Blair v. Metro. Life Ins. Co.

• Decision Date: 28 June 2013
• Docket Number: Case No. 4:12–cv–1776–JEO.
• Citation: 955 F.Supp.2d 1229
• Parties: Sharon BLAIR, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Northern District of Alabama

955 F.Supp.2d 1229

Sharon BLAIR, Plaintiff,

v.METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

Case No. 4:12–cv–1776–JEO.

United States District Court,

N.D. Alabama,

Middle Division.

June 28, 2013.

Myron K. Allenstein, Rose Marie Allenstein, Allenstein & Allenstein LLC, Gadsden, AL, for Plaintiff.

Summer A. Davis, T. Matthew Miller, Bradley Arant Boult Cummings LLP, Birmingham, AL, for Defendants.

MEMORANDUM OPINION

JOHN E. OTT, United States Chief Magistrate Judge.

In this action originally filed in state court, Plaintiff Sharon Blair brings a claim under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., alleging that her Long Term Disability (“LTD”) benefits under an employee welfare benefit plan were wrongfully terminated. (Doc.¹ 1–1 at 3–4 (“Complaint” or “Compl.”)). Defendant Metropolitan Life Insurance Company (“MetLife”), the plan's claims administrator,removed the action to this court. (Doc. 1). The case was assigned to the undersigned United States Magistrate Judge pursuant to a general order of reference, and the parties have consented to an exercise of plenary jurisdiction. See28 U.S.C. § 636(c), Fed.R.Civ.P. 73, and LR 73.2. The cause now comes to be heard on five pending motions: (1) Plaintiff's motion for partial summary judgment, on the issues of the applicable standard of review and the scope of the evidence to be considered (Doc. 14); (2) Plaintiff's motion for discovery (Doc. 15); (3) Plaintiff's motion “for judgment on liability” (Doc. 18); (4) MetLife's cross-motion “for judgment as a matter of law” (Doc. 23); and (5) Plaintiff's motion to remand the action to allow MetLife to conduct further review. (Doc. 29). The motions have been fully briefed and are ripe for decision. Upon consideration, the court concludes that MetLife's motion for judgment as a matter of law (Doc. 23) is due to be granted and that all of Plaintiff's motions are due to be denied.

I. BACKGROUNDA. Plaintiff is Awarded LTD Benefits Under the Plan

Plaintiff, a woman born in 1958, is a former employee of Progressive Corporation (“Progressive”), an insurance company. (1164 ²). She worked as a Claims Specialist, a job entailing, inter alia, analyzing and determining Progressive's liability for loss or damages, attempting settlement with claimants and attorneys, corresponding with and interviewing witnesses and claimants, and calculating and paying claims. (1120–21). Plaintiff's last active day of work was August 13, 2007. It appears that she was hospitalized on that date for one day because of an episode at work in which she experienced stroke-like symptoms, including left-sided paralysis. (1081).

Progressive established an employee welfare benefit plan (the “Plan”) that includes LTD coverage. It is undisputed that the Plan is subject to ERISA. As relevant here, under the Plan, the term “Disabled” or “Disability” means that, “due to Sickness, pregnancy or accidental injury [the employee is] receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and”

1. during the Elimination Period and the next 24 months of Sickness or accidental injury, [the employee is] unable to earn more than 80% of [the employee's] Pre-disability Earnings or Indexed Pre–Disability Earnings at [the employee's] Own Occupation from any employer in [the employee's] Local Economy; or

2. after the 24 month period, [the employee] is unable to earn more than 80% of [the employee's] Pre-disability Earnings from any employer in [the employee's] Local Economy at any gainful occupation for which [the employee is] reasonably qualified taking into account [the employee's] training, education, experience and Pre–Disability Earnings.(31). The Plan also provides that benefits for disability resulting from a “mental or nervous disorder or disease” are generally subject to a 24–month limitation. (7, 27, 39). By its terms, the Plan grants MetLife, the claims administrator, discretionary authority and provides that MetLife's determinations “shall be given full force and effect” unless “arbitrary and capricious.” (15, 27, 42, 54).

On November 13, 2007, MetLife received a claim from Plaintiff seeking LTD benefits under the Plan. (1164). Plaintiff's Personal Profile, a document she submitted in support of her claim, identifies her work-limiting impairments as left-side pain, numbness, headaches, and difficulty with concentration and memory. (1103). On January 8, 2008, MetLife approved Plaintiff's claim, granting LTD benefits retroactive to November 13, 2007, based upon a determination that she had a “mental or nervous disorder or disease” (1045–46), specifically, recurrent major depression. (140). Accordingly, Plaintiff was advised that her LTD benefits were subject to a 24–month maximum and were thus scheduled to cease as of November 12, 2009. (1046). MetLife further advised that in order to remain eligible for LTD benefits, Plaintiff “must continue to satisfy the definition of disability and all other requirements” under the Plan and that she would be periodically required to provide updated medical information regarding her disability. ( Id.)

Also on January 8, 2008, Plaintiff applied for Social Security benefits. (1027–28). On March 7, 2008, the Social Security Administration (“SSA”) notified Plaintiff that her application had been approved and that she would receive benefits effective February 2008.³ (1022–25). After Plaintiff advised MetLife of the SSA's favorable decision (173–47, 1021–25), her LTD benefits were offset by the amount she began receiving from Social Security, as provided under the Plan. (5, 34, 35, 1008–09).

B. MetLife Terminates Benefits

On March 14, 2008, MetLife advised Plaintiff that it needed additional information from her and her healthcare providers to verify that she continued to be eligible for LTD benefits. (996). MetLife also faxed medical record requests to Plaintiff's three then-treating doctors of record: Dr. Rafael A. Beltran, a psychiatrist; Dr. A. Bartow Ray, a psychologist; and Dr. John A. Just, a neurologist. (996). When MetLife initially failed to receive the records, it terminated Plaintiff's LTD benefits effective May 14, 2008. (1006). However, MetLife soon thereafter received records from Dr. Just and Dr. Ray and advised Plaintiff in a letter dated May 28, 2008 that her benefits were reinstated effective May 15, 2008.(993).

However, on August 20, 2008 and September 30, 2008, MetLife again requested that Plaintiff provide recent medical information. (967, 974, 984, 987). After receiving updated medical records from Dr. Just and Dr. Ray, MetLife notified Plaintiff by letter dated November 6, 2008, her records no longer supported that she could not perform the duties of her claims specialist position. (949–52). As a result, MetLife terminated Plaintiff's LTD benefits, effective the date of the notice. ( Id.)C. MetLife Denies Plaintiff's Administrative Appeal

Plaintiff timely pursued an administrative appeal of MetLife's decision. (943). For that review, MetLife enlisted Dr. Lee H. Becker, a psychiatrist, and Dr. Sheri Phillips, a physician board-certified in occupational medicine, to evaluate Plaintiff's medical records. After doing so, Dr. Becker and Dr. Phillips authored respective reports, each concluding that Plaintiff's medical records did not support that Plaintiff suffered from impairments that rendered her unable to perform the duties of her occupation from November 7, 2008 and ongoing. (926–33; 935–38). MetLife faxed those reports to Drs. Just and Ray, respectively, on January 16, 2009, soliciting their comments and additional clinical evidence if they disagreed with the reports. (856, 839). Not having received a response, MetLife faxed the reports to Drs. Just and Ray a second time on January 22, 2009, requesting comments and additional clinical evidence by the next day. (925, 904).

On January 30, 2009, still not having heard from Dr. Just or Dr. Ray, MetLife issued its decision denying Plaintiff's administrative appeal. (824–27). Although MetLife's letter of November 6, 2008, terminating Plaintiff's benefits had not referenced that Plaintiff had been awarded Social Security benefits, MetLife's letter rejecting Plaintiff's appeal expressly acknowledged that fact. (825). MetLife explained, however, that a Social Security award “does not guarantee the approval or continuation of [LTD] benefits” and that the SSA's “determination is separate from and governed by different standards than MetLife's review and determination pursuant to the terms of [the Plan].” (825). After setting forth a summary of the respective reports of Drs. Becker and Phillips, MetLife stated that those reports and the “available medical documentation” failed to support functional impairment or restrictions which would preclude Plaintiff from performing her own occupation for any employer beyond November 7, 2008.(826). Therefore, MetLife found that Plaintiff “failed to satisfy the Plan's definition of disability and the previous decision to terminate LTD benefits for the time period in question is upheld.” (827). The notice concluded by advising that the latest “review constitutes MetLife's final determination on Appeal in accordance with the Plan and federal law” and that Plaintiff had the right to file a civil lawsuit under ERISA. ( Id.)

D. Plaintiff Retains Counsel and Seeks Additional Administrative Review

Just over four months later, MetLife received a letter dated June 3, 2009, from Myron K. Allenstein, an attorney retained by Plaintiff, in which he requested copies of all documents related to the decision to discontinue benefits. (822). Plaintiff's counsel further requested 45 days from the date such materials were mailed to him to submit additional information or arguments in support of Plaintiff's claim. (822). MetLife sent Allenstein a copy of its claim file but also reiterated that Plaintiff had been notified that she had exhausted administrative...