Dunn v. Standard Insurance

156 F. Supp. 2d 227, 2001 WL 958811
CourtDistrict Court, D. Connecticut
DecidedAugust 23, 2001
DocketCIV.3:00CV00219(AWT)
StatusPublished

This text of 156 F. Supp. 2d 227 (Dunn v. Standard Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dunn v. Standard Insurance, 156 F. Supp. 2d 227, 2001 WL 958811 (D. Conn. 2001).

Opinion

RULING ON MOTION FOR SUMMARY JUDGMENT

THOMPSON, District Judge.

The plaintiff, a former employee of Balfour Beatty Insurance Company, brings this action asserting a claim against each defendant pursuant to 29 U.S.C. § 1132(a)(1)(B) for wrongful denial of employee welfare benefits and a claim against each defendant for violation of the Connecticut Unfair Trade Practices Act, Conn. GemStat. § 42-110a et seq. (“CUTPA”). The defendants have moved for summary judgment on all four counts of the plaintiffs complaint. For the reasons stated below, the defendants’ motion for summary judgment is being granted as to all counts.

I. FACTUAL BACKGROUND

The plaintiff, Maureen Dunn (“Dunn”), resides in Old Saybrook, Connecticut. Old Saybrook borders Old Lyme, Connecticut, where Lyme disease was first reported in 1975. From August of 1997 until June 23, 1998, Dunn was employed as a full-time assistant document controller by defendant Balfour Beatty, Inc., a/k/a Balfour Beatty Construction, Inc. (“Balfour”). On June 23, 1998, Dunn ceased working, as recommended by her employer, due to disabling symptoms such as depression, fatigue, anxiety, blurry vision, dizziness, memory loss and numbness in her limbs.

As an employee of Balfour, Dunn was covered under Balfour’s self-funded short-term disability plan, (“STD Plan”). The 1996 summary of benefits for the STD Plan states that short-term disability benefits last for up to 13 weeks. The summary also states that the benefits listed therein are subject to being changed or canceled without notice.

When the plaintiff stopped working, she applied for coverage under the STD Plan. She received disability benefits for a period of 26 weeks, i.e., from July 7, 1998 through January 1, 1999. The plaintiff received 26 weeks of benefits because it was Balfour’s policy at the time to give 26 weeks of benefits under the STD Plan, notwithstanding the fact that the 1996 summary of benefits stated that only 13 weeks of benefits would be provided.

When Dunn’s short-term disability payments ceased, she applied for benefits under Balfour’s long-term disability plan (“LTD Plan”). The LTD Plan was issued by defendant Standard Insurance Company (“Standard”) to Balfour, and Standard is the administrator of the LTD Plan. It became effective May 1,1996.

The LTD Plan contains an “Exclusions and Limitations” section whereby a preexisting condition exclusion period of 90 days applies to any individual who has not been continuously insured under the policy for twelve months. Under this exclusion, an employee may be denied long-term disability benefits if the employee is claiming disability for a mental or physical condition for which he or she, during the 90-day exclusion period, a) consulted a physician, b) received medical treatment or services, or c) took prescribed drugs or medications. The LTD Plan states that *230 Pavick Aff. Ex. A. at D 10013. In Dunn’s case, the 90-day period prior to her being covered by the LTD Plan commenced on June 20, 1997 and ended on September 17, 1997.

*229 you are not covered for a disability caused or contributed to by a preexisting condition or medical or surgical treatment of a preexisting condition unless, on the date you become disabled, you ... have been continuously insured under the group policy for the entire exclusion period ... and have been 'actively at work for at least one full day after the end of the exclusion period.

*230 A. Dunn’s Relevant Medical History

Upon Standard’s receipt of the plaintiffs claim under the LTD Plan, it was assigned to Michelle Pavick, a disability benefits analyst. Pavick reviewed Dunn’s medical records. Pavick learned that the plaintiff saw a general practitioner, Dr. James Pe-trelli, on two separate occasions during the preexisting condition exclusion period. During the plaintiffs first visit, on July 9, 1997, Dr. Petrelli noted Dunn’s symptoms as follows: “Complaint of nervousness. Patient having major stresses in life, marital difficulties with their business and children. Patient exhibiting signs of mild depression, sleep disorder, lack of appetite, [emotionality]. Lack of energy. Patient also complaining of symptoms of sweats, chills, myalgias, runny nose.” Pavick Aff. Ex. A at 10176. Dr. Petrelli prescribed Paxil and Xanax for Dunn’s “depression with anxiety.” Id. He also prescribed remedies for a viral illness and for gastroe-sophageal reflux disease. On July 22, 1997, for Dunn’s second office visit, Dr. Petrelli recorded her symptoms as follows: “Anxiety, depression. Patient has started marital counseling which she says is helping a lot. She stopped the Paxil because of dizziness and dry mouth. Complaining of some right shoulder pain. Nonspecific, denies trauma.” Pavick Aff. Ex. A at 10175. Dunn was directed to continue using the Xanax on a limited basis for her “mild anxiety with depression.” Id.

On November 20, 1997, Dunn visited Dr. Kornelia Keszler at her office in Madison, Connecticut. Dunn states that she went to see Dr. Keszler because of a complaint about an itchy red rash that both the plaintiff and her husband had noticed on Dunn’s lower back in late October. 1 By the time Dunn actually saw Dr. Keszler, the rash was no longer visible. Dr. Kesz-ler’s notes from the November 20, 1997 visit indicate that Dunn’s symptoms included involuntary loss of thirty-five pounds since July of 1997, family stress, depression, muscle stiffness, cramps, sinus congestion, numbness, heartburn and weepiness. There is no mention of the plaintiff having had a rash. However, Dr. Keszler did note that in 1991, another doctor suspected that the plaintiff had Lyme disease but Dunn’s tests at the time yielded negative results.

After the plaintiffs November office visit, Dr. Keszler sent a blood sample to the University of Connecticut Health Center to be tested for Lyme disease. The laboratory reported that the tests results were “negative,” but on December 9, 1997, Dr. Keszler telephoned the plaintiff and informed her that she had Lyme disease. 2 Throughout 1998, Dr. Keszler treated Dunn for Lyme disease and continued to record in her treatment notes that the *231 plaintiffs symptoms included numbness, depression, headaches, muscle aches and pains, and dizziness. In her March 6, 1998 treatment notes, Dr. Keszler made reference to a rash on the upper part of Dunn’s back. 3 Additionally, during an April 21, 1998 visit, Dr. Keszler decided to refer the plaintiff to a psychiatrist, Dr. Stanbury, for psychiatric help for depression.

In May of 1998, at the direction of Dr. Keszler, Dunn underwent a Brain SPECT (Single Photon Emission Computed Technology) scan and a Brain MRI (Magnetic Resonance Imagery) scan. According to Dr. Keszler, the Brain SPECT results were grossly abnormal and indicated that some parts of the plaintiffs brain were not receiving uniform blood flow.

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156 F. Supp. 2d 227, 2001 WL 958811, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dunn-v-standard-insurance-ctd-2001.