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Chronister v. Baptist Health

October 15, 2007

SANDRA J. CHRONISTER PLAINTIFF
v.
BAPTIST HEALTH AND UNUM LIFE INSURANCE COMPANY OF AMERICA DEFENDANTS



The opinion of the court was delivered by: James M. Moody United States District Judge

ORDER

There are several motions pending in this case: Plaintiff's Motion for Discovery and Stay, Plaintiff's Motion for Summary Judgment, Unum's Motion for Judgment on the Administrative Record, Plaintiff's Motion to Strike and for Sanctions. For the reasons set forth below, Plaintiff's motions are DENIED and Defendant's Motion for Judgment on the Administrative Record is GRANTED.

By Order dated November 29, 2004, the Court remanded this case back to Defendant Unum with directions to re-open the administrative record and make a new determination of the Plaintiff's claim without reliance on the self-reported symptom limitation.*fn1 In February 2005, both parties appealed the Court's Order to the Eighth Circuit Court of Appeals. The Eighth Circuit affirmed this Court's ruling on May 18, 2006. On January 4, 2007, Plaintiff asked this Court to reopen the case. The Court granted the motion.

Plaintiff filed an Amended Complaint claiming that Unum breached the contract between the parties by denying Plaintiff's long term disability benefits in December 2001. Further, Plaintiff alleged that Unum denied her benefits in an untimely manner.

In July 2007, Unum filed supplemental records which became a part of the administrative record after the Court's remand of the case. This supplement included Unum's January 19, 2007 denial of Plaintiff's disability benefits and a vocational assessment conducted by Richard Byrd dated January 11, 2007.

In the denial letter, Unum stated that it was applying the "any occupation" standard of disability pursuant to the policy. The letter noted that Unum had considered the results of Plaintiff's FCE completed on April 11, 2006, and Plaintiff's medical records from 1997 through 2006. The letter further stated:

We acknowledge that your client has multiple illnesses. Those illnesses that have been confirmed are fibromyalgia, mild sleep apnea, sinus tachycardia, mitral valve prolapse, L5-S1 disc bulge, degenerative changes in the cervical spine, mild gastritis, renal cysts, and hypothyroidism. Illnesses that have not been confirmed are neurogenic syncope/orthostatic hypotension and Raynaud's disease. However, illness does not equate to disability. It is the existence and severity of the manifestations of symptoms of an illness that determine if someone is disabled. . . .

There is no doubt that your client has some limitations on her functioning and should be reasonably restricted from some activities. However, if we were to take into account the restrictions on her functioning that have been established by her medical providers that would remain after a reasonable conditioning program, she could do the following:

* Maintain a sedentary level of activity of exerting up to 10 lbs. pounds [sic] of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. She should have the ability to shift position as necessary for comfort.

* Occasionally reach or extend arm above the head as would be necessary to reach for an item.

* Engage in brief periods of bending, stooping, or reaching below the waist to retrieve an item below the waist.

* Stand/walk/stair climb for no more than 1/3 of the workday.

In summary, the medical evidence establishes that your client had the capacity for a sedentary occupation, taking into account the above abilities. (UACL-Post Remand-00543-544).

Unum discussed the vocational review which identified four occupations that could be performed with Plaintiff's level of ability. These occupations included Telephonic Nurse Case Manager, Telephonic Triage Nurse, Insurance File Review Nurse, and Utilization Review Nurse. Each of these occupations were found to exist in Plaintiff's local area. Based upon this information, Unum determined ...


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