ERISA-Second Circuit Finds A Dispute As To Plaintiff’s Disability and Vacates Summary Judgment Against Her

In O’Hara v. National Union Fire Insurance Company of Pittsburgh, PA, No. 10-1433-cv (2nd Cir. 2011), the plaintiff, Patricia O’Hara (“O’Hara “), had sued the defendant, National Union Fire Insurance Company of Pittsburgh, PA (“National Union”), under ERISA for disability benefits. The district court granted summary judgment in favor of National Union, and O’Hara appealed. National Union had argued that O’Hara is not entitled to disability benefits because she was present at work during the period of alleged disability. However, the Second Circuit Court found that O’Hara had presented evidence that she was disabled during all periods required by National Union’s plan. Based on this evidence, a reasonable fact finder could conclude that O’Hara was entitled to disability benefits. The Second Circuit Court therefore vacated the district court’s judgment and remanded the case for further proceedings.

O’Hara had been employed by ITT Flygt Corporation (“ITT”). There, she had participated in a voluntary disability plan which was established by ITT, and which was insured and administered by National Union (“the Plan” ). O’Hara fell and suffered a head injury in March, 2001. As a result of this injury, she began to have headaches. She was fired in June, 2002. In August, 2002, O’Hara was diagnosed as suffering from post traumatic headache disorder. In January, 2004, she submitted a claim for disability benefits under Plan. Her claim was denied, and this suit was filed.

In analyzing the case, the Court noted that, since the Plan did not vest the administrator with discretionary authority to determine eligibility for benefits, National Union’s denial of benefits is not entitled to deference, and must be reviewed de novo. Further, the district court may not grant summary judgment if the record reveals a dispute over an issue of material fact.

Under the Plan, O’Hara is eligible for benefits if she is totally and permanently disabled from qualified work, and that disability commences within one year of an accident and continued for at least one year. National Union argues that O’Hara cannot meet the foregoing, because she had appeared at work from the time of her injury, until the date on which she was fired, about 15 months later. However, the Court said that there is no blanket rule that an employee cannot be disabled when she is present at work; one can be physically present at her place of employment but unable to work. If there is a genuine dispute about whether the employee was disabled, this question is for the fact finder. Here, there was such a dispute, since O’Hara had presented evidence from which a reasonable fact finder could conclude that she was disabled within the meaning of the Plan. For example, one doctor reported that O’Hara was totally disabled from qualified work within 1 year of the March, 2001 fall. O’Hara also presented evidence that her head injury prevented her from successfully interacting with others in a work environment, and that her headaches and memory disturbance prevented her from engaging in other work. Due to the dispute over material facts, the district court’s grant of summary judgment is in error. Accordingly, the Court vacated the summary judgment and remanded the case.

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