Cosey v. Prudential Insurance Co. of America

900 F. Supp. 2d 640, 55 Employee Benefits Cas. (BNA) 1161, 2012 WL 4581454, 2012 U.S. Dist. LEXIS 141066
CourtDistrict Court, M.D. North Carolina
DecidedSeptember 30, 2012
DocketNo. 1:11-cv-00121
StatusPublished
Cited by1 cases

This text of 900 F. Supp. 2d 640 (Cosey v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, M.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cosey v. Prudential Insurance Co. of America, 900 F. Supp. 2d 640, 55 Employee Benefits Cas. (BNA) 1161, 2012 WL 4581454, 2012 U.S. Dist. LEXIS 141066 (M.D.N.C. 2012).

Opinion

MEMORANDUM OPINION AND ORDER

THOMAS D. SCHROEDER, District Judge.

Plaintiff Beth A. Cosey (“Cosey”) brings this action for short-term disability (“STD”) and long-term disability (“LTD”) benefits. Cosey and Defendants, The Prudential Insurance Company of America (“Prudential”) and bioMerieux, Inc. (“bioMerieux”), have cross-moved for summary judgment pursuant to Federal Rule of Civil Procedure 56. (Docs. 24, 25.) For the reasons set forth below, Cosey’s motion will be denied, and Defendants’ motion will be granted.

I. BACKGROUND

A. Cosey’s Employment and Benefits Claims

Cosey was employed for some time by bioMerieux, a medical diagnostics company in Durham County, North Carolina, and was at the time relevant to this dispute a Senior Clinical Marketing Manager in her mid-forties.1 (Doc. 25-3 at 2.) Her responsibilities included setting pricing, promotion, and placement over several product lines, developing marketing plans and strategies, and sales promotion. (Administrative Record (“A.R.”) at 352, 372-74, 816-17.) She was also required to travel, including domestically several times a month and internationally one to two times a year. (Id. at 352.)

On May 26, 2007, Cosey stopped working following complaints of fatigue, hypo-tension (low blood pressure), weight loss, and sleep apnea. (Doc. 25-3 at 2.) She submitted a claim for STD benefits to Prudential, an insurance company acting as claims administrator for STD and LTD benefits pursuant to group insurance policies issued to bioMerieux, the plan administrator and sponsor. Prudential initially approved her claim and started making payments on June 5, 2007. (Id.) Effective June 30, 2007, however, it terminated Cosey’s STD benefits claim and disallowed LTD benefits on the ground that the medical information received did not support an impairment that would prevent her from performing the material and substantial duties of her regular occupation. (Id.) Cosey appealed the denial, but Prudential upheld its decision via letters dated October 18, 2007, January 3, 2008, and July 14, 2008. (Id.)

On June 15, 2008, Cosey was terminated from bioMerieux. (A.R. at 891.) On July 26, 2008, Cosey filed suit in the United States District Court for the District of South Carolina, seeking to recover her STD and LTD benefits. See Cosey v. bioMerieux, Inc. Short Term Benefit Plan and The Prudential Ins. Co. of Am., C.A. No. 4:08-cv-02670-RBH (D.S.C.). Nine days later, on August 4, 2008, bioMerieux re-hired Cosey in a limited capacity. (A.R. at 36.) During this time, she worked from her home in South Carolina, and her travel was limited to attending regular meetings at the company’s Durham site; her inter[643]*643national travel would resume beginning April 1, 2009. (A.R. at 375.) Cosey apparently continued in this capacity for some time as her condition seemed to improve, and on January 21, 2009, she notified the federal court that she had settled her lawsuit. An order of dismissal without prejudice was entered that same day, pending consummation of the settlement. (Doc. 25-6 at 4; Doc. 25-7 at 2.) The terms of the settlement have not been disclosed by either party (but the parties eventually filed a stipulation of dismissal with prejudice on June 1, 2009 (Doc. 25-6 at 4)).

Shortly thereafter, however, on March 9, 2009, Cosey again left her employment at bioMerieux. (A.R. at 910.) She cited medical concerns and submitted a second claim for STD and LTD benefits. (A.R. at 942, 936, 761.) In materials submitted to Prudential, she complained of fatigue, sleep disorder, dysautonomia (disease of the autonomic nervous system), myoclonus (muscle twitching), dizziness, and fibromyalgia (body-wide pain and tenderness). (A.R. at 758.) Prudential approved her STD benefits claim on March 24, 2009. (Id. at 942.)

On May 15, 2009, Prudential suspended Cosey’s benefits, pending the receipt of additional medical documentation. (Id. at 932.) On July 6, 2009, it notified Cosey that it was terminating her STD benefits because the submitted documentation did not support any continuing impairment. (Id. at 930-31.) Cosey appealed, but Prudential upheld its decision by letter dated February 11, 2010. (Id. at 916.) Prudential also notified Cosey that she was not eligible for LTD benefits. (Id. at 908.)

Cosey filed a second-level appeal, and Prudential again upheld its decision on December 20, 2010. (Id. at 870, 880.) The instant lawsuit followed.

B. Relevant Medical History

Since 2007, Cosey has undergone extensive specialty assessments for complaints of overwhelming fatigue, dizziness, and tremors, among other things. She has seen multiple specialists in the areas of neurology, cardiology, endocrinology, and sleep medicine. Specific medical testing has included an electroencephalogram (recording electrical activity of the brain), serology, holter (heart) monitoring, a poly-sonogram (sleep study), x-rays, magnetic resonance imaging, radiological scans, and tilt table testing. Despite these numerous multi-specialty evaluations, Cosey’s physicians have failed to find an underlying cause to adequately explain her symptoms.

Cosey was initially evaluated for fatigue in'May 2007 by her primary care physician, Dr. Cara Davis, who stated that Cosey had “no diagnosis/treatment established” and that her medical impairment was “overwhelming fatigue.” (Id. at 697.) Cosey subsequently consulted Dr. Sigaravelu Jagadeesan for fatigue, trouble with balance, and tremors in her hands. (Id. at 206.) At this time she was assessed with hypersomnia (excessive daytime sleepiness), an essential tremor, ataxia (lack of muscle coordination), and chronic disequilibrium with no evidence of cerebellar dysfunction. (Id. at 207.) An overnight sleep study revealed mild obstructive sleep apnea. (Id. at 209.) However, it was noted that these results would not explain Cosey’s reported level of daytime sleepiness. (Id.)

In October 2007, endocrinology records indicated that Cosey’s fatigue was stable, but its origin was still unknown, and although Cosey reported that her weight fell from 170 to 1332 pounds due to loss of appetite, she is noted to have “improved [644]*64460% over the last few months.” (Id. at 559-60.) A neurological evaluation in November 2007 was “relatively unremarkable,” and no cause for Cosey’s dizziness and fatigue was identified. (Id. at 689.) Further testing at the Diabetes & Endocrine Center noted a vitamin D deficiency but otherwise failed to shed light on Cosey’s symptoms. (Id. at 573.) During this time, Cosey also saw Dr. Robert Conder for complaints about cognitive and memory abilities. (Id. at 503.) Dr. Conder found Cosey’s neurocognitive abilities to be in the “Above Average to Superior range or greater” and diagnosed her with superior intellectual functioning and somatoform disorder (a psychiatric condition where physical conditions cannot be fully explained by a medical disorder). (Id. at 505.)

Following her return to work at bioMerieux in August 2008, Cosey reported to her cardiologist that she felt much better, was no longer having dizziness or lightheadedness, and was able to work, exercise, and play golf on the weekends. (Id.

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900 F. Supp. 2d 640, 55 Employee Benefits Cas. (BNA) 1161, 2012 WL 4581454, 2012 U.S. Dist. LEXIS 141066, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cosey-v-prudential-insurance-co-of-america-ncmd-2012.