JOHN G. KOELTL, District Judge.
This case arises from the denial by Cigna Life Insurance Company of New York ("CLICNY") of a claim for disability benefits by Dr. Sergei Chepilko ("Chepilko"), the plaintiff
CLICNY has now moved for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure, arguing that the statute of limitations has run, and that, in any event, Chepilko has failed to raise a material issue of fact, and that the undisputed facts show that he was able to perform the material duties of his job and was therefore not disabled as defined by the Policy, for a continuous 180-day period, as required by the Policy. Jurisdiction is proper pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e)(1). For the reasons explained below, the motion for summary judgment is
The standard for granting summary judgment is well established. "The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a);
Summary judgment is appropriate if it appears that the nonmoving party cannot prove an element that is essential to the nonmoving party's case and on which it will bear the burden of proof at trial.
The following facts are undisputed unless otherwise noted:
Chepilko held a research position at Cornell University's Weill Medical College ("WMC") since at least 1997. (Arbitrio Decl., Ex. B ("Administrative Record" or "AR"), at 175.) In June, 2001, Chepilko was appointed to a one year position as a postdoctoral fellow in the Department of Pharmacology at WMC, which was renewable based on, among other things, performance. (AR at 173-174.)
Chepilko was assigned to work on a project relating to the effect of particular compounds on insulin secretion by the pancreas. (Def.'s R. 56.1 Stmt. ¶ 3; Pl.'s R. 56.1 Resp. ¶ 3.) Chepilko was expected to conduct experiments, interpret data, and prepare manuscripts for publication. (Def.'s R. 56.1 Stmt. ¶ 5; Pl.'s R. 56.1 Resp. ¶ 5.)
On September 26, 2001, Chepilko, received a termination letter, effective on September 28, 2001. (AR at 438.) The letter asserted that Chepilko had "failed to make any progress," had "failed in even the most basic laboratory skills," and had "managed to contaminate the cell culture incubator, putting everybody's work at risk." (AR at 438.)
CLICNY insured Chepilko under the Policy, which was offered through WMC. (Def.'s R. 56.1 Stmt. ¶ 2; Pl.'s R. 56.1 Resp. ¶ 2.) A person covered under the Policy is considered disabled if, "because of Injury or Sickness . . . he is unable to perform all the material duties of his regular occupation." (AR at 39;
Under the Policy, an employee only becomes eligible for benefits if the employee is continuously disabled over the course of a waiting period. (
The parties dispute the exact origin of Chepilko's alleged disability. Chepilko asserts that he has "suffered from lower back pain for many years," (Pl.'s R. 56.1 Resp. at ¶ 11;
CLICNY asserts that Chepilko worked full time until September 27, 2011, and that September 28, his termination date, was his first day off due to his claimed disability. (Def.'s R. 56.1 Stmt. ¶¶ 14-15;
With respect to Chepilko's medical issues and the medical history of the alleged disability, there is evidence in the record supporting the following facts.
Chepilko first saw Dr. George Fieberg, a chiropractor, on September 14, 2001. Chepilko's subjective complaints included sharp, shooting pain in the neck and lower back, both of which Chepilko complained "preclude[d] carrying out activities of daily living. (AR at 232.) Dr. Fieberg noted the "Date of Onset" as September 11, 2001. (AR at 232.) Dr. Fieberg's objective evaluation confirmed that Chepilko was in "severe pain." (AR at 232.) Dr. Fieberg concluded that "[t]he prognosis for Mr. Chepilko is fair at this time. His is a complicated case and despite the probability of permanent residuals, continued improvement is expected." (AR at 233.) Chepilko continued to see Dr. Fieberg over the course of the next year.
Chepilko visited the New York-Presbyterian Hospital's Emergency Department on September 27, 2001. There is no explicit mention in those records of back or foot problems; rather, the notes indicated that Chepilko was suffering from hypertension and anxiety. (
The next day, September 28, 2001, Chepilko saw Dr. Fieberg again. Dr. Fieberg noted the same symptoms that he had noted on September 14, 2001, and found Chepilko's condition unchanged and unimproved. (AR at 234-35.) With respect to Chepilko's subjective complaints, Dr. Fieberg noted that Chepilko complained that the pain "seriously affected" his daily activities. (AR at 234.) Dr. Fieberg described Chepilko as being in a "relief phase of care," and recommended a treatment plan including physical therapy, traction, and electrical muscle stimulation with the goal of decreasing Chepilko's pain and "returning the patient to his pre-clinical status." (AR at 235.) Dr. Fieberg gave virtually identical evaluations through five subsequent visits in October, 2001, and four in November, 2001. (
Chepilko saw a podiatrist, Dr. Jonathan Thurm, for the first time on November 26, 2001, and Dr. Thurm's notes indicate subsequent visits on November 29, 2001, and on January 17 and March 12, 2002. (
On December, 2001, Dr. Fieberg noted that Chepilko had "experienced some improvement" since his last visit, although Dr. Fieberg's objective assessment, and the subjective complaints listed, remained virtually identical. (AR at 254-55.) On December 28, 2001, Dr. Fieberg noted "minor improvement" since Chepilko's previous visit. (AR at 256-257.) Dr. Fieberg then noted "some improvement" or "minor improvement" since each previous visit at each of six visits in January, 2002, four visits in February, 2002, three visits in March, 2002, one visit in April, 200, and two in May 2002. (AR at 258-289.) Dr. Freiberg's objective findings with respect to his examination of Chepilko did not change over the course of this time, and Chepilko's subjective complaints continued to assert that his level of pain was unchanged and continued to "seriously affect[] his daily activities." (
Dr. Fieberg referred Chepilko for various tests during the course of his treatment. Dr. Fieberg referred Chepilko for electrodiagnostic testing by Doctor Gary Weiss, a neurologist. In December, 2001 and January, 2002, Chepilko underwent a Nerve Conduction Study and a Dermatomal Somatosensory Evoked Potential test, both of which use "electrodes . . . placed at various positions along the peripheral nerves." 229-230, 346-350. Dr. Weiss, a neurologist, interpreted the tests, and concluded that the test results for Chepilko's "lower extremity" were "consistent with . . . radiculopathy." (AR at 229, 346, 349.)
In early February, 2002, separate MRIs were taken of Chepilko's foot and lower back (lumbar spine). (
In January, 2002, Chepilko also began seeing Dr. Igor Ostrovsky, a pain specialist. (Def's R. 56.1 Stmt ¶ 25; Pl.'s R. 56.1 Resp. ¶ 25.) Dr. Ostrovsky diagnosed Chepilko with lumbar radiculopathy due to a bulging disc, myalgia, muscle spasm, and plantar fasciitis, and noted his "impression that radiculopathy is the main sauce [sic] of the pain." (AR at 307-308.) Dr. Ostrovsky noted that Chepilko appeared to be in "severe pain," but he did not opine as to whether he was totally disabled or otherwise unable to perform the material duties of his job. (AR at 307-308.) Dr. Ostrovsky prescribed physical therapy three times a week, Vioxx, and paravertebral blocks "[t]o control severe pain." (AR at 308.) On January 31, 2002, Chepilko saw Dr. Ostrovsky again and received an injection for his back, which Dr. Ostrovsky noted provided "instant pain relief." (AR at 302.) Chepilko saw Dr. Ostrovsky again on February 7, 2002, and March 21, 2002, and Dr. Ostrovsky's assessment at both evaluations was virtually identical to his initial evaluation from January 21, 2002. (AR at 303-306.)
Chepilko also had an initial evaluation at the Metropolitan Pain Center in Manhattan on March 14, 2002. The initial evaluation stated that Chepilko suffered from mid-back and lower back pain that was aggravated by prolonged sitting and prolonged walking. (AR at 203.) At the initial visit, Chepilko was prescribed continued therapy and therapeutic exercise. (AR at 202.) The evaluation noted that Chepilko was "on disability now," but did not state whether Chepilko was unable to perform the material duties of his job. (AR at 202-203.) There is evidence in the record of further visits to the pain center through November of 2002 for lower back pain. (
In September, 2002, Chepilko also sought the services of the Medical Massage Group, located at the same address as the Pain Center, for lower back pain. (
Chepilko filed a claim for long term disability benefits with CLICNY on March 26, 2002. (Def.'s R. 56.1 Stmt ¶ 21; Pl.'s R. 56.1 Resp. ¶ 21;
Chepilko submitted with his claim form a Physician's Statement of Disability filled out and signed by Dr. Ostrovsky. Dr. Ostrovsky indicated on the form that Chepilko had a herniated lumbar disc, plantar fasciitis, and mylagia. (
On April 16, 2002, Chepilko completed a Disability Proof of Loss form. He stated on the form that he was suffering from "severe pain in low [sic] back and left foot, periodically strong headaches." (AR at 331-32.) He indicated that his condition was an "illness" and not an "injury," and that his "[d]ate of illness" was September 11, 2001. (AR at 331.) Chepilko indicated on the form that his last day worked was September 26, 2001, on which day he claimed he worked zero hours, and he indicated that the date on which he was first unable to work was September 12, 2001. (AR at 331.) Chepilko also indicated that he was not laid off or terminated. (AR at 332.)
On April 22, 2002, Chepilko filled out an "Activities of Daily Living" Questionnaire as part of his application for benefits. (Def.'s R. 56.1 Stmt. ¶ 26; Pl.'s R. 56.1 Resp. ¶ 26;
On June 7, 2002, CLICNY denied Chepilko's claim for Long-Term Disability benefits under the Policy. (AR at 292-93.) CLICNY explained in a letter to Chepilko that it was denying benefits because there was no evidence that Chepilko had been disabled for the entire 180 day waiting period beginning on September 27, 2001. (
CLICNY received Dr. Fieberg's notes shortly after the initial denial of benefits, and, in a conversation with Chepilko on June 10, 2002, the case manager for Chepilko's case explained to Chepilko that CLICNY could not simply change its determination and that he would need to appeal the denial. (
In January, 2003, CLICNY classified Chepilko's occupation as a "light" duty occupation. (AR at 147.) CLICNY determined that the job description in their database that most closely matched Chepilko's job description was "biochemist," a light duty occupation. (
As part of the appeal process, CLICNY sent Chepilko's file for an independent physician review. (
CLICNY denied Chepilko's appeal in February, 2003. (AR at 131-32.) In a letter to Chepilko dated February 12, 2003, CLICNY explained that it was affirming the denial of benefits, largely based on Dr. Graulich's conclusion that "there is no medical evidence in your file to support your inability to work at any type of work." (AR at 131;
Chepilko filed this lawsuit on March 26, 2008.
CLICNY argues that this action is barred by the statute of limitations contained within the Policy.
The Policy provides that "[n]o action at law or equity will be brought to recover on the policy until at least 60 days after proof of loss has been filed with the Insurance Company. No action will be brought at all unless brought within 3 years (Kansas: 5 years; South Carolina: 6 years), after the time within which proof of loss is required by the policy." (AR at 61.) Chepilko's claim file indicates that the "Proof of Loss Date" for his claim was June 4, 2002. (AR at 3.).
Chepilko argues that the statute of limitations for a breach of contract action in New York is six years. (
Chepilko argues that the "legal actions provision is vague," with "no specifications for other states, including New York." (Pl.'s R. 56.1 Resp. ¶ 86.) CLICNY argues that the meaning of the provision is plain and unambiguous. CLICNY is correct.
Courts in this Circuit construe the terms in ERISA plans in accordance with federal common law, and give the terms of the Plan their plain meanings.
In this case, a reasonably intelligent person could come to only one conclusion as to the meaning of the disputed term in the policy: legal actions must be filed within three years of the date on which proof of loss is required under the Policy, but there are exceptions to this rule in Kansas, where the period is five years, and South Carolina, where the period is six years. Moreover, federal courts interpreting ERISA-covered plans employ the "familiar rules of contract interpretation."
The next issue is whether the limitations period in the Policy is enforceable. The Court of Appeals for the Second Circuit has explicitly addressed this point, and held that such limitations periods are enforceable.
Because the limitations period prescribed by the Policy in this case is enforceable, and because Chepilko's claim was filed over two years after that period had run, Chepilko's claim was filed barred. The defendant's motion for summary judgment is therefore granted.
The Court has considered all of the arguments raised by the parties. To the extent not specifically addressed, the arguments are either moot or without merit.
The defendant's motion for summary judgment is granted.
The Clerk is directed to enter judgment, to close this case and to close all pending motions.
SO ORDBRBD.