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RAVESLOOT v. ADMINISTRATIVE COMMITTEE OF BAXTER INT'L

June 23, 2004.

NANCY RAVESLOOT, Plaintiff,
v.
ADMINISTRATIVE COMMITTEE OF BAXTER INTERNATIONAL, INC., in its capacity as Plan Administrator for Baxter International, Inc., Defendant.



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.

I. Background

  The facts in this ERISA case are essentially undisputed and are based on the administrative record.

  A. The Plan

  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 occupation.

  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 midback.

  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 ...


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