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Wernicki-Stevens v. Reliance Standard Life Ins. Co.

July 15, 2009


The opinion of the court was delivered by: Eduardo C. Robreno, J.


Plaintiff Marla Wernicki-Stevens ("Plaintiff") brings this ERISA action seeking payment of long-term disability benefits, retroactive to May 3, 2007, by Defendant Reliance Standard Life Insurance Company ("Reliance").*fn1 Before the Court are cross-motions for summary judgment. For the reasons that follow, each motion for summary judgment will be granted in part and denied in part.


Until January 25, 1999, Plaintiff was employed as a graphic designer at the Art Guild, Inc., in West Deptford, New Jersey. During her employment, Plaintiff enrolled in The RSL Group and Blanket Insurance Trust (the "Plan"), a group long-term disability policy, which is insured by Reliance under a policy bearing Group Policy No. LSC 067377.*fn2 Under the terms of the Plan, Reliance retained discretionary authority to determine a participant's eligibility for benefits.*fn3

On January 26, 1999, Plaintiff was diagnosed with chronic fatigue syndrome secondary to Lyme disease, post herpatic neuropathy, and anxiety.*fn4 As a result, she took a medical leave of absence from the Art Guild, Inc. and applied for long-term disability benefits under the Plan. On April 26, 1999, Plaintiff's request for long term disability benefits was granted and Plaintiff began receiving benefits under the Plan.*fn5

Plaintiff continued to receive these long-term disability benefits for approximately eight years, until May 3, 2007.

On May 3, 2007, however, citing the results of a Functional Capacity Examination ("FCE") that Plaintiff had undergone on March 20-21, 2007,*fn6 Reliance terminated Plaintiff's long-term disability benefits, finding that Plaintiff no longer met the Plan's definition of "Total Disability." (Pl.'s Mot. for Summ. J. Ex. M, doc. no. 10.) Specifically, Reliance found that Plaintiff was "capable of full-time sedentary restrictions and limitations with position change, and restrictions on upper extremity use." (Id.) Further, Reliance noted that Plaintiff's occupation, Graphic Designer, required only sedentary exertion. (Id.; see also id. Ex. U (vocational review concluding that Plaintiff would be able to perform the duties of a graphic designer, despite physical restrictions indicated by FCE).)

On August 8, 2007, Plaintiff appealed Reliance's decision. In support of her appeal, Plaintiff submitted additional medical records and a one-page letter from her treating physician, Dr. Emilia Eiras, dated October 10, 2007, in which Dr. Eiras stated that "[a]fter reviewing Marla's Functional Capacity Examination, it is clear to me that Marla is incapacitated to work in any capacity." (Id. Ex. Q.) Reliance referred Plaintiff's entire claim file to Dr. Howard Choi, a board certified physical medicine and rehabilitation specialist, for an independent review. Dr. Choi issued two reports, dated October 15 and December 10, 2007, in which he concluded that Plaintiff's total disability claim was not supported by "objective findings." (Id. Exs. N & O.) Specifically, Dr. Choi noted that "Dr. Eiras' letter of 10/10/07 does not include a rationale for why she concluded that the FCE showed that the claimant was incapacitated to work in any capacity" and that "[t]he records for each visit with Dr. Eiras . . . reflect that this health care provider essentially catalogs the claimant's complaints and then proceeds to prescribe medications, without a neurological, musculoskeletal or functional examination." (Id. Ex. O.) Plaintiff's appeal was denied on January 8, 2008. (Id. Ex. T.) This lawsuit followed.


A. Motion for Summary Judgment under Fed. R. Civ. P. 56

A court may grant summary judgment when "the pleadings, the discovery and the disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(C). A fact is "material" if its existence or non-existence would affect the outcome of the suit under governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). An issue of fact is "genuine" when there is sufficient evidence from which a reasonable jury could find in favor of the non-moving party regarding the existence of that fact. Id. at 248-49. "In considering the evidence, the court should draw all reasonable inferences against the moving party." El v. Se. Pa. Transp. Auth., 479 F.3d 232, 238 (3d Cir. 2007). However, while the moving party bears the initial burden of showing the absence of a genuine issue of material fact, the non-moving party "may not rely merely on allegations or denials in its own pleading; rather its response must - by affidavits or as otherwise provided in [Rule 56] - set out specific facts showing a genuine issue for trial." Fed. R. Civ. P. 56(e)(2).

These rules apply with equal force to cross-motions for summary judgment. See Lawrence v. City of Phila., 527 F.3d 299, 310 (3d Cir. 2008). When confronted with cross-motions for summary judgment, as in this case, the Court considers each motion separately. See Coolspring Stone Supply, Inc. v. Am. States Life Ins. Co., 10 F.3d 144, 150 (3d Cir. 1993) (noting that concessions made for purposes of one party's summary judgment motion do not carry over into the court's separate consideration of opposing party's motion).

B. ERISA Standard of Review

A denial of a claim for benefits brought pursuant to ERISA is governed by a de novo standard of review, "unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). Where the plan administrator is granted such discretion, the Court must review the administrator's denial of a claim for benefits using an arbitrary and capricious standard of review. See id. at 111 (noting ...

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