Austin v. Continental Casualty Co.

216 F. Supp. 2d 550, 29 Employee Benefits Cas. (BNA) 1792, 2002 U.S. Dist. LEXIS 16654, 2002 WL 1969342
CourtDistrict Court, W.D. North Carolina
DecidedAugust 23, 2002
Docket1:01-cv-00187
StatusPublished
Cited by6 cases

This text of 216 F. Supp. 2d 550 (Austin v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, W.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Austin v. Continental Casualty Co., 216 F. Supp. 2d 550, 29 Employee Benefits Cas. (BNA) 1792, 2002 U.S. Dist. LEXIS 16654, 2002 WL 1969342 (W.D.N.C. 2002).

Opinion

MEMORANDUM OF DECISION

COGBURN, United States Magistrate Judge.

THIS MATTER is before the court upon plaintiffs Motion for Summary Judgment and defendant’s cross Motion for Summary Judgment. In support of and in opposition to such motions, the respective parties have submitted concise memoranda of law and a well-organized administrative record. For the reasons discussed below, the court will grant plaintiffs Motion for Summary Judgment, deny defendant’s Motion for Summary Judgment, reverse the decision of the plan administrator, and award plaintiff plan benefits.

I. Background

A. Plaintiffs Work History, Impairments, and Medical/Vocational Record

Plaintiff was a long-term employee of Baxter International, Inc., (“Baxter”), working on a sub-assembly line for nearly 24 years. While she had a high-school education, she possessed no greater than fourth-grade skills in reading and comprehension and was limited to second-grade level in her math skills.

Plaintiff purchased from her employer, Baxter, a long-term care insurance plan, which was provided and administered by defendant herein. Plaintiff has suffered from diabetes mellitus since she was 11 and became insulin dependent two years before she ceased working in 1999. In addition to diabetes, plaintiff has also suffered from a progressive neck disorder, which began in 1987, and was followed by her family doctor. By 1989, the pain from her neck disorder had worsened, and she was referred to an arthritis specialist by her family doctor, who noted that plaintiffs pain was interfering with her work-related activities. After that referral, her family doctor diagnosed cervical arthritis with a component of fibromyalgia.

In early 1999, plaintiffs family doctor referred her to an orthopedic surgeon, who noted that plaintiff had a 10-to-12-year history of progressive neck and shoulder *553 pain and reported that her neck pulled to the left, causing spasms and pain when she resisted such pulls. He also noted aggravation of the condition upon bending, lifting, walking, or staying in one position and improvement when plaintiff was allowed to change positions at will. She reported pain at the 10 level.

Objective evaluation by the orthopedic surgeon resulted in a probable diagnosis of spasmodic torticollis, but that process was hampered by less-than-optimal x-ray films caused by plaintiffs inability to move her neck. Based upon such diagnosis, the orthopedic surgeon referred plaintiff to a neurologist.

The neurologist noted that plaintiff suffered from “grossly apparent” spasmodic torticollis. He noted that plaintiff had constant head tilt to the left, with the left shoulder slightly raised. He concurred in the earlier diagnosis, recommended botulism toxin treatment for the spasms, and referred plaintiff to another neurologist for that treatment.

The second neurologist concurred in the diagnosis. He noted that he was surprised that plaintiff had been able to work for 12 years with the condition and agreed with plaintiff to withhold any determination as to her ability to work until he saw how she responded to the injection therapy. Plaintiffs initial response was poor, and after several months, her neurologist concluded that her condition was significant and opined that it would be “very difficult for her to work on a production line at any facility.”

The second neurologist also issued an opinion letter as to the functional limitations caused by plaintiffs disease. He stated that the disease made it very difficult for her to sit for very long periods of time and that she could not raise her hands above her head, lift, or perform rapid movements of the upper extremities. Even after repeated treatments, such treating physician determined that her condition was permanent and there was no real prospect of her returning to work.

In addition to the insulin-dependent diabetes and spasmodic torticollis, plaintiff developed retinopathy changes in both eyes, with advanced peripheral retinal ischemia, secondary to diabetes, in 2000. Her eye problems were treated by another physician through photo coagulation and panretinal photo coagulation. Plaintiff was also diagnosed with cervical dystonia, which is the apparent cause of the involuntary head turning, as opposed to the torti-collis, which caused plaintiffs spasms.

Plaintiff also underwent a vocational evaluation by a certified vocational evaluator (“VE”), who, through testing, made the educational determinations discussed earlier. After considering plaintiffs age, medical conditions, vocational history, and level of pain, the VE determined that plaintiff was “very limited vocationally due to her low academic functioning,” even before the functional limitations caused by her medical problems were considered. When her functional limitations were combined with her diminished access to the labor market, the VE determined that plaintiff was unable to meet the critical demands of competitive employment. He explained his determination, finding that plaintiff was unable to

(1) concentrate on tasks;
(2) maintain persistence or pace;
(3) maintain attendance and punctuality;
(4) carry out tasks in a timely manner; and
(5) complete a workday or workweek without an unreasonable number of breaks related to her symptoms.

B. Responsive Evidence Developed By Defendant

In determining whether plaintiff was entitled to continued benefits after her short- *554 term benefits expired, defendant developed evidence from independent 1 experts. In making its determination that plaintiff was not entitled to long-term disability benefits, the defendant hired a vocational consultant, who conducted a personal interview with plaintiff, but no vocational testing, and a medical expert, who conducted no independent medical examination, only a records review.

The report of defendant’s vocational evaluator indicated that plaintiff was wearing a foam neck collar and that her head leaned toward her right shoulder, but never fell onto her shoulders. The evaluator stated that she never observed plaintiff twitching. In addition, she noted that plaintiff had a high-school education with no further training and that plaintiff believed she could not do any work due to her condition and that she experienced pain with the least activity. In addition to conducting no tests, the evaluator made no determinations concerning plaintiffs residual functional capacity. The evaluator did note that plaintiff got out of her sports utility vehicle without difficulty and talked with the evaluator for 65 minutes without noticeable trouble.

Plaintiff was also interviewed by one of defendant’s vocational case managers. In that interview, plaintiff discussed her activities of daily living. She reported that relatives did her shopping, cooking, and cleaning, and that she mostly sat or laid down and did some walking.

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Cite This Page — Counsel Stack

Bluebook (online)
216 F. Supp. 2d 550, 29 Employee Benefits Cas. (BNA) 1792, 2002 U.S. Dist. LEXIS 16654, 2002 WL 1969342, Counsel Stack Legal Research, https://law.counselstack.com/opinion/austin-v-continental-casualty-co-ncwd-2002.