Rao v. Life Insurance Co. of North America

100 F. Supp. 3d 210, 2015 U.S. Dist. LEXIS 55518, 2015 WL 1849866
CourtDistrict Court, N.D. New York
DecidedApril 23, 2015
DocketNo. 5:12-CV-1459
StatusPublished
Cited by2 cases

This text of 100 F. Supp. 3d 210 (Rao v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rao v. Life Insurance Co. of North America, 100 F. Supp. 3d 210, 2015 U.S. Dist. LEXIS 55518, 2015 WL 1849866 (N.D.N.Y. 2015).

Opinion

[212]*212MEMORANDUM — DECISION and ORDER

DAVID N. HURD, District Judge.

I. INTRODUCTION

Plaintiff Joann Rao (“Rao” or “plaintiff’) filed this action pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., alleging, inter alia, that she was wrongfully, denied short- and long-term disability benefits by defendant E.C. Barton & Co. Disability Plan (the “Disability Plan”), a benefits plan offered by her former employer, defendant E.C. Barton & Co., Inc. (“E.C. Barton”), and underwritten by defendant Life Insurance Company of North America (“LINA”). After the parties stipulated that LINA would be the sole party liable to plaintiff for any successful benefits claims, E.C. Barton and the Disability Plan were dismissed from the action. Thereafter, plaintiff and LINA, the sole remaining defendant, cross-moved for summary judgment pursuant to Federal Rule of Civil Procedure (“Rule”) 56. The motions have been fully briefed and were considered without oral argument.

II. BACKGROUND

The following chronology of Rao’s medical treatment as well as her applications for, and appeals from denials of, benefits under the disability policies at issue is derived from an independent review of the administrative record and the parties’ various submissions. However, given the voluminous nature of this material, the parties’ respective statements of material facts have been utilized to assist in identifying the relevant documents to be addressed.1

Rao worked as the Head Cashier at one of E.C. Barton’s Bargain Outlet stores until February 16, 2011,. when she left work to care for her husband under the Family Medical Leave Act (“FMLA”). See Pl.’s Statement of Material Facts, ECF No. 29-8, ¶ 16 (“Pl.’s Rule 7.1 Stat.”). The parties agree that, as of the date this FMLA leave began, plaintiff was a covered participant of both short- and long-term disability insurance policies offered by E.C. Barton and underwritten by LINA. Id. ¶¶ 1, 16; Def.’s Statement of Material Facts, ECF No. 31-2, ¶ 1 (“Def.’s Rule 7.1 Stat.”).

On April 28, 2011, Rao, still on FMLA leave to care for her husband, visited John Cambareri, M.D., of Syracuse Orthopedic Specialists, complaining of pain in her cervical spine that had been present for “quite awhile” but had been “growing worse in the last few months.” AR at 696-99.2 In particular, plaintiff told Dr. Cambareri that she had been suffering from this pain for approximately two to three years but that, in general, “the progression of the problem seem[ed] to be getting worse.” Id. at 696. Plaintiff explained to Dr. Cambareri that the pain was located along her “whole right side,” radiating from her neck into her right shoulder, arm, and elbow. Id. at 696-97.

Dr. Cambareri’s exam of Rao’s neck revealed tenderness to palpation of the right para-vertebral muscles; tenderness over the musculature adjacent to the right scapula; a spasm in the mild right para-vertebral muscles;. abnormal bilateral sensation; a moderate “global loss” to the range of motion of plaintiffs neck; and pain at the “extremes of motion.” Id. at 698.

[213]*213Dr. Cambareri’s exam of Rao’s right shoulder likewise revealed that she was “positive” for both the Hawkins and Neer Impingement Signs and that she suffered tenderness to palpation that was present at the anterior joint line. AR at 698. Dr. Cambareri also noted a “global loss” to plaintiffs range of motion in her right shoulder that included pain at the extremes of movement. Id. However, Dr. Cambareri also recorded plaintiffs gait as normal and noted that there were no signs of instability or deformity in her cervical spine. Id.

Ultimately, Dr. Cambareri concluded Rao had neck pain which he believed was primarily due to “cervical radiculopathy” and secondarily due to “right rotator cuff tendinitis or impingement.” AR at 699. Noting that plaintiff has “had [this problem] for almost six years now” and “has been to [physical therapy] in the past,” Dr. Cambareri recommended an MRI imaging study of her cervical spine. Id. However, he did not comment on plaintiffs fitness to return to work because he noted she was already out on FMLA leave at the time of her visit. Id.

On May 3, 2011, Rao underwent the recommended MRI imaging study of her cervical spine. AR at 743. The results of this study revealed a central disc herniation at C3-C4 causing “mild flattening of the ventral margin of the cervical cord”; a central disc herniation at C6-C7 causing an indent to “the ventral margin of the thecal sac”; a para-central disc herniation at C4-C5 causing “right lateral recess stenosis”; “severe right neural foraminal stenosis”; and “right uncovertebral hyper-trophic changes” at C4-C5. Id.

The very next day, May 4, 2011, Dr. Cambareri discussed the results of this MRI imaging study with Rao via telephone. AR at 663. Dr. Cambareri explained to plaintiff that she suffered from three herniated discs in her neck and that her treatment options ranged from “nothing to physical therapy to nerve blocks to surgery.” Id. Since plaintiff “just couldn’t make up her mind what to do,” Dr. Cam-bareri instructed her to call his office “if she decides to either pursue physical therapy and nerve block or pursue a surgical opinion” with one of his associates at the medical practice. Id.

On May 12, 2011, Rao first submitted paperwork to her employer claiming a spinal disability under E.C. Barton’s short-term disability policy. Pl.’s Rule 7.1 Stat. ¶ 17. While she awaited a response from the policy claims department, Dr. Cambar-eri issued plaintiff a doctor’s note dated May 13, 2011 indicating she would be “out of work until the next visit or until further notice, until 5/18/11.” AR at 662.

On May 18, 2011, Thomas Haher, M.D., also of Syracuse Orthopedic Specialists, examined Rao. AR at 659-61. At this visit, plaintiff complained of pain at a different location — in her lower back and the right side of her hip. Id. at 659. Dr. Haher’s exam revealed mostly normal results. Id. at 660-61. Notably, Dr. Haher concluded plaintiff had a full range of motion with no pain, tenderness, or deformity of her cervical spine. Id. at 660. However, Dr. Haher also reviewed plaintiff’s MRI images, noting that they showed “evidence of disk disease, most prominently at C4-5 on the right.” Id. Ultimately, Dr. Haher • assessed plaintiff as suffering from a herniated cervical disk without myelopathy. Id. Dr. Haher issued a note indicating plaintiff was under a “TOTAL DISABILITY — Until next visit or further notice.” Id. at 658, 661.

On May 23, 2011, Rao checked in with Dennis Daly, M.D., her primary care provider. AR at 596-99. A physical exam completed that day also revealed mostly normal results, but included assessments for unspecified backache and an inter-ver[214]*214tebral cervical disc displacement without myelopathy. Id. at 597-98. Dr. Daly’s report also noted that plaintiffs depressive disorder, which she had suffered from in the past, had recurred. Id. Finally, Dr.

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Bluebook (online)
100 F. Supp. 3d 210, 2015 U.S. Dist. LEXIS 55518, 2015 WL 1849866, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rao-v-life-insurance-co-of-north-america-nynd-2015.