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Black v. Pitney Bowes Inc.

August 26, 2008

JERROLD R. BLACK, PLAINTIFF,
v.
PITNEY BOWES INC., PITNEY BOWES INC. LONG-TERM DISABILITY PLAN, AND PITNEY BOWES INC. EMPLOYEE BENEFITS COMMITTEE, DEFENDANTS.



The opinion of the court was delivered by: Gerard E. Lynch, District Judge

OPINION AND ORDER

Plaintiff Jerrold Black brings this action pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001, et seq., challenging denials of disability benefits by defendant Pitney Bowes Inc., his employer, defendant Pitney Bowes Inc. Long-Term Disability Plan, its employee benefits plan, and defendant Employee Benefits Committee of Pitney Bowes, Inc., the plan administrator. Both sides move for summary judgment, or in the alternative, judgment on the administrative record. For the following reasons, plaintiff's motion will be granted in part and denied in part, and defendants' motion will be granted in part and denied in part.

BACKGROUND

I. Factual and Procedural History

On October 2, 2003, plaintiff Jerrold Black, who had been employed as a technician for defendant Pitney Bowes Inc. ("Pitney Bowes") for over 25 years, stopped working and sought short-term disability ("STD") benefits from his employer, pursuant to its short-term disability policy (the "STD Policy" or the "Policy"). (STD Adm. Rec. 34, 56-57.*fn1 ) Black's claim was accompanied by a diagnosis from his primary care physician, Dr. Matthew Miller, who reported that Black suffered from "anxiety" and "depression" that prevented Black from being able to "perform his job currently." (Id. 34.) Black's application was evaluated by ValueOptions, a company engaged by Pitney Bowes, which in turn retained Dr. Gabrielle Stutman, a psychologist, to assess Black's condition.*fn2 (Pl. R. 56.1 Statement ¶ 3.) On October 21, ValueOptions reviewed Dr. Miller's diagnosis and Dr. Stutman's assessment and recommended STD benefits for two weeks in addition to the three weeks that had passed since Black had stopped working. (Id. 47) Pitney Bowes accepted this recommendation and approved short-term disability benefits through November 5, 2003. (Id. 31.)

On November 10, ValueOptions recommended rejecting Black's request to extend his disability benefits period, and Pitney Bowes accepted that recommendation as well. (Id. 32, 33, 48.) Black appealed this decision, supported by another letter from Dr. Miller as well as a letter from his dentist. (Id. 49, 50-51, 52.) Pitney Bowes denied the appeal, contending that Black's "level of anxiety does not support extension" of benefits. (Id. 49, 53.)

A year later, in November 2004, Black applied for long-term disability ("LTD") benefits pursuant to the Pitney Bowes Inc. Long-Term Disability Plan (the "LTD Plan" or the "Plan"). (LTD Adm. Rec. 158-59.) Black's application for LTD benefits included a diagnosis from Dr. Neil Berliner, a psychiatrist, that Black suffered from a "panic disorder," that he was "unable to work because of this disability," and that it was uncertain when he would be "able to perform usual work." (Id. 160.) Black also submitted a third letter from Dr. Miller, stating that Black was "currently totally disabled from work," and that it was uncertain "when or if he will be able to return to work." (Id. 96.) Finding that Black's symptoms "do not meet the definition of disability," Pitney Bowes denied Black's application. (Id. 87, 88.)

In June 2005, Black appealed this decision, submitting all the materials he had previously submitted, plus a letter from the Social Security Administration advising Black that he had been found eligible for Social Security disability benefits, and a report from Dr. Berliner recommending "continuation of current treatment and long term disability." (Id. 92, 102, 103, 104.) In response, Pitney Bowes requested additional information from Black and asked that he submit to an independent medical examination ("IME"). (Id. 185.) Black refused to provide the additional information or to submit to an IME (id. 192), and he refused again upon Pitney Bowes's renewal of the request (id. 195-96, 198).

Black's appeal was considered by defendant Pitney Bowes Inc. Employee Benefits Committee (the "Employee Benefits Committee" or the "Committee"), the administrator of the LTD Plan. (Id. 208-14.) The Committee denied the appeal, finding that Black's failure to consent to the IME and to provide additional requested information gave rise to a "procedural ground for denial of benefits," and that Black in any event had failed to provide "sufficient objective evidence" that he was disabled. (Id. 212-13.)

Black sued, seeking review and reversal of these decisions.*fn3 Both sides move for summary judgment or, in the alternative, judgment on the administrative record.

II. The Short-Term Disability Policy

The STD Policy provides that a disabled employee is entitled to a percentage of his normal pay for up to twenty-two weeks. (STD Adm Rec. 5, 10.) An employee is considered "disabled" if he suffers "a non-occupational mental or physical injury or illness which renders the Employee unable to perform the material duties of his or her own job." (Id. 5.) To initiate a claim for benefits, an employee must provide "objective medical evidence" of the "extent and nature of the Disability." (Id. 12.) In addition to such evidence, an employee is required "to submit whatever proof the Company may require . . . , including the statements of one or more duly qualified physicians or clinical psychologists." (Id.) An employee must submit to a "medical or psychological examination or evaluation" as required by Pitney Bowes. (Id. 14.)

In evaluating claims for STD benefits, Pitney Bowes is empowered to "interpret and construe the terms and provisions of the Policy, to apply such terms and provisions . . . , [and] to determine questions of eligibility and of the status and rights of Employees." (Id. 16.) The Policy provides that Connecticut law governs its construction. (Id. 19.)

III. The Long-Term Disability Plan

The LTD Plan provides that a disabled employee is entitled to a percentage of his normal pay until that employee is no longer disabled, retires, or dies. (LTD Adm. Rec. 13-14.) An employee is considered disabled during the first twelve months of receiving benefits if he is unable "to perform the material duties of his or her own occupation," and he is considered disabled beyond that point if he is "unable . . . to engage in any gainful occupation or profession for which he is, or could become, reasonably suited by education, experience, or training." (Id. 11.)

In order to substantiate a claim for disability, an employee must "submit initially and from time to time whatever proof or documentation the Disability Department*fn4 may require . . . , including the medical records and medical analysis of one or more duly qualified physicians or clinical psychologists." (Id. 18.) In addition, as a "condition to the payment of benefits . . . , the Disability Department shall have the right to direct such employee to submit from time ...


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