Opinion ID: 57057
Heading Depth: 3
Heading Rank: 1

Heading: Factual Basis for Claim

Text: Keith, a thirty-seven year old female, was formerly employed by MBNA Technology in a sedentary position known as “Team Manager II.” As an MBNA employee, Keith was a participant in a group long-term disability plan issued and administered by Prudential. Keith has suffered from several medical conditions since at least the mid-1990s, although her primary diagnosis is fibromyalgia, a chronic syndrome characterized by significant muscle pain. Because of her medical conditions, she struggles to perform even sedentary job functions.1 Since 1 Keith has been diagnosed with, among other things, Sjögren’s syndrome, fibromyalgia, and Arnold Chiari Malformation. Keith maintains these conditions cause her to suffer from debilitating pain and fatigue leading to difficulty in performing essential job tasks, including 2 1999, Keith had been permitted to accommodate her symptoms by working from home, working shortened hours, and working on individual projects that did not require her to attend long meetings. This modified schedule afforded her the flexibility to rest and perform continuous therapy throughout her day. Despite her employer’s accommodations, Keith’s condition worsened to the point where she felt unable to work, even in a modified manner. In the spring of 2002, Keith became pregnant, and on or about August 8, 2002, she ceased working for MBNA due to her alleged disability. On November 21, 2002, approximately one month before the birth of her child, Keith filed a claim with Prudential for long-term disability benefits. Although benefits were approved in early February 2003, after further review Prudential determined that its initial conclusion that Keith could not perform sedentary work was unsupported by objective evidence contained in her medical records. Accordingly, on May 30, 2003, Prudential informed Keith that her benefits would be discontinued as of July 1, 2003. Keith subsequently filed three requests for reconsideration. concentrating, sitting or standing for extended periods of time, and performing repeated tasks such as keyboarding. Although Keith has been prescribed medication for her symptoms, she is unable to tolerate many of her prescriptions. As a result, she attempts to manage her symptoms through a time-consuming regimen of heat, ice, and physical therapy. According to Keith, this regimen leaves her with little energy to perform daily tasks outside of the workplace, such as cooking and caring for her child. 3 During the reconsideration process, three medical professionals reviewed Keith’s records and confirmed that objective evidence supported Prudential’s conclusion that Keith was not totally disabled.2 Prudential concluded there had been no significant deterioration in Keith’s condition between the time she originally filed for benefits and the time she stopped working altogether. Prudential also determined that the level of physicality necessary to care for her infant child exceeded the level of physicality necessary to perform her sedentary job functions. Finally, Prudential noted that Keith’s supervisor had agreed to accommodate her by continuing her modified work schedule. Accordingly, Prudential upheld its previous determination that Keith was not totally disabled as defined by its policy. 2 Prudential’s policy defines “disabled” as follows: You are disabled when Prudential determines that: • you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and • you have a 20% or more loss in your indexed monthly earnings due to that sickness or injury. (Mem. Op. 5 (emphases in original).) Adele Glita, a registered nurse, reviewed Keith’s records and concluded there was insufficient evidence to indicate that she was unable to perform sedentary work. A medical consultant who is board certified in physical medicine and rehabilitation also reviewed her records and reached the same conclusion. Finally, Keith’s records were evaluated by Dr. Joel F. Moorhead, an independent medical professional and Assistant Professor at Emory University, who also concluded that she was not totally disabled. 4 Keith filed the present action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq., seeking to overturn the denial of her claim for long-term disability benefits. Both parties filed motions for summary judgment which were denied. The parties then agreed that the district court would decide the case based upon the administrative record and the briefs of the parties.