Towner v. Cigna Life Ins. Co. of New York
| Decision Date | 07 March 2006 |
| Docket Number | No. 3:04 CV 1749 JCH.,3:04 CV 1749 JCH. |
| Citation | 419 F.Supp.2d 172 |
| Parties | Dwight TOWNER Plaintiff, v. CIGNA LIFE INSURANCE COMPANY OF NEW YORK, and the Pfizer Long Term Disability Plan Defendants, |
| Court | U.S. District Court — District of Connecticut |
Ian O. Smith, Thomas G. Moukawsher, Moukawsher & Walsh, Hartford, CT, for Plaintiff.
Robert C. McNamee, Day, Berry & Howard, Hartford, CT, for Defendants.
RULING RE: DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND PLAINTIFF'S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD
[DOC. NOS. 23 & 26]
The plaintiff, Dwight Towner, brings this action under the Employment Retirement Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq., against CIGNA Life Insurance Company of New York and the Pfizer Long Term Disability Plan, which CIGNA insures and administers (hereinafter referred to collectively as "CIGNA"). Towner claims that CIGNA wrongfully denied to him long term disability ("LTD") benefits to which he was entitled under the Pfizer employee welfare benefit plan, and that CIGNA failed to send to him plan documents as required by law.
CIGNA seeks summary judgment on all claims against it, arguing, inter alia, that it acted properly within its discretion to deny disability benefits to Towner. CINA moves, in the alternative, for judgment on the administrative record. Def. Memo. of Law in Sup. Of Mot. for Sum. Judg., p. 2 n. 1 p [Doc. No. 23]. Towner cross moves for judgment on the administrative record, arguing, inter alia, that the evidence in the record demonstrates his entitlement to benefits under the terms of the LTD plan. For the reasons set forth below, CIGNA's motion is GRANTED in part and DENIED in part, and Towner's motion is GRANTED in part and DENIED in part.
Towner is a resident of Groton, Connecticut and, as an employee of Pfizer, Inc., is a participant in the Pfizer LTD Plan. The Pfizer LTD Plan is insured by CIGNA Life, which acts as the Plan's claim administrator. Pfizer is the Plan's plan administrator. Defs' Rule 56(a)(1) Statement, ¶¶ 6-7; Id. at CIG2059-60.2
The Pfizer LTD Plan provides that eligible employees can receive LTD benefits, which are equal to a percentage of their annual pay, if they become disabled, as the term is defined in the plan. The LTD Plan gives CIGNA the discretion to interpret the terms of the Plan.
Towner is sixty-one years old and has worked in the pharmaceutical industry for more than thirty-five years. In 1995, Towner's then-employer was acquired by Pfizer, and, in 2002, Towner was transferred by Pfizer to the position of "toxicokinetic report writer," a position that involves data analysis and report writing for drug evaluation studies. Id. at CIG0211.
Since birth, Towner has been diagnosed with congenital nystagmus, a condition characterized by involuntary eye movement, and ocular atrophy, which causes a decrease in visual function. Id. at CIG0040, CIG0060-63. As a result, Towner has had poor visual acuity and has worn glasses his entire life. According to Towner, his vision has also degenerated gradually over time. Id. at Towner Dec., CIG0057. In 1997, Towner had cataract surgery on his right eye and, in October 2002, underwent cataract surgery on his left eye.
From the beginning of 2002, Towner received poor performance reviews in his role as a report writer, and he was placed on an informal improvement plan in May and August 2002. Towner contended, in a response to a performance review, that his vision problems were the cause of his performance issues. Pfizer supplied Towner with a 21" computer monitor and a magnifier, but his inadequate performance continued. In August 2003, Towner applied for, and received, short term disability benefits from Pfizer based upon his poor vision.
In September 2003, Towner submitted an application to CIGNA for LTD benefits based upon "his reading vision" which he described as "insufficient to permit [eight hour] computer use." Id. at CIG0201. Towner's application was accompanied by a Physician Statement from Dr. Peter J. Famiglietti, who diagnosed Towner as having Ocular Atrophy and Nystagmus, and described Towner as experiencing "decreased vision" and "double vision." Id. at CIG0206. Dr. Famiglietti also wrote in the Statement that Towner had a 40% decrease in visual acuity, a 40% decrease in ocular motility (i.e., visual tracking), and a 20% decrease in peripheral field vision. Id. The Statement also indicated that Dr. Famiglietti had seen Towner eleven times between October 2002 and June 2003. In a series of checkboxes, Dr. Famiglietti indicated that Towner was able to do physical tasks such as standing and kneeling. Id. at CIG0207. In response to the question, "[w]hen was patient able to go to work?," Dr. Famiglietti wrote "[n]o." In response to the question, "[c]an present job be modified to allow for handling with impairment?," Dr. Famiglietti check the box labeled "[n]o."
In September 2003, Towner also applied for Social Security disability benefits. Dr. Famiglietti wrote a letter to the Vocational Disability Examiner in support of Towner's application. In the letter, Dr. Famligietti noted, in addition to the percentages stated above, that Towner had "best corrective visual acuity of 20/70 in each eye." Id. at CIG0086. On the basis of this information, Dr. Famiglietti concluded that "[t]his translates to essentially 100% visual disability in each eye or 90% disability of total body the standard disability tables" and stated that "this should qualify the patient for disability benefits due to his visual condition." Id.
In December 2003, CIGNA sent Towner an acknowledgment of its receipt of his LTD benefits application and requested some additional information from Towner and Dr. Famiglietti. Dr. Famiglietti returned a "Physical Assessment Form" to CIGNA in which he checked a box indicating that Towner was unable to tolerate, with positional changes and meal breaks, seeing for any portion of the work day and, in response to "Estimated Return to Work," stated "indefinite/permanently disabled." Id. at CIG0081-83. Dr. Famiglietti also included in his submission to CIGNA the letter that he had sent to the Social Security Administration regarding Towner's vision.
Towner returned a completed "Disability Questionaire," in which he provided information about his daily life and indicated, in a series of checkboxes and fill-in spots, the number of hours that he spent doing different activities on a weekly basis. Id. at CIG108. Towner indicated that he cooks one hour per day, twice a week (two hours total); cleans one hour per day, five days a week (five hours total); shops two hours per day, once a week (one hour total); does laundry three hours per day, once a week (three hours total); does yard work two-three hours per day, twice a week (four to six hours total); watches television five hours per day, seven days a week (thirty-five hours total); and "other" for two hours per day, five days a week (ten hours total). Id. Towner did not check the box to indicate that he engages in reading as an activity, although he did indicate that he uses a "lighted magnifier" to read. Id. Towner also indicated that he uses a home computer for two hours per week. Id. In a separate declaration submitted with his benefits appeal to CIGNA, Towner stated that his home computer use consisted of one 15-20 minute sitting each day, or several shorter sittings, in which he checked his email, visiting a media website, or monitored his bank account balance. Id. at CIG0058. Towner also sent to CIGNA a copy of his driver's license which showed that he was approved to drive during daylight hours. Id. at CIG0168.
On December 19, 2003, CIGNA requested that Dr. Famiglietti send to it copies of his notes and test results from July 2003 to the date of the request. Dr. Famiglietti responded that Towner has only visited once during that period, on November 12, 2003, and he sent to CIGNA his notes from that visit. Subsequently, CIGNA asked an "associated medical doctor," Dr. Seiferth, to examine the information submitted on behalf of Towner's claim. Dr. Seiferth's notes indicate that he did not find that the medical evidence supported the conclusion that Towner's disability precluded him from doing his job. Id. at CIG0145.
On December 29, 2003, CIGNA sent Towner a written denial of his LTD benefits claim. The denial listed some of the findings of Dr. Famiglietti, and stated, in part:
Dr. Famijlietti [sic] completed a Physical Abilities Assessment indicating that you are physically capable of performing heavy duties. Your occupation as defined by the National Economy is classified as sedentary duty levels. The Disability Questionnaire provided by you on December 8, 2003 states that your vision is well enough for you to drive in the daytime and use your home computer. The medical information provided by Dr. Famijlietti [sic] supported your treatment for ocular atrophy and nystagmus, but does not indicate that you are restricted in your activities as a Report Writer. We are not stating that you may not have some visual problems as a result of your condition, rather, we have not been provided with medical documentation to support an impairment of functional capacity severe enough to affect your ability to work.
Id. at CIG0075. The denial letter also informed Towner of his right to appeal the decision, as well as his ability to submit additional information in support of his appeal.
On March 25, 2004, Towner's counsel wrote to CIGNA to request a copy of Towner's claim file, a copy of the Summary Plan Description ("SPD") for the Pfizer LTD Plan, as well as other relevant documents. Id. at CIG0131-36. CIGNA acknowledged its response of Towner's request on March 31, 2004, and requested an written authorization to release information by Towner to Towner's counsel. Id. at CIG0128. According to Towner, his counsel returned the signed release, but CIGNA never sent the requested documents....
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