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Moser v. Liberty Life Assurance Co. of Boston

January 9, 2007

DENNIS MOSER, PLAINTIFF,
v.
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, DEFENDANT.



The opinion of the court was delivered by: James F. McClure, Jr. United States District Judge

(Judge McClure)

MEMORANDUM

BACKGROUND:

On January 12, 2006, plaintiff Dennis Moser filed a complaint against defendant Liberty Life Assurance Company of Boston. Plaintiff's cause of action arises under the Employee Retirement Income Security Act of 1974 ("ERISA"). This court has jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). Plaintiff seeks to recover long-term disability benefits.

The record before the Plan Administrator when it denied plaintiff's benefits has been filed with the court. Both parties have filed motions for summary judgment. Opposing briefs have been filed and the motions are now ripe for our review. Now, 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 Liberty and against plaintiff Moser.

DISCUSSION:

I. LEGAL STANDARD

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 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, (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).

II. STATEMENT OF FACTS

In this case we have cross motions for summary judgment. Fortunately for the court, the facts from each motion can be synthesized into a single statements of facts. It is important to note that the record in this case is lengthy and involves numerous medical reports. We obviously have not included every such report in this statement of facts, but only those that were mentioned by each party in its statement of material facts and those others that we believe are relevant to our decision.

Plaintiff Dennis Moser ("Moser") is an adult individual who was an over-the-road truck driver with Wise Foods. Liberty Life Assurance Company of Boston ("Liberty") is a corporation that provides disability insurance to the employees of Wise Foods pursuant to a group disability policy ("Plan").

The Plan provides Liberty with the authority "in its sole discretion, to construe the terms of [the] policy and to determine benefit eligibility." (Admin. Rec. & Plan, Rec. Doc. No. 11, at LL-0050.) The Plan indicates that to be eligible for long-term disability benefits, the employee's condition must prevent him or her from performing the material and substantial duties of his or her "own occupation" during the elimination period and the next twenty-four months of disability. (Id. at LL-0009.) To continue to receive benefits after the elimination period and the next twenty-four months, the employee's condition must prevent him or her from performing, with reasonable continuity, the material and substantial duties of "any occupation." (Id.)

On August 14, 2001, Moser was involved in a motor vehicle accident in which he blacked out while driving his truck for Wise Foods. Moser's family physician, Dr. Michael Weisner, diagnosed Moser with severe abnormal vasovagal syncope. Moser was unable to return to work because of the risk that he would have another black-out while driving. (Id. at LL-0588.) Therefore, he went on short-term disability.

In February of 2002, Moser saw Dr. Randle Storm, a cardiologist. At this point, his symptoms were lightheadedness and dizziness, in addition to the blackouts caused by the syncope. On March 7, 2002, Moser had a pacemaker implanted by Dr. Storm. The purpose of this pacemaker was to help with the blackouts. Evidently, the pacemaker had a positive effect. On October 9, 2002, Dr. Storm stated that Moser could return to driving because there had been no blackouts since the insertion of the pacemaker. (Id. at ...


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