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September 26, 2001


The opinion of the court was delivered by: McLAUGHLIN, District Judge.



The underlying action is this case presents a challenge to a plan administrator's decision to deny the Plaintiff, Tracy E. Rendulic's (hereinafter "Plaintiff" or "Rendulic"), request for reinstatement of benefits under a long-term disability policy sponsored by her former employer, the Defendant, Kaiser Aluminum & Chemical Corporation (hereinafter "Defendant" or "Kaiser"). Presently pending before the Court are cross-motions for summary judgment.*fn1


Plaintiff worked as a salaried employee of Kaiser in its former Erie, Pennsylvania facility from approximately May 27, 1986 until November 30, 1989. Due to back problems, she commenced receiving benefits under Kaiser's Long Term Disability Benefits Plan for Salaried Employees (the "Plan") on June 16, 1990. Plaintiff is entitled to such benefits if she remains "totally disabled" as that term is defined by the Plan. Section 4.6 of the Plan defines "totally disabled" as follows:

(c) "Totally disabled" under the Long Term Disability Program after the first 24 months shall mean that the eligible Participant is continuously unable to do any work for pay or profit which he or she is or could become reasonably qualified by education, training or experience due to a severe physical impairment which can be demonstrated by clinical and laboratory diagnosis.

Exhibits to Defendant's Motion for Summary Judgment, [Doc. No. 12] Exhibit 2.*fn3

Plaintiff s benefits were terminated effective June 1, 1995 based upon an assessment and determination of a Senior Case Management Specialist at MetLife dated May 8, 1995. Defendant's Ex. 18. The Senior Case Management Specialist found that, based upon her age, education, work experience and medical reports, the Plaintiff had sufficient transferable skills to perform sedentary to light duty employment. Specifically. employment alternatives such as supervisor, production clerk, forms analyst and information scientist were identified as jobs within the plaintiff's residual functional capacity and commensurate with her previous salary. Consequently, the Senior Case Management Specialist concluded that the Plaintiff was no longer disabled as that term is defined in the Plan documents. Defendant's Ex. 18.

The termination of the plaintiff's benefits was subsequently reviewed by Doug Allen, the individual designated by the Plan as the "Plan Manager." On September 6, 1996, after reviewing all of the relevant materials concerning her claim, Mr. Allen confirmed the termination of the plaintiff's benefits. Defendant's Ex. 6. Pursuant to the terms of the Plan, the Plaintiff appealed Mr. Allen's determination to the Kaiser Aluminum Personnel Policy Committee (the "Committee"). Defendant's Ex. 5. The Committee is comprised of six members, five of whom participated in the review of the plaintiff's claim. Defendant's Ex. 1.

On July 21, 1997. the Committee reviewed and evaluated the plaintiff's appeal. The Committee considered various documentary exhibits, including medical records, reports and relevant correspondence relating to her claim. Prior to the Committee's meeting and determination, these materials were provided to the Plaintiff for her review and comment. Defendant's Ex. 3. Plaintiff provided additional office records from her orthopedic surgeon, Dr. John J. Euliano, Jr., and her responsive correspondence and enclosed physician office notes were included in the record reviewed by the Committee. Defendant's Ex. 1, 87 & 88.

The Committee also considered that Dr. Euliano had, 16 months prior to the termination of her benefits, opined that she was totally disabled from all work at that time. The Committee noted, however, that he subsequently stated in his office note of May 4, 1995, approximately one month before the termination of her benefits, that her condition had improved:

[Plaintiff] is feeling quite a bit better with the Relafen as long as she limits her lifting and bending. At this point in time, I don't [believe] we are talking about anything surgical. I would recommend exercises and re-evaluation in approximately a years (sic) time.

Defendant's Ex. 87. Additional office notes supplied to the Committee by the Plaintiff indicated that she had difficulty caring for her child and often needed her mother's help. plaintiff's Ex. 7. The notes also indicated that she was never completely without pain, and had difficulty walking. plaintiff's Ex. 7. The notes additionally reflect that the Relafen was discontinued since the Plaintiff did not feel it was working. plaintiff's Ex. 7.

The Committee also considered persuasive the April 15, 1994 report of Robert C. Porter, M.D., a National Medical Review Board certified occupational physician. Dr. Porter did not examine the Plaintiff, but reviewed her file at the request of MetLife. Plaintiff's Ex. 11. Dr. Porter reviewed the plaintiff's records from Dr. Euliano, Dr. Edward T. Spiegel, D.D.S., John F. Schmitt, D.C., and Dr. N. Rehmatullah, M.D., who performed an independent medical evaluation of the Plaintiff on June 21, 1993. plaintiff's Ex. 11. Dr. Porter concluded that the Plaintiff "should be able to perform sedentary type employment" and therefore was not "continuously unable to do any work for pay or profit." Plaintiff's Ex. 11. Although Dr. Porter later stated that the Plaintiff should be considered totally disabled, this conclusion was based primarily upon her pregnancy. Defendant's Ex. 31. Plaintiff's Plan benefits, which had been discontinued effective February 1, 1994, were reinstated by letter dated August 2, 1994 and continued during her pregnancy. Defendant's Ex. 30 & 37.

In addition, the Committee found relevant an MRI performed on April 26, 1995, which, although it showed some disc disease, revealed no overt disc herniation and only slight disc bulging. The Committee also considered the plaintiff's statements in a Premium Waiver Claim form dated August 31, 1995 as indicating significant mobility, since she stated that she cooked meals, helped her husband bathe her baby, washed dishes, helped her husband with the laundry, handled finances and dusted. Defendant's Ex. 11. The statement also indicatetl that she hired help to vacuum, clean the floors and bathroom. Her husband helped with the baby if necessary, and did the outside chores. Defendant's Ex. 11. The Committee also found that the record contained evidence indicating improved strength on the plaintiff's part in her attempt to move her two-year-old baby into and out of a car seat, even though this attempt did aggravate her lower back problem. Defendant's Ex. 1.

Finally, the Committee reviewed the report of Dr. N. Rehmatullah dated June 21, 1993, which concluded that the Plaintiff was not able to perform her work as a heat treatment foreman. Defendant's Ex. 41. The Committee determined that Dr. Rehmatullah's report was of limited relevance because it was based on an evaluation almost two years prior to the discontinuance of the plaintiff's long-term disability benefits and did not consider her ability to work in other occupations.

A member of the Committee also noted that the Plaintiff was apparently awarded Social Security disability benefits on August 20, 1994 by a Social Security Administrative Law Judge ("ALJ") after her prior claims for such benefits had previously been denied. (Defendant's Ex. 43 & 47). The ALJ concluded that the Plaintiff "does not even retain the residual functional capacity to engage in the full range of sedentary work activities as they are defined in 20 C.F.R. § 404.1567(a)." plaintiff's Ex. 18. The Committee noted that this award appeared to be based, in part, on a finding that the Plaintiff was unable to hold her neck in an upright or stationary position for extended periods, and she was unable to engage in extensive speaking; limitations which, if they had continued through June 1, 1995, would have been highly relevant to the Committee in determining her eligibility for benefits. The Committee observed, however, that the award of Social Security benefits appeared to be related to evidence submitted almost one year or more prior to the decision to terminate the Plaintiff's Plan benefits on June 1, 1995. In addition, the Committee considered the letters from Dr. Edward P. Spiegel, D.D.S. dated March 17, 1994 and Dr. John F. Schmitt, D.C. dated February 10, 1994, which indicated that the Plaintiff suffered from neck and speaking problems. Defendant's Ex. 34 & 35. The Committee noted however, that no further mention of these limitations appeared in the statements by the Plaintiff (Defendant's Ex. 10, 13 & 58) or by her orthopedic surgeon. Defendant's Ex. 14, 16, 19 & 36. The Committee concluded that the plaintiff's ability to do work for pay or profit on June 1, 1995 was not affected by these limitations. Also, the Committee noted that the ALJ found that the Plaintiff did not have any acquired work skills that were transferable to the skilled or semi-skilled work activities of other work, a finding that conflicted with the more recent vocational rehabilitation reports reviewed by the Committee and other portions of the record. (Defendant's Ex. 11, 21, 38, 43 & 47). For these reasons, the Committee found that the ALJ's decision was neither persuasive authority nor timely with respect to the issue of whether the Plaintiff was totally disabled under the Plan's definition on June 1, 1995.

After further discussion, the Committee decided. based upon the two vocational addenda discussed above, the letter of Dr. Porter, the April 26, 1995 MRI, and various indications of retained mobility, to deny the plaintiff's claim for reinstatement of long-term disability benefits, notwithstanding her prior award of Social Security benefits. The Committee unanimously adopted the following resolution:

RESOLVED, that the appeal of Tracy Rendulic for the reinstatement of Long Term disability benefits under the Kaiser Aluminum & Chemical Corporation Long Term Disability Benefits Plan for Salaried Employees ...

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