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Miller v. Ameritech Long Term Disability Plan

November 4, 2008

MARY ERIN MILLER, PLAINTIFF,
v.
AMERITECH LONG TERM DISABILITY PLAN, DEFENDANT.



The opinion of the court was delivered by: Michael P. McCUSKEY Chief U.S. District Judge

OPINION

On June 26, 2007, Plaintiff, Mary Erin Miller, filed her Complaint (#1) against Defendant, Ameritech Long Term Disability Plan. Plaintiff brought her action under section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), as amended (29 U.S.C. § 1132(a)(1)(B)). Plaintiff alleged that she became eligible for long term disability benefits under the Plan provided by Defendant. Plaintiff alleged that Defendant unilaterally terminated her benefits effective October 1, 2006. She alleged that Defendant's unilateral action violated the terms of the Plan. Plaintiff asked this court to enter judgment against Defendant for all unlawfully withheld amounts of disability benefits to which she is entitled, together with statutory interest, as well as her reasonable attorney's fees and litigation expenses.

This case is now before the court for ruling on Defendant's Motion for Summary Judgment (#19). This court has carefully reviewed the arguments of the parties and the complete administrative record provided by Defendant. Following this careful review, Defendant's Motion for Summary Judgment (#19) is GRANTED.

FACTS*fn1

Plaintiff is currently 48 years old. She was employed by Illinois Bell Telephone Company*fn2 from 1986 until she took short-term disability leave in May 2005 due to back problems. In January 2006, Plaintiff was notified that her short-term disability benefits would end on April 9, 2006, but that she might be eligible for long-term disability benefits under the Ameritech Long Term Disability Plan (Plan) if she met the Plan's criteria. Under the Plan, participants are eligible to receive monthly payments provided that they meet the Plan's definition of "disabled." The Plan states:

"Disability" or "Disabled" . . . shall mean an illness or injury, other than accidental injury arising out of and in the course of employment by the Company, or a Participating Company, supported by objective medical documentation, that prevents the Eligible Employee from engaging in any occupation or employment (with reasonable accommodation as determined by the Company or its delegate), for which the Eligible Employee is qualified, based on training, education, or experience. An employee shall continue to be considered disabled if prevented by reason of such illness or injury, supported by objective medical documentation, from working at a job which pays wages which, when combined with benefits payable from the Plan, equal less than 75% of the Eligible Employee's Base Pay at the time the Disability occurred.

The Plan further provides that the "Committee has full discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with Plan terms."

In January 2006, Plaintiff applied for long-term disability benefits under the Plan. In support of her application for benefits, Plaintiff provided the notes of her treating physician, Dr. Russell Nockels. Dr. Nockels notes, dated January 26, 2006, stated:

Mary returns 3 months following her second surgery. She is doing well. We will return her to work full-time with restrictions, and prescribe continued physical activity and Elavil. I plan to see her again in 6 weeks. Her xrays today look fine.

Consistent with those notes, on January 27, 2006, Dr. Nockels advised the Claims Administrator that Plaintiff could return to work full-time effective January 30, 2006, so long as she was restricted from lifting anything heavier than 10 pounds, repetitively bending, lifting or twisting, and driving more than 30 minutes at a time.

Subsequently, Plaintiff provided Dr. Nockels' March 23, 2006, notes, which stated:

Mary is making slow but steady progress. Her wound is healed, although she still has significant back pain. Her leg pain is gone.

I believe she will never return to full employment lifting greater than 50#. However, at this juncture she is making sufficient progress to go back to work at a sedentary level as of 3/27. I provided her documentation for this.

On March 30, 2006, the Claims Administrator noted that Dr. Nockels provided the following restrictions on Plaintiff's ability to work: "sedentary position only no lifting >20lbs no repetitive bending, lifting, twisting, duration 3 months." The notes stated that Dr. Nockels had imposed a permanent restriction of no lifting more than 50 pounds.

To determine whether Plaintiff could perform any job within the medical restrictions provided by Dr. Nockels, the Claims Administrator conducted a Transferable Skills Assessment on April 3, 2006. The report stated:

By way of summary, the employee is a 46 year old female who ceased work as a Customer Systems Tech on 1/31/06 due to osteophyte formation at L3-4 & at L5-S1 & disc degeneration w/a post annular tear & superimposed central posterior disc herniation. She resides in Decatur, IL (which is approximately 50 miles from Champaign, IL) and her case manager has identified her gainful wage as $14.10 per hour in a 40-hour workweek. Her date of hire was 3/6/89.

The report also stated that Plaintiff had completed high school and one year of college and reported having computer skills. The report listed Plaintiff's work experience since 1981 and stated that Plaintiff's most recent job as a customer systems technician is listed as "heavy skilled work capacity" and "involves installing and repairing telephone and telegraph lines, poles and related equipment." The report concluded:

Based on the above stated work history, she would have demonstrated the following skills: the ability to problem solve, communication skills in a wide variety of situations, ability to work with small hand tools, perform routine and repetitive tasks, accurately record, code and classify information and knowledge of electrical functions. Ms. Miller should have the ability to make decisions, communicate, familiarity w/ keyboarding and various computer systems, sort, file, and have basic general office skills.

At this point in time Ms. Miller only has sedentary work capacity and she has a high gainful wage of $14.10. Given the wage is so high and her physical ability is very limited, no gainful occupations can be offered at this time. Please refer file in again once the restrictions change.

Based upon the Transferable Skill Assessment, the Claims Administrator approved Plaintiff's application for long-term disability benefits under the Plan in a letter dated April 11, 2006.

On July 30, 2006, in response to the Claims Administrator's request that she update her medical information, Plaintiff completed an Employee Disability Questionnaire. In response to the question, "Do you have plans to return to work in the future?" Plaintiff responded, "Yes, but [I] need to find a job that I can do." Plaintiff also stated that she did not "do much" and had a "hard time sleeping at night, due to back pain." She stated that "[i]f I take the sleeping pills the doctor gave me - I'm groggy all day and still have back pain." Plaintiff stated that she was unable to carry laundry and could do no bending. She stated that she did not drive very often and "can't sit for very long in car, so don't go too far." Plaintiff listed the medications she was taking.

On September 13, 2006, Dr. Nockels completed a "Certificate to Return to Work or School" for Plaintiff. The Certificate stated that he had examined Plaintiff on June 28, 2006, and that Plaintiff was able to return to work with the following limitations: "Moderate work level: No lifting >20 lbs. Limited bending, twisting[,] Frequent position changes." Dr. Nockels stated that these "restrictions are permanent." After receiving this Certificate, the Claims Administrator conducted another Transferable Skills Assessment on October 12, 2006. The report stated that Plaintiff' work restrictions were "moderate work level, no lifting >20lbs, limited bending, twisting, frequent position changes." The report stated that the "restrictions are permanent." Based upon these work restrictions provided by Dr. Nockels, the Claims Administrator identified six sedentary positions in which Plaintiff could earn as much as or more than her previous position: Dispatcher, Motor Vehicles; Secretary; Customer Account Clerk; Expediter; Dispatcher, Generic; and Customer Service Rep.

On November 6, 2006, the Claims Administrator sent a letter to Plaintiff which stated that, "based upon your training, education and experience" and the restrictions and limitations imposed by Dr. Nockels, a vocational assessment had identified six occupations she "should be able to perform" which would provide at least 50% of her basic wage rate at the time long-term disability started. The letter then listed the six identified positions. The letter stated that Plaintiff no longer qualified for payment under the Plan as of October 1, 2006. The letter also advised Plaintiff of her appeal rights. The letter stated:

In your appeal, please state the reason(s) you believe your claim should not be denied. You may also submit additional medical or vocational information, and any facts, data, questions, or comments you deem appropriate for us to give your appeal proper consideration. . . . .

You shall be provided, upon written request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits.

On January 12, 2007, Plaintiff appealed the decision to discontinue her long-term disability benefits. Plaintiff submitted a statement regarding her condition. She stated:

My level of functionality impacts my ability to work because I have horrific pain in my lower back that limits my ability to sit and stand for very long. This pain is causing extreme anxiety which, in turn, causes migraine headaches. ...


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