Erbe v. Connecticut General Life Ins. Co.

• Decision Date: 10 March 2010
• Docket Number: Civil Action No. 06-113.
• Citation: 695 F. Supp.2d 232
• Parties: Mary Karen ERBE, Executrix of the Estate of Edward Erbe, Plaintiff, v. CONNECTICUT GENERAL LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Western District of Pennsylvania

695 F. Supp.2d 232

Mary Karen ERBE, Executrix of the Estate of Edward Erbe, Plaintiff, v. CONNECTICUT GENERAL LIFE INSURANCE COMPANY, Defendant.

Civil Action No. 06-113.

United States District Court, W.D. Pennsylvania.

March 10, 2010.

James M. Fox, Ned J. Nakles, Jr., Nakles and Nakles, Latrobe, PA, for Plaintiff.

MEMORANDUM ORDER

TERRENCE F. McVERRY, District Judge.

Plaintiff's complaint was received by the Clerk of Court on January 27, 2006, upon removal from the Court of Common Pleas of Westmoreland County, Pennsylvania, and was referred to United States Magistrate Judge Lisa Pupo Lenihan for pretrial proceedings in accordance with the Magistrate Judges Act, 28 U.S.C. § 636(b)(1), and Local Rules of Court 72.C and 72.D.

The Magistrate Judge's Report and Recommendation (Doc. No. 84), filed on February 17, 2010, recommended that Plaintiff's Motion for Summary Judgment (Doc. No. 69) be denied, Defendant's Motion for Summary Judgment (Doc. No. 65) be granted, and Judgment be entered in favor of Defendant. Service was made on counsel of record for all parties. The parties were informed that in accordance with the Magistrate Judges Act, 28 U.S.C. § 636(b)(1)(B) and (C), and Rule 72.D.2 of the Local Rules of Court, that they had fourteen (14) days to file any objections. No objections have been filed to the Report and Recommendation.

After review of the pleadings and documents in the case, together with the Report and Recommendation, the following order is entered:

AND NOW, this 10th day of March, 2010,

IT IS HEREBY ORDERED that Plaintiff's Motion for Summary Judgment (Doc. No. 69) is DENIED.

IT IS FURTHER ORDERED that Defendant's Motion for Summary Judgment (Doc. No. 65) is GRANTED, and Judgment is entered in favor of Defendant and against Plaintiff.

IT IS FURTHER ORDERED that the Report and Recommendation of Magistrate Judge Lenihan, dated February 17, 2010, is adopted as the opinion of the Court.

IT IS FURTHER ORDERED that the Clerk of Court shall mark this case closed.

REPORT AND RECOMMENDATION

LISA PUPO LENIHAN, United States Magistrate Judge.

I. RECOMMENDATION

It is respectfully recommended that Plaintiffs Motion for Summary Judgment (Doc. No. 69) be denied and that Defendant's Motion for Summary Judgment (Doc. No. 65) be granted.

II. REPORT

Currently before the Court for disposition are cross-motions for summary judgment in this ERISA action brought under 29 U.S.C. § 1132(a)(1)(B) for review of a denial of benefits. The sole issue before the Court is whether, under a de novo standard of review, Defendant properly denied Plaintiffs claim for accidental death and dismemberment benefits.

A. Statement of Relevant Facts and Procedural History

At the time of his death on July 21, 2003, Edward Erbe was a 57-year old lubrication engineer who had been employed by Exxon Mobil Corporation for 34 years. As a lubrication engineer, Mr. Erbe was responsible for troubleshooting and performing inspections at different sites and making recommendations. In addition, Mr. Erbe advised customers on the proper lubricants to use with various machinery, provided support for sales representatives, and trained other lubrication specialists and engineers. Mr. Erbe maintained a home office where he performed some of his responsibilities. (R. 105, 137-38.)¹

Mr. Erbe's medical history reveals that on March 13, 1997, he sought medical attention at Latrobe Area Hospital for complaints of chest pain. (R. 213.) After conducting a series of tests, Mr. Erbe was discharged after one day with the conclusion that his chest pain was non-cardiac in nature. (R. 214.) It was documented during this hospitalization that Mr. Erbe was a heavy smoker of 2 to 3 packs of cigarettes a day for 20 years.² (Id.) Upon his discharge, Mr. Erbe was instructed to follow-up with his family physician and to stop smoking. (Id.) Mr. Erbe's past medical history also consisted of some gastrointestinal problems in 1998 and 2001. (Id.) Although his cholesterol was reported as elevated in 1992 and 1995 (R. 217), Mr. Erbe was not taking any medication at the time of his death other than daily aspirin (R. 140, 144). Also, according to Mrs. Erbe, her husband was never diagnosed with high blood pressure. (R. 144.) Mr. Erbe underwent yearly check-ups with his family physician of 20 years, and at no point during this time was he under the regular care of a cardiologist. (R. 134, 136.) Also, Mr. Erbe underwent biannual physical examinations through Exxon Mobil, which sometimes included a stress test. (R. 141.)³ After reviewing the entire administrative record, the Court could not find any notation of a cardiac problem or the diagnosis of such problem with regard to Mr. Erbe prior to his fatal heart attack on July 23, 2001.

On the date of his death, Mr. Erbe left his home and picked up his co-worker, Greg Sadowski, at 8:45 a.m., and together they traveled to U.S. Steel Corporation's Mon Valley Works to inspect the gears of the machinery in the "hot mill" section of the plant, which is where the steel is actually produced. (R. 157-58.) In anticipation of the inspection, the hot mill operation had been shut down at 8:30 a.m. (R. 158, 173.) Ninety minutes later, heat continued to emanate from the gear boxes that Mr. Erbe and Mr. Sadowski were about to inspect. (173-74.)

Mr. Erbe and Mr. Sadowski arrived at the hot mill around 9:30 a.m. and prior to commencing their inspection, dressed in protective coveralls which they wore over their work clothes, as well as gloves, safety boots, safety glasses, and hard hats. (R. 159, 163-64.) The coveralls, which were provided by the plant, were a type of fireresistant, plastic suit. (R. 163.) The inspection began at 10:00 a.m. and lasted approximately two and one-half hours. (R. 167, 173.) During the course of the inspection, Mr. Erbe and Mr. Sadowski inspected 13 or 14 mill stands. (R. 161.) In order to inspect the condition of the gears, it was necessary to look through the inspection port, which required climbing either one or two plates, each approximately one foot in height, for a side view, or a ladder to view a top portal. (R. 161-62, 173.) Mr. Erbe acted more as a mentor during the inspection; Mr. Sadowski did a lot of the inspection and physical labor, and if he discovered something that did not look right, he asked Mr. Erbe for his opinion, to double check his work. (R. 162-63, 195, 204-06.) Mr. Sadowski recalled that there were only two top portals and he did not recall Mr. Erbe climbing on those two. (R. 195, 204.) However, Mr. Erbe accompanied Mr. Sadowski to each of the gear boxes, which required Mr. Erbe to work his way around each mill stand, i.e., climbing steps, walking across the mezzanine and coming down to the next stand. (R. 163, 204-06.)

On two separate occasions, Mr. Sadowski estimated the temperature in the "hot mill" section to be between 90 and 100 degrees Fahrenheit (R. 200), and between 85 and 95 degrees (R. 164). The combination of the coveralls and the temperature caused both men to "sweat profusely literally drenching their clothing." (R. 164-65, 185.) They took several breaks during the inspection where they would sit and consume a Gatorade type drink for five to ten minutes. (R. 165.) On one or two of these breaks, the men were able to sit in an air-conditioned room. (R. 166.) Mr. Erbe did not complain of any chest pains or other problems during the inspection. (R. 166, 188.) Also, Mr. Sadowski noted that Mr. Erbe smoked during the inspection but could not recall the number of cigarettes he smoked. (R. 174-75.)

After the inspection was completed, while Mr. Sadowski was reviewing the results of the inspection with the maintenance staff, Mr. Erbe complained that he was not feeling well and was rubbing his chest. (R. 168-69.) Mr. Sadowski stated that both of them were very tired after the inspection as it had been a tough day, meaning that they felt pretty well drained from working in those temperatures. (R. 169.) Mr. Erbe did not make any such complaints to Mr. Sadowski on the drive to the plant earlier that day. (R. 175, 188.) Mr. Erbe and Mr. Sadowski left the plant between 12:30 p.m. and 1:00 p.m., with Mr. Erbe doing the driving. (R. 177-79.) They stopped at a mini-mart to purchase a couple of Gatorades, and while Mr. Sadowski was inside the mini-mart, Mr. Erbe moved to the passenger side of the vehicle. (R. 179-80.) When he returned to the vehicle, Mr. Sadowski took over the driving and shortly thereafter, he again asked Mr. Erbe how he was feeling, to which Erbe responded that he was having chest pains. (R. 183.) At that point, Mr. Sadowski told Mr. Erbe he was taking him to the hospital. (Id.) However, when Mr. Sadowski glanced over at Mr. Erbe, he was already gone. (R. 190-91.) Mr. Erbe's fatal heart attack occurred within approximately ten to fifteen minutes after leaving the plant. (R. 181.) Mr. Erbe was taken to UPMC McKeesport by ambulance where he was diagnosed as a cardiac arrest. (R. 239.)

The Certificate of Death completed on July 22, 2003 lists "Arteriosclerotic Cardiovascular Disease" as the cause of death and the manner of death as "natural.". (R. 312.) In addition, the Autopsy Report of that same date determined the cause of death to be Arteriosclerotic Cardiovascular Disease and the manner of death was "natural." (R. 277.) With regard to the cardiovascular system, the Autopsy Report stated that the main left coronary artery was markedly calcified and was 90% blocked. (R. 283.) The Autopsy Report further indicated that the left anterior descending coronary artery appeared severely calcified and was 90% blocked. (Id.) Also, the right coronary artery was calcified and was 50% blocked. (Id.) In addition, the aorta showed mild to moderate atherosclerosis, with no ulcerated plaques. (R. 284.)

Subsequently, on or about September 24, 2003, Plaintiff, Mary Karen Erbe, the spouse and executrix of the estate of Edward Erbe, submitted a claim for benefits under the Basic...