Dennis F. Sperandeo v. Lorillard Tobacco Company, Incorporated, and Continental Casualty Company, Also Known as Cna

460 F.3d 866, 38 Employee Benefits Cas. (BNA) 2115, 2006 U.S. App. LEXIS 21216, 2006 WL 2382459
CourtCourt of Appeals for the Seventh Circuit
DecidedAugust 18, 2006
Docket05-1916
StatusPublished
Cited by24 cases

This text of 460 F.3d 866 (Dennis F. Sperandeo v. Lorillard Tobacco Company, Incorporated, and Continental Casualty Company, Also Known as Cna) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dennis F. Sperandeo v. Lorillard Tobacco Company, Incorporated, and Continental Casualty Company, Also Known as Cna, 460 F.3d 866, 38 Employee Benefits Cas. (BNA) 2115, 2006 U.S. App. LEXIS 21216, 2006 WL 2382459 (7th Cir. 2006).

Opinion

RIPPLE, Circuit Judge.

Dennis Sperandeo brought this action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. He sought an award of disability payments under ERISA, 29 U.S.C. § 1132(a)(1)(B), seeking disability income benefits from Lorillard Tobacco Company, Inc.’s (“Lorillard”) Group Disability Income Insurance Policy, underwritten by Continental Casualty Company, also known as CNA (“CNA”). The district court granted summary judgment in favor of the plan administrator CNA. For the reasons set forth in the following opinion, we affirm in part and reverse in part the judgment of the district court and remand the case to the district court for further proceedings consistent with this opinion.

I

BACKGROUND

A. Facts

Mr. Sperandeo began working at Loril-lard as a sales representative in September 1970. On May 7, 2001, he was involved in an automobile accident while he was delivering boxes of tobacco to one of Lorillard’s customers. As a result of this collision, he suffered injuries to his head and shoulder. The. hospital records from the day of the accident indicate that Mr. Sperandeo suffered a concussion and a “shoulder sprain.” R.14, Ex.B at 204-05. The extent of those injuries, as well as their lasting effects on Mr. Sperandeo, are disputed.

Since the accident, Mr. Sperandeo has been treated by a number of physicians and has undergone physical therapy. On August 29, 2001, he underwent left rotator cuff and acromioplasty surgery performed by Dr. David Zoellick. On October 10, 2002, he underwent a second rotator cuff reconstructive surgery performed by Dr. *868 Jeffery Visotsky. Mr. Sperandeo also was treated by a neurologist, Dr. Glen Glista, and by an otologist-neurologist, Dr. Dennis Moore. Additionally, he was examined by several other neurological specialists. With the exception of two days in January 2002, Mr. Sperandeo has not returned to work at Lorillard.

At all times relevant to this litigation, Mr. Sperandeo was covered by Lorillard’s Group Disability Income Insurance Policy, which is underwritten and administered by CNA. The plan qualifies as a defined welfare benefit plan under ERISA, 29 U.S.C. § 1002(1). The Certificate of Insurance issued by CNA contains the following language defining disability:

How do We define Disability?
Disability or Disabled means that You [the Lorillard employee to whom the Certificate was issued] satisfy the Occupation Qualifier or the Earnings Qualifier as defined below.
Occupation Qualifier Disability means that during the Elimination Period and the following 24 months, Injury or Sickness causes physical or mental impairment to such a degree of severity that You are:
1) continuously unable to perform the Material and Substantial Duties of Your Regular Occupation; and
2) not Gainfully Employed.

R.14, Ex.A at 13, 25 (emphasis omitted). “Material and Substantial Duties” of employment are defined to mean “the necessary functions of Your Regular Occupation which cannot be reasonably omitted or altered.” Id. at 24 (emphasis omitted).

On July 10, 2002, Mr. Sperandeo filed a claim with Lorillard for long term disability benefits under the plan; Lorillard submitted Mr. Sperandeo’s claim to CNA for review. The claim was accompanied by a number of medical records submitted by Mr. Sperandeo and a Physical Demands Analysis (“PDA”) completed by Lorillard. The PDA detailed the primary duties of the job of sales representative, which included driving to and from clients’ businesses, rotating and checking clients’ inventories of cigarettes, assembling display units and data entry. The PDA outlined the physical demands of accomplishing these duties. They included bending, twisting, extending/reaching and lifting products weighing from two pounds for one carton of cigarettes to thirty-eight pounds for a whole case.

CNA employees reviewed Mr. Speran-deo’s medical records and interviewed him regarding his symptoms and limitations. On October 4, 2002, CNA denied Mr. Sper-andeo’s claim for benefits. CNA informed Mr. Sperandeo that the medical evidence did not support “functional impairments from either a physical or mental/nervous standpoint that would continuously preclude [him] from performing the substantial and material duties” of a sales representative. Id., Ex.B at 188.

Mr. Sperandeo appealed this decision and supplied CNA with additional medical records. On January 28, 2003, the appeals committee notified him that it had upheld the denial of benefits. See id. at 5-6. Mr. Sperandeo then brought this action against CNA and Lorillard 1 under ERISA, 29 U.S.C. § 1132(a)(1)(B), seeking an award of disability income benefits under the plan.

*869 B. District Court Proceedings

1.

In ruling on CNA’s motion for summary judgment, the district court first decided that the appropriate standard for its review of CNA’s determination was de novo. In reaching that conclusion, it articulated the rule set forth by the Supreme Court in Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Under that rule, a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard “unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone, 489 U.S. at 115, 109 S.Ct. 948. The district court noted that the language granting discretionary authority to CNA only was found in the Summary Plan Description (“SPD”) and the Certificate of Insurance (“Certificate”), not in the policy itself. CNA had contended that the discretionary language in the Certificate should be considered part of the policy or, in the alternative, that it was incorporated into the policy. The district court rejected both submissions. The court noted that the Certificate explicitly states that the Certificate is not part of the policy; similarly, the SPD states that it is not part of the plan. The court further noted that the policy, while discussing the contents of the Certificate, did not incorporate the Certificate into the policy. R.26 at 8. The district court then reasoned that, because the discretionary language was not part of the policy, it was not part of the plan. Accordingly, the court followed the rule announced in Firestone and concluded that de novo review was appropriate.

2.

The district court then turned to the merits of the summary judgment motion.

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460 F.3d 866, 38 Employee Benefits Cas. (BNA) 2115, 2006 U.S. App. LEXIS 21216, 2006 WL 2382459, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dennis-f-sperandeo-v-lorillard-tobacco-company-incorporated-and-ca7-2006.