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Andrew J. Defayette v. Verizon Communications

August 30, 2011

ANDREW J. DEFAYETTE, PLAINTIFF,
v.
VERIZON COMMUNICATIONS, INC. AND THE VERIZON CLAIMS REVIEW COMMITTEE OF VERIZON SICKNESS AND ACCIDENT DISABILITY PLAN OF NEW YORK AND NEW ENGLAND ASSOCIATES, DEFENDANTS.



The opinion of the court was delivered by: Brown, Chief Judge

NOT FOR PUBLICATION

MEMORANDUM OPINION

This matter comes before the Court upon the motion of defendants Verizon Communications, Inc. and the Verizon Claims Review Committee of Verizon Sickness and Accident Plan of New York and New England Associates (collectively "Defendants") for summary judgment (Doc. No. 11) and the cross-motion of plaintiff Andrew J. DeFayette ("Plaintiff") for summary judgment (Doc. No. 16) pursuant to Federal Rule of Civil Procedure 56. The Court has decided the matter without oral argument, pursuant to Federal Rule of Civil Procedure 78. For the reasons that follow, the Court will grant Defendants' motion and deny Plaintiff's cross-motion.

I. BACKGROUND

Verizon Communications, Inc. hired Plaintiff on January 2, 2000 as a telephone lineman. (Certification of Mary B. Rogers ("Rogers Cert.") Ex. A ¶ 10). During the course of his employment, Plaintiff sustained three distinct injuries while performing job-related tasks. (See Rogers Cert. Ex. G at 3-4). On November 9, 2000, Plaintiff suffered an injury to his right knee while installing a pole. (Rogers Cert. Ex. N). On May 16, 2002, Plaintiff sustained an injury to his left shoulder when he slipped and fell while moving a reel of cable. (Id. at 5). The final injury occurred on January 13, 2003 when Plaintiff sustained a lower back injury moving a reel of wire with a pry bar. (Id.)

Plaintiff thereafter received "accident" benefits pursuant to the Verizon Sickness and Accident Disability Benefit Plan for New York Associates ("the Plan"). (Rogers Cert. Ex. P). Under the Plan, accident disability is defined as follows:

5.1 Participation

All Employees shall be participants in the Accident Disability Benefit Plan and qualified to receive payments under the Plan on account of physical disability to work by reason of accidental injury . . . arising out of and in the course of employment by the Employing Company.

5.5 Relationship of Injury to Employment

Accidental injuries shall be considered as arising out of and in the course of employment only when the injury has resulted solely from an accident during and in direct connection with the performance of duties to which the Employee is assigned in the service of the Employing Company, or which he is directed to perform by proper authority, or in voluntarily protecting the Employing Company's property or interests. There must be a clear and well-established history of the cause and circumstances of injury accidentally inflicted, which must be sufficient to produce the alleged injury, and there must be satisfactory evidence that such injury renders the Employee unable to perform his duty in the service of the Employing Company.

(Rogers Cert. Ex. B at 9-10).

The Plan defines a sickness disability beneficiary in Section 4.1 as one who is "qualified to receive payments under the Plan on account of a physical disability to work by reason of sickness." (Id. at 7). Section 4.1 provides that a sickness "shall include an injury other than accidental injury arising out of and in the course of employment by the Employing Company." (Id.)

In the course of monitoring Plaintiff's disability absence, the Verizon Workers' Compensation Department arranged for Plaintiff to undergo an Independent Medical Evaluation ("IME") on October 23, 2004. (Rogers Cert. Ex. N). Dr. Edwin Mohler, an orthopedic surgeon, conducted the examination, which focused on Plaintiff's right knee, shoulder and back injuries. (Id.) Dr. Mohler concluded in the IME report that Plaintiff's back injury had been resolved and there was no basis for relating any back pain suffered by Plaintiff to his 2003 workplace injury. (Rogers Cert. Ex. O). With regards to Plaintiff's shoulder and right knee impairments, Dr. Mohler found Plaintiff suffered pre-existing conditions that were exacerbated by the workplace injuries, but that overall Plaintiff's total body pain was unrelated to the workplace injuries. (Id.) Dr. Mohler also noted that many of Plaintiff's responses appeared to be exaggerated and that Plaintiff no longer suffered any disabilities as a result of his workplace injuries. (Rogers Cert. Ex. N).

After the IME report concluded that Plaintiff's injuries were no longer related to his workplace injuries, the Verizon Workers' Compensation Department terminated Plaintiff's workers' compensation benefits effective October 28, 2004. (See id.). Plaintiff appealed the decision and on December 6, 2005 New York State Workers' Compensation Law Judge Jeffrey Romero upheld the Verizon Workers' Compensation Department decision to terminate the benefits. (Rogers Cert. Ex. N). Plaintiff ...


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