Stern subsequently denied speaking to anyone from "Broadsprire Insurance." (UPS 0177.) As a result, UPS submitted plaintiff's claim for peer review two more times. Ennis's report states that the phone conference "confirms the fact that there are no objective findings on physical examination, which would preclude claimant from returning to the core activities of his own work." (UPS 149) Stern as part of the peer review process, and Dr. Ennis reviewed plaintiff's claim at the request of UPS. Plaintiff administratively appealed his benefits denial. The Committee, however, found no evidence in the record to support a claim of continuing disability after December 18, 2005. (UPS 0120-121.) Benefits were temporarily suspended from Novemto December 18, 2005, but based on additional medical information submitted by plaintiff during his administrative appeal, the UPS Claims Review Committee approved retroactive benefits for that period. Stern's evaluation of the objective medical evidence, and in accordance with the terms of the Plan, UPS approved short-term disability payments from Septemthrough December 18, 2005. Stern indicated that plaintiff could return to work on Decemwith the following restrictions: no lifting over ten pounds, no repetitive bending, and no repetitive flexion/extension of the cervical area.īased on Dr. Stern opined that plaintiff was unable to work through December 12, 2005. He further opined that plaintiff should be off work for two weeks, at which time he would be reevaluated. Stern noted that there "may be a bipolar C2-3, non-compressive and slightly bulging disc." (UPS 160). Stern ordered a MRI of the cervical spine and noted that "x-rays were reviewed and seem to be within normal limits." (UPS 159.) The MRI "read out as basically negative," although Dr. Treatment notes from the emergency room indicate that "here is no fracture, subluxation, destructive lesion or significant arthritis" and x-rays of the cervical spine were "essentially negative." (UPS 153). (UPS 0151-0152.) Plaintiff reported to work that day, but later reportedly suffered from headaches and neck tightness and left work to go to the emergency room. On September 27, 2005, plaintiff was involved in an automobile accident when his car was rear-ended by another car. the exclusive right and discretion to interpret the terms and conditions of the Plan, and to decide all matters arising in its administration and operation, including questions of fact and issues pertaining to eligibility for, and the amount of, benefits to be paid by the Plan." (UPS 0094.) 3
The Plan also grants UPS, "as Plan Administrator. The burden is on the employee to provide objective medical information supporting a claim for disability. (UPS 0058.) Pursuant to the Plan, employees are considered disabled and therefore entitled to STD payments if the Claims Administrator determines that "you are limited from performing the material and substantial duties of your regular occupation because of a non-occupational illness or injury." Id. Under the terms of the Plan, part-time employees may be eligible for up to 26 weeks of short-term disability (STD) payments. As an eligible employee of UPS, plaintiff was a participant, as that term is defined by ERISA, in a plan of short-term disability coverage (the "Plan"). UPS employed plaintiff as a part-time "pickoff" worker, responsible for sorting packages, that weighed on average twelve pounds, by pushing, pulling, sliding, and infrequently lifting the packages onto the correct chutes or rollers. The parties have consented to disposition by the United States Magistrate Judge pursuant to 28 U.S.C. 14) and the parties' cross-motions for judgment on the administrative record. Now before the Court is the Administrative Record, including a copy of the Plan (Doc. Through this civil action, Plaintiff seeks a reinstatement of the payment of these benefits. At that latter time, UPS found no evidence in the record supporting a continuing claim of disability after Decemand, therefore, UPS then discontinued paying such benefits. Plaintiff was awarded short-term disability benefits from Septemthrough December 18, 2005. Relief is sought from the UPS Health and Welfare Package ("UPS"), the Plan Administrator of UPS's short-term disability policy (the "Plan") (AR UPS 0001-0099).
This is an ERISA 1 benefits recovery action through which plaintiff seeks an award of disability benefits from his former employer, United Parcel Services.
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