Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management Co.

693 F. Supp. 2d 856, 2010 U.S. Dist. LEXIS 24334, 2010 WL 933983
CourtDistrict Court, S.D. Indiana
DecidedMarch 16, 2010
DocketCase 1:07-cv-0483-DFH-DML
StatusPublished
Cited by7 cases

This text of 693 F. Supp. 2d 856 (Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management Co., 693 F. Supp. 2d 856, 2010 U.S. Dist. LEXIS 24334, 2010 WL 933983 (S.D. Ind. 2010).

Opinion

ENTRY ON THE MERITS

DAVID F. HAMILTON, Circuit Judge. *

Plaintiff Robert Gessling has sued defendant Group Long Term Disability Plan for Employees of Sprint/United Management Company alleging that the plan administrator abused its discretion in terminating his long-term disability benefits, violating the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. The administrator — Hartford Life — initially granted benefits to Gessling but later terminated them after conducting surveillance of Gessling and reviewing its medical consultants’ opinions that Gessling was not disabled. After the Supreme Court decided Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), the court denied both parties’ motions for summary judgment to give them an opportunity to discover and present additional evidence on Hartford Life’s conflict of interest so that it could be compared to the conflict that Metropolitan Life faced in Glenn. The plan administrator had discretion to interpret and administer the plan. It decided whether to pay or deny benefits. Decisions to deny benefits had the direct effect of leaving money in its pocket, as the administrator. The parties have presented that evidence, and Gessling has renewed his motion for summary judgment. The court finds that the conflict-of-interest evidence shows no unusual aggravating or mitigating factors, though the conflict itself remains a factor in the analysis. The case is ripe for a final decision on the merits based on the administrative record and the additional evidence submitted by the parties.

Even under the deferential standard that applies to the administrator’s decision, the termination of Gessling’s benefits was arbitrary and capricious. Hartford Life unreasonably discounted Gessling’s treating physician’s and his own assessments of his pain and limitations. The reliance on the surveillance did not rationally support the decision to terminate benefits, and Hartford Life’s consulting doctors did not provide a reasoned basis for discounting the evidence from Gessling and his treating physician showing he had been struggling with severe and disabling pain. The court orders that the benefits be reinstated for the remaining months of the two-year “own occupation” benefit period, and remands Gessling’s case to Hartford Life for a fresh look at whether he qualified for benefits beyond that time into the “any occupation” benefit period. The court reaches this decision without relying on the conflict of interest issue under Metropolitan Life v. Glenn and the evidence presented concerning it.

I. The Standard of Review

The employee benefit plan here gave Hartford Life “full discretion” to determine eligibility for benefits and to interpret the plan’s terms. R. 31. That plan provision is sufficient to require the court *859 to review the denial of benefits under the deferential “arbitrary and capricious” standard. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 111, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Gutta v. Standard Select Trust Ins. Plans, 530 F.3d 614, 619 (7th Cir.2008); Williams v. Aetna Life Ins. Co., 509 F.3d 317, 321 (7th Cir.2007). The court addresses the conflict of interest evidence in Part IV of this entry.

II. Facts from Administrative Record

Plaintiff Robert Gessling began working for Sprint/United Management Company (“Sprint”) in December 1998 as an account executive. He was responsible for managing national accounts. He spent about half of his time working in an office and half of his time out of the office with customers. R. 137. He often drove to customer locations but had the option of flying if needed.

According to his supervisor, Gessling’s duties required frequent walking and repetitive hand motions, occasional standing and sitting, and minimal lifting and carrying. R. 824. Gessling spent about fifteen percent of each workday in written communication and about ten percent of each workday driving. He worked forty hours per week, managed himself, scheduled his own meetings, and had flexibility in creating his travel schedule. R. 137, 820.

In May 2002, Gessling was involved in a traffic accident. While his car was at a standstill, a semi-tractor trailer traveling about forty miles per hour hit his car from behind. R. 776. The impact caused significant damage to Gessling’s car, but Gessling himself did not seem injured immediately after the accident. The person who towed Gessling’s car dropped him off at home. His wife later took him to a hospital because he was complaining of pain in his neck, right shoulder, arm, and lower back. R. 668. The record does not include any documentation of that first hospital visit after the accident. His neck pain continued. On August 16, 2002, Dr. Dan Nordmann saw Gessling and reviewed an MRI taken on June 13, 2002. The MRI revealed bony outgrowths and inflammation in and around Gessling’s third, fourth, fifth, and sixth cervical vertebrae. R. 776. Dr. Nordmann injected lidocaine into the right side of Gessling’s second, third, fourth, fifth, and sixth cervical vertebrae. R. 777. Almost immediately after the injections, Gessling reported complete pain relief. In September 2002, Dr. Judith Dunipace injected steroids in the nerve roots on the right side of Gessling’s fifth cervical vertebra. R. 797. The record does not include any medical evidence between September 2002 and February 2005.

Gessling worked for more than two years, through February 15, 2005, but he then took disability leave. R. 820. He saw his primary physician, Dr. John Walker, on February 16, 2005. R. 726. Dr. Walker noted that Gessling suffered from chronic neck pain and anxiety, and he ordered another MRI. The new MRI revealed several areas of degeneration since the June 13, 2002 MRI: (1) broad-based disc bulges and disc herniation, bone spurs, associated moderate stenosis, and foraminal narrowing at the fifth and sixth cervical vertebrae; (2) bone spurs and mild stenosis at the third, fourth, and fifth cervical vertebrae; (3) mild broad-based disc bulges at the sixth and seventh cervical vertebrae; and (4) mild disc herniation at the seventh cervical vertebrae and the first thoracic vertebrae. R. 576-77. Dr. Timothy Divens interpreted these changes as mild spondylosis of the lower cervical spine. R. 659.

On February 18, 2005, Gessling applied for disability benefits from Sprint, attaching an evaluation from Dr. Walker reporting diagnoses of “cervical spine pain with foraminal stenosis, disc herniation, spondylosis,” and headaches. R. 825-26. Gess *860

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Bluebook (online)
693 F. Supp. 2d 856, 2010 U.S. Dist. LEXIS 24334, 2010 WL 933983, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gessling-v-group-long-term-disability-plan-for-employees-of-sprintunited-insd-2010.