Mullins v. Connecticut General Life Insurance

880 F. Supp. 2d 713, 2010 WL 8755388, 2010 U.S. Dist. LEXIS 144783
CourtDistrict Court, E.D. Virginia
DecidedJuly 21, 2010
DocketCase No. 1:03-cv-69-A (GBL)
StatusPublished
Cited by1 cases

This text of 880 F. Supp. 2d 713 (Mullins v. Connecticut General Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mullins v. Connecticut General Life Insurance, 880 F. Supp. 2d 713, 2010 WL 8755388, 2010 U.S. Dist. LEXIS 144783 (E.D. Va. 2010).

Opinion

MEMORANDUM ORDER

GERALD BRUCE LEE, District Judge.

THIS MATTER is before the Court on Plaintiff Margaret Mullins’s Renewed Motion for Summary Judgment on Count I (Dkt. No. 130). This case concerns Plaintiffs claim that Defendant Connecticut General Life Insurance Company (“CGLIC”) improperly denied her claim for long term disability (“LTD”) benefits as claims administrator of her employee disability plan. After ample opportunity for briefing and argument, the issue before the Court on remand remains whether CGLIC abused its discretion in denying Plaintiffs LTD benefits claim. The Court denies Plaintiffs Renewed Motion for Summary Judgment and reaffirms its ruling in favor of CGLIC because CGLIC reasonably determined Plaintiff was not entitled to LTD benefits under the Plan.

I. BACKGROUND

Defendant AT & T Corporation (“AT & T”) employed Plaintiff as a Communications Assistant. Plaintiff participated in AT & T’s Long Term Disability Plan for Occupational Employees (the “Plan”), an employee welfare plan funded by Defendant AT & T..The Plan is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461 (West 1999 & Supp.2008). The Financial and Service Agreement (the “Agreement”) entered into by CGLIC, AT & T, and Lucent Technologies, Inc., sets forth CGLIC’s responsibilities as claims administrator of the Plan.

The Plan provides that the:

[716]*716Claims Administrator shall serve as the final review committee under the Plan and shall have sole and complete discretionary authority to determine conclusively for all parties ... any and all questions arising from administration of the Plan and interpretation of all Plan provisions, determination of all questions relating to participation ... and eligibility for benefits, determination of all relevant facts, the amount and type of benefits payable ... and construction of all terms of the Plan.

(Plan § M.) An employee is entitled to receive LTD benefits under the Plan when, “in the sole opinion of the Claims Administrator, the ... [e]mployee is determined to be incapable of performing the requirements of any job for any employer ... for which the individual is qualified or may reasonably become qualified by training, education, or experience.... ” (Plan § B(6).) The Plan further requires that the claims administrator use ERISA-compliant appeals procedures. (Plan § M.)

CGLIC has a manual (the “Claims Manual”), known at one time as “The Book of Operating Knowledge,” which sets forth procedures for case managers in processing claims for long term disability benefits. The Introduction section of the Claims Manual states that its purpose is “[t]o provide a referenced guide to Managed Disability Claims Management Policies and Procedures.” (Def.’s Opp’n Renewed Mot. Summ. J. Ex. 4 at A00004.) The specific Claims Manual Bulletins at issue are discussed in detail in Section C of the Analysis, below.

In April 1998, physicians diagnosed Plaintiff with carpal tunnel syndrome. Plaintiff is also diabetic and physicians believed her diabetic condition worsened her carpal tunnel. In late 1998 and early 1999, Plaintiff underwent two unsuccessful surgeries for her condition. In April 1999, Plaintiffs physicians found her totally disabled from her position as a Communications Assistant. In September 1999, Plaintiff applied for LTD benefits under the Plan. On January 27, 2000, CGLIC denied Plaintiffs Claim for LTD benefits (AR at 159-62) and, after a review, sent Plaintiff a letter dated November 27, 2000, upholding the original denial of benefits (AR at 518-25). On May 7, 2002, Plaintiff again sought reconsideration of CGLIC’s decision. CGLIC forwarded Plaintiffs file to its appeals team. After review by the appeals team, on January 9, 2003, CGLIC again denied benefits. (AR 642-43.) Plaintiff then sought review by this Court of CGLIC’s determination.

The procedural history of this case is quite lengthy. On January 23, 2003, Plaintiff filed a Complaint in this Court against Defendants for improper denial of disability benefits under the Plan. On June 20, 2003, Plaintiff filed an Amended Complaint and on September 8, 2003, the parties filed cross Motions for Summary Judgment. On August 4, 2004, the Court granted CGLIC’s Motion for Summary Judgment on Count I, wrongful denial of claim for LTD benefits, and denied Plaintiffs Motion on Count I because the Court found that CGLIC did not abuse its discretion in determining Plaintiff was capable of performing sedentary work and was therefore not disabled from any job with any employer.

Plaintiff appealed to the Fourth Circuit, arguing that this Court erred in denying her discovery requests because, without access to the information and processes CGLIC used to resolve disability claims, she could not demonstrate that the materials considered by CGLIC were inadequate or challenge the quality of CGLIC’s decisionmaking process. On April 24, 2006, the Fourth Circuit issued a one page order remanding the case without opinion on the merits, instructing this Court to: 1) ascer[717]*717tain the existence of any claims processing documents; 2) examine those documents; 3) provide Plaintiff any such documents relevant to her LTD benefits claim; and 4) allow the parties an opportunity to address the issue of Plaintiffs disability.

On August 14, 2006, this Court ordered CGLIC to produce numerous versions of its Claims Manual and other claims processing documents for the Court’s in camera review. On February 28, 2007, after reviewing the documents, the Court affirmed summary judgment in favor of CGLIC, finding that CGLIC did not abuse its discretion in denying Plaintiffs LTD benefits claim because: 1) the weight of medical authority indicated that Plaintiff was capable of performing some level of work; 2) the Functional Capacity Examination (“FCE”) remarks were reasonably considered in conjunction with the exam results as a whole and indicated that sedentary work was suitable for Plaintiff; and 3) mention of Plaintiffs potential mental condition did not show bias against Plaintiff in considering her claim.

Plaintiff again appealed, arguing that this Court failed to comply with the mandate of the Fourth Circuit’s remand order because Plaintiff was not permitted to review the relevant portions of the claims processing documents or to make arguments about the significance of those documents to her claim for disability benefits. On September 3, 2008, the Fourth Circuit again remanded the case with instructions that this Court provide Plaintiff with all claims processing documents relevant to her claim for long term disability benefits and allow Plaintiff reasonable time to review the documents and present argument as to how the documents support her contention that CGLIC improperly denied her claim.

On November 7, 2008, this Court ordered CGLIC to produce to Plaintiff all claims processing documents originally produced to this Court in response to its August 14, 2006, Order. Plaintiff now renews her Motion for Summary Judgment on Count I, arguing that CGLIC’s failure to follow its claims processing procedures constitutes an abuse of discretion. Pursuant to the Fourth Circuit’s instructions on remand, this Court now considers Plaintiffs arguments and determines whether this Court should reaffirm summary judgment in favor of CGLIC or whether it should in some way modify its prior decision.

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Bluebook (online)
880 F. Supp. 2d 713, 2010 WL 8755388, 2010 U.S. Dist. LEXIS 144783, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mullins-v-connecticut-general-life-insurance-vaed-2010.