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Tottey v. Life Insurance Co. of North America

February 18, 2009

JULIE TOTTEY, PLAINTIFF,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA A/K/A CIGNA GROUP INSURANCE, DEFENDANT.



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

MEMORANDUM-DECISION AND ORDER

I. INTRODUCTION

The Court conducted a bench trial to resolve this matter on September 17-18, 2007. At the commencement of the trial, the parties agreed that the only facts in dispute were (1) whether Plaintiff was entitled to long-term disability benefits under the Policy and (2) whether, as of May 4, 2005, Plaintiff was unable to perform all the material duties of any occupation for which she was reasonably qualified based on her education, training, and experience. Likewise, they agreed that the only issue of law for the Court to resolve was whether, as of May 4, 2005, Plaintiff was totally disabled within the meaning of the Plan requirements. Finally, the parties agreed that the standard of review in this case is de novo.

II. BACKGROUND

Plaintiff filed her complaint against Defendant on July 14, 2005. See Dkt. No. 1. Defendant is the long-term disability insurance benefits carrier for qualified Cornell University employees, and Plaintiff is a covered employee under this contract.

Plaintiff left her employment at Cornell University in October 2003 because of ongoing and chronic epilepsy complex seizures, a chronic seizure disorder, and numerous psychiatric disabilities resulting from her seizure disorder. Plaintiff received long-term disability benefits from Defendant for her disability from October 2003 through May 4, 2005.

On or about May 4, 2005, Defendant informed Plaintiff that Defendant no longer considered her disabled from her occupation under the definition of disability contained in the long-term disability policy, that Defendant was closing her insurance claim, and that Defendant would pay her no further benefits.

Plaintiff filed an internal appeal of the denial of her claim, which resulted in Defendant affirming its denial in a letter dated June 14, 2005. Plaintiff then filed this action seeking an order requiring Defendant to pay her all long-term disability benefits to which she was entitled under the Plan, together with interest from May 5, 2005, reinstating her medical insurance coverage, and awarding her attorney's fees.

After Defendant withdrew its motion for partial summary judgment, based on the parties' stipulation, the Court scheduled the trial of this matter. At trial, Plaintiff called the following witnesses: (1) Judy Jensvold, (2) Cheryl Littel, (3) Patricia Riddle, (4) Robert Tottey, (5) Julie Tottey, and (6) Dr. William Wittlin. She also provided the Court with the transcript, as well as the DVD, of the deposition of her neurologist, Dr. Anthony Ritaccio. Defendant called no witnesses to testify. Finally, the parties submitted Defendant's Long-Term Disability Administrative Record for the Court's review.

The following constitute the Court's findings of facts and conclusions of law as Rule 52(a) of the Federal Rules of Civil Procedure requires.

III. DISCUSSION

A. Findings of Fact

Having reviewed the witness' trial testimony, the deposition transcript of Dr. Ritaccio, and Defendant's Administrative Record, the Court makes the following findings of fact:

1. The testimony of Ms. Jensvold, Plaintiff's direct supervisor at Cornell University, and Ms. Littel, one of Plaintiff's co-workers, is irrelevant because neither of them had any knowledge of Plaintiff's condition in May 2005.

2. Ms. Riddle, Cornell University's Medical Leaves Administrator, had no involvement with Plaintiff's case between June 2004 when Plaintiff reversed its initial denial and May 2005. See Testimony of Patricia Riddle, Trial Transcript dated September 17, 2007 ("Riddle Tr. I") at 48-49.

3. In May 2005, Defendant contacted Ms. Riddle and told her that Defendant would be sending Plaintiff a letter closing her long term disability because Plaintiff had had surgery ...


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