United States District Court, E.D. Pennsylvania
For Mary Plank, Plaintiff: JOHN J. STANZIONE, LEAD ATTORNEY, LAMB MCERLANE PC, West Chester, PA USA.
For Aetna Life Insurance Co., Defendant: MELISSA MURPHY WEBER, ELLIOTT GREENLEAF & SIEDZIKOWSKI, P.C., Blue Bell, PA USA.
RONALD L. BUCKWALTER, Senior United States District Judge.
Currently pending before the Court is Plaintiff Mary Plank's Motion for Summary Judgment. For the following reasons, the Motion is granted in part and denied in part.
I. FACTUAL BACKGROUND
Plaintiff Mary Plank was hired by The Devereux Foundation (" Devereux" ) on February 1, 1993. (Administrative Record (" A.R." ) 502-03, 656.) At the time of Plaintiff's disability onset, she was the Director of Food Services for Devereux. (Id.) According to Plaintiff's description of her job, she worked approximately fifty to sixty hours per week cooking approximately 700 meals, cleaning food stations, ordering supplies and food products, and managing other employees. (Id. at 219.) She had a high stress level; was required to sit up to three hours per day; stand between six and seven hours per day, which included walking between five and six hours per day; lift items in excess of fifty pounds; frequently bend, stoop, kneel, and reach above her shoulders; and occasionally crawl. (Id.) The job description provided by Devereux indicated the following summary of the physical requirements for the position of Food Services Director: " Significant amounts of walking, sitting, and standing. Some lifting required. Some repetitive wrist/hand movements, normal hearing and vision. Occasional use of computers and office equipment. Occasional driving of Devereux vehicles for business purpose." (Id. at 670.) Aetna was aware of both Devereux's official job description for Plaintiff's occupation and Plaintiff's description of her duties she performed as part of that occupation. (Pl.'s Mot. Summ. J. ¶ 4; Def. Aetna's Resp. Opp'n Summ. J. ¶ 4.)
On July 12, 2007, Plaintiff stopped working for Devereux due to various medical injuries and conditions, and applied for long-term disability benefits (" LTD benefits" ) pursuant to Devereux's Long Term Disability Plan (the " Plan" ) with Aetna Life Insurance Company (" Aetna" ). (A.R. 497-99, 505-14.) Aetna administers the Plan, and the Plan gives Aetna complete discretionary authority to determine whether and to what extent Plan participants are entitled to benefits and to review all claims for denied benefits. (Id. at 55.) Aetna also insures the LTD benefits,
which are funded through a Group Insurance Policy issued by Aetna. (Pl.'s Mot. Summ. J. 6; Def. Aetna's Resp. Opp'n Summ. J. ¶ 6.) At the time Plaintiff applied for LTD benefits, she was purportedly suffering from various medical conditions including chronic pain in the cervical area with radiation into the shoulder and upper extremities, chronic pain with radiation into the lower extremities, and chronic bilateral hip tendinopathy, as well as anxiety, depression, and psychological illness resulting from a 2003 motor vehicle accident. (A.R. 540-73, 623-41.) Concurrent with her application, Plaintiff was treating for these conditions with various providers including psychologist Dr. Janet Belitsky, pain management specialists Dr. Jeffrey Friedman, Dr. John Kraus, and Dr. Phillip Kim, and neurologist Dr. Leonard Geiger. (Pl.'s Mot. Summ. J. ¶ 8; Def. Aetna's Resp. Opp'n Summ. J. ¶ 8.)
The Plan provided as follows:
With respect to all employees earning less than $60,000 a year:
You will be deemed to be disabled on any day if you are not able to perform the material duties of your own occupation for more than half a day, solely because of disease or injury. However, if you start work at any reasonable occupation, you will no longer be deemed to be disabled.
After the first 60 months that any Monthly Benefit is payable during a period of disability, you will be deemed to be disabled on any day if you are not able to work at any reasonable occupation solely because of:
o disease; or
A.R. 3 (emphasis in original).) The Plan defines " own occupation" as " the occupation that you are routinely performing when your period of disability begins." (Id. at 15.) " Reasonable occupation" is " any gainful activity for which you are; or may reasonably become; fitted by: education; training; or experience; and which results in; or can be expected to result in; an income of more than 80% of your adjusted predisability earnings." (Id.)
On November 12, 2007, Plaintiff was approved for LTD benefits retroactive to October 10, 2007. (Id. at 699-701.) Her LTD monthly benefit amount was $2,855.11, which was sixty percent of her monthly earnings. (Id.) In addition, on November 9, 2007, Aetna advised Plaintiff that based on its review of her file, Aetna believed Plaintiff " may be eligible for Social Security disability benefits." (Id. at 1425.) Plaintiff applied for Social Security benefits in April 2008, and was awarded such benefits in July 2008, in the amount of $1,357 per month retroactive to January 1, 2008. (A.R. 1355; Pl.'s Mot. Summ. J. ¶ ¶ 12, 14; Def. Aetna's Resp. Opp'n Summ. J. ¶ ¶ 12, 14.) As a result of this determination, Defendant reduced Plaintiff's LTD benefits to $1,498.11 per month retroactive to January 1, 2008. (A.R. 1354-61.) Plaintiff continued to receive LTD benefits at the reduced rate after January 1, 2008, and Aetna would periodically investigate Plaintiff's receipt of benefits and conduct reviews of Plaintiff's ongoing medical care and treatment. (Pl.'s Mot. Summ. J. ¶ 16; Def. Aetna's Resp. Opp'n Summ. J. ¶ 16.)
By letter dated June 5, 2012 (" Termination Letter" ), Aetna advised Plaintiff that she was no longer entitled to LTD benefits after June 5, 2012 because she was no longer totally disabled from performing her " own occupation" as defined by the Plan. (Pl.'s Mot. Summ. J., Ex. A.) Specifically, the letter stated, in pertinent part as follows:
We are writing to you regarding your Long Term Disability (LTD) benefits provided by your employer, Devereux,
pursuant to a plan maintained under ERISA (Employee Retirement Security Act of 1974). Based on our review, we are unable to continue your Long Term Disability benefit payments beyond June 5, 2012.
. . .
We have continued to evaluate your ability to perform the duties of your own occupation and whether you would be eligible to continue to receive benefits, and meet the definition of disability, own occupation, until 10/10/2012.
. . .
Our Vocational Rehabilitation department evaluated the job description provided by your employer, Devereux, and was able to verify that your occupational requirements as a Food Service Manager for Devereux fell within the light, full time occupation definition. In addition, it was also determined that there was a viable labor market for your functional work capacity in your geographical area, which verified that your occupation under the Dictionary of Occupational Titles (DOT) definition is light. The vocational assessment also determined you had transferrable skills that would allow you to perform at a sedentary occupation as well. In the Transferrable Skills Analysis completed by our Vocational Rehabilitation department utilizing OASYS and research standard vocational resources such as the DOT, Occupational Information Network (O*NET) and Standard Occupational Classification (SOC) ...