United States District Court, E.D. Michigan, Southern Division
K. Majzoub U.S. Magistrate Judge.
ORDER DENYING PLAINTIFF'S CROSS MOTION TO REVERSE
DEFENDANT'S ERISA DETERMINATION AND MOTION FOR SUMMARY
JUDGMENT  AND GRANTING DEFENDANT'S MOTION FOR
JUDGMENT ON THE ADMINISTRATIVE RECORD
J. Tarnow, Senior United States District Judge.
Angela Toro is 45-years old and suffers from degenerative
cervical disc disease, lumbar spondyloses, and rheumatoid
arthritis. She challenges the decision by Defendant Hartford
Life and Accident Insurance Company to deny her claim for
Long Term Disability (“LTD”) benefits issued
under an ERISA-governed employee benefit plan (“the
Plan”) to her employer, ZF North America, Inc.
Plaintiff's claim falls under 502(a)(1)(B) of ERISA, 29
U.S.C. § 1132(a)(1)(B).
reasons stated below, Plaintiff's Cross Motion to Reverse
Defendant's ERISA Determination and Motion for Summary
Judgment  is DENIED. Defendant's
Motion for Judgment on the Administrative Record  is
old Angela Toro worked as a machinist from August 2011 to
October 2012 at ZF Lemforder. Through her employment, she
participated in the Plan, which was sponsored and
administered by ZF Group North America, Inc. Defendant
Hartford Life and Accident Insurance Company is the
has a long history of neck and back ailments. She had an MRI
of her thoracic spine and an MRI of her lumbar spine in
January 2010. HA 685-86. Plaintiff had a second MRI of her
lumbar spine in September 2012. HA 345-48. She stopped
working on October 23, 2012 because she needed a procedure to
alleviate her back pain. HA 694. Dr. Salwa Mohamedahmed,
Plaintiff's treating physician, indicated that Plaintiff
was excused from work from October 29, 2012 to January 2,
2013. HA 681. Plaintiff applied for and received Short Term
Disability (“STD”) Benefits from approximately
October 30, 2012 through April 22, 2013. HA 166.
December 26, 2012, Dr. Mohamedahmed extended Plaintiff's
leave to April 29, 2013. HA 679. On April 23, 2013, Dr.
Rudram Muppuri extended Plaintiff's leave time again, to
May 22, 2013, due to uncontrolled chronic lower back pain. HA
678. Plaintiff had another MRI of her thoracic spine on April
25, 2013 and an MRI of her lumbar spine in August 2014. HA
339-40, 343-44, 393-94.
The Terms of the Insurance Policy
Group North America, Inc. sponsored and administered the
Insurance Policy at issue for the benefit of its employees.
The Policy provides disability benefits if a participant
becomes disabled while insured under the policy, remains
disabled during and after the elimination period, and submits
proof of loss. HA 725. To receive coverage, an
individual's disability must result from accidental
bodily injury, sickness, mental illness, substance abuse, or
pregnancy. HA 734. An individual is considered disabled under
the Policy if she is prevented from performing one or more of
the essential duties of:
1) Your occupation during the elimination period;
2) Your occupation for the 24 month(s) following the
elimination period, and as a result your current monthly
earnings are less than 80% of your indexed pre-disability
3) After that, any occupation.
occupation” refers to “your occupation as it is
recognized in the general workplace, ” rather than
“the specific job you are performing for a specific
employer or at a specific location.” HA 737. “Any
Any occupation for which you are qualified by education,
training or experience, and that has an earnings potential
greater than the lesser of:
1) The product of your Indexed Pre-Disability Earnings and
the Benefit Percentage; or
2) The maximum monthly benefit.
“Essential Duty” is one that “is
substantial, not incidental; is fundamental or inherent to
the occupation; and cannot be reasonably omitted or
changed.” HA 734. A participant's ability to work
the number of hours in a regularly scheduled work week
qualifies as an Essential Duty. HA 734. Benefit payments will
stop when the participant is no longer disabled. HA 726.
Plaintiff's claim for Long Term ...