Plaintiff-Appellant Patricia O’Hara appeals from a judgment of the United States District Court for the Western District of New York (Larimer, /.) granting summary judgment to Defendant-Appellee National Union Fire Insurance Company of Pittsburgh, PA (“National Union”) and dismissing O’Hara’s claim for disability benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). National Union argues that O’Hara cannot recover disability benefits because she was present at work during the period of alleged disability. We disagree. O’Hara presented evidence that she was disabled during all periods required by National Union’s plan, and based on such evidence, a reasonable factfinder could conclude that O’Hara was entitled to disability benefits. Therefore, we vacate the district court’s judgment and remand for further proceedings.
I.
A.
In 1993, ITT Flygt Corporation (“ITT”) hired Patricia O’Hara as an office administrator. O’Hara had over 20 years of experience in office administration and management. During her employment, O’Hara participated in a voluntary disability insurance plan held by ITT and issued by National Union (“the plan” or “the National Union plan”). Under the plan, O’Hara was eligible to recover insurance proceeds if, as a result of an accidental injury, she was totally and permanently disabled and prevented from engaging in “each and every occupation or employment ... for which [she was] reasonably qualified by reason of [her] education, training or experience” (“qualified work”) within one year of the accident, and such disability continued for a year.
On March 15, 2001, while working in ITT’s Rochester, New York office, O’Hara tripped and fell, striking her head on the floor. She was taken to the emergency room, where she complained of headaches.
After the accident, O’Hara continued to work at ITT. By July 2001, three of O’Hara’s coworkers had complained to her supervisor that she was behaving unprofessionally and had difficulty maintaining satisfactory working relationships with colleagues. O’Hara’s supervisor found the complaints credible and discussed them with O’Hara, warning her that if she did not act in a professional manner, “[ITT] may have to terminate your employment with the company.” On June 6, 2002, ITT fired O’Hara because of her “performance
B.
After her fall in March 2001, O’Hara initially was treated by a neurologist, Dr. Tim Counihan. O’Hara took several medications prescribed by Dr. Counihan but reported that they did not alleviate her persistent headaches. In October 2001, O’Hara’s internist, Dr. David Sischy, referred her to a different neurologist, Dr. Joseph Mann. After Dr. Mann examined O’Hara on October 8, 2001, he wrote to O’Hara’s internist with his initial diagnosis. Dr. Mann stated that O’Hara was being evaluated for headaches that “were associated with a decrease in executive function, mood changes, and sleep disorder.” Dr. Mann noted that O’Hara had “daily” headaches that “seem[ed] to encircle the head” and could “worsen as the day goes on.” Dr. Mann concluded that “[m]y feeling at this point is that the patient has a post-traumatic headache disorder associated with problems with executive function, mood, and sleep.”
Dr. Mann continued treating O’Hara and sending written reports to Dr. Sischy. After an examination on February 14, 2002, Dr. Mann wrote that O’Hara “needs a nap” during many days and had to “constantly mak[e] notes at work and at home” to remember her tasks. Dr. Mann concluded that O’Hara “still has a post-traumatic headache disorder with memory disturbance.” Dr. Mann examined O’Hara again on March 14, 2002, less than one year after her March 15, 2001 injury. After this examination, Dr. Mann wrote that O’Hara “continues to have chronic daily headaches, insomnia, and also complains of pain involving her upper arms.” Dr. Mann described the headaches as “mostly posterior,” containing “migrainous components.” Dr. Mann concluded that O’Hara continued to have “memory disturbance” and that “[a]t this point, it appears that [O’Hara] continues with a post-traumatic headache disorder which she’s now had for a year.”
C.
A year after her injury, O’Hara continued seeking treatment from Dr. Mann. Over the course of O’Hara’s second year after her injury, Dr. Mann examined O’Hara at least six times. In July 2002, Dr. Mann noted that O’Hara was “completely disabled,” “unable to work,” and “continue[d] to be in severe pain intolerant of medications.” In August 2002, Dr. Mann again diagnosed O’Hara as suffering “a post traumatic headache disorder with sleep disturbance, memory disturbance, cognitive problems and chronic pain involving her neck and upper back area.” In November and December 2002, Dr. Mann stated that O’Hara remained “totally disabled.” In January 2003, Dr. Mann wrote that “[t]here has been no major change in [O’Hara’s] headache pattern,” as she continued to have “chronic daily headaches.” On March 14, 2003, Dr. Mann prescribed to O’Hara treatment used for patients with “intractable chronic daily headache[s].”
In mid-2002, while she was receiving treatment from Dr. Mann, O’Hara began treatment with a pain management specialist, Dr. Jaimala Thanik, whom Dr. Mann recommended. After the initial examination, Dr. Thanik concluded that “[O’Hara’s] pain problem is definitely post traumatic headaches” and diagnosed the headaches as “[m]uscle contraction headaches with a component of occipital neuralgia.” In February 2003, Dr. Thanik noted that “[O’Hara’s] symptoms remain about the same. Nothing seems to have worked for her.... She will continue working with Dr. Mann on headache management and see Dr. Kuttner for depression.”
In April 2003, more than two years after O’Hara’s accident, pain specialist Dr. Thanik recommended that O’Hara join a fitness center “for daily exercises, especially swimming, walking, etc.,” and noted that “I also have suggested that she may try going back to work doing half days with restrictions of no repetitive type work.” In May 2003, Dr. Thanik noted that “[t]he patient continues to have constant pain.”
D.
On January 29, 2004, O’Hara submitted a claim for disability benefits under the National Union disability plan. AIG Domestic Claims, Inc. (“AIG”) processed O’Hara’s claims and reviewed O’Hara’s medical records and workers’ compensation medical reports.
At AIG’s request, Dr. David Marzulo, a neurologist, examined O’Hara on September 12, 2005. After the examination, Dr. Marzulo stated that given the probability that O’Hara’s continued employment in her present position would be marred by “deficiencies in recalling conversations, verbal transactions, and other minute to minute and hour to hour activities in a busy office setting,” he did not “feel that she can perform her pre-injury occupation.” Moreover, Dr. Marzulo observed that “[O’Hara’s] disability was present from March 15, 2001,” the date of the accident. However, Dr. Marzulo felt this was “a partial disability” and that “[a] low emotional stress job duty which would not necessitate a multitude of recall actions or marked responsibility on the part of the claimant I feel could be initiated on a part time basis ie. up to 20 hours per week initially as a so-called testing ground.”
On January 6, 2006, AIG denied O’Hara’s claim for benefits, stating that “while there is proof that [O’Hara was] disabled from [her] own job, there is [a] lack of objective medical evidence showing [disability] from any employment.” AIG concluded that “there is neither proof of a generalized inability to work nor have any of [O’Hara’s] doctors actually opined that [her] disability is permanent, as required by the policy.”
On March 3, 2006, O’Hara appealed and on April 17, 2006 AIG requested that O’Hara “provide documentation that substantiates the information that you have presented in your letter.” In response, O’Hara submitted a June 28, 2006 letter from Dr. Mann. In the letter, Dr. Mann wrote that “[immediately after [O’Hara’s March 15, 2001 injury], and continuously, she was disabled because of posttraumatic migrainous headache disorder with chronic daily headache pattern.” Moreover, Dr. Mann stated that O’Hara had “developed a posttraumatic stress disorder with depression.” Dr. Mann concluded that:
[O’Hara] was totally disabled and prevented from engaging in each and every occupation or employment for compensation or profit that she was reasonably qualified for within 1 year of the March 15, 2001 fall.
On March 18, 2008, O’Hara filed suit against National Union in the Western District of New York, alleging that National Union violated ERISA by denying her disability benefits. About a year later, National Union moved for summary judgment. On March 23, 2010, the district court granted National Union’s motion.
O’Hara v. Nat’l Union Fire Ins. Co. of Pittsburgh, PA,
First, the district court considered whether O’Hara’s notice of claim was untimely. Under the plan, a notice of claim must be submitted “within twenty days after the occurrence or commencement of any loss covered by [the] policy, or as soon thereafter as is reasonably possible.”
Id.
at 478 (emphasis omitted). Although O’Hara filed her claim on January 29, 2004 — well outside the twenty-day window specified in the plan — the district court concluded that because National Union “never objected to the timeliness of O’Hara’s claim, or suggested anywhere that her notice of claim had not been filed ‘as soon as [was] reasonably possible’ in light of the nature and progression of O’Hara’s disability,” it had waived that defense.
Id.
(citing
Shutts v. First Unum Life Ins. Co. of Am.,
Second, the district court reviewed, on a motion for summary judgment, National Union’s denial of benefits. Because the plan does not give the plan administrator discretionary authority to determine benefits, the district court stated that it could review “all aspects of the administrator’s eligibility determination, including fact issues, de novo.”
O’Hara,
Applying this standard of review, the district court found that:
the denial of O’Hara’s application for disability benefits was based on sufficient evidence, because there is no credible proof that O’Hara suffered from a permanent and total disability which “commenced] within one year of the date of the accident.”
Id. at 478-79. The district court stated that:
To the extent that O’Hara purports to rely on Dr. Mann’s June 28, 2006 letter opining that O’Hara became totally disabled in the year following her accident, I find that this letter, which contains no analysis whatsoever, is unsupported by any medical or other evidence, and in fact, is contradicted by other medical evidence in the record.
Id. at 480. The district court concluded that National Union’s denial of benefits to O’Hara “was correct, and is supported by sufficient evidence of record.” Id. at 482.
II.
A.
We review de novo a district court’s grant of summary judgment in an ERISA action.
Hobson v. Metro. Life Ins. Co.,
Although there is no right to a jury trial in a suit brought to recover ERISA benefits,
see, e.g., Tischmann v. ITT/Sheraton Corp.,
Here, the parties did not stipulate to a “summary trial” or a “bench trial ‘on the papers,’ ” and thus the district court was obliged to proceed in traditional summary judgment fashion.
B.
The threshold question is whether the district court correctly applied our well-settled standard of review for summary judgment. We conclude that it did not.
The district court correctly determined that because National Union’s plan fails to explicitly vest the plan administrator with “discretionary authority to determine eligibility for benefits,” the administrator’s denial of benefits is not entitled to deference.
O’Hara,
After reviewing the record, the district court concluded that the plan administrator’s decision was supported by “sufficient evidence.”
O’Hara,
Accordingly, the district court failed to properly apply the summary judgment standard set forth by this Court. That error requires a remand to the district court for reconsideration in light of the applicable legal standard.
See Davidson v. Chestnut,
C.
Under the plan, O’Hara is eligible for benefits if:
as the result of injury and commencing within one year of the date of the accident [she] is totally and permanently disabled and prevented from engaging in each and every occupation and employment for compensation or profit for which [she] is reasonably qualified by reason of [her] education, training or experience ... [and] such disability has continued for a period of twelve consecutive months and is total, continuous and permanent at the end of this period....
That is, O’Hara is eligible for benefits under the plan if she is totally and permanently disabled from qualified work and that disability commences within one year of the accident and continued for at least one year. For example, if, as a result of an accident on March 15, 2001, O’Hara were totally and permanently disabled from qualified work as of December 1, 2001, she would be eligible for benefits on December 1, 2002. If, on the other hand, she became totally and permanently disabled from qualified work as of March 16, 2002, she would not be eligible for benefits regardless of the length of her disability.
National Union argues that O’Hara cannot make such a showing, and thus summary judgment for National Union was proper. In particular, National Union argues that: (1) O’Hara is ineligible for benefits because she was present at work during a period in which she now claims she was disabled; (2) there is no genuine dispute about whether, within one year of the accident, O’Hara was totally and per
1.
National Union argues that because O’Hara “continue[d] to report for work” during a period of disability required for benefits under her plan, O’Hara “cannot simultaneously be deemed ‘disabled’ for purposes of receiving benefits under an ERISA plan.”
National Union claims that our decision in
Kunstenaar v. Conn. Gen. Life Ins. Co.,
We recently reiterated this understanding of
Kunstenaar,
rejecting an insurer’s argument that “an insured who works full time until quitting or being terminated cannot recover benefits, even if allegedly suffering from an illness at the time.”
Locher v. Unum Life Ins. Co. of America,
In sum, neither
Kunstenaar
nor
Locher
stands for the blanket rule that an employee, as a matter of law, cannot be disabled when she is present at work. One may be at one’s place of employment but not able to work. An employee’s continued presence at her place of employment does not preclude a finding of disability when there is evidence that the
Here, O’Hara reported to work until she was fired on June 6, 2002 — almost 15 months after her accident — and now argues that she was disabled within 12 months of her accident. Pursuant to Kunstenaar and Locher, we must determine whether O’Hara presented evidence from which a reasonable factfinder could conclude that she was disabled within the meaning of the National Union plan.
2.
National Union argues that no reasonable factfinder could determine that, as of March 15, 2002, O’Hara was totally and permanently disabled from engaging in qualified work.
Both parties agree that under the explicit terms of the plan, O’Hara need not be totally and permanently disabled from engaging in every occupation providing any compensation. Rather, O’Hara need only be totally and permanently disabled from engaging in “each and every occupation and employment for compensation or profit for which [she] is reasonably qualified by reason of [her] education, training or experience.” Under this plan, O’Hara is ineligible for benefits if, at any point within two years of her accident, she could engage in occupations or employment “rising to the dignity of an income or livelihood” and for which she was reasonably qualified.
See Demirovic v. Bldg. Serv. 82 B-J Pension Fund,
O’Hara claims that, within one year of her accident, her head injury totally and permanently disabled her from engaging in any occupation rising to the dignity of an income or livelihood — much less an occupation for which she was reasonably qualified. In June 2006, Dr. Mann affirmed that O’Hara was totally disabled from qualified work “within 1 year of the March 15, 2001 fall.” Dr. Mann’s contemporaneous notes indicate that within a year of her accident, O’Hara “ha[d] a post-traumatic headache disorder with memory disturbance.” As the district court observed, the record contains “substantial evidence” that “the onset and intensification of impaired executive functions stemming from her fall ... caused her to be disabled from her job as an administrative assistant at ITT on or before March 15, 2002.”
O’Hara,
National Union disagrees with such a conclusion and principally objects to any reliance on Dr. Mann’s June 2006 letter stating that O’Hara had been totally disabled from qualified work “within 1 year of the March 15, 2001 fall.” National Union emphasizes that Dr. Mann did not state by March 15, 2002 that O’Hara was totally and permanently disabled from qualified
In sum, there is a genuine dispute regarding whether O’Hara was totally and permanently disabled from qualified work within a year after her accident.
3.
Lastly, National Union argues that there is no genuine dispute about whether O’Hara remained totally and permanently disabled from qualified work “for a period of twelve consecutive months.” We disagree. A reasonable factfinder could conclude that Dr. Mann’s diagnoses were consistent from his first examination of O’Hara in October 2001 until his letter to National Union in June 2006. During this period, Dr. Mann noted that O’Hara continued to suffer from “daily headaches that build up as the day progresses” and he concluded that O’Hara was “totally disabled from employment.” In November and December 2002, Dr. Mann stated that O’Hara “remains totally disabled” and in January 2008 he saw “no major change in her headache pattern,” as she continued to have “chronic daily headaches,” for which he could not “see a ready explanation.” On March 14, 2003, Dr. Mann prescribed to O’Hara treatment used for patients with “intractable chronic daily headache[s].”
Despite this evidence, National Union argues that four doctors disputed Dr. Mann’s opinion that O’Hara could not work, and therefore, no reasonable factfinder could find that, for two years after her accident, O’Hara had remained totally and permanently disabled from qualified work. O’Hara, in contrast, responds that the other four doctors neither made such a determination nor dealt with the precise medical issues diagnosed by Dr. Mann. First, in a report dated March 24, 2003 (shortly after the plan date to determine the status of the injury), psychiatrist Dr. Letourneau stated that O’Hara “has the type of depression typically associated with chronic pain, [which] reflects her loss of her previous functional abilities.” Dr. Letourneau concluded that because O’Hara “always cited her headaches, and never her emotional symptoms” as limiting her, she did not have a “psychiatric disability” and thus “[f]rom a psychiatric standpoint, she is able to return to work full-time.” O’Hara, however, argues not that she had a psychiatric disability resulting from depression, but a neurological disability resulting from a head injury. Second, in April 2003, pain specialist Dr. Thanik “suggested that [O’Hara] may try going back to work doing half days with restrictions of no repetitive type work.” Far from concluding that O’Hara was able to engage in qualified work, Dr. Thanik simply recommended that exercise may help and that O’Hara “may try” to go back to work, if such work was suitably restricted and short. Third, in July 2003, neurosurgeon Dr. Corkill stated that O’Hara had a “mild temporary and partial” disability, and did so only on the cover page of his report, without ex
Accordingly, genuine issues exist regarding whether O’Hara remained totally and permanently disabled from qualified work for at least one year starting at some time within the first year after her accident.
III.
We express no opinion about the ultimate merits of O’Hara’s claim. However, because a reasonable factfinder could conclude that O’Hara is entitled to disability benefits under the plan, we vacate the district court’s grant of summary judgment to National Union. Irrespective of whether a district court is tasked with reviewing a plan administrator’s denial of benefits de novo, a district court may not grant a motion for summary judgment if the record reveals a dispute over an issue of material fact. Because the evidence presented by O’Hara indicates there is such a dispute, the district court erred in granting National Union’s motion for summary judgment.
CONCLUSION
For the foregoing reasons, the district court’s judgment is VACATED and the case is REMANDED for further proceedings.
Notes
. The district court found that National Union waived its argument that O'Hara failed to file a timely notice of claim.
O'Hara,
