Marcum v. Zimmer, Civ. A. No. 1:94-0246.

• Decision Date: 07 June 1995
• Docket Number: Civ. A. No. 1:94-0246.
• Citation: 887 F. Supp. 891
• Court: U.S. District Court — Southern District of West Virginia
• Parties: Wilbert MARCUM, Plaintiff, v. ZIMMER, et al., Defendants.

887 F. Supp. 891

Wilbert MARCUM, Plaintiff, v. ZIMMER, et al., Defendants.

Civ. A. No. 1:94-0246.

United States District Court, S.D. West Virginia, Bluefield Division.

June 7, 1995.

Juliet Walker Rundle, Pineville, WV, for plaintiff.

Kevin A. Nelson, Kay, Casto, Chaney, Love & Wise, Charleston, WV, for defendants.

MEMORANDUM OPINION AND ORDER

HADEN, Chief Judge.

Pending are the defendants' motions to dismiss and for summary judgment. Plaintiff has responded only to the motion for summary judgment, and defendants have replied. These matters are ripe for adjudication.

I.

Mr. Marcum filed this action against 1) his former employer, Zimmer, Inc. ("Zimmer"), 2) Thomas L. Jacobs & Associates, Inc., a claims administrator for his ERISA¹ benefit plan, and 3) Bristol-Myers Squibb Company, the employer of his ERISA benefit plan administrator. Plaintiff was a participant in the Bristol-Myers Squibb Company Long Term Disability Income Plan (the "Plan") and he asserts the defendants wrongfully denied him disability benefits due him under the Plan. Plaintiff did not sue the Plan or the Plan administrator.

Mr. Marcum was injured in a non-work related automobile accident on September 12, 1990. Initially he was granted six months of disability payments under the related Bristol-Myers Squibb Short Term Disability Plan. He then was granted an initial six months of benefits under the Plan. Plaintiff received benefits under the Plan because the Plan determined he was totally disabled. Chronologically, the Plan includes two definitions of totally disabled. To qualify for benefits for the first year-long period (the first six months of benefits were made under the Short Term Plan and the Second six months of benefits were made under the instant Long Term Plan), a claimant need show he "is unable to perform each and every duty pertaining to his own occupation or any other job that the Company offers him and is not engaged in any other occupation." Defendants' Exhibit 2A at 5. There is no dispute Plaintiff met this criteria and was paid benefits for the initial year-long period.

At the expiration of the first year of benefits, the Plan heightens the criteria for one to qualify for continuation of "totally disabled" benefits. To qualify, a Plan participant must show he "is unable to engage in any occupation for which he is qualified by education, training or experience." Defendants' Exhibit 2A at 5-6. The qualification standard for benefits thus changed from proof of an inability to perform the employee's most recent job, to proof of an inability to perform any job for which the employee is qualified.

Plaintiff sought to qualify for an extension of benefits under the higher standard by submitting medical evidence from Dr. Vadak Ranganathan, his treating neurologist. Dr. Ranganathan submitted medical reports reflecting his analysis of Plaintiff's condition. In response to specific written questions from an agent of the Plan Administrator, Dr. Ranganathan outlined the Plaintiff's "current restrictions/limitations" as of July 22, 1991, stating "because of headaches and dizziness patient cannot perform active work including any movement or exertion for over 15 min., as he gets dizzy." Defendants' Memorandum in Support of Motion for Summary Judgment, Exhibit 3. Dr. Ranganathan also opined Plaintiff's "prognosis for return to work" was "poor" but "would try vocational rehabilitation for a desk job." Id. Neither the Plan Administrator nor his agents requested Dr. Ranganathan express an opinion regarding Plaintiff's ability to perform "any occupation for which he is qualified by education, training or experience." However, in response to a later question regarding when Plaintiff would be released to work, Dr. Ranganathan opined Plaintiff "can try restricted duty; I am very pessimistic that patient will tolerate and work." Id.

By letter dated September 5, 1991, an agent of the Plan administrator informed Mr. Marcum his request for an extension of total disability benefits had been denied because he did not meet the heightened total disability standard. The letter found Dr. Ranganathan's opinion "could not be supported by his objective findings." Plaintiff's Memorandum in Opposition to Plaintiff's Motion for Summary Judgment, Exhibit 2 at 2. The letter informed Plaintiff he had a right to appeal the denial within sixty days. Id. Plaintiff exercised his appeal prerogative and submitted further medical reports.

By letter dated February 11, 1992, Aldon D. Daniels, the Manager of Health and Disability Programs for defendant Bristol-Myers Squibb Company, and the person designated to resolve Plaintiff's appeal of the benefits denial, informed Plaintiff his appeal was denied. Mr. Daniels noted Plaintiff's appeal had been reviewed by both him and Dr. E.R. Blonsky, the Medical Director of an agent of the Plan Administrator, defendant T.L. Jacobs & Associates, Inc. Mr. Daniels denied Plaintiff's appeal because, "the objective medical evidence available does not support or verify an impairment of such severity as to render Plaintiff disabled within the meaning of the Plan." Defendants' Memorandum in Support of Motion for Summary Judgment, Exhibit 4 at 3. The letter addressed the findings of Drs. Ranganathan and Paflas as follows:

"Dr. Vadak Ranganathan stated that your prognosis for return to work is poor. However, Dr. Ranganathan was unable to provide specific work restrictions and/or limitations which could be supported by objective medical information. Medical information received from Dr. Paflas did show findings of vertigo, but again there was no indication that this was a severe condition which would be disabling." Id. at 2.

After his appeal was denied, Plaintiff initiated this civil action.

II.

Defendants assert they are not proper party defendants in this action. Defendant Zimmer was Plaintiff's employer. Defendant T.L. Jacobs & Associates, Inc. was apparently designated by the Plan administrator to initially adjudicate Plaintiff's request for total disability benefits. Defendant Bristol-Myers Squibb Company employs both the Plan Administrator, E. Lynn Daniels, who is also its Senior Vice President of Human Resources, and the person designated by E.L. Daniels to adjudicate Plaintiff's appeal of his denial of benefits, Aldon D. Daniels, who is its Manager of Health and Disability Programs. Defendants assert only the Plan administrator or the Plan itself may properly be named as defendants in an action alleging wrongful denial of benefits under ERISA.

It is clear one of the defendants was wrongfully named. An employer may not be named a defendant in an ERISA action unless the plaintiff shows the employer controlled or influenced the administration of the plan. Daniel v. Eaton Corp., 839 F.2d 263, 266 (6th Cir.), cert. denied, 488 U.S. 826, 109 S.Ct. 76, 102 L.Ed.2d 52 (1988), citing, Boyer v. J.A. Majors Co. Emp. Profit Sharing Plan, 481 F.Supp. 454, 457-58 (N.D.Ga. 1979) and Foulke v. Bethlehem 1980 Salaried Pension Plan, 565 F.Supp. 882 (E.D.Pa. 1983); Rossi v. Boston Gas Co., 833 F.Supp. 62, 67 (D.Mass.1993); Green v. Eastern Airlines, 138 F.R.D. 146, 147 (M.D.Fla.1991); In re Robertson, 115 B.R. 613, 621 n. 6 (Bankr. N.D.Ill.1990); Adamo v. Anchor Hocking Corp., 720 F.Supp. 491, 498 (W.D.Pa.1989); Reynolds v. Bethlehem Steel Corp., 619 F.Supp. 919, 928 (D.Md.1984). Here, Plaintiff has not shown the employer, Zimmer controlled or influenced the administration of the Plan in any way.² Zimmer's motions to dismiss and for summary judgment are GRANTED.

On the other hand, both Defendants T.L. Jacobs & Associates, Inc., and Bristol-Myers Squibb Company appear to have substantial ties to the administration of the Plan. See Yeseta v. Baima, 837 F.2d 380, 383 (9th Cir.1988). T.L. Jacobs & Associates, Inc. was delegated authority to adjudicate Plaintiff's claim for total disability benefits. Its medical director, Dr. Blonsky served as an advisor to the Plan in the adjudication of the denial of benefits. A Bristol-Myers Squibb Company executive, Mr. E.L. Daniels is designated as the Plan Administrator by virtue of his position with the company; a second executive, Mr. A.D. Daniels was delegated responsibility by the Plan Administrator to adjudicate Plaintiff's appeal of his denial of benefits. It thus appears both T.L. Jacobs & Associates, Inc., and the Bristol-Myers Squibb Company exercised sufficient control over the administration of the Plan to be proper party defendants in this lawsuit. The remaining Defendants' motions to dismiss and for summary judgment on that basis are DENIED.

III.

This Court addressed the standard of review of a denial of benefits by an ERISA Plan in Pritt v. United Mine Workers of America 1950 Benefit Plan and Trust, 847 F.Supp. 427, 429 (S.D.W.Va.1994) (Haden, C.J.):

"The standard of review of a decision made by Trustees of an ERISA benefit plan is ordinarily de novo. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989); Richards v. United Mine Workers of America Health and Retirement Fund, 895 F.2d 133, 135 (4th Cir.1990); de Nobel v. Vitro Corp., 885 F.2d 1180, 1186 (4th Cir.1989). However, where the Plan gives the Trustees discretion to determine benefit eligibility or to construe plan terms, the standard of review is whether the Trustees abused that discretion.3 Firestone, supra, 489 U.S. at 111, 109 S.Ct. at 954, 103 L.Ed.2d at 92-93 ("Trust principles make a deferential standard of review appropriate when a trustee exercises discretionary powers. Where discretion is conferred upon the trustee with respect to the exercise of a power, its exercise is not subject to control by the court except to prevent an abuse of discretion. A trustee may be given power to construe disputed or doubtful terms, and in such circumstances the trustee's interpretation will not be disturbed if reasonable." (citations and internal quotations omitted))." (emphasis in original

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