Opinion ID: 774209
Heading Depth: 2
Heading Rank: 2

Heading: Marshall's Claim for Long-term Disability Benefits.

Text: 9 The Plan is a non-contributory employee welfare benefit plan available to eligible non-pilot employees of Delta Airlines, Inc. it provides both short-term and long-term disability benefits. An employee is eligible for long-term disability benefits under the Plan provided he is disabled at that time as a result of demonstrable injury or disease (including mental or nervous disorders) which will continuously and totally prevent him from engaging in any occupation whatsoever for compensation or profit, including part-time work. 10 On March 5, 1992, after receiving the maximum amount of short-term benefits allowed under the Plan, Marshall signed a claim notice for long-term disability benefits. In support of his claim, Marshall submitted an Attending Physician's Statement from Dr. Chakales stating that Marshall was totally disabled both for his regular job and for any occupation. The Plan approved Marshall's claim for long-term disability benefits on March 18, 1992. The Plan paid long-term disability benefits to Marshall until March 31, 1998. 11 During the six years in which he received long-term disability benefits, Marshall underwent several Independent Medical Examinations (IMEs) by orthopaedists and Independent Psychiatric Examinations (IPEs) by psychiatrists, at the request of the Plan. Three examinations are pertinent to the pending appeal. 4 12 On April 3, 1996, orthopaedist William Blankenship performed an IME. Dr. Blankenship concluded that Marshall was at that time capable from a physical standpoint of performing some type of work in the form of restricted or light duty, clerical, and part-time. Dr. Blankenship stated that the work should be sedentary in nature and should not require a lot of bending or stooping. 13 The following month, Marshall underwent an IPE by Stephen C. Buchanan, M.D., a psychiatrist. Dr. Buchanan stated that Marshall seemed to be totally disabled physically in that he was unable to sit or stand for any length of time, his concentration was impaired by the medications that he was taking, and his energy level and ability to relate to others were impacted by his depression. Dr. Buchanan opined that Marshall was likely to be chronically incapacitated, but also thought it was possible that Marshall could work some kind of job from his home involving the telephone, at which Marshal could set his own hours. Dr. Buchanan recommended that Marshall receive psychotherapy with a psychotherapist. On July 10, 1996, Dr. Buchanan submitted an addendum to his report stating that he had subsequently reviewed the report of Dr. Blankenship's IME and concluded that, whatever one might say about whether Marshall was disabled from an orthopaedic perspective, one could nevertheless say that Marshall was totally disabled due to his depression, chronic pain, and his need to take medications that impair his concentration. 14 One year later, Marshall underwent a second IPE, this time performed by Bradley Diner, M.D.,a psychiatrist. 5 After meeting with Marshall and evaluating his records, Dr. Diner concluded that Marshall's pain was not fully associated with non-psychiatric medical or neurological findings. Dr. Diner also noted that Marshall's depression had been only superficially addressed because the psychiatric intervention has mainly focused on pain management. Dr. Diner also raised a concern about what he regarded as Marshall's overuse of pain medications and recommended a pain management program. 6 Dr. Diner concluded that there was nothing from a psychiatric standpoint to prevent Marshall from working; his depression was not severe enough to warrant any significant disability. Accordingly, Dr. Diner opined that Marshall was immediately capable of performing some type of work, particularly of a sedentary nature, that offered the freedom to take breaks as needed and set self-determined hours. 15 The Plan also required Marshall to submit to a Functional Capacity Evaluation with a physical therapist on March 12, 1998. Barbara Morris, M.S., performed an evaluation lasting several hours from which she concluded that, from a physical standpoint, Marshall was capable of performing some type of work in the sedentary category with lifting restrictions of 25 pounds. 16