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Love v. Eaton Corporation Disability Plan For U.S. Employees

United States District Court, E.D. North Carolina, Western Division

December 12, 2017

DIANE LOVE, Plaintiff,
v.
EATON CORPORATION DISABILITY PLAN FOR U.S. EMPLOYEES, Defendant.

          ORDER

          LOUISE W. FLANAGAN, UNITED STATES DISTRICT JUDGE.

         This matter is before the court on the parties' cross-motions for summary judgment pursuant to Federal Rule of Civil Procedure 56. (DE 33, 35). The issues raised are ripe for ruling. For the following reasons, the court grants plaintiff's motion for summary judgment and denies defendant's motion.

         STATEMENT OF THE CASE

         Plaintiff initiated the instant action by complaint filed October 20, 2016, alleging that she is entitled to recover long-term disability benefits, or is entitled to a review of her application for long-term disability benefits, under a group insurance policy (“plan”) issued by defendant, pursuant to 29 U.S.C. § 1132(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (“ERISA”).[1]On May 24, 2017, defendant filed the administrative record for this case under seal. (DE 24-32). On June 9, 2017, defendant filed the instant motion for summary judgment arguing in part that because plaintiff did not apply for and receive 26 weeks of short-term disability benefits (six months or 182 days), as required under the plain language of the plan, she did not qualify to receive long-term disability benefits and her application for those benefits was correctly denied. On June 12, 2017, plaintiff filed her instant motion for summary judgment, arguing in part the plain language of the plan does not require a claimant to apply for and receive six months of short-term disability benefits before applying for long-term disability benefits. Plaintiff seeks a determination on the record that she is entitled to long-term disability benefits or that she is entitled to remand of her case for reconsideration of her application for long-term disability benefits.

         STATEMENT OF THE UNDISPUTED FACTS

         The undisputed facts as relevant to the instant motions may be summarized as follows. On November 8, 1999, plaintiff began working for the Eaton Corporation. (Admin. R. at 961). On October 25, 2014, plaintiff stopped working at the direction of her physician and was determined by the plan to be qualified as of that day to receive short-term disability benefits through January 15, 2015. (Id. at 1014). On January 19, 2015, due to the nature of plaintiff's disability, the plan extended short-term disability benefits until January 31, 2015, but informed plaintiff she would need to submit additional medical evidence to support additional short-term disability benefits. (Id. at 1017). On February 16, 2015, the plan informed plaintiff that because she failed to submit additional medical evidence concerning her ongoing disability, she no longer qualified for short-term disability benefits effective February 1, 2015. (Id. at 1021).

         On February 28, 2015, plaintiff appealed the denial of her continued short-term disability benefits to the plan's first level of administrative review, submitting medical documentation at that time. (Id. at 1112-24, 1130-33, 1152-54, 1164, 1230-31). Plaintiff submitted additional medical evidence after receiving an extension of time to do so. (Id. at 1125-29, 1161-63). On April 3, 2015, the plan upheld the suspension of short-term disability benefits, finding plaintiff did not qualify for ongoing short-term disability benefits. (Id. at 1027-28).

         On April 17, 2015, plaintiff appealed the denial of continued short-term disability to the plan's second level review, submitting additional medical evidence after receiving an extension of time to do so. (Id. at 1231-32, 1173-88). The plan again upheld the denial of continued short-term disability benefits on July 15, 2015. (Id. at 1036-38).

         On December 17, 2015, plaintiff submitted a long-term disability benefits claim. (Id. at 1206-1219). The plan denied plaintiff's request on December 21, 2015, stating that because plaintiff had not qualified for and received six months of short-term disability benefits, she could not qualify for long-term disability benefits. (Id. 1094-95). Plaintiff appealed her denial through the plan's first level review. On February 12, 2016, in upholding the denial, the plan's first level review stated that “this is an administrative decision, ” “it is not based on a determination of whether or not [plaintiff] has met the definition of disability, ” and therefore “[a]dditional medical documentation is not relevant to the appeals decision.” (Id. at 1104).[2] Plaintiff appealed her denial of long-term disability benefits through the plan's second level review. On June 9, 2016, in upholding the denial, the plan's second level review held “the Committee interprets the Plan as specifically requiring an individual to fully exhaust the six months of disability coverage as provided under the [short-term disability] plan, ” which plaintiff did not do. (Id. at 1285).

         DISCUSSION

         A. Standard of Review

         Summary judgment is appropriate where “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). The party seeking summary judgment “bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986).

         Once the moving party has met its burden, the non-moving party must then “come forward with specific facts showing that there is a genuine issue for trial.” Matsushita Elec. Indus. Co. Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986) (internal quotation omitted). Only disputes between the parties over facts that might affect the outcome of the case properly preclude the entry of summary judgment. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986) (holding that a factual dispute is “material” only if it might affect the outcome of the suit and “genuine” only if there is sufficient evidence for a reasonable jury to return a verdict for the non-moving party).

         “[A]t the summary judgment stage the [court's] function is not [itself] to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.” Id. at 249. In determining whether there is a genuine issue for trial, “evidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in [non-movant's] favor.” Id. at 255; see United States v. Diebold, Inc., 369 U.S. 654, 655 (1962) (“On summary judgment the inferences to be drawn from the underlying facts contained in [affidavits, attached exhibits, and depositions] must be viewed in the light most favorable to the party opposing the motion.”).

         Nevertheless, “permissible inferences must still be within the range of reasonable probability, ... and it is the duty of the court to withdraw the case from the [factfinder] when the necessary inference is so tenuous that it rests merely upon speculation and conjecture.” Lovelace v. Sherwin-Williams Co., 681 F.2d 230, 241 (4th Cir. 1982) (quotations omitted). Thus, judgment as a matter of law is warranted where “the verdict in favor of the non-moving party would necessarily be based on speculation and conjecture.” Myrick v. Prime Ins. Syndicate, Inc., 395 F.3d 485, 489 (4th Cir. 2005). By contrast, when “the ...


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