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05/02/97 VALERI DECASTRIS v. STATE EMPLOYEES

May 2, 1997

VALERI DECASTRIS, PLAINTIFF-APPELLANT,
v.
THE STATE EMPLOYEES RETIREMENT SYSTEM OF ILLINOIS, AND MICHAEL MORY, AS EXECUTIVE SECRETARY, DEFENDANTS-APPELLEES.



Appeal from Circuit Court of Sangamon County. No. 95MR325. Honorable Donald M. Cadagin, Judge Presiding.

As Corrected September 23, 1997.

Honorable Robert J. Steigmann, P.j., Honorable John T. McCullough, J. - Concur, Honorable Robert W. Cook, J. - Concur. Presiding Justice Steigmann delivered the opinion of the court.

The opinion of the court was delivered by: Steigmann

PRESIDING JUSTICE STEIGMANN delivered the opinion of the court:

In March 1994, plaintiff, Valeri DeCastris, an employee of the State Department of Public Health (DPH), filed a claim for nonoccupational disability benefits (40 ILCS 5/14-124 (West 1994)) with defendant State Employees Retirement System of Illinois (SERS). In October 1995, the SERS Board of Trustees (Board) concluded that plaintiff had not shown that she was suffering from a disabling condition and denied her claim. In November 1995, plaintiff sought administrative review of the Board's decision, and in July 1996, the circuit court affirmed.

Plaintiff appeals, arguing that the circuit court's order affirming the Board's decision was against the manifest weight of the evidence. We agree and reverse and remand with directions.

I. BACKGROUND

The underlying facts in this case are undisputed. DPH employed plaintiff as a sanitarian II (toxicologist) from March 1992 through February 1994. Her supervisor described her duties as involving the "review and interpretation of the environmental and health data with the purpose of discerning whether an exposure to chemical or physical agents may result in harm to human or nonhuman life." Plaintiff handled telephone inquiries regarding exposure to chemicals or physical agents, and she worked out of the office (field work) approximately two or three times per month. With the exception of the field work, plaintiff primarily had a "sitting job." The field work varied from a few minutes to collect a sample to several days to collect multiple samples. The field work occasionally required plaintiff to carry sampling equipment, coolers, or bottles of water. Her duties also required her to use a computer and write and interpret scientific data. Her supervisor testified that a person who was incapacitated in some "intangible nonphysical way" would have difficulty performing plaintiff's job.

In the spring of 1994, plaintiff submitted medical evidence to SERS in support of her claim for nonoccupational disability benefits. The evidence consisted primarily of a report from Dr. Mark Stern, a physician and rheumatologist who had been treating her "for many years" for fibromyalgia, which he described, in part, as "a condition which produces significant soft tissue pain as well as a sleep disorder and irritable bowel."

Dr. Stern certified plaintiff was "temporarily, totally disabled" from both her own occupation and from any occupation. However, he stated she could return to work in 30 days. Dr. Stern classified plaintiff's physical impairment as a "slight limitation of functional activity; capable of light work." He stated she had full, normal range of motion in all joints and normal muscle strength, but also noted that fibromyalgia patients are expected to have normal laboratory test results. He also recommended "a disability leave to begin immediately," explaining that fibromyalgia "is a condition that leads to chronic pain or persistent discomfort."

On July 22, 1994, the SERS claims division sent a memorandum to Dr. Edward G. Ference, identified in the memorandum as "SERS Chief Medical Consultant," informing him of plaintiff's claim and asking him to review the medical information on file "and make a recommendation as to the existence of a disability."

Four days later, Dr. Ference responded in a memorandum that he recommended denial of plaintiff's claim. Despite not having examined--or even seen--plaintiff himself, Dr. Ference disagreed with Dr. Stern's diagnosis of fibromyalgia. In its entirety, Dr. Ference's memorandum reads as follows:

"This employee claims disability benefits because of chronic fatigue syndrome and fibromyalgia. She has a sedentary work job description. She is being treated with Zoloft.

Actually, she has an anxiety syndrome. All her laboratory findings are normal. She is obese weighing 191-1/2 pounds. (Dr. Stern calls this fibromyalgia.)

The activities of daily living are much more stressful and require more strength than the job description of this employee. I do not believe she is disabled from her regular job." (Emphasis added.)

Two days later, a SERS claims examiner sent plaintiff a letter informing her that her file "had been reviewed by the [SERS'] medical director" and that SERS was temporarily denying her claim (pending review by the SERS Executive Committee (hereafter the Committee)) because "it is the [SERS'] opinion that a disabling condition has not been established."

In August 1994, the same claims examiner wrote to plaintiff that the Committee had met "and moved to deny [her] benefits." The examiner further informed plaintiff that "this constitutes the initial disposition" of her claim by the Committee, but she could appeal this decision and ask for a personal appearance before the Committee.

In September 1994, plaintiff hired an attorney, who pursued the appeal on her behalf. He obtained further reports from Dr. Stern, who provided additional descriptions of ...


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