McLaren-Knipfer v. Arvinmeritor, Inc.

876 F. Supp. 2d 913, 2012 U.S. Dist. LEXIS 88891, 2012 WL 2462317
CourtDistrict Court, E.D. Kentucky
DecidedJune 27, 2012
DocketCivil Action No. 2:11cv16 (WOB-CJS)
StatusPublished

This text of 876 F. Supp. 2d 913 (McLaren-Knipfer v. Arvinmeritor, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McLaren-Knipfer v. Arvinmeritor, Inc., 876 F. Supp. 2d 913, 2012 U.S. Dist. LEXIS 88891, 2012 WL 2462317 (E.D. Ky. 2012).

Opinion

MEMORANDUM OPINION & ORDER

WILLIAM O. BERTELSMAN, District Judge.

Plaintiff brings this action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a). This matter is presently before the Court on the parties’ cross-motions for summary judgment, a motion to strike certain evidence, the ERISA plan, and the Administrative Record. See Doc. 30 (“Amended Complaint”); Doc. 53-1 (“Plf. MSJ”); Doc. 66 (“Meritor Sealed MSJ”); Doc. 63 (motion to strike); Docs. 40-1— 40-6 (“Plan”) (citation to internal pagination); Doc. 44 (“Sealed Record”) (citation to Bates-stamp pagination).

Having previously heard oral argument on this motion, the Court now issues the following Memorandum Opinion and Order.

BACKGROUND

A. Parties

Plaintiff initially named as defendants her former employer ArvinMeritor, Inc. (“Meritor”), and Meritor’s insurer and claims fiduciary CIGNA Corporation. The parties subsequently agreed to substitute the Life Insurance Company of North America (“LINA”) for CIGNA, after which they reached a confidential settlement on the claim for long-term benefits. The short-term disability benefits are self-insured by Meritor. See Docs. 21, 73, 74; see also Meritor Sealed MSJ at 2, n. 1.

Different LINA/CIGNA individuals were involved with Plaintiffs claim, and CIGNA is the corporate entity that appears on the appeal documents. Meritor is “responsible for making the final decision with respect to all claims,” Plan at 161, and is the ERISA fiduciary, see id. at 161, 164. Meritor acquiesced in the final result without issuing a separate decision. See, e.g., Doc. 71-1 at 1 (letter dated 11/2/10 — “your second appeal ... was denied ... Your claim is closed”). The Court collectively refers to those involved with the claim as “reviewers.”

B. Chronological Overview

Meritor hired Plaintiff in 1988, when she was thirty-nine years old. She performed customer service jobs for more than two decades and has been a Plan participant [916]*916since 2004. She suffers from Chronic Obstructive Pulmonary Disease (“COPD”). Due to problems associated with that condition, Plaintiffs last day at work was February 10, 2010. Plaintiffs appeal of her application for short-term benefits concluded on November 1, 2010, when the reviewers issued a letter that explained the reason for the denial. See, e.g., Amended Complaint at 3; Plf. MSJ at 2-3; Meritor Sealed MSJ at 3, 6; Doc. 53-4 (“Plf. Aff.”).

After the denial and further correspondence with Plaintiffs treating physician, Dr. Robert Otte, Meritor issued a “termination” letter to Plaintiff on December 2, 2010, based on her “inability to perform the essential functions of her job.” Doc. 71-4 at 1. The Social Security Administration subsequently granted Plaintiff disability benefits on December 17, 2010, with a start date for the award of February 11, 2010. See, e.g., Plf. Aff. ¶¶ 13-14, 16.1

C. Plan Terms

The Plan provides short-term disability benefits for “disabled” employees for up to twenty-six weeks per episode, and offsets any payment with other benefits received, such as Social Security disability awards. See Plan at 44-47. If a disability recurs within three months, the Plan considers it to be “a resumption of the prior” disability. Id. at 47.

The Plan defines “disabled” in two ways. See id. at 45. As applicable here, the “occupation qualifier” test considers employees “disabled” if they are “[cjontinuously unable to perform the material and substantial duties of [their] regular occupation.” Id. (internal emphasis omitted). The duties are those “normally required for the performance” of the employee’s regular occupation. Id.

Plaintiffs customer service position was sedentary and performed exclusively in an office environment. Both parties cite a written job description as the source of her duties:

• Providing timely customer ordering, order maintenance and process resolution services as well as order-board management.
• Receives and processes customer orders, in a fast[-]paced setting, according to specified policies and procedures.
• Interfaces with Inventory, Pricing, Marketing, Sales, Customer Credit, Specifications, and Operations groups, as well as external customers, to ensure prompt and efficient order processing.
• Ability to handle multiple tasks simultaneously.
• Displaying professional phone communication skills and a ‘customer service’ attitude.

Sealed Record at 627; see also Plf. MSJ at 2; Meritor Sealed MSJ at 3, 8.

Plaintiffs affidavit describes the work-related activities that would be physically too' taxing, even with full-time use of an oxygen tank. See Plf. Aff. ¶ 10. It states that her COPD “rendered her incapable of carrying on the ‘fast paced’ work at her former employment or at any other employment,” id. ¶ 9, and that her former job, “although sedentary in nature, was extremely stressful,” id. ¶ 10. She elaborates that:

Her health condition has made it difficult for her to stay on the telephone for long periods of time, to do the required [917]*917extensive filing because of fatigue, and the oxygen dependency from which she suffers increases in severity with any stress or engagement in any physical activity; she has a very difficult time going up and down any stairs, which is sometimes required for her to go on a company break or to attend company ‘fire drills’. Additionally, she has difficulty driving to and from work, walking around the building, and tolerating the air quality at work because of the COPD.
... since she must carry a tank of oxygen with her at all times, she periodically has to go to her automobile, while on the job, to get additional oxygen tanks in order to make it through the day.
... [Dr.] Otte ... has indicated that any exercise or other stress will increase her oxygen dependency.

Id. ¶¶ 10-12.

The Plan provides that it will not pay short-term benefits if any of four conditions occur, one of which is if the employee “[f]ail[s] to provide proof of [his or her] Disability — including any medical documentation that may be requested.” Plan at 47.

D. Proof Submitted For Claim

Plaintiff was ill with bronchitis and sprained ribs for seventeen days in January 2010, and she received short-term benefits for her absence from work. She returned to work for seventeen days and left work. The reviewers considered Plaintiffs absence in February a “recurrent” claim, and the claims representative told Plaintiff the Plan would reopen her earlier claim and request additional medical records. See Meritor Sealed MSJ at 6; see ■ also Sealed Record at 427.

The reviewers initially denied the claim on April 13, 2010.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
876 F. Supp. 2d 913, 2012 U.S. Dist. LEXIS 88891, 2012 WL 2462317, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mclaren-knipfer-v-arvinmeritor-inc-kyed-2012.