Terry Smith v. Ameritech Ameritech Publishing, Inc. Sickness and Accident Disability Benefit Plan Long Term Disability Plan

129 F.3d 857, 21 Employee Benefits Cas. (BNA) 2126, 7 Am. Disabilities Cas. (BNA) 917, 156 L.R.R.M. (BNA) 2947, 1997 U.S. App. LEXIS 32784, 1997 WL 721788
CourtCourt of Appeals for the Sixth Circuit
DecidedNovember 20, 1997
Docket96-4263
StatusPublished
Cited by406 cases

This text of 129 F.3d 857 (Terry Smith v. Ameritech Ameritech Publishing, Inc. Sickness and Accident Disability Benefit Plan Long Term Disability Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Terry Smith v. Ameritech Ameritech Publishing, Inc. Sickness and Accident Disability Benefit Plan Long Term Disability Plan, 129 F.3d 857, 21 Employee Benefits Cas. (BNA) 2126, 7 Am. Disabilities Cas. (BNA) 917, 156 L.R.R.M. (BNA) 2947, 1997 U.S. App. LEXIS 32784, 1997 WL 721788 (6th Cir. 1997).

Opinion

OPINION

KENNEDY, Circuit Judge.

Plaintiff, Terry Smith, appeals from the District Court’s order granting summary judgment in favor of defendants, Ameritech, Ameritech Publishing, Inc. (now known as Ameritech Advertising Services), their .Sickness and' Accident Disability Benefit Plan (“SADB Plan”), and their Long Term Disability Plan (“LTD Plan”) (hereinafter collectively referred to as defendants). Plaintiff alleged that defendants denied him disability benefits in violation of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001-1461; interfered with his right to future disability benefits in violation of ERISA § 510, 29 U.S.C. § 1140; denied him reasonable accommodations for his disability in violation of both the Americans with Disabilities Act- (“ADA”), 42 U.S.C. §§ 12111-12213, and Ohio Rev.Code Ann. *860 § 441202(A); and discharged him without just cause in violation of a collective»bargam-ing agreement. The District Court granted summary judgment in favor of defendants on all of his claims. For the following reasons, we affirm.

I. Facts

In 1991, plaintiff began working for Am-eritech Advertising Services as a “premises sales representative.” In that capacity, plaintiff traveléd through northwestern Ohio and southeastern Michigan selling advertising space in Ameritech’s yellow pages directories. On April 16, 1992, while traveling from a personal errand to meet with a business client, plaintiff was injured in an automobile collision. Plaintiff suffered a herniated disc at the T7-T8 level of his spine, causing chronic back pain. Despite the pain, plaintiff continued working for eighteen months, until he took a disability leave of absence on October 19, 1993.

At that time, Ameritech and Ameritech Advertising Services offered two plans which provided benefits to employees who were prevented from working by illness or injury arising outside the scope of employment. The Sickness and Accident Disability Benefit Plan (“SADB Plan”) provided qualified employees with short-term disability benefits for up to fifty-twó weeks. After receiving SADB Plan benefits for fifty-two weeks, an employee who still is disabled from working becomes eligible for benefits under the Long Term Disability Plan (“LTD Plan”). It is undisputed that both plans qualified as “employee welfare benefit plans” under ERISA, 29 U.S.C. § 1002(1). The original SADB Plan designated the “Company” as the plan administrator. A subsequent modification to the SADB Plan vested the Ameritech Employees’ Benefit Committee with

full discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. The Committee decides conclusively for all parties all questions arising in the administration of the Plan and any decision of this committee is not subject to further review.

In practice, Ameritech’s Occupational Medicine Department made the initial decisions regarding claims for benefits under the SADB Plan, and the Employees’ Benefit Committee convened to review the appeals of applicants who had been denied benefits.

Upon plaintiffs application, Ameritech initially approved SADB Plan benefits from a start date of October 26, 1993. The SADB Plan required plaintiff to submit medical disability forms from his physician to support his claim for benefits. Between October, 1993 and July, 1994, plaintiff submitted several letters and reports from physicians to Ameriteeh’s Occupational Medicine Department. These reports were authored by three doctors: Dr. Zambrano, plaintiffs physician; Dr. Sullivan, an orthopaedist specializing in spinal surgery; and Dr. Spetka, another specialist who provided a second opinion on plaintiffs condition. In a letter dated October 6, 1993, Dr. Sullivan reported his initial diagnosis that plaintiff had “a disc herniation at this [T7-T8] level, although it is not striking.” He recommended that plaintiff “modify his activity, take medication, and ‘live with this problem,’ ” because surgical intervention “would be a somewhat formidable procedure” that is indicated “only for intractable pain.” Sometime in November of 1993, Dr. Zambrano submitted a report to Ameritech that diagnosed plaintiff with a herniated disc and osteoarthritis and stated that the date he could be expected to return to work was “undetermined at this time.”

The next report from Dr. Zambrano, dated December 3, 1993, reported that plaintiff could not work at that time because he “has pain on any exertion; lifting, bending, standing for a long l[ength] of time.” It also reported that plaintiff could be expected to return to work on February 1, 1994. Dr. Sullivan’s next letter, dated January 3, 1994, reiterated that a non-operative plan of “essentially ‘living with’ his disability and getting on with his life” was preferred over surgical intervention. Dr. Sullivan’s report to Ameritech dated January 19, 1994 reported the same diagnosis and plan but postponed the return to work date to June 1, 1994. In February, Dr. Sullivan issued two more reports recommending the same nonsurgical treatment plan and estimating the *861 same retum-to-work date of June 1, 1994. Dr. Sullivan submitted another report on March 3, 1994, that was based on plaintiffs February appointment and reached the same conclusions. Eight days later, Dr. Sullivan issued another report based on the same February physical examination. This report stated that plaintiff was “totally disabled” and could not be expected back to work until August 1, 1994.

Ameritech’s Manager of Sickness - Disability Administration, Dr. Anfield, wrote a letter dated March 23, 1994 to Dr. Sullivan concerning the medical basis for plaintiffs disability benefits. Dr. Anfield 'wrote that, while plaintiffs “conservative treatment plan of physical therapy” had not led to any improvement in his apparent condition, his reluctance to pursue surgical treatment suggested “that the employee does, not find his discomfort so severe as to be intolerable or totally disabling.” Dr. Anfield commented that this seemed to conflict with Dr. Sullivan’s determination that plaintiff was “totally disabled.” He concluded that he could not “continue to certify the employee’s receipt of wage indemnity under the company’s sickness disability benefits plan without particularized and detailed data describing the employee’s symptoms, his impairment and how he is, in fact, totally disabled.” Dr. Anfield’s letter warned Dr. Sullivan that, without a response, plaintiffs short-term disability benefits would lapse in ten working days.

In response, Dr. Sullivan issued a brief letter to Dr. Anfield, dated March 24, 1994, stating that he had already "provided his diagnoses of plaintiffs medical condition and that plaintiff “continues with the same restrictions.” In a letter dated April 28, 1994, Dr. Spetka provided a second opinion concurring in Dr. Sullivan’s diagnosis and non-surgical treatment plan.

Despite Dr.

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129 F.3d 857, 21 Employee Benefits Cas. (BNA) 2126, 7 Am. Disabilities Cas. (BNA) 917, 156 L.R.R.M. (BNA) 2947, 1997 U.S. App. LEXIS 32784, 1997 WL 721788, Counsel Stack Legal Research, https://law.counselstack.com/opinion/terry-smith-v-ameritech-ameritech-publishing-inc-sickness-and-accident-ca6-1997.