Cullett v. Kanawha Insurance Company, 1:12-cv-01501

Kathleen Cullett received long-term disability (LTD) benefits from Kanawha under an ERISA-governed employer plan after diagnoses including Sjogren’s syndrome and fibromyalgia; benefits were approved April 2011 and terminated February 27, 2012.
The Plan defines disability for the first 24 months post-elimination period as inability to perform one or more "Essential Duties" of "Your Occupation" (a generalized occupation standard); after 24 months the standard becomes "Any Occupation."
Cullett’s treating physicians (primary care Dr. McCrea and rheumatologist Dr. Getz) opined she could not work full-time based largely on her subjective reports of fatigue and episodic incapacitation; they acknowledged objective tests are limited for fatigue-related disorders.
Kanawha relied on surveillance video, two independent physician reviewers (Drs. Alghafeer and Cooper), and the Social Security Administration’s denial to conclude Cullett could perform her occupation and terminated benefits.
Magistrate Judge ordered de novo review; discovery completed and both parties moved for summary judgment. The court limited review to the "Your Occupation" (first 24-month) standard and found genuine disputes requiring a bench trial.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Proper standard of review	De novo review applies (Magistrate already ruled)	Agreed Magistrate ruling controls	Court applied de novo (independent decision), not arbitrary-and-capricious
Whether travel is an essential duty of her occupation	Travel required by OSF made it essential	Travel was employer-specific and not essential to the generalized occupation	Travel is not an Essential Duty under the Plan’s "Your Occupation" definition
Whether subjective (self-reported) symptoms suffice to prove disability under the Plan	Treating physicians’ opinions based on subjective reports are valid evidence; objective tests may not exist for fatigue conditions	Plan can rely on objective evidence and independent reviewers; claimant lacks objective proof of functional limitation	Subjective evidence (supported by treating physicians) is admissible; cannot grant summary judgment for defendant on this basis
Admissibility/weight of independent reviewers and SSA decision	Contested that reviewers were not properly disclosed and SSA finding is not binding or controlling	Reviewers were consulted pre-litigation and are part of the administrative record; SSA decision is relevant	Reviewers’ opinions and SSA denial are admissible and create genuine factual disputes; summary judgment denied for both sides

Krolnick v. Prudential Ins. Co. of Am., 570 F.3d 841 (7th Cir. 2009) (explaining de novo review is an independent decision and permitting discovery beyond the administrative record)
Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640 (7th Cir. 2007) (court must make an independent decision on disability under de novo review)
Williams v. Aetna Life Ins. Co., 509 F.3d 317 (7th Cir. 2007) (plans may require objective documentation and give it dispositive weight depending on plan language)
Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914 (7th Cir. 2003) (it is arbitrary to reject subjective symptom-based claims when objective verification is unavailable)
Pakovich v. Broadspire Servs., Inc., 535 F.3d 601 (7th Cir. 2008) (courts may remand when the plan administrator never decided an issue such as the "any occupation" standard)
Seman v. FMC Corp. Retirement Plan for Hourly Employees, 334 F.3d 728 (8th Cir. 2003) (when administrator fails to render a decision, courts should remand for an initial determination)
Mote v. Aetna Life Ins. Co., 502 F.3d 601 (7th Cir. 2007) (SSA determinations are often instructive in LTD cases)
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (U.S. 1989) (ERISA benefits claims are governed by contract principles and the plan’s language controls)
Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (U.S. 1986) (summary judgment standard: genuine dispute of material fact precludes judgment)