Johnson v. Continental Casualty Co.

222 F. Supp. 2d 776, 2002 WL 31175140
CourtDistrict Court, W.D. North Carolina
DecidedSeptember 27, 2002
Docket1:01CV169-C
StatusPublished
Cited by1 cases

This text of 222 F. Supp. 2d 776 (Johnson v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, W.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Johnson v. Continental Casualty Co., 222 F. Supp. 2d 776, 2002 WL 31175140 (W.D.N.C. 2002).

Opinion

MEMORANDUM OF DECISION

COGBURN, United States Magistrate Judge.

THIS MATTER is before the court upon plaintiffs Motion for Summary Judgment and defendant’s cross Motion for Summary Judgment. In support of and in opposition to such motions, the respective parties have submitted memoranda of law and an administrative record via exhibits to their respective briefs. For the reasons discussed below, the court will grant defendant’s Motion for Summary Judgment, deny plaintiffs Motion for Summary Judgment, and affirm the decision of the plan administrator.

I. Background

A. Plaintiff’s Work History, Impairments, and Medical/Vocational Record

Plaintiff brings this action under the Employee Retirement Income Security Act of 1974, “ERISA.” Plaintiff was employed by AMP, Inc., (“AMP”) as a materials handler and was covered by both short-term and long-term disability plans provided by AMP. AMP’s long-term disability plan was administered by defendant herein, the “plan administrator.” Plaintiff received short-term disability benefits from November 8, 1999, through November 19, 1999, and those benefits are not disputed.

The nature of plaintiffs claim of disability is an on-the-job neck injury and resulting surgery. He contends that defendant’s denial of his long-term claim was improper and that he continues to suffer from quadri paresis as a result of spinal cord dysfunction from stenosis. It appears that in addition to the neck surgery, which occurred during the exclusion period, plaintiff also suffered from a back problem that existed and was treated after the period of exclusion closed.

Plaintiff was diagnosed with cervical spondylosis in August 1999 and ceased work on November 2, 1999. Coincidently, AMP closed its doors November 19, 1999, and terminated plaintiffs position. Plaintiff returned to work on November 19, 1999, and filed a claim for short-term disability, which was granted for the closed period of November 8 through the plant’s closing on November 19.

Plaintiff underwent a posterior cervical laminectomy on December 17, 1999, and was discharged from his surgeon’s care on April 25, 2000. At that point, plaintiffs surgeon opined that plaintiffs cervical spine was stable, decompression was excellent, and plaintiff had no weakness, reflex changes, or sensory loss that would suggest a need for further treatment.

Plaintiff has also suffered from a back problem, which first manifested itself in June 2000. This back problem, of which there is no evidence prior to the end of the elimination period in May 2000, is not relevant tp plaintiffs claim for long-term disability benefits.

In addition, the note dated June 13, 2000, prepared by or for plaintiffs surgeon and clearing plaintiff to return to work on June 1, 2000, is of no consequence, inasmuch as the surgeon had not seen plaintiff after April 25, and the opinion contained in the note was not supported by additional medical findings. It is well within the *778 realm of reason for a plan administrator to disregard a physician’s note where it is obvious that it is an attempt to manufacture a return-to-work date that would have provided benefits to the patient. This is especially appropriate where the uncontra-dicted medical record from the same physician indicates that the employee was undeniably fit for duty on an earlier date and no subsequent clinical findings were made.

Plaintiff was also interviewed by one of defendant’s vocational case managers. In that interview on January 19, 2001, plaintiff stated that he stopped work because of his neck injury and surgery in December 1999; he did not return to work between December 1999 and June 2000 because the plant had closed; and he had not applied for Social Security disability because he wanted to return to work at some point in time.

Plaintiffs claim for long-term benefits was denied initially and upon formal administrative appeal. It appearing that the administrative record is complete and that all briefs have been filed, this matter is now ripe for resolution on the cross motions for summary judgment.

II. Summary Judgment

On a motion for summary judgment, the moving party has the burden of production to show that there are no genuine issues for trial. Upon the moving party’s meeting that burden, the nonmoving party has the burden of persuasion to establish that there is a genuine issue for trial.

When the moving party has carried its burden under Rule 56(c), its opponent must do more than simply show that there is some metaphysical doubt as to the material facts. In the language of the Rule, the nonmoving party must come forward with “specific facts showing that there is a genuine issue for trial.” Where the record taken as a whole could not lead a rational trier of fact to find for the non-moving [sic] party, there is no “genuine issue for trial.”

Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986) (citations omitted; emphasis in the original) (quoting Fed.R.Civ.P. 56). There must be more than just a factual dispute; the fact in question must be material and readily identifiable by the substantive law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

In this case, the parties have submitted cross motions for summary judgment, wherein each side contends that there are no issues for trial and that judgment may be rendered as a matter of law. Finding that the facts are adequately presented in the administrative record, that the court’s review is limited to the administrative record that was before the plan administrator, and that no genuine issues of material fact exist, the court determines that summary judgment is an appropriate means to resolve the issues presented.

III. The Benefits Decision

A. Long-Term Disability Claim

Plaintiff is claiming entitlement to long-term disability benefits. He applied for and received short-term benefits for a closed period of disability, and receipt of those benefits is not in dispute. Under the terms of the long-term disability plan, a claimant is considered disabled when:

during the Elimination Period ... the Insured Employee ... is:
(1) continuously unable to perform the substantial and material duties of their regular occupation;
(2) under the regular care of a physician other than himself/herself; and
(3) not gainfully employed in any occupation for which he is or becomes *779 qualified by education, training or experience.

B. Standard of Review of the Administrative Decision

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47 F. Supp. 3d 318 (M.D. North Carolina, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
222 F. Supp. 2d 776, 2002 WL 31175140, Counsel Stack Legal Research, https://law.counselstack.com/opinion/johnson-v-continental-casualty-co-ncwd-2002.