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Williams v. Group Long Term Disability Insurance

February 27, 2009

MARK D. WILLIAMS, PLAINTIFF,
v.
GROUP LONG TERM DISABILITY INSURANCE AND RELIANCE STANDARD LIFE INSURANCE COMPANY, DEFENDANTS.



The opinion of the court was delivered by: Wayne R. Andersen District Judge

MEMORANDUM OPINION AND ORDER

This case is before the court on the parties' cross-motions for summary judgment. The case arises from plaintiff Mark Williams' claim for long-term disability benefits pursuant to Section 502(a)(1)(B) of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(b). Williams previously appealed the plan administrator's denial of benefits and this court remanded the case to the plan administrator for a new review of his claim. Williams v. Group Long Term Disability Ins., 2006 U.S. Dist LEXIS 56679, at *28-29 (N.D. Ill. Aug. 2, 2006). Pursuant to the remand, the plan administrator conducted additional proceedings and again denied Williams' claim for long-term disability benefits. For the following reasons, Williams' motion for summary judgment [35] is denied. Defendants' Group Long Term Disability Insurance and Reliance Standard Life Insurance Co. cross-motion for summary judgment [48] is granted. Defendants are entitled to reimbursement for overpaid benefits for Social Security in the amount of $30,469.13.

BACKGROUND

Williams was employed as a software developer for Tellabs Operations Inc. Williams' job responsibilities included providing technical support for products and processing, troubleshooting problems, and developing and supporting software applications. As part of his employment with Tellabs, Williams was enrolled in defendant Group Long Term Disability Insurance ("the Plan") for long-term disability benefits, which was underwritten by defendant Reliance Standard Life Insurance Co. Williams worked for Tellabs on a full-time basis until March 1, 2002, at which time he took medical leave. He was employed part-time by Tellabs until October 1, 2002, at which time he alleged that he could no longer work due to nausea, light headedness, and fatigue. (Administrative Record ("AR") 000368) On February 25, 2003, Williams filed an application for long-term disability benefits with Reliance that formed the basis of the dispute in Williams v. Group Long Term Disability Ins., 2006 U.S. Dist LEXIS 56679 (N.D. Ill. Aug. 2, 2006).

Under the Plan, Reliance is obligated to pay long-term disability benefits if the beneficiary meets the Plan's definition of "Total Disability," which is defined as being unable to "perform the material duties of his/her regular occupation" for 180 days. (AR 000175-78) If the disability is caused by mental or nervous disorders, which the Plan defines as including anxiety-related and depression-related disorders, Reliance only is obligated to pay benefits for 24 months. (AR 000215) Reliance also has the right under the Plan to have a beneficiary interviewed or examined physically, psychologically, and/or psychiatrically to determine the existence of any Total Disability. (AR 000181) The Plan states that "[t]his right may be used as often as it is reasonably required while a claim is pending." (Id.) In the prior proceeding, this court reiterated Reliance's right to have Williams undergo a neuropsychological examination during any proceedings conducted pursuant to the remand order. Williams, 2006 U.S. Dist. LEXIS at *28. Finally, the Plan gives Reliance "discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits." (AR 000181)

In the prior proceeding, this court granted Williams' motion for summary judgment and remanded the case to the plan administrator for further proceedings consistent with the court's opinion. Specifically, this court held that the plan administrator "acted arbitrarily and capriciously when it determined Williams' disabling condition was caused by a mental disorder" Williams, 2006 U.S. Dist LEXIS at *22. After examining the entire record, we concluded that at least three of the five factors the Seventh Circuit instructed courts to consider in Chalmers v. Quaker Oats Co., 61 F.3d 1340 (7th Cir. 1995), weighed in favor of finding that Reliance acted arbitrarily and capriciously. Williams, 2006 U.S. Dist. LEXIS at *17. This court specifically noted that Reliance's process was deficient in light of the complexity of the issues presented by Williams' claim, because Reliance failed to effectively utilize the assistance of experts, and because Reliance relied upon insufficient evidence to uphold its determination that Williams' disability resulted from a mental cause. Id. at *18-22.

Furthermore, this court explained that administrative remand was the appropriate remedy because the court found that, based on an examination of the record, Reliance never made an initial finding that Williams' condition was the result of a physical disability. Id. at *27. As such, Reliance's determination that the cause was mental, despite being arbitrary and capricious, was the equivalent of an initial determination. Id. We concluded that ordering Reliance to reinstate benefits would require the court to substitute its judgment for that of the plant administrator, which this court is not permitted to do. Id. at *27-28 (citing Gallo v. Amoco Corp., 102 F. 3d 918, 923 (7th Cir. 1996), cert denied, 521 U.S. 1129 (1997)).

Following this court's remand, Reliance arranged for Williams to be evaluated by two independent doctors: an occupational medicine specialist and a neuropsychologist. Defendants' Statement of Facts, ¶ 34. Williams saw Dr. Shirley Conibear, MD, MPH, a board certified occupational medicine specialist on January 8, 2007. Defendants' Statement of Facts, ¶ 35. Dr. Conibear undertook a comprehensive review of Williams' medical history and physically examined Williams personally for approximately 45 minutes, but did not conduct any independent laboratory testing. Dr. Conibear concluded that Williams suffered from Generalized Anxiety Disorder, Major Depressive Disorder, hypogonadism, hypertension, steatosis of the liver, and obstructive sleep apnea. Dr. Conibear further concluded that he did not have chronic EBV infection, chronic fatigue syndrome, hypothyroidism or orthostatic hypotension. Based on these conclusions Dr. Conibear stated that Williams had "no physical limitations except for deconditioning" and recommended neuropsychological testing to determine what cognitive limits, if any, existed. Id.

On January 9, 2007, Williams underwent a neuropsychological examination by Dr. Christopher Randolph Ph.D., ABPP/CN. Dr. Randolph is a Clinical Professor of Neurology and Director, Neuropsychology Service at Loyola University Medical Center. Defendants' Statement of Facts, ¶ 37. Dr. Randolph conducted formal testing and concluded that Williams suffered from no impairment of neurocognitive functioning, and suggested that his test results showed "clear-cut evidence of attempted feigning of neurocognitive impairment" during the testing. Defendants' Statement of Facts, ¶ 38. Dr. Randolph's final conclusion regarding the Williams' complaints was that they were the result of a somatoform disorder and "entirely psychiatric in etiology."

Defendants' Statement of Facts, ¶ 39. Following these two evaluations, on February 9, 2007, Reliance notified Williams' that his request for long-term disability benefits had been denied. According to Reliance the basis for the denial was the twenty-four month limitation on benefits for conditions caused by mental disorders. Somatoform disorders are included within the mental disorder limitation. Defendants' Statement of Facts, ¶ 40.

In response to Reliance's denial, Williams appealed the plan administrator's decision. On March 23, 2007, Williams submitted a letter to Reliance that formed the basis for his appeal. Williams retained Dr. Freeman to review the evaluations performed by Drs. Conibear and Randolph. The March 23 letter contained a summary of the comments provided by Dr. Freeman critiquing the reports issued by Drs. Conibear and Randolph that were relied upon by Reliance in denying Williams' claim. In the same letter, Williams' also requested the raw data from his psychological evaluation be forwarded to Dr. Alan Friedman, a psychologist, for review. Plaintiff's Statement of Facts, Exhibit 1. On July 27, 2007, Williams submitted Dr. Friedman's analytical report, which further critiqued the evaluations of Drs. Conibear and Randolph. Plaintiff's Statement of Facts, Exhibit 3. Following receipt of these critiques, Reliance forwarded them to Drs. Conibear and Randolph. Defendants' Statement of Facts, ¶ 45. On September 4, 2007, Dr. Randolph responded to Williams' criticisms and provided further explanation for his conclusion that Williams suffered from a somatoform disorder. Defendants' Statement of Facts, Exhibit G. Dr. Conibear responded in writing to the criticisms on October 12, 2007, emphasizing that the purpose of her report was not "to provide an assessment of the extent to which psychiatric diagnoses versus physical diagnoses account for Mark Williams's (sic) symptoms and alleged incapacity" but rather "[e]ach person must be assessed in terms of the degree of incapacity resulting from all of their problems." Defendants' Statement of the Facts, Exhibit F. During this review, Williams did not submit the results of any additional medical testing to Reliance for review.

Based on these responses, on October 15, 2007, Reliance notified Williams of its decision to affirm the denial of his long-term disability benefits. In its final denial of benefits, Reliance stated that it did not agree that Drs. Conibear and Randolph were not qualified to evaluate Williams' condition. Reliance further stated that the replies provided by Drs. Conibear and Randolph adequately addressed the criticisms presented by Drs. Friedman and Freeman. Plaintiff's Statement of Facts, Exhibit 7. Having exhausted the administrative remedies available under the policy terms, Williams filled this lawsuit, seeking for the second time to reinstate his benefits under §502(a)(1)(B) of the Employee Retirement Income Security Act.

DISCUSSION

Both Williams and Reliance have moved for summary judgment pursuant to Federal Rule of Civil Procedure Rule 56. A party is entitled to summary judgment "if the pleadings, depositions, answers to interrogatories, and admissions of fact, together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." FED. R. CIV. PRO. 56(c). The party seeking summary judgment carries the initial burden of demonstrating an absence of evidence to support the position of the nonmoving party. See Doe v. R.R. Donnelley & Sons Co., 42 F. 3d 439, 443 (7th Cir. 1994). The nonmoving party must then set forth specific facts showing there is a genuine issue of material fact and that the moving party is not entitled to judgment as a matter of law. See Anderson v. Liberty Lobby, 477 U.S. 242, 252 (1986). On cross-motions for summary judgment, the court "considers the merits of each cross-motion separately and draws ...


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