Bova v. American Cyanamid Co.

662 F. Supp. 483, 1987 U.S. Dist. LEXIS 16981
CourtDistrict Court, S.D. Ohio
DecidedJune 10, 1987
DocketC-2-82-659
StatusPublished
Cited by13 cases

This text of 662 F. Supp. 483 (Bova v. American Cyanamid Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bova v. American Cyanamid Co., 662 F. Supp. 483, 1987 U.S. Dist. LEXIS 16981 (S.D. Ohio 1987).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW

GRAHAM, District Judge.

FINDINGS OF FACT

1. Defendant American Cyanamid Company is a corporation with headquarters located in Wayne, New Jersey. Lederle Laboratories, Pearl River, New York, is a division of American Cyanamid. Defendant W.P. Brown is the administrator of *485 American Cyanamid’s employee benefit plans.

2. American Cyanamid maintains three employee benefit plans. The Personal Protection Program provides medical benefits, life insurance, and weekly disability payments for a period of up to twenty-six weeks. The Long Term Disability Plan allows for benefits in the case of an employee who has been disabled for a period of at least twenty-six weeks. Long term disability benefits are available for two years, or for a longer, term coextensive with the duration of the disability. The long term disability benefits are diminished by the amount of social security and worker’s compensation payments and by retirement benefits paid under American Cyan-amid’s retirement plan. The Employees Retirement Plan provides a retirement pension for employees who retire at age sixty-five and who have at least five years of service. The Plan permits early retirement at any time after age fifty-five if the employee’s age plus years of service equal at least sixty-five. Upon early retirement, an employee’s benefits are reduced by three percent for each year that his early retirement date falls short of his normal retirement date, or, in the case of an employee with twenty years of continuous service, his sixty-second birthday.

3. The Retirement Plan ■ also includes total and permanent disability benefits. An employee qualifies for total and permanent disability benefits if he is unable, because of bodily injury or disease, to engage in any occupation or employment for substantial remuneration or profit, his condition has existed continuously for at least six months, and his condition is expected to continue to at least age sixty-five. Total and permanent disability benefits are reduced by the amount of any worker’s compensation benefits and, depending upon the method of calculation used, by fifty percent of any benefits under social security. A person who qualifies for these benefits remains an employee and cannot receive pension benefits simultaneously. In the event that an employee recovers from his disability and returns to active service, his pension credits begin to accrue again on the date of his return, he retains all credits earned prior to his disability and the entire period of total and permanent disability is counted as continuous service. Health and life insurance premiums are paid by the plan under the total and permanent disability provisions.

4. Summary information concerning the plans is distributed to new employees, to current employees upon request or when any changes are made in the plan. Employees are also sent annual reports concerning their current personal status as to benefits payable under the plans. Employees were instructed to address any questions concerning the plans to their personnel division. The complete plan description contains certain information concerning benefits and the process of appeal from denial of benefits not found in the plan summaries.

5. The retirement plan provides that if any claim for benefits is denied in whole or in part, the administrator shall notify the claimant in writing within ninety days after the submission of such claim. The ninety-day period may be extended for an additional ninety days upon written notice to the claimant. The written notice of denial shall contain the specific reason for the denial, the specific provision of the plan on which the denial is based, a description of any additional information required to perfect the claim, an explanation of why such information is necessary, and an explanation of the appeals process. Within sixty days the claimant may request a review by the administrator of the denial of the claim. The administrator’s decision must be rendered no later than one hundred and twenty days after receipt of the request for review, must be in writing and must include the specific reasons for the denial.

6. Plaintiff commenced his employment with Lederle Laboratories in 1948 and had slightly over twenty-nine years of continuous service with the company as of June, 1975. Plaintiff’s job entailed the sale of pharmaceutical products to doctors and pharmacies within his assigned territory. Plaintiff was vested under the terms of all *486 three American Cyanamid employee benefits plans.

7. Plaintiff was injured in a work-related automobile accident in November, 1974. He sustained additional injuries in a second work-related automobile accident in March, 1975. He was hospitalized and underwent a cervical laminectomy in April, 1975. Plaintiff returned to work two weeks after surgery and continued to work until June 10, 1975, at which time he was placed on medical leave by the company physician, Dr. Dolor. He never returned to active status with the company.

8. Plaintiffs physical condition deteriorated through 1976 and into 1977. In September of 1977 he was again hospitalized for back surgery.

9. Plaintiff received weekly benefits under the Personal Protection Program for the maximum period allowed, twenty-six weeks.

10. Plaintiff received benefits under the Long Term Disability Plan from December, 1975 to July 31, 1978. During that time, plaintiff’s long term disability benefits were for the most part completely offset by his worker’s compensation, and social security income. During certain months, the company was unaware that plaintiff was also receiving social security benefits, and paid long term disability benefits to plaintiff, resulting in an overpayment of long term disability benefits in the amount of $4,295.90. Plaintiff’s long term disability benefits terminated as of July 31, 1978, because the benefits were completely offset by plaintiff’s social security and worker’s compensation benefits. Since then, the amount of long term disability benefits he would have received has been completely offset by other benefits.

11. Under company policy, two years was the maximum period of time allowed for a continuous medical leave of absence from active service with the company. Plaintiff was advised by a letter dated April 18,1977 from Mr. Blasko, manager of benefits and pensions for Lederle Laboratories, that the maximum leave of absence period of two years would expire in June of 1977. Plaintiff was provided with an application form for total and permanent disability benefits. The application was returned to Mr. Blasko by Arthur Thomas, plaintiff’s attorney, in May of 1977 with the indication that medical reports would follow.

12. Plaintiff’s employment was terminated on June 10, 1977 pursuant to the employer’s standing policy. At that time, plaintiff had been on continuous leave of absence for two years.

13. The determination of eligibility for total and permanent disability benefits is made by the Central Medical Committee, composed of William Gerristead, supervisor of benefits, and Dr. Dolor, company physician for American Cyanamid.

14. Mr. Gerristead considered various medical data in connection with plaintiff’s application for total and permanent disability benefits.

He reviewed a report by Dr.

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Bluebook (online)
662 F. Supp. 483, 1987 U.S. Dist. LEXIS 16981, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bova-v-american-cyanamid-co-ohsd-1987.