Milson v. St Luke's Episcopal Hospital

71 F. Supp. 2d 634, 1999 U.S. Dist. LEXIS 20613, 1999 WL 1091884
CourtDistrict Court, S.D. Texas
DecidedAugust 2, 1999
DocketCiv.A. H-98-1766
StatusPublished
Cited by4 cases

This text of 71 F. Supp. 2d 634 (Milson v. St Luke's Episcopal Hospital) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Milson v. St Luke's Episcopal Hospital, 71 F. Supp. 2d 634, 1999 U.S. Dist. LEXIS 20613, 1999 WL 1091884 (S.D. Tex. 1999).

Opinion

ORDER

GILMORE, District Judge.

Pending before the Court are motions for summary judgment filed by Plaintiff and Defendants. (Instrument Nos. 22 and 23). Based on the parties’ submissions and the applicable law, the Court finds that Plaintiffs motion should be DENIED and that Defendants’ motion should be GRANTED.

I.

Plaintiff Geraldine Milson (“Milson”) brings this action against Defendants St. Luke’s Episcopal Hospital (“St.Luke’s”), Administrator of St. Luke’s Episcopal Hospital Long Term Disability Plan, and Metropolitan Life Insurance Company (“MetLife”) under the Employment Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), requesting this Court to review MetLife’s denial of her claim for long-term disability (“LTD”) benefits.

Milson began her employment with St. Luke’s in August of 1989 as an Environmental Assistant or a housekeeper. (Plaintiffs Motion, Instrument No. 23, at 4). As an Environmental Assistant, Mil-son was required “to dust, spot clean, empty trash, and inspect for an report any possible repairs which might be necessary.” (Defendants’ Motion, Instrument No. 22, at 3 and Exh. 2).

St. Luke’s established and maintained an employee welfare benefit plan (the “Plan”) for its employees. Initially, the Travelers Indemnity Company of Rhode Island (“Travelers”) served as the claims administrator for the Plan. (Plaintiffs Motion, Instrument No. 23, at 5). Currently, “MetLife serves as the claims administrator with responsibility for processing and evaluating claims for LTD benefits made by participants of the Plan.” (Defendants’ Motion, Instrument No. 22, Appendix, at 1). St. Luke’s is the Plan Administrator. (Id).

On or about March 18, 1991, Milson allegedly sustained a back injury while attempting to move a filing cabinet. (Id at 5). Travelers received Milson’s Statement of Claim for LTD benefits and Attending Physician’s Statement on September 10, 1991. In her Statement of Claim, Milson claimed to suffer from several conditions, including ruptures of two discs, swelling in her upper back, and numbness in her left hand and legs. (Defendants’ Motion, Instrument No. 22, Exh. 3). Mil- *636 son also stated that she had been treated by Dr. Barry Martin (“Martin”) and Dr. Day P. McNeel (“McNeel”). The Attending Physician’s Statement, which was completed by McNeel, indicated that Milson suffered from cervical herniated and a thoracic sprain. (Id.). McNeel also stated that Milson experienced pain in her upper back between her shoulder blades, neck pain, and headaches. (Id.). McNeel concluded that Milson was totally disabled and not a suitable candidate for trial employment. (Id.).

Then, in a letter dated September 26, 1991, Travelers requested additional information from Martin and McNeel so that the company could evaluate Milson’s disability. (Defendant’s Motion, Instrument No. 22, Exh. 4). Travelers asked the doctors to provide “a detailed narrative report summarizing ... [Milson’s] past and present medical history including a complete diagnosis, prescribed medication(s), treatment and prognosis.” (Id.).

After reviewing the additional documents and information, Travelers approved Milson’s claim for LTD benefits on November 11, 1991. (Defendants’ Motion, Instrument No. 22, Exh. 5). Travelers determined that Milson became disabled on April 26, 1991, and that her benefits began on July 26, 1991. (Id.). Travelers also informed Milson that she had to be “Totally Disabled” as defined in the Plan in order to continue to receive LTD benefits. (Id.). The Plan provides that:

[t]o be considered Totally Disabled, you must meet the following requirements: During the first 36 months of disability, you must be unable to perform all the normal duties of your regular occupation for any employer and you must at no time engage in any occupation or employment for pay or profit. This must be due to your disability. The travelers will decide if this is the case.
After the first 36 months of your disability, you must be completely unable to engage in any occupation or employment for which you are or become qualified. You could be qualified because of your education, training, or experience.
All time you spend completing the Qualifying Disability Period will count in the 36 months.

(Defendants’ Motion, Instrument No. 22, Exh. 1, at 19-20). The first 36 months of disability (where the participant is unable to perform his own job) is referred to as Phase I. Phase II comprises the period after the first 36 months of the participant’s disability (where the participant is unable to perform any job for which he/she is qualified).

On September 5, 1992, Milson was awarded social security benefits. The Administrative Law Judge allegedly concluded that “Milson’s physical impairments of herniated discs and bulging discs in the cervical, thoracic and lumbar spine were severe.” (Plaintiffs Motion, Instrument No. 23, at 11). According to Milson, she still receives social security benefits and was awarded supplementary benefits in December of 1996. (Plaintiffs Motion, Instrument No. 23, at 11).

On February 2, 1994, Travelers sent Milson a letter reminding her that she had to be totally disabled from any occupation in order to continue to receive LTD benefits after July 26, 1994. (Defendants’ Motion, Instrument No. 22, Exh. 6). Travelers informed Milson that it was reviewing her claim to determine whether she was totally disabled from any occupation and requested Milson to complete a Personal Profile Evaluation and Medical Authorization. (Id.). Travelers also requested Mil-son to have her physician complete the Attending Physician’s Statement and a Physical Capacity Form. (Id.).

Dr. Martin completed the Attending Physician’s Statement on February 25, 1994, and indicated that Milson’s progress' was unchanged. (Id.). Martin stated that Milson could reach above shoulder level, operate a motor vehicle, but could not climb, twist, bend or stoop. (Id.). Martin also reported that she could sit, stand, and *637 walk for approximately one (1) hour. (Id.). Martin further indicated that Milson could only occasionally lift up to twenty (20) pounds. (Id.). On the Personal Profile Evaluation, Milson stated that her back, spine, and shoulders hurt constantly, that she could not turn her neck, and that she experienced swelling on the right side of her throat and numbness in her legs. (Id.).

Then, on April 7, 1994, Travelers requested that Dr. Martin complete an Orthopedic Questionnaire and indicate whether Milson was experiencing any neurological deficits based on her herniated disc. (Id.). Travelers also asked Martin whether he believed Milson would be able to perform sedentary work activity. (Id.). On February 5, 1995, Travelers sent Mil-son a Personal Profile and Claimant’s Authorization Form for her to complete.

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Bluebook (online)
71 F. Supp. 2d 634, 1999 U.S. Dist. LEXIS 20613, 1999 WL 1091884, Counsel Stack Legal Research, https://law.counselstack.com/opinion/milson-v-st-lukes-episcopal-hospital-txsd-1999.