The opinion of the court was delivered by: WAYNE ANDERSEN, District Judge
MEMORANDUM, OPINION AND ORDER
Plaintiff Susan Kazenas comes before the Court on a motion for summary
judgment to recover long-term disability benefits from Defendants Oracle
Corporation's Long Term Disability Plan and Hartford Life and Accident
Insurance Company under § 502(a)(1)(B) of the Employee Retirement Income
and Security Act. Defendants have filed a cross-motion for summary
judgment. The Court holds that the arbitrary and capricious standard of
review applies in this case. Under this deferential standard, the issue
is whether Hartford, acting as plan administrator, had a reasonable basis
for denying Plaintiff's claim for benefits. For the reasons set forth
below, the Court concludes that Defendants' denial of benefits was not
arbitrary or capricious. Thus, Plaintiff's motion for summary judgment is
denied and Defendants' motion for summary judgment is granted. In
addition, Plaintiff's motion for leave to file her favorable Social
Security decision is denied.
Plaintiff Susan Kazenas ("Plaintiff") was employed by Defendant Oracle
Corporation ("Oracle") as a senior software consultant from May 2, 1996
until December 4, 2000, when she took a medical leave of absence.
Plaintiff was a participant in the Oracle Corporation Long Term
Disability Plan ("Plan"), which is an employee welfare benefit plan that
Oracle established through its purchase of group insurance issued by
Defendant Hartford Life and Accident Insurance Company ("Hartford").
The Plan provides long-term disability benefits for employees it deems
totally disabled. Under the Plan, total disability "means that: (1)
during the elimination period; and (2) for the next 24 months, you are
prevented by: (a) accidental bodily injury; (b) sickness; (c) mental
illness; (d) substance abuse; or (e) pregnancy, from performing the
essential duties of your occupation. . . ." The elimination period
is the period of time the insured must be disabled before benefits become
payable. Under this Plan, the elimination period is the first three
consecutive months of any one period of disability. The parties agree
that the elimination period ran from December 4, 2000, the date Plaintiff
became unable to work as a result of her alleged disability, through
March 3, 2001.
On April 3, 2001, Plaintiff filed an application for disability
benefits with Hartford, In her application, Plaintiff stated that chronic
headaches prevented her from performing the essential duties of her
employment, including travel. She noted in her application that travel
caused her stress and fatigue, resulting in severe headaches. In support
of her claim, Plaintiff's physician, Dr. McNamara, submitted an
application on her behalf that listed a primary diagnosis of "chronic
fatigue syndrome, fatigue." In
addition, Oracle filed documentation that listed Plaintiff's reason
for stopping work as headaches that precluded travel and concentration.
In reviewing the claim, Hartford referred Plaintiff's file to Dr. F.B.
Dibble, an associate medical director for Hartford. Because he had found
inconsistencies in the record, Dr. Dibble contacted Dr. McNamara for
clarification of the Plaintiff's condition and learned that Dr. McNamara
had changed his diagnosis from fatigue to depression. In addition, there
was documentation from Pamela Rak, a social worker, and from Dr. Cary
Haywood, a doctor of osteopathy, that Plaintiff was being treated for an
anxiety disorder and depression.
Further, Dr. McNamara's treatment records from an office visit with
Plaintiff on December 1, 2000 indicated that personal problems may have
contributed to her condition. During another office visit on January 26,
2001, Dr. McNamara noted that Plaintiff was having headaches but was
stable and was considering alternative employment. Also considered by
Hartford was the fact that Dr. McNamara granted Plaintiff permission to
return to work during the elimination period. He had signed a work
release form giving Plaintiff permission to return to work as of February
26, 2001. On July 9, 2001, Hartford denied Plaintiff's application for
benefits, having determined the medical evidence submitted on her behalf
was insufficient to establish a physical or psychiatric disability.
On July 28, 2001, Plaintiff appealed Hartford's decision and reasserted
her claim of disability due to headaches. In support of her appeal, Dr.
McNamara revised his diagnosis to migraine headaches and depression.
Hartford submitted this information to Dr. Dibble, but he concluded more
substantiation of the migraine diagnosis would be
needed to establish a physical disability. On November 5, 2001, Hartford
upheld its denial of benefits.
On January 21, 2002, Plaintiff again appealed Hartford's decision. This
time Hartford referred Plaintiff's claim to an internal appeals
specialist, who placed significant weight on Dr. McNamara's actual
treatment notes as first-hand representations of the Plaintiff's
condition during the elimination period. Due to the perceived
inconsistencies and unreliability of Dr. McNamara's treatment notes and
the conclusions of Dr. Dibble, the appeals specialist concluded that
Plaintiff was not totally disabled under the Plan. On April 26, 2002,
Hartford maintained its decision to deny Plaintiff's claim. Plaintiff
filed this lawsuit on November 6, 2002.
Summary judgment is appropriate "if the pleadings, depositions, answers
to interrogatories, and admissions of file, together with 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). The party seeking summary judgment carries the initial
burden of demonstrating an absence of evidence to support the position of
the nonmoving party. Doe v. R.R. Donnelley & Sons Co., 42 F.3d 439, 443
(7th Cir. 1994). The nonmoving party must then set forth specific facts
showing there is a genuine issue of material fact and that the moving
party is not entitled to judgment as a matter of law. Anderson v. Liberty
Lobby, 477 U.S. 242, 252 (1986). On cross-motions for summary judgment,
the Court "considers the merits of each cross-motion separately and draws
all reasonable inferences and resolves all factual
uncertainties against the party whose motion is under consideration."
Rawell v. Life Ins. Co, of N. Am., 1998 WL 708805, at *3 (N.D. Ill. Sept
I. The Arbitrary and Capricious Standard of Review Applies
Benefit determinations under ERISA are reviewed de novo unless the
trustees of the plan have been given discretion to determine benefit
eligibility, in which case the Court reviews benefit determinations under
the arbitrary and capricious standard of review. Trombetta v. Cragin
Federal Bank for Savings Employee Stock Ownership Plan, 102 F.3d 1435,
1437 (7th Cir. 1997). In this case, the Plan gave Hartford full
discretion to make factual benefit determinations: "The Hartford has full
discretion and authority to determine eligibility for benefits and to
construe and interpret all terms and provisions of the Group ...