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JOHNSON v. LONG TERM DISABILITY PLAN AND IMC GLOBAL

October 7, 2004.

CATHERINE JOHNSON, Plaintiff,
v.
LONG TERM DISABILITY PLAN and IMC GLOBAL, INC., Defendants.



The opinion of the court was delivered by: ROBERT GETTLEMAN, District Judge

MEMORANDUM OPINION AND ORDER

Plaintiff Catherine Johnson has filed suit against her former employer, IMC Global, Inc. ("IMC") and its Long Term Disability Plan (together "defendant") under § 502(a)(1)(B) of the Employment Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), to recover long term disability benefits denied to her. The parties have filed cross motions for summary judgment, agreeing that the material facts are not in dispute and that the court should decide the case on the record presented. For the reasons set forth below, defendant's motion for summary judgment is granted, plaintiff's motion is denied, and the decision to deny benefits is affirmed.

BACKGROUND

  IMC sponsors an ERISA-governed life, health and disability benefits plan for its salaried and nonunion hourly employees (the "Plan"). Defendant Long Term Disability Plan is one part of the Plan. The Plan is self-funded from the assets of IMC, which serves as administrator, is a fiduciary, and is the named fiduciary under § 402 of ERISA. As part of the Plan, participants may qualify for Short Term Disability ("STD") benefits and Long Term Disability ("LTD") benefits. For the first 30 months of any period of disability during which STD or LTD benefits are received, disability is defined as "the inability to perform all the material duties of your occupation, or another occupation offered by IMC due to illness or injury." For any disability lasting more than 30 months due to the original disabling condition, the participant must be unable to perform all the important duties of any job the participant could be reasonably expected to perform, including jobs that require training for qualification. IMC is not required to be the company offering another job or training after 30 months.

  Prior to August 22, 2002, the Plan included a "Proper Care and Treatment" provision, under which the Plan could terminate benefits "if you no longer attempt to follow your physician's instructions regarding your disabling condition." On August 22, 2002, the proper care and treatment provision was amended to read, "If you are on LTD, you are required to be under the care of a qualified health care provider. If you refuse treatment to improve your condition, or if other efforts to enable a return to work are refused, your LTD benefits will terminate." The Plan further provides that "If you cease to be disabled by the condition that originally disabled you, benefits will stop even if you are disabled by a different condition, if that second condition occurred after the original disabling condition."*fn1

  IMC serves as Plan Administrator, and in that capacity is invested with full and complete authority, responsibility and control over the management, administration and operation of the Plan. Under the terms of the Plan, that authority includes the power to: (a) construe and interpret the Plan, to decide all questions of Plan eligibility, to determine the amount, manner and time of payment of any benefits under the Plan, and to remedy ambiguities, inconsistencies, or omissions in Plan terms and/or administration;

  * * *

 
(c) make determinations as to the right of any person to a benefit, to afford any person dissatisfied with such determination the right to a hearing thereon, and to direct payments or distributions from the trust fund in accordance with the provisions of the Plan; and
(d) Decide all questions arising under the plan.
  IMC has delegated the authority to decide claims and appeals to its claim administrators or insurance companies. IMC and the claims administrators share the duties of administering the Plan. Initial determinations of eligibility under the LTD Plan are made by Hartford Life Insurance Company ("Hartford") as claims administrator.

  The Plan provides for a two-level administrative review process. The first level appeals of LTD benefit decisions are conducted by CorVel Corporation ("CorVel") on behalf of IMC. If the first level appeal is denied, a participant may make a second level appeal to an Employee Benefits Committee ("Benefits Committee") which was created by IMC to assist in administration of the Plan. The Benefits Committee is delegated with the power to interpret Plan documents and the responsibility of ensuring that the plan is operated in a manner that is fair to all Plan participants.

 
All determinations of Employee Benefits Committee in any matter arising under the Plan, including questions of construction and interpretation, shall be final, binding and conclusive upon all interested parties, and shall be given the maximum possible deference allowed by law.
  Plaintiff first stopped actively working at IMC on January 15, 2001. One month later, on February 10, 2001, Dr. Kenneth R. Margules diagnosed plaintiff with systemic lupus erythematosus ("lupus" or "SLE"). In a letter to IMC Dr. Margules listed plaintiff's specific limitations affecting her ability to work as profound fatigue and joint pain, reporting that plaintiff is beset by profound fatigue, Raynaud's Phenomenon, and joint pain with morning stiffness. Based on the information provided, including the diagnosis of lupus, Hartford approved plaintiff's STD benefits.

  Plaintiff received STD benefits from January 15 through April 22, 2001. She returned to work on April 23, 2001, her lupus having improved, but then permanently ceased working at IMC after May 14, 2001, when her condition worsened.

  In June 2001 Hartford wrote plaintiff informing her that to extend her benefits past July 3, 2001, her physician needed to supply a letter indicating her current condition, treatment, restrictions/limitations and expected return to work date. The following month, Hartford again wrote plaintiff to inform her that her STD benefits were set to expire on August 8, 2001. Enclosed with the letter was a "Long Term Disability Income Benefits Questionnaire" to begin plaintiff's application for LTD benefits. Hartford again informed plaintiff that she needed to provide a detailed update from her attending physician with regard to her current condition, treatment plan, restrictions and prognosis for returning to work. Plaintiff submitted that questionnaire on July 18, 2001, in which she listed Dr. Margules as the physician providing the first medical attention for her current disability. Plaintiff also listed that she had consulted with Dr. Lana Peters, whom she had seen on referral from Dr. Margules in September 2000. Plaintiff had two out-patient visits with Dr. Peters, Phd., a psychotherapist, who gave a provisional diagnosis of "Depressive Disorder NOS" (not otherwise specified) and recommended continued treatment with antidepressant medication and outpatient psychotherapy. Despite this recommendation, plaintiff did not see another mental health care provider for ten months, when she saw Dr. James Marks, a psychiatrist on July 20, 2001. Dr. Marks diagnosed plaintiff with dysthymia, a disorder with similar but longer-lasting and milder symptoms than clinical depression, and suggested that she return to see Dr. Peters for psychotherapy. Dr. Marks scheduled a return visit for three weeks later and planned to continue managing plaintiff's psychiatric pharmacologic treatment on a regular basis. Plaintiff never returned to Dr. Marks.

  On September 10, 2001, Dr. Margules completed an Attending Physician Statement of Disability. In that statement, Dr. Margules listed plaintiff's primary diagnosis as depression, with a secondary diagnosis of lupus, and noted that plaintiff had retrogressed. Dr. Margules also indicated that plaintiff was "impaired by arthralgia of small joints of hands, weakness, lassitude, and by feelings of emptiness and non-value of life.

  On September 24, 2001, a Hartford benefits examiner, Terrian Weyer noted symptoms of lupus and Raynaud's syndrome, both of which can cause significant depression. Weyer also determined that plaintiff was "co-morbid" for physical and mental nervous symptoms and that she had a high risk of depression for ...


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