Prabhakar v. Life Insurance Co. of North America

996 F. Supp. 2d 124, 56 Employee Benefits Cas. (BNA) 1576, 2013 WL 4458728, 2013 U.S. Dist. LEXIS 116151
CourtDistrict Court, E.D. New York
DecidedAugust 16, 2013
DocketNo. 09-CV-05530 (PKC)
StatusPublished
Cited by3 cases

This text of 996 F. Supp. 2d 124 (Prabhakar v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Prabhakar v. Life Insurance Co. of North America, 996 F. Supp. 2d 124, 56 Employee Benefits Cas. (BNA) 1576, 2013 WL 4458728, 2013 U.S. Dist. LEXIS 116151 (E.D.N.Y. 2013).

Opinion

MEMORANDUM & ORDER

PAMELA K. CHEN, District Judge:

On December 16, 2009, Plaintiff Ratna Prabhakar, acting pro se, filed her complaint alleging that Defendant Life Insurance Company of America (“LINA”) had violated the terms of the Group Long Term Disability Income Policy (the “Policy”) issued to State Farm Mutual Automobile Insurance Company (“State Farm”). (Dkt. No. 45 (“Joint Pre-Trial Order”), at 4.) The alleged violation occurred when LINA terminated Plaintiffs coverage under the Policy as a State Farm employee, and denied the payment of long term disability benefits to Plaintiff in December 2003. (Dkt. No. 1 (“Compl.”) ¶¶ 6, 9, 15.)

On June 6, 2013, at a pre-trial conference in this action, this Court ruled that, although the administrative record constituting Plaintiffs claim history under the Policy would comprise the core evidence at trial, the parties would also be permitted to introduce extra-record evidence relating to, inter alia, (i) whether Plaintiffs copy of the Policy contained the provision notifying her of the three-year limitations period for filing this action, and (ii) the offset applied against Plaintiffs long term disability benefits based on a lump sum workers’ compensation award. (Dkt. No. 47.)

On July 22, 2013, this Court conducted a one-day bench trial in this action. See Sullivan v. LTV Aerospace & Defense Co., 82 F.3d 1251, 1258-59 (2d Cir.1996) (“[T]here is no right to a jury trial in a suit brought to recover ERISA benefits.”). Plaintiff presented her own testimony and that of her son, Sunil Prabhakar, and introduced three documents into evidence (Plaintiffs Exhibits (“PI. Exs.”) A-C). LINA presented the testimony of Richard Lodi, one of its Senior Operations Representatives, and, through Mr. Lodi, introduced the administrative record into evi[127]*127dence (Defendant’s Exhibit (“Def. Ex.”) D.1

On July 29, 2013, this Court directed LINA to submit a sworn declaration, providing additional evidence relating to the three-year limitations period applicable to this action. (Dkt. No. 53.) LINA submitted a declaration from Mr. Lodi. (Dkt. No. 54 (“Lodi Deck”).)

Based on the administrative record and other evidence received during and after trial, this Court finds that, even though this evidence demonstrates that LINA improperly denied Plaintiffs long term disability benefits in December 2003, she cannot recover such benefits, because this action is untimely. The limitations period applicable to this action is three years. The Policy contained a provision notifying State Farm employees of the three-year limitations period, and the evidence establishes that Plaintiff received at least one copy of the Policy containing this provision. Accordingly, this Court must dismiss this action with prejudice as being time-barred.

This Court’s decision is based on the findings of fact and conclusions of law set forth below.

* * *

I. Findings of Fact

From June 20, 1988 to September 17, 1990, Plaintiff was employed by State Farm as a secretary and senior mail records clerk. (LINA 612, 731, 861; Tr. 49.)2 On December 12, 1989, while at work, Plaintiff tripped and fell, resulting in injuries to her head and leg. (LINA 654, 862; see Joint Pre-Trial Order, at 4.)

A. LINA’s Payment of Long Term Disability Benefits to Plaintiff

1. Plaintiffs Total Disability

As a State Farm employee, Plaintiff was covered by the Policy with LINA.3 (PI. Ex. A; LINA 6^47.) Within a week of the accident, Plaintiff began seeing a neurologist, Dr. Ira Casson, who diagnosed Plaintiff as suffering from post-concussion syndrome. (LINA 646, 654, 731-32, 859.) Dr. Casson also concluded that Plaintiff was totally disabled. (LINA 646, 834, 859-60.)

In the summer of 1990, despite her continuing total disability, Plaintiff returned to work at State Farm. (LINA 731, 802, 835-36.) On September 17, 1990, however, Plaintiff stopped working. (LINA 731, 858, 861.) She started receiving long term disability benefits as of March 17, 1991. (LINA 797-99.)

In September 1991, following a referral from Dr. Casson, Dr. Eugene Zanger, a psychologist, concluded, inter alia, that Plaintiff was suffering from an “organic mental syndrome”4 and displaying symp[128]*128toms of severe depression and anxiety. (LINA 652, 656.) Dr. Zanger also found that Plaintiff was “unable to function in almost any realm except the most routine behaviors.” (LINA 653.)

On July 25, 1993, Dr. Casson provided a “Comprehensive Medical Report” summarizing in detail his treatment of Plaintiff since December 1989. The report concluded with Dr. Casson’s findings that:

This patient is suffering from a severe post-concussion syndrome with headaches, vestibular dysfunction and severe cognitive and memory impairment. As a result of the severe post-concussion syndrome, she is also suffering from a[sic] severe anxiety and depression but this is clearly post-traumatic in origin. The fact that she may have had some mild depression prior to this injury in the past does not change the fact that the present illness clearly is causally related to the injuries sustained at work in December of 1989. This is not a preexisting condition. The patient’s severe headaches, vestibular dysfunction and cognitive and memory impairment all make it impossible for her to perform any type of work in any capacity whatsoever. At this point, more than four years following the injury, these conditions are permanent. There is no reason to ever expect any improvement in her situation. The patient is 100% impaired and will remain so permanently. There is no therapy, medication or any other type of treatment which will enable her to ever return to any type of work whatsoever,5

(LINA 657 (emphasis added); see also LINA 714 (handwritten note, dated May 4, 1993, indicating that Plaintiff was “totally and permanently disabled” and “unable to work at any occupation”).) LINA requested but did not require Dr. Casson to submit treatment notes in support of this report.6 (LINA 684, 722, 747-48.)

On April 8, 1994, a psychiatrist who had started seeing Plaintiff about a year prior, Dr. Kishore Saraf, prepared a letter, which was provided to LINA and indicated, inter alia, that, based on his examination and treatment of Plaintiff, he had diagnosed her with organic mental disorder “secondary to concussion” and organic mood disorder.7 (LINA 619, 622.) Like Dr. Casson, Dr. Saraf concluded that Plaintiff was permanently disabled:

In view of the persistence of affective cognitive and neuropsychiatric deficits that the patient is still showing despite being medication free for six weeks, and my repeated observation upon examina[129]*129tion, it leaves me to conclude that patient has suffered permanent Organic Mental Disorder secondary to the concussion and fully [sic] recovery to her preconcussion level seems impossible. In short, the patient is permanently disabled as a consequence of the head injury she suffered on December 12, 1989.

(LINA 622 (emphasis added).)

Dr.

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996 F. Supp. 2d 124, 56 Employee Benefits Cas. (BNA) 1576, 2013 WL 4458728, 2013 U.S. Dist. LEXIS 116151, Counsel Stack Legal Research, https://law.counselstack.com/opinion/prabhakar-v-life-insurance-co-of-north-america-nyed-2013.