Opinion
IP 00-C-983-B/S
January 28, 2002
ENTRY GRANTING DEFENDANTS' MOTION TO DISMISS AND DENYING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT
Plaintiff Katherine Blickenstaff filed suit against R.R. Donnelley Sons Company ("Donnelley"), R.R. Donnelley Sons Company Short-Term Disability Plan, and The Hartford Life Accident Insurance Company ("Hartford"), alleging breach of fiduciary duty and improper denial of benefits under a plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132 et seq. For the reasons stated below, we GRANT Defendants' Motion to Dismiss and we DENY Defendants' Motion for Summary Judgment.
Factual Background
The majority of the underlying facts are undisputed. Katherine Blickenstaff is a participant in an employee benefit plan ("Plan"), the short-term disability ("STD") portion of which is self-funded by her employer, Donnelley. (D's Statement of Facts ¶ 5.) The effective date for the Plan is October 1, 1998. (Id. ¶ 6.) Donnelley serves as the plan administrator, and a Hartford subsidiary serves as claims evaluator. (Id. ¶ 8.) Under the terms of the Plan, the claims evaluator "has full discretion and authority to determine benefits payable and to construe and interpret all terms and provisions of the Plan in connection with this determination." (Id.) The Plan further provides:
The Claims Evaluator is delegated the duties of the Employer to determine benefits payable according to the terms and conditions of the Plan. The Claims Evaluator also has the responsibility for deciding appeals of claims which were initially denied, and for making final determinations regarding eligibility for coverage.
(Id. ¶ 9.) The STD portion of the plan contains the following definition:
Total Disability or Totally Disabled means that you are prevented by:
1) accidental bodily injury;
2) sickness;
3) Mental Illness;
4) Substance Abuse: or
5) pregnancy, from performing the essential duties of your occupation, or a reasonable alternative offered to you by the Employer, and as a result, you are earning less than 20% of your predisability Weekly Earnings.
(Id. ¶ 10.) The STD Plan defines "reasonable alternative" as "a job position with the Employer, within the same general location, the essential duties of which you are able to perform." (Id. ¶ 11.) The STD Plan further provides, "If you are no longer [a] Regular Full-time or Benefits Eligible Part-time Employee because you are disabled," coverage for short-term disability continues "(1) while you remain Disabled; and (2) until the end of the period for which you are entitled to receive Short-Term Disability Benefits." (Id. ¶ 12.)
From April 30, 1998, until June 1, 1998, Plaintiff received short-term disability benefits for chronic lower back pain under a short-term disability plan that preceded the Plan at issue in this case. (Id. ¶ 15.) On June 1, 1998, Plaintiff returned to work as a Material Handler at Donnelley, which Defendants contend requires the following essential duties during an eight-hour workday:
(1) sitting, standing and walking for four hours, three hours and one hour, respectively;
(2) lifting 1-10 lbs. constantly, lifting 11-20 lbs. frequently, lifting 21-50 lbs. occasionally, and never lifting more than 51 lbs.
(3) stooping frequently, kneeling and crouching occasionally, and never climbing balancing or crawling;
(4) reaching above shoulder level and at and below waist level frequently, handling frequently, and fingering and feeling constantly;
(5) no repetitive use of the feet;
(6) sedentary work for 10 percent of the time and light work for 90 percent of the time.
(Id. ¶ 14.) Plaintiff argues that this job description applied to her accommodated duties after June 1, 1998. Defendants maintain, however, that Plaintiff's accommodated position after June 1, 1998, required that she "refrain from standing more than 2 hours, lifting anything greater than 10 lbs., bending, stooping, or climbing." (D's Statement of Facts ¶ 16.)
Despite this disagreement as to Plaintiff's essential functions, the parties agree that Plaintiff worked in the capacity of Materials Handler (accommodated or otherwise) from at least early 1998 until October 23, 1998, when her employment with Donnelley was terminated. (Id. ¶ 17.) Plaintiff applied for and received short-term disability benefits under the Plan from October 26, 1998, to March 18, 1999. (Id. ¶ 19.) On or about February 10, 1999, Plaintiff applied for long-term disability benefits under an insured policy separate from the STD portion of the Plan on the basis of back pain and possible fibromyalgia. (Id. ¶ 20.) On February 16, 1999, Plaintiff underwent a functional capacities evaluation ("FCE"), which revealed that she was capable of working at the light physical demand level, as defined by the Dictionary of Occupational Titles, for an eight-hour day. (Id. ¶ 21.) The results of the FCE indicated that Plaintiff could lift 10-20 lbs. occasionally, 7-15 lbs. frequently, and 5-7 lbs. constantly. (Id. ¶ 22.) Plaintiff could also sit, stand, and walk frequently. (Id.) Hartford sent these results to be reviewed by Mark Williams, M.D., Plaintiff's treating physician. (Id. ¶ 23.) Hartford requested that Dr. Williams indicate "which areas of this FCE you find . . . inaccurate" and "Ms. Blickenstaff's specific restrictions and limitations if they are different from that shown in the FCE." (Id. ¶ 23.) In a letter dated March 15, 1999, Dr. Williams stated that he agreed with the results of the FCE. (Id. ¶ 24.)
On March 18, 1999, Hartford notified Plaintiff that she was not entitled to short-term disability benefits after March 14, 1999, because she was capable of performing the essential duties of her occupation as a Material Handler, as modified by Donnelley, and therefore did not meet the Plan definition of "Total Disability." (Id. ¶ 25.) In the letter notifying Plaintiff of the denial, Hartford identified the data on which it based its decision, including Dr. Williams's Statement of Disability taken on November 17, 1998, a Physical Demands Analysis performed by Leslie Snook on November 19, 1998, and the FCE performed on February 16, 1999. (Id., Ex. J.) On April 5, 1999, Hartford received Plaintiff's administrative appeal of the denial of short-term and long-term disability benefits. (Id. ¶ 27.) In her appeal, Plaintiff asserted that she suffered from fibromyalgia and granted permission for Hartford to access her Donnelley medical files, which she alleged stated that she had fibromyalgia. (Id.) On April 21, 1999, Hartford denied Plaintiff's administrative appeal on the basis that Plaintiff's treating physician, Mark Williams, M.D., was uncertain of the diagnosis of fibromyalgia. (Id. ¶ 31.) The denial letter also stated, "[I]f you have additional information that you feel would assist us in evaluating your claim, you may submit it. No additional medical information was submitted in your letter of appeal." (Id.) Plaintiff submitted reports of subsequent medical examinations, including a report produced by Osvaldo Acosta-Rodriguez, M.D., on May 3, 1999, and one produced by Scott Douglas, M.D., on May 19, 1999. (Pl's Resp. to D's Motion for Summ. J. at 12-13.) Hartford declined to consider evidence of Plaintiff's medical condition compiled after the eligibility determination. (Id.)
Analysis
1. Defendants' Motion to Dismiss
Defendants first challenge the sufficiency of Plaintiff's Second Amended Complaint. In our January 29, 2001 Order, we dismissed the claims against Donnelley and Hartford with prejudice and we instructed Plaintiff to revise the remaining claim against the Plan. On February 28, 2001, we granted Plaintiff's Motion for Leave to Amend the Complaint without passing on the sufficiency of the amended pleading filed simultaneously. Defendants have filed a Motion to Dismiss portions of the Second Amended Complaint because the revised pleading includes the two claims we had earlier dismissed with prejudice. Plaintiff has not responded to the Motion but has included arguments addressing the merits of the dismissed claims in the Response to the Motion for Summary Judgment.
A dismissal with prejudice "bar[s], by operation of the doctrine of res judicata, the relitigation of the suit on the merits." T.W. by Enk v. Brophy, 124 F.3d 893, 897 (7th Cir. 1997); see also Black's Law Dictionary 7th ed. (defining "dismissal with prejudice" as "[a] dismissal . . . barring the plaintiff from prosecuting any later law suit on the same claim"). Here, the Second Amended Complaint plainly realleges claims against Hartford and Donnelley that we dismissed with prejudice in the previous order. Plaintiff has not responded to Defendants' Motion to Dismiss and offers no explanation in the Response to Motion for Summary Judgment as to why these dismissed claims should be revived. Accordingly, we GRANT Defendants' Motion to Dismiss claims against Hartford and Donnelley and consider Defendants' Motion for Summary Judgment only with respect to the remaining claim against the Plan.
2. Defendants' Motion for Summary Judgment
Defendants move for summary judgment, contending that the denial of Plaintiff's short-term disability benefits was reasonable because Plaintiff did not meet the plan definition of "totally disabled," a necessary prerequisite for her to receive benefits after March 14, 1999. Plaintiff counters that the Plan, through administrator Hartford, wrongfully ignored evidence of Plaintiff's disability in denying her claim for benefits.
Summary judgment is appropriate if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c). A genuine issue of material fact exists if there is sufficient evidence for a reasonable jury to return a verdict in favor of the non-moving party on the particular issue. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The nonmovant must establish more than mere doubt as to the material facts, but must "adduce evidence `set[ting] forth specific facts showing that there is a genuine issue for trial.'" Fed.R.Civ.P. 56(e); Packman v. Chicago Tribune Co., 267 F.3d 628, 6374 (7th Cir. 2001). The mere existence of a factual dispute will not bar summary judgment; the facts in dispute must be outcome-determinative. Id. In considering a motion for summary judgment, a court must review the record and draw all reasonable inferences in the light most favorable to the non-moving party. Id. at 255; Del Raso v. U.S., 244 F.3d 567, 570 (7th Cir. 2001). "If the non-movant does not come forward with evidence that would reasonably permit the finder of fact to find in [his] favor on a material question, then the court must enter summary judgment against [him]." Waldridge v. American Hoechst Corp., 24 F.3d 918, 920 (7th Cir. 1994), citing Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 585-87 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 322-24 (1986); Anderson, 477 U.S. at 249-52. Evidence inadmissible at trial is similarly unusable in the resolution of this Motion. Minor v. Ivy Tech State College, 174 F.3d 855, 856 (7th Cir. 1999); Flynn v. Aerchem, Inc., 2001 WL 791677 (S.D.Ind. July 12, 2001).
It is undisputed that, under the terms of the Plan, the claims evaluator "has full discretion and authority to determine benefits payable and to construe and interpret all terms and provisions of the Plan in connection with this determination." (D's Statement of Facts ¶ 8.) Therefore, we must review the benefits eligibility decision under the arbitrary and capricious standard. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 110-11 (1989); Brehmer v. Inland Steel Indus. Pension Plan, 114 F.3d 656, 660 (7th Cir. 1997). This deferential standard of review essentially requires us to determine whether the fiduciary's benefits decision was "downright unreasonable." Donato v. Metropolitan Life Ins. Co., 19 F.3d 375, 380 (7th Cir. 1994), quoting Fuller v. CBT Corp., 905 F.2d 1055, 1058 (7th Cir. 1990); see also Johnson v. Allsteel, Inc., 259 F.3d 885, 890 (7th Cir. 2001); Schaub v. Consolidated Freightways, Inc. Extended Sick Pay Plan, 895 F. Supp. 1136, 1140 (S.D.Ind. 1995).
Plaintiff alleges that Defendants' failure to consider evidence of Plaintiff's medical condition past March 13, 1999, constitutes bad faith. To support this assertion, Plaintiff offers the affidavit of LeRoy Utschig, "an expert in the field of insurance claims and coverage." (Pl's Resp. To D's Mot. For Summ. J. at 4.) Plaintiff's reliance on this affidavit is misplaced, however. Such legal conclusions are not a proper subject for expert testimony. U.S. v. Cross, 113 F. Supp.2d 1282, 1285 (S.D.Ind. 2000); Paradigm Sales, Inc. v. Weber Marking Sys., Inc., 880 F. Supp. 1247, 1255 (N.D.Ind. 1995). "[A]n expert may offer his opinion as to facts that, if found, would support a conclusion that the legal standard at issue was satisfied, but he may not testify as to whether the legal standard has been satisfied." Burkhart v. Washington Metro. Area Transit Authority, 112 F.3d 1207, 1212-13 (D.C. Cir. 1997). More relevant to our immediate purpose, the Utschig report and affidavit were stricken from the record in this case by order of the Court on October 3, 2001. Therefore, we must disregard Plaintiff's contention that the Utschig affidavit establishes that Defendants acted in bad faith.
Furthermore, given the deferential standard of review under which we must view Defendants' benefits determination, we do not find the decision to exclude evidence amassed after March 13, 1999, to be downright unreasonable. Defendants' refusal to consider such evidence is rationally related to the goal of determining Plaintiff's physical capabilities on the specific dates for which coverage was sought and ultimately denied. Both Dr. Williams and Dr. Acosta indicated that Plaintiff's FCE accurately reflected her capabilities. Such conclusions naturally reflect Plaintiff's condition on the date she underwent examination. Defendants' refusal to extrapolate backward in time from the date of these examinations to determine Plaintiff's physical condition two months earlier was not sufficiently unreasonable to warrant disruption of the benefits eligibility decision.
However, Plaintiff also alleges that Defendants unreasonably terminated her short-term benefits by relying on inaccurate descriptions of her essential responsibilities in finding her to be less than "totally disabled." Specifically, Plaintiff argues that Defendants used a less strenuous account of Plaintiff's accommodated duties to support the finding that she was capable of performing in the Materials Handler capacity. The actual modified job description, Plaintiff contends, required:
(1) sitting, standing and walking for four hours, three hours and one hour, respectively;
(2) lifting 1-10 lbs. constantly, lifting 11-20 lbs. frequently, lifting 21-50 lbs. occasionally, and never lifting more than 51 lbs.
(3) stooping frequently, kneeling and crouching occasionally, and never climbing balancing or crawling;
(4) reaching above shoulder level and at and below waist level frequently, handling frequently, and fingering and feeling constantly;
(5) no repetitive use of the feet;
(6) sedentary work for 10 percent of the time and light work for 90 percent of the time.
(Id. ¶ 14.) Defendants counter that the termination decision was based on Plaintiff's ability to perform under her modified job description effective June 1, 1998, which required that she "refrain from standing more than 2 hours, lifting anything greater than 10 lbs., bending, stooping, or climbing." (D's Statement of Facts ¶ 16.)
The administrative record and the briefs on this Motion reflect two versions of Plaintiff's essential job functions purportedly used to evaluate her physical capability and disability status at different times but fail to establish which of these descriptions ultimately defined the position. Defendants suggest that discrepancies regarding the two different standards were merely unintentional misstatements. Intentional or not, such discrepancies and their effect on the disability determination present a genuine issue of material fact that must preclude summary judgment on this claim. Therefore, because we are unable from the record to determine the precise basis for Defendants' decision to deny Plaintiff's short-term disability benefits, and therefore cannot properly evaluate the reasonableness of such decision, we must DENY summary judgment on the claim against the Plan.
Conclusion
Defendants moved to dismiss claims against Hartford and Donnelley and moved for summary judgment as to all remaining claims. For the reasons stated above, we find that 1) Plaintiff's claims against Hartford and Donnelley must be dismissed based on their prior dismissal with prejudice; 2) Defendants' refusal to consider evidence of Plaintiff's physical condition after March 13, 1999, did not render the benefits determination unreasonable; and 3) Defendants' apparent reliance on conflicting job descriptions in determining Plaintiff's eligibility status presents a genuine issue of material fact that precludes summary judgment on the claim against the Plan. Accordingly, we GRANT the Motion to Dismiss and we DENY the Motion for Summary Judgment.
It is so ORDERED.