United States District Court, D. Maryland
MEMORANDUM & ORDER RE: SUMMARY JUDGMENT
J. Garbis United States District Judge
Court has before it Defendants' Motion for Summary
Judgment [ECF No. 31], Plaintiff's Cross-Motion for
Summary Judgment [ECF No. 34], and the materials submitted
relating thereto. The Court has reviewed the exhibits and
considered the materials submitted by the parties. The Court
finds a hearing unnecessary.
Wiley Joseph Smith (“Smith”) worked for Defendant
The PNC Financial Services Group, Inc. (“PNC”)
from 1990 until September 5, 2013, at which time he was a
Regional Manager II in PNC's Realty Services. Smith was a
participant in PNC's short and long-term disability plan,
a self-funded plan under the Employee Retirement Income
Security Act (“ERISA”), 29 U.S.C. § 1132
et seq. Smith was diagnosed with depression and
anxiety in 2008 and was receiving treatment, but his
condition worsened in August 2013, when he became unable to
continue performing his job duties as a result of disabling
major depression and panic disorder. Smith was granted
short-term disability benefits beginning on September 5,
2013. He has never returned to work, and the record contains
no evidence indicating that a return to work is reasonably
the period of short-term disability, Smith applied for
long-term disability (“LTD”) benefits to commence
on December 4, 2013, after the 91-day elimination period
covered by the short-term disability benefits. Defendant
Liberty Life Assurance Company of Boston (“Liberty
Life”), the claims administrator of the policy under
which benefits are payable, denied Smith's claim for
has brought the instant lawsuit against Defendants PNC,
Liberty Life, and The PNC Financial Services Group, Inc. and
Affiliates Long-Term Disability Plan (“the Plan”)
(collectively “Defendants”) under ERISA, 29
U.S.C. § 1001, et seq., and more specifically,
ERISA § 502, 29 U.S.C. § 1132. Smith seeks a
declaration of rights under the long-term disability plan at
issue, payment of all disability insurance benefits due and
owing plus interest, and an award of attorney's fees and
The Benefits Plan
Plan is an employee welfare benefits plan as defined by
ERISA, 29 U.S.C § 1002(1). The Plan provides full-time,
salaried employees who are totally disabled due to injury or
illness for longer than ninety-one days (the
“Elimination Period”) with LTD benefits of up to
60% of their base salary.
qualify for LTD benefits, an employee covered by the Plan
must meet the definition of LTD.
For disabilities that extend beyond 91 consecutive calendar
days and are considered long term, the definition of
disability is as follows:
For the first 24 months (from the date LTD benefits
begin): you are disabled if your disability makes
you unable to perform the material or essential duties of
your own occupation as it is normally performed in the
. . . .
The claims administrator determines whether your disability
meets these definitions.
AR 164, ECF No. 16. The Plan also provides that LTD benefits
paid due to a mental illness will stop after 24 months,
unless certain circumstances exist, such as confinement in a
hospital or institution. AR 170.
was employed as a Regional Manager II in PNC's Realty
Services line of business. The job is a “[s]enior level
operations position with direct responsibility for all
day-today facility management activities for a portfolio of
assigned buildings.” AR 13. This includes
“interaction with outside property management
companies, end-users, tenants, vendors/contractors, problem
resolution, and ongoing construction/maintenance
projects.” AR 14. The job's essential functions are
described as requiring “significant organizational and
time management skills” and are considered
“critical to the well being of the company.” AR
14. Also, close monitoring of expenses is considered critical
with direct responsibility for a budget of $20-50 million
dollars per year and shared responsibility for
capital/expense projects in excess of $10 million dollars. AR
15, 18. “The requirements of a Regional Manager II are
particularly complicated, requiring the management of
numerous sites spread out over a large geographic
footprint.” AR 17.
skills and competencies required to perform the job are
stated to include:
Must have demonstrated strong oral and written communications
skills, leadership, and decision making abilities. Must be
able to assess strategic problems and make accurate decisions
with significant financial and risk implications. Must be
team oriented and have an ability to provide exceptional
service to customers and service partners. Must also have the
ability to balance increased workload due to the sheer number
of properties being managed. The ability to identify
opportunities, research, analyze, question information and
problem solve is essential. Obtains information from staff,
service partners, consultants, vendors and determines
appropriate course of action. Must be able to react to
emergencies in a decisive manner. Interacts with all levels
of management, including Corporate CEOs and LOB heads. Also
interfaces with third parry property management firms, all of
levels of end users, and various outside consultants,
vendors, contractors, code officials, and suppliers.
Illness and Short-term Disability
2008, when Smith was 55,  he has experienced recurrent major
depression and has been receiving treatment for depression
and anxiety. AR 66. In August 2013, he experienced a
recurrence of symptoms including “sense of dread, chest
pain, difficulty thinking and getting thoughts out, and panic
attacks.” AR 66. He was unable to function at work and
was advised by his treating doctor, Stephen W. Saunders, M.D.
(“Dr. Saunders”), to remain off work and avoid
all stressors. AR 66. He was treated with two
antidepressants, an anti-anxiety medication, and a stimulant.
Saunders met with Smith again in October and on November 21,
2013, at which times Dr. Saunders noted that Smith was in
“partial remission only.” AR 66. In Dr.
Saunders' letter of December 4, 2013, he summarized that
Smith “appears disabled from working in his previous
employment, and also any employment at this time.” AR
stopped working on September 4, 2013 and was granted
short-term disability benefits beginning on September 5, 2013
(“Date of Disability”). AR 1, 8. Based on
Smith's Date of Disability, the 91-day Elimination Period
ended on December 5, 2013, which is also the LTD effective
date. AR 1, 164.
Life reviewed the records that Smith provided in support of
his short-term disability claim, which included Dr.
Saunders' Office Visit notes. AR 19-22. Liberty Life
wrote to Smith on November 12, 2013 requesting further
information and documentation that it needed for making an
LTD claim determination. AR 23-24. Smith provided the
requested documents, including Smith's completed
Activities Questionnaire, AR 54-56, and records from Dr.
Saunders, AR 58-61 and 65-71, and he spoke with Liberty Life
by telephone on November 15, 2013, AR 6-9.
own statement explained what prevented him from working:
My depression and anxiety make it very difficult for me to
interact with people in work situations or to handle multiple
tasks at one time. When anxiety and panic set in I become
forgetful and cannot function normally.
Life referred Smith's LTD claim for a psychiatric medical
review to determine if the record supported any impairments
that translated to restriction and limitations. AR 72. The
review was performed by Dr. Roland Segal (“Dr.
Segal”), who opined in his December 17, 2013 report
that the medical records supported a diagnosis of major
depressive disorder and generalized anxiety disorder. AR
75-78. Dr. Segal reported there was evidence of impairment
through October 1, 2013, but not thereafter. AR 75-78. Dr.
Segal added that there was no evidence that the prescribed
medications caused any impairment. AR 75-78. Dr. Segal
misinterpreted some of Dr. Saunders' notes, reading the
notes as indicating that Smith “was stressed by
multiple tasks of buying a house and wanting to attend a
nursing school and change working to part time.” AR 76,
see also AR 83 (“The claimant is apparently
buying a house and is either thinking of attending nursing
school or is already attending nursing school.”) In
actuality, Dr. Saunders' notes indicated that Smith's
son (not Smith) was buying a house, and Smith's daughter
(not Smith) was entering a nursing program. AR 70, 107.
Saunders completed an Attending Physician's Statement on
November 21, 2013. AR 60-61. On the form, Dr.
Saunders indicated that Smith had a Class 4 Mental/Nervous
Impairment, “Patient is unable to engage in stressful
situations or engage in interpersonal relations (marked
limitations).” AR 61.
Saunders also provided a medical summary letter dated
December 4, 2013, which stated:
He went off work and was advised to remain off work and avoid
all stressors [u]ntil completely being recovered. He was seen
by me July 2013, September 2013, Oct 2013, and lastly
11-21-13. At that time he was being treated with 2
antidepressants, an anti-anxiety medication, and a stimulant,
and was in partial remission only.
In summary, he appears disabled from working in his previous
employment, and also any employment at this time.
Dr. Segal was asked to make at least three separate attempts
to contact Dr. Saunders by telephone, he was unable to make
the contacts. See AR 75-76, 82-83. Dr. Segal sent a
letter to Dr. Saunders on December 17, 2013, stating Dr.
Segal's opinion that there was no impairment after
October 1, 2013, and asked Dr. Saunders to verify his
understanding and provide additional information if any
disagreement. AR 79-80. Dr. Saunders responded with a brief
hand-written sentence on the bottom of the letter stating:
“Note- his symptoms improved when the stress was
relieved! (not at work)”. AR 81 (emphasis in
Saunders called Dr. Segal on December 26, 2013. AR 84. Dr.
Segal updated the file with a memorandum stating that Dr.
Saunders communicated that Smith “was better at a
certain point ‘because he was not working and did not
have a stress of that particular job, and that is the reason
for his improvement.' This information does not change my
opinion as it is outlined in the original memorandum on
December 17, 2013.” AR 84. By letter of December 30,
2013, Smith was advised that his LTD claim was denied because
he did not meet the Plan's definition of disability, and
impairment was not supported beyond October 1, 2013. AR
January 9, 2014, Smith sent a letter to Liberty Life to
appeal the denial of his claim. AR 90. He wrote a
follow-up letter on January 15, 2014, providing information
that he indicated was either missed, ignored, or
misinterpreted by Dr. Segal. AR 94-95. Smith specifically
clarified the misleading statements in Dr. Segal's report
regarding Smith's buying a house and going to nursing
school. AR 95. He also identified restrictions from Dr.
Saunders that appeared to have not been taken into
consideration. AR 94.
January 20, 2014, Dr. Segal provided an addendum to his
report, noting that his December 26, 2013 addendum had not
made it into the file, nor had Dr. Saunders' brief
written response to Dr. Segal's letter: “His
symptoms improved when the stress was relieved! (not at
work).” AR 119. Dr. Segal noted that his opinion had
not changed: “In conclusion, the medical evidence and
communications with Dr. Sanders [sic] confirms the opinion as
outlined in the original memorandum that there is no medical
evidence of psychiatric impairment since October l,
2Ol3.” AR 119.
LTD claim file was referred to Liberty Life's appeals
unit, and a letter was sent to Smith on January 22, 2014,
stating that a decision is generally provided in 45 days, but
no longer than 90 days. AR 120. On February 26, 2014, Liberty
Life referred Smith's LTD claim file to Behavioral
Management, Inc. (“BMI”), an independent vendor,
requesting a review to be conducted by an independent
physician that was board-certified in psychiatry. AR 133-136.
Liberty Life also sent a letter to Smith on February 26,
2014, advising him that his medical records had been referred
for further medical review, and a decision would be rendered
within the 90-day deadline. AR 137.
independent review was assigned to Dr. Sandra Kalnins
(“Dr. Kalnins”). AR 139-153. Dr. Kalnins spoke
with Dr. Saunders on March 5, 2014, and summarized the
conversation by letter dated March 6, 2014. AR 139-140. Dr.
Saunders indicated that he disagreed with Dr. Segal, that his
records had been misinterpreted, and that he did not consider
Smith capable of returning to work. AR 139-140. Dr. Saunders
suggested that it may be helpful for Dr. Kalnins to interview
Smith. AR 140. Dr. Kalnins also appeared to be
under the false impression that Smith had considered going to
nursing school himself. AR 139. Dr. Kalnins reviewed Dr.
Saunders' records, Dr. Segal's review and
correspondence, Smith's job description, and other
documents from Smith's LTD claim file. AR 145-147.
Kalnins provided a written report to Liberty Life on March
13, 2014. AR 145-149. Dr. Kalnins' review stated:
The available records and teleconference information support
diagnoses of recurrent major depression and anxiety disorder.
The records support impairing levels of symptoms from 9/5/13
until the next psychiatric visit on l0/l/13, when the
claimant's mood was improved and no treatment changes
made. The records and the teleconference information from Dr.
Saunders do not provide objective evidence of severe and
persistent mood, cognitive, or behavioral symptoms preventing
the claimant from functioning. Treatment was not consistent
with impairing levels of symptoms, where the following would
be expected: frequent psychiatric visits with aggressive
medication adjustments, documentation of severe and
persistent psychiatric symptoms, ongoing intensive therapy,
and referrals to higher levels of treatment such as IOP, PHP,
or hospitalization if symptoms were persisting.
In teleconference, Dr. Saunders indicated that the claimant
was improved when he was placed out of work. The psychiatrist
describes the placement out of work as the treatment
intervention without explaining how that could be considered
active psychiatric treatment.
The records support impairing levels of depression and
anxiety from 9/5/13 to l0/l/l3. These symptoms would
interfere in the claimant's ability to maintain stable
emotions, make complex decisions, concentrate adequately on
complex tasks, and maintain stable interpersonal
interactions. In an office visit on l0/l/l3, the
claimant's mood was described as better and no treatment
changes were made. The records do not support severe and
persistent mood, cognitive, or behavioral symptoms beyond
l0/l/13 and do not indicate levels of psychiatric treatment
expected with impairing symptoms. The psychiatrist indicated
that there was no return to work plan.
Life sent Smith a letter on April 10, 2014, upholding its
previous determination to deny Smith's LTD claim. AR
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