Thomas v. Liberty Life Assur. Co. of Boston

226 F. Supp. 2d 735, 29 Employee Benefits Cas. (BNA) 2444, 2002 U.S. Dist. LEXIS 19198, 2002 WL 31259920
CourtDistrict Court, D. Maryland
DecidedOctober 7, 2002
DocketCIV. H-02-1254
StatusPublished
Cited by3 cases

This text of 226 F. Supp. 2d 735 (Thomas v. Liberty Life Assur. Co. of Boston) 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
Thomas v. Liberty Life Assur. Co. of Boston, 226 F. Supp. 2d 735, 29 Employee Benefits Cas. (BNA) 2444, 2002 U.S. Dist. LEXIS 19198, 2002 WL 31259920 (D. Md. 2002).

Opinion

MEMORANDUM OPINION

ALEXANDER HARVEY, II, Senior District Judge.

In this civil action, plaintiff, Lou Thomas (“Thomas”), is seeking to recover benefits under his employer’s long term disability plan which was insured by defendant Liberty Life Assurance Company of Boston (“Liberty Life”). This action was originally filed in the Circuit Court for Baltimore County and was removed by defendant to this Court pursuant to 28 U.S.C. § 1441, et seq. Count I of the original complaint asserted a claim of breach of contract, and Count II sought a recovery for defendant’s bad faith refusal to pay policy benefits.

After the case was removed to this Court, defendant Liberty Life filed a motion to dismiss or for summary judgment, contending that the Employment Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., preempted the two state law claims asserted by plaintiff and that the complaint should therefore be dismissed. In its Order of April 25, 2002, this Court granted defendant’s motion to dismiss and also granted plaintiff leave to file an amended complaint alleging a proper ERISA claim. In his amended complaint, plaintiff Thomas asserts that this action arises under ERISA, and he seeks declaratory, injunc-tive and equitable relief under that statute as well as attorneys’ fees and costs. Plaintiff alleges that he became disabled during the period of his employment with Chase Manhattan Bank (“Chase Bank”), that he applied for benefits under the bank’s long term disability plan which was insured by defendant Liberty Life and that his claim was denied.

Presently pending in the case is defendant’s motion to dismiss or for summary judgment. Plaintiff in turn has filed a cross-motion for summary judgment. Memoranda and voluminous exhibits have been submitted by the parties in support of their pending motions. A hearing has been held in open court. For the reasons stated herein, plaintiffs motion for summary judgment will be denied, and defendant’s motion for summary judgment will be granted.

I

Background Facts

Plaintiff Thomas was employed by Chase Bank for several years as a loan officer. As an employee of Chase Bank, Thomas was a participant in its employee benefit plan which was established pursuant to ERISA and which provided, inter alia, long term disability benefits. Chase Bank had purchased from Liberty Life a “group disability income policy,” and it is *737 that policy (“the Policy”) which is at issue here. The Policy defines the term “disability” and contains provisions which identify persons eligible to receive benefits. During the first twenty-four months of an employee’s disability, he is required, in order to qualify for benefits under the Policy, to show that he is merely unable to perform all of the material and substantial duties of his occupation. For an employee to be entitled to benefits after the first twenty-four months, the test becomes stricter, and it is required that the employee be unable to perform, with reasonable continuity, all of the material and substantial duties of his own or any other occupation for which he is or becomes reasonably fitted by training, education, experience, age and physical and mental capacity.

Thomas has a history of serious health problems which date back to 1984 when he had a heart attack. At the time, he was diagnosed with diabetes, and Thomas’ present health problems are mainly attributable to his diabetes. 1 In 1996, he began experiencing pain in his legs, and as a result a vascular bypass was performed on his right leg. However, because of this surgery he developed a staff infection which lingered for months, requiring three separate procedures for the wound to heal. He then began experiencing pain in both of his feet and underwent several unsuccessful nerve blocks in an attempt to alleviate the pain. In August of 1997, he was forced to take a leave of absence from work to undergo another vascular bypass in his right leg. However, his leave of absence became permanent when his condition did not improve. Since he could not return to work, Thomas submitted an application requesting the payment under the Policy of long term disability benefits based on his claimed inability to perform his duties as a loan officer with Chase Bank. On March 26, 1998, Liberty Life approved Thomas’ application for benefits. The payment of benefits was made retroactive to February 11,1998.

In November 1998, Liberty Life began a follow-up investigation of Thomas’ claim as well as an investigation into whether Thomas would be eligible for benefits beyond the initial twenty-four month period. Liberty Life undertook at the time to assist Thomas in obtaining Social Security disability benefits. In February 1999, an Administrative Law Judge determined that Thomas was totally disabled and awarded him disability benefits.

In March 1999, Thomas’ claim under the Policy was referred for internal review to a registered nurse employed by Liberty Life. The nurse examined the medical records in Thomas’ file and contacted Thomas’ treating physicians requesting updated records. After reviewing new records submitted by some of Thomas’ doctors, the nurse recommended that his file be reviewed by an outside peer review consultant.

Thomas’ complete file was then sent to Dr. Stephen Jones for outside peer review. After examining the file and speaking with Dr. Roger Scheider who was one of Thomas’ treating doctors, Dr. Jones concluded that Thomas was then able to continue to work as a bank officer and that there was no vascular surgery condition preventing Thomas from returning to work.

After receiving Dr. Jones’ report, Liberty Life sent a copy of it to Dr. James Mersey for his comments. Dr. Mersey, another of Thomas’ treating doctors, agreed with the assessment of Thomas’ vascular condition, but opined that Thom *738 as’ disability was due to his painful neuro-pathy which is “unrelieved by any medications, and all have been tried.” Dr. Mersey also filled out a physical capacities form indicating that Thomas could stand only 20% of the day, lift 2% of the day, walk and stand 5% of the day, and drive 10% of the day. Liberty Life then requested that Dr. Mersey supply an EMG/ nerve conduction report confirming the existence of peripheral neuropathy. Dr. Mersey sent additional records to Liberty Life in response to its request, but the records did not include an EMG report.

During the summer of 1999, Liberty Life hired an independent investigator to determine if Thomas was then engaged in gainful employment and whether his claimed inability to perform certain functions was true. Thereafter, the investigator observed Thomas for a few hours a day for a total of five separate days between July 21 and November 29, 1999.

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Moore v. Liberty Life Assurance Co.
129 F. Supp. 3d 408 (W.D. Virginia, 2015)
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368 F. Supp. 2d 461 (D. Maryland, 2005)
Dunbar v. Orbital Sciences Corp. Group Disability Plan
265 F. Supp. 2d 572 (D. Maryland, 2003)

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Bluebook (online)
226 F. Supp. 2d 735, 29 Employee Benefits Cas. (BNA) 2444, 2002 U.S. Dist. LEXIS 19198, 2002 WL 31259920, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thomas-v-liberty-life-assur-co-of-boston-mdd-2002.