Javery v. Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees

741 F.3d 686, 57 Employee Benefits Cas. (BNA) 2168, 2014 WL 349741, 2014 U.S. App. LEXIS 1992
CourtCourt of Appeals for the Sixth Circuit
DecidedFebruary 3, 2014
Docket12-3834
StatusPublished
Cited by96 cases

This text of 741 F.3d 686 (Javery v. Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Javery v. Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees, 741 F.3d 686, 57 Employee Benefits Cas. (BNA) 2168, 2014 WL 349741, 2014 U.S. App. LEXIS 1992 (6th Cir. 2014).

Opinion

OPINION

CLAY, Circuit Judge.

Plaintiff Nilratan Javery appeals the judgment of the district court in favor of Defendant, Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees (“the Plan”), denying Plaintiffs claim for disability benefits under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq.

Plaintiff contends that the Plan wrongfully denied his application for long term disability benefits. In support of his claim, Plaintiff submitted opinions and evaluations from several medical doctors and psychiatrists, the majority of whom assert that Plaintiff was unable to perform his job as a result of his physical and mental illnesses. Plaintiff also offered other evidence including his successful application for Social Security disability benefits to show that he was “disabled” as that term is defined in the Plan. Defendant argues that Plaintiff has not established by a preponderance of the evidence that he was “disabled” at the relevant time. Additionally, Defendant contends that Plaintiff should be judicially estopped from pursuing his ERISA claim because Plaintiff failed to disclose the claim in his Chapter 13 personal bankruptcy action.

On appeal, Plaintiff requests this Court, on de novo review, to reverse the order of the district court denying Plaintiff long term disability benefits. For the reasons *689 set forth below, we REVERSE the order of the district court, and REMAND to the district court with instructions that the district court enter judgment in favor of Plaintiff on the administrative record.

BACKGROUND

Plaintiff began working for Lucent Technologies, Inc. (“Lucent”) as a software engineer in 1998. As an employee of Lu-cent, Plaintiff was a participant in Lucent’s ERISA qualified welfare benefit plan: the Lucent Technologies Inc. Long Term Disability Plan for Management or LBA Employees (“the Plan”). The Plan offers long term disability benefits to participants who meet its defined requirements for eligibility. Lucent delegated the Plan’s administration to a third party, Connecticut General Life Insurance Company (“CIGNA” or “the plan administrator”).

Plaintiffs job as a software engineer required him to sit continuously for eight to ten hours each day. Plaintiff reported that the work was “fast-paced and it involved supporting [Lucent] employees and several consultants round the clock.... in excess of 70-75 hours per week over 5-6 months straight.” (Admin.R.556) It was also a technically and intellectually demanding job which required knowledge of “[sjoftware based tools: Progress and Oracle database, Unix Operating system, Unix based 4GL languages such as awk, shell, scripting, perl.” (Admin.R.521)

In early November 2002, Plaintiff first reported experiencing back pain. His family doctor, Dr. Dorado, prescribed medicine and additional testing, and recommended that Plaintiff take some time off work. Plaintiff took two weeks off in November 2002, and then returned to work at Lucent. In January 2003, after Lucent transferred Plaintiff from Ohio to Illinois, Plaintiff sought treatment from another physician, Dr. Jay Seymour. Plaintiffs lower back pain worsened. In May 2005, Dr. Seymour advised Plaintiff to stop working. Plaintiff stopped working on May 19, 2005.

Lucent approved and paid short term disability benefits from May 19, 2005 until those benefits expired on November 25, 2005. Lucent then notified the plan administrator that it believed Plaintiff might be eligible for long term disability benefits under the Plan. The plan administrator contacted Plaintiff and invited him to apply for long term disability benefits.

Under the terms of the Plan, a participant is entitled to receive a monthly disability benefit from the Plan if he or she is “disabled,” which the Plan defines as follows:

The term “Disability” or “Disabled” shall mean, for the one year period commencing immediately after the 26 weeks of Short Term Disability Benefits have been paid, that the Eligible Employee is prevented by reason of such disability, other than accidental injury arising out of and in the course of employment of the Company, from engaging in his or her occupation or employment at the Company, for which the eligible employee is qualified, based on training, education or experience. Thereafter, an Eligible Employee shall continue to be considered as disabled under the Plan if, in the sole opinion of the Claims Administrator, the Eligible Employee is determined to be incapable of performing the requirements of any job for any employer (including non-[Lucent] employment), (as a management or LBA employee), for which the individual is qualified or may reasonably become qualified by training, education or experience, other than a job that pays less than 60% of the Eligible Employee’s Eligible Pay that would have been in effect on the day preceding the day that the Eligible Em *690 ployee’s Short Term Disability Benefits ceased.

(Admin. R. 005)

We note at the outset that only the first definition is relevant to our resolution of the present case: Plaintiff is entitled to disability benefits if he was “prevented by reason of ... disability ... from engaging in [his] occupation or employment at [Lu-cent].” As discussed below, when Plaintiff submitted his application for long term disability benefits on or about November 25, 2005, the plan administrator evaluated Plaintiffs eligibility for benefits “for the one year period commencing immediately after the 26 weeks of Short Term Disability Benefits have been paid,” and denied Plaintiffs application. Though this case has a complicated procedural history, the dispute at the heart of the matter is whether or not the plan administrator’s denial of Plaintiffs application at that time was proper. In other words, notwithstanding the fact that it is now 2014, the relevant time period is still November 25, 2005 through November 25, 2006, and the relevant inquiry is whether Plaintiff was unable to work as a software engineer at that time. 1

Plaintiff submitted his application for long term disability benefits on or around November 25, 2005. In his application, he described his disability as follows:

[A]t work I have suffered severe aggravation to my degenerative diseased disc at L4-L5 and L5-S1. This degeneration is progressing and causing increased pain. So much so that I am unable to sit and perform basic physical and mental activities due to extreme back pain.... Medications and intense back pain prevents me- physically and mentally to continue performing timely and quality work.

(Admin. R. 519) Plaintiff stated that he could “not even imagine delivering any commercial grade work as [he is] always in pain and quite disoriented.” (Admin.R.520) Along with his application, Plaintiff submitted a great deal of medical evidence from various medical professionals, including:

• Attending Physician Statement by Dr. Jay Seymour, dated November 22, 2005. Dr.

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741 F.3d 686, 57 Employee Benefits Cas. (BNA) 2168, 2014 WL 349741, 2014 U.S. App. LEXIS 1992, Counsel Stack Legal Research, https://law.counselstack.com/opinion/javery-v-lucent-technologies-inc-long-term-disability-plan-for-ca6-2014.