Pini v. First Unum Life Ins. Co.

• Decision Date: 05 November 2013
• Docket Number: No. 2:12–cv–00698.,2:12–cv–00698.
• Citation: 981 F.Supp.2d 386
• Parties: Janice C. PINI, Plaintiff, v. FIRST UNUM LIFE INSURANCE COMPANY, The CA, Inc. Group Long Term Disability Plan, and CA, Inc., Defendants.
• Court: U.S. District Court — Western District of Pennsylvania

981 F.Supp.2d 386

Janice C. PINI, Plaintiff,

v.FIRST UNUM LIFE INSURANCE COMPANY, The CA, Inc. Group Long Term Disability Plan, and CA, Inc., Defendants.

No. 2:12–cv–00698.

United States District Court, W.D. Pennsylvania.

Nov. 5, 2013.

Tybe A. Brett, Feinstein Doyle Payne & Kravec, LLC, Pittsburgh, PA, for Plaintiff.

Peter D. Post, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., Pittsburgh, PA, for Defendants.

MEMORANDUM OPINION

TERRENCE F. McVERRY, Senior District Judge.

Before the Court for disposition are the Plaintiff's MOTION FOR SUMMARY JUDGMENT ( ECF No. 29 ), the Plaintiff's Concise Statement of Material Facts ( ECF No. 30), the Plaintiff's Exhibits in Support of Motion for Summary Judgment ( ECF Nos. [30–1]–[30–12] ), the Plaintiff's Brief in Support of Motion for Summary Judgment ( ECF No. 31 ), the Defendants' MOTION FOR SUMMARY JUDGMENT ( ECF No. 32), the Defendants' Brief in Support of Motion for Summary Judgment ( ECF No. 33), the Defendants' Concise Statement of Material Facts ( ECF No. 34 ), the Administrative Record ( ECF Nos. 35–[35–17] ), the Plaintiff's Brief in Opposition to the Defendants' Motion for Summary Judgment ( ECF No. 38 ), the Plaintiff's Response to the Defendants' Concise Statement of Material Facts ( ECF No. 39 ), the Defendants' Brief in Opposition to the Plaintiff s Motion for Summary Judgment ( ECF No. 40 ), the Defendants' Response to the Plaintiff's Concise Statement of Material Facts ( ECF No. 41 ), and the Plaintiff's Reply to the Defendants' Responsive Brief ( ECF No. 42 ). For the reasons that follow, the Plaintiff's Motion for Summary Judgment ( ECF No. 29 ) will be denied, and the Defendants' Motion for Summary Judgment ( ECF No. 32 ) will be granted.

I. Background

Plaintiff Janice C. Pini (“Pini”) was hired to work as a Senior Principal Product Manager for CA, Inc. (“CA”), on March 29, 2004. ECF No. 41 at ¶ 1. In that capacity, she was “responsible for driving strategy and requirements for multiple major product lines.” ECF No. 35–4 at 40. The position required Pini to spend roughly 50% of her time traveling. Id. at 41.

As an employee of CA working in the United States, Pini participated in CA's Short–Term Disability Plan (“STD Plan”). ECF No. 41 at ¶ 6. The STD Plan, which became effective on January 1, 2007, provides financial protection for CA employees by paying portions of their salary during periods of disability. ECF No. 30–5 at 6. Benefits available under the STD Plan are payable for a maximum period of twenty-six weeks from the date of an employee's disability. Id. The portion of the STD Plan defining the term “disability” provides as follows:

HOW IS DISABILITY DEFINED FOR THE PLAN?

You are disabled when the Plan Administrator determines that:

• you are Limited from performing the Material and Substantial Duties of your Regular Occupation due to your Sickness or Injury; and

• you have a 20% or more loss in Weekly Earnings due to the same Sickness or Injury.

LIMITED means what you cannot or are unable to do.

MATERIAL AND SUBSTANTIAL DUTIES means duties that:

• are normally required for the performance of your Regular Occupation; and

• cannot be reasonably omitted or modified, except if you are required to work on average in excess of 40 hours per week, the Plan will consider you able to perform that requirement if you are working or have the capacity to work 40 hours per week.

REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. The Plan Administrator will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

Id. at 7 (boldface type and capitalization in original). The STD Plan is an unfunded, self-insured plan. ECF No. 41 at ¶ 6. Benefits provided under the STD Plan are paid from CA's general assets. Id. The day-to-day administration of the STD Plan is controlled by First Unum Life Insurance Company (“Unum”). Id. at ¶¶ 7–8.

Pini also participated in CA's Group Long–Term Disability Plan (“LTD Plan”). ECF No. 41 at ¶ 12. Unum administers the LTD Plan. Id. at ¶ 14. The LTD Plan is funded by insurance issued by Unum. Id. at ¶ 13. The LTD Plan defines the term “disability” as follows:

HOW DOES UNUM DEFINE DISABILITY?

You are disabled when Unum determines that:

— you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and

— you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

You must be under the regular care of a physician in order to be considered disabled.

* * *

MATERIAL AND SUBSTANTIAL DUTIES means that:

— are normally required for the performance of your regular occupation; and

— cannot be reasonably omitted or modified.

* * *

REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

ECF No. 1–1 at 13, 27, 29 (boldface type and capitalization in original). As the foregoing language illustrates, the definition of the term “disability” contained in the LTD Plan is not significantly different from that found in the STD Plan.

Pini apparently clashed with her male supervisor during the spring of 2009. ECF No. 35–6 at 5–6. Although the supervisor did not engage in any forms of sexual harassment or gender-based discrimination, he allegedly created an atmosphere of “intimidation and ridicule.” Id. at 6. The supervisor's aggressive management style supposedly put Pini in a “hellish situation” and made her work experience very stressful. Id. at 5.

On June 6, 2009, Pini felt pressure in her chest, shoulder and jaw while watching a televised hockey game involving the Pittsburgh Penguins. ECF No. 35–2 at 51; ECF No. 35–6 at 5. Believing that the symptoms were attributable to a muscle pull, she “laid down and got drowsy.” ECF No. 35–6 at 5. After awakening during the early morning hours of June 7, 2009, Pini continued to experience the same symptoms. Id. She went to the emergency room at Canonsburg General Hospital for treatment. ECF No. 35–2 at 51. Because Pini had elevated cardiac enzymes and chest pain, she was transferred and admitted to St. Clair Hospital for “more definitive therapy.” Id.

Dr. Adil Waheed, a cardiologist, performed a cardiac catheterization on Pini. ECF No. 41 at ¶ 21. The procedure left Dr. Waheed with the impression that Pini was suffering from Takotsubo cardiomyopathy, which is a stress-induced heart condition.¹ ECF No. 35–2 at 20. Since Pini had suffered a myocardial infarction, an echocardiogram was performed on June 8, 2009. Id. at 48. Aside from some “regional wall motion abnormalities” in Pini's left ventricular chamber, the test yielded normal results. Id. Pini was discharged the next day. Id. at 50. She started to attend sessions with Kristin Kristoff (“Kristoff”), a stress management therapist, on June 16, 2009. ECF No. 35–4 at 25.

Since she was unable to return to work in the immediate aftermath of her cardiac event, Pini applied for benefits under the STD Plan. ECF No. 35–2 at 26–31. Dr. James Moretti, Pini's primary care physician, was asked to submit a statement describing her work-related abilities and limitations. In a statement dated June 22, 2009, Dr. Moretti informed Unum that Pini had suffered an acute myocardial infarction, and that she could not engage in “heavy lifting.” Id. at 11–12. Dr. Moretti further reported that Pini was expected to return to work on July 19, 2009. Id. On July 7, 2009, Unum found Dr. Moretti's opinion to be supported by the documentary evidence of Pini's treatment. ECF No. 35–4 at 27. Pini's application for benefits was approved.

Unum sought additional information from Dr. Moretti on July 17, 2009. ECF No. 35–2 at 15. In response to Unum's inquiry, Dr. Moretti advised that Pini needed to remain “off of work indefinitely.” Id. After performing a follow-up examination of Pini on July 20, 2009, Dr. Waheed informed Dr. Moretti that Pini's “overall clinical history” suggested that she had suffered a stress-induced cardiomyopathy. Id. at 51. On August 4, 2009, Kristoff reported that Pini should not return to a high-stress “corporate environment.” ECF No. 35–3 at 11. The information provided by Pini's treating sources convinced Unum to continue her benefits for a few additional weeks. ECF No. 35–4 at 31.

In a letter to Dr. Moretti dated August 20, 2009, Dr. Waheed stated that Pini had experienced “episodes of chest pain and jaw pain” during her cardiac rehabilitation sessions. ECF No. 35–3 at 37. Dr. Waheed suggested that Pini's recurrent chest pain was attributable to coronary spasms. Id. He also opined that she was suffering from acute systolic heart failure and hypothyroidism. Id.

Pini experienced chest pain on September 7, 2009. ECF No. 39 at ¶ 10. She was admitted to St. Clair Hospital later that day. Id. Dr. David Burkey, a treating cardiologist, observed that Pini's chest pain was “possibly anginal in nature.” ECF No. 35–4 at 2. A stress nuclear study yielded normal results. Id. at 2–3. In light of Pini's prior myocardial infarction, however, Dr. Burkey was concerned that “another event” could occur. Id. at 3. Pini was discharged on September 8, 2009. ECF No. 41 at ¶ 34. Ten days later, Kristoff informed Unum that Pini was participating in a treatment plan designed to “decrease her anxiety and stress levels.” ECF No. 35–4 at 7. On September 24, 2009, Unum employees decided to procure treatment notes documenting the severity of Pini's symptoms. Id. at...