Bowling v. PBG Long-Term Disability Plan & VPA, Inc.

584 F. Supp. 2d 797, 2008 U.S. Dist. LEXIS 91111
CourtDistrict Court, D. Maryland
DecidedNovember 5, 2008
DocketCivil JFM-07-02984
StatusPublished
Cited by1 cases

This text of 584 F. Supp. 2d 797 (Bowling v. PBG Long-Term Disability Plan & VPA, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bowling v. PBG Long-Term Disability Plan & VPA, Inc., 584 F. Supp. 2d 797, 2008 U.S. Dist. LEXIS 91111 (D. Md. 2008).

Opinion

MEMORANDUM

J. FREDERICK MOTZ, District Judge.

On November 5, 2007, plaintiff Keith Bowling (“Bowling”) filed suit under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., challenging the termination of his long-term disability benefits by defendants PBG Long-Term Disability Plan and VPA, Inc. (“VPA”). VPA filed a counterclaim requesting an equitable lien on alleged overpayments made to Bowling. Now pending before the Court is Defendants’ Motion for Summary Judgment as to Plaintiffs claim and Defendants’ counterclaim. For the reasons that follow, I will grant Defendants’ motion.

I. Factual Background

The facts that follow are presented in the light most favorable to the non-moving party. See Lee v. York County Sch. Div., 484 F.3d 687, 693 (4th Cir.2007). Keith Bowling began his employment with the Pepsi Bottling Group, Inc. (“PBG”) on July 29, 2003. (Mem. Supp. Defs.’ Mot. Summ. J. (“Defs.’ Mem.”) 1.) He participated in the PBG Long Term Disability (“LTD”) Plan (“the Plan”), an employee welfare benefit plan administered by VPA. Bowling was employed at PBG as a Delivery Driver, where he prepared daily deliveries, drove to delivery locations, and delivered products to customers. (Defs.’ Mem., Ex. 2A at 85.) The physical demands of his position included frequent lifting and carrying of up to 100 pounds, frequent bending, standing, walking, and sitting, and occasional squatting, kneeling, twisting, turning, and climbing. {Id. at 86.)

On August 26, 2003, less than a month after beginning work at PBG, Bowling became unable to perform his job as a Delivery Driver. 1 (Answer ¶ 7.) He was awarded 26 weeks of short-term disability benefits beginning August 26, 2003, and long-term disability benefits beginning February 24, 2004. (Pl.’s Response Defs.’ Mot. Summ. J. (“Pl.’s Response”) 2.)

Bowling was first treated by Dr. Mikhail, a family practitioner, who completed Bowling’s certificate for disability benefits on October 23, 2003. (Defs.’ Mem., Ex. 2A at 245.) Dr. Mikhail diagnosed Bowling with lower back pain and radicilitis. {Id. at 246.) Dr. Naiman, an orthopedic surgeon, also treated Bowling in October 2003. After examining Bowling and reviewing radiographs and MRI films, Dr. Naiman diagnosed him with a congenital *800 anomaly of the lumbar spine, a pars defect, and spondylolisthesis. (Id. at 249-50.) Dr. Naiman recommended physical therapy and anti-inflammatories. (Id. at 250.) He also “recommended that [Bowling] resume occupational activities on a light duty basis.” (Id.) According to Dr. Naiman’s report, Bowling stated to Dr. Naiman that “he will not resume occupational activities.” (Id.)

Dr. Mikhail referred Bowling to Dr. Park for a neurological consultation. (Id. at 258.) Dr. Park first saw Bowling on November 6, 2003, and observed that Bowling “has a difficult time walking or standing straight” and “cannot walk any length of time.” (Id.) Dr. Park recommended physical therapy, muscle relaxants, and anti-inflammatories, and noted that Bowling may need a stabilization procedure in his back if his condition did not improve. (Id.) Dr. Park continued to see Bowling over the coming months, with Bowling’s next visit on December 11, 2003. (Id. at 257.) At that point, Bowling had not started physical therapy due to a change in insurance. (Id.) Bowling returned to Dr. Park on January 15, 2004, by which time he had completed some physical therapy and was “feeling maybe a little better.” (Id. at 151.) Dr. Park recommended that the physical therapy continue. (Id.)

On February 24, 2004, after Bowling’s 26 weeks of short-term disability expired, VPA began paying long-term disability benefits. In May 2004, Dr. Park reported that Bowling’s pain was getting worse and proposed surgery. (Id. at 174.) In October 2004, Dr. Park again reported that Bowling’s “symptoms are getting worse and worse,” and noted that Bowling would like to have surgery. (Id. at 190.) On November 4, 2004, Dr. Park wrote that because Bowling was scheduled for a lumbar spinal fusion surgery, he would be unable to work for twelve months. (Id. at 192.) On December 21, 2004, Dr. Park told VPA that Bowling was to be scheduled for the surgery, and could not resume work until December 2, 2005. (Id. at 193.) As of July 3, 2007, Bowling had not undergone any surgical procedures. (Id. at 60.)

During the first 24 months of disability benefits, a participant is considered “totally disabled” under the Plan if he is unable “to perform all of the material or essential duties pertaining to his ‘own occupation.’ ” (Id. at 11; Plan Documents at 2.25(a)(1).) After 24 months of disability, however, the Plan’s definition of “totally disabled” is more stringent. A participant is entitled to benefits only if he is unable to engage in any “Reasonable Occupation ... for which he is, or may reasonably become, qualified by education, training, or experience, and [t]hat is available to the Participant in his geographic area.” (Id. at 12; Plan Documents at 2.25(a)(3).) On February 1, 2005, a VPA representative informed Bowling that the stricter definition of “Total Disability” would take effect on August 27, 2005. (Id. at 194-95.) The letter indicated that VPA was evaluating Bowling’s continued eligibility for benefits. (Id. at 195.) Toward that end, VPA requested an independent orthopedic evaluation, which was performed by Dr. Halikman on July 11, 2005. (Id. at 78.) Bowling reported to Dr. Halikman that his condition since the 2003 accident had not really improved. (Id.) After examining numerous medical records and conducting a physical examination of Bowling, Dr. Halikman diagnosed Bowling with “pre-existing degenerative lumbar disc disease with an isthmic spondylolis-thesis and foraminal stenosis.” (Id. at 81.) Dr. Halikman concluded:

This gentleman is not able to do his regular job at this time. He could do sedentary work, but it should be noted that sitting for extended periods of time may also be bothersome for him. He is not able to lift objects at this point *801 weighing more than twenty pounds on a regular basis and working in any type of awkward positions such as stooping, bending, squatting, kneeling or crawling would be absolutely forbidden.

(Id.) Dr. Halikman’s opinion was that Bowling was “not able to work at his usual job at this time and from a practical matter, it would be difficult for him to work in any kind of gainful employment.” (Id. at 82.) In addition to his report, Dr. Halik-man completed a Physical Capacities Evaluation Form, indicating that Bowling could stand for a total of two hours at a time during a regular workday, and walk, sit, or drive for a total of one hour at a time each during a regular workday. (Id.

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Bluebook (online)
584 F. Supp. 2d 797, 2008 U.S. Dist. LEXIS 91111, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bowling-v-pbg-long-term-disability-plan-vpa-inc-mdd-2008.