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Gibala v. Eaton Corporation Long Term Disability Plan for U.S. Employees

November 30, 2006

ANGELINE GIBALA, PLAINTIFF,
v.
EATON CORPORATION LONG TERM DISABILITY PLAN FOR U.S. EMPLOYEES, DEFENDANT.



The opinion of the court was delivered by: Magistrate Judge Geraldine Soat Brown

MEMORANDUM OPINION AND ORDER

Before the court are cross-motions for summary judgment filed by Plaintiff Angeline Gibala ("Gibala") and Defendant Eaton Corporation Long Term Disability Plan for U.S. Employees ("the Plan"). For the reasons set forth below, the Plan's motion [dkt 26] is granted and Gibala's motion [dkt 30] is denied.

JURISDICTION

Gibala alleges that the termination of her long-term disability benefits was wrongful under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). (Compl. ¶ 4.) [Dkt 1.] Federal jurisdiction therefore exists in this case under 29 U.S.C. § 1132(e)(1). The parties consented to the jurisdiction of a magistrate judge [dkt 10], and this case was assigned to this court pursuant to 28 U.S.C. § 636(c) [dkt 9].

BACKGROUND*fn1

Gibala was employed as an inventory clerk for approximately five years by Eaton Corporation ("Eaton") until March 9, 1995, when she stopped working due to pain in her back and legs. (Pl.'s LR Resp. ¶¶ 4, 6; Def.'s LR Resp. ¶¶ 7, 11.) As a benefit of her employment, Gibala participated in an employee welfare benefit plan that was sponsored, maintained, funded, and administered by Eaton. (Def.'s LR Resp. ¶ 8.) The named defendant in this case (i.e., the "Plan") is the benefit plan in which Gibala participated, and is an "employee welfare benefit plan" as defined by ERISA, 29 U.S.C. § 1002(a). (Def.'s LR Resp. ¶ 8.) Gibala was a "participant" of the Plan, as defined by ERISA, 29 U.S.C. § 1002(7). (Def.'s LR Resp. ¶ 8.)

After Gibala stopped working, Eaton, through its third-party administrator Broadspire Services Inc. ("Broadspire"), awarded Gibala long term disability benefits under the Plan. (Def.'s LR Resp. ¶ 10; Pl.'s LR Resp. ¶ 6.) Eaton paid Gibala such benefits for approximately nine years after she stopped working. (Def.'s LR Resp. ¶ 10; Pl.'s LR Resp. ¶ 6.) Broadspire terminated Gibala's benefits after Gibala was physically examined by her treating physician and another evaluator, who both reported Gibala was capable of light to sedentary work. (Pl.'s LR Resp. ¶¶ 12, 14, 17.) The parties agree that all administrative or internal appeals required by ERISA have been exhausted. (Def.'s LR Resp. ¶ 4.) The issue raised by each party's motion is whether the administrator's decision to terminate Gibala's benefits was arbitrary and capricious, i.e., whether there is no rational support in Gibala's medical record for the administrator's decision.

I. The Plan's Relevant Terms

The Plan's definition of "covered disability" in the first 24 months of disability is different from the definition thereafter. (See Def.'s LR Resp. ¶ 9.) Since the initial 24-month period expired in approximately September 1997, the only definition relevant to this action is the definition Gibala was required to meet since that time: "totally and continuously unable to engage in any occupation or perform any work for compensation or profit for which [she is], or may become, reasonably well fitted by reason of education, training or experience." (Pl.'s LR Resp. ¶ 9; Def.'s LR Resp. ¶ 9; AR 00047.)

The Plan also requires that a covered disability be supported by "objective findings", defined as "findings . . . that can be observed by your physician through objective means, not just from your description of the symptoms." (AR 00052.) The Plan lists the following particular examples of objective findings:

* Physical examination findings (functional impairments/capacity);

* Diagnostic tests results/imaging studies;

* Diagnosis;

* X-ray results;

* Observation of anatomical, physiological or psychological abnormalities; and

* Medications and/or treatment plan. (AR 00052.)

II. Initial Award and Termination of Gibala's Long Term Disability Benefits

The record suggests that Gibala's medical condition began in 1992, when she fell and injured her back. (See Def.'s LR Resp. ¶ 14.) It is undisputed that Gibala stopped working on March 9, 1995 due to severe pain in her back, that she applied for long term disability benefits at some point thereafter, that Eaton awarded her such benefits, and that she began receiving them on September 5, 1995. (Def.'s LR Resp. ¶¶ 7, 10; Pl.'s LR Resp. ¶¶ 4, 6.) Gibala had several surgeries during the period in which she received benefits, including back surgery*fn2 in November 1995 (Def.'s LR Resp. ¶ 14), knee surgery*fn3 on March 18, 1998 (see Def.'s LR Resp. ¶ 14; AR 00090, 00244), and ankle surgery*fn4 in February 2003 (Def.'s LR Resp. ¶ 18).

It appears from the record that the administrator of the Plan monitored Gibala's physical condition during periodically the disability period. (See Pl.'s LR Resp. ¶ 10.) For example, Gibala underwent a physical examination, called a Functional Capacities Evaluation ("FCE"), in February 1998 at HealthSouth Rehabilitation Center. (See Def.'s LR Resp. ¶ 26; AR 00134-35.) The 1998 FCE concluded Gibala was not employable (AR 00135), and Gibala continued to receive benefits thereafter.

Broadspire also asked Gibala to periodically provide updated medical information. (Pl.'s LR Resp. ¶ 10.) Apparently as a result of one such request, Gibala submitted two forms completed by her treating physician, Dr. Stanislaw Maslanka in or about November or December 2003. (Pl.'s LR Resp. ¶¶ 11, 12.) Dr. Maslanka indicated on both forms that Gibala was capable of performing "sedentary" or "light" work. (AR 00160, 00161.)

Specifically, on one of the forms, Dr. Maslanka checked a box next to the statement "Marked limitation of functional capacity/capable of sedentary work." (AR 00160 (emphasis added).) He did not check the box for the statement "Severe limitation of functional capacity/incapable of sedentary work." (Id.) He also noted that Gibala had achieved maximum medical improvement and that her prognosis was "poor." (Id.; Pl.'s LR Resp. ¶ 12.) On the other form, Dr. Maslanka checked a box next to the statement, "Sustainable (8-hour) energy expenditure" and indicated that Gibala was capable of "light" work.*fn5 (AR 00161.) While he noted that Gibala should "never" be stooping, crouching/squatting, kneeling, or crawling, there were other activities that she could do "frequently" or "constantly," such as reaching, walking, or sitting. (Id.)

Apparently Dr. Maslanka's reports prompted the Plan to initiate two peer reviews of Gibala's medical file. Neither peer reviewer personally examined Gibala, although each reviewed Gibala's available medical records. (Pl.'s LR Resp. ¶ 13; see also Def.'s LR Resp. ¶¶ 27, 28.) Each peer reviewer concluded that the available records did not support that Gibala was disabled from working at any occupation. (AR 00130-31, 00133.) Dr. Wendy Weinstein, a specialist in internal medicine, relied on, among other records, Dr. Maslanka's evaluation, as well as a statement by Gibala that she is able to cook, shop, do laundry, dust and do the dishes, and that she tries to go to church, watches some TV, reads, and works on the internet for a few minutes at a time. (AR 00130-31.) Dr. Vaughan Cohan, a neurologist, concluded that there was "no evidence to support continued disability for any occupation," noting that there was insufficient documentation to determine "whether the claimant has objective impairment with respect to her low back." (AR 00133.)

It appears that Dr. Maslanka's reports also prompted the Plan to initiate another FCE by HealthSouth, as well as a vocational assessment, to identify suitable and available jobs for Gibala. That FCE, conducted in March 2004, concluded that Gibala "is currently demonstrating the ability to perform at the 'Light' physical demand level within the material handling and positional tolerances set forth in this report . . . ."*fn6 (Pl.'s LR Resp. ¶ 14; AR 00141.) The FCE report noted that Gibala could sit for 2 1/2 to 5 1/2 hours per day, stand for 2 1/2 to 5 1/2 hours per day, and walk for 2 1/2 to 5 1/2 hours per day. (Def.'s LR Resp. ¶ 23; AR 00143.) The FCE evaluator also noted that Gibala "appeared to give consistent effort throughout the evaluation. However, her subjective reports of pain . . . were not supported by her physiological response as her heart rate decreased from 69 bpm to 62 bpm." (Pl.'s LR Resp. ¶ 14; AR 00141.)

Gibala's vocational assessment involved two reports, the Employment Assessment Report and the Labor Market Survey. The Employment Assessment Report identified several positions that were all "close or good matches" for Gibala's past relevant work, including Sorter/Pricer, Expediter Clerk, and Mail Clerk. (Pl.'s LR Resp. ¶ 15; AR 00119.)*fn7 The Labor Market Survey identified five specific job openings in Plaintiff's geographical area that were purportedly appropriate functionally and economically, including two that were considered "light duty" and three that were considered "sedentary/light duty." (Pl.'s LR Resp. ¶ 16.) The jobs identified were a temporary receptionist position, three permanent receptionist positions, and a temporary office clerk position. (AR 00126-28.)

Broadspire terminated Gibala's long term disability benefits as of September 30, 2004, shortly after the peer reviews, FCE, and vocational assessments ...


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