Allen v. Unum Life Insurance Co. of America

289 F. Supp. 2d 745, 2003 U.S. Dist. LEXIS 23748, 2003 WL 22462382
CourtDistrict Court, W.D. Virginia
DecidedMarch 31, 2003
Docket1:02 CV 00097
StatusPublished
Cited by2 cases

This text of 289 F. Supp. 2d 745 (Allen v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allen v. Unum Life Insurance Co. of America, 289 F. Supp. 2d 745, 2003 U.S. Dist. LEXIS 23748, 2003 WL 22462382 (W.D. Va. 2003).

Opinion

OPINION

JONES, District Judge.

In this ERISA case, in which the plaintiff seeks long-term disability benefits, I find after a careful review of the record of the plan administrator’s denial of benefits that summary judgment should be entered for the defendant.

I

The plaintiff, Carolyn Allen, received her degree in nursing from Southwest Virginia Community College in 1991 (R. at 663 1 ) and was employed as a registered nurse at the Buchanan General Hospital, Inc. (“Hospital”) from 1992 to 1998. (R. at 661.) On September 17, 1998, she filed a claim for long-term disability benefits pursuant to an employee benefit plan established by the Hospital (the “Plan”) and administered by Unum Life Insurance Company of America (“Unum”), the defendant in this case.

Under the Plan, an eligible Hospital employee is deemed disabled and eligible for benefits for the first twenty-four months when “Unum determines that you are limited from performing the material and substantial duties of your regular occupation due to ... sickness or injury; and you have 20% • or more loss in your indexed monthly earnings due to the same sickness or injury.” (R. at 126.) Following this twenty-four month period, a claimant is eligible for benefits only if she can demonstrate that she is “unable to perform the duties of any gainful occupation for which [she is] reasonably fitted by education, training, or experience.” (R. at 126.)

Allen’s claim for benefits was based on her complaints of back pain attributed to an accident that occurred while she was employed at the Hospital. Upon consideration of the submitted documents, Unum determined that Allen was disabled and could not perform her regular occupation. However, once the first twenty-four month period in which benefits were paid had passed, Unum determined that Allen was able to perform other gainful occupations in keeping with her education, training, and physical abilities. Therefore, Unum ended the payment of benefits.

Allen filed this action on June 4, 2002, seeking a judgment requiring the defendant .to pay long-term disability benefits to her under the Plan. Allen’s cause of action arises under the provisions of the Employee Retirement Income Security Act of 1974, 29 U.S.C.A. §§ 1001-1461 (West 1999 & Supp.2002) (“ERISA”) and jurisdiction of this court exists pursuant to 29 U.S.C.A. § 1132(f) (West 1999). Both parties have filed motions for summary judgment, which have been briefed and argued. The case is now ripe for decision.

II

The plaintiff claims that on March 28, 1998, she injured her back while aiding a 300-pound patient who had fallen. (R. at 610.) The plaintiff did not go to the emergency room nor was she seen by a doctor until March 30, 1998, when she was examined by D. Patel, M.D. 2 (Id.)

*748 Dr. D. Patel observed “marked LS tenderness with muscle spasms; no neurological deficit, si and s2 normal” and did not see any dislocation or fracture after examining X rays of the plaintiffs lumbar spine. (R. -at 610.) Dr. D. Patel diagnosed the plaintiff with an LS sprain, advised the plaintiff to rest, apply Biofreeze (a topical pain reliever), and take Tylenol. (Id.) The plaintiff again presented to Dr. D. Patel on April 3, 1998, with a backache and radiation of pain to the left leg. (R. at 611.) Based on her symptoms, Dr. D. Patel ordered the plaintiff to “stay off work,” and prescribed her anti-inflammatory medication. (Id.) The plaintiff returned to Dr. D. Patel on April 8, 1998, continuing to complain of back pain and numbness in the right leg. (Id.) Dr. D. Patel ordered a CT scan, which showed a bulging disc at the L5-S1 region. (Id.) Dr. D. Patel directed the plaintiff to continue using muscle relaxants, told her to remain off work, and to start a two week program of physical therapy. (Id.) The plaintiff was examined by Dr. D. Patel again on April 23, 1998, for back pain and radiation of pain to the left leg. (R. at 612.) Because of her continuing complaints of pain, Dr. D. Patel referred the plaintiff to J. McConnell, M.D., an orthopaedic surgeon and spine specialist. (R. at 612.)

Dr. McConnell examined the plaintiff on May 13,1998, and also examined her previously taken X rays and CT scan. (R. at 593.) Dr. McConnell noted that the plaintiff was a “healthy-appearing ... woman in no obvious discomfort ... [whose] lower back shows normal alignment.” (R. at 592.) Additionally, Dr. McConnell found that her voluntary range of motion was limited and that she was “tender to palpation in the left sacroiliac joint area.” (Id.) After examining her radiographic data, Dr. McConnell noted that the X rays of the plaintiffs spine showed no abnormalities and that the CT scan did not show any “obvious herniated disc.” (Id.) He stated that there “may be a small disc herniation on the left side at L5-S1.” (Id.) Based on his findings, Dr. McConnell ordered an MRI scan to rule out radiculopathy secondary to a herniated disc. (Id.) Dr. McConnell advised the plaintiff to remain off work until further treatment recommendations could be made. (Id.)

The plaintiff returned to Dr. D. Patel on May 14, 1998, again complaining of back pain. Again, Dr. D. Patel advised the plaintiff to rest, apply heat, and stay off work for three weeks. (R. at 612.) Dr. D. Patel examined the plaintiff on May 26 and June 9, 1998, for back pain and pain in both legs. (R. at 613.) Dr. D. Patel directed the plaintiff to continue her application of Biofreeze and recommended that she take Motrin for pain. (Id.)

The plaintiff returned to Dr. McConnell on June 12, 1998, for a follow-up visit. According to his notes, the MRI scan showed “no evidence of disc herniation,” but did show “multi-level degenerative discs in the lumbar region.” (R. at 599.) Dr. McConnell advised the plaintiff to “begin an active physical therapy program ... [and] encouraged [her] to continue walking as much as possible.” (Id.) Finally, Dr. McConnell noted that the plaintiff “might be able to return to work in four weeks.” (Id.)

Dr. McConnell examined the plaintiff on August 3, 1998, and determined that an evaluation of the plaintiffs nerves in her right leg was completely normal and he recommended non-operative treatment. (Id.)

Dr. D. Patel continued to evaluate the plaintiffs continuing complaints of back and leg pain throughout 1998 and 1999. On June 22, 1998, Dr. D. Patel referred the plaintiff to Dr. J. Jayne, a neurosurgeon, for a second opinion regarding Dr. McConnell’s findings. (R. at 614.) According to the treatment notes made by *749 Dr. D. Patel, the plaintiff was not actually examined until September 30, 1998, at which time a CT myelogram scan showed a bulging disc. (R. at 618.) 3 In addition, during his many evaluations of the plaintiff, Dr. D. Patel continued to observe restricted forward flexion to thirty degrees, LS tenderness present, and SLR positive on forty-five degrees. (R. at 615, 617, 618.) Following his evaluation on October 14, 1998, Dr. D.

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Bluebook (online)
289 F. Supp. 2d 745, 2003 U.S. Dist. LEXIS 23748, 2003 WL 22462382, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allen-v-unum-life-insurance-co-of-america-vawd-2003.