Barber v. Sun Life & Health Insurance

894 F. Supp. 2d 174
CourtDistrict Court, D. Connecticut
DecidedFebruary 13, 2012
DocketCivil No. 3:09CV00163(AVC)
StatusPublished
Cited by1 cases

This text of 894 F. Supp. 2d 174 (Barber v. Sun Life & Health Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barber v. Sun Life & Health Insurance, 894 F. Supp. 2d 174 (D. Conn. 2012).

Opinion

RULING ON TBS MOTIONS FOR SUMMARY JUDGMENT

ALFRED Y. COVELLO, District Judge.

This is an action for long term disability benefit relief in which the plaintiff, Kristen Barber, alleges unlawful denial of her claim for long term disability income by the defendant, Sun Life. It is brought pursuant to ERISA § 502(a)(1)(B).

The plaintiff and the defendant have filed motions for summary judgment, pursuant to Federal Rule of Civil Procedure 56, arguing that there are no genuine disputes as to any material fact and that they are entitled to judgment as a matter of law on all claims. For the reasons that follow the defendant’s motion is granted in part [176]*176and denied in part and the plaintiffs motion is denied.

FACTS

An examination of the complaint, pleadings, Local Rule 56 statements, exhibits accompanying the motions for summary judgment, and responses thereto, discloses the following undisputed facts:

Barber was employed by X-Ray Associates, Inc. (X-Ray) as a Director of Marketing until July 17, 2003, with a monthly salary of $10,402.00.

On January 31, 2001, while working for X-Ray Associates, an MRI scan of Barber’s brain showed lesions consistent with Multiple Sclerosis (“MS”).

In May 2001, Dr. Joseph Guarnaccia began treating Barber. Barber presented symptoms of fatigue, weakness in her ankle and foot, and numbness in her right thigh following a fall on ice in January 2001. Dr. Guarnaccia documented evidence of central nervous system damage and the doctor’s “impression was new onset MS.”

On April 25, 2002, another MRI of Barber’s brain was conducted, revealing “multiple well-defined foci of hyper intense signals in the periventricular white matter, consistent with MS.”

On February 6, 2003, Barber reported to Dr. Guarnaccia that she had “difficulty carrying loads of equipment from office to office” and that she had fatigue in the evenings.

On June 16 2003, another MRI was conducted on Barber’s brain, again showing results consistent with MS.

In June 2003 and July 2003 meetings with Dr. Guarnaccia, Barber complained of “muscle fatigue in her legs after walking short distances,” “pain in the lower extremities, slight paresthesias in her hands and feet,” and weak upper extremities, She also complained of decreased endurance in terms of her ability to walk and carry items, numb hands “if she use[d] them for any length of time,” spasms, balance problems, urinary frequency, periods of fatigue, and cognitive difficulties. Upon examination, Dr. Guarnaccia documented “abnormal eye movements, impairment of posture on the examination table, weakness of the right arm, clumsy hand coordination, and leg weakness greater on the right.”

On July 17, 2003, Dr. Guarnaccia wrote in an office note “[a]t this point, I do not feel that she can continue working.” He recommended “that she go on total disability.”

On July 18, 2003, Barber stopped working in her regular position as Director of Marketing, and subsequently filed a claim for long term disability benefits to GE Group Life Assurance Company. In connection with the claim, Dr. Guarnaccia completed an Attending Physician’s Statement (“APS”) which indicated that Barber “suffered from MS, with symptoms of fatigue, leg and arm weakness, spasms, numbness and cognitive dysfunction, which affected her ability to work.”

On November 19, 2003, GE Group Life Assurance Company, which later changed its name to Genworth and then Sun Life, through various business acquisitions, approved Barber’s claim for long term disability benefits based on the medical reports provided by Dr. Guarnaccia. The long term disability policy defines “Total Disability” as follows; “Total Disability must be caused by Sickness or Injury and must commence while you are insured under the policy. You will be considered totally disabled if you are unable to perform all the material and substantial duties of your regular occupation.” The claims certificate states that GE Group Life Assurance Company has “sole and exclusive [177]*177discretion and authority to carry out all actions involving claims procedures explained in the Policy.”

On December 6, 2003, the Social Security Administration awarded Barber disability benefits, finding her disabled under its rules. Barber began receiving a monthly payment of $1,701.20.

In February 2004, GE requested additional information regarding Barber’s disability, including a claimant statement and a physician’s statement. In the claimant statement, Barber reported less physical activity and decreased cognitive function. Dr. Guarnaceia’s statement noted that Barber “continued to have fatigue, weakness, pain, and cognitive dysfunction due to her MS, and remained significantly impaired.”

In September 2004, GE again requested additional information regarding Barber’s disability, including a claimant statement and a physician statement. In the claimant statement, Barber notes that her symptoms have worsened. Dr. Guarnaccia stated that Barber continued to suffer from impairments and would never be able to return to work.

Between June 2005 and August 2008, Barber met with Dr. Guarnaccia nine times. Physical examinations during these visits reflected unchanged conditions.

On May 20, 2005, the insurer again requested updated claim documentation. X-Ra/s long term disability was now being administered by Genworth Financial Group. In the claimant statement, Barber indicates that she “had worsened cognitive function and increased weakness in her arms and legs.” In the physician statement, Dr. Guarnaccia noted that Barber continued to suffer from limitations, and could not lift or carry any weight on a regular basis.

On July 28 and 30, 2005, as well as September 6 and 7, 2005, Genworth conducted surveillance of Barber going on errands and having lunch with a friend.

On November 14, 2005, after Genworth requested cognitive testing of Barber, Dr. Guarnaccia submitted a report to Gen-worth outlining Barber’s ongoing complaints of spasms, numbness, fatigue, poor stamina, cognitive complaints, physical limitations, and sleep disturbance. He also noted that Barber took significant medications in an effort to combat her MS that impaired her ability to work.1

On December 14, 2005, Genworth referred Barber’s file for review, “asking the psychologist to comment on Plaintiffs prognosis and her restrictions and limitations.” On December 19, 2005, Dr. James William Pier, Ph.D., provided a three page written report, in which he was critical of Dr. Guarnaccia’s decision to not request a neuropsychological evaluation.

On January 4, 2006, Genworth again requested neuropsychological evaluation, following Dr. Pier’s review, claiming the testing was necessary to evaluate Barber’s prognosis and restrictions.

On February 15, 2006, a Genworth consultant, Dr. Thomas Hicks, concluded that “given the physical requirements of her occupation and the documented fatigue reported by the claimant, it is my opinion that the claimant has a level of impairment that precludes her from performing her own occupation.” Genworth then deter[178]*178mined that Barber continued to qualify for long term disability benefits.

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Bluebook (online)
894 F. Supp. 2d 174, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barber-v-sun-life-health-insurance-ctd-2012.