Lamanna v. Special Agents Mut. Benefits Ass'n

• Decision Date: 06 March 2008
• Docket Number: Civil Action No. 07-733.
• Citation: 546 F.Supp.2d 261
• Parties: Elizabeth J. LAMANNA, Plaintiff, v. SPECIAL AGENTS MUTUAL BENEFITS ASSOCIATION, d/b/a/ Samba Group Insurance Plan, Defendant.
• Court: U.S. District Court — Western District of Pennsylvania

546 F.Supp.2d 261

Elizabeth J. LAMANNA, Plaintiff, v. SPECIAL AGENTS MUTUAL BENEFITS ASSOCIATION, d/b/a/ Samba Group Insurance Plan, Defendant.

Civil Action No. 07-733.

United States District Court, W.D. Pennsylvania.

March 6, 2008.

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Francis M. Moore, Mansmann & Moore, Pittsburgh, PA, for Plaintiff.

Amber M. Schuknecht, Pepper Hamilton, Pittsburgh, PA, David M. Ermer, Gordon & Ermer, Washington, DC, Brian P. Downey, Pepper, Hamilton & Scheetz, Harrisburg, PA, for Defendant.

MEMORANDUM OPINION

WILLIAM L. STANDISH, District Judge.

I. INTRODUCTION

According to the Complaint filed in this Court on May 30, 2007, Plaintiff Elizabeth J. Lamanna was insured under a long-term disability insurance plan ("the Plan") administered by Defendant Special Agents Mutual Benefits Association ("SAMBA") while she was employed by the Federal Bureau of Investigation ("FBI.") When she became disabled as a result of significant medical problems beginning in 1996, Ms. Lamanna sought benefits from Defendant through the Plan. Plaintiff received long-term disability ("LTD") benefits from 1996 through 2004, but SAMBA subsequently determined that although she could not return to her former work with the FBI, she was not completely disabled and her benefits were terminated as of January 30, 2005. Following review and appeal, SAMBA issued a final denial letter on September 30, 2005.

Having exhausted her administrative appeals, Plaintiff filed suit in this Court pursuant to the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. ("ERISA"), seeking the full amount of benefits due under the Plan together with attorney's fees and costs as provided by ERISA.

Defendant's answer to the Complaint conceded that SAMBA is the Plan sponsor, named fiduciary and administrator of the Plan, and that at one time, Plaintiff received LTD benefits under the Plan. (Doc. No. 6 at 1-2.) However, Defendant argues the evidence shows that according to the terms of the Plan, Plaintiff was able to perform gainful work other than her own occupation; consequently, SAMBA justifiably terminated her LTD benefits. (Id. at 2.)

The parties were unable to resolve the matter amicably and advised the Court that they both believed summary judgment motions were appropriate, based on the extensive administrative record. The Court therefore ordered the parties to file cross-motions for summary judgment pursuant to Federal Rule of Civil Procedure 56, together with concise statements of fact and briefs in support their motions. (Order of Court, September 11, 2007, Doc. No. 12.) The parties having complied with the Order of Court, this matter is now ripe for decision.

After careful consideration and for the reasons set forth below, Plaintiff's motion for summary judgment (Doc. No. 21) is granted and Defendant's cross-motion (Doc. No. 18) is denied.

II. JURISDICTION AND VENUE

This Court has jurisdiction over Plaintiff's claims pursuant to 29 U.S.C. § 1132(e)(1). Venue is appropriate in this district inasmuch as the Plan is administered and Defendant's alleged breaches of duty occurred in this district. 29 U.S.C. § 1132(e)(2).

III. STANDARD FOR SUMMARY JUDGMENT

A court may grant summary judgment if the party so moving can show "there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c); Sollon v. Ohio Cos. Ins. Co., 396 F.Supp.2d 560, 568 (W.D.Pa.2005). If a reasonable jury could return a verdict for the non-movant, the dispute is genuine and if, under substantive law, the dispute would affect the outcome of the suit, it is material. A factual dispute between the parties that is both genuine and material will defeat a motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

In considering a motion for summary judgment, the court must view all evidence in the light most favorable to the nonmovant, accept the non-movant's version of the facts as true, and resolve any conflicts in its favor. Sollon, id.,citing Matsushita Elec. Indus. Co. Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986), and Big Apple BMW, Inc. v. BMW of North America, Inc., 974 F.2d 1358, 1363 (3d Cir.1992). In short, the movant must show that if the pleadings, depositions and other evidentiary material were admissible at trial, the other party could not carry its burden of proof based on that evidence and a reasonable jury would thus decide all genuine material disputes in the movant's favor. Celotex Corp. v. Catrett, 477 U.S. 317, 318, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

Once the movant has demonstrated that there are no genuine issues of material fact, the burden shifts to the non-moving party to "make a showing sufficient to establish the existence of every element essential to his case, based on the affidavits or by depositions and admissions on file." Celotex, id. at 322-323, 106 S.Ct. 2548; Sollon, id.; Fed.R.Civ.P. 56(e). The sum of the affirmative evidence to be presented by the non-moving party must be such that a reasonable jury could find in its favor, and it cannot simply reiterate unsupported assertions, conclusory allegations, or mere suspicious beliefs. Liberty Lobby, id. at 250-252, 106 S.Ct. 2548; Groman v. Township of Manalapan, 47 F.3d 628, 633 (3d Cir.1995).

A court addressing cross-motions for summary judgment considers each motion separately. Smith v. Prudential Ins. Co. of Am., 513 F.Supp.2d 448, 452 (E.D.Pa.2007), citing Coolspring Stone Supply, Inc. v. Am. States Life Ins. Co., 10 F.3d 144, 150 (3d Cir.1993). A party's concessions made for purposes of its own summary judgment motion do not carry over into the court's consideration of the opposing party's motion. Coolsprincr Stone Supply, id.

IV. FACTUAL HISTORY¹

We set out in considerable detail the factual history because in deciding a motion for summary judgment in an ERISA case where the plaintiff claims benefits were improperly denied, a reviewing court is generally limited to the facts known to the plan administrator at the time the decision was made. Post v. Hartford Ins. Co., 501 F.3d 154, 168 (3d Cir. 2007). Moreover, the inquiry as to whether and how far the abuse of discretion standard should be heightened is an extremely fact-intensive exercise and therefore, in order to make this determination, the court must have all the relevant facts set out. Gibson v. Hartford Life & Accident Ins. Co., CA No. 06-3418, 2007 WL 1892486, *3, 2007 U.S. Dist. LEXIS 47337, *8 (E.D. Pa. June 27, 2007).

Elizabeth Lamanna was born, raised, and educated in Pittsburgh, Pennsylvania, where she received a law degree from Duquesne University in 1981. After several years as an assistant district attorney in Pittsburgh, Plaintiff began working as a special agent for the FBI in January 1986. As an FBI employee, she was eligible to elect long term disability insurance coverage through a policy offered by SAMBA² which in turn was insured by Fidelity Security Life Insurance Company ("Fidelity.") At all times relevant to the events herein, Plaintiff was covered under the Plan.

According to a report to one of her physicians, Ms. Lamanna was in good health until July or August 1992 when she began to experience a flu-like illness with aches, pains, fever, sore throat, headaches, and profound fatigue. After a week or so, all the symptoms disappeared except for significant chronic fatigue, muscle achiness, and weakness. Ms. Lamanna consulted a physician who diagnosed her with hypothyroidism³ and began treating her with thyroid replacement therapy. In October 1993, after she collapsed while jogging, she was admitted to a hospital in Greenwich,`Connecticut, for heart palpitations. Doctors there concluded she had been mis-diagnosed and that treatment with thyroid replacement had actually resulted in hyperthyroidism.⁴ In addition, they discovered she had a positive test result for Lyme disease⁵ which Ms. Lamanna could have contracted from possible exposure to ticks during weapons field training required by the FBI.

In April 1994, Ms. Lamanna consulted with a rheumatologist, Dr. Richard L. Danehower. Dr. Danehower noted by that time, Ms. Lamanna had probably seen as many as fifteen other doctors in an effort to determine the source of her illness. Following a physical examination which he described as "essentially normal," the physician noted:

A search for tender points was essentially negative. Despite the absence of tender points, I think much of what she is describing is in the fibrositis⁶ category. Whether this is idiopathic⁷ fibrositis or whether this is post Lyme fibrositis I am not sure. Whether [intravenous] antibiotics would help her with this I do not know. My guess is that they would not, but of course if they did, that might offer for her the possibility of permanent cure, which is otherwise not something that I can offer her for idiopathic fibrositis.

(Administrative Record, Docket Nos. 15, 16, and 17, "AR," at 229.)

Plaintiff was also examined in May 1994 by an infectious disease specialist, Dr. Peter C. Welch, who ordered a number of blood tests to rule out Lyme disease. Dr. Welch concluded, "My impression is that she has fatigue and [joint pain], the exact cause of which is not clear. Possibilities include fibromyalgia [or] Lyme disease, with or without fibromyalgia...." (AR 225.)

In July 1994, Dr. Frank Pappalardo, Ms. Lamanna's general practitioner, recommended that she be examined at the Mayo Clinic in Rochester, Minnesota. Between July 25 and July 29, 1994, she was examined by a number of specialists at Mayo who effectively ruled out Lyme disease, continuing thyroid conditions, and other infectious or major rheumatologic disorders. The lead physician concluded, "I suspect this is all fibromyalgia" (AR 210), while other Mayo...