The opinion of the court was delivered by: James F. McClure, Jr. United States District Judge
On May 19, 2005, plaintiff Shirley Rupert ("Rupert") filed a complaint against defendant The Prudential Insurance Company ("Prudential"). 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 her entitlement to future benefits under her Plan. See 29 U.S.C. § 1132(a)(1)(B).
Both parties' cross motions for summary judgment are fully briefed and 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 Prudential and against plaintiff Rupert.
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 to 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 non-movant'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, 578 (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.
A. Undisputed Background Facts
Plaintiff Shirley Rupert was an employee of the Centre Daily Times ("Daily Times"), a subsidiary of Knight Ridder, Inc., and began her employment on July 14, 1982. As an employee of the Centre Daily Times, Rupert purchased through her employer a long-term disability policy with the defendant Prudential. Deductions were taken from Rupert's pay and the Daily Times was responsible for paying the insurance premium for Rupert's disability insurance policy to Prudential. Prudential is an insurance company that both funds and administers the plan.
Beginning in May 2002 Rupert began seeing her family physician Dr. Michael Greenberg for headaches. On May 31, 2002 an MRI of the cervical spine was conducted on Rupert. Conclusions drawn from the MRI were that Rupert suffered from "mild spondylosis at C5-C6 and C6-C7." (Rec. Doc. No. 22, at PRU 168.) The report also indicated that there was some loss of depth of the canal in the AP direction at C5-C6, but there was no evidence for cord compression. The MRI also revealed that there was bilateral neural foraminal narrowing, and at the C6-C7 there was mild right-sided neural foraminal narrowing. (Rec. Doc. No. 22, at PRU 168.)
On June 19, 2002, Rupert stopped working as the circulation business manager for the Daily Times due to headaches.*fn1 During the Summer of 2002 Rupert continued treatment with Dr. Greenberg who recommended that she avoid the stress of work until her condition improved. On September 10, 2002, Dr. Greenberg noted he doubted Rupert would ever return to work due to the incapacitating headaches.
On October 4, 2002, Rupert filed a claim for long-term disability under Group Contract 74600 ("Policy") issued to her employer's parent company, Knight-Ridder, Inc. She submitted this claim as a result of her diagnosis of headaches and degenerative joint disease. As part of this application Dr. Anothony Marrar's attending physician statement was included. That statement indicated diagnoses of multiple cervical subluxations, cervical disc degeneration, and cephalalgia. (Rec. Doc. No. 22, at PRU 92-94.) On November 21, 2002, defendant denied plaintiff's claim for benefits. (Rec. Doc. No. 22, at PRU 314-16.) In denying plaintiff's claim for benefits, defendant summarized as follows: We have determined that your medical condition would not prevent you from performing the material and substantial duties of your occupation. The objective exams submitted only indicate mild changes in your neck. Although you may continue to experience symptoms that may require ongoing treatment for your condition, the medical information on file does not provide evidence of an impairment which would render you Totally Disabled from performing the duties of your own occupation as a Circulation Business Manager. Therefore, your Long Term Disability claim has been Disallowed effective November 22, 2002. (Rec. Doc. No. 22, at PRU 315.)
During the fall of 2002 Rupert continued following up with Dr. Greenberg for headaches. On November 14, 2002, a colonoscopy was performed on Rupert with an impression of colitis. (Rec. Doc. No. 22, at PRU 133.) On November 21, 2002, defendant's claim examiner spoke with Rupert who indicated that she had only been to a neurologist once. (Rec. Doc. No. 22, at PRU 375.) She also advised the examiner that she continued to have headaches and other forms of debilitating pain. (Rec. Doc. No. 22, at PRU 375.)
Rupert appealed Prudential's initial decision on January 15, 2003. On February 28, 2003, Dr. Greenberg drafted a letter advising that Rupert had been seen by numerous specialists and the consensus of the physicians who had seen her was that Rupert's headaches were secondary to a neurovascular component as well as a degenerative disease affecting her cervical spine. (Rec. Doc. No. 22, at PRU 87.) He also stated in that document that he doubted that Rupert would be able to return to any occupation for which she was suitably trained. (Rec. Doc. No. 22, at PRU 87.) On March 24, 2003, Prudential upheld its decision to deny plaintiff's claim for long term disability benefits. (Rec. Doc. No. 22, at PRU 318-20.)
Three days earlier on March 21, 2003, and independent of Rupert's claim for benefits from Prudential, Rupert was examined by Dr. Gregory Neurudian on behalf of social security disability. (Rec. Doc. No. 22, at 76-78.) Dr. Neurudian summarized that Rupert had "some type of neuromuscular migraine disorder, who has attacks frequently during the week, who has not gained relief from her medication, who has in addition, a mitral valve prolapse with irregular heartbeat." (Rec. Doc. No. 22, at PRU 78.) Throughout April and May Rupert continued follow up visits with Dr. Greenberg regarding her headaches and cervical condition. (Rec. Doc. No. 22, at PRU 182-83.)
On June 19, 2003, Rupert visited surgeon Dr. Nicholas DiCuccio. In his notes describing Rupert's first visit with him, Dr. DiCuccio noted that "[t]his patient is completely disabled from a multi-faceted medical standing and should be on Social security disability." (Rec. Doc. No. 22, at PRU 115.) His initial impressions were that Rupert had intractable neck pain, advancing degenerative disk disease of spine, systemic arthritis, osteoporosis, colitis, and intractable pain. (Rec. Doc. No. 22, at PRU 114.)
On June 20, 2003, an ALJ found that Rupert had met the disability insured status requirement of the Social Security Act from June 20, 2002 to December 31, 2007. (Rec. Doc. No. 22, at PRU 63-69.)
On July 29, 2003, Dr. DiCuccio saw Rupert and found that:
She has been doing fair. The patient denied any excessive difficulty. The medications for her gut has been helping. The patient is doing excellently. She is not having any other difficulties. The arthritis still gives her tremendous amount of problems with pain on the right side of her neck and it radiates down into her hand causing a lot of difficulties with this area. . . . .
Patient is totally disabled and Social Security Disablity has been achieved. Her private insurance also disabled the patient. (Rec. Doc. No. 22, at PRU 115.)
Rupert submitted a request for administrative reconsideration on August 7, 2003. (Rec. Doc. No. 22, at PRU 83.) As part of that request Rupert's counsel noted that Rupert has been approved for social security disability and that in Dr. DiCuccio's opinion she was totally disabled. (See DiCuccio's July 30, 2003 Letter, Rec. Doc. No. 22, at PRU 81-82). In August and September Rupert followed up with Dr. Greenberg. In September, October, November, and December of 2003, Rupert followed up with Dr. DiCuccio.*fn2 (Rec. Doc. No. 22, at PRU 116-17.)
On September 8, 2003, Prudential requested that Rupert provide additional documentation in the form of physical examination findings, test results, or data to support the opinion that she was unable to work. Plaintiff did not provide any further medical documentation and requested a prompt decision. (Rec. Doc. No. 22, at PRU 70-71.) On December 18, 2003, two of defendant's claim handlers evaluated Rupert's claim on appeal. (Rec. Doc. No. 22, at 361-62.) On January 8, 2005, Prudential upheld its initial decision. (Rec. Doc. No. 22, at PRU 326-28.)
In that document Prudential stated:
In summary, the medical documentation in file indicates that although Ms. Rupert may experience discomfort from her conditions, the documentation does not support that they impair her ability to perform her regular occupation. Therefore, we have upheld our decision to disallow her claim. (Rec. Doc. No. 22, at PRU 327.)
In January and February of 2004, Dr. DiCuccio found the impression of intractable neck pain (degenerative disk disease; osteophytic spurs; lateral ligament calcifications), possible collagenous colitis, systemic arthritis, probable seronegative rheumatoid arthritis, advanced degenerative disk disease of the spine, osteoporosis, intractable pain syndrome, and hyperlipidemia. (Rec. Doc. No. 22, at PRU 117.) ...