Pelletier v. Reliance Standard Life Insurance

223 F. Supp. 2d 298, 2002 U.S. Dist. LEXIS 18443, 2002 WL 31159438
CourtDistrict Court, D. Maine
DecidedSeptember 27, 2002
DocketCIV.02-10-P-C
StatusPublished
Cited by6 cases

This text of 223 F. Supp. 2d 298 (Pelletier v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pelletier v. Reliance Standard Life Insurance, 223 F. Supp. 2d 298, 2002 U.S. Dist. LEXIS 18443, 2002 WL 31159438 (D. Me. 2002).

Opinion

MEMORANDUM OF DECISION AND ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT AND GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

GENE CARTER, District Judge.

This case arises out of Plaintiff Lorette Pelletier’s claim for long-term disability benefits under the insurance policy issued to her employer by Defendant Reliance Standard Life Insurance Company (“Reliance”). Plaintiff has filed suit under 29 U.S.C. § 1132(a)(1)(B), the civil enforcement section of the Employee Retirement' Income Security Act of 1974 (“ERISA”), alleging wrongful termination and denial of benefits payable under Defendant’s insurance policy. The Court now has before it Plaintiffs and Defendant’s cross Motions for Summary Judgment and their supporting Statements of Material Facts, as well as the respective objections and replies thereto. After consideration of the eviden-tiary record and the arguments made by the parties, the Court will grant Defendant’s Motion for Summary Judgment and deny Plaintiffs Motion for Summary Judgment.

I. FACTS

Reliance issued a group long-term disability policy to Falcon Shoe Manufacturing Company (“Falcon Shoe”). By virtue of her employment with Falcon Shoe, Plaintiff was insured under this policy. Since October of 1992, Plaintiff was employed as supervisor of the stitching department at Falcon Shoe, a position she held until she terminated her employment there on October 1, 1999. (R. 133.) On the same day she terminated her employment, Plaintiff applied for disability income benefits from Defendant Reliance, claiming she was unable to continue working due to fibromyalgia and osteoarthritis. (R. 133-38).

In October of 1998, Plaintiff was referred by her treating cardiologist and family physician, Dr. Robert Weiss. He referred her to Dr. Lee Kendall, a rheu-matologist. At that time, Plaintiff was complaining of multiple areas of joint pain, including her shoulder, arm, hip, and lower back. (R. 182.) At this first visit, Dr. Kendall diagnosed her as having osteoarthritis, primarily affecting the hips and probably her lower back, and bursitis of the right shoulder. (R. 184.) When Plaintiff returned one month later, Dr. Kendall diagnosed her with mild osteoarthritis affecting the hips and probably the hands, and fibromyalgia. (R. 180). He pronounced her prognosis as “only fair at best.” (R. 181.) In March of 1998, Plaintiff discussed being declared disabled with Dr. Kendall, but at that time, he indicated that he believed “if [he and Plaintiff] could find the right combination [of medicine and exercise] ... she may not need [to be declared disabled].” (R. 179.)

However, in late September of 1999, when Plaintiff saw Dr. Weiss, her treating cardiologist and family physician, he indicated that “[s]he is totally exhausted and frazzled,” and that he “really [thought] she should stop working. She cannot take the stress.” (R. 169.) When she then visited Dr. Kendall on October 1, 1999, he noted that Dr. Weiss had felt she was under “a tremendous amount of stress” and that he *300 had given her a slip to stay out of work, “related to anxiety.” (R. 177.) He lastly indicated that her fibromyalgia “certainly may be exacerbated by her stress and distress.” Id. It was at this time that Plaintiff ceased working and requested disability benefits.

In support of Plaintiffs application for disability benefits, Reliance received a Physician’s Statement dated October 6, 1999, from Dr. Weiss. The form indicated that Plaintiffs symptoms were “exacerbation of fibromyalgia, osteoarthritis, weight loss, and CAD [coronary artery disease],” and that he had referred Plaintiff to Dr. Lee Kendall, a rheumatologist, for her osteoarthritis and fibromyalgia. (R. 198.) The form further indicated that Plaintiff was capable of one to three hours of standing, sitting, walking, and driving in an eight-hour workday, and that she was able to use her upper extremities for repetitive simple grasping, pushing and pulling, and fine manipulation. (R. 199.) Finally, Dr. Weiss indicated that in an eight-hour day, Plaintiff was capable of light work, meaning she was able to lift or carry twenty pounds maximum and frequently lift or carry up to ten pounds. Id. The form submitted to Reliance did not say anything about any stress or anxiety and its effect on her ability to work.

To further evaluate Plaintiffs claim, Reliance requested medical records for the period of July 1, 1999, to the date of its request letter, October 29, 1999, from Dr. Weiss. (R. 115.) Subsequently, Reliance sent a request for medical records to Dr. Kendall. (R. 112, 106, 108.) The most recent information provided by Dr. Kendall related to an office visit by Plaintiff in January of 2000. The doctor’s note from that visit indicated that Plaintiff had fibro-myalgia/myofascial pain of the neck and shoulders and early osteoarthritis. (R. 175.) It also noted that he would see her again for a follow-up in about a year, and that she’d be following up with Dr. Weiss for her general medical care. Id.

On March 3, 2000, Defendant advised Plaintiff that she had been awarded long-term disability benefits, effective January 1, 2000. (R. 96.) The letter advised Plaintiff that “periodic objective documentation” of her disability status would be required in order to continue her benefits and that “[ojbjective documentation of your continuous disability must be provided by the physician who is treating you and satisfactory to us.” Id. On March 28, 2000, less than one month after notifying Plaintiff that they had approved her long-term disability benefits, Reliance wrote a letter notifying Dr. Weiss that it was undertaking a review of Plaintiffs disability status. (R. 95.) It requested all copies of medical records from January 20, 1999, to the then present and requested that he fill out a medical questionnaire (Physical Capacities Assessment form) based on his most recent evaluation of the patient’s condition. Id.

On the form submitted to Reliance pursuant to its request, dated April 4, 2000, Dr. Weiss again indicated that Plaintiff was capable of significant standing or walking, and/or working at a light level of exertion, involving lifting a maximum of twenty pounds. (R. 164.) He likewise maintained that she was able to use her upper extremities for repetitive activities such as simple grasping, pushing and pulling, and fine manipulation. Id. When asked if there were any other factors affecting the patient’s physical abilities, Dr. Weiss marked “N/A.” (R. 165.) Based on this assessment of Dr. Weiss and the Dictionary of Occupational Titles listing Plaintiffs occupation as light-duty work, requiring the lifting of twenty pounds occasionally and up to ten pounds frequently, Reliance determined that Plaintiff was no longer totally disabled. (R. 93-94.) *301 As of May 1, 2000, Plaintiffs benefits were terminated. Id. On May 1, 2000, Dr. Weiss sent a letter “To Whom it May Concern” to supplement the earlier form he had filled out on April 4. In this letter, Dr. Weiss explained that when he said that Plaintiff could lift twenty pounds, “this was meant to state that she could lift 20 pounds at home, but did not mean to imply that she could do this at work.

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Bluebook (online)
223 F. Supp. 2d 298, 2002 U.S. Dist. LEXIS 18443, 2002 WL 31159438, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pelletier-v-reliance-standard-life-insurance-med-2002.