99 F.3d 181 (6th Cir. 1996), 95-5269, Parker v. Metropolitan Life Ins. Co.

Docket Nº:95-5269.
Citation:99 F.3d 181
Party Name:Ouida Sue PARKER, Plaintiff-Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, Schering-Plough Corporation, and Schering-Plough Health Care Products, Inc., Defendants-Appellees.
Case Date:October 25, 1996
Court:United States Courts of Appeals, Court of Appeals for the Sixth Circuit
 
FREE EXCERPT

Page 181

99 F.3d 181 (6th Cir. 1996)

Ouida Sue PARKER, Plaintiff-Appellant,

v.

METROPOLITAN LIFE INSURANCE COMPANY, Schering-Plough

Corporation, and Schering-Plough Health Care

Products, Inc., Defendants-Appellees.

No. 95-5269.

United States Court of Appeals, Sixth Circuit

October 25, 1996

Argued April 9, 1996.

Page 182

[Copyrighted Material Omitted]

Page 183

Roger K. Rutledge (briefed), Kaye G. Burson (argued and briefed), Memphis, TN, for Ouida Sue Parker.

Joseph Trovato (briefed), New York City, John J. Heflin, Rickey, Bourland, Heflin & Alvarez, Memphis, TN, Alan E. Lazarescu, Allan M. Marcus (argued and briefed), New York City, for Metropolitan Life Insurance Co.

Frederick J. Lewis (argued and briefed), Rhonda M. Taylor (briefed), McKnight, Hudson, Lewis & Henderson, Memphis, TN, for Schering-Plough Corporation, Schering-Plough Health Care Products, Inc.

Caroline G. LaCheen (briefed), New York Lawyers for the Public Interest, New York City, for AIDS Action Council, American Foundation for AIDS Research, American Public Health Association, National Alliance for the Mentally Ill, National Association of Protection and Advocacy Systems, National Minority AIDS Council, Amici Curiae.

Ann E. Reesman (briefed), McGuiness & Williams, Washington, DC, Gail S. Coleman (briefed), Mary L. Clark (argued), Office of the General Counsel, Washington, DC, for Equal Employment Advisory Council, Amicus Curiae.

Before: MERRITT and MILBURN, Circuit Judges; and O'MALLEY, District Judge. [*]

MERRITT, Circuit Judge.

Plaintiff filed this action against her employer, Schering-Plough, and her employer's insurance company, Metropolitan Life, under the Americans with Disabilities Act ("Disabilities Act" or "the Act"), 42 U.S.C. §§ 12101-12213, and the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001-1461. After working for Schering for nine years, the Plaintiff became totally disabled due to "severe depression." Under the long term disability plan offered through her employer, she was given benefits for twenty-four months. Because her disability was deemed to be caused by a "nervous/mental" disorder, her benefits were then cut off. Had her disability been due to physical problems, she would have continued to receive benefits until the age of 65.

The District Court found that the Plaintiff did not have standing to sue under Title I of the Disabilities Act because she is not a "qualified individual with a disability," due to the fact that she can no longer perform the essential functions of her job. The District Court also held that the Plaintiff does not have standing to sue under Title III of the Disabilities Act because she was not denied physical access to goods or services. And finally, the District Court granted Defendants' motion for summary judgment on Plaintiff's ERISA claim because it found that Defendants' classification of Plaintiff's disorder as "nervous/mental," rather than physical, was not arbitrary and capricious. We AFFIRM the decisions of the District Court with respect to Plaintiff's ERISA and Title I claims.

The decision of the District Court with respect to Plaintiff's Title III claim, however, must be REVERSED. The statutory language of the Disabilities Act is sufficiently broad to prohibit discrimination in the contents of insurance products, not just physical access to insurance company offices. In addition, the legislative history of the Act, agency interpretation, and interpreting case law all support the conclusion that the Disabilities Act prohibits discrimination in the

Page 184

contents of insurance products. Thus, the Plaintiff has standing to bring her Title III claim. Plaintiff must still prove, however, that the specific differentiation engaged in here, where those with nervous/mental disorders are treated differently from those with physical disorders in the provision of long term disability benefits, is, as a substantive matter, discriminatory under the Disabilities Act. We therefore REMAND this case for further proceedings consistent with this opinion.

I. Facts and Procedural History

Ouida Sue Parker worked for Schering-Plough from 1981 until 1990. During that time, she chose to participate in Schering's Long Term Disability plan, which was administered through Metropolitan Life Insurance Company. According to her complaint, on October 29, 1990, she became totally disabled due to "chronic severe major depression of a physical origin."

Ms. Parker began receiving benefits on April 29, 1993, after the twenty-six week waiting period expired. Under the MetLife Disability Plan, persons who are deemed to be totally disabled due to a mental or nervous disorder can receive benefits for up to twenty-four months. (Persons "fully disabled" under the plan are those who, because of sickness or injury, cannot do their job.) At the end of the twenty-four months, benefits continue only if the person is confined to a hospital or qualified institution. In contrast, persons considered totally disabled due to physical disorders receive benefits until the age of sixty-five.

During the period in which Ms. Parker was receiving disability benefits, her doctor sent MetLife reports indicating that she remained totally disabled primarily due to "major depression" and secondarily due to "generalized anxiety disorder." MetLife wrote to her on April 15, 1993, indicating that benefits would terminate on the 29th of that month. Ms. Parker appealed the decision, arguing that her disability could not be considered completely mental and nervous. MetLife denied the appeal, stating that major depression falls under the mental/nervous disorder provision. In May, 1993, Ms. Parker's doctor again wrote to MetLife, stating that the major depression she suffered was "a chemical disorder of a deepseated nature." MetLife had one of its consulting psychiatrists review the file. He concluded that:

Irrespective of any chemical factors in its etiology, major depression is a DSM III R diagnosis; Ms. Parker is being treated by a psychiatrist with psychoactive medication. In my opinion, her major depression should be reimbursed under the nervous/mental illness clause of her contract.

MetLife again upheld the termination of her benefits.

Ms. Parker then filed this action, alleging violations of Titles I and III of the Americans with Disabilities Act and a violation of the Employee Retirement Income Security Act. The District Court granted Defendants' motions for summary judgment. First, it found that Ms. Parker did not have standing to sue under Title I of the Disabilities Act, because the statute provides relief only to "qualified individuals with a disability" and, at the time her benefits were terminated, Ms. Parker was not a "qualified individual with a disability" because her disorder prevented her from "performing the essential functions of her job." The District Court also dismissed Ms. Parker's claim against MetLife under Title III of the Disabilities Act because it found that the statute does not cover discrimination in insurance policies; it covers only physical access to goods and services. The District Court dismissed Plaintiff's Title III claim against Schering for the additional reason that the Disabilities Act explicitly states that Title I governs employment practices, not Title III. Finally, the District Court granted summary judgment in favor of the Defendants on Plaintiff's ERISA claim. It held that the appropriate standard of review of a plan administrator or fiduciary's interpretation of an insurance plan provision is the "arbitrary and capricious" standard, and, in this case, Plaintiff failed to raise sufficient evidence that the classification of her disorder as "nervous/mental" was arbitrary and capricious.

II. ERISA Claim

The District Court granted Defendants' motion for summary judgment on Plaintiff's ERISA claim. Plaintiff claims that the MetLife/Schering decision to classify Ms. Parker's

Page 185

disability as "nervous/mental" should be reviewed de novo. Plaintiff then argues that under such a standard, summary judgment is inappropriate because there is a genuine issue of material fact regarding the cause of Plaintiff's disability. As the District Court noted, however, the Supreme Court has held that "a denial of benefits challenged under [ERISA] is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956-57, 103 L.Ed.2d 80 (1989). In this case, the plan contains a detailed and explicit provision granting Defendants the authority to do just that.

In 1991, in Miller v. Metropolitan Life Insurance Co., this Court held that where such discretion exists, an ERISA benefit plan administrator's decisions on eligibility for benefits are not arbitrary and capricious if they are "rational in light of the plan's provisions." 925 F.2d 979, 984 (6th Cir.1991) (citing Daniel v. Eaton Corp., 839 F.2d 263, 267 (6th Cir.), cert. denied, 488 U.S. 826, 109 S.Ct. 76, 102 L.Ed.2d 52 (1988)). The decision to terminate Ms. Parker's benefits based on the categorization of her disability as "nervous/mental" clearly meets that standard. Ms. Parker's doctor told MetLife that she was suffering primarily from "major depression" and secondarily from a "generalized anxiety disorder." Ms. Parker then wrote to MetLife, stating that her disability could not be considered "completely" mental and nervous. While it is true that Ms. Parker's doctor then wrote to MetLife, stating that the major depression she suffered was "a chemical disorder of a deepseated nature," MetLife's consulting psychiatrist reviewed the file and concluded that:

Irrespective of any chemical factors in its etiology, major depression is a DSM III R diagnosis; Ms....

To continue reading

FREE SIGN UP