Pikulas v. DaimlerChrysler

397 F. Supp. 2d 883, 2005 U.S. Dist. LEXIS 25920, 2005 WL 2923981
CourtDistrict Court, E.D. Michigan
DecidedOctober 31, 2005
Docket05-70846
StatusPublished
Cited by1 cases

This text of 397 F. Supp. 2d 883 (Pikulas v. DaimlerChrysler) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pikulas v. DaimlerChrysler, 397 F. Supp. 2d 883, 2005 U.S. Dist. LEXIS 25920, 2005 WL 2923981 (E.D. Mich. 2005).

Opinion

OPINION AND ORDER

DUGGAN, District Judge.

Christine Pikulas filed suit against Da-imlerChrysler to recover long-term disability benefits under section 502 of the Employee Retirement Income and Security Act, 29 U.S.C. § 1132(a)(1)(B) (“ERISA!’), after DaimlerChrysler issued a final denial of Plaintiffs claim for benefits. Presently before the Court are Plaintiffs Motion .for Judgment on the Administrative Record Reversing Defendant’s Denial of Benefits and Defendant’s Motion to Affirm Administrator’s Decision, both filed on August 1, 2005. This Court held a hearing on. the motions on October 20, 2005.

I. Background

Defendant’s long-term' disability (LTD) plan is an employer-funded disability benefits plan. Plan benefits are paid by Defendant, which is also the plan administrator. (Pl.’s Mot. Ex. 1, Art. II, secs. 2.17, 2.202; Art. III; Art. VII, sec. 7.01). As plan administrator, Defendant has the discretion to administer and interpret the Plan, including the determination of eligibility for, and payment of, plan benefits. (Id. at Art. VII, sec. 7.03). The plan also gives Defendant the authority to appoint a third- *886 party administrator to administer the plan. (Id.). Defendant has appointed ESIS, Inc. as the third-party administrator.

Plaintiff was working as a communications specialist for Defendant Daimler-Chrysler Corporation in 1992 when she was diagnosed as having Chronic Fatigue Syndrome with Lyme disease and Epstein Barr Virus. As an employee of Daimler-Chrysler, Plaintiff was covered by Defendant’s LTD plan. In 1994, Plaintiffs physician, Dr. A. Martin Lerner certified her as completely disabled and Plaintiff was approved for LTD benefits under the plan.

Under the plan, Plaintiff was required to provide periodic proof of her continuing disability. (Id. at Art. IV, sec. 4.02). As proof of her disability, from 1994 through 2003, Dr. Lerner provided Attending Physician Statements to Defendant.

In December 2000, DaimlerChrysler directed Plaintiff to undergo a “Cardio Disability Evaluation Program” examination. (Pl.’s Mot. Ex. 4, AR 288-89). On January 8, 2001, Dr. Eldred G.' Zobl examined Plaintiff. Dr. Zobl’s report stated that Plaintiff was “not disabled in any way from a cardiac standpoint, and’that there [was] no reason for her to be on any medical disability as a result of any cardiac disability.” (Pl.’s Mot. Ex. 5, AR 100). However, he noted: “As far as chronic fatigue syndrome, I do not feel that I am qualified to evaluate that and I would recommend that an evaluation be referred to some other more qualified physician.” (Id.).

After Dr. Zobl’s exam, Dr. Lerner submitted Attending Physician Statements indicating that Plaintiff remained disabled due to Chronic Fatigue Syndrome, Lyme disease, and Epstein-Barr Virus. (PL’s Mot. Ex. 2, AR 59-62, 87-96,102).

On October 25, 2002, DaimlerChryslér initiated a fraud investigation of Plaintiff after surveillance of Plaintiff revealed that she had been shopping and driving. (PL’s Mot. Ex. 6, AR 2-5). Dr. Theresa Bartlett from Defendant’s Corporate Disability Program requested a health care investigation of Plaintiff. (Id. at 2). .

On January 10, 2003, Dr. Lerner provided an Attending Physician Statement indicating that Plaintiff remained disabled due to Epstein-Barr Virus. (PL’s Mot. Ex. 2, AR 64).

On February 11, 2003, Plaintiff was ordered to submit to a “DC/EDB/DEP Exam” with Dr. Tom Madhavan, whose specialty is infectious disease. (PL’s Mot. Ex. 4, AR 281). This exam took place on February 21, 2003. (PL’s Mot. Ex. 5, AR 55). Plaintiffs medical information and test results from Dr. Lerner were available to Dr. Madhavan. (See id. at 55-58). In a report dated February 21, 2003, Dr. Madhavan concluded:

1. Chronic fatigue syndrome, clinical picture is compatible.
2. Doubt Lyme disease, only marginally positive serology.

(Id. at 58).

Moreover, Dr. Madhavan found that Plaintiff was able to “return to employment in the area of management” without any major limitations, “however, she should be advised and encouraged to gradually increase her physical duty.” (Id.).

On February 21, 2003, following the independent medical examination, Dr. Ma-dhavan’s office called the third-party administrator with the verbal result of the examination. (See PL’s Mot. Ex. 7, AR 46). That same day, the third-party administrator emailed Dr. Bartlett and another DaimlerChrysler employee, Neil Levins, which stated, in part: “CHRISTINE PIRULAS WAS FOUND ABLE TO RETURN TO WORE WITH NO RESTRICTIONS .... Let me know how you want me to handle this claim.” (Id.).

On March 17, 2003, an ESIS employee contacted Plaintiff and told her that she *887 was required to return to work. (Pl.’s Mot. Ex. 4, AR 280). Plaintiff contends that the third-party administrator also verbally informed Plaintiff that her benefit checks were stopping as of March 17, 2003, contrary to the plan’s provisions which require that the third-party administrator provide written notice (Pl.’s Mot. Ex. 1, Art. VII, sec. 7.04(a)-(b)). In a letter dated March 19, 2003, Plaintiff received a written denial from DaimlerChrysler’s Human Resources Manager, stating: ‘You have been off work because of a disability since February 5, 1993. While your leave was justified for a time, we have no medical evidence of a continuing disability beyond March 18, 2003.” (Pl.’s Mot. Ex. 8, AR 40).

Plaintiff reported to DaimlerChrysler’s Medical Department on March 20, 2003. Based on the results of Dr. Madhavan’s examination, Defendant’s physicians agreed that Plaintiff was healthy and able to work. 1 (PL’s Mot. Ex. 9, AR 292-94).

Plaintiff submitted a letter from Dr. Lerner, dated March 24, 2003, which stated: “This is to indicate that Ms. Christine Pikulas meets the Centers for Disease Control (CDC) criteria for chronic fatigue syndrome. She is unable to work at 'this time. Her energy index score is 4.5. The cause of her chronic fatigue syndrome is persistent Epstein-Barr virus infection.” (PL’s Mot. Ex. 10, AR 38). On April 24, May 12, and June 19, 2003, Plaintiff and her counsel advised the third-party administrator that Plaintiff had submitted further proof of disability and that Plaintiff had never received a written denial from the third-party administrator as required by the plan. (Pl.’s Mot. Ex. 7, AR 43-44, 47-50, 52-53, 302-03). 2 The third-party administrator forwarded Plaintiffs requests to Defendant DaimlerChrysler. {See id.).

On July 23, 2003, Defendant informed Plaintiff that her “appeal” of the termination of her LTD benefits was denied based on the results of her independent medical examination. (Pl.’s Mot. Ex. 8, AR 297). In December 2003, Plaintiff filed her first complaint in this Court alleging that Defendant violated Section 502 of ERISA when it terminated her LTD benefits.

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Bluebook (online)
397 F. Supp. 2d 883, 2005 U.S. Dist. LEXIS 25920, 2005 WL 2923981, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pikulas-v-daimlerchrysler-mied-2005.