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Shiverdecker v. Life Insurance Company of North America

November 19, 2007

PATRICIA A. SHIVERDECKER, PLAINTIFF,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, DEFENDANT.



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

(VARLAN/SHIRLEY)

MEMORANDUM OPINION

Plaintiff Patricia Shiverdecker filed this action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001-1461, to recover long-term disability benefits from defendant, Life Insurance Company of North America ("LINA").*fn1 The case is before the Court on plaintiff's Motion for Judgment on Administrative Record [Doc. 33] and defendant's Motion for Judgment [Doc. 34]. Plaintiff argues that defendant acted arbitrarily and capriciously in denying her claim for benefits under her Group Long Term Disability policy with defendant. Defendant argues that plaintiff's claim is barred by the statute of limitations. Alternatively, defendant contends that the decision to deny plaintiff long-term disability benefits is supported by the administrative record and should be affirmed.

The Court has carefully considered the parties' briefs [Docs. 33, 34, 35, 35], 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.

I. Relevant Facts

Plaintiff, Patricia A. Shriverdecker, was employed with Wackenhut Corporation as a Security Police Officer from June 11, 1984 until January 4, 2001. [AR at 193.] In 1996, one of her daily duties was to close a tower hatch door. [AR at 164.] On June 28, 1996, a Tower 33 gate failed and fell, striking plaintiff in the back. [Id. at 198.] As a result of this incident, plaintiff suffered a back injury but was initially able to return to work. However, she continued to experience back pain and in December 1997 she took leave from work and underwent surgery--a laminectomy at the L5/S1 portion of her back on a herniated disc. [AR at 74, 143-44.] She returned to work on June 1, 1998 without incident or restrictions. [AR at 139, 198.] Plaintiff's surgeon, Dr. Killeffer, found that she had no residual symptoms or ongoing pain and that she was in excellent condition. [AR at 139.]

On January 1, 2001, plaintiff was cleaning her kitchen and cooking breakfast when she felt a sudden, sharp pain in her right lower back, stretching through her buttock and foot. [AR at 198.] Plaintiff was immobilized with pain and had to have her mother to stay with her to take care of her family. [AR at 198.] Tests showed that the injury was "the same problem and same area that [plaintiff] had surgery on in 98." [AR at 198.] On January 8, 2001, Dr. Killeffer ordered an MRI which indicated a recurrent herniated disk in the right L5/S1 section of her back. [AR at 136.] Plaintiff was given an epidural block as treatment for this injury. [AR at 135.] After this treatment failed, Dr. Killeffer performed another surgery on January 23, 2001 on the same L5/S1 portion of her back. [AR at 136, 137.]

Plaintiff continued to experience pain and ultimately underwent a third surgery on July 12, 2001. [AR at 200.] Despite the surgery, plaintiff still feels intense pain throughout her lower back. [AR at 201.] Plaintiff has received treatment from Dr. Demers, a psychiatrist for depression related to her back injury. [AR at 201.] In June 2002, Dr. Demers determined that plaintiff was permanently disabled as a result of her January 1, 2001 injury. [AR at 176.]

At the time plaintiff began experiencing back pain in January 2001, she was covered for accidental death and dismemberment benefits by defendant LINA through her Wackenhut sponsored Group Long Terms Disability policy, effective date October 1, 1999. [AR at 212-34.] The policy provides benefits for permanent and total disabilities resulting from accidental injuries. [AR at 212-34.] There is a three year limitations period in which a beneficiary may bring a legal action for policy benefits. [AR at 219.]

On April 26, 2002, plaintiff filed a claim for benefits under the policy with defendant LINA based on her January 1, 2001 injury. [AR at 158-68.] LINA denied this claim on July 2, 2002 stating, "based on all of the information available to us, we have determined that you have not suffered a covered loss." [AR at 108.] The denial letter further stated that LINA did not find plaintiff's injury covered because it could not determine that it was a result of an accidental injury but rather it determined that plaintiff's pain was caused by a previous injury or cumulative wear and tear. [AR at 108-09.] The letter gave instructions for appealing LINA's decision:

You may request a review of this denial by writing to the Life Insurance Company of North America representative signing this letter. The written request for a review must be sent within 180 days of receipt of this letter and state the reasons why you feel your claim should not have been denied. . . . You have a right to bring a legal action for benefits under the Employee Retirement Income Security Act of 1974 if you claim is denied on appeal. [AR at 110.]

Plaintiff timely filed an appeal of LINA's initial denial providing additional medical documentation. [AR at 93-106.] On August 21, 2002, defendant LINA sent plaintiff a letter denying her appeal. [AR at 89-91.] Again this letter included instructions for filing an appeal and noting plaintiff's right to file a claim under ERISA. [AR at 91.] Plaintiff filed a second appeal of LINA's denial of her claim. LINA denied this appeal by letter dated October 30, 2002. [AR at 83-84.] This letter did not include any instructions for appealing the decision or a notice of a right to bring an ERISA action. On September 10, 2003, plaintiff sent a letter to LINA expressing dissatisfaction with the handling of her claim. [AR at 79.] LINA responded by letter dated October 3, 2003 stating that, "We must advise you that all administrative levels of appeal have been exhausted and we cannot honor any further appeals on this claim." [AR at 78.] Plaintiff filed her complaint in this Court on November 2, 2005. [Doc. 1; AR at 72-76.]

II. Analysis

A. Standard of ...


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