The opinion of the court was delivered by: BLANCHE MANNING, District Judge
MEMORANDUM OPINION AND ORDER
Plaintiff Nancy Ravesloot contends that she was wrongfully
denied long term disability benefits under a group policy issued
to her former employer, Baxter International, in violation of §
1132(a)(1)(B) of the Employee Retirement Income Security Act of
1974, 29 U.S.C. § 1001, et seq. The parties' cross-motions for
summary judgment and Ms. Ravesloot's motion for fees are before
the court. For the following reasons, Ms. Ravesloot's motion for
summary judgment is granted, her motion for fees is denied as
premature, and the plan administrator's motion for summary
judgment is denied.
The facts in this ERISA case are essentially undisputed and are
based on the administrative record.
Baxter employed Ms. Ravesloot as a customer service specialist.
This job required her to work four 10-hour days per week, wear a
headset for phone usage during the work day, sit at a computer,
tab or scroll to specific places on an on-line form, and then
fill in data. Ms. Ravesloot was a participant in Baxter's long term disability plan. The plan
provided benefits for short term disability. It also defined an
employee as disabled if, after twelve months, she has an "injury
or sickness" which causes physical or mental impairment to such a
degree of severity that the individual is: (1) continuously
unable to engage in any occupation for which she is or becomes
qualified by means of education, training, or experience; and (2)
not gainfully employed.
To submit a claim, the plan required a participant to submit
proof of disability, such as objective medical findings
supporting a finding of disability such as tests, procedures, or
clinical examinations accepted in the practice of medicine. In
addition, the plan required participants to provide proof showing
the extent of their disability, including restrictions and
limitations that prevent them from performing their regular
The plan further stated that the plan administrator and plan
fiduciaries "have discretionary authority to determine . . .
eligibility for and entitlement to benefits" under the plan and
the core plan administrator has "delegated sole discretionary
authority to CNA Group Life Assurance Company to determine . . .
eligibility for benefits and to interpret the terms and
provisions of the policy."
B. Ms. Ravesloot's Short Term Disability Claim and Initial
Receipt of Benefits
In October of 2001, CNA received medical records from Scott
Reiser, Ms. Ravesloot's chiropractor, in support of her claim for
short term disability benefits. Dr. Reiser indicated that in
August of 2001, Ms. Ravesloot had slipped on a melted popsicle at
Sam's Club. The fall resulted in "severe neck pain, mid back
pain, lower back pain, right hip pain, headaches, nauseated
[sic], left shoulder and arm pain and left leg to toes numb and
tingling." He also reported x-ray findings from examinations of
Ms. Ravesloot's spine. At this time, Dr. Mary Kohrs, an associate of Dr. Reiser, certified that Ms. Ravesloot
was unable to perform the duties of her position but was
potentially able to perform other kinds of work. CNA subsequently
approved short term disability benefits for the period of
September 17, 2001, thorough October 11, 2001.
C. Ms. Ravesloot's Interim Receipt of Benefits
In September of 2001, Dr. Reiser noted minor improvement in Ms.
Ravesloot's condition. In early October of 2001, Dr. Reiser
examined Ms. Ravesloot and authorized her to work half days for
one week and then have a follow-up appointment. At that
appointment, Dr. Reiser noted some minor improvement, but stated
that portions of Ms. Ravesloot's back were tender and spasming
and that she was experiencing moderately severe pain in her neck,
back, and shoulder. During the test week where Ms. Ravesloot
worked half days, she left work early once due to numbness in her
left arm and stated that her pain was a bit worse in the neck and
At about this same time, Dr. Kohrs completed a medical report
stating that Ms. Ravesloot had: (1) "Acute severe prolapse,
protrusion, rupture or herniation of the disc with headaches,
neck pain, cervical sprain/strain and radiculopathy, (2) Acute
severe prolapse, protrusion, rupture or herniation of the disc
with low back pain, lumbar sprain/strain and radiculopathy, (3)
Acute severe thoracic sprain/strain with upper back pain."
On October 10, 2001, Dr. Reiser wrote a letter indicating that
cervical and lumbar MRIs had been performed. These tests
indicated that Ms. Ravesloot had degenerated centrally bulging
C5-C6 and C6-C7 discs as well as lumbar spondylosis and
degenerative disc disease with Schmorl's nodes. Dr. Reiser thus
concluded that, "[d]ue to the extensive injury from the slip on
08-21-01, I recommend the patient to remain off of work." On November 12, 2001, Dr. Kohrs signed a request for extension
of benefits which restricted work to no more than five hours per
day with no lifting, bending, or twisting. She gave an
anticipated return to work date of November 27, 2001, and
referred Ms. Ravesloot to neurology for an EMG ...