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Lockhart v. Jefferson Pilot Financial Insurance Co.

March 31, 2009

LEONORA LOCKHART PLAINTIFF,
v.
JEFFERSON PILOT FINANCIAL INSURANCE CO., DEFENDANT.



The opinion of the court was delivered by: Honorable David H. Coar

MEMORANDUM OPINION AND ORDER

Pursuant to Section 502(a)(1)(B) of the Employee Retirement Income Security Act ("ERISA") of 1974, 29 U.S.C. § 1123(a)(1)(B), Plaintiff Leonora Lockhart ("Plaintiff") seeks judicial review of Defendant Jefferson Pilot Financial Insurance Company's ("Defendant") decision to deny her long-term disability insurance benefits under a group policy issued to her employer, the Illinois Hospital Association ("IHA"). Following several years of litigation, including a trial on the papers before Magistrate Judge Levin that ended with a remand for further fact development, the parties have filed cross-motions for judgment. These motions come before the Court now.

I. BACKGROUND

a. Introduction

The facts of this case have been amply and well documented in Judge Levin's Amended Memorandum Opinion and Order ("Amended Order"). Lockhart v. Jefferson Pilot Financial Ins. Co., No. 03 C 1745, 2005 WL 914446 (N.D.Ill. March 29, 2005). The Court will restate here the most pertinent facts, drawing heavily from Judge Levin's summary.

Plaintiff, an attorney, was employed in a non-legal position at the IHA as a Risk Management Consultant from April 24, 1997 through January 31, 2002. Parties Joint Appendix, Dkt. No. 69 ("JPF") 0270, 0285. Plaintiff was terminated from her position at the IHA on January 31, 2002. JPF 0245.

b. Plaintiff's Job Duties

In her capacity as a Risk Management Consultant ("RMC"), Plaintiff's was responsible for providing risk management services to insured physicians and member/client hospitals in order to assist them in developing and maintaining effective internal risk management programs, according to the RMC position description as provided by the IHA. JPF 0275. The position description also provides an "outline of responsibilities" which delineates that Plaintiff was responsible for performing consultative services for client inquiries regarding risk management and medical-legal concerns; identifying problems, patterns and trends in hospitals or physician practices and recommending corrective action to prevent patient harm and minimize financial loss; providing educational programs for clients in the form of in-service programs, seminars and risk management committee meetings; performing on-site services which include risk management surveys and audits of clinical areas and follow-up on risk management issues; conducting underwriting site visits at applicant member hospitals; and publishing a quarterly newsletter for insured physicians. Id. Plaintiff's position description indicated she was required to use a computer for word processing and other types of computer programs, copy machine, calculator and dictating equipment. JPF 0276. She was also required to work additional morning and evening hours and travel approximately thirty-five percent of the time. Id.

In addition, a long-term disability claim job analysis completed by Defendant indicated that Plaintiff was required to do many of the same activities as described in the position description; such as, typing on a computer, using a telephone and traveling by automobile. JPF 0272-73. With regard to the other physical aspects of Plaintiff's position, the job analysis also indicated she needed to frequently stand, walk and sit, with "frequently" defined to mean a task that the individual performs 34-66% of the time. JPF 0272-73. Furthermore, the job analysis indicated Plaintiff frequently needed to relate to others, engage in written and verbal communication, make independent judgments and exert math and language reasoning skills. JPF 0272.

c. Termination and Disability Claim

Plaintiff's employment with the IHA was terminated on January 24, 2002 due to poor performance. In the termination letter, Cheryl Church, Plaintiff's supervisor, wrote that the termination was due to "ongoing concerns about [Plaintiff's] limited ability to recognize and understand clinical risk management issues and your poor productivity." JPF 0245.

Following Plaintiff's termination, Plaintiff retained an attorney who worked with counsel for the IHA in developing two letters: a letter of recommendation and a letter regarding her alleged disability. JPF 0165-66. In a letter dated April 9, 2002, the IHA attorney agreed to the following language in a letter regarding Plaintiff's alleged disability:

[Plaintiff] worked for the Illinois Hospital and Health Systems Association as a Risk Management Consultant from April 24, 1997 through January 31, 2002. At the end of her employment, it appeared that [Plaintiff's] performance was adversely affected by her medical condition.

JPF 0165-66.

Plaintiff had participated in the IHA's Long Term Disability Plan ("Plan"), which is an employee welfare benefit plan established and maintained by the IHA in accordance with ERISA.*fn1 JPF 0015-0045, 0051-0083. The Plan's long-term disability coverage is provided pursuant to a group policy issued to the IHA by Defendant. JPF 0015-45, 0051-83. An insured's coverage under the group policy ends when the insured is no longer employed by the IHA. JPF 0015, 0016, 0028, 0054, 0067. The group policy provides an insured, upon termination of his or her employment, with the opportunity to obtain converted long term disability insurance (i.e., individual policy). JPF 0029, 0069. Further details about the group policy are in the discussion section below.

Following Plaintiff's termination on January 31, 2002, she was no longer a covered insured under the group policy. On February 28, 2002, Defendant extended the time period by thirty-one days for former employees to exercise their conversion privilege under the group policy. JPF 0289. Plaintiff inquired about converting her group disability insurance coverage into individual coverage, but she decided not to convert (and continue) her coverage. JPF 0290-91. On July 24, 2002, Plaintiff submitted a claim for long-term disability benefits alleging she was disabled due to psoriatic arthritis*fn2 since January 24, 2002, the last day Plaintiff alleges she was able to work due to her disability.*fn3 JPF 0281-84. In her claim for benefits, Plaintiff alleged that she had had pain and stiffness in her hands during 2000 and 2001 and, more recently, she had experienced pain in her feet and neck. JPF 0283. Plaintiff indicated that her pain and stiffness were worse in the mornings and she had to lie in bed for thirty minutes to an hour before she felt well enough to get out of bed. Id. Plaintiff further stated that her condition made it difficult for her to get dressed and attend to her personal hygiene which included bathing as well as brushing her teeth and hair. Id.

In her claim for disability benefits, Plaintiff indicated that because her joint pain was worse during cold or wet weather, she frequently went to warmer locales during 2000 and 2001. JPF 0283. Plaintiff also stated that "fatigue is a tremendous problem" and she did not sleep well due to joint pain and muscle aches. Id. She indicated that her medications cause side-effects which include bronchitis, sinusitis, conjunctivitis, nosebleeds, and psoriatic flare-ups. Plaintiff indicated that these side-effects were not disabling; however, they were troublesome and needed to be treated. JPF 0283-84. Moreover, Plaintiff stated that she had a history of depression and that her physical limitations prevented her from walking which was one way she managed her depression and stress. JPF 284. She further indicated that before she stopped working, she avoided out-of-town travel as much as possible, had difficulty in getting files out of cabinets, was very tired after sitting at a desk for extended periods of time, came in as late as possible due to early morning pain and stiffness, and could not stuff packets for mailings. Id.

d. Medical Evidence

Plaintiff supported her claim for long-term disability benefits (and her later appeal of Defendant's denial of those benefits) with numerous medical records and reports from her treating physicians. These physicians are: (1) Dr. Shelly L. Betman, M.D., Plaintiff's internist, who filled out Plaintiff's Attending Physician's Statement form for her disability claim; (2) Dr. Rosalind Ramsey-Goldman, M.D., Plaintiff's treating rheumatologist; (3) Dr. Farid Karimi, Plaintiff's treating psychiatrist after November 5, 2001; (4) Dr. Robert Lawton, M.D., from whom Plaintiff primarily received psychiatric care before being treated by Dr. Karimi*fn4 ; and (5) Dr. Mary Szatkowski-Pritikin, M.D., Plaintiff's ophthalmologist. The administrative record is voluminous, and not every medical record supports Plaintiff's claim that she was totally disabled as of January 24, 2002. Since Plaintiff's claim hinges on the onset date of her disabling condition, the most pertinent documents/events are arranged chronologically below:

* June 19, 1997 through October 5, 2001. As indicated by Dr. Lawton's numerous sessions notes, Plaintiff was treated for a major depressive disorder during this time period and was prescribed medications including Effexor and Ritalin for her disorder. JPF 0173-85. Dr. Lawton saw Plaintiff six times in 2001: January 11, 2001; March 7, 2001; May 7, 2001; June 20, 2001; August 30, 2001; and October 5, 2001. At the last session, on October 5, 2001, Dr. Lawton noted that Plaintiff is "[d]oing reasonably well but she is beginning to dread winter" and she is "awakening" from a "transient dysphoria." JPF 0175.

* October 9, 2001. Treatment notes from Dr. Ramsey-Goldman state: "Since last visit ha[ve] noted more swelling [and] pain. Not limiting her from working. No new patches of psoriasis. JPF 0109. The notes also indicate that Plaintiff no longer needed to take Vioxx*fn5 ; however, she still needed to take Arava, Effexor,*fn6 Ritalin,*fn7 and Allegra.*fn8 JPF 0109. It was also noted that Plaintiff has active psoriatic arthritis and moderate synovitis with deformity and she may need to take Enbrel or Remicade which are medications used to treat active rheumatoid arthritis. JPF 0112.

* October 9, 2001. Plaintiff underwent x-ray evaluations of her wrists and hands which were ordered by Dr. Ramsey-Goldman. JPF 0147-50. Regarding Plaintiff's x-ray evaluation of her hands, Dr. Earl Nudelman, M.D., the attending radiologist, reported that:

Joint space narrowing is present at the interphalangeal joints of the hand. There is soft tissue prominence, marked joint space narrowing, marginal sclerosis, and osteophyte formation present at the distal interphalangeal joints of both hands. No definite bone erosion or bone destruction is seen. No fracture is seen. Some minor periarticular deossification is noted at the interphalangeal joints of the hand, most marked at the proximal interphalangeal joints.

JPF 0148. With respect to Plaintiff's left wrist, Dr. Nudelman indicated that "[a] slightly coarse trabecular pattern is identified compatible with some bony deossification. No joint space narrowing, significant osteophyte formation, or bone erosion is seen at the left wrist. No fracture is seen." JPF 0149. Moreover, with regard to Plaintiff's right wrist, Dr. Nudelman found that, "[a] slightly coarse trabecular pattern is identified compatible with some bony deossification. No bone erosion or significant osteophyte formation is present at the right wrist. No abnormal calcifications are present. No fracture is seen." JPF 0150.

* December 5, 2001.*fn9 In the initial psychiatric/psychological evaluation pertaining to Plaintiff, Dr. Karimi indicated that Plaintiff's attention and concentration were "good/pass" and her memory, reasoning and judgment were "good." JPF 0217. Dr. Karimi also indicated in his initial evaluation that Plaintiff had a global assessment of functioning ("GAF") score of 60.*fn10 Id. Otherwise, the initial psychiatric evaluation, progress notes and medication record submitted by Dr. Karimi are essentially illegible. JPF 0208, 0212-0217.

* December 24, 2001. Plaintiff sought treatment from Dr. Betman for fatigue and a sore throat. JPF 0238.

* December 28, 2001.Plaintiff underwent blood tests which were ordered by Dr. Betman. JPF 0232-34.

* January 2, 2002. Dr. Karimi's progress notes indicate that Plaintiff is "feeling [fifty percent] better." JPF 0215.

* January 7, 2002. Plaintiff's ophthalmologist Dr. Szatkowski-Pritikin noted Plaintiff's active rheumatoid arthritis, blurry vision, inability to wear contact lenses and burning eyes. JPF 0156-60.

* January 8, 2002. Plaintiff saw Dr. Betman for a follow-up visit. Dr. Betman indicated that Plaintiff should ...


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