Alexander v. Winthrop, Stimson, Putnam

• Decision Date: 17 July 2007
• Docket Number: No. 04 CV 760(RJD)(KAM).,04 CV 760(RJD)(KAM).
• Citation: 497 F.Supp.2d 429
• Parties: Rosalyn ALEXANDER, Plaintiff, v. WINTHROP, STIMSON, PUTNAM AND ROBERTS LONG TERM DISABILITY COVERAGE, et al., Defendants.
• Court: U.S. District Court — Eastern District of New York

497 F.Supp.2d 429

Rosalyn ALEXANDER, Plaintiff, v. WINTHROP, STIMSON, PUTNAM AND ROBERTS LONG TERM DISABILITY COVERAGE, et al., Defendants.

No. 04 CV 760(RJD)(KAM).

United States District Court, E.D. New York.

July 17, 2007.

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Gary Steven Stone, Legal Services for the Elderly, New York City, for Plaintiff.

Edward Joseph Boyle, Wilson, Elser, Moskowitz, Edelman & Dicker, L.L.P., New York City, for Defendants.

MEMORANDUM & ORDER

DEARIE, Chief Judge.

Plaintiff, formerly an employee of defendant law firm Winthrop, Stimson, Putnam and Roberts LLP ("Winthrop Stimson"), brings this action pursuant to the Employee Retirement Security Income Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., and claims that defendants Winthrop Stimson and Prudential Insurance Company of America ("Prudential") improperly denied her long-term disability benefits. Plaintiff moved for summary judgment, and defendants cross-moved for judgment on the administrative record. In a Memorandum & Order dated September 27, 2005, the Court denied both motions and invited the parties to submit final submissions addressing the facts. Both parties having done so, and upon a de novo review of the administrative record, the Court finds that plaintiff is totally disabled within the meaning of Winthrop Stimson's long-term disability benefits plan and therefore is entitled to benefits.

BACKGROUND

The facts underlying this case are set out in detail in this Court's Memorandum and Order of September 27, 2005. Accordingly, the Court now provides only a brief summary.

Plaintiff, now sixty years old, was employed continuously for thirty-three years, and worked at Winthrop Stimson as a legal secretary for at least nine years.¹ Pl,'s Rule 56.1 Stat't ¶¶ 1-2. Beginning in 1994, plaintiff began experiencing lower back pain, which she claims made it increasingly difficult for her to perform her secretarial duties. Id. ¶¶ 3, 6. She was placed on disability leave from Winthrop Stimson on several occasions. Id. ¶ 6; PRU198.² By November 1997, according to plaintiff, she was unable to return to work. Pl.'s Rule 56.1 Stat ¶ 6.

On February 9, 1998, plaintiff applied for benefits under Winthrop Stimson's Long Term Disability Coverage plan (the "Plan"), which is underwritten by defendant Prudential. Defs.' Rule 56.1 Stat't ¶¶ 3, 6. On March 12, 1998, Winthrop Stimson notified plaintiff by letter that "based upon [her] doctor's determination that [she was] totally disabled ... it [was] not possible to continue to hold a position open for [her]," and that it had terminated her employment retroactive to February 26, 1998. Pl.'s Rule 56.1 Stat't ¶ 2; PRU127. On May 19, 1998, Prudential approved the payment of benefits. Id. ¶ 15. Several months later, on January 28, 1999, Prudential reversed this decision. Id. ¶ 21. Plaintiff appealed, but her appeal was unsuccessful. Prudential's final denial of benefits issued on July 27, 1999. Id. ¶ 36.

While pursuing benefits under the Plan, plaintiff also applied for Social Security Disability insurance benefits. The attorneys who represented during this process sere recommended to her and paid by Prudential. PRU278. Her application was denied, PRU275, but an Administrative Law Judge ("ALP) reviewed the denial, and on July 13, 1999, without requiring a hearing, he issued a ruling in which he found that plaintiff was disabled and entitled to receive benefits. Pl.'s Rule 56.1 Stat't ¶¶ 33-35; PRU151-61.

Plaintiff subsequently brought this ERISA action.

DISCUSSION

A. Standard of Review and Procedural Posture

Plaintiff challenges defendants' denial of long-term disability benefits under Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a) (1)(B), which empowers a participant in an employee benefit plan within the statute's coverage to bring a civil action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan"; and under Section 502(a)(3) of ERISA, 29 U.S.C. § 1132(a)(3), which empowers a plan participant to bring a civil action "to enjoin any act or practice which violates any provision of this title or the terms of the plan, or ... to obtain other appropriate equitable relief ... to redress such violations or ... to enforce any provisions of this title or the terms of the plan." See Am. Compl. ¶¶ 42, 50.

As the Court explained in its Memorandum & Order of September 27, 2005, Prudential did not have discretionary authority to determine plaintiffs eligibility for long-term disability benefits under the Plan. Thus the Court reviews Prudential's denial of benefits de novo. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989) ("[W]e hold that a denial of benefits challenged under [29 U.S.C.] § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.").

Plaintiffs motion for summary judgment having been denied, the Court proceeds based on an examination of the administrative record. See Muller v. First Unum Life Ins. Co., 341 F.3d 119, 124 (2d Cir. 2003) ("[T]he decision on the motion for judgment on the administrative record, or the District Court's de novo review of the parties' submissions and resolution thereof, can best be understood as essentially a bench trial on the papers with the District Court acting as the finder of fact. Since there is no right to a jury trial under ERISA, this form of bench trial was entirely proper.") (internal quotation marks and citation omitted).

Plaintiff bears the burden of proving her entitlement to benefits. See Slupinski v. First Unum Life Ins. Co., No. 99 Civ. 0616, 2005 WL 2385852, at *6, 2005 U.S. Dist. LEXIS 21601, at *18 (S.D.N.Y. Sept. 27, 2005) ("It is well established that plaintiff bears the burden of showing that he was entitled to long term disability benefits under his plan.") (citing Maniatty v. Unumprovident Corp., 62 Fed.Appx. 413 (2d Cir.2003)); O'Sullivan v. Prudential Ins. Co. of Am., No. 00 Civ. 7915, 2002 WL 484847, at *8, 2002 U.S. Dist. LEXIS 5349, at *22 (S.D.N.Y. Mar. 29, 2002) ("The burden of establishing total disability ... rests with [plaintiff].") (citing Barnable v. First Fortis Life Ins. Co.,, 44 F.Supp.2d 196, 204 (E.D.N.Y.1999)).

B. Plaintiffs Entitlement to Long-Term Disability Benefits

Under the terms of the Plan, plaintiff is "totally disabled" and entitled to benefits if she meets the following conditions:

(1) Due to Sickness or accidental Injury, both of these are true:

(a) [She is] not able to perform, for wage or profit, the material and substantial duties of [her] occupation.

(b) After the Initial Duration of a period of Total Disability, [she is] not able to perform for wage or profit the material and substantial duties of any job for which [she is] reasonably fitted by [her] education, training or experience....

(2) [She is] not working at any job for wage or profit.

(3) [She is] under the regular care of a Doctor.

PRU373. Neither party disputes that plaintiff is not working for wage or profit, or that she is under a doctor's regular care. Thus two questions are in dispute: (1) whether plaintiff can perform the material and substantial duties of her occupation; and (2) whether plaintiff can perform the material and substantial duties of any other occupation for which she is reasonably fitted by her education, training, and experience. Upon de novo review of the administrative record, the Court answers both questions in the negative. It finds that plaintiff suffers from severe, chronic lower back pain; that, as a result, she can perform neither the material and substantial duties of her own occupation, nor those of any other occupation for which she is reasonably fitted; that she is totally disabled within the meaning of the Plan; and that she is entitled to receive benefits.

1. Plaintiff Suffers From Severe, Chronic Lower Back Pain

Plaintiff's complaints of pain are an important factor to be considered in determining whether she is disabled. Connors v. Connecticut Gen. Life Ins. Co.,, 272 F.3d 127, 136 (2d Cir.2001) ("It has long been the law of this Circuit that the subjective element of pain is an important factor to be considered in determining disability.'") (quoting Mimms v. Heckler, 750 F.2d 180, 185 (2d Cir.1984)).

Citing diagnoses of degenerative arthritis, facet degenerative disease, lumbosacral myofasciitis, and fibromyalgia,³ Pl.'s Final Submission J. Pleadings [hereinafter Pl.'s Mem.] at 2 n. 2, plaintiff claims to have suffered from severe, persistent lower back pain since 1994. Defendants respond that the medical evidence in the record does not substantiate plaintiffs complaints. In particular, they point to the finding of consulting physician Dr. Barry Halejian that plaintiff's account of her symptoms "was out of proportion to the objective medical findings." Defs.' Reply Final Submission [hereinafter Defs.' Reply] at 4.

The Court finds that the record contains substantial medical evidence supporting plaintiffs claims of severe, persistent lower back pain. The evidence includes magnetic resonance imaging ("MRI") scans of plaintiffs back from 1994 and 1998 indicating a disc bulge at L5-S1, degenerative arthritis, and facet degenerative disease, PRU305, PRU211; as well as a 1997 X-ray revealing degenerative changes in plaintiffs lumbar spine, PRU262.

Also supporting plaintiffs account is the opinion of Dr. Santi DiFranco, who has treated plaintiff for her back problems since 1995, and who reported in 1998 that plaintiff suffered from a "painful bulge of the lumbar discs in her spine"; that she was participating in physical therapy, taking amitriptyline and hydrocodone to relieve her pain, and wearing a back brace; and that she was unable to...