Opinion
98 Civ. 8522 (JSM)
September 8, 2000
MEMORANDUM OPINION AND ORDER
Plaintiff Cliff Connors ("Connors") commenced this action seeking review of the defendant's denial of Connors' long-term disability claim. In a Memorandum Opinion and Order dated December 16, 1999, the Court granted the defendant's motion to strike Connors' demand for a jury trial and ruled that the Court's review of the reasonableness of the defendant's denial of Connors' claim would be limited to the record reviewed by the defendant, Connecticut General Life Insurance Company ("CGLIC"). This ruling was without prejudice to Connors' right to include in his brief on the merits a further argument that the record should be supplemented. Having reviewed the submissions of the parties, the Court finds no error with CGLIC's determination and concludes that there is no basis to supplement the record.
FACTS
Connors was employed by Time Warner Cable, which is a subsidiary of American Television and Communications Corporation ("American"). See Conners v. Connecticut Gen. Life Ins. Co., No. 98 Civ. 8522, 1999 WL 1211831, at *1 n. 1 (S.D.N.Y. Dec. 16, 1999). As such, Connors was a covered employee under American's Group Long Term Disability Insurance Policy ("Policy") issued by CGLIC. The Policy is explained more thoroughly in the Group Insurance Plan for Life, Long and Short Term ("Plan").
When Connors applied for benefits under the Policy claiming total disability, CGLIC denied his claim because CGLIC determined that he was not totally disabled. Connors brought this action both for a declaratory judgment regarding CGLIC's obligations to Connors under the Policy and for a judgment awarding him a sum certain representing the amount of an offset deducted by CGLIC in calculating Connors' long-term disability benefits.
DISCUSSION I. De Novo Review of the Administrative Record
Upon de novo review of the administrative record, CGLIC did not err when it determined that Connors was not "totally disabled" as defined by the Policy. First, Connors' disability is merely his back pain, which is a subjective matter. Second, one of the examining doctors, Dr. Mazurek, concluded that Connors could perform sedentary work and could sit for four hours and stand for four hours each day. Presumably, this conclusion was based upon the doctor's observations of, and conversations with, Connors.
Third, the medical evidence submitted by Connors in support of his claim consisted of either brief summary reports by physicians that contained no detailed analysis to support their conclusions or longer reports that did not conclude that Connors was totally disabled. Connors was referred to at least one of the physicians who summarily concluded that he was totally disabled, Dr. Reddy, by his attorney, whom Dr. Reddy thanked for the referral in one of his reports. The summary nature of the physician reports that concluded that Connors was totally disabled and the fact that Connors was referred to Dr. Reddy by his attorney gives this evidence less weight than the evidence that Connors is capable of performing sedentary work.
Even were additional evidence beyond the administrative record to be admitted, the additional evidence submitted by Connors does not establish that he is totally disabled. This additional evidence merely consists of (1) an affidavit containing Connors' subjective complaints of pain, (2) two 1998 medical reports that conclude that Connors is totally disabled after describing his pain but without discussing his specific task limitations, and (3) a report of a rehabilitation expert, who basically repeats his conclusions from an earlier report. Moreover, if Connors' additional evidence were considered, the Court would also have to consider the portion of his deposition offered by CGLIC in which Connors admitted that while he was allegedly disabled, he participated in the production of a video.
In sum, on the record reviewed by CGLIC, or on the expanded record, the Court concurs with CGLIC that Connors was not totally disabled. Thus, Connors' application for a declaratory judgment regarding CGLIC's obligations to Connors under the Policy is denied.
II. Admissibility of Additional Evidence Beyond the Administrative Record A. Conflicted Administrator
In its prior opinion, the Court concluded that it would not admit additional evidence beyond the administrative record on the grounds that CGLIC was a conflicted administrator. See Connors, 1999 WL 1211831, at *3. The Court found that CGLIC was not a conflicted administrator because Connors' former "employer ultimately pays all amounts due under the plan." Id. Connors now seeks to reargue that CGLIC is a conflicted administrator. Connors contends that the Court mistakenly found that Connors' former employer paid all amounts due under the plan. However, as explained above, even if the Court were to find that Connors' former employer did not pay all amounts and to admit additional evidence, this additional evidence would not affect the Court's conclusion that CGLIC did not err when it determined that Connors was not totally disabled. Thus, Connors' untimely motion to reargue that additional evidence should be received because CGLIC was a conflicted administrator is denied.
B. Deficient Record
In its prior opinion, the Court noted that its ruling regarding whether CGLIC was a conflicted administrator was "without prejudice to the plaintiff's right to argue that the record is so deficient that additional evidence should be received." Connors, 1999 WL 1211831, at *3. Connors now argues that additional evidence should be admitted because the administrative record is deficient. This application is denied because as set forth above the Court is satisfied that the record supports finding that Connors is not totally disabled.
III. Benefits Deducted from Connors' Monthly Disability Benefits Representing Workers' Compensation Benefits
Connors also seeks a judgment awarding him a sum certain representing the amount of workers' compensation benefits that CGLIC deducted as "Other Benefits" under the Policy from Connors' monthly disability benefits from October 1990 to March 1995. Connors claims that CGLIC was unjustly enriched because CGLIC reduced Connors' monthly benefits by the amount of his workers' compensation benefits but did not pay the amount of this reduction back to Connors when he repaid his workers' compensation benefits in connection with the settlement of his personal injury suit against the owner of the location of his accident.
Connors' application for the amount of this reduction is denied because CGLIC was not unjustly enriched at the expense of Connors by this reduction. The Policy provides for this reduction to Connors' monthly disability benefits where he received "Other Benefits," so CGLIC was not unjustly enriched when this reduction initially occurred. Moreover, CGLIC was not unjustly enriched when Connors later repaid his workers' compensation benefits. Connors repaid the workers' compensation benefits because his personal injury settlement compensated him for the economic losses for which he received these benefits. Thus, Connors' repayment was not made at his expense, as he was merely receiving payment for his economic losses from another source, i.e., from the settlement instead of workers' compensation.
CONCLUSION
For the foregoing reasons, upon de novo review of the administrative record, the complaint is dismissed.
SO ORDERED.