Fairbaugh v. Life Insurance Co. of North America

737 F. Supp. 2d 68, 2010 U.S. Dist. LEXIS 83337, 2010 WL 3257663
CourtDistrict Court, D. Connecticut
DecidedAugust 16, 2010
Docket3:09-cv-1434 (CSH)
StatusPublished
Cited by9 cases

This text of 737 F. Supp. 2d 68 (Fairbaugh v. Life Insurance Co. of North America) 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
Fairbaugh v. Life Insurance Co. of North America, 737 F. Supp. 2d 68, 2010 U.S. Dist. LEXIS 83337, 2010 WL 3257663 (D. Conn. 2010).

Opinion

RULING ON CROSS-MOTIONS FOR JUDGMENT ON THE ADMINISTRATIVE RECORD

CHARLES S. HAIGHT, JR., Senior District Judge.

Plaintiff Paige Fairbaugh brings this action against Defendant Life Insurance Company of North America, doing business as CIGNA Group Insurance (“LINA” or “CIGNA”), for violation of the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001, et seq. (“ERISA”). Plaintiff, who has Multiple Sclerosis (“MS”), is a participant in an ERISA welfare benefit plan for provision of Long Term Disability (“LTD”) benefits (“the Plan”) that was issued to Plaintiffs former employer, UBS. 1 The Plan was insured by LINA and LINA administered claims for benefits under the Plan.

In a two count complaint, Plaintiff alleges that LINA violated ERISA in that it terminated her LTD benefits without presenting any medical evidence supporting its decision, disregarded the medical opinions of Plaintiffs treating physician without justification for doing so, and failed to provide a reasonable claims procedure. She seeks to recover benefits under the Plan, to clarify and enforce her present rights under the Plan, and to recover costs and attorney’s fees. Specifically, Count One for “Enforcement of Plan Terms” seeks a declaration of Plaintiffs entitlement to ongoing LTD benefits, and an award of the unpaid LTD benefits of $5,300 per month back to May 20, 2009, plus prejudgment interest. Plaintiff also seeks restitution, with prejudgment interest, for the cost of obtaining medical coverage since May 20, 2009, because disqualification from LTD benefits resulted in Plaintiffs disqualification from continued participation in UBS’s medical plan. Count Two seeks attorney’s fees and costs under ERISA.

The parties filed cross-motions for Judgment on the Administrative Record. The complete Administrative Record 2 (“AR”) was manually filed under seal by Defendant. [Doc. 35] For the reasons stated herein, Plaintiffs Motion for Judgment on the Administrative Record [Doc. 19] is GRANTED, and Defendant’s Motion for Judgment on the Administrative Record [Doc. 29] is DENIED.

I. BACKGROUND

Plaintiff began working for UBS in December 1997. She was diagnosed with Multiple Sclerosis in October 1998. (AR *73 566) A neurologist, Dr. Joseph Guarnaccia, treated Plaintiff for MS from 2002 onward. (AR 507) Plaintiffs last position at UBS was described alternatively as “Client Events Team Project Leader in the Event Marketing Department” [Doc. 21 at ¶ 2] and “Associate Director, Corporate Event Planner/Project Leader.” [Doc. 28 at ¶ 2] Plaintiff maintains that her job as a corporate event planner was highly stressful, required multi-tasking and responsiveness to time-sensitive matters, and involved significant travel, with the physical demands that accompany travel. Defendant disputes this characterization, maintaining that Plaintiffs job was largely sedentary, that any travel was minimal and was within her physical capabilities, and that Plaintiff only began to claim otherwise after her LTD benefits were terminated. The official classification of Plaintiffs job under the Dictionary of Occupational Titles (“DOT”) is “light,” which by definition involves more physical demands than a job with a “sedentary” classification. (AR 366)

Plaintiffs Receipt of Benefits under the Plan

UBS contracted with LINA to provide long-term disability (“LTD”) insurance coverage for UBS’s eligible employees under policy number LK0030546 (“LTD Plan” or “Plan”). (AR 236-60) The LTD Plan grants LINA, which acts as the Claims Administrator, the “authority, in its discretion, to interpret the terms of the Plan documents, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact.” (AR 255) Plaintiff participated in this Plan.

In March 2007, Plaintiff sought short term disability (“STD”) benefits, which were also administered by LINA. (AR 364, 566-67) With respect to short term disability, “Disability or Disabled means that you are unable to perform all the material and substantial duties of your occupation on an active employment basis because of an Injury or Sickness.” (AR 813) (emphasis added). Plaintiffs claim for short term disability benefits was granted, and her STD benefits commenced on April 5, 2007, and were subsequently extended. (AR 785) Plaintiff returned to work full time on or about September 4, 2007, with a work from home accommodation. (AR 750; see also AR 542 (“as she is currently working from the home ... ”)) In May 2008, Plaintiff again sought and was granted short term disability benefits, which commenced on May 17, 2008, and she continued to receive short term disability benefits for six months, through November 14, 2008. (AR 290)

Prior to expiration of her short term disability benefits, Plaintiff applied for Long Term Disability benefits, eligibility for which is defined in the Plan as follows 3

An Employee is Disabled if, because of Injury or Sickness;

1. he or she is unable to perform all the material duties of his or her regular occupation, or solely due to Injury or Sickness, he or she is unable to earn more than 80% of his or her Indexed Covered Earnings; and
2. after Disability Benefits have been payable for 24 months, he or she is unable to perform all the material duties of any occupation for which he or she may reasonably become qualified based on education, training or experience, or solely due to Injury or Sickness, he or she is unable to earn more than 80% of his or her Indexed Covered Earnings. *74 (AR 245) (emphases added). The period of receipt of short term disability benefits does not count against the 24 months of long term disability benefits to which an eligible applicant is entitled under the “regular occupation” standard, before being subject to the “any occupation” standard. 4 Thus, Plaintiffs LTD claim was to be evaluated under the “regular occupation” standard. On October 28, 2008, Plaintiff was notified that her claim for long term disability benefits, in the amount of $5,300 monthly 5 , had been approved, and that her LTD benefits would commence on November 15, 2008, the day after her short term disability benefits expired. (AR 280-81)

Social Security Disability Benefits Denied,

The Long Term Disability benefits received by a participant in the Plan are reduced by any Other Income Benefits, including Social Security disability benefits, that are received by the participant. (AR 250, 280) Defendant provided Plaintiff assistance in applying for Social Security disability benefits. 6 (AR 283-86) On March 11, 2009, the Social Security Administration issued a determination that Plaintiff was “not entitled to disability benefits based on the claim you filed,” further stating:

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Bluebook (online)
737 F. Supp. 2d 68, 2010 U.S. Dist. LEXIS 83337, 2010 WL 3257663, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fairbaugh-v-life-insurance-co-of-north-america-ctd-2010.