STANLEY R. CHESLER, District Judge.
This matter comes before the Court upon the motion by Defendant Hoffmann-La Roche Inc. ("Roche" or "Defendant") for summary judgment [docket entry 12]. A briefing schedule set by the Court's January 18, 2012 Order required Plaintiff Dina Priovolos Colonias ("Plaintiff" or "Colonias") to submit any and all opposition to the motion on or before March 6, 2012, yet to date, Plaintiff has not opposed the motion. The Court therefore proceeds to adjudicate the motion for summary judgment as unopposed. It has considered Defendant's submissions and, pursuant to Federal Rule of Civil Procedure 78, has opted to rule without oral argument. For the reasons discussed below, this Court grants Defendant's motion.
This is an action for allegedly improper termination of Plaintiff's long-term disability ("LTD") benefits under Defendant Roche's Long-Term Disability Plan (the "Plan"), an employee welfare benefit plan as defined by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001,
Colonias was employed by Roche in 1999 when she was diagnosed with a herniated lumbar disc. On January 26, 2000, Colonias was approved for LTD benefits under the Plan, effective November 3, 1999. In relevant part, the Plan deems an employee eligible for Plan benefits when that employee becomes "Totally Disabled as defined in Article 4.2 as a result of Injury or Sickness" and remains so continuously during the "Elimination Period," a defined time period following inception of the disability during which benefits are not payable. (Plan, Art. II, § 2.8 & Art. IV, § 4.1.) The standard for what constitutes "Totally Disabled" status depends on when the employee seeks LTD benefits in relation to the "Elimination Period." In the first 24 months following the Elimination Period, "Totally Disabled" means that the employee is completely unable to engage in an occupation that would pay him at least 80% of the employee's base pay. (Plan, Art. IV, § 4.2.) In the time period thereafter, that is, commencing 24 months after the end of the Elimination Period, the employee is "Totally Disabled" if he is "completely unable to perform the material duties of any occupation for which he is or could become reasonably qualified by training, education or experience . . . ." (
The Plan authorizes review of an employee's continuing eligibility for LTD benefits. It provides that a person receiving LTD benefits "may be required periodically to undergo a medical examination . . . and/or submit evidence of continued Total Disability . . . ." (Plan, Art. IV, § 4.4(b).) In July 2009, the Plan administrator, Disability Management Alternatives, LLC ("DMA")
(1) an October 14, 2008 statement from Plaintiff's attending physician noting Colonias was capable of sedentary work at that time;
(2) surveillance of Plaintiff at her residence for eight hours on June 19, 2009, during which Colonias was observed doing yard work, dragging garbage cans and recycling cans into the garage and engaging in other activities which appeared to be strenuous;
(3) the Functional Capacity Evaluation of July 9, 2009, which reported that Colonias was capable of sustaining a light level of work for eight hours a day and 40 hours a week, basing this conclusion on a battery of tests including Plaintiff's ability to sit, stand, climb stairs, engage in frequent walking, and push and pull certain weights, among others; and
(4) a Vocational Review, completed on July 17, 2009, assessing Plaintiff's education and experience.
Colonias appealed DMA's determination. DMA submitted Plaintiff's medical records for review by a medical consultant, a board certified orthopedic surgeon, who opined that Colonias would be capable of performing at least light level work. On March 22, 2010, DMA affirmed the discontinuation of Plaintiff's LTD benefits, concluding she did not satisfy the Plan's standard. In support of this decision, it cited the medical consultant's opinion, as well as the July 9, 2009 Functional Capacity Evaluation and the July 17, 2009 Vocational Review.
Plaintiff initiated this lawsuit in state court on or about July 14, 2011 challenging her LTD benefits termination under a breach of contract theory. Defendant thereafter removed the case to federal court based on complete preemption under ERISA. This Court has subject matter jurisdiction over this action pursuant to 28 U.S.C. § 1331, as it arises under a question of federal law.
The standard upon which a court must evaluate a summary judgment motion is well-established. Federal Rule of Civil Procedure 56(a) provides that summary judgment should be granted "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a);
Once the moving party has properly supported its showing of no triable issue of fact and of an entitlement to judgment as a matter of law, the non-moving party "must do more than simply show that there is some metaphysical doubt as to material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). The party opposing the motion for summary judgment cannot rest on mere allegations and instead must present actual evidence that creates a genuine issue as to a material fact for trial. Anderson, 477 U.S. at 248; see also Fed.R.Civ.P. 56(c) (setting forth types of evidence on which nonmoving party must rely to support its assertion that genuine issues of material fact exist). "[U]nsupported allegations . . . and pleadings are insufficient to repel summary judgment." Schoch v. First Fid. Bancorporation, 912 F.2d 654, 657 (3d Cir. 1990). "A nonmoving party has created a genuine issue of material fact if it has provided sufficient evidence to allow a jury to find in its favor at trial." Gleason v. Norwest Mortg., Inc., 243 F.3d 130, 138 (3d Cir. 2001). If the nonmoving party has failed "to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial, . . . there can be `no genuine issue of material fact,' since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial."
The Court begins by noting that although Plaintiff's Complaint seeks relief under a breach of contract theory, her instant legal challenge to the denial of LTD benefits under her employer-sponsored welfare plan must be construed by the Court as a claim to recover unpaid benefits pursuant to ERISA § 502(a)(1)(B).
(Plan, Art. VIII, § 8.1.) The Administrative Services Agreement likewise vests this discretionary authority with claims administrator DMA:
(Administrative Services Agreement, Art. VI, B.) It is well-settled that in such situations, where the administrator has discretionary authority to make benefits decisions, the standard of review is the highly deferential "arbitrary and capricious standard."
Defendant has presented sufficient evidence to demonstrate that no reasonable factfinder could conclude that the decision of DMA to discontinue Plaintiff's LTD benefits was arbitrary and capricious. The record shows that DMA's appeals unit supported its conclusion that Colonias was not "Totally Disabled," as defined by the Plan, with substantial evidence. Its March 22, 2010 letter upholding the determination to discontinue LTD benefits cited the Functional Capacity Evaluation, the Vocational Review and the opinion of an orthopedic surgeon consulted by DMA as grounds for finding that Colonias was, as of her 2009 re-evaluation, ineligible for LTD benefits. This evidence, as discussed in more detail above, was comprised of assessments that Colonias was capable of performing at least light level work and possessed a college degree and work experience that would enable her to be gainfully employed. The evidence on which the DMA appeals unit relied certainly suffices as adequate, to the reasonable mind, to support the administrator's conclusion that Colonias was not "completely unable to perform the material duties of any occupation for which [she] is or could become reasonably qualified by training, education or experience," that is, that she did not meet the applicable standard of "Totally Disabled" under the Plan. Defendant, in short, has established that Plaintiff could not, as a matter of law, prove that DMA's determination that she was ineligible for LTD benefits as of July 2009 was arbitrary and capricious.
Plaintiff, having failed to oppose the motion for summary judgment, adduces no evidence that would raise a genuine issue of fact as to whether her LTD benefits were improperly terminated. Assuming Plaintiff might argue that DMA disregarded evidence she submitted in connection with her appeal demonstrating that the Social Security Administration and Workers' Compensation Court had both found her to be disabled, such an argument would be completely unavailing to defeat this motion for summary judgment. There is no indication that those determinations were based on the same standard of disability applicable under the Plan, nor has Plaintiff presented any authority that would bind the Plan to such determinations.
For the foregoing reasons, the Court will grant Defendant's motion for summary judgment. An appropriate form of order will be filed together with this Opinion.