Geiger v. Pfizer, Inc.

918 F. Supp. 2d 697, 2013 WL 170178, 2013 U.S. Dist. LEXIS 7099
CourtDistrict Court, S.D. Ohio
DecidedJanuary 16, 2013
DocketCase No. 2:10-cv-106
StatusPublished
Cited by1 cases

This text of 918 F. Supp. 2d 697 (Geiger v. Pfizer, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Geiger v. Pfizer, Inc., 918 F. Supp. 2d 697, 2013 WL 170178, 2013 U.S. Dist. LEXIS 7099 (S.D. Ohio 2013).

Opinion

OPINION AND ORDER

GEORGE C. SMITH, District Judge.

Plaintiff Chris Geiger brings this action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. § 1132. On March 9, 2010, Plaintiff moved for judgment on the administrative record (Doc. 47) against Defendant CIGNA Life Insurance Company of New York (“CIGNA-NY”), alleging an unlawful termination of benefits to which she is entitled under Pfizer, Inc.’s Long-Term Disability Plan No. 504. On this same day, Defendants CIGNA Group Insurance, Pfizer, Inc. Long-Term Disability Plan, and CIGNANY (collectively, “Defendants”) filed a cross-motion for judgment on the administrative record (Doc. 45).1 Each side has filed responses. These motions are now ripe for review. For the reasons that follow, the Court GRANTS IN PART AND DENIES IN PART Plaintiffs Motion for Judgment on the Administrative Record and DENIES Defendants’ Cross-Motion for Judgment on the Administrative Record.

I. BACKGROUND

Plaintiff is a former employee of Pfizer, Inc. She was employed full-time as a Senior Professional Healthcare Representative (ie., a pharmaceutical sales rep). Plaintiff is a licensed registered nurse with a Bachelor of Science degree. She began her career with Abbott Laboratories in 1979 until she took a position with the Warner-Lambert Company. She then became employed by Pfizer in June 2000 when Pfizer and Warner-Lambert merged. Defendant CIGNA-NY is the claims administrator and insurer of Pfizer, Inc.’s Long-Term Disability Plan No. 504, Policy No. NYK-2279 (“the Plan”). At all times relevant to this action, Plaintiff was a participant in the Plan. (Administrative Record (“AR”), Doc. 49, 513, 598-600).

On May 19, 2007, Plaintiff fell while horseback riding and fractured her hip. (AR 584-85). She never returned to work at Pfizer. In November 2007, Plaintiff filed a claim for long-term disability (“LTD”) benefits due to her hip injury and related problems. On November 20, 2007, Plaintiff underwent total hip replacement surgery. On November 27, 2007, CIGNANY approved Plaintiffs receipt of LTD benefits (with a start date of November 19, 2007). (AR 546-48). CIGNA-NY discontinued those benefits on March 26, 2009, based on a review of Plaintiffs medical information by a nurse case manager. The medical information did not reveal “what current restrictions or limitations prevent [Plaintiff] from returning to work.” (AR 313-17, 323).

Some notable reports of Plaintiffs health that were considered by CIGNANY when deciding to discontinue Plaintiffs benefits include:

• On February 14, 2008, Dr. Barsoum indicated that Plaintiff had full, painless range of motion, with mild pain in the left hip that had “no effect on ordinary activity.” (AR 412-14).
• On March 17, 2008, Dr. Hackshaw, a rheumatologist, noted that Plaintiffs left hip was functioning well and that she had “been able to resume her [701]*701horseback riding.” (AR 429-30). He also noted tender points consistent with fibromyalgia, but “[njothing else ... beyond that.” (Id.).
• On July 28, 2008, Dr. Hackshaw noted that Plaintiff was still horseback riding and that she had injured her finger “doing some farming work.” (AR 431-32). He again noted tender points consistent with fibromyalgia, but “[njothing else ... beyond that.” (Id.).
• On August 12, 2008, Plaintiff competed as a rider in the Buckeye Morgan Challenge, a horseback riding competition. (AR 477-79). She placed in three separate events.
• On December 12, 2008, Dr. Hackshaw noted that Plaintiff had twisted her knee while “cleaning a horse” but that she did not have any “difficulty in riding.” (AR 427-28).
• On February 2, 2009, CIGNA-NY requested Dr. Hackshaw complete a physical ability assessment form outlining Plaintiffs limitations, but he refused. (AR 416-21). He again did not respond to a February 18, 2009 request for clarification from CIGNANY as to how Plaintiff was able to clean and ride her horses, but was not able to work. (AR 343).
• On February 11, 2009, Plaintiff saw Dr. Caligluri and included on her patient history form that she got regular exercise “showing horses” and cleaning stalls.” (AR 335).

In addition to the hip issues, Plaintiff also suffers from fibromyalgia, narcolepsy, osteoarthritis, joint pain, pain in both knees, quads and calves, extreme pain in the lower lumbar region, LI vertebral fracture, multilevel degenerative disc disease, neural foraman narrowing, depression, cognitive dysfunction, and migraines. (AR 266, 268, 336). Plaintiff appealed the denial of LTD benefits based on the combination of all of her medical issues. (AR 262-75). Plaintiff submitted additional medical documentation from Drs. Hackshaw, Saribalas, Richardson and Singh opining that Plaintiff should refrain from working or is unable to work. (AR 303-13). On September 23, 2009, CIGNA-NY denied that appeal. (AR 102). On January 8, 2010, Plaintiff was awarded Social Security disability benefits based on a finding that she is unable to work in any job in the national economy. Plaintiff informed CIGNA-NY of this on January 20, 2010. Plaintiff again appealed to CIGNANY and it upheld its denial on March 2, 2010. (AR 95-97). Plaintiff then filed this lawsuit on February 5, 2010.

A. Plaintiffs Job Description

The essential functions of Plaintiffs position as a Senior Professional Healthcare Representative include:

• Make at least 8-10 sales calls per day to physicians’ offices within her territory;
• Perform 8 hours of field time each day per district standard hours;
• Conduct/attend evening programs when warranted;
• Handle and distribute starter drug samples in accordance with company policy;
• Use a computer to enter all calls and drug sample drugs into database each day;
• Check voice mail regularly during the work day;
• Log in and answer e-mail each business evening;
• Travel to, attend and participate in evening district functions such as dinners or team meetings;
• Send required reports into District Manager on a weekly/monthly basis;
[702]*702• Lift up to 25 pounds; and
• Safely operate a motor vehicle in accordance with company policy and applicable driving rules and regulations.

(AR 600).

B. Applicable Plan Provisions

The Plan provides for replacement of a portion of a participating employee’s annual pay should the employee become unable to work for an extended period of time due to a sickness or injury, as defined by the Plan.2 Following a benefit waiting period, benefits are payable for up to 24 months when the employee’s sickness or injury makes her “unable to perform all the material duties of his or her regular occupation” (referred to as the “own occupation period”). (AR 202).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Pfenning v. Liberty Life Assurance Co.
354 F. Supp. 3d 826 (S.D. Ohio, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
918 F. Supp. 2d 697, 2013 WL 170178, 2013 U.S. Dist. LEXIS 7099, Counsel Stack Legal Research, https://law.counselstack.com/opinion/geiger-v-pfizer-inc-ohsd-2013.