Suson v. PNC Fin. Servs. Grp., Inc.
| Decision Date | 31 July 2017 |
| Docket Number | No. 15-CV-10817,15-CV-10817 |
| Parties | JODI SUSON, Plaintiff, v. THE PNC FINANCIAL SERVICES GROUP, INC. AND AFFILIATES LONG TERM DISABILITY PLAN and THE PNC FINANCIAL SERVICES GROUP, INC., Defendants. |
| Court | U.S. District Court — Northern District of Illinois |
Hon. Amy J. St. Eve
AMY J. ST. EVE, District Court Judge:
Before the Court are the parties' cross-motions for summary judgment pursuant to Federal Rule of Civil Procedure 56(a). (R. 62, R. 66.) Plaintiff Jodi Suson seeks a declaratory judgment that Defendant THE PNC FINANCIAL SERVICES GROUP, INC. ("PNC") arbitrarily and capriciously denied her request for long-term disability benefits under THE PNC FINANCIAL SERVICES GROUP, INC. AND AFFILIATES LONG TERM DISABILITY PLAN (hereinafter "the Plan") in violation of the Employee Retirement Insurance Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. (R. 62.) Suson also seeks statutory penalties against PNC for its alleged failure to provide her with the trust agreement for the Plan. (R. 62.) PNC, however, also seeks a declaratory judgment that it properly denied Suson's request for long-term disability benefits after a full and fair review, and in accordance with ERISA. (R. 66.) PNC also seeks a denial of Suson's request for statutory penalties. (R. 66.) For the following reasons, the Court grants Suson's motion for summary judgment (R. 62.) in part and denies it in part. The Court denies Defendants' motion for summary judgment (R. 66) in part and grants it in part.
Suson is a former employee of PNC and participated in the Plan. PNC is the Plan Sponsor and Plan Administrator of the Plan, which is an employee welfare benefit plan governed by ERISA. (Id. at ¶ 3.) The Plan provides long-term disability ("LTD) benefits at 60% or 70% of participants' pre-disability eligible compensation if a participant becomes disabled and is unable to work for longer than 91 consecutive days. (R. 72, AR 836.) Liberty Life Assurance Company of Boston ("Liberty") is the Plan's claim administrator.
The Plan provides the following discretionary authority:
Plan Administrator
The Plan Administrator shall have the authority to control and manage the operation and administration of the Plan. The Plan Administrator shall have the exclusive discretionary authority to determine eligibility for benefits under the Plan, to construe the terms of the Plan and to determine any question which may arise in connection with its operation or administration, except to the extent that the Plan Administrator has authorized the claims administrator to make such determinations. Its decisions or actions in respect thereof shall be conclusive and binding upon the employer and upon and all participants and survivors, their beneficiaries, and their respective heirs, distributes executors, administrators and assignees; subject, however, to the right of the participant or survivor to file a written claim or appeal under the procedures described above. The Plan Administrator may delegate any of its duties hereunder to person or persons it may designate from time to time.
(R. 72, AR 848.)
The Plan defines the following relevant terms, in pertinent part, as follows:
Definition of LTD
For disabilities that extend beyond 91 consecutive calendar days and are considered long term, the definition of disability is as follows:
(R. 72, AR 837.)
Claims for benefits under the Plan must be submitted in writing to the claims administrator. If your claim is wholly or partially denied, written or electronic notice of the decision shall be furnished within a reasonable period of time, but not later than 45 days after receipt of the claim by the Plan.
(Id, AR 847.)
As a condition of receiving benefits under the Plan, any person may be required to submit whatever proof the Plan Administrator may require (either directly to the Plan Administrator or to any person delegated by it.)
(Id., AR 851.)
If your claim for benefits under the Plan is denied, you (or your representative) may appeal the adverse benefit determination by submitting a request for review in writing to theclaims administrator within 180 days after your receipt of the written or electronic notice of denial. The Plan shall provide a review that does not afford deference to the initial adverse benefit determination that is conducted by an appropriate named fiduciary of the Plan who is neither the individual who made the adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual.
If the adverse determination was based in whole or in part on a medical judgment, the appropriate named fiduciary shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. The Plan shall identify any medical or vocation experts whose advice was obtained on behalf of the Plan in connection with the claimant's adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination. Any health care professional engaged by the Plan for purposes of consultation shall be an individual who is neither an individual who was consulted in connection with the adverse benefit determination that is the subject of the appeal, nor the subordinate of any such individual. In connection with your appeal, you are entitled to review pertinent documents and submit issues and comments in writing to the Plan. A hearing may be held in the discretion of the Plan Administrator for the purpose of making factual findings.
(Id., AR 847-48.)
Starting on July 30, 2012, Suson worked for PNC as a Financial Specialist I. According to the job profile that PNC sent to Liberty, the position of Financial Specialist I required Suson to:
1.) Serve as the Branch Focal Point for PNC Investments in the branch ecosystem to cultivate and develop investment relationships by profiling customers andproviding guidance regarding choices and performing transactions or service requests as needed, 2.) Recommend a limited PNCJ [sic] Investment Product set resulting from analysis of customer needs in order to determine product suggestions that meet the customer's long-term objectives (recommendations/sales of Investment Product sets based on appropriate FINRA licensing status). 3.) Assist Branch Manager with Investment Goals by coaching and training staff and organizing and leading focused activities, and 4.) Perform Branch Banking duties as needed.
Suson was diagnosed with bipolar disorder in 1996 and has received regular psychiatric treatment. (Id. at ¶ 10.) Since the late 1990s, Dr. Blaise Wolfrum has treated Suson for her bipolar disorder. (Id.) In addition, Suson has also been diagnosed with fibromyalgia and several other degenerative joint diseases for which she has received regular treatment. (Id.) In September 2009, Suson began receiving chiropractic treatment from Dr. Warren E. Wolschlager. (Id. at ¶ 11.) Suson was treated at least 22 separate times from September 3, 2009 through May 19, 2010, and reported severe pain in her mid-back, low-back, and neck. (Id.)
On June 26, 2012, Suson saw her primary care physician, Dr. Stephanie Battels. (Id. at ¶ 12.) Suson reported that she fell ten days earlier and had left hip pain, as well as right side, neck and shoulder pain. (Id.) Suson saw Dr. Bartels again on July 3, 2013, complaining of persistent neck pain since her fall. (Id. at ¶ 13.) Dr. Bartls ordered an MRI of Suson's cervical spinal cord which showed spondylosis and arthritis at multiple levels of her cervical spine. (Id.) Suson again saw Dr. Bartels on November 18, 2013 and reported that, the previous week, she was flushed, very hot, and had a spell where she could not breathe. (Id. at ¶ 14.) Dr. Bartles observed that Suson had a "flighty" affect, was not answering questions directly, and had rapid speech. (Id.) Dr. Bartels noted that Suson's symptoms could be panic attacks and that she was somewhat manic. (Id.) Dr. Bartels instructed Suson to follow up with her psychiatrist. (Id.)
Suson again saw Dr. Bartles on December 11, 2013 due to pain and swelling in her left index finger, which Suson said was difficult to bend. (Id. at ¶ 15.) Dr. Sharon Spak-Schreiner treated Suson and ordered an X-ray of the hand. (Id.) The X-ray showed narrowing of the first carpometacarpal joint spaces and mild associated sclerosis in the left index finger and mild narrowing of the DIP joint of the second finger. (Id.)
On December 16, 2013, Suson saw Dr. Wolfrum and reported that she could not stay focused and was yelling at her peers. (Id., at ¶ 16.) Suson began a leave of absence from PNC on December 17, 2013 due to erratic behavior cause by bipolar disorder. (Id. at ¶ 17.) Suson applied for and began receiving short-term disability ("STD") benefits from PNC's STD plan. (Id.) The following week, Dr. Wolfrum completed a Behavioral Health Provider's Statement of Work Capacity and Impairment which documented depression, erratic behavior, and anxiety. (Id. at ¶ 18.) On December 27, 2013, Suson told Dr. Wolfrum that she continued to suffer from sleep problems and bipolar symptoms. (Id. at ¶ 19.)
At Dr. Wolfrum's recommendation, Suson was hospitalized at Alexian Brothers Behavioral Health Hospital...
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