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Lori Fisher v. Continental Casualty Company

July 30, 2012

LORI FISHER, PLAINTIFF,
v.
CONTINENTAL CASUALTY COMPANY, AND HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Jeremiah C. Lynch United States Magistrate Judge

Before the Court are the parties' cross motions for summary judgment on the merits of Plaintiff Lori Fisher's claim for an award of continued disability benefits pursuant to a disability insurance plan governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. For the reasons discussed, and after conducting a bench trial on the administrative record before the Court, I conclude Fisher has not met her burden of proof to establish her continued eligibility for disability benefits under the terms of the subject ERISA plan, and this action is dismissed.

ORDER

I. BACKGROUND

Fisher was insured under a long term disability income insurance plan ("the Plan") issued by Defendant Continental Casualty Company (Continental) as a benefit of her former employment with Stream International, Inc. In November of 2001, Fisher became disabled due to fibromyalgia and chronic fatigue syndrome. Through litigation Fisher secured an award of disability benefit payments under the Plan from Continental effective as of November 16, 2001. As a result of further litigation between Fisher and Continental, Continental later agreed to pay Fisher long term disability benefits through January 2009, and to continue the benefits thereafter as long as Fisher qualified for benefits under the provisions of the Plan.

Defendant Hartford Life and Accident Insurance Company (Hartford) is the current administrator of the Plan. In February of 2009, Hartford began to reevaluate Fisher's eligibility for continued disability benefits. Following its evaluation of Fisher's medical conditions and her resulting functional ability to work, Hartford informed Fisher by letter dated January 20, 2010, of its conclusion that she no longer qualified as disabled under the provisions of the Plan. And Hartford terminated Fisher's benefits as of January 21, 2010.

Fisher appealed Hartford's termination of her disability benefits. She provided Hartford with additional information in support of her asserted eligibility for benefits. Hartford, in turn, obtained further medical opinions as to Fisher's conditions and her ability to work. On June 11, 2010, Hartford denied Fisher's appeal, and upheld the decision to terminate her disability benefits. This litigation ensued.

II. DISCUSSION

A. Legal Standards

Fisher commenced this action under ERISA at 29 U.S.C. § 1132(a)(1)(B) challenging Hartford's decision to terminate her disability benefits. Section 1132(a)(1)(B) authorizes a civil action to obtain insurance plan benefits as follows:

§ 1132. Civil enforcement

(a) Persons empowered to bring a civil action A civil action may be brought--

(1) by a participant or beneficiary-- [...]

(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan[.] 29 U.S.C. § 1132(a)(1)(B).

The parties stipulated that Hartford's decision to terminate Fisher's disability benefits is subject to de novo review by this Court under section 1132(a)(1)(B).

When conducting a de novo review of the record, the court does not give deference to the claim administrator's decision, but rather determines in the first instance if the claimant has adequately established that he or she is disabled under the terms of the plan.

Muniz v. Amec Construction Management, Inc., 623 F.3d 1290, 1295-96 (9th Cir. 2010). The court may construe the provisions of an ERISA plan under the rules of interpretation normally applied to insurance policies. Lang v. Long-Term Disability Plan of Sponsors Applied Remote Technology, Inc., 125 F.3d 794, 799 (9th Cir. 1997).

Further, in cases involving the de novo standard of review, the claimant bears the burden of proof - by a preponderance of the evidence - to establish his or her entitlement to benefits under the provisions of the applicable plan. Muniz, 623 F.3d at 1294. See also Langlois v. Metropolitan Life Ins. Co., 2012 WL 1910020, *12 (N.D. Cal. 2012). And the burden remains with the claimant even in situations where the claimant had previously been receiving disability benefits, but the plan administrator terminated those benefits - the burden does not shift to the administrator in those circumstances. Muniz, 623 F.3d at 1296. Although evidence of a prior award of disability benefits may prove probative of whether a claimant is disabled, that prior award does not operate to bind or commit a plan administrator to continue paying the benefits indefinitely without periodic eligibility reevaluations. Muniz, 623 F.3d at 1296-97.

The parties have further agreed to submit this matter on cross motions for the Court's resolution of any issues of fact by way of a bench trial on the administrative record. Dkt. 42 at 1-2. See Kearney v. Standard Ins. Co., 175 F.3d 1084, 1094-95 (9th Cir. 1999). The parties' motions for judgment require the court to "decide whether the plaintiff is disabled under the terms of the policy at issue." Langlois, 2012 WL 1910020 at *1 (citing Kearney, 175 F.3d at 1095). In conducting the bench trial on the record, the court must evaluate the persuasiveness of conflicting testimony, decide what facts are more likely true, and make findings of fact. Kearney, 175 F.3d at 1095. The bench trial on the record may "consist[] of no more than the trial judge []reading [the administrative record.]" Id. See also Langlois, 2012 WL 1910020 at *1.

In an ERISA case under 29 U.S.C. § 1132(a)(1)(B) where the plaintiff is entitled to a bench trial on the record, the parties' cross motions for judgment may be decided under Fed. R. Civ. P. 52 even if the parties styled their motions as ones for summary judgment.*fn1 Lee v. Kaiser Foundation Health Plan Long Term Disability Plan, 2012 WL 664733, *2 n.4 (N.D. Cal. 2012). Rule 52(a)(1) provides that "[i]n an action tried on the facts without a jury [...], the court must find the facts specially and state its conclusions of law separately." Fed. R. Civ. P. 52(a)(1). See Sullivan v. Deutsche Bank Americas Holding Corp., 2011 WL 4961973, *1 (S.D. Cal. 2011) (applying Rule 52 in de novo review of a plaintiff's entitlement to benefits under an ERISA plan).

Objective evidence of a claimant's functional capacity limitations caused by a medical condition carries more weight when the court is considering whether the claimant is disabled under the terms of an ERISA plan. Although a claimant may not be required to produce objective evidence establishing the existence of the medical conditions of fibromyalgia or chronic fatigue syndrome, it is reasonable to require a claimant to produce objective evidence of how those conditions affect her functional capacity to perform work. O'Bryan v. Consol Energy, Inc., 2010 WL 935373, *6 (E.D. Ky. 2010). See also Pralutsky v. Metropolitan Life Ins. Co., 435 F.3d 833, 839 (8th Cir. 2006) (fibromyalgia); Williams v. Aetna Life Ins. Co., 509 F.3d 317, 322-323 (7th Cir. 2007) (requiring objective evidence of functional limitations caused by fibromyalgia and chronic fatigue). "[T]he ...


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