Bennett v. Life Insurance Co. of North America

398 F. Supp. 2d 533, 2005 WL 2648355
CourtDistrict Court, N.D. Texas
DecidedApril 21, 2005
Docket3:04-cv-01281
StatusPublished

This text of 398 F. Supp. 2d 533 (Bennett v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bennett v. Life Insurance Co. of North America, 398 F. Supp. 2d 533, 2005 WL 2648355 (N.D. Tex. 2005).

Opinion

MEMORANDUM ORDER

BOYLE, District Judge.

Before the Court is the Motion of the Defendants, Life Insurance Company of North America (“LINA”) and Patti Holt (“Holt”) (collectively, “Defendants”) for Summary Judgment. The Defendants served the Plaintiff, Tawana Bennett (“Bennett”), with the motion on December 23, 2004 pursuant to the joint submission procedures set forth in the June 21, 2004 Scheduling Order. On February 1, 2005, the Court denied the Plaintiffs request for enlargement of time to respond to the motion. Having reviewed the pleadings and evidence on file, the Court GRANTS the Defendants’ motion for the reasons that follow.

I. Factual and Procedural Background 1

A. Procedural Background.

Tawana Bennett (“Bennett”) filed this lawsuit against the Defendants in Texas State Court on May 14, 2004. Bennett seeks actual and punitive damages for claims alleged under the Texas Insurance Code and the Texas Deceptive Trade Practices Act (“TDPTA”). Bennett has alleged the following claims: (1) breach of the implied duty of good faith and fair dealing, (2) breach of express and implied warranty, and (3) fraud and unconscionable conduct. To date, Bennett has never asserted any ERISA claims. (Orig.Pet.). The Defendants removed the case to the Federal District Court for the Northern District of Texas on June 11, 2004. Defendant LINA asserted ERISA preemption in its answer. (Orig.Answer). On July 15, 2004, Bennett acknowledged in her response to Holt’s Motion to Dismiss that the Plan is governed by ERISA and that ERISA preemption applies, (“Response to Motion to Dismiss at 3”), but maintains that her claims against LINA do not arise under ERISA because LINA “is the insurance company providing the benefits under the plan.” (Id.).

In compliance with the joint submission procedures set forth in the June 21, 2004 Scheduling Order, Defendants served Bennett with the instant motion for Summary Judgment on December 23, 2004, thus making her deadline for serving her response January 12, 2004, twenty days after the motion was served. Bennett failed to *535 respond in a timely manner, and, after reviewing pleadings from both parties, the Court denied Bennett’s motion to enlarge time to respond to the motion for summary judgment on February 1, 2005. 2

B. Factual Background.

1. Bennett’s Participation in the Plan.

During the relevant time period in 2003, Bennett was a customer service employee of Solomon Smith Barney (“SSB”), a subsidiary of Citigroup, Inc. (“Citigroup”). Some SSB employees are provided disability insurance coverage from Cigna Life Insurance Company of New York (“CLI-NY”) through Citigroup’s ERISA employee benefit plan (the “Plan”). (Motion at 2). In her status with SSB, Bennett, a “Class 1” employee, was entitled to certain disability benefits under the terms of CLINY Policy Number NYK 2260 (the “Policy”). (Id. at 2; Exh. A, Affidavit of Richard M. Lodi (“Lodi Affidavit”), App. 1-3 and 5-59).

As a Class 1 employee under the Plan and the Policy, if Bennett were to become “totally disabled,” she would be automatically entitled to receive disability benefits in the amount of 60% of her base monthly earnings, less other benefits, up to a maximum of $2,500 a month. (Lodi Affidavit, App. 13, 32, 34, 37-38, 299, 324). Under the Plan, an insured is “totally disabled” if she is “unable to perform all the essentials of [her] occupation.” However, the individual will not be considered “totally disabled” for a period in excess of twenty-four months unless “because of Injury or Sickness, [she is] unable to perform all the essential duties of any occupation for which [she] is or may reasonably become qualified based on [her] education, training or experience.” (App.43, 45).

CLINY is designated as the Plan’s claims administrator. (App.17). CLINY, however, delegated its role as claims administrator to LINA. In this capacity, LINA is authorized to “receive, review, administer and adjudicate” SSB employees’ long-term disability benefits claims. (App.1-3). Bennett’s claim was one such claim. (Id.). As the acting claims administrator, LINA is the fiduciary for both adjudicating benefits claims and for making decisions on benefit claims appeals. (App.7, 17). The Plan specifically states that all decisions made by the claims administrator “shall be binding on participants and beneficiaries to the full extent permitted by law.” (Id.).

2. Bennett’s Claim for Long Term Disability Benefits.

Some time in early 2003, Bennett submitted a claim for disability benefits under the Plan and Policy. As the basis of her claim, she averred that symptoms of pain, dizziness and memory difficulties disabled her. (App.330-32, 336-37). More specifically, in Original Petition, Bennett alleges that she became disabled as of February 6, 2003 as a result of “systemic lupus, erythe-matosis, vertigo, hypertension and other diseases.” (Plaintiffs Original Petition 2-3). Bennett asserts that she became incapable of continuing her position as a telephone customer service representative at SSB. (Id.). In that position, Bennett was required to be capable of “sitting, seeing, hearing, and, occasionally, standing or walking.” (App.331, 333-35). LINA made a number of requests asking Bennett to submit medical evidence corroborating her claim for disability benefits. (App.76, 80, 115, 126, 127, 146, 254, 255, 271, 273, *536 293, 322). Bennett supplied some medical information, but included within her submission LINA’s request for records. (Motion at 4).

3. Bennett’s Lack of Sufficient Medical Documentation.

Bennett submitted records in support of her claim from four separate physicians: (1) a rheumatologist, Dr. Don Cheatum, (2), an internist, Dr. Mahendra Kakarla, (3) an ear/nose throat specialist, Dr. J.R. Williams, and (4) a hand specialist, Dr. Olayinka Onguro. In addition to these four physicians, Bennett later submitted records from a rheumatologist she began seeing after making her claim, Dr. Imran Iqbal. (Motion at 5; see also generally, App. 60-338). In her records, however, there was no medical evidence validating her claims of systemic lupus, “erythemato-sis” or hypertension or her assertions that medicál conditions made her incapable of performing her unique job duties. (Id.). Additionally, Bennett did not submit any medical records in support of her claims-of pain and dizziness.

Notably, although Bennett asserted in her claim that Drs. Cheatum and Williams advised her not to continue working in February 2003, she did not offer any documentation of these assertions. (App.213, 336). Finally, Bennett did not submit any evidence that her medical conditions had worsened at the time of her claim, and she had complained of the same conditions for the previous nine years, according to her documentation. See generally, (Id,.).

Bennett stated in her claim that “stress at work” was a possible cause of her medical issues. (App 213).

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