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Gibson v. Prudential Insurance Co. of America

June 12, 2007


The opinion of the court was delivered by: Thomas A. Varlan United States District Judge



Plaintiff Rhonda Gibson filed this action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C.§ 1001, et seq., to recover long-term disability benefits from defendant, The Prudential Life Insurance Company of America ("Prudential"). The case is before the Court on the plaintiff's Motion for Judgment on the Administrative Record [Doc. 6] and the defendant's Motion for Judgment on the Record [Doc. 7]. Plaintiff argues that defendant acted arbitrarily and capriciously in the refusal to continue payment of her long-term disability benefits and urges the Court to reverse defendant's administrative decision to that effect. Plaintiff also contends that defendant breached a fiduciary duty owed to her by failing to provide her with rehabilitative assistance. Defendant argues that the decision to deny plaintiff long-term disability benefits is supported by the administrative record and should be affirmed. As to plaintiff's breach of fiduciary duty claim, defendant argues that it breached no duty because it was not required to offer rehabilitative assistance under the terms of the benefit plan at issue in this case, and in the alternative, that plaintiff is barred by ERISA from bringing such a claim in this action.

The Court has carefully considered the parties' briefs [Docs. 8, 9, 10], as well as the entire administrative record. For the reasons set forth herein, the Court will deny plaintiff's motion for judgment on the administrative record and grant defendant's motion for judgment on the record.

I. Relevant Facts

Plaintiff was employed by Hartco Flooring Company ("Hartco") as a wood floor grader in Oneida, Tennessee. [Doc. 6 at 2; Doc. 8 at 1; Administrative Record ("AR") at 93.] This position required that plaintiff constantly stand, work with her arms over her head while standing, and work bent over while in a standing or stooping position. [AR at 238.] As an employee of Hartco, plaintiff was covered under Hartco's Group Policy No. 77239 (the "Plan"), a policy providing long-term disability benefits and subject to ERISA. [Id. at 52-91.] Under the terms of the Plan, Armstrong World Industries, Inc. ("Armstrong"), Hartco's parent company, is the plan sponsor and administrator, [id. at 85-86], and defendant, Prudential, is the claims administrator [id. at 86]. The Plan sets forth two definitions of what it means to be disabled, with these varying based upon how long the covered individual has been receiving disability benefits:

You are disabled when Prudential determines that:

* you are unable to perform 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 that sickness or injury.

After 24 months of payment, you are disabled when Prudential 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. [AR at 64.] The Plan goes on to define "gainful occupation" as being "an occupation, including self employment, that is or can be expected to provide you with income equal to or at least 60% of your indexed monthly earnings within 12 months of your return to work." [Id.]

On January 27, 2003, plaintiff sustained a work-related injury while pulling lumber that resulted in her experiencing neck, back, and shoulder pain. [AR at 93-94; 246.] As a result, plaintiff went out of work on April 23, 2003, [id. at 94], and was eventually placed on short-term disability leave for six months. [See id. at 104.]

On October 3, 2003, plaintiff applied for long-term disability benefits. [AR at 93-94.] Defendant informed her by letter on June 22, 2004 that this request was approved effective as of October 21, 2003 on the basis of defendant's determination that, pursuant to the Plan's definition of disability, her injury resulted in her being unable to perform the material and substantial duties of her regular occupation. [Id. at 115, 122.] This letter stated that defendant "can require examinations as often as it is reasonable to do so" and "may also require you to be interviewed by an authorized Prudential representative." [Id. at 115.] The letter further noted that "[r]efusal to be examined or interviewed may result in denial or termination of your claim." [Id.] On the same date, defendant also sent a letter to plaintiff's counsel informing him of its approval of her request for long-term disability benefits, and in that letter noted that "[w]e will follow [up] with you for periodic updated medical information and we will ask that you notify us when Ms. Gibson has recovered and returned to work." [Id. at 122.]

After this award of long-term disability benefits, defendant states that it continued to "monitor the plaintiff's medical progress." [Doc. 8 at 3.] To this end, and as the administrative record indicates, on December 20, 2004, defendant sent plaintiff a fax requesting that she indicate whether she was interested in obtaining vocational assistance services. [AR at 133.] After receiving no response, defendant again contacted plaintiff by letter on January 20, 2005, and ask that she provide it with information on her specific restrictions and limitations so that it could "identify alternative employment possibilities while recovering." [Id. at 134.] Plaintiff's counsel responded by letter on March 24, 2005, and enclosed a medical report from Dr. Merrill White, plaintiff's primary care physician, indicating that as of May 7, 2003, plaintiff was unable to engage in overhead work and any lifting over twenty pounds, and that plaintiff required alternate standing and sitting while working. [AR at 291.] Defendant then sent plaintiff a letter on April 18, 2005, noting the Plan's bifurcated definition of "total disability" and indicating that plaintiff's "initial period of benefits as defined above will end on October 20, 2005." [Id. at 136.]

Also during this time, the administrative record shows that defendant ordered an employability assessment of plaintiff be undertaken on April 1, 2005 by Thomas Virgilio, a vocational rehabilitation specialist. [AR at 188-189.] This assessment noted that plaintiff was "a HS graduate with 6 years of work experience at her former, Armstrong Wood Products" and that the assessment would take into consideration "recommendations made by Dr. White," resulting in a focus on "occupations with tasks that are performed while standing and sitting...." [Id. at 188.] As a result, the assessment "identified a number of occupations for which [plaintiff] has the residual functional capacity to perform given her current medical status" and in which plaintiff "is ...

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