Miranda Vega v. Cingular Wireless

568 F. Supp. 2d 180, 2008 U.S. Dist. LEXIS 68304, 2008 WL 2931595
CourtDistrict Court, D. Puerto Rico
DecidedJuly 31, 2008
DocketCivil 06-1732 (RLA)
StatusPublished
Cited by3 cases

This text of 568 F. Supp. 2d 180 (Miranda Vega v. Cingular Wireless) is published on Counsel Stack Legal Research, covering District Court, D. Puerto Rico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Miranda Vega v. Cingular Wireless, 568 F. Supp. 2d 180, 2008 U.S. Dist. LEXIS 68304, 2008 WL 2931595 (prd 2008).

Opinion

ORDER GRANTING DEFENDANTS’ MOTIONS FOR SUMMARY JUDGMENT

RAYMOND L. ACOSTA, District Judge.

This action was instituted by Griselle Miranda Vega alleging violations to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001-1461 as well as to Puerto Rico’s Law No. 80 of May 30, 1976, P.R. Laws Ann. tit. 29, §§ 185a-185m (2002) (“Law 80”) and the Puerto Rico Disabilities Act, Law No. 44 of July 2, 1985, P.R. Laws Ann. tit. 1 §§ 501— 511 (1999) (“Law 44”).

Named defendants are C.C.P.R. Services, Inc. d/b/a Cingular Wireless (“Cin-gular”), Cingular Wireless Disability Plan for Non-Bargained Employees (the “Plan”) and Broadspire Services, Inc. (“Broadspire”).

Specifically, plaintiff challenges the denial of disability benefits under the Plan. Ms. Miranda also alleges that she was wrongfully terminated from her employment in retaliation for having requested information regarding the Plan. Further, plaintiff claims that she was terminated without just cause in violation of Law 80 and also in contravention to Law 44.

Defendants have filed two motions for summary judgment one addressing the adequacy of the denial of benefits based on the record before the Claims Administrator and the other disposing of the remaining claims challenging her termination which will be addressed seriatim.

THE FACTS

The court finds the following material facts undisputed based on the evidence on record.

C.C.P.R. Services, Inc. d/b/a Cingular Wireless is a company dedicated to providing wireless communication services to individuals and businesses.

The Cingular Wireless Disability Plan for Non-Bargained Employees is an ERISA plan that provides short and long-term disability benefits to Cingular’s non-bargained employees.

*183 Plaintiff commenced working as a sales representative for Cingular on February 16,1995.

As a Cingular employee, plaintiff was eligible to participate in the Plan.

On June 11, 2001, plaintiff was involved in an automobile accident which caused her to miss almost a year of work due to the injuries sustained as a result thereof.

On June 1, 2002, plaintiff returned to work after having requested and being granted short and long-term benefits under the Plan.

On November 29, 2004, plaintiff left Cin-gular due to her deteriorating health allegedly caused by her June 11, 2001, accident.

On February 4, 2005, plaintiff requested short-term disability benefits retroactive to November 29, 2004.

Short-term disability benefits under the Plan are available only when a claimant establishes that he or she has a total disability. “Total disability” as defined in the Plan means that due to an illness or injury the claimant is unable to perform his or her customary job or other available job assigned by the company with the same full-or part-time classification for which the claimant reasonably qualified. Further, the Plan requires a claimant to establish his/her disability based on “credible objective medical evidence.”

Broadspire was Cingular’s third-party administrator for Short Term Disability (“STD”) claims from January 1, 2005 to December 15, 2005. As Cingular’s STD third-party administrator, (“TPA”) Broad-spire had full discretion and authority to make all STD claims determinations and appeals determinations under the Plan.

While there was no signed contract between Broadspire and Cingular, the parties abided by the following fee arrangement:

a. Broadspire was paid an initial implementation fee after the completion of key implementation tasks;
b. With regard to Cingular’s STD program, Cingular paid Broadspire a monthly Administrative Services Only, (“ASO”), fee. This fee was paid to Broadspire for TPA services that Broadspire provided to Cingu-lar. The ASO fee was based on Cingular’s covered employee headcount. Specifically, Broadspire was paid on a monthly basis a flat rate ASO fee multiplied by the number of employees eligible for participation in the applicable disability benefits plan.
c. Cingular also paid Broadspire flat rate fees for certain additional services provided by Broadspire, such as peer reviews or an appeal brief which included a peer review.

Broadspire’s approval or denial of an STD claim had no economic impact on Broadspire. Specifically, Broadspire was not paid any additional fee, payment or bonus for approval or denial of an STD claim.

The Cingular Wireless Summary Plan Description (“SPD”) dated January 2005 specifically delegated full responsibility for disability claims determinations and appeals to Broadspire. Additionally, Broad-spire represented itself as the claims administrator in its correspondence with plaintiff.

On February 24, 2005, plaintiff was informed that her claim was being denied by Broadspire for failure to submit proof of disability.

In a letter dated March 1, 2005, plaintiff acknowledged having been notified of the denial of benefits as well as the fact that the pertinent medical certificate had not *184 been provided. Specifically, plaintiffs correspondence reads as follows:

On February 24, 2005, I was notified that the claim had been denied due to lack of documentation.

I would like to request a reconsideration of my case as the required documentation had not been provided by my doctor because he was out of the office on vacation.
I enclose the completed document accompanied by a copy of the last medical certificate provided by my doctor for your review and consideration.

The SPD establishes a process to file a claim and an appeal of a denied claim of disability benefits.

On April 14, 2005, Broadspire confirmed to plaintiff that it had received her request for appeal of the denial of disability benefits.

On May 26, 2005, plaintiffs claim file, along with the medical records submitted, were referred back to the claims unit for further processing.

Plaintiffs medical records submitted in Spanish were translated into English.

Plaintiffs claim was presented to Lawrence Blumberg, M.D. (Orthopedic Surgeon) for a Peer Review. Dr. Blumberg concluded that the evidence available did not support a disability determination. In his recommendation, Dr. Blumberg specifically indicated:

Al: Based on the documentation and job description, the information does not support a functional impairment that precludes work from 11/29/04 through present. The claimant is a 52-year old Sales Representative for Cingular which is a sedentary position. The claimant sustained a left hip acetabular fracture on 6/11/2001 which was treated with a closed reduction and physical therapy. She suffered continuing left hip pain which is exacerbated by prolonged sitting, standing or walking. Her hip x-rays showed early osteoarthritis. Her examination on 3/23/05 demonstrated some loss of motion with hip rotation.

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Bluebook (online)
568 F. Supp. 2d 180, 2008 U.S. Dist. LEXIS 68304, 2008 WL 2931595, Counsel Stack Legal Research, https://law.counselstack.com/opinion/miranda-vega-v-cingular-wireless-prd-2008.