Solnin v. Sun Life and Health Ins. Co.

766 F. Supp. 2d 380, 2011 U.S. Dist. LEXIS 8834, 2011 WL 318105
CourtDistrict Court, E.D. New York
DecidedJanuary 31, 2011
Docket08 CV 2759(DRH)(ARL)
StatusPublished
Cited by6 cases

This text of 766 F. Supp. 2d 380 (Solnin v. Sun Life and Health Ins. Co.) 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.

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Solnin v. Sun Life and Health Ins. Co., 766 F. Supp. 2d 380, 2011 U.S. Dist. LEXIS 8834, 2011 WL 318105 (E.D.N.Y. 2011).

Opinion

MEMORANDUM & ORDER

HURLEY, Senior District Judge:

INTRODUCTION

Plaintiff Janet Solnin (“Plaintiff’) brings the present action under the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001, et. seq. (“ERISA”) to recover benefits allegedly due under an employee benefit plan. Defendants Sun Life and Health Insurance Company (“Sun Life”), Genworth Life and Health Insurance Company (“Genworth”), GE Group Life Assurance Company (“GE Group Life”), and Phoenix Life Insurance Company (“Phoenix Life”) (collectively, “Defendants”) have moved for summary judgment pursuant to Federal Rule of Civil Procedure 56. For the reasons set forth below, Defendants’ motion is DENIED.

BACKGROUND

The material facts are drawn from the Complaint, the parties’ Local Civil Rule 56.1 Statements, and the Court’s March 23, 2008 Memorandum and Order issued in a prior, separate action between Plaintiff, GE Group Life, and Phoenix Life (the “Remand Order”), 1 and are undisputed unless otherwise noted.

PlaintifTs Injury and Approval for Long Term Disability Benefits

Plaintiff was employed as an Assistant Manager by Reliance Federal Savings Bank (“Reliance”). On November 18, 1998, Plaintiff suffered a back injury at work when she crawled underneath a table to fix a computer. On February 13, 1999, she filed a Notice of Claim for Disability Benefits under the disability insurance policy (the “Policy”) provided by Reliance; her application was filed on July 26, 1999. By letter dated August 31, 1999, Phoenix Life notified Plaintiff that her claim for long term disability benefits had been approved, and she began receiving such benefits commencing with the period August 4 through August 13,1999.

The Policy

The Policy was administered by Phoenix Life until April 2000, when GE Group Life acquired the group life and health operation of Phoenix Life and thereafter became the new Administrator. Defendants contend that Phoenix Life is now known as Sun Life & Health Insurance Company (U.S.), although Plaintiff states that Sun Life has not provided “discovery responses sufficient” to confirm that statement, nor has it produced “a controlling document that grants discretionary authority to defendant Sun Life and Health Insurance Company.” (Pl.’s Response to Defs.’ 56.1 ¶ 2.) It appears from the records produced in connection with this motion that Gen-worth is now known as Sun Life Financial. 2 (AR 279.) 3

*383 The Policy is an employee welfare benefit plan governed by ERISA. The Policy defines “Total Disability” and “Totally Disabled” as:

1. During the Elimination Period and the following 24 months, you are unable to perform all the material and substantial duties of your regular occupation.
2. After the Elimination Period and the following 24 months, you are unable to perform the duties of Any Occupation. 4

Change in Eligibility for Beneñts

By letter dated March 28, 2002, GE Group Life advised Plaintiff that the definition of “Total Disability” applicable to her claim had changed because the 24-month period following the Elimination Period had expired. Plaintiff was notified by letter that additional medical information was required from her and that additional benefits could not be considered until the requested information was received and reviewed.

That same day, GE Group Life received a Supplemental Statement of Disability from Plaintiff and an Attending Physician’s Supplemental Statement and medical report from Dr. Thomas M. Mauri, M.D., Plaintiffs treating physician. Thereafter, on April 3, 2002, GE Group Life received additional information from Plaintiff concerning her medical condition, including a one-page report from Plaintiffs physical therapist and a transcript from a Workers’ Compensation Board hearing on September 28, 2001. On April 5, 2002, GE Group Life received a one-page report from Plaintiffs physical therapist.

Dr. Hicks’ April 2002 Report

GE Group Life then referred Plaintiffs claim to one of its outside medical doctor-consultants, Thomas Hicks, M.D., for a determination regarding Plaintiffs restrictions and limitations. Dr. Hicks’ notes indicated that he considered a February 24, 1999 report of Raphael P. Davis, M.D., a neurosurgeon who saw Plaintiff in consultation that day, and that he reviewed an April 26, 2000 report of Robert L. Michaels, M.D., who examined Plaintiff on behalf of her workers’ compensation carrier. On April 5, 2002, Dr. Hicks issued a report and noted, in pertinent part:

After reviewing the provided records, it is my opinion that the claimant is not impaired to the point where it would prevent her from working. I believe that she is capable of performing sedentary occupation. Restrictions and limitations that I believe to be appropriate include limited walking, no climbing stairs/ladder, no bending/kneeling/squatting/stooping, no lifting greater than 5 *384 lbs. and sit/stand/walk as tolerated, and no pushing or pulling.

(Remand Order at 8.)

The Video Surveillance

In an undated memorandum to the file, Jacque C. Cassella (“Cassella”) from GE Group Life noted that his efforts to obtain Plaintiffs physical therapy records were apparently being thwarted by Plaintiffs rescission of her earlier signed authorization to release records. 5 He further noted that additional information had been received that cast some doubt on the veracity of Plaintiffs claims. 6 Accordingly, Cassella noted that he was going to arrange for video surveillance to determine Plaintiffs functional capabilities.

On April 10, 2002, GE Group Life was informed by Plaintiffs physical therapist’s office that Plaintiff had instructed it not to release any records to GE Group Life. By letter dated April 12, 2002, Cassella wrote to Plaintiff noting, inter alia, the difficulties he had encountered in attempting to obtain her physical therapy records. He advised her that if she continued to refuse to provide such records, GE Group Life would make a final determination regarding her eligibility based upon the medical information it had.

In late April 2002, GE Group Life received the reports and video tape of the surveillance of Plaintiff that it had arranged.

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766 F. Supp. 2d 380, 2011 U.S. Dist. LEXIS 8834, 2011 WL 318105, Counsel Stack Legal Research, https://law.counselstack.com/opinion/solnin-v-sun-life-and-health-ins-co-nyed-2011.