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September 27, 2005.

DANIEL T. BOWMAN, Plaintiff,

The opinion of the court was delivered by: JAMES McCLURE, Senior District Judge



On October 4, 2004, plaintiff Daniel T. Bowman filed a complaint against defendant Hartford Life and Accident Insurance Company. Plaintiff's action arises under the Employee Retirement Income Security Act of 1974 ("ERISA"). This court has jurisdiction pursuant to 29 U.S.C. § 1132(e). Plaintiff seeks to recover long-term disability benefits, and the court's clarification of his entitlement to future benefits under his Plan. See 29 U.S.C. § 1132(a)(1)(B).

  On April 10, 2005, we ordered that a copy of the Plan and the record before the Plan administrator when it denied plaintiff's benefits be filed before April 29, 2005. At that time the court intended to rule on defendant's motion for the application of the arbitrary and capricious standard of review upon receipt of the Plan and record. Following a further case management conference the parties agreed that the court would postpone its decision on the exact standard of review until it was to rule on the parties' opposing motions for summary judgment. The Plan and the record have since been filed, and both motions for summary judgment are now ripe for our review. For the following reasons we will grant defendant's motion for summary judgment, deny plaintiff's motion for summary judgment, and enter judgment in favor of defendant Hartford and against plaintiff Bowman.

  It is appropriate for a court to grant a motion for summary judgment "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled a judgment as a matter of law." Fed.R.Civ.P. 56(c).

  "If the nonmoving party has the burden of persuasion at trial, `the party moving for summary judgment may meet its burden by showing that the evidentiary materials of record, if reduced to admissible evidence, would be insufficient to carry the nonmovant's burden of proof at trial.'" Jalil v. Avdel Corp., 873 F.2d 701, 706 (3d Cir. 1989) (quoting Chippolini v. Spencer Gifts, Inc., 814 F.2d 893, 896 (3d. Cir. 1987)); see also Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986).

  In evaluating a motion for summary judgment the court will draw all reasonable inferences from the evidence in the record in favor of the nonmoving party. Am. Flint Glass Workers Union v. Beaumont Glass Co., 62 F.3d 574, (3d Cir. 1995). The nonmoving party, however, cannot defeat a motion for summary judgment by merely offering general denials, vague allegations, or conclusory statements; rather the party must point to specific evidence in the record that creates a genuine issue as to a material fact. See Celotex, 477 U.S. at 32; Ridgewood Bd. of Educ. v. N.E. ex rel. M.E., 172 F.3d 238, 252 (3d Cir. 1999).


  In this case we have cross motions for summary judgment. Fortunately, the facts relating to both motions can be synthesized under a single statement of the facts. Because the facts are largely undisputed this statement closely mirrors Hartford's statement of undisputed facts.

  Plaintiff Daniel T. Bowman ("Bowman") is an adult individual who resides in Mifflinburg, Pennsylvania. Hartford is a Connecticut corporation with its principal place of business in Simsbury, Connecticut. Hartford insures the Food Lion hourly employees' long-term disability plan ("Plan"). The Plan provides Hartford with "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy." (Admin. Rec. & Plan, Rec. Doc. No. 19, at HLI00816.) The relevant text of the Plan indicates that "Total Disability or Totally Disabled means that: (1) during the Elimination Period; and (2) for the next 24 months, you are prevented by . . . accidental bodily injury . . . from performing the essential duties of your occupation. . . . After that, you must be so prevented from performing the essential duties of any occupation for which you are qualified by education, training, or experience." (Rec. Doc. No. 19, at HLI00799.)

  The plaintiff was hired by Food Lion on July 15, 1991, and became insured under the Food Lion hourly employees' long-term disability plan on November 1, 1995. Bowman worked as a "Meat Department" manager for Food Lion in Orlando, Florida. On January 2, 1996, Bowman was injured when pushing a pallet jack. Bowman's last day of work was January 3, 1996. (Rec. Doc. No. 19, HLI00787.)*fn1

  On August 27, 1996, Bowman underwent a surgical fusion procedure on his back. On May 19, 1997, Dr. Flynn, the orthopedic surgeon who performed the spinal fusion, stated that he did not believe Bowman would be able to return to his own occupation, but instead would "require sedentary type work with sitting and standing as needed." (Rec. Doc. No. 19, at HLI00744.) On July 14, 1997 and August 4, 1997, Dr. Flynn reiterated that Bowman would need sedentary type work. (Rec. Doc. No. 19, at HLI00747, HLI00774.) On August 7, 1997, Dr. Flynn opined that Bowman was totally disabled from his own job and from any other job. However, he noted that in the future it was possible for a fundamental or marked change in Bowman's capabilities. (Rec. Doc. No. 19, at HLI00781-782.) At that time Dr. Flynn identified Bowman as a suitable candidate for further rehabilitation services and stated that a job modification might enable Bowman to work with his impairment. (Id.)

  On September 19, 1997, Hartford awarded long-term disability ("LTD") benefits to Bowman payable effective July 5, 1996. (Rec. Doc. No. 19, at HLI00724-726.) Pursuant to the Plan, Bowman was notified that he would continue to receive benefits as long as he met the Plan definition of Total Disability, but not beyond July 4, 2021. Bowman was also informed that following the first twenty-four months of disability the definition of total disability changed and he must be prevented from performing the essential duties of any occupation for which he was qualified by education, training or experience in order to be considered totally disabled.

  On November 18, 1997, Bowman's application for Social Security benefits was denied. (Rec. Doc. No. 19, at 697-698.) Bowman subsequently filed a request for reconsideration of that denial. (Rec. Doc. No. 19, at HLI00695.) On January 22, 1999, the SSA upheld the denial of Bowman's claim for benefits. As part of that decision the ALJ concluded that Bowman had the residual functional capacity to perform the full range of sedentary work and was not entitled to Social Security benefits. (Rec. Doc. No. 19, at HLI00612-624.) On October 27, 2000, the Social Security Appeals Council concluded that there was no basis to review his claim and authorized him to pursue a federal civil action if he so wished. (Rec. Doc. No. 19, at HLI00525-526.)

  On February 12, 1998, Dr. Flynn reported that Bowman could stand and walk for two hours each per day for four days a week, could occasionally lift and carry a maximum of 20 pounds, and could reach or work overhead occasionally. (Rec. Doc. No. 19, at HLI00687-688.) On April 9, 1998, Dr. Flynn completed a physical capacities evaluation in which he noted that Bowman could stand, sit, walk and drive for one to three hours in an eight-hour workday. (Rec. Doc. No. 19, at HLI00638.) Dr. Flynn also indicated that Bowman was capable of simple grasping, pushing and pulling and fine manipulation, and could reach above his shoulder and use his feet frequently. He noted that Bowman was unable to bend, squat, climb, kneel, or crawl. He also noted that he had a 20-pound maximum lifting capacity but that he could frequently lift or carry up to 10 pounds which was classified as light work, that Bowman was unaffected by environmental factors, and that he ...

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