O'Hara v. Nat. Union Fire Ins. Co. of Pittsburgh

642 F.3d 110, 51 Employee Benefits Cas. (BNA) 1097, 2011 U.S. App. LEXIS 7675, 2011 WL 1405448
CourtCourt of Appeals for the Second Circuit
DecidedApril 14, 2011
DocketDocket 10-1433-cv
StatusPublished
Cited by60 cases

This text of 642 F.3d 110 (O'Hara v. Nat. Union Fire Ins. Co. of Pittsburgh) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O'Hara v. Nat. Union Fire Ins. Co. of Pittsburgh, 642 F.3d 110, 51 Employee Benefits Cas. (BNA) 1097, 2011 U.S. App. LEXIS 7675, 2011 WL 1405448 (2d Cir. 2011).

Opinion

POOLER, Circuit Judge:

Plaintiff-Appellant Patricia O’Hara appeals from a judgment of the United States District Court for the Western District of New York (Larimer, /.) granting summary judgment to Defendant-Appellee National Union Fire Insurance Company of Pittsburgh, PA (“National Union”) and dismissing O’Hara’s claim for disability benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). National Union argues that O’Hara cannot recover disability benefits because she was present at work during the period of alleged disability. We disagree. O’Hara presented evidence that she was disabled during all periods required by National Union’s plan, and based on such evidence, a reasonable factfinder could conclude that O’Hara was entitled to disability benefits. Therefore, we vacate the district court’s judgment and remand for further proceedings.

I.

A.

In 1993, ITT Flygt Corporation (“ITT”) hired Patricia O’Hara as an office administrator. O’Hara had over 20 years of experience in office administration and management. During her employment, O’Hara participated in a voluntary disability insurance plan held by ITT and issued by National Union (“the plan” or “the National Union plan”). Under the plan, O’Hara was eligible to recover insurance proceeds if, as a result of an accidental injury, she was totally and permanently disabled and prevented from engaging in “each and every occupation or employment ... for which [she was] reasonably qualified by reason of [her] education, training or experience” (“qualified work”) within one year of the accident, and such disability continued for a year.

On March 15, 2001, while working in ITT’s Rochester, New York office, O’Hara tripped and fell, striking her head on the floor. She was taken to the emergency room, where she complained of headaches.

After the accident, O’Hara continued to work at ITT. By July 2001, three of O’Hara’s coworkers had complained to her supervisor that she was behaving unprofessionally and had difficulty maintaining satisfactory working relationships with colleagues. O’Hara’s supervisor found the complaints credible and discussed them with O’Hara, warning her that if she did not act in a professional manner, “[ITT] may have to terminate your employment with the company.” On June 6, 2002, ITT fired O’Hara because of her “performance *113 and dealings, interactions, etc. with [ITT] employees.”

B.

After her fall in March 2001, O’Hara initially was treated by a neurologist, Dr. Tim Counihan. O’Hara took several medications prescribed by Dr. Counihan but reported that they did not alleviate her persistent headaches. In October 2001, O’Hara’s internist, Dr. David Sischy, referred her to a different neurologist, Dr. Joseph Mann. After Dr. Mann examined O’Hara on October 8, 2001, he wrote to O’Hara’s internist with his initial diagnosis. Dr. Mann stated that O’Hara was being evaluated for headaches that “were associated with a decrease in executive function, mood changes, and sleep disorder.” Dr. Mann noted that O’Hara had “daily” headaches that “seem[ed] to encircle the head” and could “worsen as the day goes on.” Dr. Mann concluded that “[m]y feeling at this point is that the patient has a post-traumatic headache disorder associated with problems with executive function, mood, and sleep.”

Dr. Mann continued treating O’Hara and sending written reports to Dr. Sischy. After an examination on February 14, 2002, Dr. Mann wrote that O’Hara “needs a nap” during many days and had to “constantly mak[e] notes at work and at home” to remember her tasks. Dr. Mann concluded that O’Hara “still has a post-traumatic headache disorder with memory disturbance.” Dr. Mann examined O’Hara again on March 14, 2002, less than one year after her March 15, 2001 injury. After this examination, Dr. Mann wrote that O’Hara “continues to have chronic daily headaches, insomnia, and also complains of pain involving her upper arms.” Dr. Mann described the headaches as “mostly posterior,” containing “migrainous components.” Dr. Mann concluded that O’Hara continued to have “memory disturbance” and that “[a]t this point, it appears that [O’Hara] continues with a post-traumatic headache disorder which she’s now had for a year.”

C.

A year after her injury, O’Hara continued seeking treatment from Dr. Mann. Over the course of O’Hara’s second year after her injury, Dr. Mann examined O’Hara at least six times. In July 2002, Dr. Mann noted that O’Hara was “completely disabled,” “unable to work,” and “continue[d] to be in severe pain intolerant of medications.” In August 2002, Dr. Mann again diagnosed O’Hara as suffering “a post traumatic headache disorder with sleep disturbance, memory disturbance, cognitive problems and chronic pain involving her neck and upper back area.” In November and December 2002, Dr. Mann stated that O’Hara remained “totally disabled.” In January 2003, Dr. Mann wrote that “[t]here has been no major change in [O’Hara’s] headache pattern,” as she continued to have “chronic daily headaches.” On March 14, 2003, Dr. Mann prescribed to O’Hara treatment used for patients with “intractable chronic daily headache[s].”

In mid-2002, while she was receiving treatment from Dr. Mann, O’Hara began treatment with a pain management specialist, Dr. Jaimala Thanik, whom Dr. Mann recommended. After the initial examination, Dr. Thanik concluded that “[O’Hara’s] pain problem is definitely post traumatic headaches” and diagnosed the headaches as “[m]uscle contraction headaches with a component of occipital neuralgia.” In February 2003, Dr. Thanik noted that “[O’Hara’s] symptoms remain about the same. Nothing seems to have worked for her.... She will continue working with Dr. Mann on headache management and see Dr. Kuttner for depression.”

*114 In late 2002 and early 2003, two doctors examined O’Hara for purposes of her New York workers’ compensation claim. Dr. Guy Corkill, a neurosurgeon, examined O’Hara on three occasions beginning in September 2002 and concluded in July 2003 that O’Hara had a “[m]ild temporary and partial” disability arising from the accident. In addition, Dr. Thomas Letourneau, a neurologist, examined O’Hara in March 2003 and stated that although O’Hara was suffering from mild/moderate depression stemming from chronic pain, “[t]here is no psychiatric disability [causing her depression]. From a psychiatric standpoint, she is able to return to work full-time.” The New York State Workers’ Compensation Board ultimately granted O’Hara disability benefits.

In April 2003, more than two years after O’Hara’s accident, pain specialist Dr. Thanik recommended that O’Hara join a fitness center “for daily exercises, especially swimming, walking, etc.,” and noted that “I also have suggested that she may try going back to work doing half days with restrictions of no repetitive type work.” In May 2003, Dr. Thanik noted that “[t]he patient continues to have constant pain.”

D.

On January 29, 2004, O’Hara submitted a claim for disability benefits under the National Union disability plan. AIG Domestic Claims, Inc. (“AIG”) processed O’Hara’s claims and reviewed O’Hara’s medical records and workers’ compensation medical reports.

At AIG’s request, Dr. David Marzulo, a neurologist, examined O’Hara on September 12, 2005. After the examination, Dr.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
642 F.3d 110, 51 Employee Benefits Cas. (BNA) 1097, 2011 U.S. App. LEXIS 7675, 2011 WL 1405448, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ohara-v-nat-union-fire-ins-co-of-pittsburgh-ca2-2011.