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URBANA v. URBANA
March 12, 2003
JAMES LATZKE, PLAINTIFF,
CONTINENTAL CASUALTY COMPANY, DEFENDANT.
The opinion of the court was delivered by: Michael P. McCUSKEY, District Judge.
Following a denial of long-term disability benefits, James Latzke
initiated this lawsuit against Continental Casualty Company, the
administrator of his employer's benefits plan. Although the claim was
originally filed in state court, Continental Casualty removed the action
here based on this courts federal question jurisdiction over matters
governed by the Employee Retirement Income Security Act of 1974,
29 U.S.C. § 1001 et seq. (ERISA). Continental Casualty has now filed
a Motion for Summary Judgment and/or Motion for Judgment on the Merits
(#7). Latzke filed a Response (#8), and Continental Casualty then
tendered a Reply Memorandum (#10). This court has carefully considered
these documents, which include the record of the administrative
proceedings, and for the reasons discussed below, Continental Casualty's
motion for summary judgment is granted.
Latzke worked as a store manager for Kmart Corporation. On September
22, 2000, Latzke claims to have been diagnosed with depression, anxiety,
and post-traumatic stress disorder. He began receiving short-term
disability payments pursuant to Kmart's disability plan, and on March
23, 2001, he applied for long-term disability benefits.
Kmart's long-term benefits plan was funded by an insurance policy
issued through Continental Casualty, and the plan provided that
Continental Casualty retained discretionary authority to the determine
eligibility for benefits. According to definitions in the plan,
claimants must prove they are continuously disabled for the six months
following the onset of their disability (the "elimination period"), at
which point benefits will begin to accrue. "Disability," in general,
refers to a physical or mental impairment that renders claimants
continuously unable to perform their regular job responsibilities. For
making the disability determination, the plan requires claimants to
submit proof that they are under the care of a physician, objective
medical findings supporting their claim of disability, and information
about the extent of their disability and the limitations preventing them
To gather Latzke's medial records, Continental Casualty faxed to Dr.
Jay Liss, Latzke's psychiatrist, a Provider Report for
Psychiatric/Psychological Claims form to fill out concerning Latzke's
symptoms, diagnosis, treatment, and ability to work. When the due date
for completing and returning these forms came, someone from Continental
Casualty called Dr. Liss's office to confirm that he would supply the
needed information. Continental Casualty then faxed another copy of the
provider report to Dr. Liss, and he eventually responded to the request by
providing notes from four of Latzke's office visits, but he left blank a
substantial portion of the form.
Cathi Figoni, a Psychiatric Nurse Case Manager for Continental
Casualty, reviewed the information Dr. Liss provided, as well as medical
records from Dr. Patrick Cerra, Latzke's therapist. Figoni also looked over notes from Dr. Steven Kindred, Latzke's prior
primary care physician, and Dr. Lee, although it is unclear what type of
doctor he is. Moreover, Figoni interviewed Latzke himself.
Based on all of the information Figoni collected and synthesized,
Continental Casualty denied Latzke's request for long-term disability
benefits, finding that he did not meet the definition of "disability."
Continental Casualty advised Latzke that "your doctors must be able to
provide medical evidence of a physically or mentally disabling impairment
that would prevent you from performing the substantial and material
duties of your regular occupation."
Latzke requested that Continental Casualty reconsider its
determination, although he did not submit any additional medical
information. Continental Casualty referred his claim to the Appeals
Committee for review, which eventually upheld the denial of benefits.
The Appeals Committee found that, although Latzke's condition may have
initially impaired his ability to work, medical records showed
improvement during the relevant time period. Accordingly, Latzke did not
satisfy the disability requirement.
Following the denial of his appeal, Latzke initiated this lawsuit, and
Continental Casualty now claims that it is entitled to summary judgment.
Summary judgment is proper if "the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if
any, show that there is no genuine issue as to any material fact and that
the moving party is entitled to a judgment as a matter of law."
Fed.R.Civ.P. 56(c); see also Celotex Corp. v. Catrett, 477 U.S. 317,
322-23 (1986). In evaluating a summary judgment motion, the court
focuses on whether any material dispute of fact exists that would require
a trial. Winter v. Minn. Mut. Life Ins. Co., 199 F.3d 399, 408 (7th
Cir. 1999). In making this determination, the court construes all facts
and draws all reasonable inferences in favor of the nonmoving party.
King v. Preferred Technical Group, 166 F.3d 887, 890 (7th Cir. 1999).
Because the purpose of summary judgment is to isolate and dispose of
factually unsupported claims, however, the nonmoving party must respond
to the motion with evidence setting forth specific facts showing that
there is a genuine issue for trial. Michael v. St. Joseph County,
259 F.3d 842, 845 (7th Cir. 2001), cert. denied, 122 S.Ct. 2328 (2002).
In addition to a request for summary judgment, Continental Casualty
also suggests that this court could enter judgment as a matter of law
after reviewing the administrative record as described in Wilkins v.
Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998). That
procedure has not yet been adopted in this circuit, and without
instruction from the Seventh Circuit concerning the propriety of
disposing of ERISA cases in that manner, this court will not entertain
that possibility. See, e.g., Stryker v. Cont'l Cas. Co., 2002 WL 1821907, at *7 n. 5
(S.D.Ind. 2002); Reagan v. First Unum Life Ins. Co., 39 F. Supp.2d 1121,
1128 n. 9 (C.D.Ill. 1999). Analysis will instead focus on whether the
summary judgment standard has been met.
In ERISA cases, if the benefits plan at issue vests in the plan
administrator discretion in making claim determinations, then the role of
the court system is limited to analyzing whether the administrator abused
that discretion by acting arbitrarily and capriciously. Ladd v. ITT
Corp., 148 F.3d 753, 753-54 (7th Cir. 1998). This court will only
reverse the decision of the plan administrator if it is "downright
unreasonable." James v. Gen. Motors Corp., 230 F.3d 315, 317 (7th Cir.
2000); Hightshue v. AIG Life Ins. Co., 135 F.3d 1144, 1147 (7th Cir. 1998). A
denial of benefits will be upheld if it was an informed judgment based on
a reasonable ...
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