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MARCINIAK v. TRAVELERS INS.

January 16, 1998

MAUREEN MARCINIAK, Plaintiff,
v.
THE TRAVELERS INSURANCE, INC., Defendant.



The opinion of the court was delivered by: BUCKLO

 The plaintiff, Maureen Marciniak, sued the defendant, The Travelers Insurance Company ("Travelers"), *fn1" under the Employee Retirement Income Security Act of 1974 ("ERISA"). 29 U.S.C. § 1000 et seq. Ms. Marciniak argues that denial of her long-term disability ("LTD") benefits violates ERISA. Travelers moves for summary judgment. For the following reasons, Travelers' motion is granted.

 Background2

 Ms. Marciniak worked for Travelers as a Senior Benefits Specialist from January, 1983, to October, 1990. She left Travelers due to continuing, severe pain in her right arm that prohibited her from performing her job. Ms. Marciniak was diagnosed with ulnar neuritis in her right arm and carpel tunnel syndrome in her left hand. She underwent surgery on her right arm in June, 1991, and in August, 1991, was cleared to return to work by Dr. John Sonnenberg, her treating physician. Ms. Marciniak was restricted from activities involving repetitive motion with her right hand. In October, 1991, Ms. Marciniak returned to Travelers on a full-time basis as a Customer Service Representative.

 In January, 1992, Ms. Marciniak left Travelers, complaining of pain in both hands. She filed for LTD benefits under The Travelers Disability Income Plan ("Plan") in June, 1992. Travelers' Employee Benefits Committee ("EBC") serves as the Plan Administrator and makes determinations as to eligibility for LTD benefits. Ms. Marciniak began receiving LTD benefits in July, 1992. Under the Plan, a participant may receive LTD benefits if she can prove she suffers from a "total disability." A "total disability" is defined differently based on how long the participant has been disabled:

 
During the first 30 months of disability, you must be unable to perform the substantial and material duties of your regular occupation for any employer and may not work for pay or profit.
 
After 30 months of disability, you must be unable to engage in any occupation or employment for which you are or become qualified by training, education, or experience.

 (Benefits Handbook at 63). Ms. Marciniak became disabled in January, 1992, and received benefits until July, 1994. At that time, Ms. Marciniak's continued benefits were dependent on her proving she was unable to "engage in any occupation" for which she was qualified. Traveler's EBC determined, based on medical and vocational reports, that Ms. Marciniak could engage in certain, sedentary employment. Ms. Marciniak's benefits were terminated in July, 1994. Ms. Marciniak appealed, twice, but the EBC upheld its earlier decision, finding Ms. Marciniak failed to prove she was incapable of performing any job. This suit followed.

 Long Term Disability Benefits

 Both parties agree that the EBC's decision to deny Ms. Marciniak LTD benefits should be reviewed under the arbitrary and capricious standard. See Gallo v. Amoco Corp., 102 F.3d 918, 921 (7th Cir. 1996)(finding that where a plan confers upon an administrator discretion to interpret it, challenges to the administrator's interpretations are to be reviewed under the arbitrary and capricious standard). Under the arbitrary and capricious standard, EBC's decision must be "based on a reasonable interpretation of [the Plan] and an adequate consideration of the relevant factual circumstances." Russo v. Health, Welfare, & Pension Fund, Local 705, Int'l Bhd. of Teamsters, 984 F.2d 762, 766 (7th Cir. 1993); accord Fuller v. CBT Corp., 905 F.2d 1055, 1058 (7th Cir. 1990)(finding that for plan administrator to abuse discretion, interpretation must be "downright unreasonable").

 While the EBC's interpretation is entitled to great deference, review is still required. The EBC's decision will not stand if the EBC:

 
relied on factors which Congress has not intended it to consider, entirely failed to consider an important aspect of the problem, offered an explanation for its decision that runs counter to the evidence before [it], or is so implausible that it could not be ascribed to a difference in view or the product of [its] expertise.

 Motor Vehicle Mfrs. Ass'n of the United States, Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43, 77 L. Ed. 2d 443, 103 S. Ct. 2856 (1983). In reviewing the EBC's decision, I may only consider the evidence before the EBC at the time of its determination. Trombetta v. Cragin Fed. Bank for Sav. Employee Stock Ownership Plan, 102 F.3d 1435, 1438 n.1 (7th Cir. 1996).

 The EBC was presented with considerable evidence that Ms. Marciniak was capable of working in some employment setting. In June, 1992, Ms. Marciniak's personal physician, Dr. Sonnenberg, recommended that she return to work in a job that avoided repetitive use of her right hand. (Def. Ex. G). Dr. Sonnenberg noted that Ms. Marciniak showed no signs of atrophy and had a full range of motion in her right hand. In August, 1992, Ms. Marciniak went through testing at Workers Rehabilitation Services, Inc., to determine whether her skills were transferable to another job setting. Based on a battery of tests and given the limitation on the use of her hands, Workers ...


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