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Gray v. Prudential Insurance Company of America

September 5, 2006

CYNTHIA GRAY PLAINTIFF
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA DEFENDANT



The opinion of the court was delivered by: Wm. R. Wilson, Jr. United States District Judge

ORDER

Plaintiff, Cynthia Gray, filed her Complaint under the Employee Retirement Income Security Act of 1974 ("ERISA")*fn1 seeking review of Defendant's decision to deny her claim for long term disability ("LTD") benefits. Plaintiff was eligible for the benefits under an employee welfare benefit plan ("the Plan") sponsored by her former employer, American Greetings, Inc., and insured by Defendant. Finding that Plaintiff's regular occupation had changed and, therefore, was not disabled as defined by the Plan, Defendant denied her benefits. The parties have filed cross-motions for summary judgment (Doc. Nos. 10 & 25). For the following reasons, Plaintiff's Motion for Summary Judgment is DENIED. Defendant's Motion for Summary Judgment is GRANTED.

I. Background

Plaintiff began working for American Greetings Corporation as a general factory worker on October 7, 1991.*fn2 In late 1998, Plaintiff noticed numbness in her fingers, weakness in both arms, pain in her shoulder blades, and headaches. Dr. Richard Kyle, a neurosurgeon examined her on February 15, 1999, and again on February 24, 1999. A CT scan revealed that Plaintiff had multiple cervical bulges. Despite these findings, Dr. Kyle diagnosed Plaintiff with carpal tunnel syndrome,*fn3 for which he performed surgery on May 14, 1999. Plaintiff took medical leave from April 1999 until December 17, 1999.

Before returning to work, Plaintiff saw a second physician, Dr. Tonyman. After reading the CT scan as showing "multilevel cervical spondylosis," Dr. Tonyman asked Plaintiff to have some additional tests. A myelogram performed on January 5, 2000, revealed that Plaintiff was suffering from "multilevel degenerative disc disease at C4-5, C5-6, and C6-7." Dr. Tonyman placed Plaintiff on a 20 pound weight restriction but did not recommend surgery. As a result of her various injuries, when Plaintiff returned to work, American Greetings assigned her to an "accommodated position," that required less bending, stooping, and lifting and allowed her to sit more often.*fn4

Plaintiff had been in the accommodated position for over two years when American Greetings changed its accommodation plan and opted to no longer offer the position as of February 5, 2002. Rather than find another position within American Greetings, Plaintiff immediately took medical leave under the Family Medical Leave Act ("FMLA") and applied for LTD benefits on February 8, 2002. When Plaintiff exhausted her FMLA protected time on April 10, 2002, she went on a medical leave of absence. When Plaintiff did not return to work within a year, she was terminated.

By letter issued on August 14, 2002, Defendant denied Plaintiff's request for LTD benefits. Plaintiff immediately asked for reconsideration; however, that request was denied on November 12, 2002.*fn5 In its denial, Defendant noted that Plaintiff had not documented a change in her longstanding condition and reasoned that American Greetings' "inability to keep [her] in the Packaging Department" was the reason Plaintiff stopped working.*fn6

After this, Plaintiff, with the help of newly retained counsel, informed Defendant by letter sent January 12, 2003, that she would like a third review of its decision.*fn7 Due to the ongoing appeal process, Defendant granted Plaintiff an extension of time to file additional information by July 15, 2003. Plaintiff argued that the underlying conditions that necessitated her subsequent surgeries existed during the policy elimination period.*fn8

Nevertheless, on July 31, 2002, Defendant again determined that Plaintiff's reason for stopping work was the elimination of her accommodated position.*fn9

On September 24, 2003, Plaintiff provided Defendant with records from Occupational Health Consultants of America.*fn10 In response, Defendant sent a letter to Plaintiff's attorney on October 7, 2003, confirming that it had received the records from Occupational Health, and stating, "[i]t is unclear to our office if you intend for this documentation to constitute a third appeal, and if so if that appeal is complete."*fn11 The letter requested that Plaintiff's attorney notify Defendant if the information was to be reviewed for an appeal.*fn12 When Defendant received no answer, it again wrote Plaintiff's attorney on November 13, 2003, inquiring whether the September 24 document submission was intended to be an appeal.*fn13

Plaintiff's counsel submitted a letter of appeal on December 17, 2003, but indicated that additional documentation was forthcoming.*fn14 On January 6, 2004, Defendant sent a letter to Plaintiff's counsel explaining that it was unclear whether Plaintiff's claim submission was complete, or if Plaintiff planned to provide additional documentation on appeal.*fn15 Defendant again requested that Plaintiff give them notification when her appeal submission was complete. Then, on February 3, 2004, Defendant sent a letter to Plaintiff's counsel memorializing that one of its claim managers had contacted counsel's office and was told that additional documentation had already been sent to Defendant.*fn16 Defendant again requested that Plaintiff advise when her appeal submission was complete.

On April 4, 2004, Defendant documented through a letter sent to Plaintiff's counsel that it had been told that Plaintiff would submit MRI results, but that those results had not yet been received.*fn17 Defendant requested that Plaintiff advise it when her appeal submission was complete. On April 28, 2004, Plaintiff's counsel submitted records from Neurological Associates of Northeast Arkansas, including MRI test results.*fn18 On April 20, 2004, Plaintiff's counsel submitted records from the Mississippi County Primary Care Clinic.*fn19

On June 8, 2004, Defendant faxed a letter to Plaintiff's counsel inquiring about Plaintiff's worked hours and earnings during 1999 and 2000 so Defendant could "assess if an earlier date of disability . . . is warranted."*fn20 That same day, Defendant also sent a letter to Plaintiff's counsel stating that Defendant would require an extension of time to complete its review of Plaintiff's third appeal.*fn21

On September 23, 2004, as Defendant continued to review Plaintiff's claim, Defendant faxed a letter to Plaintiff's employer requesting information relevant to Plaintiff's claim such as salary increases, return to work dates, etc.*fn22 In a December 2004 letter to Plaintiff's counsel, Defendant explained that it required an extension of time because it was "waiting for some additional information from [Plaintiff's] employer."*fn23 On February 14, 2005, Defendant faxed a letter to Plaintiff's attorney stating, "[w]e apologize for the delay for a decision but we are trying to reach a decision [by] this Friday."*fn24 Defendant faxed ...


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