Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Cheryl A. Loomis v. Life Insurance Company of North America

June 21, 2011

CHERYL A. LOOMIS
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, ET AL.



The opinion of the court was delivered by: Goldberg, J.

MEMORANDUM OPINION

Plaintiff, Cheryl Loomis, filed suit against Life Insurance Company of North America, d/b/a CIGNA Group Insurance (LINA) and Lockheed Martin Corporation (Lockheed), alleging a violation of § 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B). Loomis claims that LINA abused its discretion in applying an improper standard in terminating her long-term disability benefits.

Before the Court are both parties' cross-motions for summary judgment. Because we agree that LINA did apply the wrong standard in deciding to terminate Plaintiff's disability benefits, Plaintiff's motion will be granted in part. Defendants' motion will only be granted so that Lockheed is dismissed. The basis for our ruling is set forth below.

I. FACTUAL AND PROCEDURAL BACKGROUND*fn1 Cheryl Loomis began working for Lockheed as a desk support technician on March 16, 1998,

and was covered by a long-term disability plan administered by LINA. The plan contained the following definition of disability:

An employee will be considered Disabled if because of Injury and Sickness,

1. he or she is unable to perform each and every material duty of his or her regular occupation; and

2. after Monthly Benefits have been payable for 24 months, he or she is unable to perform each and every material duty of any occupation for which he or she may reasonably become qualified based on education, training or experience.

(Def.'s State. Facts ¶¶ 1, 4.) In January 2007, Plaintiff took a leave of absence from work to be treated at the Renfrew Center (Renfrew) because she had lost approximately fifty percent of her body weight over a four year period and was having difficulty "concentrating and functioning on a daily basis due to struggling with her eating disorder symptoms [sic]." At the time of her admission, Plaintiff was 94.9 pounds, approximately 28 pounds less then her ideal body weight. Plaintiff received inpatient treatment at Renfrew for 24 days, and upon her discharge, was diagnosed with an eating disorder, major depressive disorder and generalized anxiety disorder. (LINA at 280-81.)*fn2

On April 22, 2007, Plaintiff filed a claim for long-term disability benefits under LINA's policy, indicating that vision, shakes, fatigue and poor memory prevented her from working. In a contemporaneous disability questionnaire, she claimed that she was disabled due to anxiety, depression, poor memory, stress, weight loss, anger and vision problems. In conjunction with this claim, Plaintiff's primary care physician, Dr. Francis W. Brennan, submitted a Statement of Disability identifying depression and anorexia as Plaintiff's disabling conditions, and opining that Plaintiff was "unable to return to work due to comprehensive testing by [a] gastroenterologist." (Def.'s State. Facts ¶¶ 1-2, 10-12, 19, 22, 26-28; Pl.'s State. Facts ¶ 5; LINA at 366-67, 421-22.)

LINA approved Plaintiff's disability claim on May 31, 2007 and began making monthly long-term disability payments of $3,236 on June 22, 2007. LINA's approval letter declared that Plaintiff was eligible for benefits, but did not describe the basis for its decision.*fn3 (Def.'s State. Facts ¶¶ 26-28; Pl.'s State. Facts ¶ 5.)

On September 13, 2007, LINA learned that the results of the gastrointestinal testing referenced in Dr. Brennan's Statement of Disability had come back negative. Thereafter, between September and December of 2007, LINA sent Plaintiff three letters asking her to submit the names of any behavioral therapists with whom she was receiving ongoing psychological treatment or counseling. Plaintiff failed to respond to these requests. On January 15, 2008, LINA wrote to Plaintiff claiming it had no current medical information to substantiate a disabling condition and terminating her long-term disability benefits as of January 9, 2008. (LINA at 231, 309-11.)

Because Plaintiff had been receiving benefits for less than 24 months, in reaching its decision, LINA was required to evaluate whether Plaintiff could "perform each and every material duty of . . . her regular occupation." LINA does not dispute this point. However, the "Summary" portion of LINA's January 15, 2008 denial letter provided:

In reviewing your claim, Life Insurance Company of North America considered your claim file as a whole for purposes of determining your entitlement to benefits. The Plan provides that Life Insurance Company of North America would pay benefits only if you are prevented by Disability from performing any occupation; however the weight of the evidence in your claim file supports your ability to perform any occupation. (Def.'s State. Facts ¶¶ 32-35; Pl.'s State. Facts ¶ 8.) In the portion of this letter informing Plaintiff of her appellate rights, LINA did advise Plaintiff that she could submit recent ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.