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Pini v. First Unum Life Ins. Co.

United States District Court, W.D. Pennsylvania

November 5, 2013

JANICE C. PINI, Plaintiff,
v.
FIRST UNUM LIFE INSURANCE COMPANY, THE CA, INC. GROUP LONG TERM DISABILITY PLAN, AND CA, INC., Defendants

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For JANICE C. PINI, Plaintiff: Tybe A. Brett, LEAD ATTORNEY, Feinstein Doyle Payne & Kravec, LLC, Pittsburgh, PA.

For FIRST UNUM LIFE INSURANCE COMPANY, THE CA, INC. GROUP LONG TERM DISABILITY PLAN, CA, INC., Defendants: Peter D. Post, LEAD ATTORNEY, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., Pittsburgh, PA.

OPINION

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MEMORANDUM OPINION

Terrence F. McVerry, Senior United States District Judge.

Before the Court for disposition are the Plaintiff's MOTION FOR SUMMARY JUDGMENT ( ECF No. 29 ), the Plaintiff's Concise Statement of Material Facts ( ECF No. 30 ), the Plaintiff's Exhibits in Support of Motion for Summary Judgment (ECF Nos. [30-1]-[30-12]), the Plaintiff's Brief in Support of Motion for Summary Judgment ( ECF No. 31 ), the Defendants' MOTION FOR SUMMARY JUDGMENT ( ECF No. 32 ), the Defendants' Brief in Support of Motion for Summary Judgment ( ECF No. 33 ), the Defendants' Concise Statement of Material Facts ( ECF No. 34 ), the Administrative Record ( ECF Nos. 35-[35-17] ), the Plaintiff's Brief in Opposition to the Defendants' Motion for Summary Judgment ( ECF No. 38 ), the Plaintiff's Response to the Defendants' Concise Statement of Material Facts ( ECF No. 39 ), the Defendants' Brief in Opposition to the Plaintiff's Motion for Summary Judgment ( ECF No. 40 ), the Defendants' Response to the Plaintiff's Concise Statement of Material Facts ( ECF No. 41 ), and the Plaintiff's Reply to the Defendants' Responsive Brief ( ECF No. 42 ). For the reasons that follow, the Plaintiff's Motion for Summary Judgment ( ECF No. 29 ) will be denied, and the Defendants' Motion for Summary Judgment ( ECF No. 32 ) will be granted.

I. Background

Plaintiff Janice C. Pini (" Pini" ) was hired to work as a Senior Principal Product Manager for CA, Inc. (" CA" ), on

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March 29, 2004. ECF No. 41 at ¶ 1. In that capacity, she was " responsible for driving strategy and requirements for multiple major product lines." ECF No. 35-4 at 40. The position required Pini to spend roughly 50% of her time traveling. Id. at 41.

As an employee of CA working in the United States, Pini participated in CA's Short-Term Disability Plan (" STD Plan" ). ECF No. 41 at ¶ 6. The STD Plan, which became effective on January 1, 2007, provides financial protection for CA employees by paying portions of their salary during periods of disability. ECF No. 30-5 at 6. Benefits available under the STD Plan are payable for a maximum period of twenty-six weeks from the date of an employee's disability. Id. The portion of the STD Plan defining the term " disability" provides as follows:

HOW IS DISABILITY DEFINED FOR THE PLAN?
You are disabled when the Plan Administrator determines that:
o you are Limited from performing the Material and Substantial Duties of your Regular Occupation due to your Sickness or Injury; and
o you have a 20% or more loss in Weekly Earnings due to the same Sickness or Injury.
LIMITED means what you cannot or are unable to do.
MATERIAL AND SUBSTANTIAL DUTIES means duties that:
o are normally required for the performance of your Regular Occupation; and
o cannot be reasonably omitted or modified, except if you are required to work on average in excess of 40 hours per week, the Plan will consider you able to perform that requirement if you are working or have the capacity to work 40 hours per week.
REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. The Plan Administrator will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

Id. at 7 (boldface type and capitalization in original). The STD Plan is an unfunded, self-insured plan. ECF No. 41 at ¶ 6. Benefits provided under the STD Plan are paid from CA's general assets. Id. The day-to-day administration of the STD Plan is controlled by First Unum Life Insurance Company (" Unum" ). Id. at ¶ ¶ 7-8.

Pini also participated in CA's Group Long-Term Disability Plan (" LTD Plan" ). ECF No. 41 at ¶ 12. Unum administers the LTD Plan. Id. at ¶ 14. The LTD Plan is funded by insurance issued by Unum. Id. at ¶ 13. The LTD Plan defines the term " disability" as follows:

HOW DOES UNUM DEFINE DISABILITY?
You are disabled when Unum determines that:
- you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and
- you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.
After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

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You must be under the regular care of a physician in order to be considered disabled.
***
MATERIAL AND SUBSTANTIAL DUTIES means that:
- are normally required for the performance of your regular occupation; and
- cannot be reasonably omitted or modified.
***
REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

ECF No. 1-1 at 13, 27, 29 (boldface type and capitalization in original). As the foregoing language illustrates, the definition of the term " disability" contained in the LTD Plan is not significantly different from that found in the STD Plan.

Pini apparently clashed with her male supervisor during the spring of 2009. ECF No. 35-6 at 5-6. Although the supervisor did not engage in any forms of sexual harassment or gender-based discrimination, he allegedly created an atmosphere of " intimidation and ridicule." Id. at 6. The supervisor's aggressive management style supposedly put Pini in a " hellish situation" and made her work experience very stressful. Id. at 5.

On June 6, 2009, Pini felt pressure in her chest, shoulder and jaw while watching a televised hockey game involving the Pittsburgh Penguins. ECF No. 35-2 at 51; ECF No. 35-6 at 5. Believing that the symptoms were attributable to a muscle pull, she " laid down and got drowsy." ECF No. 35-6 at 5. After awakening during the early morning hours of June 7, 2009, Pini continued to experience the same symptoms. Id. She went to the emergency room at Canonsburg General Hospital for treatment. ECF No. 35-2 at 51. Because Pini had elevated cardiac enzymes and chest pain, she was transferred and admitted to St. Clair Hospital for " more definitive therapy." Id.

Dr. Adil Waheed, a cardiologist, performed a cardiac catheterization on Pini. ECF No. 41 at ¶ 21. The procedure left Dr. Waheed with the impression that Pini was suffering from Takotsubo cardiomyopathy, which is a stress-induced heart condition. [1] ECF No. 35-2 at 20. Since Pini had suffered a myocardial infarction, an echocardiogram was performed on June 8, 2009. Id. at 48. Aside from some " regional wall motion abnormalities" in Pini's left ventricular chamber, the test yielded normal results. Id. Pini was discharged the next day. Id. at 50. She started to attend sessions with Kristin Kristoff (" Kristoff" ), a stress management therapist, on June 16, 2009. ECF No. 35-4 at 25.

Since she was unable to return to work in the immediate aftermath of her cardiac event, Pini applied for benefits under the STD Plan. ECF No. 35-2 at 26-31. Dr. James Moretti, Pini's primary care physician, was asked to submit a statement describing her work-related abilities and limitations. In a statement dated June 22, 2009, Dr. Moretti informed Unum that Pini had suffered an acute myocardial infarction, and that she could not engage in " heavy lifting." Id. at 11-12. Dr. Moretti further reported that Pini was expected to return to work on July 19, 2009. Id. On July 7, 2009, Unum found Dr. Moretti's opinion to be supported by the documentary evidence of Pini's treatment. ECF No.

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35-4 at 27. Pini's application for benefits was approved.

Unum sought additional information from Dr. Moretti on July 17, 2009. ECF No. 35-2 at 15. In response to Unum's inquiry, Dr. Moretti advised that Pini needed to remain " off of work indefinitely." Id. After performing a follow-up examination of Pini on July 20, 2009, Dr. Waheed informed Dr. Moretti that Pini's " overall clinical history" suggested that she had suffered a stress-induced cardiomyopathy. Id. at 51. On August 4, 2009, Kristoff reported that Pini should not return to a high-stress " corporate environment." ECF No. 35-3 at 11. The information provided by Pini's treating sources convinced Unum to continue her benefits for a few additional weeks. ECF No. 35-4 at 31.

In a letter to Dr. Moretti dated August 20, 2009, Dr. Waheed stated that Pini had experienced " episodes of chest pain and jaw pain" during her cardiac rehabilitation sessions. ECF No. 35-3 at 37. Dr. Waheed suggested that Pini's recurrent chest pain was attributable to coronary spasms. Id. He also opined that she was suffering from acute systolic heart failure and hypothyroidism. Id.

Pini experienced chest pain on September 7, 2009. ECF No. 39 at ¶ 10. She was admitted to St. Clair Hospital later that day. Id. Dr. David Burkey, a treating cardiologist, observed that Pini's chest pain was " possibly anginal in nature." ECF No. 35-4 at 2. A stress nuclear study yielded normal results. Id. at 2-3. In light of Pini's prior myocardial infarction, however, Dr. Burkey was concerned that " another event" could occur. Id. at 3. Pini was discharged on September 8, 2009. ECF No. 41 at ¶ 34. Ten days later, Kristoff informed Unum that Pini was participating in a treatment plan designed to " decrease her anxiety and stress levels." ECF No. 35-4 at 7. On September 24, 2009, Unum employees decided to procure treatment notes documenting the severity of Pini's symptoms. Id. at 33.

Unum personnel apparently sought further information about Pini's medical condition. John Merrifield (" Merrifield" ), a Unum employee, was evidently responsible for obtaining that information. In a letter to Merrifield dated September 30, 2009, Dr. Waheed briefly described the history of Pini's treatment. ECF No. 35-4 at 18-19. Dr. Waheed summarized his conclusions by stating as follows:

In summary, Janice Pini has a stress induced cardiomyopathy also known as takotsubo syndrome. This has been documented in the medical literature to be related to significant periods of stress and anxiety. Physical activity in itself is not a contributing factor but stressful situations are. She needs to avoid situations where this can be a problem as patient's [sic] with this condition can be plagued with relapses. Fortunately, the most recent stress test and echocardiogram showed complete recovery in LV function. I think, if anxiety and stressful situations cannot be avoided in her work environment, she would not be able to perform this job any further.

Id. Although Merrifield had requested information about Pini's physical limitations, Dr. Waheed advised that Pini's " main problem" was not related to her physical activities. Id. at 18.

Dr. Moretti provided Merrifield with additional information in a letter dated October 2, 2009. ECF No. 35-4 at 13-14. In his letter, Dr. Moretti explained that Pini had been cleared " to resume her prior levels of physical activity" after her September 8, 2009, release from St. Clair Hospital. Id. at 13. Discussing Pini's work-related abilities, Dr. Moretti made the following observations:

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Based on discussions with Janice, it is clear that her current job as Senior Principal Product Manager at CA, Inc. is the primary source of her previous high stress levels. Since being off work due to her heart attack, and with the introduction of Lexapro, Ativan and stress management counseling, her stress levels have reduced. Even with reduced stress levels, her coronary spasms continue to cause angina symptoms which have high potential to cause another heart attack.
It is my recommendation that Janice not return to any line of work that includes moderate to high stress levels, including deadlines, high work loads, or office " political" environments.

Id. at 14. Copies of Pini's test results were sent with Dr. Moretti's letter. Id.

Jayne S. Pasquali (" Pasquali" ), a Disability Benefits Specialist for Unum, sought follow-up information from Dr. Waheed. In a written inquiry dated October 14, 2009, Pasquali described Takotsubo cardiomyopathy as " a transient disorder and a reversible condition." ECF No. 35-4 at 22. She further stated that Pini's medical problem appeared to be " psychological in nature." Id. In response to a series of written questions sent by Pasquali, Dr. Waheed expressed concern that Pini's work environment at CA was sufficiently " intense" to " cause a relapse." Id. When asked to identify the " specific stressors" impacting Pini's functional capacity, Dr. Waheed made reference to Pini's interactions with her supervisor. Id. at 23. Dr. Waheed opined that Pini would be alright if she managed to avoid the stress associated with her position at CA, and that she " should be able to" perform the duties of her occupation for a different employer. Id. The form conveying Dr. Waheed's responses to Pasquali's questions was completed on October 15, 2009. Id.

In a letter to Merrifield dated October 21, 2009, Kristoff stated that Pini " continue[d] to experience angina symptoms caused by coronary spasms and related to stressful events." ECF No. 35-4 at 25. Discussing Pini's ability to function in a work environment, Kristoff went on to make the following observations:

Based on our discussions during treatment, it is clear that Janice's current position as Senior Principal Product Manager at CA, Inc. has been the primary source of her high stress levels. Since her leave from work due to her heart attack, and with the introduction of medications (Lexapro and Ativan) and stress management counseling, her stress levels have mildly decreased. Even with this improvement, she has reported to me that her coronary spasms continue to cause angina symptoms that her physicians warn indicate a high potential for additional heart attack(s).
Janice has been diagnosed with Acute Stress Disorder. It is my recommendation that she not return to any form of employment that includes moderate to acute stressors such as deadlines, continuous high work loads, and office environments that can be described as highly " political" and conflict-filled.

Id. at 25-26. Kristoff's comments about Pini's condition were substantially similar to the statements that had previously been made in Dr. Moretti's letter. Id. at 14.

Carol Fletcher (" Fletcher" ), a vocational rehabilitation consultant for Unum, completed an occupational assessment of Pini's claim on October 30, 2009. ECF No. 35-4 at 37. After reviewing all relevant information, Fletcher concluded that Pini's position at CA had been ...


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