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Mustico v. Continental Casualty Co.

September 25, 2009

KATHLEEN M. MUSTICO, PLAINTIFF,
v.
CONTINENTAL CASUALTY COMPANY D/B/A CNA, AND HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, DEFENDANTS.



The opinion of the court was delivered by: Michael A. Telesca United States District Judge

DECISION and ORDER

INTRODUCTION

Plaintiff Kathleen Mustico ("Mustico") brings this action pursuant to the Employee Retirement and Income Security Act of 1974 claiming that she was wrongfully denied long term disability benefits by the defendants, Continental Casualty Company, ("Continental") and Hartford Life and Accident Insurance Company ("Hartford"). Specifically, plaintiff claims that while she was covered by a long term disability insurance plan issued by Continental and administered by Hartford, she became completely disabled following an automobile accident. She claims that the defendants wrongfully denied her claim for benefits.

The defendants deny plaintiff's allegations, and move for summary judgment on grounds that there are no material questions of fact in dispute, and that as a matter of law, they are entitled to judgment in their favor. In support of their motion, defendants contend that their decision to deny plaintiff benefits was based on a reasonable interpretation of the medical evidence available to them and that the decision is supported by substantial evidence contained in the record. Plaintiff opposes the defendants' motion, and cross-moves for summary judgment arguing that the medical evidence demonstrates that she is totally disabled.

For the reasons set forth below, I grant defendants' motion for summary judgment, and deny plaintiff's cross-motion for summary judgment.

BACKGROUND

I. Medical Background

On June 19, 2000, plaintiff Kathleen Mustico became employed as an executive assistant by the Chemung County, New York, ARC, (the "ARC of Chemung County" or "Chemung County ARC") an advocacy organization for persons with developmental disabilities. As an executive assistant, plaintiff was responsible for providing administrative support to the Director of the organization and its Board of Directors.

On January 2, 2001, plaintiff was involved in a motor vehicle accident. Plaintiff was wearing a seatbelt at the time of the accident, did not lose consciousness during or after the accident, and her airbag did not deploy. Following the accident, plaintiff sought treatment at a local hospital emergency room. According to the emergency room report, plaintiff complained of neck pain, but exhibited no bruising, swelling or redness. X-rays revealed degenerative changes in her cervical spine, but no changes due to trauma. She did show signs of a bruise in her chest area. Plaintiff was discharged from the emergency room with no work restrictions.

Thereafter, on January 5, 2001, plaintiff attempted to return to work, but was unable to remain there more than three or four hours due to discomfort caused by back and neck pain. Plaintiff never returned to work after January 5, 2001, and on April 2, 2001, her employment with the Chemung County ARC was terminated.

On February 14, 2001, plaintiff went to the emergency room of Arnot Ogden Medical Center complaining of dizziness, neck pain, and headaches. Dr. Naber examined the plaintiff, and noted that she had some discomfort in her neck. A CT scan of plaintiff's neck and back again revealed degenerative changes, but no changes due to traumatic injury. Plaintiff was discharged from the emergency room with no work restrictions.

In March, 2001, plaintiff saw a neurologist, Dr. Bhat, who opined that plaintiff suffered from whiplash and considerable musculo-ligamentous injuries. He did not, however, place plaintiff on any work restrictions. Shortly thereafter, plaintiff saw Dr. Madden, a pain specialist. Dr. Madden noted that plaintiff complained of dizziness, weakness, insomnia, and numbness which pre-dated her January, 2001, motor vehicle accident. Indeed, an MRI of her lumbar spine taken in November, 2000 (two months prior to her motor vehicle accident) revealed early disc desiccation and mild bulging at discs L3-4 and L2-3. Dr. Madden diagnosed plaintiff as suffering from several chronic conditions including chronic fibromyalgia, headaches, pain syndrome, and neck and back pain. Despite these conditions, Dr. Madden did not place any work restrictions on the plaintiff that would prevent her from performing her job as an administrative assistant.

Also in March, 2001, plaintiff saw Dr. Pilcher, a neurosurgeon, who noted that MRI's of plaintiff's cervical spine revealed bulging a C4-5, C5-6, and C6-7. He opined that there was no compression or narrowing at these locations, and that plaintiff had "excellent" range of motion in her cervical and lumbar spines. Dr. Pilcher noted no disc herniation, and did not recommend surgery. He placed no work restrictions on the plaintiff that would prevent her from performing her duties as an executive assistant, which consisted of secretarial duties. Following further imaging of plaintiff's neck and back, plaintiff again saw Dr. Pilcher on May 18, 2001. He noted minimal degenerative changes in the cervical spine, with minor bulging at C5-6. He also noted minor bulging in two areas of the lumbar spine. He opined that plaintiff suffered from severe musculoskeletal pain after the January, 2001 automobile accident, but did not recommend surgical intervention. He placed no restrictions on plaintiff that would prevent her from working as an executive assistant.

Another pain management specialist, Dr. Hong, saw the plaintiff on June 6, June 11, and June 26, 2001. Dr. Hong noted normal neck movement, but weakness in her extremities due to pain. He diagnosed her as suffering from, inter alia, myofascial pain syndrome and cervical degenerative disc disease. He did not ...


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