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Krol-Knight v. Highmark Life & Casualty Group

March 9, 2006

ANNIE A. KROL-KNIGHT, PLAINTIFF
v.
HIGHMARK LIFE & CASUALTY GROUP AND HIGHMARK LIFE INSURANCE COMPANY, DEFENDANTS



The opinion of the court was delivered by: Magistrate Judge Smyser

MEMORANDUM AND ORDER

This civil action was started by a complaint filed on April 12, 2005. The plaintiff, Annie A. Krol-Knight, brought the action to recover long term disability benefits wrongfully denied and to clarify her right to long term disability benefits. The action is brought under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). The plaintiff claims a right to have long term disability benefits under the Highmark Life and Casualty Long Term Disability Plan and an insurance policy that is issued under an "employee benefit plan" pursuant to ERISA, 29 U.S.C. § 1002(3). The court has jurisdiction under 29 U.S.C. § 1132(e)(1). The parties consented to a magistrate judge as the presiding officer pursuant to 28 U.S.C. § 636(c).

The plaintiff resides in Enola, Pennsylvania. The defendant Highmark Life and Casualty Group is a Pennsylvania corporation. The plaintiff worked at Highmark as a claims examiner from July 22, 1991 to April 10, 2003.

A disability insurance policy was provided for employees of Highmark Life and Casualty Group (Highmark Plan). The plan administrator was defendant Highmark Life Insurance Company.

An answer was filed by defendants on June 8, 2005 to the plaintiff's complaint. Doc. 3. A case management conference was held on September 23, 2005, and a case management order was issued. Doc. 13. The parties agreed that the case is appropriate for disposition pursuant to summary judgment motions upon an agreed record. A stipulation filed on January 4, 2006 stated that Doc. 16, Exhibit A is the complete set of administrative records used by the Plan Administrator in determining that the plaintiff was no longer eligible to receive long term disability benefits under the Group Disability Insurance Policy involved here. Summary judgment motions were filed on January 17, 2006 along with briefs and LR 56.1 statements of material fact. Docs. 16-24. Briefs in opposition were filed and answers to LR 56.1 statements were filed.

The plaintiff stopped working on September 5, 2002, and began to receive short-term disability benefits under the Highmark Plan. She had earlier been certified as disabled, in 2001.

The insurer certified disability from March 19, 2001 through April 24, 2001 based upon the report of Dr. Nasir. Doc. 16, p. 14. By notification dated April 30, 2001, Highmark informed the plaintiff that "your claim cannot be certified further since updated medical information received from your attending physician does not support continued disability." Id. at p. 15. On May 29, 2001, Highmark notified the plaintiff that, based upon information from Dr. Nasir, disability had been certified from March 19, 2001 through June 12, 2001. Id. at p. 16. By letter of June 28, 2001, certification was again extended to July 10, 2001. Id. p. 17. By letter of August 6, 2001, the certification was extended to August 19, 2001. Id. p. 18.

By letter of October 11, 2001 the plaintiff was told that long term disability payments had been approved. Id. pp. 21-22. By letter of November 30, 2001 she was told the following:

November 30, 2001

Ms. Annie Krol-Knight

71 Sherwood Circle

Enola, PA 17025 RE: LONG TERM DISABILITY BENEFITS

CLAIM #2001-262-55447 GROUP ...


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