ERISA-Seventh Circuit Holds That A Doctor Is Not Entitled To Long-Term Disability Benefits

In Marantz v. Permanente Medical Group, Inc., No. 10-1136 (7th Cir. 2012), the plaintiff, Dr. Susan Marantz (“Dr. Marantz”) sued her employer, the Permanente Medical Group, Inc. (“Permanente”), and the Life Insurance Company of North America (“LINA”), claiming that they violated ERISA by refusing to provide her with long-term disability (“LTD”) payments as required under Permanente’s disability insurance plan (the “Plan”). LINA-as plan administrator- denied that Dr. Marantz qualified for the benefits. The district court held that Dr. Marantz did not satisfy her burden of proving that in April 2005 she was entitled to LTD benefits under the terms of the Plan. On appeal, the Seventh Circuit Court of Appeal (the “Court”) affirmed the holding of the district court.

Dr. Marantz was employed as a doctor by Permanente, and became covered under the Plan. At Permanente, she was chief of pulmonary care. In response to back pain, in 1997 Dr. Marantz underwent surgery to treat a herniated disc and degenerative disc disease, but the surgery did not eliminate her pain and, as of August 1999, she stopped working full time. On October 13, 1999, Dr. Marantz filed a claim with LINA seeking LTD benefits under the Plan, claiming that radiculopathy, pain, and paresthesia prevented her from performing her duties as chief of pulmonary care. The Plan stated, in pertinent part that “After Disability Benefits have been payable for 60 months, you are Disabled if your Injury or Sickness makes you unable to perform all the material duties of any occupation for which you may reasonably become qualified based on education, training or experience, or solely due to Injury or Sickness, you are unable to earn more than 80% of your Indexed Covered Earnings”. LINA approved payment of the LTD benefits for 60 months, but then questioned if Dr. Marantz continued to be Disabled under the Plan. LINA determined that she was not, and stopped benefit payments. This suit ensued.

The Court reviewed the evidence in the case, including a surveillance video, a functional capacity evaluation, and reports and testimony of treating physicians and LINA’s physicians. Based on this evidence, the Court concluded that Dr. Marantz was unable to prove that she was “Disabled” within the meaning of the Plan. Accordingly, the Court affirmed the district court’s holding.

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