit eligibility hereunder. Liberty decisions regarding construction of the terms of this policy and benefit eligibility shall be conclusive and binding. (Administrative Record ("AR") 401).

According to the Policy's Summary Plan Description (the "SPD"), employees of Fleet are entitled to a disability benefit equal to 40%, 50% or 60% of their annual base pre-(disability) salary, depending upon their benefit election. In Plaintiff's case, she elected coverage equal to 60% of her pre-disability income. (AR 374).

The SPD states that LTD benefits commence after the expiration of a 180-day Elimination Period, during which the employee must be totally or partially disabled. The Policy also contains a 180-day Elimination Period. (AR 377).

The SPD defines the terms "disability" and "disabled" as follows:

For Plan purposes, disability and disabled mean that because of injury or illness:

* During the first 24 months of benefits, you cannot perform each of the material substantial duties of your occupation as an active employee.

* After benefits have been paid for 24 months, you cannot perform with reasonable continuity, all of the material and substantial duties of your own or any occupation for which you are or become reasonably fitted by training, education, experience, age, and physical and mental capacity.

The Policy contains a similar, and functionally equivalent, definition of the terms "disability" and "disabled:"

"Disability" or Disabled" means:

1. For persons other than pilots, co-pilots, and crew of an aircraft:

I. If the Covered Person is eligible for the 24 Month Own Occupation Benefit, "Disability" or "Disabled" means during the Elimination Period and the next 24 months of Disability the Covered Person is unable to perform all of the material and substantial duties of his occupation on an Active Employment basis because of an Injury or Sickness; and

ii. After 24 months of benefits have been paid, the Covered Person is unable to perform, with reasonable continuity, all of the material and substantial duties of his own occupation or any other occupation for which he is or becomes fitted by training, education, experience, age and physical and mental capacity.

(AR 379-80).

Both the SPD and the Policy provide that LTD benefits continue to age sixty-five, if the disability commences before the claimant's sixtieth birthday. (AR 378).

Under the Policy, LTD benefits are reduced by the amount of disability benefits that a claimant receives, or is eligible to receive, from the Social Security Administration. (AR 388). The SPD actually requires a claimant to apply for Social Security disability benefits. According to the SPD, Liberty Life may provide assistance on Social Security disability claims to disabled Fleet employees:

Often, LTD recipients are not immediately accepted as disabled when applying for Social Security disability benefits. Because proper third-party representation throughout the LTD process greatly increases the chances of a Social Security disability award being made, Liberty may be available to aid LTD recipients at no cost. . . . If you are receiving LTD benefits and Social Security has not accepted you as disabled, Liberty may assist you in pursuing your Social Security claim. For assistance please contact your Liberty claims manager.

The SPD acknowledges that the Social Security Administration utilizes a different definition of "disability" than the LTD Plan:

Note: Because Social Security's definition of disability differs from Fleet's, many claimants entitled to benefits under the Fleet LTD Plan may not be eligible or immediately eligible for benefits from Social Security. . . .

With respect to the commencement of an action for benefits, the Policy provides, in pertinent part:

Legal Proceedings

A claimant or the claimant's authorized representative cannot start any legal action:

1. until 60 days after proof of claim has been given; nor

2. more than one year after the time proof of claim is required.

However, the SPD does not contain a limitation on a claimant's time to file a lawsuit to recover disability benefits.

Chronology of Events

Plaintiff has a history of right knee pain going back to 1997, and she underwent surgery on her right knee in 1998. (AR 352-70). In or about March of 2001, she began "experiencing some rather painful symptoms around the medial aspect of her right knee." (AR 352). On March 27, 2001, she was examined by Kevin G. Vesey, M.D., an orthopedic surgeon. According to Dr. Vesey's notes: "The patient states that she stands all the time now and is very active at work where as previously she had a much more sedentary position." Id. ...

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