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Marantz v. Permanente Med. Group, Inc. Long Term Disability Plan

Marantz v. Permanente Med. Group, Inc. Long Term Disability Plan

United States Court of Appeals for the Seventh Circuit

January 6, 2011, Argued; July 10, 2012, Decided

No. 10-1136

Opinion

 [*322]  Rovner, Circuit Judge. Susan Marantz sued her employer, the Permanente Medical Group, Inc. and the Life Insurance Company of North America (LINA), claiming that they violated the Employee Retirement Income Securities Act (ERISA) by refusing to provide her with long-term disability payments as required under the employer's disability insurance plan. LINA denied that Dr. Marantz qualified for the benefits and the district court held that Dr. Marantz did not satisfy her burden of proving that in April 2005 she was entitled to long-term disability benefits under the terms of the policy. On appeal, we affirm the holding of the district court.

Before Susan Marantz  [**2] became a patient visiting many back and pain specialists, she was herself the doctor. From 1996 to 1999, Dr. Marantz practiced pulmonary and critical care medicine at a Kaiser Permanente Hospital in California. Before she left that position in 1999, Dr. Marantz served as the chief of pulmonary and critical care medicine, and as assistant head of quality assurance and director of utilization. She performed procedures such as bronchoscopes and intubations, inserted arterial lines, and was standing for many hours at a time. 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.

As a benefit of her employment with Kaiser Permanente, Dr. Marantz received disability insurance coverage from LINA. On October 13, 1999, Dr. Marantz filed a claim with LINA seeking long-term disability benefits, claiming that radiculopathy, pain, and paresthesia prevented her from performing her duties as chief of pulmonary care. The policy under which she made the claim stated as follows:

For purposes of coverage under the Policy, you are Disabled if,  [**3] because of Injury or Sickness, you are unable to perform all the material duties of your regular occupation, or solely due to Injury or Sickness, you are unable to earn more than 80% of your Indexed Covered Earnings.

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687 F.3d 320 *; 2012 U.S. App. LEXIS 14004 **; 2012 WL 2764792

SUSAN MARANTZ, Plaintiff-Appellant, v. PERMANENTE MEDICAL GROUP, INC. LONG TERM DISABILITY PLAN and LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendants-Appellees.

Prior History:  [**1] Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No. 1:06-cv-03051—James F. Holderman, Chief Judge.

Marantz v. Permanente Med. Group Inc. Long Term Disability Plan, 2009 U.S. Dist. LEXIS 118594 (N.D. Ill., Dec. 21, 2009)

CORE TERMS

district court, pain, disability, testing, surveillance, full-time, lift, earn, sit, evaluations, salary, sedentary, benefits, surveillance video, walking, shopping, disability benefits, pounds, occupation, public health, pulmonologist, limitations, termination, part-time, minutes, discomfort, long-term, pulmonary, claimant, medicine

Civil Procedure, Appeals, Standards of Review, Clearly Erroneous Review, Pensions & Benefits Law, Judicial Review, De Novo Standard of Review, Questions of Fact & Law, Judges, Inability to Proceed, Successor Judges, Dismissal, Voluntary Dismissals, Appellate Review, Discovery, Methods of Discovery, Stipulations, Trials, Bench Trials, De Novo Review, ERISA, Claim Procedures, Evidence, Demonstrative Evidence, Photographs, Visual Formats, Civil Litigation, Causes of Action, General Overview, Suits to Recover Plan Benefits