Sessa v. Dell, Inc., CIVIL ACTION NO. 14-CV-2518

• Decision Date: 09 June 2015
• Docket Number: CIVIL ACTION NO. 14-CV-2518
• Parties: GERALDINE SESSA Plaintiff v. DELL, INC., LONG TERM DISABILITY INSURANCE PLAN, DELL, INC. SHORT TERM DISABILITY INSURANCE PLAN, AETNA LIFE INSURANCE COMPANY and DELL, INC. Defendants
• Court: U.S. District Court — Eastern District of Pennsylvania

GERALDINE SESSA Plaintiff v. DELL, INC., LONG TERM DISABILITY INSURANCE PLAN,DELL, INC. SHORT TERM DISABILITY INSURANCE PLAN,AETNA LIFE INSURANCE COMPANY and DELL, INC. Defendants

CIVIL ACTION NO. 14-CV-2518

UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

June 9, 2015

MEMORANDUM AND ORDER

JOYNER, J.

This case has been brought before the Court on competing motions for summary judgment of the Plaintiff and both of the Defendants. For the reasons outlined below, the motions shall be granted in part and denied in part.

History of the Case

This is an action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §1001, et. seq. which was commenced on May 1, 2014 by Plaintiff Geraldine Sessa to recover short term and long term disability benefits from her former employer Dell, Inc., Dell's Long Term and Short Term Disability Plans, and Aetna Life Insurance Company as the underwriter and benefits administrator of the Plans. Subsequent to the denial ofthose benefits, Plaintiff exhausted all of her appeals before filing this suit. (Aetna 0480-0481, 1141-1143).

As the administrative record in this matter reflects, Plaintiff was hired as an Outside Sales Specialist II for Dell, Inc.'s Boomi Division on May 27, 2011, working out of its office located in Berwyn, Pennsylvania. According to the posted job description, this position required, inter alia, that Ms. Sessa: identify appropriate solutions and services to meet the full range of customers' needs, develop and manage relationships with key partners and customers, manage complex sales cycles and present to decision makers the value of Dell's full suite of applications, skillfully negotiate with others to achieve desired results and meet customer needs, forecast sales activity and revenue achievement in salesforce.com, while creating satisfied customers and perform high-level, on-time demonstrations of Dell's products and solutions via web technologies and web-based presentations. (Aetna 0840). In addition to salary, Dell offered its employees an employee benefits package which included health and dental care as well as plans covering both short and long term disability. Enrollment in the short term disability plan was automatic with employment and paid for entirely by the employer. The long term disability plan required the employee to enroll and pay a portion of the premium through payroll deduction.

Plaintiff apparently performed her job to Dell's satisfaction for several months from the time of her hire until she began experiencing cognitive problems in late summer, 2011. On September 15, 2011, Plaintiff saw her family doctor with complaints of memory loss, chest tightness, difficulty reading things and not absorbing what she read, feeling "stupid," "weird," and "funky," especially when she stood up; her head felt like it was "in a bubble," she felt feverish for a few nights, but without a fever, and she reported that she had gained 20 pounds over the past year, but without eating any more. Ms. Sessa also complained of fatigue and reported that she had gotten on the expressway going in the wrong direction, that she had had dinner with an old boss who said she needed to get evaluated and that she had gotten written up at work for a poor presentation - she had apparently stumbled on and forgotten words. (Aetna 0626-0627).

Over the next several months, Plaintiff underwent numerous blood tests, ultrasounds, x-rays and MRIs of virtually her entire body, an endoscopy and biopsies of the esophagus, gastric mucosa and duodenum, was treated with antibiotics and other drugs, for, inter alia, suspected inner ear disturbance, lupus, lyme disease, post-concussion syndrome, and gastroesophageal reflux disease. (Aetna 0629-0643, 0779-0781, 0791). Indeed, immediately after a tympanogram test showed abnormalities, Plaintiff was advised thatshe had a balance disorder and vestibular dysfunction for which she was prescribed antibiotics. Throughout this period, Plaintiff kept her supervisor and the Human Relations officers at Dell apprised of her health problems and symptoms and of the testing she had undergone and the tentative diagnosis of balance disorder/vestibular dysfunction. (Aetna 0693-0695).

Despite having apparently not missed any time from work as a result of her continuing health problems, Plaintiff was terminated by Dell on October 17, 2011 because she "did not make plan." In a follow-up email to Dell Human Resources officer Noreen Manalo the same day as her firing, Plaintiff again explained that there was a medical reason for her inability to perform her job and reminded Ms. Manalo of her prior emails to her and her supervisors describing her health issues. Plaintiff again attached copies of medical documentation from her doctors and requested "input in this matter" from Ms. Manalo. (Aetna 0696). Two days later on October 19, 2011, Plaintiff again emailed Ms. Manalo to advise that the Ear, Nose and Throat specialist whom she had seen the preceding day and who had diagnosed her with vestibular dysfunction was now of the opinion that Plaintiff's problems were instead neurological and he had referred her for evaluation to a neurologist. Plaintiff also noted that she had only been "put on plan" by Dell two days after she had informed her supervisors that she had made a doctorsappointment because she was having difficulty retaining information. (Aetna 0697, 0716, 0759).

Several days later on October 23, 2011, Plaintiff sent an email to Kimberly Gress, Director of Client Services at Dell apologizing for the problems that she was having coordinating her thoughts and expressing them and with her memory, which problems had caused her to be unable to perform her job. She again explained that the medical testing she had undergone had led to the diagnosis of vestibular dysfunction but that it now appeared that her problems were actually neurologic. On October 26, 2011, Ms. Gress responded only that Ms. Sessa need not apologize to her and that she hoped that she would be "able to get to the bottom of what is impacting your memory. Good luck." (Aetna 0698). Then, on November 4, 2011, Plaintiff again, in apparent follow up to a telephone conversation earlier that afternoon, sent an email to Noreen Manalo enclosing additional documentation and stating: "The Neurologist has confirmed that there is indeed something wrong that has affected my thinking. My initial MRI showed an abnormality which right now has been diagnosed as MS." (Aetna 0699-0701, 0732-0736, 0755). There is no evidence in the record that Ms. Manalo ever responded to any of these email communications.

Over the next several months, Plaintiff continued to undergo testing, including a lumbar puncture (spinal tap) to confirm themultiple sclerosis diagnosis. (Aetna 0717-0736, 0763-0767, 0785-0806). In an email on April 2, 2012 to Noreen Manalo, Plaintiff advised that

"it was determined in March that I was suffering from post concussion syndrome and clinically probable multiple sclerosis," and "I have been under the care of two neurologist [sic]. One from the MS center at Jefferson University Hospital and a primary neurologist. Attached please find a letter from Fred Weinblatt, MD, regarding my final diagnosis." (Aetna 0702).

Four days later, Ms. Manalo did respond:

Hi Geri,

Since a medical claim wasn't submitted and targets weren't being met during your employment, the termination still stands however, you can reapply to any of our open requisitions. The link to our website is below.

Plaintiff responded back later that same day:

Noreen,

Thanks for the email. I will take a look at the link. I know that my termination would still stand as I did not make plan. My inquiry to you had to do with short term disability. I have been told that because my disability occurred prior to the end of my employment, I would also be eligible to apply for short term/long term disability benefits. I have been told that this is true, even if I was terminated prior to the time when disability benefits would begin. I did email the receipts of my Dr. Visits before being terminated when the initial issues occurred and I began to be tested. I also emailed you the copies from these initial visits after being terminated. I have all the records, of all the tests that were done after my termination.

How do I move forward applying for these benefits as I truly was completely disabled from working for the last 6 months?

Regards,

Geri Sessa

Fifteen minutes later, Ms. Manalo replied:

Hi Geri,

I would refer you to our Benefits Call Center at 888-DELL-ONE, option 5 to speak to an Aetna leave specialist. When you get someone live, please ask to talk to a Disability Manager. They will be the ones to ask your question.

On April 10, 2012, Ms. Manalo followed up with:

Hi Geri,

Were you able to contact Aetna?

I had also reached out to Dell Benefits and below is the answer. Since you did not go on leave in September, you were not eligible for STD.

-If Geri Sessa was terminated 10/17/2011 and is just now wanting to file a claim with Aetna for a condition that had her out of work (if this is the case) prior to 10/17/11, it is too late.

- If she went out sometime in September of 2011, contacted Aetna within 8 days into her disability for a medical condition that took place prior to termination, and supporting documentation was submitted by her doctor and was approved by Aetna, then she could possibly continue to be approved STD and/or LTD.

If you have further questions, please let me know or contact Aetna.

(Aetna 0702-0705)(emphasis in original).

Apparently, Plaintiff took no further action until late August, 2012 when she again contacted Noreen Manalo (now Noreen Obiacoro) via phone and email to obtain a detailed description regarding the Aetna Long Term Disability policy in effect while she was at Dell, as she could only locate a summary of the plan. (Aetna 0706). Ms. Obiacoro then wrote via email dated August 29, 2012:

Hi Geri,

Benefits gave me

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