Robinson v. Liberty Life Assurance Co.

25 F. Supp. 3d 541, 2014 WL 2611563, 2014 U.S. Dist. LEXIS 79366
CourtDistrict Court, M.D. Pennsylvania
DecidedJune 11, 2014
DocketNo. 1:13-cv-0602
StatusPublished
Cited by2 cases

This text of 25 F. Supp. 3d 541 (Robinson v. Liberty Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Robinson v. Liberty Life Assurance Co., 25 F. Supp. 3d 541, 2014 WL 2611563, 2014 U.S. Dist. LEXIS 79366 (M.D. Pa. 2014).

Opinion

MEMORANDUM

JOHN E. JONES III, District Judge.

Before the Court are the parties’ cross-motions for summary judgment in this matter respecting the Employment and Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001-1461. For the reasons that follow, the Court will deny Plaintiffs motion and grant Defendant’s motion.

I. BACKGROUND

We begin by enumerating the undisputed facts, which are supported by record evidence, noting as we do that the parties fundamentally disagree on some significant factual points.

Plaintiff worked for Comcast from 2004 to 2010 and was a resident of California. (Doc. 1, ¶ 11). As a full-time employee, she became insured under a group Long-Term Disability Policy (the “LTD Policy” or the “Policy”), effective June 1, 2005. (Doc. 1, ¶ 12). Defendant provides long-term disability insurance to employees of Comcast pursuant to the Policy. (Doc. 29, ¶1).

A. The Policy

Relevantly, the LTD Policy categorizes employees as either Class 3 or Class 4, which among other things, affects eligibili-. ty for benefits. (See Doc. 1-1; Doc. 30-1). The Policy provides a general definition of “disability,” which pertinently states as follows:

1. For persons other than pilots, co-pilots, and crewmembers of an aircraft:
b. i. if the Covered Person is eligible for the 12 Month own Occupation benefit, “Disability” or “Disabled” means that during the Elimination Period and the next 12 months of Disability the Covered Person, as a result of [545]*545Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and ii. thereafter, the Covered' Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.

(Doc. 1-1, p. 9; Doc. 30-1, p. 10). For purposes of the 12-month “own occupation benefit,” “own occupation” refers to the occupation a covered person was performing when his disability began. (Doc. 1-1, p. 12; Doc. 30-1, p. 13). “If the Covered Person is unable to earn 80% of his pre-disability earnings, he will be considered unable to perform his Own Occupation. For purposes of determining Disability under this policy, Liberty will consider the Covered Person’s occupation as it is normally performed in the national economy.” (Doc. 1-1, p. 12; Doc. 30-1, p. 13).

Following the 12-month period, a covered person must be unable to perform “any occupation” to be considered disabled, and the Policy provides different definitions of “any occupation” depending on the class of employee. With respect to Class 3 employees, “any occupation” “means any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity. If the covered person is unable to earn more than 60% of his pre-disability earnings, he will be considered unable to perform Any Occupation.” (Doc. 1-1, p. 7; Doc. 30-1, p. 8). As to Class 4 employees, “any occupation” is defined as “any gainful occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity. Gainful occupation means any occupation in which the earnings are: equal to or greater than 80% of the Employee’s pre-disability income; less than 80% of the Employee’s average pre-disability income, but higher than the average earnings for the geographic area in which the Employee resides; or equal to or greater than the gross benefit.” (Doc. 1-1, p. 7; Doc. 30-1, p. 8).

Additionally, the Policy states that “Liberty shall possess the authority, in its sole discretion, to construe the terms of this policy and to determine benefits eligibility hereunder. Liberty’s decision regarding construction of the terms of this policy and benefits eligibility shall be conclusive and binding.” (Doc. 26-2, p. 46; Doc. 30-1, p. 46).1

B. Plaintiffs disability claims

On October 13, 2010, in anticipation of knee-replacement surgery, Plaintiff notified Defendant that she would be claiming short-term disability benefits. (Doc. 29, ¶ 3). The parties agree that Plaintiff had a disability onset date of October 17, 2010. (Doc. 26, ¶ 1). Plaintiff underwent surgery on her right knee on November 8, 2010, and attended physical therapy from November 15, 2010, until January 14, 2011. (Doc. 1, ¶ 15). Ultimately, Defendant approved Plaintiffs claim for short-term disability benefits, and she received benefits under the plan through April 15, 2011, the maximum duration for short-term benefits. (Doc. 29, ¶ 5).

Shortly before the expiration of her short-term benefits, Defendant began eval[546]*546uating whether Plaintiff was eligible for benefits under the LTD Policy, which involved an evaluation of whether Plaintiff could return to her “own occupation” within the meaning of the Policy (Doc. 29, ¶ 6). The most recent relevant medical information in Plaintiffs file was a letter dated January 27, 2011, from Plaintiffs orthopedic surgeon, Dr. William Richard Cimino, M.D. (Doc. 29, ¶ 8). The note declared Plaintiff “permanently disabled from cable sales and installation related to the right knee surgery,” which “precluded [her] from climbing, squatting, and kneeling.” (Doc. 29, ¶ 8). Defendant utilized these restrictions in determining whether Plaintiff could perform her “own occupation” and referred Plaintiffs case to its Vocational Rehabilitation Department for an occupational analysis. (Doc. 29, ¶ ¶ 9-10).2 Vocational Case Manager Alice Bartha prepared a report (Doc. 30-7, pp. 9-13), opining that Plaintiffs occupation was best represented by the general sales representative occupation described by various Department of Labor publications, and concluding that such occupation was typically performed in the national economy at both the sedentary and light physical demand levels, with sufficient opportunities existing in both subsets. (Doc. 29, ¶ 11). Although Defendant determined that Plaintiff was physically able to return to her own occupation, as performed in the national economy, Defendant nonetheless approved her long-term disability claim because it found that the earnings of the relevant occupation fell short of 80% of Plaintiffs pre-disability earnings, as required by the definition of “own occupation” in the LTD Policy. (Doc. 29, ¶ 12). Accordingly, Plaintiff began receiving long-term disability benefits under the Policy effective April 16, 2011. (Doc. 29, ¶ 14). Pursuant to the applicable definition of “disability,” Plaintiff was entitled to receive 12 months of this “own occupation benefit”; after the 12 month period, Plaintiff would be eligible for long-term benefits only if she was “unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.” (Doc. 1-1, p. 9; Doc. 30-1, p. 10).3

On November 2, 2011, in anticipation of the 'application of the “any occupation” provision (due to occur on April 16, 2012), Defendant requested updated medical records from Plaintiffs treating physicians. (Doc. 29, ¶ 15). Thereafter, Plaintiff notified Defendant that the January 27, 2011, letter from Dr. Cimino constituted the most recent medical record. (Doc. 29, ¶ 16). Defendant then requested the preparation of a Transferable Skills Analysis and Labor Market Information Report to aid in its benefits determination. (Doc.

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25 F. Supp. 3d 541, 2014 WL 2611563, 2014 U.S. Dist. LEXIS 79366, Counsel Stack Legal Research, https://law.counselstack.com/opinion/robinson-v-liberty-life-assurance-co-pamd-2014.