United States District Court, Central District of Illinois, Urbana Division
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 interpretation of the plan documents, even if this court
would have reached a different conclusion. Carr v. Gates Health Care
Plan, 195 F.3d 292, 294 (7th Cir. 1999).
Continental Casualty argues that the denial of benefits is supported by
the administrative record and a reasonable interpretation of plan
documents. Specifically, it relies on the disability requirements in the
plan and the medical information gathered from Latzke's various doctors to
support its conclusion that Latzke was not entitled to benefits. Keeping
in mind the relevant six-month elimination period, which for Latzke's
claim is September 23, 2000 through March 23, 2001, this court cannot
conclude that Continental Casualty's decision was arbitrary or
capricious. Indeed, the administrative record supported Continental
Casualty's denial of benefits.
In early October 2000, Dr. Cerra, Latzke's therapist, noted that Latzke
was suffering intense anxiety, panic and depressive symptoms, manifesting
in insomnia, weight loss, crying spells, and poor concentration. Latzke
reported job stress to Dr. Cerra, but planned to return to work in two or
three weeks. A few days later, Dr. Kindred, Latzke's former primary care
physician, diagnosed him to be suffering from depression and anxiety, but
noted that his panic attacks were improving. Dr. Kindred referred Latzke
to a psychiatrist, and observed that although he was currently unable to
function in a work setting, he should be able to return to work within
At Latzke's first appointment with his psychiatrist Dr. Liss, he
reported symptoms of anxiety and depression. At the time, Latzke was
taking both Xanax and Zoloft as treatment. After diagnosing Latzke as
suffering from anxiety disorder with agoraphobia and depressive
disorder, Dr. Liss recommended he take only the Zoloft. Later that same
week, Dr. Lee diagnosed Latke with a recurrent depressive disorder
brought on by his work situation and marital problems. Dr. Lee concluded
that Latzke was unable to return to work due to lack of concentration and
In November 2000, Dr. Cerra again met with Latzke and noted that he was
improving but that he still suffered some anxiety and depression. Dr.
Cerra reported that, although Latzke was apprehensive about returning to
work, he could likely sustain a six-hour work day given his desire to
"coast" into mid-January and then retire.
At another visit with Dr. Liss in November, Latzke reported still being
depressed and anxious and lacking energy and concentration. Dr. Liss
noted that Latzke
was being tested for sleep apnea. At his appointment with Dr. Liss the following month, Latzke reported
that he had suffered a panic attack and agoraphobia when he went into a
Kmart store. Dr. Liss recommended that he continue taking Zoloft and
also prescribed Paxil for the panic, noting that Latzke's panic problems
Latzke also discussed the panic attack he had with Dr. Cerra in January
2001. Dr. Cerra noted that Latzke was doing better, but appeared "rather
avoidant and does not seem very motivated." Dr. Cerra told Latzke he
needed to be seen on a weekly basis at that point. In Dr. Cerra's notes
concerning Latzke's final visit with him at the end of January, he again
mentioned a need to see Latzke more routinely. Dr. Cerra indicated that
Latzke's next visit was scheduled for February 2001, at which point they
would discuss returning to work because he felt that Latzke was "likely
biding time until he can retire from the company."
At the end of February, Latzke again saw Dr. Liss, and he complained of
depression, anxiety, agoraphobia, and lack of organization. Dr. Liss
added a dose of Paxil to Latzke's medication.
In addition to providing copies of Latzke's office visits, Dr. Liss
also returned the Provider Report for Psychiatric/Psychological Claims
form, but much of the form was left blank. Dr. Liss did not, for
example, list any symptoms Latzke exhibited, describe his functional
capacity, or assess his mental status. Dr. Liss mentioned Paxil and
Zoloft as Latzke's only current medications, and he noted that Latzke was
being seen every one to two months. At the end of the form, Dr. Liss
stated that Latzke was permanently disabled due to the severity of the
depression and would be unable to perform his occupation. This
diagnosis, however, was entirely unsupported and unexplained by the rest
of the provider form or the medical records Dr. Liss submitted.
After summarizing the information received from Latzke's medical care
providers, Continental Casualty found that it did not have enough
objective medical evidence to find that Latzke was continuously
disabled. Figoni, the case manager, was unsure why Dr. Liss omitted so
many details from the provider form, and given the importance of a
medical assessment of Latzke's symptoms and abilities, she was unable to
determine Latzke's functionality. The other medical reports indicated
that Latzke had symptoms of depression and anxiety but that he was being
treated with medication and regular office visits. Continental Casualty
concluded that nothing in the administrative record indicated a severe
mental or emotional condition that would impair Latzke's abilities to the
extent that he would be rendered disabled.
Continental Casualty argues that the administrative record supports its
denial of long-term disability benefits. Nothing in this decision is a
"downright unreasonable" interpretation of the available evidence.
Accordingly, this court will not disturb the denial of long-term
Latzke's arguments to the contrary are not persuasive. He first
suggests that Continental Casualty failed to consider medical findings of
Drs. Lee, Kindred, and Liss, but the administrative record belies that
contention. Clearly, based on the summary provided by Figoni,
information from Drs. Lee, Kindred, and Liss was incorporated into the
Next, Latzke relies on the notes from his visits with Dr. Liss to argue
that he was truly disabled. But Latzke is reading those forms
incorrectly. The portions of the report that he points to as proof of
his limitations are merely the subjective complaints he made to Dr.
Liss. Given that the
plan specifically requires objective medical
evidence of a disability, Continental Casualty was not unreasonable in
giving little weight to Latzke's subjective assessments of his
Finally, Latzke contends that Dr. Liss's notation on the claims form
that he is permanently disabled and unable to return to work is
sufficient to grant his request for benefits. But as Continental
Casualty asserts, this conclusory statement does not rise to the level of
an objective medical finding. Dr. Liss failed to support this claim with
any other information concerning his testing, treatment, or diagnosis of
Latzke or his disability and limitations. And the office notes he
provided are mostly summaries of Latzke's complaints rather than any kind
of diagnosis or assessment. It was not "downright unreasonable" for
Continental Casualty to discount such an unsupported statement.
IT IS THEREFORE ORDERED:
(1) The docket sheet will be changed to reflect the
correct name of Defendant — Continental Casualty
(2) Defendant's Motion for Summary Judgment (#7) is
GRANTED. Judgment is entered in favor of Defendant
Continental Casualty Company and against Plaintiff
(3) This case is terminated.
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