Pretty v. Prudential Insurance Co. of America

696 F. Supp. 2d 170, 2010 U.S. Dist. LEXIS 19979, 2010 WL 814986
CourtDistrict Court, D. Connecticut
DecidedMarch 5, 2010
Docket3:08-cr-00060
StatusPublished
Cited by7 cases

This text of 696 F. Supp. 2d 170 (Pretty v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pretty v. Prudential Insurance Co. of America, 696 F. Supp. 2d 170, 2010 U.S. Dist. LEXIS 19979, 2010 WL 814986 (D. Conn. 2010).

Opinion

MEMORANDUM OF DECISION GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Doc. # 56] AND DENYING PLAINTIFF’S MOTION TO COMPEL [Doc. # 64]

VANESSA L. BRYANT, District Judge.

The Plaintiff, Veronica Pretty, brought this action against the Defendants, the Prudential Insurance Company of America and Wallach Surgical Devices, Inc., seeking reinstatement of her long-term disability benefits under an employee benefit plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (hereinafter referred to as “E.R.I.S.A.”). The Plaintiff had also asserted Connecticut state law claims for breach of contract and fraudulent misrepresentation, but these claims were dismissed by the Court’s Order dated January 27, 2009. See Doc. # 52. The Plaintiffs two remaining claims sound in E.R.I.S.A. Presently pending before the Court is the Plaintiffs motion to compel deposition testimony and the Defendants’ motion for summary judgment. See Doc. ## 56, 64. For the reasons that follow, the Plaintiffs motion to compel is DENIED. The Defendants’ motion for summary judgment is GRANTED.

I. FACTUAL AND PROCEDURAL BACKGROUND

The following facts relevant to the Defendants’ motion for summary judgment are undisputed unless otherwise noted.

The Plaintiff was formerly employed at Defendant Wallach Surgical Devices, Inc. (hereinafter “Wallach”). She began her employment at Wallach on April 23, 1990 and, at all times relevant to this action, worked as an accounts payable clerk. Wallach provided long-term disability coverage to its employees, including the Plaintiff, pursuant to an employee benefit plan (hereinafter the “Plan”), which is governed by E.R.I.S.A. The Plan was underwritten by Defendant Prudential Insurance Company of America (hereinafter “Prudential”) pursuant to Group Insurance Contract No. PVIB-04 (hereinafter the “Group Contract”). Prudential is designated as the *173 Claims Administrator of the Plan and, pursuant to the Group Contract, is thereby vested with fiduciary authority to determine whether a participant enrolled under the Plan is eligible for benefits. See Adm. Record at D00604 (“The Prudential Insurance Company of America as Claims Administrator has the sole discretion to interpret the terms of the Group Contract, to make factual findings, and to determine eligibility for benefits.”). The Plaintiff asserts, however, that the grant of fiduciary authority to Prudential was invalid because Prudential determines both eligibility to participate in the Plan and eligibility to receive benefits, and because the Plaintiff did not participate in the negotiation of the terms of the Plan nor in the selection of a fiduciary to administer the Plan. Pursuant to the Plan, Prudential is to pay a monthly payment for a period of disability. Disability exists when Prudential determines that each of the following conditions are satisfied: (a) the claimant is “unable to perform the material and substantial duties of [her] regular occupation due to [her] sickness or injury;” and (b) the claimant has “a 20% or more loss in [her] indexed monthly earnings due to that sickness or injury.” Adm. Record at D00582.

On October 7, 2004, the Plaintiff applied for long-term disability benefits under the Plan. Adm. Record at D00017-D00037. The Plaintiff claimed that she was unable to tolerate sitting and physical work due to a chronic recurrent cervical condition, for which she had surgery in 1999. Under the Plan, benefits may begin after an “elimination period,” which is the first 90 days of continuous disability. Adm. Record at D00575. The Plaintiff remained out of work during the 90-day elimination period. On November 1, 2004, Prudential informed the Plaintiff that her claim for long-term disability benefits had been approved effective October 13, 2004 based upon medical information provided by her treating physician. See Adm. Record at D00038-D00039. The Plaintiff was granted a monthly benefit of $2,179.82. Following the initial eligibility determination, Prudential continued to evaluate the Plaintiffs claim for current eligibility.

By letter dated November 4, 2005, Prudential informed the Plaintiff that, at that time, she no longer qualified for long-term disability benefits under the Plan because the medical records on file did not indicate restrictions or limitations that would prevent her from performing seated work duties. Specifically, Prudential made the following determination:

We have reviewed the updated medical information in your case file including a MRI dated November 12, 2004, and an office visit dated September 12, 2005 from your treating physician, Dr. Wijeskero. Based on the medical information reviewed, which indicated a prior history of a second level cervical fusion, we would expect you to have restrictions of no overhead reaching, no overhead lifting, and no lifting over 201bs and no sustained flexion or extension of the neck. The medical records on file did not indicate restrictions or limitations that would preclude you from seated work duties, and there is no evidence of neural foraminal stenosis or spinal cord impingement.
The material duties of your occupation as an Accounts Payable Clerk involves the following: Performs any combination of the following: calculating, posting, and verifying duties to obtain financial data for use in maintaining records.
In performing the occupation’s material and substantial duties a person would generally be required to exert force to lift, carry, push and pull an object weighing up to lOlbs occasionally. The individual would be primarily seated but *174 may involve standing or walking on an occasional basis. It requires frequent reaching, handling and fingering. It would not require overhead reaching or sustained flexion of the neck as an employee could reasonably alter his or her position throughout the day.
After a thorough evaluation of the above information, we have determined that as of November 4, 2005, you no longer meet the definition of being totally disabled from performing the duties of your own occupation as defined above.

Adm. Record at D00013-D00016.

The Plaintiff appealed Prudential’s decision on December 16, 2005. To assist in its evaluation of the Plaintiffs appeal, in February of 2006, Prudential scheduled two file reviews. The first file review was conducted by R. David Bauer, M.D., a physician specializing in spinal surgery, to address the Plaintiffs alleged physical impairments. The second file review was conducted by Stephen Gerson, M.D., a board certified psychiatrist, to address the Plaintiffs alleged psychiatric impairments. After reviewing the medical records provided, Dr. Bauer prepared a report in which he made the following conclusions:

Without any apparent physiological reason, the claimant has significant self-reported complaints that have been unresponsive to objective treatments. This is not consistent with any known physiological disease. Therefore in my opinion there are no significant functional impairments from November 4, 2005 forward.

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696 F. Supp. 2d 170, 2010 U.S. Dist. LEXIS 19979, 2010 WL 814986, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pretty-v-prudential-insurance-co-of-america-ctd-2010.