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Williams v. Aetna Life Insurance Co.

September 28, 2006

LEE K. WILLIAMS, PLAINTIFF,
v.
AETNA LIFE INSURANCE CO. AND THE SYSCO CORPORATION GROUP BENEFIT PLAN, DEFENDANTS.



The opinion of the court was delivered by: Judge Ronald A. Guzmán

MEMORANDUM OPINION AND ORDER

Lee K. Williams has sued Aetna Life Insurance Co. ("Aetna") and the SYSCO Corporation Group Benefit Plan ("the Plan") pursuant to § 1132(a)(1)(B) of the Employee Retirement Income Security Act ("ERISA"), claiming that he was wrongfully denied long-term disability benefits. The case is before the Court on plaintiff's motion to strike the affidavits of Kaz Takashima ("Takashima") and the parties' cross-motions for summary judgment pursuant to Federal Rule of Civil Procedure ("Rule") 56. For the reasons set forth below, plaintiff's motion to strike and for summary judgment are denied and defendants' motion for summary judgment is granted.

Facts*fn1

The Plan is maintained by SYSCO to provide, among other things, long-term disability ("LTD") benefits to its employees. (Def.'s LR 56.1(a)(3) Stmt. ¶ 5.) Aetna is the underwriter for the LTD policy issued to SYSCO and the claims administrator for the LTD component of the Plan. (Id. ¶ 4; R. at 000029.) As claims administrator, Aetna is vested with "discretionary authority to: determine whether and to what extent employees and beneficiaries are entitled to benefits; and construe any disputed or doubtful terms of [the] policy." (R. at 000029, 000063-64.)

From November 1, 1994 to July 26, 2002, plaintiff was employed as a truck driver for the SYSCO corporation and was a participant in the Plan. (Pl.'s LR56.1(a) Stmt. ¶¶ 7-8.)

On July 26, 2002, Williams began to feel ill at work and was subsequently admitted to the hospital with complaints of shortness of breath, dizziness, and cough. (Id. at ¶ 17.) After plaintiff was released from the hospital, he continued to suffer from a variety of ailments, including extreme fatigue. (Id. ¶¶ 18-41.) For months thereafter, Williams visited numerous doctors and underwent a myriad of tests, all of which produced normal results. (Id.) Finally, in late 2002, Williams was diagnosed with Chronic Fatigue Syndrome ("CFS").*fn2 (R. at 000293.) As a result, in February 2003, plaintiff applied for LTD benefits from the Plan. (Id. at 000752.)

In March 2003, SYSCO completed a physical demand analysis for plaintiff's job, which it sent to Aetna. (Id. at 000492.) The analysis indicated that Williams' truck driver job required him to: (1) climb ladders, kneel, twist and stoop occasionally; (2) push, pull and reach frequently; (3) lift, carry and bend continuously; (4) grasp and engage in fine and gross manipulations frequently; (5) sit, stand, walk and climb stairs frequently; (6) lift up to twenty pounds continuously; (7) lift up to fifty pounds frequently; and (8) lift over fifty pounds occasionally. (Id.)

On May 5, 2003, Dr. Burton, a medical examiner employed by Aetna, reviewed Williams' medical records and concluded that they did not show that plaintiff had "a diagnosable medical condition that explain[ed] his subjective symptoms of fatigue" or that he lacked the functional capacity to drive a truck for SYSCO. (Id. at 000694.)

According to defendants, the Plan denied Williams' claim on May 12, 2003, though the denial letter is incorrectly dated April 25, 2003. (Id. at ¶ 46; Defs.' Proposed Findings Fact Supp. Mot. Summ. J., Takashima Aff. ¶ 12; Defs.' Add'l Proposed Findings Fact Opp'n Pl.'s Resp. Defs.' Mot. Summ J., Takashima Supp. Aff. ¶¶ 6-10.)

On August 11, 2003, Dr. Sorin, Williams' treating physician, completed and submitted to Aetna a CFS residual functional capacity questionnaire regarding Williams. (Pl.'s LR56.1(a) Stmt. ¶ 50.) Among other things, the questionnaire says that Williams can walk only one or two city blocks without rest; can stand or walk for less than two hours of an eight-hour work day; needs a job in which he can shift positions at will; will frequently need to take thirty-minute rest breaks while working; can lift less than ten pounds, twist, bend, crouch, and climb ladders or stairs only occasionally; and has significant limitations doing repetitive reaching, handling and fingering. (R. at 000285-86.)

Dr. Sorin did not, however, provide the results of any functional testing to support his conclusions. (Id.) Nor did he provide all of the information requested by the questionnaire. In the section asking how long Williams can sit or stand at one time, Dr. Sorin wrote "Unknown." (Id. at 000285.) Similarly, in the section asking the percentage of time in an eight-hour day that Williams can grasp, turn and twist objects, perform fine manipulations with his fingers and reach over head with his arms, Dr. Sorin wrote "Untested." (Id. at 000286.)

In September 2003, plaintiff appealed the denial of his claim. (Pl.'s LR56.1(a) Stmt. ¶ 52.)

In a letter dated January 9, 2004, the Plan denied plaintiff's appeal because there was insufficient evidence to support Williams' contention that he was unable to perform the functions of his job. (R. at 000740-42.)

On July 28, 2004, plaintiff requested his administrative claim file from defendants and informed defendants that the Social Security Administration had found him disabled. (Pl.'s LR56.1(a) Stmt. ¶ 54.) Thereafter, he filed this suit.

Discussion

Motion to Strike

In connection with the summary judgment motions, defendants have submitted two affidavits from Kaz Takashima, the claims analyst who handled plaintiff's claim. In both affidavits, Takashima asserts that he sent to Williams the letter denying his LTD claim on May 12, 2003. (See Defs.' Proposed Findings Fact Supp. Mot. Summ. J., Takashima Aff. ¶ 12; Defs.' Add'l Proposed Findings Fact Opp'n Pl.'s Resp. Defs.' Mot. Summ J., Takashima Supplemental Aff. ¶¶ 6-10.) In the second affidavit, Takashima says that the April 25, 2003 date on the denial letter was an error that resulted from his use of another letter of that date as a template. (Defs.' Add'l Proposed Findings Fact Opp'n Pl.'s Resp. Defs.' Mot. Summ J., Takashima Supplemental Aff. ¶¶ 8-10.) Plaintiff asks the Court to strike the affidavits because they disclose Takashima's mental processes, which are irrelevant under the arbitrary and capricious standard of review that applies to this case and, in any event, were filed too late to enable plaintiff to take discovery on them.

It is true, as plaintiff asserts, that the Court cannot properly inquire into the plan administrator's mental processes on arbitrary and capricious review. See Perlman v. Swiss Bank Corp. Comprehensive Disability Prot. Plan, 195 F.3d 975, 982 (7th Cir. 1990). But mental processes are "the thought processes of [Aetna's] staff, the training of those who considered [plaintiff's] claim, and in general who said what to whom within [Aetna]." Id. at 981. These affidavits do not contain any of that information. They simply explain a typographical error in the denial letter. Thus, Perlman does not require that they be stricken.

Plaintiff's second argument, that they will be prejudiced if the affidavits are allowed to stand, is no more persuasive. Though the affidavits explaining the date discrepancy were not filed until after discovery closed, the existence of the discrepancy is apparent from the claim file, which was produced during discovery. (Compare R. at 000297 (denial letter dated April 25, 2003) with id. at 000296 (Aetna Notice of Disability to SYSCO stating that Williams' claim was denied on May 12, 2003).) Therefore, plaintiff could have explored the issue during discovery. In addition, regardless of the status of discovery, plaintiff could have countered Takashima's affidavits with evidence of his own; an affidavit, perhaps, attesting that he had received the denial letter before May 12, ...


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