Benson v. Long Term Disability Income Plan for the Employees of Xerox

108 F. Supp. 2d 1074, 1999 U.S. Dist. LEXIS 22838, 1999 WL 1940016
CourtDistrict Court, C.D. California
DecidedSeptember 16, 1999
DocketCV-98-6328LGB (RCX)
StatusPublished
Cited by7 cases

This text of 108 F. Supp. 2d 1074 (Benson v. Long Term Disability Income Plan for the Employees of Xerox) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Benson v. Long Term Disability Income Plan for the Employees of Xerox, 108 F. Supp. 2d 1074, 1999 U.S. Dist. LEXIS 22838, 1999 WL 1940016 (C.D. Cal. 1999).

Opinion

ORDER GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

BAIRD, District Judge.

I. INTRODUCTION

This case arises out of the alleged wrongful termination of Long Term Disability (LTD) benefits by plaintiffs employer Xerox, the Long-Term Disability Income Plan for the Employees of Xerox, and Health International (HI). Plaintiff also alleges that she was wrongfully terminated in retaliation of her making an ERISA based LTD benefit claim, and appealing the same.

II. FACTUAL AND PROCEDURAL BACKGROUND

A. PLAINTIFF’S RECEIPT OF DISABILITY BENEFITS

Unless stated otherwise, the following facts are undisputed: Plaintiff was an employee of Xerox. See Pl.’s Statement of Genuine Issues at 2 (PL’s Statement). In 1997, Xerox offered two types of disability benefits — short-term disability benefits, and long-term disability benefits. See id. The plan became effective for eligible and qualified Xerox employees on August 1, 1996. See id. Under the LTD plan, disability is defined as follows:

For employees who become disabled on or after August 1, 1996, (i) months one (1) through seven (7), following the expiration of the short-term disability period — the inability to perform, with or without reasonable accommodation, one or more of the essential duties of one’s occupation or a comparable alternative offered by the Company or another employer because of Personal impairment caused by injury or illness, occupational or non-occupational; (ii) months eight (8) through twenty-four (24) — the inability to be employed in any substantial and gainful work either inside or outside of Xerox because of personal impairment caused by injury or illness, occupational or non-occupational.

Id. at 2-3.

In January 1997, plaintiff applied for and received short term disability benefits from January 29, 1997 through June 29, 1997. See id. at 5-6. After plaintiff exhausted her short term disability benefits, she applied for benefits under the LTD plan. See id. at 6. HI authorized LTD benefits to plaintiff beginning June 29, 1997. See id. In July 1997, HI determined that plaintiff no longer qualified for benefits under the LTD plan and terminated her benefits as of July 18,1997. See id. Hi’s denial was based on the conclusion, by an independent third party board specialist, Harvey Wieseltier, M.D., that plaintiffs medical condition did not satisfy the definition of disability, and that she was able to perform her usual and customary duties. See id. at 6-7.

On August 5, 1997, plaintiff appealed Hi’s decision denying any further LTD benefits, and the denial was upheld by HI on August 21, 1997. See id. at 7. The decision to uphold the denial was based on *1078 a review by a third party independent board specialist who, after review of the Administrative Record, concurred with the evaluation of Doctor Wieseltier. See id. at 7-8.

Because it was determined that plaintiff was not totally disabled, as defined under the Plan, and therefore able to perform her duties at Xerox, Xerox Human Resources Manager Susan Johnson sent plaintiff a memorandum indicating that she was to return to work on September 15. See id. at 8. Plaintiff did not return to work on that date, or any time thereafter. See id. 1 Because plaintiff failed to return to work, she was notified by a letter dated September 22, 1997 that effective September 22, 1997, she was being “voluntarily terminated” for absence without notice pursuant to Xerox’s employment policy. See id. at 9. Xerox’s Policy No. 404.1, Section 6, indicates that “[e]mployees who are absent for four consecutive days without notice to their supervisor, and satisfactory explanation, will be considered voluntary resignations.” See id.

B. PLAN ADMINISTRATION

Under the plan, the Plan Administrator has discretion to determine eligibility for LTD benefits. See id. at 3. The Plan Administrator under the Plan was Patricia Nazemeth. See Nazemeth Deck; Xerox Corp. LTD Income Plan, Nazemeth Decl. Ex. A, Sec. 7.1 at 15 (Xerox LTD Plan) (“The plan shall be administered by a Plan Administrator who shall be Patricia Na-zemeth”). The LTD plan allowed the Plan Administrator to delegate her discretion to determine eligibility for LTD benefits. See Xerox LTD Plan, Sec. 7.1 at 15 (“The Plan Administrator may delegate any of her administrative duties under the Plan and may delegate any of her discretionary authority to construe the terms of the Plan and determine eligibility for benefits.”).

Pursuant to such authority, Xerox’s Plan Administrator delegated her responsibility to determine medical eligibility for LTD benefits to Health International, Inc. See Nazemeth Decl., at 2. 2 As part of that delegation, and as provided under the contract between Xerox and HI, HI has the discretion, as Medical Case Manager and claims fiduciary under the LTD plan, for making determinations regarding eligibility for disability in connection with denials and final decisions on appeal. See Pl.’s *1079 Statement at 4. HI also has the discretionary authority to determine the length of time for which the disability is certified and to construe the terms of the plan. See id. at 5. The agreement provides that all HI decisions on appealed claims regarding medical eligibility for disability benefits are final and binding. See id.

If HI determines that disability benefits are to be paid, Xerox pays the LTD benefits from its own assets, not Hi’s. See id. Additionally, Hi’s compensation is not dependent upon whether it approves or disapproves a claim. See id. at 4-5. Furthermore, in administering its duties as Case Manager and claims fiduciary, HI acts as an independent company which administers disability plans for various organizations, including Xerox. See id. at 4. 3

C. PROCEDURAL BACKGROUND

Plaintiff filed her complaint on August 4, 1998. The original complaint named the Long-Term Disability Income Plan for the Employees of Xerox Corporation; Patricia Nazemeth, acting for Xerox Corporation; ITT-Comprehensive Employee Benefit Service Co., a subsidiary of Hartford Life & Accident Insurance Company; Prudential Disability Management Services; and Health International as defendants. All the named parties answered the complaint. On April 23, 1999, a stipulation was entered thereby dismissing with prejudice defendants ITT-Comprehensive Employee Benefit Service Co. On September 1, 1999, another stipulation was entered into thereby dismissing with prejudice defendant Prudential.

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Bluebook (online)
108 F. Supp. 2d 1074, 1999 U.S. Dist. LEXIS 22838, 1999 WL 1940016, Counsel Stack Legal Research, https://law.counselstack.com/opinion/benson-v-long-term-disability-income-plan-for-the-employees-of-xerox-cacd-1999.