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Escalona v. Board of Trustees





Appeal from the Circuit Court of Cook County; the Hon. Arthur L. Dunne, Judge, presiding.


Plaintiff appeals from an order entered on administrative review, affirming a decision of the Board of Trustees of the State Employees' Retirement System (SERS) terminating plaintiff's disability compensation. Plaintiff contends that the decision (1) was an improper exercise of discretionary power by SERS; (2) violated her right to due process, since no standards were established by SERS; and (3) was against the manifest weight of the evidence.

Plaintiff is a former State employee who was a caseworker for the Illinois Department of Public Aid, performing essentially clerical duties for approximately 10 years. She took a nonoccupational leave of absence, beginning October 19, 1981, and received disability benefits from November 5, 1981, to February 2, 1982. This initial period of disability was for repeated bladder infections and hypertension, as reported by her physician at that time, Dr. Vulgaris, who also estimated that she would be able to return to work on February 2, 1982. Plaintiff made the same estimate when she filled out her application for disability benefits.

On January 26, 1982, SERS notified plaintiff that her disability benefits would be terminated on February 2, 1982, unless she submitted further medical evidence from her attending physician. In response, she submitted a report from her psychiatrist, Dr. Josep Pasic, dated January 27, 1982, stating that "Mrs. Escalona is in psychotherapy for mental and emotional reasons and disabled from work for indefinite time." She also submitted a report from a Dr. Luiz Subrack, dated February 7, 1982, stating that she was disabled for employment because of "multiple recurrent physical illness and severe emotional imbalance."

On March 23, 1982, plaintiff was interviewed by a SERS caseworker, who reported that plaintiff did not appear to be disturbed; that she does her own shopping and cooking; that except for trips to the store and weekly visits to her doctor, her activities were primarily restricted to her apartment, where she lives alone with no outside help; and that she was a college graduate with advanced graduate study work.

In August 1982, SERS scheduled two examinations for plaintiff, by a psychiatrist and by an internist. The letters to her, however, did not clearly indicate that two distinct examinations were scheduled, and she appeared only for the psychiatric examination on August 27 by Dr. Rigaberto Rodriguez. Prior thereto, SERS informed Dr. Rodriguez of the disability for which plaintiff was receiving benefits and of the nature of her job. SERS requested his opinion, based on his objective findings, as to whether plaintiff could perform the duties of her position.

The report of Dr. Rodriguez states that plaintiff is under the psychiatric care of Dr. Pasic and takes Librium 25 mg., Lithium 300 mg., and Mellaril 25 mg.; that there is no history of mental illness in her family, and she has never been a patient in a psychiatric hospital; that she sleeps well, has a normal appetite, and has had no significant weight loss; that she denies hallucinations, delusions, and homicidal or suicidal attempts; that she is coherent, with no indication of gross motor behavior; and that she lives alone and does her own cleaning, cooking, laundry, and shopping. Dr. Rodriguez, in his report, also stated that she complained of losing her ability to concentrate at the beginning of last year and said she was getting so nervous that she could not be with people, and that she also complained of having colitis and was very uneasy about returning to work. He diagnosed her condition as "mild situational depression" and gave his opinion as follows:

"Based on the objective findings of this examination and review of the job description, this patient would be able to return to her normal occupational duties along with being capable of performing simple routine, repetitive tasks at a competitive rate with normal amount of supervision, capable of understanding, remembering and carrying out simple instructions, capable of responding appropriately to supervisors and co-workers and to customary work pressures in a routine work setting."

After reviewing plaintiff's file and the report of Dr. Rodriguez, SERS notified her that her benefits would be terminated on September 30, 1982, because she was no longer disabled. The executive committee upheld this decision.

She then appealed, and in support thereof submitted various medical reports. The 1981 reports of Drs. Vulgaris and Wilkey referred to hypertension and repeated bladder infections, the conditions for which disability benefits had originally been authorized. A report of Dr. Sudbrack, dated February 1, 1982, referred to the same conditions and stated that she was temporarily disabled "from her regular occupation" but not from all occupations. In a June 9, 1982, report, Dr. Sudbrack stated that he recently treated plaintiff for osteoarthritis of her knee, hypertension, and colitis, and that she was disabled and unable to perform her regular activities. Plaintiff also filed two reports from her psychiatrist, Dr. Pasic. In one dated August 25, 1982, he described her condition as "agitated depression with paralyzing anxieties" and further stated that those symptoms appeared when plaintiff dealt with the stressful activities of daily living. In a later report of September 9, 1982, he diagnosed plaintiff's condition as "Major depression, Single Episode, unspecified (DSM III, 296.20). Agitated depression with paralyzing anxieties."

On November 22, 1982, SERS directed its chief medical consultant, Dr. Edward Ference, to review plaintiff's file in order to make a recommendation regarding her eligibility for disability benefits. Dr. Ference reported on November 30, 1982, that in his review of plaintiff's file he found no evidence that plaintiff was disabled, and he further stated that no benefits were warranted. The SERS executive committee denied plaintiff's appeal on December 8, 1982, and the board of trustees ratified the decision on December 15, 1982.

Plaintiff then requested a reappeal of that decision, submitting another report dated January 12, 1983, from Dr. Pasic and a letter from him dated February 2, 1983, both of which described the plaintiff's condition, symptoms, and therapy and stated that she was unable to work.

On March 7, 1983, Dr. Ference was requested by SERS to again review plaintiff's file for purposes of the reappeal. In his evaluation, Dr. Ference stated that he had reviewed the entire file, including Dr. Pasic's latest report, and that although the reports of Dr. Pasic listed symptoms indicating an impairment, no disabling condition was shown. On March 9, 1983, the executive committee reviewed the case and denied the reappeal. The board of trustees ratified this decision at its meeting of March 24, 1983, and SERS notified plaintiff of the decision on April 5, 1983.

Plaintiff again reappealed this decision, submitting a lengthy report from Dr. Pasic dated April 20, 1983, in which he expressed disagreement with Dr. Rodriguez' evaluation of plaintiff and restated his opinion that plaintiff was disabled. Dr. Ference once more reviewed plaintiff's file and reported that Dr. Pasic again "gives no objective evidence of disability" and reasserted his belief that plaintiff could return to ...

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