The opinion of the court was delivered by: Judge Blanche M. Manning
Plaintiff Jennifer Guerrero was denied short-term disability benefits by defendant Hartford Financial Services Group ("Hartford"), claims administrator for defendant The Northern Trust Company Welfare Benefit Plan ("Plan"). Guerrero filed suit alleging that the administrator's denial of benefits was unreasonable, arbitrary and capricious, and in violation of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001, et seq. The parties have cross-moved for summary judgment. For the reasons stated below, the defendants' motion is granted and the plaintiff's motion is denied.
A. The Northern Trust STD Plan
The plaintiff worked as a desktop specialist for The Northern Trust Company. She was eligible to participate in the short-term disability (STD) benefit program, which is part of the Northern Trust Employee Welfare Benefit Plan. Defendant Hartford administered short-term benefits under the plan. Defendant The Northern Trust Company Employee Benefit Administrative Committee is the plan administrator.
Northern Trust entered into a Disability Plan Claim Administration Service Agreement with CNA Group Life Assurance Company. The service agreement designated CNA Group Life Assurance Company ("CNAGLAC") as claims administrator of the STD benefits portion of the plan. Pursuant to that authority, CNAGLAC was to determine eligibility for benefits and interpret the provisions of the Plan, and was the party responsible for managing appeals and rendering final claim determinations on behalf of the Plan. Hartford replaced CNAGLAC as the claims and appeal administrator when Hartford acquired CNAGLAC. The STD benefits are fully funded from the general assets of The Northern Trust Company and not from the proceeds of any insurance policy.
The plan is described in a summary plan description called "Your Sourcebook: A Guide to Your Welfare Benefits." The sourcebook states that a "'short-term' disability is defined as a physical or mental impairment that totally prevents you from performing the material and substantial duties of your regular occupation." If a clamaint is found eligible for STD benefits, the benefits continue until a clamaint is no longer disabled from work or up to the 90th calendar day of his or her disability, whichever happens first. The sourcebook also states that the claimant's health care provider is required to provide the plan's disability specialist with medical information to substantiate the disability. It goes on to indicate that "[t]his information is required at the onset of the disability, from time to time during extended disabilities, and could include requiring you to submit to an independent medical exam or tests . . . ."
If Hartford denies a claim, an "adverse benefit determination" (ABD) will be sent in a notice to the claimant. The sourcebook provides that "[i]n deciding an appeal of any ABD that is based in whole or in part on a medical judgment, the Appeals Administrator will consult with a health care professional (who is not the same individual consulted in connection with the ABD nor a subordinate of the individual) who has appropriate training and experience in the field of medicine involved in the medical judgment."
When she provided notice of her STD claim, the plaintiff indicated her last day of work as a desktop specialist was June 24, 2004. Hartford opened a file on June 29, 2004, contacted the plaintiff, and sent her treating physician, Dr. Beverlee Brisbin, a Medical Assessment Tool/Back Pain (MAT) form and request for the plaintiff's records. By July 14, 2004, Hartford had not received a response despite a follow-up call on July 1, 2004. Therefore, Hartford notified the plaintiff that it was suspending the processing of her claim until it received the information it had requested from Dr. Brisbin.
Dr. Brisbin returned the MAT form on July 15, 2004, which indicated that the estimated return to work date was "unknown until re-evaluated on August 9, 2004." Then, on July 21, 2004, Dr. Brisbin faxed Hartford an MRI examination and chart notes documenting one office visit on or around June 21, 2004, and one telephone message left with the plaintiff. A notation made by another individual dated June 30, 2004, states that Dr. Brisbin recommended two physical limitations: that the plaintiff change positions every 30 minutes and not lift more than 10 pounds.
Dr. Brisbin's June 21, 2004, treatment notes indicate, among other things, that the plaintiff had complaints of low back pain, and had therapy which helped somewhat. Further, the pain she had in her leg had resolved, and she had no numbness, paresthesia, or incontinence. The treatment notes further indicate that the plaintiff tried various anti-inflammatory medications with limited relief, and that the pain was usually worse when sitting or standing for prolonged periods of time. These notes also indicated that the plaintiff works out on a regular basis and that the plaintiff's weightlifting and elliptical training aggravated her symptoms.*fn1
Further, the notes indicate as follows: no fever or chills; no prior history of injury; walked with a normal gait; was able to heel and toe walk without difficulty; no focal tenderness of the cervical, thoracic and lumbosacral spine; no tenderness over the greater trochanters or sciatic notch; a focal tenderness over the right proximal SI joint area; good range of motion with forward flexion and extension at the hip; lower extremity reflexes 2/4 bilaterally; strength is 5/5; sensation intact except for mild diminished sensation in the right medial ankle area; negative seated and supine straight leg raise test; positive Faber test on the right; able to do a straight leg test without difficulty; and has good rotation of the hip.
Moreover, outside x-rays of the spine showed well-preserved disc height space and normal alignment. An MRI indicated some disc protrusion at the L4-5 level but without foraminal narrowing.
The doctor concluded that the plaintiff had "low back pain, right sacroiliitis, piriformis syndrome." It was further noted that while the plaintiff showed some degenerative disc disease, her exam was "relatively unremarkable except for the sensory discrepancy on the right." The doctor stated that "her most focal findings seem to be the SI joint," and that before considering epidural injections, she would recommend physical therapy. The notes further state that the plaintiff could continue with activities as tolerated but she should avoid those that provoke her symptoms. Finally, the doctor noted that the plaintiff should follow-up in four to five weeks, and if she was not improving, could benefit from epidural injections.
Further, notes by Michelle Class, an employee of Hartford, indicate that the plaintiff told her during a phone conversation that if she was "up" for a couple of hours, she needed to lie down, that she "tries to rest and not sit too much," "lays down mostly," and that it is "[h]ard to find a comfortable spot as leg hurts if in one position too long." Another Hartford employee's notes indicate that the plaintiff's job as a desktop specialist require her to sit 90% of the time with 10% standing and walking.
On July 27, 2004, Hartford called and left a message for Dr. Brisbin to inquire about the doctor's restrictions that the plaintiff change positions every 30 minutes and not lift more than 10 pounds. Although it appears that Dr. Brisbin was aware of the plaintiff's position as a computer specialist, which the doctor described in her notes as "predominantly sedentary," there is no indication in the record that Dr. Brisbin was aware of the plaintiff's specific job duties.
When Hartford received no response to the July 27 message, it placed a second call on July 29, 2004. On August 2, 2004, Dr. Brisbin's office faxed the same records sent on July 21 as well as a letter dated June 23, 2004, stating that the plaintiff should not return to work until the next evaluation on August 9, 2004. The letter stated that the plaintiff had been diagnosed with sacroilitis piriformis syndrome but did not indicate specifically why the plaintiff should remain off work.
In the meantime, Hartford contacted the plaintiff's supervisor, Gloria Wilson, who indicated that the job of a desktop specialist requires the plaintiff to be seated at a computer with some standing and walking to a printer. Wilson told Hartford that the plaintiff is able to stand and stretch when needed and can do any lifting of copies and materials "little by little or as she is able." Hartford's notes of its conversation with Wilson also state that she could not give a specific weight of the papers that need to be lifted by desktop specialists, but that it could be thousands of papers. Hartford also spoke with the plaintiff and verified that she reportedly ceased work due to back pain, which she attributed to sitting too long. The plaintiff reported to Hartford that she was attending physical therapy, was doing home exercises and was not "taking any RX." The plaintiff also confirmed with Hartford that in her job as a desktop specialist she was primarily seated but that she had the option to stand when needed.
C. The Defendants' Denial and Appeal
On August 23, 2004, Hartford advised the plaintiff that her claim for STD benefits had been denied. Among other things, the denial stated that the desktop specialist position required sitting at a desk using a computer with no lifting requirements. The letter also stated: "Although we do not dispute that small disc protrusion with slight compression of thecal sac may cause some occasional discomfort this does not suggest a functional impairment that would prevent you from performing work in a seated position with the ability to stretch as needed for comfort. Also, the restrictions noted by your physician are within the requirements of your job . . ."
On October 1, 2004, Hartford received a letter from the plaintiff dated September 24, 2004, which stated, among other things, that she was in pain from a bulging disc. The letter also stated "As far as Dr. Brisbin's results from tests, I can't explain." The plaintiff stated that she could not stretch at work because stretching required her to be on the floor which she did not believe could be done in business attire. Moreover, the plaintiff stated that she believed her job was hard to perform when she was restricted to lifting 10 pounds, and that her job required lifting copies which were sometimes hundreds or even thousands of pages as well as lifting boxes that were half her weight. Further, the plaintiff noted that her job requires her to put boxes of paper on a cart, bring the cart to the print room, and unload the reams on shelving unit. The plaintiff also stated that her back problem made sitting unbearable and walking and climbing stairs more challenging. She also stated that she had frequently been brought to tears due to the severity of the pain. Further, the plaintiff indicated that she had been through physical therapy and had had two epidural injections, which were painful and had not been helpful.
With the September 24, 2004, letter, the plaintiff included: (1) a note from Dr. Brisbin dated August 9, 2004, indicating that the plaintiff was not able to return to work until she was reevaluated on August 23, 2004; (2) a prescription for physical therapy dated June 21, 2004; (3) pain management discharge summaries from Little Company of Mary Hospital dated August 27, 2004, and September 8, 2004;*fn2 (4) a request for leave under the FMLA dated August 8, 2004; and (5) a Certification of Health Care Provider form dated August 23, 2004, signed by Dr. Brisbin stating that the plaintiff was unable to perform all essential functions of her job and that the plaintiff has been "off work completely from June 21, 2004, and continuing until tests are completed" and that work status ...