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Bake v. Life Insurance Company of North America

August 26, 2008

JANICE BAKE, PLAINTIFF,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, DEFENDANT.



The opinion of the court was delivered by: Samuel Der-Yeghiayan United States District Court Judge

MEMORANDUM OPINION

SAMUEL DER-YEGHIAYAN, District Judge

This matter is before the court on Defendant Life Insurance Company's ("LINA") motion for summary judgment. For the reasons stated below, we deny the motion for summary judgment.

BACKGROUND

Plaintiff Janice Bake ("Bake") alleges that she was employed by Corus Bank ("Corus") until June 2006, when she was forced to stop work due to a severe degenerative disease of the spine. After ceasing employment, Bake allegedly made a claim for long-term disability ("LTD") benefits under an employee benefits plan ("Benefits Plan"), which was administered under a group policy ("Group Policy"). LINA is allegedly the underwriter and insurer of the Benefits Plan. Bake states that she also applied for and was ultimately awarded Social Security disability benefits. In November 2006, LINA denied Bake's claim for LTD benefits. Bake allegedly submitted an administrative appeal and included medical evidence from her treating physicians in support. LINA allegedly denied the appeal, and Bake filed a second administrative appeal. LINA then allegedly denied the second appeal. Bake then brought the instant action seeking a review, pursuant to 29 U.S.C. § 1132 of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"), of LINA's decision to deny her claim for LTD benefits. On April 4, 2008, we denied LINA's motion for a protective order. In ruling on the motion, we held that the proper standard of review in this case is the de novo standard of review since the Group Policy did not contain discretionary language for the administrator's decisions. LINA now moves for summary judgment.

LEGAL STANDARD

Summary judgment is appropriate when the record, viewed in the light most favorable to the non-moving party, reveals that there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c). In seeking a grant of summary judgment, the moving party must identify "those portions of 'the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,' which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)(quoting Fed. R. Civ. P. 56(c)). This initial burden may be satisfied by presenting specific evidence on a particular issue or by pointing out "an absence of evidence to support the non-moving party's case." Id. at 325. Once the movant has met this burden, the non-moving party cannot simply rest on the allegations in the pleadings, but, "by affidavits or as otherwise provided for in [Rule 56], must set forth specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56(e). A "genuine issue" in the context of a motion for summary judgment is not simply a "metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Rather, a genuine issue of material fact exists when "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986); Insolia v. Philip Morris, Inc., 216 F.3d 596, 599 (7th Cir. 2000). The court must consider the record as a whole, in a light most favorable to the non-moving party, and draw all reasonable inferences that favor the non-moving party. Anderson, 477 U.S. at 255; Bay v. Cassens Transport Co., 212 F.3d 969, 972 (7th Cir. 2000).

DISCUSSION

LINA argues that the evidence pointed to by Bake in this case is so flawed that there are no genuinely disputed material facts in this case. It is undisputed that the Group Policy defines the term "disability" as the following:

An employee is Disabled if, because of Injury or Sickness,

1. he or she is unable to perform all the material duties of his or her regular occupation, or solely due to Injury Sickness, he or she is unable to earn more than 60% of his or her Indexed Covered Earnings; and

2. after Disability Benefits have been payable for 24 months, he or she is unable to perform all the material duties of any occupation for which he or she may reasonably become qualified based on education, training or experience.

(R SF Par. 5). The parties agree that the position of First Vice President, Operations Analysis, held by Bake, is a sedentary position under the definition in The Dictionary of Occupational Titles. (R SF Par. 8). LINA concluded that Bake was able to perform a sedentary occupation and thus Bake had not shown that she is "unable to perform all the material duties of any occupation for which . . . she may reasonably become qualified based on education, training or experience." (R SF Par. 5). LINA's conclusion is based in large part on the opinion of Dr. Avrom Simon ("Dr. Simon"). Dr. Simon was hired by LINA to evaluate Bake's administrative appeal. Although Dr. Simon did not examine Bake, he evaluated the record and concluded that Bake's physical restrictions did not prevent her from performing her sedentary occupation. LINA ...


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