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Witte v. Connecticut General Life Ins. Co.

December 6, 2007




Dear Litigants:

This matter comes before the Court on Plaintiff's and Defendants' cross-motions for summary judgment pursuant to Fed. R. Civ. P. 56. There was no oral argument. Fed. R. Civ. P. 78. For the reasons set forth below, both Plaintiff's and Defendants' motions for summary judgment are granted in part and denied in part.


Plaintiff, Donald Witte, was employed as an "Own Brands Sourcing Manager" for The Great Atlantic & Pacific Tea Company, Inc. ("A&P") from June 2001 until May 26, 2004. Plaintiff had been undergoing treatment for his cardiac-related health conditions since 1980 and had been hospitalized repeatedly between 1982 and 2004. In April 2004, Plaintiff required cardiac catheterization and complained of continuing chest pains and shortness of breath. According to Plaintiff, he ceased working on May 26, 2004 due to worsening symptoms related to his heart condition.

On November 11, 2004, Plaintiff made a benefits claim under A&P's Long Term Disability Plan (the "Plan"), a self-funded employee benefits plan governed by the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). The Plan provides for monthly disability payments after 180 consecutive days of total disability.*fn2

During the initial two-year period for which long term disability benefits are payable, the Summary Plan Document for the Plan defines "total disability" as being "unable to perform any and all duties of your job." (Lodi Decl. Ex. A D0087). This disability determination must be "certified by a physician and approved by the claims administrator before benefits are paid." (Murphy Decl. Ex. A D0657.)

The Plan designates A&P, Corporate Benefits Department, as the plan administrator and Connecticut General Life Insurance Company (hereinafter "CIGNA") as the claims administrator. (Lodi Decl. Ex. A D0098.) As the plan administrator, the Corporate Benefits Department "manages the day-to-day operation of the Plan and has the sole and final authority to interpret the Plan provisions, decide questions that arise in connection with the administration of the Plan, and review any denials of claims for benefits." (Lodi Decl. Ex. A D0098.) The Plan delegates the review of claims to the claims administrator, CIGNA, who must (1) approve the physician who certifies a claimant's "total disability," and (2) approve a claimant's disability. (Lodi Decl. Ex. A D0089.)

Plaintiff's claim for disability benefits was denied by the claims administrator, CIGNA, on February 1, 2005. CIGNA determined that the medical records offered by Plaintiff did not support his claim that he was unable to perform his duties as a sourcing manager--a job that CIGNA described as sedentary work. CIGNA stated that their decision was based upon CIGNA's review of Plaintiff's claim file and the opinion of their reviewing physician, who found that the "medical deficits are not supported by clinical evidence." (Lodi Decl. Ex. A D0517.)

Thereafter, Plaintiff submitted an appeal of the denial along with additional medical documentation. On October 15, 2005, CIGNA affirmed the denial of benefits based on an Independent Peer Review by Dr. Paul W. Sweeney (a non-examining physician consultant), who concluded that Plaintiff could resume his work as sourcing manager. CIGNA further stated that it could not identify the acuteness of Plaintiff's cardiac condition or loss of function severe enough to preclude him from performing his job as a sourcing manager. CIGNA indicated that they would entertain another appeal and invited Plaintiff to submit additional documentation.

After a change of attorneys, Plaintiff provided additional documentation to CIGNA including, among others, a cardiac functional capacity assessment completed by Plaintiff's treating physician, Dr. Gregory F. Sullivan, and an affidavit from Plaintiff describing the requirements of his job as Sourcing Manager at A&P. On May 24, 2006, CIGNA upheld its denial of benefits. CIGNA stated that Plaintiff's complete file was reviewed in "its entirety without deference to prior reviews," but also noted that the additional information submitted by Plaintiff duplicated the information previously reviewed. (Lodi Decl. Ex. A D0101.) Therefore, CIGNA considered this additional information insufficient to change their previous determination. All administrative remedies, as mandated in 29 U.S.C. § 1133, have been exhausted.

Plaintiff filed this ERISA suit against CIGNA, A&P, and the A&P, Long Term Disability Plan on June 19, 2006, alleging improper denial of disability benefits. Plaintiff seeks review of Defendants' denial of long term disability benefits and an award of disability benefits starting from the period of total disability in May 20, 2004 as well as interest, court costs, and attorney's fees. Plaintiff's and Defendants' cross-motions for summary judgment are now before the Court.


The Court's review of CIGNA's denial of long term disability benefits involves a determination under ERISA. See Hooven v. Exxon Mobil Corp., 465 F.3d 566, 573 (3d Cir. 2006)("every claim for relief involving an ERISA plan must be analyzed within the framework of ERISA"). Against this statutory ...

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