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Leonora Glunt v. Life Insurance Company of North America

January 24, 2012

LEONORA GLUNT, PLAINTIFF,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA,
DEFENDANT.



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

MEMORANDUM

In this Employee Retirement Income Security Act ("ERISA") case, Leonora Glunt claims that she is disabled and unable to work. She seeks short-term disability benefits under a policy she had through her employer, Quest Diagnostics, which was administered by the Life Insurance Company of North America ("LINA"). LINA contends that Glunt has failed to produce satisfactory evidence that she qualifies as disabled under the policy and therefore refuses to pay her short-term disability benefits. Before the Court are the parties' cross-motions for summary judgment. For the reasons that follow, the Court will grant Glunt's motion and deny LINA's motion.

I. BACKGROUND

A. Short-Term Disability Policy

Glunt was a phlebotomist at Quest Diagnostics. LINA provided short-term disability ("STD") coverage for Quest employees. (Def.'s Statement of Undisputed Facts in Supp. of Mot. for Summ. J. [LINA SOF] ¶¶ 1-3.) The policy defines "disabled" as follows:

Definition of Disability/Disabled The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:

1. unable to perform the material duties of his or her Regular Occupation; and

2. unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation. (Joint Appendix ["J.A."] at 105.) The policy defines "Regular Occupation" as:

[t]he occupation the Employee routinely performs at the time the Disability begins. In evaluating the Disability, the Insurance Company will consider the duties of the occupation as it is normally performed in the general labor marked in the national economy. It is not work tasks that are performed for a specific employer or at a specific location. (Id. at 124.) The policy also contains provisions that require the claimant to provide "satisfactory proof of Disability before benefits will be paid" and "continued proof of the Employee's Disability for benefits to continue." (Id. at 114.)

B. Glunt's Medical History and LINA's Review

Glunt's last day of work was on April 27, 2010, due to a "panic disorder." (Id. at 3.) She claimed that she was suffering from "palpitations, insomnia, racing thoughts, psychomotor agitation, feelings of losing control, and difficulty concentrating." (Id. at 178.) On that same day, Glunt's treating physician, Dr. Gayle Sisbarro, noted Glunt's various stressors, that Glunt's mood was anxious and nervous, that Glunt had insomnia, and that Glunt's speech was rapid and pressured. (Id. at 179.)

Glunt filed a claim with LINA for STD benefits on May 3, 2010. (Id. at 3.) The following day, Glunt again saw Dr. Sisbarro. (Id. at 181.) Dr. Sisbarro reported that Glunt was tolerating her psychiatric medicine, that employment concerns were a continued stressor for Glunt, and that Glunt's depression was gradually improving. (Id.) On May 8, Dr. Sisbarro filled out a behavioral health questionnaire claim form in which she noted Glunt's speech as racing, mood as anxious, and affect as nervous, but observed that Glunt is "able to carry out all [activities of daily living] without help or supervision." (Id. at 176.) Dr. Sisbarro concluded, however, that Glunt needed counseling and to reduce medicine prior to returning to work. (Id.) She listed a target date of June 1, 2010 for Glunt to return to work and stated that it was yet to be determined whether Glunt could return to work full time. (Id.) Dr. Sisbarro also wrote that Glunt could perform her job duties in an alternative work setting if she had a manageable work load, but that she was currently overworked. (Id. at 177.)

On May 24, 2010, Dr. Sisbarro wrote a letter to certify that Glunt's condition left her unable to work. (Id. at 172.) The letter stated that Glunt's increase in workload and responsibilities triggered an anxiety acute stress reaction, which caused difficulty in completing activities of daily living and sleeping. (Id.) Dr. Sisbarro noted that she was regulating Glunt's medication, that Glunt was attending physical therapy for ongoing back issues, and that Glunt needed two additional weeks to adjust to medicine and to continue therapy, which should help her ability to function in a fast-paced work environment. (Id.) Dr. Sisbarro estimated a return-to-work date of June 7, 2010. (Id.)

On May 19, 2010, LINA requested from Dr. Sisbarro Glunt's restrictions and limitations, (id. at 84), and on May 24, 2010, LINA requested Glunt's physical therapy records on May 24. (Id. at 79.) Prior to receiving the requested information, on May 25, 2010, Venus Thompson, a nurse case manager for LINA, reviewed Glunt's medical information and concluded that the record did not support a finding that Glunt was disabled. To support her conclusion, Thompson cited Dr. Sisbarro's failure to: (1) identify a Global Functional Impairment; (2) identify the condition with regard to severity, intensity, and duration; (3) note medications; and (4) list a diagnosis for the back pain. ...


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