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Jenkins v. Price Waterhouse Long Term Disability Plan

March 31, 2008


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


Before the Court are cross-motions for summary judgment (Docs. 48, 50, 53) and related motions to stay and to strike (Docs. 56, 59). The parties have filed responses to the cross motions (Docs. 61, 62, 63) and replies (Docs. 67, 69). The Court notes that plaintiff has filed responses to the defendants' motions for summary judgment, although he contends that he needed additional time to respond to PricewaterhouseCoopers's ("PwC") motion, in light of the time that has passed, and the lack of a supplement to the motion, the Court DENIES plaintiff's motion to stay. (Doc. 56).


Plaintiff, a resident of Maryville, Illinois, was employed as a Senior Accounting Consultant for defendant PwC from 1989 to December 1993. At the end of 1993, plaintiff was forced to cease working for the defendant when he developed symptoms of the Human Immunodeficiency Virus ("HIV"). These symptoms included: "extreme fatigue, lower extremity neuropathy, decreased sensation in fingers, bilateral manual dexterity limitations, and other opportunistic infections including condylomata, mysitis and allergic rhinitis." (Amended Complaint, Doc. 25).

Plaintiff then made a claim for benefits under defendant's Long Term Disability Plan (LTD). The LTD plan was underwritten by the Connecticut General Life Insurance Company (CGLIC), under policy No. 0303220, the plan administrator. Upon demonstrating that he was eligible for the LTD benefits by submitting various medical records and reports, it was determined that plaintiff was entitled to benefits of $2,550 per month.

From June 1994 to January 2006, the LTD paid plaintiff in full the $1,389 per month owed to him pursuant to the LTD plan's terms. Plaintiff claims that on January 5, 2006, the LTD ceased making payments to him. In addition, on August 1, 2006, he was terminated as an employee by defendant PwC and thus lost all benefit related to his employment with the defendant. Plaintiff also claims that after his termination he submitted to CGLIC multiple records and reports objectively indicating his inability to work. Notwithstanding these submissions, CGLIC and LTD did not reinstate his benefits or his employment.


The parties have filed cross motions for summary judgment. Plaintiff seeks partial summary judgment seeking judgment against LTD and against Connecticut General Life CGLIC under Group Policy No. 0303220, while his claim against PwC remains to be determined (Doc. 48). Defendants LTD and CGLIC have not only filed an opposition to that motion (Doc. 61), but have also filed a cross motion for judgment based on the administrative record (Doc. 50). Defendant PwC has filed its own motion for summary judgment and plaintiff has filed a joint response to these motions. (Doc. 63).

A. LTD and CGLIC's Motion for Summary Judgment

1. Plaintiff's Medical Review History

The record in this case is relatively simple, given that it involves a complicated medical claim. Plaintiff, who suffers from HIV, received benefits from the defendants for a period from 1994, after his diagnosis, until 2006. Defendants LTD and CGLIC assert that the termination of benefits was based upon its determination, after re-evaluations of the plaintiff in 2004-2006 that the plaintiff could obtain work, and therefore was no longer eligible for disability benefits.

The record reveals that after June of 1999, in order to continue to qualify for benefits, plaintiff had to submit evidence that he was unable to perform duties of any occupation for which he was or may reasonably have become qualified. This would take into account his education, training and experience (Administrative Record 863). In 2004, plaintiff was examined by Dr. Scott Taylor, who reviewed plaintiff's medical records and conferred with plaintiff's primary care physician, Dr. Prelutsky. Dr. Taylor concluded that it was possible, based on the medical records, for plaintiff to return to work (Admin. R. At 1062). In January of 2005, Dr. Barry Kerns determined, after reviewing plaintiff's medical records and conferring with Dr. Prelutsky, that plaintiff's HIV condition did not prevent him from performing light duty or sedentary work (Admin. R. At 989-993).

In June of 2005, Dr. Karen Shockley conducted an independent medical examination of the plaintiff. During that examination, plaintiff, himself, stated to her that he believed he could work an eight hour day (Admin. R. 399), and Dr. Shockley concluded that plaintiff could work an eight hour day of sedentary work, but over a forty hour workweek would require frequent work breaks or work absences (Admin R. 399).

In August of 2005, plaintiff underwent a Functional Capacities Examination, administered by Kathleen Schmidt, physical therapist, who concluded that the plaintiff could work a medium level job at a ...

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