Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

KAZENAS v. ORACLE CORPORATION'S LONG TERM DISABILITY PLAN

March 23, 2004.

SUSAN KAZENAS, Plaintiff
v.
ORACLE CORPORATION'S LONG TERM DISABILITY PLAN And HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendants



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. Page 2

BACKGROUND

  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 Page 3 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 Page 4 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.

  DISCUSSION

  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 Page 5 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 30, 1998).

 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 ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.