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Ragsdale v. Aetna Life Insurance Co.

June 27, 2007

MARIE E. RAGSDALE, PLAINTIFF,
v.
AETNA LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Judge Robert W. Gettleman

MEMORANDUM OPINION AND ORDER

Plaintiff Marie E. ("Elaine") Ragsdale filed a complaint against defendant Aetna Life Insurance Company ("Aetna"), alleging unlawful denial of disability benefits under ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B).*fn1 The parties have filed cross motions for summary judgment pursuant to Fed. R. Civ. P. 56. For the reasons discussed below, defendant's motion for summary judgment is granted, plaintiff's motion for summary judgment is denied, and the denial of benefits is affirmed.

FACTS*fn2

Plaintiff was employed as a project manager by Central DuPage Hospital. Plaintiff was a participant in the Central DuPage Health Welfare and Flexible Benefits Plan ("the Plan"), underwritten by defendant, to which she paid premiums for long term disability insurance. The Summary Plan Description identified the "Plan Sponsor" as Central DuPage Health and the "Plan Administrator" as Vice President of Human Resources, Central DuPage Health.

In November 2002, plaintiff was bitten by a tick and began suffering from symptoms associated with lyme disease, including nausea, vomiting, skin rashes, chronic fatigue, and memory loss. Plaintiff sought treatment from four different physicians, all of whom believed that plaintiff had contracted lyme disease. Plaintiff first sought treatment from Dr. Anette Mnabhi, DO, on January 7, 2003. Dr. Mnabhi discussed antibiotic treatment with plaintiff and treated her with homeopathic remedies through February 13, 2003. Dr. Mnabhi referred plaintiff to Dr. Joseph Mercola, who treated plaintiff with diet and herbal treatments from February 23, 2003, through April 1, 2003. From May 10, 2003 to November 4, 2003, Dr. Thomas Hesselink, MD, treated plaintiff with antibiotics. On September 9, 2003, Dr. Hesselink provided a note to Central DuPage authorizing plaintiff to return to work on September 15, 2003, stating that plaintiff was "advised against overtime, regular 40 hour week is acceptable." Dr. Rindie Coker, a naprapath specializing in connective tissue disorders, treated plaintiff with nutritional therapy and neuromodulation beginning in March 2004.

Plaintiff continued to work for the hospital for two years after contracting lyme disease. On multiple occasions, plaintiff took leaves of absence as a result of her symptoms. On May 13, 2005, plaintiff stopped working because her symptoms rendered her unable to perform her job duties.

On August 1, 2005, plaintiff applied for long term disability benefits pursuant to the Plan, which would have provided plaintiff with 50% of her monthly salary. Plaintiff submitted medical records from Dr. Coker, including a narrative from December 5, 2005, which stated that plaintiff's lyme disease was chronic, even with proper antibiotic treatment. Dr. Coker's report also stated that plaintiff was "not at this time totally disabled" and was "capable of sedentary work activity," defined as "moderate limitation of functional capacity. Exerting up to 10 pounds of force occasionally. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time." Dr. Coker also stated that plaintiff had "no limit on ADL [activities of daily living]/driving. May not push past fatigue or be in continually stressful situating [sic] subject herself to increased risk of infection."

Plaintiff also submitted a Work History and Educational Questionnaire dated August 1, 2005. In that questionnaire, she stated that in her work for Central DuPage, she spent five hours per day sitting, one hour standing, and two hours walking. She stated that she occasionally bent or stooped, reached above her shoulders, knelt, pushed or pulled, and lifted up to ten pounds. Additionally, plaintiff provided a Capabilities and Limitations Worksheet completed by Dr. Coker on August 4, 2005. Dr. Coker stated in that worksheet that plaintiff could: (1) continuously sit; (2) frequently do fine and gross manipulation and repetitive motion, stand, sit, walk, and lift up to five pounds; and (3) occasionally grasp objects with her hands, lift six to ten pounds, kneel, push, pull, reach above her shoulders, reach forward, carry objects, bend, and twist. Dr. Coker also stated that plaintiff could operate a motor vehicle. Plaintiff asked if additional medical records were necessary; defendant told her it needed only the records from Dr. Coker.

On August 25, 2005, plaintiff underwent an adrenal stress test. Plaintiff tested "normal" for three of the four tests on that day, and her overall cortisol "burden" was within the normal range.

At the time plaintiff submitted her application for disability benefits, the Plan defined "total disability" as follows:

You will be deemed to be totally disabled while either of the following applies to you:

* During the period which ends right after the first 48 months benefits are payable in a period of total disability:

You are not able, solely because of injury or disease, to perform the material duties of your own occupation; ....

* Thereafter during such period of total disability: You are not able, solely because of injury of disease, to ...


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