Lawless v. Northwestern Mutual Life Insurance

360 F. Supp. 2d 1046, 2005 U.S. Dist. LEXIS 8486, 2005 WL 40045
CourtDistrict Court, N.D. California
DecidedJanuary 5, 2005
Docket04-1732 MMC
StatusPublished
Cited by2 cases

This text of 360 F. Supp. 2d 1046 (Lawless v. Northwestern Mutual Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lawless v. Northwestern Mutual Life Insurance, 360 F. Supp. 2d 1046, 2005 U.S. Dist. LEXIS 8486, 2005 WL 40045 (N.D. Cal. 2005).

Opinion

ORDER DENYING PLAINTIFF’S MOTION FOR JUDGMENT; GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT; VACATING HEARING

CHESNEY, District Judge.

Before the Court is plaintiff Maria Lawless’s motion for judgment by the Court, pursuant to Rule 52 of the Federal Rules of Civil Procedure, and defendants’ 1 motion for summary judgment, pursuant to Rule 56. Having considered the papers filed in support of and in opposition to the motions, the Court deems the matters suitable for decision on the papers, VACATES the hearing scheduled for January 7, 2004, and rules as follows.

BACKGROUND 2

On May 31, 2001, plaintiff, an attorney, filed with defendants a claim for disability *1048 benefits under an employee benefits plan available through her employer. (See Administrative Record (“AR”) 123-24.)

The plan provides for disability benefits in the event a claimant, “as a result of Sickness, Accidental Bodily Injury or Pregnancy, [is] unable to perform with reasonable continuity the Material Duties of [her] Own Occupation.” (See AR at 45.) Under the plan, benefits are payable beginning after the “91st day of Disability in the first 105 days after [the claimant] become[s] Disabled.” (See AR 52.) The plan includes various “exclusions and limitations,” (see AR 38-39), including the limitation that a claimant is not entitled to benefits unless she is “under the ongoing care of a Physician or Practitioner during [the] disability,” (see AR 38).

In her claim, plaintiff stated that, as of March 29, 2001, she became unable to work because of an illness, which she described as “stress— increasing over past year + depression — severe.” (See AR 124.) Plaintiff also stated that she had been hospitalized for that illness from March 19, 2001 through March 23, 2001. (See id.) In response to the question, “How does your disability prevent you from working?,” plaintiff answered, “Unable to concentrate — episodes of crying uncontrollably — unable to process assignment, breaking down.” (See id.) Defendants thereafter requested plaintiffs medical records and other information concerning plaintiffs condition. (See, e.g., AR 132, 147, 149.) 3

Defendant received from plaintiffs treating physician, John Melbourne McGraw, M.D. (“Dr.McGraw”), 4 an Attending Physicians Statement form dated May 24, 2001, wherein Dr. McGraw provided the opinion that plaintiff was “very impaired” in the category of “concentration, cognition,” and was either “very impaired” or had “no useful functioning” in the category of “adaptation to stress.” (See AR 130.) In response to a question asking for the attending physician’s “view of the likelihood of return to work,” Dr. McGraw wrote: “Pt. [patient] left job in full time law practice. Pt. tried to return to work but was unsuccessful. Left permanently 4/4/01.” (See id.) In that form, Dr. McGraw also described plaintiffs prognosis as “guarded,” and, in response to the question, When do you anticipate the patient can return to work, Dr. McGraw checked a box to indicate, “Unable to determine.” (See id.)

Dr. McGraw later provided defendants with other information, specifically, a July 1998 psychiatric consultative report he had prepared after first examining plaintiff, (see AR 160-63), copies of his progress notes, the first of which is dated in July 2000 and the last of which is dated June 18, 2001, (see AR 193-248), plaintiffs prescription history, dating from July 12, 2000 to June 21, 2001, (see AR 165-180, 183-192), and a copy of an “itinerary” for a trip that plaintiff and her minor son took to Europe from June 19, 2001 to September 1, 2001, (see AR 151, 250-51).

Additionally, Dr. McGraw, on October 5, 2001, provided defendants with a completed assessment form, in which, in response to the question, “Do you find the patient to be behaviorally or cognitively impaired? If so, what is the severity,” he stated, “At the time pt. left work she was unable to function in the workplace”; (see AR 254), and in response to the question, “Based on any psychological test results and in your experience, do you find the patient to be *1049 functionally impaired? If so, what is the severity?,” he stated, “Emotionally was unable to function in workplace at the time she left,” (see id.).

On October 16, 2001, defendants forwarded the file to consulting physician Carla G. Dorsey, M.D. (“Dr.Dorsey”), a psychiatrist, with instructions to review the “medical records” therein, and to answer two questions: (1) “Is there medical documentation to support a medical condition of a severity to preclude [plaintiffs] ability to perform the material duties of her occupation as an attorney on a reasonable continuous basis?”; and (2) “If so, what limits her ability to work as an attorney and for what period of time?” (See AR 277.)

On November 1, 2001, Dr. Dorsey submitted her report to defendants, and, after discussing the evidence in the file, answered the first question posed to her, as follows:

It does appear that for approximately two months between 3/19/01 (her admission for acute alcohol detox) and approximately 5/14/01 she was significantly limited and disabled on the basis of probably co-occurring depression and alcohol abuse. It would also be reasonable to expect a two month period of time to be adequate to respond to a new medication change (Effexor to Celexa) which was instituted on 3/19/01. However, from 5/14 on it appears that she is restabilizing which would fit into the time frame of a recovery from this sort of problem. In addition, it appears that she is functional enough to travel extensively in Europe throughout the summer of 2001 which would not argue for ongoing limitations and restrictions due to' depression or alcohol abuse at any a time after 5/14/2001.
Of note as well, we have GAEs from Dr. McGraw of 40 on 7/31/98 despite the fact that she was working full-time for at least another 2$ years following that date despite the seemingly low GAF. Dr. McGraw also gives a GAF of 65 in 6/2000, a GAF of 35 in 2/2001 and a GAF of 45 in 9/2001. Thus, it appears that this patient has struggled chronically with symptoms of dysthymia and alcohol use but that these have not always been disabling to the point of her being unable to perform her occupation.

CSee AR 281-82.)

Dr. Dorsey answered the second question posed to her, as follows:

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360 F. Supp. 2d 1046, 2005 U.S. Dist. LEXIS 8486, 2005 WL 40045, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lawless-v-northwestern-mutual-life-insurance-cand-2005.