Robinson v. Phoenix Home Life Mutual Insurance

7 F. Supp. 2d 623, 1998 U.S. Dist. LEXIS 7794, 1998 WL 271657
CourtDistrict Court, D. Maryland
DecidedMay 26, 1998
DocketCIV. H-97-1086
StatusPublished
Cited by6 cases

This text of 7 F. Supp. 2d 623 (Robinson v. Phoenix Home Life Mutual Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Robinson v. Phoenix Home Life Mutual Insurance, 7 F. Supp. 2d 623, 1998 U.S. Dist. LEXIS 7794, 1998 WL 271657 (D. Md. 1998).

Opinion

ALEXANDER HARVEY, II, Senior District Judge.

In this civil action, plaintiff Richard Robinson (“Robinson”) is seeking to recover benefits under his employer’s long term disability plan which was insured by defendant Phoenix Home Life Mutual Insurance Company (“Phoenix”). Suit has been brought under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et. seq. In a claim filed with defendant Phoenix, plaintiff asserted that he had become totally disabled during the period of his employment with General Heating Engineering Co., Inc. (“General Heating”), and he applied for benefits under General Heating’s plan which was insured by defendant Phoenix. When his claim was denied, plaintiff sued defendant Phoenix in this Court, seeking a declaratory judgment and benefits pursuant to 29 U.S.C. § 1132(a)(1)(B). 1

The parties have engaged in extensive discovery and have now filed dispositive motions. Presently pending before the Court are a motion for summary judgment filed by plaintiff Robinson and a motion for summary judgment filed by defendant Phoenix. Lengthy memoranda and voluminous exhibits have been submitted by the parties in support of and in opposition to the pending motions for summary judgment. A hearing has been held in open Court. For the reasons stated herein, plaintiff’s motion for summary judgment will be denied, and defendant’s motion for summary judgment will be granted.

*626 I

Background Facts

Plaintiff Robinson began his employment with General Heating on February 25, 1985. While so employed, he served as Vice President of Safety and Security. In that capacity, Robinson had numerous safety, security and loss control responsibilities, including creating and setting up safety training programs, developing and managing programs to prevent the loss of property, conducting safety inspections of construction sites, purchasing vehicles and managing vehicle repair work.

While employed by General Heating, plaintiff suffered from various injuries and ailments. He had previously served as a Marine Corps pilot and had sustained several injuries while in the service. From time to time during his employment with General Heating, he was treated for back, knee and other musculoskeletal problems. During 1994, Robinson’s performance began to deteriorate, and there were a number of different instances in which his employer began questioning his performance and expressed concern about his health. Conditions of his employment were questioned in a memorandum from plaintiffs supervisor dated October 14,1994 which stated in part:

We are very concerned with your personal health and it’s affect [sic ] on your beha-voir [sic] during employment at General Heating. Your past behavoir [sic] has diminished your ability to manage other people. Your occasional loss of personal control at work has created a question as to your ability to emotionally handle the job.

On October 28, 1994, plaintiffs employment was terminated. 2 According to General Heating, his employer, plaintiff “was terminated from his position due to a poor job performance brought on by his irrational behavior.” 3

Following termination of his employment, plaintiff submitted to the Maryland Office of Unemployment Insurance (“the Maryland Unemployment Office”) on December 14, 1994 an application for unemployment benefits. In that application, Robinson indicated that he was able to accept full time work as of the date of the application and could “work all hours, days and shifts required in the type of work” which he was seeking. He indicated a preference first for administration work and second for safety and security work. In his application, he stated that he had been discharged by General Heating because he had been out sick two times in one month with bronchitis-pneumonia and that he had been told by his supervisor that that was too much sick leave. In a form submitted to the Maryland Unemployment Office dated December 20, 1994, Dr. Arnold Kirshenbaum had certified that Robinson was able to work full time and had been released to return to work as of November 15,1994. Plaintiff had been ill in November of 1994 and had visited Dr. Kirshenbaum on November 9, 1994. Ultimately, plaintiff was awarded $5,798 as unemployment compensation benefits by the Maryland Unemployment Office.

On or about June 7, 1996, Robinson filed with defendant Phoenix an application seeking long term disability benefits. 4 In his claim, plaintiff characterized his medical condition as “chronic generalized pain” beginning in the late 1980s and becoming “severe and chronic” in 1991. In arguments presented to the Court, plaintiff now contends that he suffered from fibromyalgia and myofascial pain syndrome.

Following receipt of plaintiffs claim, defendant instituted procedures for investigating its validity. Joseph L. Cristobal (“Cristo-bal”), an employee of Phoenix with the job *627 title of Technical Services Consultant, opened a file and obtained numerous medical records from physicians and health care providers listed by plaintiff in his claim. The records secured by Cristobal included reports from various doctors and hospitals and also records of the Maryland Unemployment Office relating to Robinson’s application for unemployment insurance benefits. Under General Heating’s plan, disability insurance coverage ceased on the date when a beneficiary was no longer an active employee. The Phoenix policy defined an employee as “totally disabled” if he is “unable to perform all the material and substantial duties of ... [his]... regular occupation.”

During the course of his investigation, Cristobal met personally with a representative of General Heating and inquired as to the reasons for the termination of Robinson’s employment. Cristobal also met with Dr. Robert Gerwin who had submitted two different reports in support of plaintiffs claim, one dated February 24, 1995 and a second dated February 20, 1996. Thereafter, Cris-tobal forwarded all the medical records which he had obtained to Dr. David Silver-man, the in-house Medical Director of Phoenix. Dr. Silverman reviewed plaintiffs medical records and submitted a memorandum to Cristobal dated September 16,1996. In that memorandum, Dr. Silverman concluded on the basis of Robinson’s medical history that there was little objective medical evidence to support plaintiffs claim that he was totally disabled during the time that he was employed by General Heating.

Following his review of all the information and documents which he had collected, including Dr. Silverman’s report, Cristobal determined that plaintiff Robinson was not disabled within the meaning of the plan and was not entitled to long term disability benefits. He so advised Robinson by letter dated September 20, 1996. Represented by counsel, Robinson filed an appeal of this decision with Phoenix. Cristobal thereafter denied this appeal in correspondence sent to plaintiffs attorney.

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7 F. Supp. 2d 623, 1998 U.S. Dist. LEXIS 7794, 1998 WL 271657, Counsel Stack Legal Research, https://law.counselstack.com/opinion/robinson-v-phoenix-home-life-mutual-insurance-mdd-1998.