Harvey v. Astra Merck Inc. Long Term Disability Plan

348 F. Supp. 2d 536, 2004 U.S. Dist. LEXIS 25400, 2004 WL 2913249
CourtDistrict Court, M.D. North Carolina
DecidedDecember 1, 2004
Docket1:03CV00334
StatusPublished

This text of 348 F. Supp. 2d 536 (Harvey v. Astra Merck Inc. Long Term Disability Plan) is published on Counsel Stack Legal Research, covering District Court, M.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harvey v. Astra Merck Inc. Long Term Disability Plan, 348 F. Supp. 2d 536, 2004 U.S. Dist. LEXIS 25400, 2004 WL 2913249 (M.D.N.C. 2004).

Opinion

MEMORANDUM OPINION

BEATY, District Judge.

This case involves an action by Plaintiff Carla H. Harvey (“Plaintiff’ or “Ms. Harvey”) to recover disability benefits under a long-term disability policy issued by Defendant Unum Life Insurance Company of American (“Unum”). This action is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). This matter is presently before the Court on Defendants’ Motion for Summary Judgment [Document # 30], Defendants’ Motion to Strike Jury Trial Demand [Document #•33], and Plaintiffs counter-Motion for Summary Judgment [Document # 35].

I. FACTUAL BACKGROUND

Plaintiff is a 43-year-old female who suffers from Multiple Sclerosis (“MS”). She obtained a Bachelor of Science Degree in Business Administration from the University of North Carolina at Greensboro in *539 1989, and began work as a pharmaceutical sales representative for Merck, Inc., which was the predecessor of Defendant AstraZ-eneca Pharmaceuticals Limited Partnership (“AstraZeneca”). Except for a brief period with another employer, Plaintiff worked for Merck, Inc. and its successor until 1997 when she became unable to continue working. Plaintiff was involved in an automobile accident in June 1997, which exacerbated the symptoms of her MS. MS is a progressive neurological disorder resulting in tissue damage in the brain. Plaintiff continued to try to work for several months, but ultimately was unable to work due to her fatigue, tiredness, headaches, weakness, memory trouble, cognitive ability, sensory abnormalities, bladder and bowel dysfunction, and similar symptoms related to her MS. The MS causes dizziness, lack of coordination, and severe pain. According to Plaintiffs physicians, eventually her spinal, column will be affected by the disease and she will be bound to a wheelchair.

Through her employer, Plaintiff was covered by a long-term disability policy issued by Unum to Astra Merck, Inc. (“the Policy”). The Policy provides benefits for disability after a 180-day elimination period. The Policy defines “disability” as follows:

You are disabled when UNUM determines that:
-You are limited from performing the material and substantial duties of your regular occupation due to your sick- . ness or injury; and -You have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.
You will continue to receive payments beyond 24 months if you are also:
-Working in any occupation and continue to have a 20% or more loss in your indexed monthly earnings due to your sickness or injury; or
-Not working and, due to the same sickness or injury, are unable to perform the duties of any gainful occu- ' pation for which you are reasonably fitted by education, training or experience.”

(Affidavit of April Atkinson [Doc. #32] Ex. A at 926.) 1 The Policy defines “limited” as “what you cannot or are unable to do” and defines “regular occupation” as “the occupation you are routinely performing when your disability begins.” (Id.)

Plaintiff applied for benefits in 1998 when she was no longer able to work. Unum approved her claim and provided her- with long-term disability benefits through June 2000. Plaintiff also began receiving Social Security Disability Benefits, based on a determination by the Social Security Administration that Plaintiff had been totally disabled from any “gainful employment activity” since December 15, 1997. However, Unum undertook an additional review of Plaintiffs claim beginning in late 1999, culminating in a decision to terminate Plaintiffs benefits on June 30, 2000. Plaintiff appealed this decision and provided Unum with additional records. Unum upheld its decision on October 17, 2000 and January 25, 2001. Plaintiffs counsel then submitted additional evidence and documentation to Unum. Unum acknowledged receipt of this additional information by letter dated December 4, 2002, and indicated that they would review the information and make a determination of Plaintiffs claim. By letter dated January 23, . 2003, Unum affirmed its prior denial *540 and refused to consider the additional material based on the fact that Plaintiff had already appealed the decision and a final determination had previously been made.

Plaintiff then filed the present suit challenging the denial of benefits on the basis that Unum’s decision was not reasonable, was not supported by substantial evidence, and was not the result of a deliberate, principled reasoning process. Plaintiff and Defendants have both moved for summary judgment, and Defendants have also moved to strike Plaintiffs jury trial demand. The Court will consider Defendants’ Motion to Strike in turn, but the Court will first consider the parties’ cross-motions for summary judgment to determine if any genuine issues of material fact exist for trial.

II. MOTIONS FOR SUMMARY JUDGMENT

A. Standard of Review

Summary judgment is appropriate when an examination of the materials properly before the Court reveals that “there is no genuine issue as to any material fact and ... the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.P. 56(c). A fact is considered “material” if it “might affect the outcome of the suit under the governing law .... ” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986). When ruling on a summary judgment motion, the Court “view[s] the evidence in the light most favorable to the non-moving party, granting that party the benefit of all reasonable inferences.” Bailey v. Blue Cross & Blue Shield of Va., 67 F.3d 53, 56 (4th Cir.1995). As a result, the Court will only enter summary judgment in favor of the moving party when “ ‘the entire record shows a right to judgment with such clarity as to leave no room for controversy and establishes affirmatively that the [nonmoving] party cannot prevail under any circumstances.’ ” Campbell v. Hewitt, Coleman & Assocs., Inc., 21 F.3d 52, 55 (4th Cir.1994) (quoting Phoenix Sav. & Loan, Inc. v. Aetna Cas. & Sur. Co., 381 F.2d 245, 249 (4th Cir.1967)).

Because this case arises under ERISA, the Court must evaluate the summary judgment motions in the context of the proper standard of review under ERISA. To determine the proper standard of review under ERISA, the Court must first determine whether the Policy grants the plan administrator discretion to determine a claimant’s eligibility for benefits.

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348 F. Supp. 2d 536, 2004 U.S. Dist. LEXIS 25400, 2004 WL 2913249, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harvey-v-astra-merck-inc-long-term-disability-plan-ncmd-2004.