Morningred v. Delta Family-Care & Survivorship Plan

790 F. Supp. 2d 177, 2011 U.S. Dist. LEXIS 70188, 2011 WL 1195771
CourtDistrict Court, D. Delaware
DecidedJune 30, 2011
DocketC.A. 10-272-MPT
StatusPublished
Cited by8 cases

This text of 790 F. Supp. 2d 177 (Morningred v. Delta Family-Care & Survivorship Plan) is published on Counsel Stack Legal Research, covering District Court, D. Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morningred v. Delta Family-Care & Survivorship Plan, 790 F. Supp. 2d 177, 2011 U.S. Dist. LEXIS 70188, 2011 WL 1195771 (D. Del. 2011).

Opinion

MEMORANDUM ORDER

MARY PAT THYNGE, United States Magistrate Judge.

Sharon Morningred filed suit against Delta Airlines, the Delta Family-Care & Survivorship Plan (“the Plan”) and Sedgwick Claim Management Services (Sedgwick CMS) alleging a violation of § 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA). 1 Morningred asserts that Sedgwick CMS, the delegated administrator of the Plan, arbitrarily and capriciously denied her short-term disability benefits following a workplace injury. Defendants filed a motion for summary judgment arguing that Sedgwick CMS’s decision to deny Morningred continued short term disability benefits for the period between *181 July 1, 2008 to November 28, 2008 was neither arbitrary nor capricious. Morningred argues that Sedgwick CMS’s review of her case failed to consider all of the relevant diagnoses, the opinion of her treating physician, and a workers’ compensation agreement finding that Morningred was totally disabled. For the reasons stated herein, the court grants in part and denies in part defendants’ motion for summary judgment, grants in part and denies in part Morningred’s cross-motion for summary judgment, and finds that the denial of Morningred’s continued short-term disability benefits within a specific time-period was not supported by substantial evidence.

1. Factual and Procedural History

At the time of her injury, Morningred was employed as a rotating Baggage Service Agent, Ticket Counter agent, Lobby and/or Lobby Assistant Agent, and/or Gate Agent. These jobs required she be able to lift bags of luggage weighing between 70 and 99 pounds. On an average work day, Morningred lifted 400 bags and 500 pieces of freight or mail. Her job also required that she be able to work eight and one-half hours per day, and be capable of walking, pushing, pulling, lifting, reaching, bending, and kneeling.

At work on May 29, 2008, Morningred slipped and fell on a puddle of water. According to a medical examination conducted that same day, Dr. Louis Lam reported that Morningred complained of pain in her left knee and both ankles. Dr. Lam diagnosed a cervical strain, a right shoulder sprain, a right elbow strain, a right wrist strain, a lumbosacral strain, a left knee contusion, and a bilateral ankle strain. X-rays taken at that time showed that Morningred had not suffered a fracture or dislocation of her ankle or knee. Morningred subsequently began receiving treatment from her physician, Dr. Debra Hudes, who noted that Morningred was unable to work.

The Delta Family-Care & Survivorship Plan provides short-term and long-term disability benefits to eligible participants who suffer an injury while at work. Morningred applied for short-term disability benefits under the Plan. Short-term disability benefits require a demonstration that the claimant is “unable to engage in [her] customary occupation as a result of a demonstrable injury or disease....” 2 Pursuant to sections 12.02(i) and 12.04, the Plan delegates claim administration duties to Sedgwick CMS and, pursuant to a service agreement contract, Sedgwick CMS is granted all discretionary power to interpret the Plan and make benefit determinations. By a letter dated June 17, 2008, Sedgwick CMS approved short-term disability benefits for the period between May 31, 2008 through June 30, 2008. The letter noted that if, at the end of the benefit period, Morningred was unable to resume her employment duties, additional medical documentation would be required to approve further benefits.

Following the expiration of the initial short-term disability benefits, Morningred sought re-certification of benefits under the Plan and submitted further medical documentation in support of a diagnosis of complex regional pain syndrome (“CRPS”). According to an August 6, 2008 report, Morningred’s orthopedic surgeon Dr. Eric Johnson diagnosed CRPS in her left lower extremity and recommended physical therapy.

Via letter on September 30, 2008, Sedgwick CMS denied the claim, citing “no objective medical documentation to sup *182 port [the] diagnosis [and] no consistent treatment plan, other than physical therapy, appropriate for this diagnosis.” 3 The letter concluded by informing Morningred of her right to administratively appeal the decision and advised her to submit information from all physicians who treated her including narrative reports and physical limitations, her course of treatment, frequency of doctor’s visits, medications prescribed, the diagnostic studies conducted during that period including test result, X-rays and clinical findings, and any other information specific to the condition or that may help in reviewing the claim.

Morningred appealed the decision on October 16, 2008, stating that although she had been cleared to return to work in a sedentary position, her manager disallowed her return until medical notice that she could return to her “normal functions within 60 days.” She stated her doctor was unwilling to provide such a diagnosis. She expressed interest in returning to work in a sedentary position as soon as possible and stated that she was willing to transfer to Atlanta for such work. To support her claim of CRPS, Morningred submitted hundreds of pages of medical records to Sedgwick CMS.

Sedgwick CMS forwarded the records to Insurance Appeal Limited to perform an independent review. On March 4, 2009, Insurance Appeal Limited issued a report concluding that due to the lack of physical damage and because of a normal electrodiagnostic test, Morningred should have been able to return to work as of July 1, 2008 through November 28, 2008.

Sedgwick CMS subsequently upheld the denial of short-term disability benefits by a letter dated April 8, 2009. Morningred filed this action on April 6, 2010. Defendants filed a motion for summary judgment on December 8, 2010. Morningred filed her answering brief on January 20, 2011 to which defendants replied on February 1, 2011.

II. Standard of Review

Where an ERISA plan grants the administrator discretionary authority to determine eligibility for benefits, the court reviews a § 502(a)(1)(B) challenge to a termination of benefits under an arbitrary and capricious standard. 4 The Plan affords the delegated administrator discretion in virtually all aspects concerning interpretation and administration of the Plan including “[t]he discretionary authority to interpret and construe the Plan, and decide all questions of eligibility of any Employee ...” 5 “Under the arbitrary or capricious (or abuse of discretion) standard of review, the District Court may overturn a decision of the plan administrator only if it is without reason, unsupported by substantial evidence or erroneous as a matter of law.” 6 The court will review the procedural factors underlying the administrator’s decision-making process and will “determine lawfulness by taking account of several different, often case-specific, factors, reaching a .result by weighing all together.”

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Bluebook (online)
790 F. Supp. 2d 177, 2011 U.S. Dist. LEXIS 70188, 2011 WL 1195771, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morningred-v-delta-family-care-survivorship-plan-ded-2011.