Opinion
Civil Action No. 2:04-CV-05408-LDD.
November 28, 2005
MEMORANDUM OPINION
Presently before the Court are defendant's motion for reconsideration of this Court's August 17, 2005 Order (Doc. No. 22); plaintiff's brief in opposition (Doc. No. 23); and defendant's response thereto (Doc. No. 24). For the following reasons, this Court grants defendant's motion for reconsideration, reverses the grant of summary judgment to plaintiff, and grants summary judgment to defendant on plaintiff's claim for long-term disability benefits ("LTD benefits") under § 502(a)(1)(B) of ERISA.
A. Motion for Reconsideration
A party may raise a motion for reconsideration within ten days from the date of entry of the judgment. See Fed.R.Civ.P. 59(e); Loc. R. Civ. P. 7.1(g). A motion for reconsideration should be granted "sparingly." Synthes v. Globus Medical Inc., 2005 WL 562764, at *1 (E.D. Pa. March 7, 2005). A motion for reconsideration may only be granted when the plaintiff demonstrates: (i) an intervening change in controlling law; (ii) new evidence that was not previously available; or (iii) the need to correct a clear error of law or fact or to prevent manifest injustice. See, e.g., North River Ins. Co. v. CIGNA Reins. Co., 52 F.3d 1194, 1218 (3d Cir. 1995). In other words, a motion for reconsideration may not be based upon new arguments that could have been raised in support of the original motion. See, e.g., Agere Systems, Inc. v. Broadcom Corp., 2004 WL 1970111, at *1 (E.D. Pa. Sep. 7, 2004). Nor should a motion for reconsideration be used as a vehicle to "reconsider repetitive arguments that have already been fully examined by the court." EEOC v. Dan Lepore Sons Co., 2004 WL 569526, at *2 (E.D. Pa. March 15, 2004).
Assuming arguendo the validity of the Court's factual findings in its August 17, 2005 Opinion, defendant argues that the Court's ultimate legal conclusion that plaintiff was entitled to LTD benefits based upon a May 15, 2003 disability date was clearly erroneous. (See Def. Br., at 1). Defendant contends that after affirming the reasonableness of defendant's April 14, 2003 conclusion that plaintiff was not totally disabled as of November 1, 2002, the Court set a new date of disability, based upon new diagnoses that postdated the original denial of LTD benefits. (Id., at 7-12). Defendant further reasons that this action violated the terms of the LTD Plan, which terminates coverage upon the refusal of a non-disabled plaintiff to return to work. (Id.). Therefore, according to defendant's logic, because plaintiff did not return to work on November 1, 2002, despite the Court's finding that she was physically capable of doing so, plaintiff's right to pursue LTD benefits ceased. (Id.).
In response, plaintiff contends that the Court acted appropriately in granting plaintiff's motion for summary judgment. Plaintiff interprets the Court's August 17, 2005 Opinion as stating that although the defendant's initial denial of benefits on April 14, 2003 was reasonable, based upon the limited record before defendant at that time, defendant's March 29, 2004 affirmation of its initial denial, based upon a review of the whole record, was arbitrary and capricious. (See Pl. Br., at 2-3). Plaintiff further reads the Court's August 27, 2005 Opinion as finding that the whole record, including all post-November 1, 2002 documentation, confirmed that plaintiff was totally disabled within the meaning of the LTD Plan "at least" as of May 15, 2003. (Id.). Pursuant to this reading, the Court implicitly and correctly concluded that defendant's March 29, 2004 finding of non-disability as of November 1, 2002 was arbitrary and capricious. (Id.).
B. The Court erred by setting a new disability date of May 15, 2003.
This Court agrees with defendant's position that an internal inconsistency exists between the disability date in the Court's August 17, 2005 Opinion and the award of benefits to plaintiff under the LTD Plan; and, as a result, reverses the award of summary judgment in favor of plaintiff. This conclusion is supported by: (i) a review of the terms of the LTD Policy; (ii) a review of the factual findings of the August 17, 2005 Opinion; and (iii) a comparison between the terms of the LTD Policy pertaining to when coverage ends and the factual findings in the August 17, 2005 Opinion as to when plaintiff became totally disabled.
However, this Court rejects defendant's suggestion that a finding of reasonableness as to defendant's initial April 14, 2003 denial of LTD benefits necessarily obligated the Court to find that defendant's final March 29, 2004 denial of benefits, after appeal, was reasonable. (See Def. Br., at 8-9).
1. The LTD Plan
The LTD Plan requires an employee to wait "6 months" before benefit eligibility. (See LTD Plan, attached as Ex. 4 to Def. Mot. For SJ., at CGLIC0018, 0024). Insurance coverage under the LTD Plan terminates when an employee's term of employment ends, which is triggered when an employee "stops active work," unless active service ends due to a disability for which benefits are payable. (Id., at CGLIC0006). "Active work" is defined as "the performance by an employee of all the duties that pertain to his or her work at the place where it is normally done. . . ." (Id., at CGLIC0005). Consequently, when a plaintiff stops active work but is not totally disabled beyond the end of the six month waiting period, coverage terminates.
Total Disability is defined as "when you're completely unable to carry out every duty of your job because of illness or injury during the waiting period before basic long-term disability benefits from the company begin and for the next 24 months. Afterwards, total disability means that you're unable to work in any occupation which you're reasonably qualified through training, education, or experience." (See Plan, Important Definitions, at CGLIC0024).
2. August 17, 2005 Opinion
In its August 17, 2005 opinion, the Court found as a matter of law that defendant's decision to deny coverage on April 14, 2003 was not arbitrary and capricious. (See August 17, 2005 Opinion, Doc. No. 25, at 25). The Court reviewed the entire medical record, including the testimony of all plaintiff's treating physicians, and determined that, as of April 14, 2003, it was reasonable to conclude that plaintiff was "capable of working on November 1, 2002, prior to the conclusion of the Plan's six month waiting period." (Id.). However, despite these factual findings, the Court noted that the documentation submitted to defendant after April 14, 2003, which documented the effect of plaintiff's post-surgery complications of chronic pain, fibromyalgia, and fatigue, precluded a finding that plaintiff was capable of working in any capacity "at least" as of May 15, 2003, the date plaintiff was unofficially diagnosed with fibromyalgia. (Id., at 19-26). The Court therefore found: (i) that plaintiff was totally disabled as of May 15, 2003, based upon diagnoses that postdated plaintiff's initial waiting period; and (ii) that by March 29, 2004, the date of defendant's final denial letter, plaintiff had exceeded a new six month "waiting period" commencing on May 15, 2003 and was entitled to LTD benefits. (Id., at 26-28) ("the Plan Administrator shall use May 15, 2003 as the date that plaintiff became totally disabled within the meaning of the Plan").
3. The Court erred by setting a new disability date, based upon new diagnoses, in violation of the terms of the LTD Plan.
This Court's decision to set a new disability date of May 15, 2003 and to grant LTD benefits to plaintiff after the completion of a new six month waiting period violated the LTD Plan. As stated earlier, in order to receive LTD benefits, plaintiff was required under the terms of the LTD Plan to remain continuously disabled throughout the initial benefit waiting period or to return to active work prior to the commencement of any new disability or waiting period. (See LTD Plan, at CGLIC0005-6). By setting a disability date other than May 15, 2002, the date that Dr. Atlas declared plaintiff to be disabled, and then by failing to resolve whether defendant acted reasonably in finding plaintiff not disabled between May 15, 2002 and May 15, 2003 (i.e., the new disability date), the Court impermissibly re-wrote the eligibility requirements of the LTD Plan. (See Attending Physician's Statement of Disability, attached as Ex. C to Pl. Mot.); see Henglein v. Colt Industries Operating Corp., 260 F.3d 201, 215 (3d Cir. 2001) ("The courts are not at liberty to rewrite the terms of an ERISA plan."). In other words, although the medical record clearly demonstrates that plaintiff was not capable of working in May 2003 because of symptoms related to fibromyalgia, fatigue, and chronic pain syndrome, this Court was not permitted to use May 15, 2003 as a new disability date; plaintiff would have been precluded from seeking LTD benefits at this time by virtue of the cessation in policy coverage. (See LTD Plan, at CGLIC0005-6).
The Court also notes that plaintiff averred in her Employee's Statement of Disability that her disability began on July 11, 2002. (See Employee's Statement, attached as Ex. 7 to Def. Mot.).
4. The medical record establishes the reasonableness of defendant's decision throughout the appellate process to deny plaintiff's application for LTD benefits because plaintiff was not continuously disabled between May 15, 2002 and November 15, 2002.
This Court's finding that it erred by using May 15, 2003 as a disability date requires a re-evaluation of whether plaintiff was totally disabled prior to May 15, 2003, and, in particular, of whether plaintiff was totally disabled for the entirety of the six month waiting period, which lapsed on November 15, 2002. Upon an exhaustive review of the medical record and the parties' various submissions, this Court concludes that defendant's decision to deny benefits because of plaintiff's lack of total disability for the entirety of this waiting period was not arbitrary and capricious as a matter of law, even under a standard of moderately heightened scrutiny.
The medical reports provide a substantial basis for defendant's conclusion that plaintiff was not totally disabled within the meaning of the LTD Plan in November 2002, prior to plaintiff's diagnosis of fibromyalgia. See, e.g., Orvosh v. Prgroam of Group Ins. For Salaried Employees of Vokswagen of Am., 222 F.3d 123, 129 (3d Cir. 2000) (under arbitrary and capricious standard of review, "plan administrator's decision will be overturned only if it is clearly not supported by the evidence in the record");Post v. Hartford Ins. Co., 2005 WL 2455818, at *13-14 E.D. Pa. Oct. 5, 2005) (even under moderately heightened arbitrary and capricious standard of review, court may not substitute its judgment for that of plan administrator's in determining benefit eligibility). For instance, Dr. Witterholt, plaintiff's surgeon, found that plaintiff was capable of returning to work in November 2002, and, therefore, was not totally disabled. (See Dr. Witterholt's Physical Ability Assessment, attached as Ex. 14 to Def. Mot.). Although Dr. Aronchick noted on October 29, 2002 that plaintiff continued to complain of constipation, pain, nausea, fatigue, and tiredness, Dr. Aronchick concluded that plaintiff was 50% improved on November 18, 2002; that plaintiff was "doing well" and "slowly improving" on December 18, 2002, suffering from only "intermittent abdominal pain and bloating;" and that plaintiff was "feeling relatively well" on March 3, 2003. (See Records of Dr. Aronchick, attached as Ex. T to Pl. Mot.). Plaintiff's primary physician, Dr. Atlas, found that plaintiff suffered from chronic abdominal pain, but that plaintiff was in "no acute distress" on January 6, 2003, January 13, 2003, and February 3, 2003, particularly because of the positive effect of her medication regimen. (See Records of Dr. Atlas, attached as Ex. 14 to Def. Mot.). The medical records from Dr. Park, Dr. Hale, and Dr. Sabilini significantly provide no insight into plaintiff's condition prior to the diagnosis of fibromyalgia, documenting plaintiff's pain-related symptoms as of May 15, 2003, October 29, 2003, and December 8, 2003 respectively. (See Records of Dr. Park, Dr. Hale, and Dr. Sabilini, attached as Ex. U, V, and W to Pl. Mot.). Dr. Sassoon, a specialist in Physical Medicine and Rehabilitation, reviewed the available medical documentation and concluded that plaintiff was capable of performing sedentary activity between May 15, 2002 and November 14, 2002. (See Dr. Sassoon's Report, attached as Ex. R to Pl. Mot.). Perhaps most importantly, however, plaintiff concedes that in November 2002, she wrote to defendant and advised her employer that she felt well enough to return to work. (See Pl. Br. For SJ., at 12).
Dr. Witterholt's Physical Ability Assessment concluded that plaintiff could stoop, crouch, kneel, finger, and grasp frequently, that plaintiff could climb, balance, crawl, push, pull, and reach occasionally, and that plaintiff could sit, stand, and walk respectively for four hours per day. (Id.).
Dr. Sassoon's finding was based upon the lack of "objective documentation" demonstrating a disabling condition. Although this Court found in its August 17, 2005 Order that defendant was not entitled to rely upon Dr. Sassoon's conclusions concerning the lack of objective medical evidence supporting a finding of disability after plaintiff's diagnosis of fibromyalgia, Dr. Sassoon also opined that the medical record indicated that plaintiff was able to perform light sedentary work in November 2002, well before any fibromyalgia or chronic pain syndrome diagnosis. (See August 17, 2005 Order, at 20-22).
Based upon this medical evidence, defendant is entitled to summary judgment on plaintiff's claim for LTD benefits under § 502(a)(1)(B) of ERISA. Indeed, it is clear that defendant's decision to deny plaintiff LTD benefits, based upon a finding that plaintiff was not disabled as of November 2002, was not arbitrary and capricious as a matter of law, even under a moderately heightened form of review. See, e.g., Bader v. RHI Refractories America, Inc., 11 Fed. Appx 117, 120 (3d Cir. 2004) (affirming plan administrator's denial of ERISA claim under moderately heightened arbitrary and capricious review). Consequently, although this Court finds that plaintiff provided medical evidence indicating that her post-surgery symptoms of fibromyalgia, chronic pain, and fatigue were severe enough to render her totally disabled as of May 15, 2003, this Court is constrained to find that this medical evidence did not establish the corollary factual prerequisite to benefit eligibility under the LTD Plan: that plaintiff was totally disabled from the complications of her surgery for the entirety of the six month waiting period that lapsed on November 15, 2002.
Plaintiff's failure to address the implications of defendant's interpretation of the LTD Plan, indeed, plaintiff's failure to identify (in her various submissions to this Court) those portions of the medical record indicating that plaintiff was disabled as of November 1, 2002, implicitly acknowledges the validity of defendant's position.
C. Conclusion
In conclusion, this Court finds that it erred as a matter of law in granting summary judgment in favor of plaintiff, based upon a new total disability date of May 15, 2003. Upon further reconsideration, the Court finds as a matter of law that it was not arbitrary and capricious for defendant to conclude that plaintiff was not disabled within the meaning of the LTD Plan in November 2002, prior to the expiration of the initial six month waiting period. In turn, because the LTD Plan requires a continuous period of total disability, and, in fact, ceases coverage when a non-disabled employee fails to return to work, defendant did not act arbitrarily and capriciously by denying initially and throughout the appeal process plaintiff's application for LTD benefits. An appropriate Order follows.
ORDER
AND NOW, this 28th day of November 2005, upon consideration of defendant's motion for reconsideration (Doc. No. 22), plaintiff's brief in opposition (Doc. No. 23), and defendant's response thereto (Doc. No. 24), it is hereby ORDERED as follows:1. Defendant's motion for reconsideration (Doc. No. 22) is GRANTED.
2. The Court's August 17, 2005 Order awarding Long Term Disability ("LTD") benefits to plaintiff is REVERSED.
3. Judgment is entered in favor of defendant and against plaintiff on plaintiff's claim for LTD benefits under § 502(a)(1)(B) of ERISA.