Cheal v. Life Insurance Co. of North America

330 F. Supp. 2d 1347, 2004 U.S. Dist. LEXIS 16075, 2004 WL 1822370
CourtDistrict Court, N.D. Georgia
DecidedJuly 28, 2004
Docket1:03-cv-03000
StatusPublished
Cited by8 cases

This text of 330 F. Supp. 2d 1347 (Cheal v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, N.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cheal v. Life Insurance Co. of North America, 330 F. Supp. 2d 1347, 2004 U.S. Dist. LEXIS 16075, 2004 WL 1822370 (N.D. Ga. 2004).

Opinion

ORDER

STORY, District Judge.

Now before the Court is Defendants’ Motion to Partially Dismiss Plaintiffs Complaint [8-1]. After considering the entire record, the Court enters the following Order.

Background

Plaintiff Arnold Earl Cheal filed this suit against Defendants Life Insurance Company of North America (“LINA”) and Matsu-shita Battery Industrial Corporation of America’s Group Short Term and Long Term Disability Insurance Plan (“the *1349 Plan”) arising out of the denial of short-term and long-term disability benefits pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”). The facts of the case are as follows. 1 Plaintiff Arnold Earl Cheal holds a doctorate in business administration and has had a long and distinguished career. At the time of the events that gave rise to this suit, Mr. Cheal was 60 years old and had been employed by Matsushita Ultra-Tech Battery Corporation (“Matsushita”) as Manager of Planning for around a year. 2 This position required a high degree of cognitive functioning including the ability to learn and retain new information, organize and plan activities, and a high degree of concentration and judgment. In his first and only performance review, Mr. Cheal received a positive review and a performance-based raise.

In November 2000, Mr. Cheal suffered a stroke, although he did not know it immediately. After his stroke, Mr. Cheal’s cognitive abilities significantly declined. Mr. Cheal began experiencing difficulties with attention and concentration, retaining new information, staying on task and meeting production norms. In early 2001, Mr. Cheal began noticing these problems before he realized why they had suddenly appeared. An April 2001 report from a family doctor noted that Mr. Cheal had been experiencing short-term memory loss and recommended tests to confirm a suspected stroke. 3 Mr. Cheal notified his employer of this information by email, stating that he had been experiencing short-term memory loss and that he “noted much difficulty in learning and understanding new concepts.” Mr. Cheal’s supervisors discussed the email in April 2001, and told Mr. Cheal not to discuss the topic with other employees.

On April 25, 2001, Mr. Cheal again visited his doctor, who noted short-term memory loss and wrote a statement restricting Mr. Cheal from working more than eight hours per day. This was a reduction from his usual schedule of fifty to sixty hours per week. Mr. Cheal provided this statement to his supervisor on April 26, 2001. 4 On May 1, 2001, Mr. Cheal’s supervisor issued a written warning that criticized Mr. Cheal’s work performance and noted that Mr. Cheal’s performance was suffering in areas including: understanding of processes; understanding of methodology; knowledge of product line up; knowledge of vendors; and knowledge of information sources. On May 24, 2001, Mr. Cheal saw a neurologist, Dr. Sidhpura, who ordered additional tests. On May 28, 2001, Mr. Cheal notified his employer that his doctor suspected “brain stem stroke.” On June 4, 2001, a brain MRI confirmed the stroke. Mr. Cheal’s employer terminated his employment on June 8, 2001, stating on his separation notice that Mr. Cheal was “unable to do the job.”

On the same day, June 8, 2001, Mr. Cheal advised LINA of his claim for short-term and long-term disability benefits under the Plan. The Plan is an “employee welfare benefit plan” as defined by *1350 ERISA, 29 U.S.C. § 1002(1). Defendant LINA is a claim fiduciary for the plan and makes all decisions regarding claims for benefits. LINA provided Mr. Cheal with disability claim forms. He completed them on July 8, 2001. On the claim forms for “Date of accident or beginning of sickness” he responded “Estimated fall of 2000,” Dr. Sidhpura completed an attending physician’s statement for LINA in which he confirmed the diagnosis of “right parietal stroke” and indicated June 8, 2001, the date of Mr. Cheal’s termination from Matsushita, as the “Date first unable to work due to aecident/illness.” Mr. Cheal wrote to LINA in November 2001, December 2001 and January 2002 to inquire about the status of his claim. He received no response. On January 29, 2002, LINA mailed an unsigned letter dated September 10, 2001 denying his claim. The letter notified Mr. Cheal that his claim was denied because “there was no loss of time from your employment” and because LINA concluded that the medical files did not support “restrictions or limitations that would support your disability prior to your date of termination.”

In March 2002, Mr. Cheal notified LINA of his intention to appeal (hereinafter “the Level One Appeal”). Mr. Cheal argued that although he was terminated in June 2001, he experienced disabling limitations beginning in late 2000. By a letter dated May 6, 2002, LINA advised Mr. Cheal that it was upholding its decision to deny benefits because there was “no evidence that supports you were in active service prior to the date you are indicating that you were unable to work due to your medical condition.”

On May 20, 2002, Mr. Cheal requested additional review of his claim (hereinafter “the Level Two Appeal”). On the Level Two Appeal Mr. Cheal argued that the language of the policy indicated that he was covered “if [his] Active Service ends because of a Disability for which benefits under the Policy are or may become payable.” Mr. Cheal inquired whether this language applied to his situation. In addition to his inquiries directed to LINA, Mr. Cheal also spoke with the Plan Administrator, Mr. John Rowe. By a letter dated July 17, 2002, Mr. Rowe advised LINA that the Plan agreed with Mr. Cheal’s interpretation of the “Continuing Coverage” language. In August 2002 Mr. Cheal received a letter from LINA acknowledging receipt of Mr. Cheal’s Level Two Appeal. The letter indicated that the file would be submitted for an independent review. In February 2003, Mr. Cheal again inquired and provided additional information in the form of a favorable Social Security Award. 5 Even though Mr. Cheal again wrote to LINA regarding his Level Two Appeal in April 2003, he never received a response.

Mr. Cheal’s counsel requested a copy of LINA’s claim file by a letter dated June 24, 2003. LINA produced the file on August 11, 2003. Mr. Cheal. filed suit against LINA and the Plan on October 2, 2003. Mr. Cheal’s Complaint asserts claims for benefits, breach of fiduciary duty, and statutory penalties for failure to timely produce the claim file. Defendants LINA and the Plan have moved to partially dismiss Plaintiffs Complaint.

Discussion

I. Standard for a Motion to Dismiss

Federal Rule of Civil Procedure 12(b)(6) empowers the Court to grant a defendant’s motion to dismiss when a complaint fails to state a claim upon which relief can be granted. In considering whether to grant or deny such a motion, *1351

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Bluebook (online)
330 F. Supp. 2d 1347, 2004 U.S. Dist. LEXIS 16075, 2004 WL 1822370, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cheal-v-life-insurance-co-of-north-america-gand-2004.