McCready v. Standard Insurance

417 F. Supp. 2d 684, 2006 U.S. Dist. LEXIS 7810, 2006 WL 490606
CourtDistrict Court, D. Maryland
DecidedMarch 1, 2006
DocketCIV. RDB 05-382
StatusPublished
Cited by9 cases

This text of 417 F. Supp. 2d 684 (McCready v. Standard Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCready v. Standard Insurance, 417 F. Supp. 2d 684, 2006 U.S. Dist. LEXIS 7810, 2006 WL 490606 (D. Md. 2006).

Opinion

MEMORANDUM OPINION

BENNETT, District Judge.

Pending before this Court are Cross Motions for Summary Judgment filed by Plaintiff Carole McCready (“Plaintiff’ or “McCready”) and Defendant The Standard Insurance Company (“Defendant” or “Standard”). On February 8, 2005, Plaintiff brought this action against Standard pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001, et. seq. 1 Plaintiff alleges that Defendant improperly denied her claim for long-term disability benefits under Group Benefit Policy No. 641252-A LTD (“Policy” or “Plan”). She seeks review of Defendant’s administrative decision to deny benefits under this Policy. Ultimately, Plaintiff asks this Court to award her long-term disability benefits.

On June 13, 2005, Defendant filed the Motion for Summary Judgment now before the Court. On June 14, 2005, Plaintiff filed an Opposition to Defendant’s Motion for Summary Judgement and a Cross Motion for Summary Judgment. On August 1, 2005, Defendant filed a Reply to Plaintiffs Opposition and a Response to Plaintiffs Cross Motion for Summary Judgment. On that same day, this Court granted Defendant’s Motion for Protective Order and denied Plaintiffs request for discovery in this case. 2

This Court has jurisdiction over this matter pursuant to 28 U.S.C. § 1331. The parties have fully briefed the issues and submitted the full administrative record to the Court. No hearing is necessary on these motions. See Local Rule 105.6 (D.Md.2004). For the reasons stated below, Defendant’s Motion for Summary Judgment is GRANTED and Plaintiffs Motion for Summary Judgment is DENIED.

BACKGROUND

Plaintiff, Carole McCready, worked for Piper Rudnick, LLP (“Piper”) for thirteen and one-half years as a legal secretary. (Compl. ¶ 7.) McCready left Piper on April 16, 2002, (Compl.Ex. 9. p. 2.), because of numerous ailments, including:

uncontrolled diabetes mellitus Type-2; moderate obstructive lung disease with a severe defect in diffusing capacity; emphysema; hypertension; hypothyroidism; obesity; asthma; extreme fatigue; and (sic) osteoarthritis.

(Compl. ¶ 10.) When initially out of work, McCready received short-term disability benefits. (Letter to Steve Thompson, *688 June 25, 2002, STND-00064.) 3 McCready was eligible to apply for long-term disability benefits to begin February 10, 2003. (Id.)

On February 2, 2003, McCready filed for long-term disability benefits through Defendant, The Standard Insurance Company (“Standard”). (Compl.Ex. 9. p. 2.) After initial review of her file, Standard determined McCready was not eligible for long-term disability under the Plan. (CompLEx. 7.) On McCready’s request, Standard conducted a second review of her file and reaffirmed its earlier decision to deny benefits. (June 4, 2003 Letter to Carole McCready, STND-00272). On independent review by Standard’s Quality Assurance Unit, denial of McCready’s benefits was reaffirmed. (CompLEx. 9.)

I. Essential Definitions Under the Long-Term Disability Plan

Standard based its decision to deny benefits under the Plan on the specific definition of two essential terms: “Own Occupation” and “Material Duties.” (CompLEx. 9.) Under the Plan, McCready would meet the definition of “Disabled” for purposes of long-term disability if she were disabled from her “Own Occupation.” (Compl. Ex. 6 p. 6.) “Own Occupation” is defined as:

any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as your regular and ordinary employment with the Employer. Your Own Occupation is not limited to your job with your Employer.

(Id.) The Plan further defines “Material Duties” as:

the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation.

(Id.)

II. Determination of McCready’s Claim

At the conclusion of three levels of review, Standard determined that McCready did not qualify as “Disabled” as to her “Own Occupation” since she could fulfill the “Material Duties” required by the general economy for legal secretaries. (Compl. Ex. 9.) As described in more detail below, Standard conducted an initial review of McCready’s claim in the spring of 2003 based on the information it had received from her in connection with her initial application for long-term disability benefits. After Standard denied her claim based on this information, McCready submitted additional medical records and Standard re-reviewed its initial decision. Based on this information, Standard’s decision to deny McCready’s claim remained unchanged. Standard automatically submitted McCready’s claim information to a separate department at Standard, the Quality Assurance Unit (“QAU”), for review. At this stage, McCready submitted additional information to Standard that she had previously failed to provide. QAU examined all the information provided by McCready and determined that she did not qualify for long-term disability.

To determine McCready’s eligibility for long-term disability benefits under the Plan, Standard had to examine two main elements. First, Standard had to determine McCready’s “Own Occupation” under the Plan. Second, to determine if McCready qualified as “Disabled” from her “Own Occupation,” Standard evaluated her medical history as provided by her various physicians: Dr. Francis Lee, Endocrinologist; Dr. Martin Clouse, Primary *689 Care; Dr. Cynthia Soriano, Pulmonologist; Dr. Michael Seheerer, Orthopedic Surgeon; Dr. Richard Scholz, Ophthalmologist. (CompLEx. 9. p. 3-8.) As previously mentioned, McCready was providing information to Standard on a rolling basis throughout its review process of her application.

A. Overmen) of Standard’s Three Levels of Review of McCready’s Claim

On April 4, 2003, McCready received her first denial of long-term disability benefits by Standard based on her February 2, 2003 claim application. (Compl. Ex. 7. p. 1; STND 00244-247.) Standard denied McCready’s claim for benefits finding that she could work in a secretarial position, although perhaps not in her previous job at Piper. (Id.) Specifically, Standard did not find a medical condition that indicated McCready would not be able to perform sedentary or light work as defined by the Department of Labor’s Dictionary of Occupational Titles (“DOT”). This assessment was based on the January 31, 2003 statements by Dr. Francis Lee, Dr. Martin Clouse, Dr. Michael Seheerer, and Dr. Richard Scholz.

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Bluebook (online)
417 F. Supp. 2d 684, 2006 U.S. Dist. LEXIS 7810, 2006 WL 490606, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccready-v-standard-insurance-mdd-2006.