The opinion of the court was delivered by: JOHN NORDBERG, Senior District Judge
MEMORANDUM OPINION AND ORDER
This is an ERISA case challenging an administrator's decision to deny
long-term disability benefits. Before the court are cross-motions for
summary judgment. For the reasons set forth below, we grant summary
judgment in favor of plaintiff Sandra A. Hillock and against defendant
Continental Casualty Company, a CNA Company ("CNA").
In 1997, Sandra Hillock began working for CF Industries, Inc. ("CF
Industries"). As an employee, she was a participant in her employer's
disability income insurance policy underwritten by CNA (Policy No.
In May of 1999, Hillock was in a car accident and injured her back. An
MRI taken after the accident revealed a herniated disk at C3-4, canal and
foraminal narrowing at C4-5, C5-6, and C6-7 and disc protrusions at the T
1-2 level. (R 154.)*fn3 Hillock had surgery to correct these problems.
But the surgery did not eliminate her symptoms as she continued to
experience numbness in her hands, pain her neck, bodily pain, sleep
disruptions, and other problems.
On February 3, 2000, Hillock underwent a second surgery to alleviate
the ongoing pain. Dr. Russell Nockles performed anterior C5-6 and C6-7
microdiskectomy and fusion surgery. In a follow-up visit to Dr. Nockles'
office four months later, Hillock indicated that she still experienced
fatigue, soreness, and low back pain that was not relieved by Tylenol. (R
106.) On December 27, 2000, another MRI was taken, which indicated that
Hillock still suffered from damage to her spine.*fn4
Based on these problems and the continuing pain, Hillock's primary care
physician, Dr. Erin Davis, advised her to quit working. Following this
advice, she stopped working on February 27, 2001. At the time, she was 56
years old and was making approximately $3,071.20 a month.
Hillock then applied for disability benefits. Under the policy, there
was a 180-day waiting period between the date of onset of the disability
and the date benefits start. In this case, this period ran from February
27, 2001 through August 28, 2001. To qualify as disabled under this
policy, Hillock is required to provide "objective medical findings"
demonstrating that she is "continuously disabled" during this elimination
period, which meant that she could not perform the "material and
substantial duties" of her job.*fn5 If she is considered disabled, she
will receive 60% of her monthly wages subject to coordination with her
social security benefits. Such benefits would be paid until she either no
longer satisfied the definition of "disability," died, or reached the age
Hillock's employer submitted her claim for long-term disability
benefits to CNA on August 16, 2001. In support of her application,
Hillock, her employer, and her primary care physician filled out forms
required by CNA and submitted medical records. Hillock filled out a CNA
form entitled LTD Employee's Statement and one entitled Employee's Job
Activities Statement. (R 150, 158-59.) On the Employee's Statement, she
indicated that she was injured in a car accident, suffered from spinal
damage, and listed 5 physicians she had consulted about her condition:
(1) Dr. Davis, (2) Dr. Nockles, (3) Dr. Cross, (4) Dr. Young, and (5) Dr.
Sliwa. (R. 150.) On the Job Activities Statement, she stated: "severe
headaches, neck & arm pain, [and] numbness occur throughout the work
day, no matter what task is performed." (R 159.) She also estimated that
a typical work day involved 7 hours sitting, 15 minutes standing, 30
minutes walking, and 30 minutes bending. (R 158.)
On the Employer's Job Activities Statement, which is similar to the
employee's form, CF Industries stated that Hillock worked as an
administrative assistant to the vice president of marketing and sales and
that her job activities were as follows: "coordinates schedules, travel,
handles phone, correspondence, files, office mgt." (R 156.) CF Industries
also answered the question about Hillock's typical work day, stating that
she spent 5 hours sitting, 2 hours standing, and 1 hour walking and that
she spent 50% of her time working with other people. (Id.)
Dr. Davis completed the Physician's Statement, which is another form
required by CNA. (R 151-52.) Dr. Davis listed under the diagnosis section
that Hillock had chronic neck pain, myofascial pain, degenerative disc
disease, and cervical fusion surgery. As for complications, Dr. Davis
stated that Hillock suffered from chronic pain, poor posture, and poor
mobility. (R 151.) In response to the physical limitations question, Dr.
Davis indicated that Hillock was unable to lift any weight, cannot stand
or sit for long periods of time, and that her concentration was affected
secondary to pain. (R 152.) As for Hillock's prognosis, Dr. Davis stated
that "prognosis is poor," that "[n]o further surgery will help," and that
Hillock will "have significant pain for the rest of her life."
(Id.) In addition to completing the Physician Statement, Dr.
Davis also attached two MRI reports to substantiate these findings. (R
The initial review of the application was made by Lydia Myers, whose
job title is "disability specialist." In addition to reviewing the
materials cited above, Myers conducted a telephone interview with Hillock
on September 7, 2001. In this interview, according to Myers' notes,
Hillock stated that she has pain in her neck, shoulders, arms, and hands,
has "almost constant" headaches, and has difficulty lifting her right
arm. (R 139-41.) Hillock also stated that she was going to physical
therapy since her accident in an effort to lessen her pain and that she
takes pain medication to be able to sleep at night. Myers also
asked Hillock about her typical daily activities. Hillock stated that she
did some gardening, grocery shopping, and a few other activities around
the house like checking her email.
Five days later, in a September 12, 2001 letter, Myers informed Hillock
that CNA had denied her claim for long-term disability benefits. This
letter serves as the most comprehensive explanation for CNA's decision.
We quote the substantive portion of this letter in full:
Dr. Erin Davis states in the Physician's Statement
that your complications/ symptoms are, "chronic
pain, poor posture, poor mobility." Physical
limitations noted by Dr. Davis include, "Patient
unable to lift any weight. Cannot stand or sit for
long periods of time. Concentration affected
secondary to pain."
According to the Employer and Employee Job
Activities Statements, as an Administrative
Assistant, you have the option of sitting or
standing throughout the work day. No lifting or
carrying is required. A headset is provided for
According to the Employee Interview conducted with
you on 09/07/01, you stated that your Activities
of Daily Living consist of gardening, pulling
weeds, watering the grass, cooking, grocery
shopping, and light housework. You are able to
care for your personal needs without difficulty.
You are also able to take short walks, check email
on your home compute[r], and sit up to 20 minutes
at an interval.
At this time, although we acknowledge that you
have a condition, the information provided does
not support that you are unable to perform the
material and substantial duties of your occupation
as an Administrative Assistant. The sit or stand
option of your job would allow you to alternate
positions as necessary. No lifting or carrying of
any weight is required.
Hillock subsequently asked CNA to reconsider the decision and submitted
a letter objecting to, among other things, CNA's description of her
typical daily activities. She also submitted additional medical evidence
consisting of a report from Dr. Sliwa, an exercise physiologist, who
examined her on one occasion in June 2001.
In a letter dated October 12, 2001, CNA denied Hillock's request for
reconsideration, stating that it did not find any reason to alter its
earlier analysis. As for the new report by Dr. Sliwa, CNA concluded that
it indicated that Hillock ...