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Klaassen v. Allstate Cafeteria Plan

August 27, 2007

CINDY KLAASSEN, PLAINTIFF
v.
ALLSTATE CAFETERIA PLAN, DEFENDANT



The opinion of the court was delivered by: Chief Judge Kane

MEMORANDUM

Plaintiff seeks to recover long-term-disability benefits allegedly owed to her under a plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Before the Court are cross-motions for summary judgment, which are ripe for disposition. For the following reasons, the Court will grant summary judgment in favor of Plaintiff and deny summary judgment for Defendant.

I. BACKGROUND

A. Factual Background*fn1

Beginning in July 1984, Plaintiff Cindy Klaassen began working as a Staff/Casualty Claims Representative for Allstate Insurance Co. ("Allstate"). While employed at Allstate, in 1994, Klaassen was diagnosed with multiple sclerosis ("MS"). Klaassen began working at home, and then began working part-time in 2001, but she remained at Allstate until February 26, 2003. On that day, Klaassen called her physician to complain of fatigue, eye pain, numbness in her left arm, and difficulty walking. Her physician, Dr. Todd Samuels, advised her not to work for a month. On February 27, 2003, Klaassen did not return to work. She has not returned to work since that time.

Under an employee benefits plan ("Plan") maintained by Allstate and administered and insured by the Hartford Life and Accident Insurance Company ("Hartford"), Klaassen was eligible to apply for long-term-disability ("LTD") benefits. The Plan applied a two-tier definition of "disability." For the first two years after a claim is made, a person is "disabled" if an enumerated condition prevents her "from performing one or more of the Essential Duties of [her] Occupation" and if, as a consequence, her earnings fall below a specified threshold. After the two-year period, however, a person is "disabled" if the condition prevents her "from performing one or more of the Essential Duties of Any Occupation," which is defined as "an occupation for which you are qualified by education, training or experience" and that meets certain earnings-potential requirements. (A.R. 17)*fn2 (emphasis added). The Plan also provided Hartford with "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of [the Plan.]" (A.R. 16.)

On June 30, 2003, Klaassen applied for LTD benefits. In her claimant questionnaire, Klaassen described her symptoms as including: "extreme fatigue & decreased concentration coupled with head pain and numbness in upper extremities"; "pain in eyes"; and "difficulty with speech and cognitive/concentration symptoms." (A.R. 301) (emphasis in original). Additionally, the application included a statement of continued disability filed by Dr. Samuels, in which he described Klaassen as having symptoms of "weakness, fatigue, [decreased] concentration." (A.R. 293.) On August 1, 2003, Hartford approved Klaassen's claim for LTD benefits and made her benefits effective as of July 18, 2003.

On March 10, 2004, Klaassen met with Dr. Ravi Dukkipati, a neurologist in the same group as Dr. Samuels. Dr. Dukkipati found that "[o]verall, [Klaassen] is stable. She continues to experience varied symptoms including fatigue, left upper extremity and lower extremity paresthesias, occipital neuralgia, dizziness, and spine parathesias, i.e. Lhermitte's phenomenon . . . Her headaches have increased somewhat since her last visit here." (A.R. 254.) A few months later, on July 9, 2004, Klaassen returned for a follow-up appointment with Dr. Dukkipati, who again found that "[o]verall, [Klaassen] is stable. Fatigue continues to be a fluctuating issue. She also described paresthesias in varied locations and headaches." (A.R. 230.)

On August 6, 2004, Hartford requested that Dr. Dukkipati answer certain questions related to Klaassen's medical condition. On August 19, 2004, Dr. Dukkipati returned the completed form document, in which he stated that Klaassen had MS and related symptoms, that an MRI showed a finding of stable MS, that Klaassen had "chronic symptoms & episodic relapses," and that Klaassen is "not able to work." (A.R. 238-39.) On August 30, 2004, Klaassen completed a second claimant questionnaire, in which she indicated that her condition remained the same as in June 2003.

On November 16, 2004, Klaassen again returned for another follow-up appointment with Dr. Dukkipati, who found that "[c]linically, [Klaassen] has been doing quite well. She continues to have fatigue as before. It is no worse. She reported intermittent headaches. Her left sided symptoms are about the same." (A.R. 232.)

On February 17, 2005, Hartford requested that Klaassen complete and return additional information to evaluate eligibility for ongoing benefits. Klaassen accordingly submitted a third questionnaire on March 10, 2005, in which she indicated that "[t]he symptoms and [her] condition seem to be at about the same level as per [her] 6/30/03 response and [her] 8/31/04 response to Hartford's inquiries/requests for Info." (A.R. 215.)

On March 15, 2005, Klaassen returned for another follow-up appointment with Dr. Dukkipati. Again, Dr. Dukkipati indicated that "[o]verall, [Klaassen] has been stable." (A.R. 126.) Dr. Dukkipati also indicated that "[t]he holidays were tough on her in terms of increased stress and aggravation of her underlying MS symptoms. She denied any new symptoms. Her current symptoms include fatigue, headaches once a week, lower extremity weakness intermittently, and dizziness." (Id.)

On April 18, 2005, at the request of Hartford, Dr. Dukkipati returned a form statement of continued disability in which he indicated that Klaassen's condition was "unchanged." (A.R. 204.) Dr. Dukkipati also indicated that Klaassen's ability to stand, walk, sit, lift, reach, push, pull, and drive was limited. (A.R. 205.) Finally, he indicated that Klaassen could occasionally lift 1-10 pounds, drive, reach, handle, finger, and feel with both hands. (A.R. 206-07.)

In a letter dated June 6, 2005, Hartford requested that Dr. Dukkipati respond to the following inquiry:

Do you agree, based on an 8 hour workday, that Ms. Klaassen retains the capacity to perform at the following level of functionality?

She is able to sit 1-3 hours at a time with the ability to get up and stretch or change positions. She is able to perform occasional standing or walking (1-2 hours total per workday). No repetitive kneeling, crouching, stooping, reaching overhead, climbing stairs, twisting or turning. She is able to perform repetitive lifting, carrying, pushing or pulling greater than 10 pounds occasionally. She is able to use her upper extremities to perform frequent to constant fingering, feeling and/ or handling. She is able to sit at a table or desk with her arms supported on the arms of a chair or on a table.

She is able to stand and/or walk longer than 2 to 3 hours at a time with the ability to change positions. She can perform occasional sitting (1-2 hours total per workday). No repetitive kneeling, crouching, stooping, reaching overhead, climbing stairs, twisting or turning. She has ability to perform lifting, carrying, pushing or pulling up to 20 pounds occasionally and up to 10 pounds frequently.

The patient can perform frequent to constant fingering, feeling and/ or handling with her bilateral upper extremities. (A.R. 197-98.) On July 5, 2005, Dr. Dukkipati returned the letter to Hartford with his signature after both statements (hereinafter, "the July 5th letter").*fn3 A week later, Dr. Dukkipati again observed Klaassen, and again described her as "stable." (A.R. 127.) However, he noted that the "increased heat of the summer tends to make her more susceptible to her chronic MS ...


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