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URBANA v. URBANA

March 12, 2003

JAMES LATZKE, PLAINTIFF,
V.
CONTINENTAL CASUALTY COMPANY, DEFENDANT.



The opinion of the court was delivered by: Michael P. McCUSKEY, District Judge.

ORDER

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.

BACKGROUND

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 from working.
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.

ANALYSIS

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 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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