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GAWRYSH v. CNA INS. CO.

June 5, 1998

DIANE GAWRYSH, Plaintiff,
v.
CNA INSURANCE COMPANY, Defendant.



The opinion of the court was delivered by: BUCKLO

MEMORANDUM OPINION AND ORDER

 The plaintiff, Diane Gawrysh, sued the defendant, CNA Insurance Company ("CNA"), under the Employee Retirement Income Security Act of 1974 ("ERISA"). 29 U.S.C. ยง 1000 et seq. Ms. Gawrysh argues the denial of her long-term disability ("LTD") benefits violates ERISA. CNA and Ms. Gawrysh both move for summary judgment. For the following reasons, Ms. Gawrysh's motion is granted and CNA's motion is denied.

 Background1

 Diane Gawrysh seeks LTD benefits under an insurance policy ("Plan") issued by CNA to her former employer, Boise Cascade Corporation ("Boise Cascade"). Ms. Gawrysh worked as an accounting supervisor at Boise Cascade. (CNA Rule 12(M) Statement P 3). In March, 1995, Ms. Gawrysh applied for LTD benefits. On her application, Ms. Gawrysh indicated she became totally disabled on November 11, 1994. (CNA Rule 12(M) Statement P 7). Ms. Gawrysh described her disability as chronic fatigue, sinus problems, severe headaches, and depression. (CNA Rule 12(M) Statement P 8). As part of her application, Ms. Gawrysh submitted a statement from her attending physician, Charlotte Blain. (CNA Rule 12(M) Statement P 10). Dr. Blain's statement indicates Ms. Gawrysh suffers from Chronic Fatigue Syndrome, sinusitis with intractable headache, *fn2" recurrent sinus infections, and Bronchitis.

 On April 28, 1995, Joye Kelly, a Claims Specialist for CNA, acknowledged receipt of Ms. Gawrysh's application for LTD benefits. CNA, as Plan administrator, obtained Ms. Gawrysh's medical records and a letter from Dr. Blain explaining Ms. Gawrysh's Chronic Fatigue Syndrome diagnosis. (CNA Rule 12(M) Statement P 12; Ex. J). Dr. Blain stated that in May, 1992, Ms. Gawrysh began to suffer from "persistent fatigue that was not related to exertion, was not alleviated by bedrest and caused her substantial reduction in her previous level of activities." (Df. Ex. J at 1). The fatigue was accompanied by "symptoms of impairment in short-term memory and concentration, recurrent sore throat, lymph node swelling, myalgias and arthralgias, headaches and sleep disturbance." Id. Dr. Blain initially did not believe Ms. Gawrysh's sinus problems were causing the fatigue, although she noted Ms. Gawrysh underwent two surgeries to deal with sinusitis. Ms. Gawrysh began taking decongestants, Vitamin B12, and gamma globulin injections. Id. Dr. Blain diagnosed Chronic Fatigue Syndrome based on the definition set forth in the Annals of Internal Medicine, which indicates Chronic Fatigue Syndrome is the "onset of persistent or relapsing fatigue or easy fatigability in a person who had no history of similar symptoms, that did not resolve with bed rest and was severe enough to reduce or impair her daily activities below 50% of premorbid activity level." Id. at 2.

 Dr. Blain noted Ms. Gawrysh's condition persisted over the following years with increased sinusitis problems. Id. Repeated attempts to treat the fatigue were unsuccessful. Dr. Blain opined that there was "no question" Ms. Gawrysh was unable to work. Id. at 3.

 Under CNA's Plan, a "total disability" is defined as:

 
"Total Disability" means that, during the Elimination Period and the Insured Employee Occupation Period shown in Statement 4 of the Application, the Insured Employee, because of Injury or Sickness is:
 
(1) continuously unable to perform the substantial and material duties of his regular occupation;
 
(2) under the regular care of a licensed physician other than himself; and
 
(3) not gainfully employed in any occupation for which he is or becomes qualified by education, training or experience.
 
After the Monthly Benefit has been payable for the Insured Employee Occupation Period shown in Statement 4 of the Application, "Total Disability" means that, because of Injury or Sickness, the Insured Employee is:
 
(1) continuously unable to engage in any occupation for which he is or becomes qualified by education, ...

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