Whitmore v. Standard Ins. Co.

527 F. Supp. 2d 913, 2007 WL 4554005
CourtDistrict Court, E.D. Missouri
DecidedDecember 19, 2007
Docket4:06CV1486 CDP
StatusPublished
Cited by1 cases

This text of 527 F. Supp. 2d 913 (Whitmore v. Standard Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Whitmore v. Standard Ins. Co., 527 F. Supp. 2d 913, 2007 WL 4554005 (E.D. Mo. 2007).

Opinion

527 F.Supp.2d 913 (2007)

Patricia WHITMORE, Plaintiff,
v.
The STANDARD INSURANCE CO. and Summers, Compton, Wells, and Hamburg, P.C., Defendants.

No. 4:06CV1486 CDP.

United States District Court, E.D. Missouri, Eastern Division.

December 19, 2007.

*914 *915 *916 John J. Pawloski, Law Offices of John J. Pawloski, LLC, St. Louis, MO, for Plaintiff.

Richard J. Pautler, Thompson Coburn, Jill R. Rembusch, Summers and Compton, St. Louis, MO, for Defendants,

MEMORANDUM AND ORDER

CATHERINE D. PERRY, District Judge.

Plaintiff Patricia Whitmore alleges that the defendants denied her disability benefits claim in violation of the Employment Retirement Income Security Act of 1974, 29 U.S.C. § 1101, et seq. The parties have filed cross-motions for summary judgment, and defendants have filed motions to strike certain evidence outside the administrative record submitted by plaintiff. I previously held that the arbitrary and capricious or abuse of discretion standard applied in this case. Therefore, I am limited to reviewing only the administrative record that was before Standard Insurance when it made its determination, so I will grant the motions to strike. The administrative record contains substantial evidence to support defendants' denial of benefits, and there is ample evidence from which a reasonable decision-maker could have determined that no benefits were due. Defendants are therefore entitled to judgment as a matter of law.

Factual and Procedural Background

Whitmore was employed by defendant Summers, Compton, Wells, & Hamburg, P.C. (SCWH) as a legal secretary, and as such, she participated in SCWH's employee welfare benefit plan. This plan included long-term disability benefits in specified circumstances. She stopped working on November 5 or 6, 2004, and sought benefits under the long-term disability plan, alleging that she was disabled because of back problems and related pain. The policy provided benefits if a claimant's disability prevented her from performing her "own occupation."

Standard initially denied Whitmore's claim for Long Term Disability benefit on September 27, 2005. After considering her appeal, it reaffirmed the denial on April 26, 2006. On September 22, 2006, the Social Security Administration awarded her disability benefits, concluding that Whitmore had been disabled since November 5, 2004.

The Medical Records

Whitmore dates the beginning of her back pain to 1998, when she received a lumbar epidural injection while in labor. She continued to work between 1998 and 2004 but had multiple MRIs, CT scans, myelograms, and EMGs. She had at least ten MRIs between 2000 and 2004, and at least ten different doctors were involved in her treatment or diagnosis. These numerous *917 examinations revealed that she had (1) mild or slight scoliosis; (2) mild degenerative disk disease at L3-4; (3) little or no foraminal narrowing; and (6) no disc herniation except possibly mild herniation at C5-6. None of the doctors found any stenosis. Further, none of the examining doctors stated that Whitmore was disabled before she stopped working. During this time period, Whitmore attempted to relieve her pain through therapy and medication.

Her most recent MRI before she quit work was done in October 2004, after she reported hearing her back "pop" when she picked up her son. Dr. Walter Holloman read this MRI as showing only very mild degenerative disk disease. In November Whitmore had Xrays, which showed localized scoliosis, normal sacral formina and normal disk interspace. Dr. Matthew Gornet performed a discogram in December, followed by a CT scan. Dr. Joshua Shimony read the. CT scan as showing multi-level degenerative disease with anterior anular tear at L3-4 and right postero-lateral small disk herniation at L5-S 1 with right neural foramina narrowing. The report stated that this narrowing at L5-S 1 was "mild," and there was no other stenosis.

On January 26, 2005, Whitmore saw Dr. Joseph Hanaway. Dr. Hanaway is the first and only doctor who has opined that she was disabled, and although he had been seeing her before this date, this was the first time he stated that opinion. He described her pain as constant, and said that she could not bend, lift, push, pull, or carry. Based on the reports of the December procedures, he described her scoliosis as "major rotatory scoliosis" and "terrible congenital rotatory scoliosis." He opined that, "There is no way this patient can work under these circumstances. She cannot even get pain relief at home." He further indicated that she had spinal stenosis as well as "multiple disc herniation and protrusions from L3 to L5-S 1 level." He prescribed medication and scheduled her to come back in two months.

Dr. Hanaway's records reflect that shortly before Whitmore came back to see him in March Of 2005, she was involved in two different automobile accidents. She was driving on both occasions, according to Dr. Hanaway's records. He ordered MRIs, which revealed mild desiccation of the L3-4 disk, but no stenosis. Additional tests performed after that date continued to reflect "mild" disease process.

Standard's Review of the Claim

In September 2005, as part of Standard's review of Whitmore's claim for benefits, Dr. Hans Carlson, a physician board certified in physiatry, reviewed all of Whitmore's medical records going back to 1995. He did not examine Whitmore. Dr. Carlson concluded that it would be reasonable for a person with Whitmore's condition to be capable of performing sedentary work on a full-time basis. He found that Whitmore's limitations would prevent her from "consistent bending, twisting, stooping activities with respect to the lumbar spine, and consistent flexion, extension activities with respect to the cervical spine but [she] would be capable of performing these activities occasionally or frequently."

Following Dr. Carlson's report, Phil Hines, a vocational case manager, concluded that Whitmore could perform the occupation of legal secretary as defined by the United States Department of Labor within the limitations set out by Dr. Carlson. Hines based, this conclusion upon the description of legal secretary in the Dictionary of Occupational Titles, rather than upon Whitmore's description of her specific job duties at SCWH.

As mentioned above, Standard denied the claim in September of 2005, concluding that although Whitmore had limitations on *918 her ability to bend, twist, stoop, and to flex and extend her neck, she was capable of performing these activities occasionally and she was capable of performing the occupation of legal secretary. Whitmore appealed, Standard referred the appeal to its "Quality Assurance Unit" for an independent review.

As part of that review, Dr. Elias Dickerman, a board-certified neurologist, reviewed all of Whitmore's medical records. Dr. Dickerman did not examine Whitmore, but based upon a review of her medical records, he concluded that she had no limitation from performing sedentary level work and would actually be able to perform some activities in the light capacity category. He particularly noted that she had chronic pain in her lower back, but that the radiological studies of the lumbar spine did not provide any explanation for this pain. In reaching his conclusion about her limitations, Dr. Dickerman discounted Dr.

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Bluebook (online)
527 F. Supp. 2d 913, 2007 WL 4554005, Counsel Stack Legal Research, https://law.counselstack.com/opinion/whitmore-v-standard-ins-co-moed-2007.