Holmstrom v. Metropolitan Life Ins. Co.

Decision Date31 March 2009
Docket NumberNo. 07-CV-6044.,07-CV-6044.
Citation615 F.Supp.2d 722
PartiesLanette HOLMSTROM, Plaintiff, v. METROPOLITAN LIFE INSURANCE, COMPANY and Experian Information Solutions, Inc. Employee Welfare Benefit Plan, Defendant. Metropolitan Life Insurance Company, Counter-Plaintiff v. Lanette Holmstrom, Counter-Defendant.
CourtU.S. District Court — Northern District of Illinois

Mark D. Debofsky, Daley, Debofsky & Bryant, Chicago, IL, for Plaintiff.

Michael J. Smith, W. Sebastian Von Schleicher, Smith, Von Schleicher & Associates, Chicago, IL, for Defendant.

Mark D. Debofsky, Daley, Debofsky & Bryant, Chicago, IL, for Counter Defendant.

MEMORANDUM OPINION AND ORDER

ROBERT M. DOW, JR., District Judge.

Plaintiff Lanette Holmstrom ("Holmstrom") filed a complaint initiating this action against Defendants Metropolitan Life Insurance Company ("Met Life") and Experian Information Solutions, Inc. Employee Welfare Benefit Plan (collectively "Defendants"). Defendants terminated Plaintiff's long term disability ("LTD") benefits and Plaintiff seeks review of that decision pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001, et seq. In addition to its answer, Met Life filed a one count counterclaim seeking to recover alleged overpayment of disability benefits to Plaintiff. Currently pending before the Court are cross motions for summary judgment filed by Holmstrom [30] and Defendants [45]. Also before the Court is Defendant Metropolitan Life's motion for summary judgment on its counterclaim [45]. For the following reasons, Plaintiff's motion for summary judgment [30] is denied and Defendants' motion for summary judgment [45] is granted in its entirety.1

I. Background2

Plaintiff was employed by Experian Information Solutions, Inc. ("Experian") as a senior training specialist in Experian's Schaumburg, Illinois office. Pl. SOF ¶ 5; Def. SOF ¶ 8. In 1999, she moved to Missouri and continued to work for Experian from home. Def. SOF ¶ 8. Her employment with Experian continued until January 2000, when she stopped working in order to undergo surgery for her right ulnar nerve entrapment and neuropathy. Def. SOF ¶ 8; Pl. SOF ¶ 10. Defendant Experian Information Solutions, Inc. Employee Welfare Benefit Plan is the Plan Administrator of a group long term disability benefit plan ("the Plan") provided to eligible employees of Experian. Pl. SOF ¶ 6. As a benefit of her employment with Experian, Plaintiff received coverage under the Plan. Id. ¶ 8. Defendant Met Life is an insurance company authorized and engaged in the business of providing insurance in the State of Illinois. Id. ¶ 7. Met Life underwrote and insured the policy of disability insurance at issue here, which had an effective date of September 1, 1999, and acted as the claims administrator for that policy. Id.

The Plan

Under the Plan, disability is defined as follows:

`Disabled' or `Disability' means that, due to sickness, pregnancy or accidental injury, you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis; and 1. during your Elimination Period and the next 24 month period, you are unable to earn more than 80% of your Predisability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy' or 2. after the 24 months period, you are unable to earn more than 60% of your Indexed Predisability Earnings from any employer in your Local Economy at any gainful occupation for which you are reasonably qualified taking into your account your training, education, experience and Predisability Earnings. Your loss of earnings must be a direct result of your sickness, pregnancy or accidental injury. Economic factors such as, but not limited to, recession, job obsolescence, paycuts and job-sharing will not be considered in determining whether you meet the loss of earnings test.

Pl. SOF ¶ 9; Def. SOF ¶ 2.

The Plan also states that "Your Monthly Benefit is reduced by Other Income Benefits shown below." Def. SOF ¶ 5. Benefits received because of the participant's disability under the Federal Social Security Act are included as "Other Income Benefits." Id. The "Monthly Benefit" "will not be further reduced due to cost-of-living increases payable under Other Income Benefits after the correct reduction has been determined." Id. The participant must refund "an amount equal to any Overpayment which resulted from any period in which we were entitled to, but did not, reduce your Monthly Benefit." Id. The Plan also states that "[w]e have the right to recover from you any amount that we determine to be an Overpayment. You have the obligation to refund to us any such amount." Def. SOF ¶ 6.

Claim History

On December 15, 1999, neurologist Diane Cornelison, D.O., wrote a letter to Eric Lomax, M.D. following her examination of Plaintiff. Def. SOF ¶ 9; Pl. SOF ¶ 18. In the introduction, Dr. Cornelison noted that Holmstrom "has had ongoing numbness and tingling predominantly of the right hand of the fourth and fifth digits for approximately eight years, progressively worse" and the "numbness and tingling does awaken her and is aggravated with any type of repetitive movement." Pl. SOF ¶ 18; Pl. Resp. ¶ 9.3 Based on a nerve conduction electromyogram ("EMG") study, Dr. Cornelison concluded as follows:

IMPRESSION: This is an abnormal study consistent with:

1. Right ulnar neuropathy, which is electrically mild to moderate with evidence of ongoing denervation. The compression appears to be about the ulnar groove and just distal to the ulnar groove.

2. There is no electrical evidence to support a right carpal tunnel syndrome.

3. There is no electrical evidence to support a left ulnar neuropathy.

4. There is no electrical evidence to support a right cervical radiculopathy.

CONCLUSION: We will refer back to you for possible surgical intervention.

Def. SOF ¶ 9; Pl. SOF ¶ 18.

On January 5, 2000, Dr. Lomax performed surgery on Plaintiff in an attempt to correct her ulnar compression. Def. SOF ¶ 9; Pl. SOF ¶ 19. Following surgery, Met Life paid short term disability benefits to Holmstrom for twenty-six weeks, the maximum period under the Plan. Def. SOF ¶ 10; Pl. SOF ¶ 11. On April 20, 2000, Holmstrom visited Dr. Cornelison complaining of pain in her right elbow and wrist. Def. SOF ¶ 11. Dr. Cornelison noted "Tinel's was positive on examination over the ulnar nerves bilaterally" and injected the ulnar scarring with Depo-Medrol. Pl. Resp. ¶ 11. Holmstrom then received another EMG from Dr. Cornelison on May 17, 2000, which noted "electrically mild" evidence of a nerve condition block adjacent to the scar tissue on Plaintiff's right elbow. Def. SOF ¶ 11; Pl. SOF ¶ 20. On June 6, 2000, Dr. Lomax performed surgery on Plaintiff to release a section of her ulnar nerve entrapped by scar tissue. Def. SOF ¶ 12; Pl. SOF ¶ 20. Following the second surgery, Plaintiff was prescribed Percocet and Oxycontin, although she complained that the Oxycontin made her too nauseated. Id.

Met Life approved Holmstrom's claim for long term disability on June 27, 2000 at the rate of $2,591.78 per month. Def. SOF ¶ 13; Pl. SOF ¶ 12. On that same date Met Life noted "expected recovery time is at 6 weeks from [surgery] on 06/06/00." Def. SOF ¶ 13. Met Life's rationale for that date was Holmstrom's "[attending physician] states that [patient] will need 6 [weeks] to recover [status post] surgery on 06/06/00." Id.

On August 2, 2000, Dr. Lomax called Met Life and reported "his concern for [Holmstrom's] questionable disability." Def. SOF ¶ 14. He stated that "[Holmstrom] is not getting any better and she should be"; "her symptoms keep changing at every visit"; "at one occasion where [Holmstrom] approached him to shake hands, [she] had to think about not using the disabling arm"; and "there are no neurological or clinical problems that can be identified." Id. Dr. Lomax then requested that Met Life obtain a functional capacity evaluation ("FCE") to assess Plaintiff's physical capabilities. Id.

Holmstrom underwent an FCE on October 18 and 19, 2000. Def. SOF ¶ 15; Pl. SOF ¶ 22. The report stated:

Pain Behavior: Client presents with a very guarded/protective posturing of the right upper extremity in adduction, 90 degree elbow flexion with slight shoulder elevation. All lifts and carries were calculated and slow with minimal evidence of full right hand grasp for gross and fine motor activities. Client's pain behavior and c/o pain were consistent and directly related to activities that stressed the r. arm and hand during activity. Client demonstrates avoidance of active use of right upper extremity/hand unilaterally and as a bilateral asset.

Safety: Client demonstrated good body mechanics and evidenced understanding of safety techniques.

Quality of Movement: Slow, guarded and cautious. Transfer of hand dominance from right to left. Fatigue consistently throughout day one and day two as well as from day one to day two. Fine motor coordination/dexterity in the right is rigid and choppy and very laborious.

Significant Abilities: Sitting tolerance. Gross motor movement in a variety of planes void of the use of the bilateral upper extremities in stressed or prolonged positions. Good lower extremity and trunk ROM and strength. Excellent communication skills and evidences a self motivated and goal oriented approach to responsibilities.

Significant Defects: Bilateral upper extremity weakness and endurance. Poor bilateral fine motor dexterity and coordination with client attempting to compensate by changing hand dominance from right to left. Below average strength in the right hand for grip and low average in the left.

Job Description Explored: According to results of the FCE she best matches the definition of "sedentary" given by the Department of Labor. However, many sedentary jobs require varying levels of hand coordination, dexterity and strength. Please refer to the FCE report for results. Due to not...

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