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Hamma v. Intel Corp.

March 20, 2009

DENISE K. HAMMA, PLAINTIFF,
v.
INTEL CORPORATION; INTEL CORPORATION LONG TERM; DISABILITY BENEFIT PLAN; INTEL DISABILITY APPEALS COMMITTEE; AND MATRIX ABSENCE MANAGEMENT, INC., DEFENDANTS.



The opinion of the court was delivered by: Garland E. Burrell, Jr. United States District Judge

ORDER

Defendants Intel Corporation, Intel Corporation Long Term Disability Plan, Intel Disability Appeals Committee (collectively "Intel"), and Matrix Absence Management ("Matrix") seek summary judgment on Plaintiff's claim under 29 U.S.C. § 1132(a)(1)(b) ("ERISA") for long term disability ("LTD") benefits. Plaintiff opposes the motion and requests in her Opposition brief that summary judgment be granted in her favor. Plaintiff's motion has not been duly noticed for hearing and is denied on that ground. The parties dispute whether Defendants abused their discretion in determining Plaintiff did not present "Objective Medical Findings" that her condition, Chiari I Malformation, was a "Disability" as defined by the LTD Plan (the "Plan"). Additionally, the parties dispute whether Plaintiff's claim should be evaluated under an abuse of discretion standard of review or a heightened standard of review since Intel funded the Plan.

Background

Plaintiff worked at Intel from June 2000 until February 2004 as an Administrative Support Specialist. On March 12, 2004, Plaintiff applied for LTD benefits under the Plan, listing her disabling condition as "Chiari malformation and Syringomyelia." (Pl. Application for LTD Benefits.) Plaintiff had previously applied for and been granted short term disability benefits under a separate plan offered to Intel employees.

Beginning in 1994, Intel delegated the responsibility for administration of the Plan to an independent third party, Matrix. Matrix makes an initial determination whether to award or deny LTD benefits to Intel employees applying for LTD benefits. If Matrix denies an application for LTD benefits, an employee may appeal his or her claim to the Intel Disability Appeals Committee ("Appeals Committee"), which is comprised of Intel employees. However, even during the appeal, Matrix acts as an intermediary, assisting employees to organize their appeal files and to obtain additional physician review of their files. The Plan granted discretion to Matrix and the Appeals Committee to make factual determinations and to interpret the terms of the Plan.

Under the Plan terms, disability is defined as "an illness or injury substantiated by objective medical findings and which renders a participant incapable of performing work." (Intel Corporation Long Term Disability Plan, 2.05.) "Objective medical findings" are defined by the Plan "as a measurable abnormality which is evidenced by one or more standard medical diagnostic procedures;" objective medical findings do not include "physicians' opinions or other third party opinions based solely on the acceptance of subjective complaints." (Id. at 2.14.) Under the Plan, even if a disability is generally recognized by the medical community and is substantiated by objective medical findings, "it will not be considered disabling if the Participant had such illness, injury or condition on the date of hire by the Company unless it can be shown by further objective medical findings that such illness, injury or condition materially deteriorated since the date of hire by the company." (Id. at 4.03(L).)

Following Matrix's receipt of Plaintiff's application, it requested and received Plaintiff's medical records from numerous physicians. (June 25, 2005 Letter from Matrix to Plaintiff.) Matrix then contacted Doctor Experts, a referral agency for independent review of medical files, in order to arrange for Plaintiff's medical records to be reviewed by an independent physician. Doctor Experts then hired Dr. Burres, and Dr. Burres reviewed Plaintiff's medical records. (Dr. Kenneth Burres, Independent Medical Examination, Ex. 21 at 7.) Thereafter, Dr. Burres concluded that "[Plaintiff is capable of performing her sedentary job at Intel [ ], and [he found] no objective or substantive reason why restrictions or limitations should be placed [on Plaintiff]." (Id. at 8.)

Matrix relied upon Dr. Burres's review and notified Plaintiff that her application for LTD benefits had been denied. Matrix explained that "the current objective medical findings do not support a disability as defined by the Plan." (Letter from Matrix Absence Management, Inc., Exhibit 2.) Matrix further notified Plaintiff that her LTD benefits claim was being denied because her condition existed prior to her employment with Intel. (Id.)

On December 2, 2004, Plaintiff appealed Matrix's denial of her LTD benefits claim. Plaintiff submitted additional information to Matrix, the entity that prepared Plaintiff's appeal file, to substantiate her claim for LTD benefits. For purposes of the appeal, Matrix consulted CORE, an independent clearinghouse for medical peer reviews, and requested that a neurologist review Plaintiff's file. CORE hired Dr. Sands, a neurologist, who concluded:

The patients [ ] pain complaints involve both upper and lower extremities and back while no signs of neurologic damage are present. . . Therefore, not only are there no objective physical findings, but the symptoms fit no pattern supportive of a precise diagnosis . . . The objective medical findings are not of so severe a nature to prevent the patient from performing any occupation for which she is or becomes qualified for based on education, training, and experience.

(Dr. Jonathan Sands Report, Ex. 28 at 1-2.)

The Appeals Committee considered Plaintiff's appeal on August 18, 2005 and affirmed Matrix's denial of LTD benefits. On September 1, 2005, Plaintiff was notified of the Appeals Committee's decision. On August 31, 2007, Plaintiff filed a complaint against Defendants for wrongful denial of benefits.

Analysis

Standard of ...


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