United States District Court, C.D. Illinois
ORDER AND OPINION
E. SHADID, UNITED STATES DISTRICT JUDGE
before the Court are cross-motions for summary judgment.
Plaintiff has filed a Motion (D. 34) for Summary Judgement.
Defendants filed a collective Response (D. 38) in Opposition
to Plaintiff's Motion for Summary Judgment and Plaintiff
replied (D. 39). Defendants have also collectively filed a
Motion (D. 35) for Summary Judgment. Plaintiff filed a
Response (D. 37) to Defendants' Motion for Summary
Judgment and Defendants replied (D. 40). For the reasons set
forth below, Plaintiff's Motion is DENIED and
Defendants' Motion is GRANTED.
Sherry Meyer (“Plaintiff” or “Meyer”)
brought this action after Defendants denied her claim for
long-term disability benefits. Defendant Group Long Term
Disability Plan for Employees of Edward D. Jones & Co.,
L.P. (the “Plan”) is an employee welfare benefit
plan sponsored by Edward D. Jones & Co. and governed by
the Employee Retirement Income Security Act of 1974, as
amended (“ERISA”), 29 U.S.C. § 1001 et.
seq. Defendant Hartford Life and Accident Insurance
Company (“Hartford”) issued an insurance policy
(the “Policy”) to Edward D. Jones & Co. to
fund long-term disability benefits under the Plan.
following facts are from the administrative record. D. 23.
Meyer has worked for Edward D. Jones & Co. as a financial
advisor since 1992. D. 23-10, at 8. Meyer stopped working
full time for Edward D. Jones & Co. in November 2013. D.
23-1, at 99. As a participant in the Plan, Meyer submitted a
claim in early-2014 under the Policy for mental illness
disability. Id. at 169. Hartford approved
Meyer's claim for long term disability benefits May 1,
2014. Id. at 130.
11, 2014, Meyer began receiving chiropractic care for pain in
her neck, shoulder, and lower back. D. 23-7, at 72. Meyer
received thirty-four chiropractic treatments for neck and
lower back pain from July 11, 2014 through May 14, 2015.
Id. at 21-89. Beginning September 19, 2014, Meyer
told her chiropractor, Dr. Kramer, that she experiences
numbness, radiating pain, stiffness, and throbbing in her
neck that radiates to both arms and hands. Id. at
21. She also described dull ache, radiating pain, and
stiffness in her lower back. Id. Meyer told Dr.
Kramer the symptoms occurred 76%-100% of the day and rated
the symptoms no lower than a seven on a zero-ten scale.
began seeing a rheumatologist, Dr. Santoro, on November 26,
2014. D. 23-7, at 12. On that date, Dr. Santoro ruled out a
diagnosis of fibromyalgia due to the absence of tender
points, hyperalgia and allodynia. Id. at 16. He
suggested her symptoms may be due to soft tissue rheumatism
and ordered a sleep study to explore her reported
un-refreshed sleep. Id.
to a regularly conducted review to determine whether Meyer
can return to fulltime work, Hartford sent a letter to
Meyer's psychiatrist, D r. K yle, in March 2015 inquiring
whether Meyer had been cleared to work full time from a
psychiatric standpoint. D. 23-7, at 104. D r. K yle responded
that Meyer was able to work up to, but no more than, 40 hours
per week. Id. at 107. D r. Kyle noted Meyer
generally worked 30 hours or less each week because Meyer
became fatigued to the point where the quality of her work
suffered. Id. D r. Kyle went on to say,
“Realistically she is not able to work more hours and
her schedule will probably stay as it is. Again, it comes
with the definition of what is full time or not. She is
certainly able to work but not at the pace she did when she
was younger.” Id. at 108. Dr. Kyle wrote that
Meyer told her on their last visit that “the most
[Meyer] can do is 40 hours” Id. at 109.
7, 2015, Hartford sent a letter to Meyer stating she no
longer qualified for long-term benefits due to her mental
illness. D. 23-1, at 97. Hartford lacked medical information
necessary to determine whether Meyer met the Policy's
definition of disability due to a physical condition and
Meyer had two options to challenge the claim denial: 1.
perfect her claim by providing specific documents to the
claim analyst, Penny Mccormick; or 2. submit an appeal to
Hartford's appeal unit. Id. The letter
acknowledged Meyer recently began seeing a rheumatologist.
Doc. 23-1, at 100. To perfect her claim, Meyer was advised to
submit an Attending Physician Statement (“APS”)
completed by a physician who was restricting Meyer from
working full-time, as well as all medical records supporting
her physical disability from July 1, 2014 to present time.
Id. Alternatively, Meyer could appeal the claim
denial by sending a signed, dated letter within 180 days
clearly stating her position. Id. at 101. Meyer
could also submit written comments, documents, records and
other information related to her claim as part of her appeal.
2, 2015, Meyer sent the following letter to Hartford:
“Hi - Enclosed are my medical records and claim forms
from two doctors. Please advise regarding my disability
income asap. EDJ [employer] still has me on part-time,
irregular schedule [sic] leave of absence. My rheumatologist
only wants me to work 28 or less hours a week.” Doc.
23-6, at 55. Meyer enclosed medical records from her
rheumatologist, D r. Santoro, as well as records from her
current and former chiropractors, Dr. Kramer and Dr. Trotter.
Id. The letter was sent to the attention of Penny
Mccormick; however, it was addressed to the appeals
August 11, 2015, Penny Mccormick sent another denial of
disability benefits. Doc. 23-1, at 82. Meyer did not meet the
Policy's definition of “disability” for a
physical condition because she had not shown that she was
unable to perform the duties of her occupation. Id.
at 84. The essential duties of her occupation included
meeting with clients, managing client finances, and
establishing new business. Id. To perform said
duties, Meyer “must be able to frequently sit with
occasional walking, standing and lift/carry [sic] up
to 25 pounds.” Id. The decision to deny
Meyer's claim was based on a full review of all the
documents in her file, including medical records and APS
forms. Id. Hartford had also sought an independent
review of her file from D r. Aayar, who was board certified
in occupational medicine. Id. Dr. Aayar had
attempted several times to contact Meyer's treating
physicians for clarification on the restrictions placed on
her work hours. Id. at 85. Dr. Aayar had been
unsuccessful in contacting Dr. Santoro and his conversation
with Dr. Kramer did not change his assessment that Meyer
could work full-time. Id. Meyer was again informed
of her appeal rights.
also called and spoke to Penny Mccormick on August 11, 2015.
D. 23-1, at 1. Mccormick explained the lack of medical
evidence to support her claim based on a physical disability
and to support the restrictions on her work hours.
Id. Mccormick explained how Dr. Aayar spoke to Dr.
Kramer, but he was unsuccessful in attempts to contact Dr.
Santoro. Id. Mccormick advised Meyer of her rights
to appeal Hartford's denial of her claim. Id.
Meyer did not appeal the August 2015 claim denial and filed
the instant action almost one year later. D. 34, at 15.
judgment is proper where the materials in the record
demonstrate that there is “no genuine dispute as to any
material fact and the movant is entitled to judgment as a
matter of law.” Fed.R.Civ.P. 56. The role of the judge
in resolving a motion for summary judgment is not to weigh
the evidence for its truth, but to determine whether
sufficient evidence exists for a jury to return a verdict in
favor of the non-movant. Anderson v. Liberty Lobby,
Inc., 477 U.S. 242, 249 (1986). The Court will construe
the record “in the light most favorable to the
non-movant” in deciding whether the case involves
genuine issues of fact requiring a trial. Payne v.
Pauley, 337 F.2d 767, 770 (7th Cir. 2003). By filing
cross-motions for summary judgment, each movant must show he
has met the traditional standards necessary to obtain
judgment as a matter of law. United Transp. Union v.