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Maureen A.Reinhart v. Broadspire Services

July 27, 2011

MAUREEN A.REINHART, PLAINTIFF,
v.
BROADSPIRE SERVICES, INC., AND HSBC BANK USA A/K/A HSBC BANK USA LONG TERM DISABILITY PLAN, DEFENDANTS.



The opinion of the court was delivered by: William M. Skretny Chief Judge United States District Court

DECISION AND ORDER

I. INTRODUCTION

Plaintiff, Maureen Reinhart, seeks to recover long-term disability benefits under HSBC Bank's Long-Term Disability Plan ("the Plan"). The Plan is insured by Lumbermens Mutual Casualty Company ("Lumbermens") and administered by Broadspire Services Inc. ("Broadspire").*fn1 It is governed by 29 U.S.C. §§ 1001, et seq., the Employee Retirement Income Security Act of 1974 ("ERISA"). Plaintiff asserts claims for benefits and declaratory relief pursuant to 29 U.S.C. § 1132(a)(1)(B), for penalty fees under 29 U.S.C. § 1024(b)(4), and for attorney's fees pursuant to 29 U.S.C. § 1132(g), which are all sections of ERISA. Presently before this Court are Plaintiff's and Defendants' dueling Motions for Summary Judgment.*fn2 *fn3 For the following reasons, Plaintiff's motion is denied and Defendants' motion is granted.

II. BACKGROUND*fn4

Plaintiff began working for Defendant HSBC Bank, USA ("HSBC") as a systems analyst in 1989. (Defendants' Statement of Facts ¶ 2, Docket No. 26.) During her employment, Plaintiff was covered under the Plan, which was insured through a Group Insurance Policy ("the Policy") that was issued to HSBC by Lumbermens. (Defendants' Statement of Facts ¶ 4.) For the first year of disability, the Policy provides long-term benefits to covered HSBC employees who are prevented from performing the "essential functions of [their] regular occupation." (Defendants' Statement of Facts ¶ 7; AR 1004.) This is referred to as the "own occupation" standard. (Id.)*fn5 Pursuant to the Policy, an eligible employee who, because of a physical or mental disability, is unable to perform the duties of their own occupation will be entitled to benefits for a period of one year. (Id.) To continue receiving long-term disability benefits after the "own occupation" period expires, the employee must then be unable to perform the essential functions of "any gainful occupation that [their] training, education, and experience would allow [them] to perform." (Id.) This is the "any occupation" standard. (Defendants' Statement of Facts ¶ 11.)

There is no dispute that Plaintiff has a history of suffering from two disabilities: "relapsing-remitting" multiple sclerosis*fn6 ("MS") and depression. (AR 5, 205.) Although it is unclear which of these disabilities caused her to stop working initially, it is clear that her employment with HSBC ended in November of 2000. (Plaintiff's Statement of Facts ¶ 3, Docket No. 23-3.) She immediately began to receive short-term benefits under the Plan's "own occupation" standard. (Plaintiff's Statement of Facts ¶ 4.) On May 14, 2001, Plaintiff began to receive long-term disability benefits due to symptoms of depression. (Defendants' Statement of Facts ¶ 10; AR 5.) Then, in May of 2003, as Plaintiff's record was reviewed and updated to account for her MS, Broadspire granted her long-term benefits under the "any occupation" standard. (AR 208.)*fn7 It is these benefits, which Plaintiff received due to her MS and which were eventually terminated, that are in dispute.

In making the determination to grant Plaintiff long-term benefits initially, Broadspire solicited neurologist, Dr. Gerald Goldberg, to evaluate Plaintiff's records. After reviewing various documents, including MRI's and evaluation notes from Plaintiff's attending physician, Dr. Goldberg concluded that Plaintiff's impairments precluded her from work under the "any occupation" standard. Leading to this conclusion, he found that the record demonstrated that Plaintiff suffered from "fluctuating enhancing lesions," "cognitive disturbances," "fatigue," and "severe defects" in processing speed and new learning.

Plaintiff continued to receive these long-term disability benefits when, in April of 2004, Broadspire informed her that it needed "to certify [her] continued eligibility for benefits." (AR 239.) According to Broadspire, this was part of a standard, periodic review. (Id.) Broadspire also requested a statement from Dr. Weinstock-Guttman, Plaintiff's attending neurological physician, asking her to explain Plaintiff's health status and her capability to work. (Defendants' Statement of Facts ¶ 16.) Complying with this request, Dr. Weinstock-Guttman indicated that Plaintiff suffered from MS and that she could not return to work due to several symptoms of this disease, including: hyperreflexia,*fn8 ocular dysmetria,*fn9 ataxia,*fn10 depression, and cognitive impairment. Id.

As part of this periodic review, Broadspire solicited Dr. Vaughn Cohen, a neurologist, to conduct a peer review of Plaintiff's file. (AR 261-62.)*fn11 Dr. Cohen considered three documents: the statement from Dr. Weinstock-Guttman, the results of a January 22, 2004 neurological exam performed by Dr.Weinstock-Guttman, and a MRI from May of 2004. (Id.) In his review, Dr. Cohen noted that the records submitted by Plaintiff indicated that her health had substantially improved. He highlighted several factors: (1) Plaintiff felt much stronger after a course of Novantrone therapy; (2) speech was normal; (3) visual acuity was 20/25; and (4) Plaintiff could walk without assistance. (Id.) Most importantly, Dr. Cohen found no evidence in the January neurological exam to support Dr. Weinstock-Guttman's determination that Plaintiff could not return to work due to hyperreflexia, ocular dysmetria, ataxia, depression, and cognitive impairment. (Id.) He wrote:

There would be no reason that the claimant could not work due to hyperrflexia or ocular dysmetria. The claimant's ataxia is described as mild, and she is independently ambulatory. Although she is said to have mild cognitive impairment, this impairment is not described in any detail. The claimant is described as awake alert and oriented. There is no description of depression, and there is no report from Behavioral Health Clinicians.

(Id.)

Dr. Cohen concluded that the record failed to "support functional impairments that preclude work." (Id.) With this, Broadspire sent a letter dated November 16, 2004, informing Plaintiff that the evidence did not support her disability claim. Instead of terminating Plaintiff's benefits, however, Broadspire instructed Plaintiff to submit any additional medical documentation that could bolster her claim. (AR 282.) Accordingly, Plaintiff sent Broadspire records that demonstrated she was hospitalized for vertigo, a complication due to multiple sclerosis, in the summer of 2004. (AR 282, 350.) Also, by letter dated December 8, 2004, Dr. Weinstock-Guttman stated that Plaintiff suffered from "very active and aggressive" multiple sclerosis, which caused blurred vision, double vision, pain behind her eyes, depression, insomnia, and disabling fatigue. (AR 288.) She concluded that "nobody could work under these circumstances." (Id.)

Accounting for the new information, Broadspire once again asked Dr. Cohen to review the record and determine whether Plaintiff was too disabled for employment. (AR 349-51.) This time Dr. Cohen reviewed seven documents: four neurological evaluations performed by Dr. Weinstock-Guttman in 2004, the letter from Dr. Weinstock-Guttman, a letter from Plaintiff, and his own peer review evaluation from July 2004. (Id.) Dr. Cohen again determined that the submitted documentation did not support a finding that her disability prevented her from working. (Id.) He noted that Plaintiff had fully recovered from the flare-up that resulted in her hospitalization in the summer and he emphasized that Plaintiff believed that she was getting stronger. He also noted that Dr. Guttman reported in November that she was "reportedly doing well with no clear-cut problems." (Id.) Dr. Cohen concluded, "While she may have been temporarily disabled from work during [the] period of time [of the hospitalization] and for a period thereafter, nonetheless it certainly appears that she had a full recovery from that exacerbation and that her multiple sclerosis is[,] as recently as November 2004, relatively quiescent." (Id.)

Broadspire also conducted an "employability assessment." (AR 324.). Accounting for Plaintiff's disability, education, work history, and salary requirements, the purpose of the assessment was to search for an appropriate job in her geographical area. Chau NgyuyenTruong, who performed the test for Broadspire, concluded that there were several local jobs that Plaintiff could perform and that also fit her skill-set, including positions as a software engineer and a manager of computer operations. (AR 324-28.)

In light of these findings, Broadspire terminated Plaintiff's disability benefits, effective February 1, 2005. (AR 373-76.) In June 2005, Plaintiff took advantage of Broadspire's internal appeal process. (AR 386.) In a letter to the appeals coordinator, Plaintiff noted her extreme fatigue and explained that she is required to consult with various specialists. She also attached several documents, including psychological consults, neurological consults, MRIs, urological test results, and visual test results. As part of the review process, Broadspire passed this information and previous documentation to five specialists for peer review. Their findings follow.

Dr. John Schmeyer, an ophthalmologist, determined that nothing in the record supported Plaintiff's claim that she could not work due to vision problems. (AR 649.)

Dr. Elana Mendelssohn, a clinical and neuropsychologist, rendered the same conclusion with respect to Plaintiff's mental status. (AR 653-54.) She found that the documentation did not substantiate "the presence of a functional impairment from a psychological perspective." (Id.)

Dr. Richard Davi, an urologist, determined that a letter from another urologist, Dr. Philip Aliotta, which indicated that Plaintiff suffered from incontinence and neurogenic bladder, was insufficient evidence to support a finding that Plaintiff's urology problems precluded work. (AR 658.)

Dr. Michael Goldman, specializing in physical medicine and rehabilitation, found that the record could not "support a functional impairment . . . that would preclude the claimant from performing any occupation." (AR 662.)

Finally, Dr. Henry Spina, a neurologist, noted that recent MRIs showed no new lesions and that her vision problems were improving. He also concluded that the documentation did not support a functional impairment for any occupation. (AR 664-67.)

Consequently, the Broadspire appeal committee upheld the decision to terminate Plaintiff's benefits; she was notified of the decision by ...


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