Ehlert v. Metro. Life Ins. Co.

• Decision Date: 23 November 2020
• Docket Number: CIVIL ACTION NO. 18-10357-MPK
• Parties: ANNE EHLERT, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — District of Massachusetts

ANNE EHLERT, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

CIVIL ACTION NO. 18-10357-MPK¹

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS

November 23, 2020

MEMORANDUM AND ORDER ON MOTION FOR JUDGMENT ON THE JUDICIAL RECORD (#54) AND DEFENDANT'S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD (#56).

KELLEY, U.S.M.J.

I. Introduction.

Plaintiff Anne Ehlert is a participant in the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001 et seq., welfare benefit plan issued to Towers Watson, plaintiff's former employer, by defendant Metropolitan Life Insurance Company (MetLife), which administers the Towers Watson Health and Welfare Benefits Plan (LTD Plan). (#14 ¶ 1.) Ehlert claims that MetLife unreasonably and unlawfully denied her long-term disability (LTD) benefitsdue to her under the LTD Plan, in violation of 29 U.S.C. § 1132. Id. ¶¶ 58-67. In addition to an award of disability benefits, plaintiff seeks to recover "a reasonable attorney's fee and costs of the action" under 29 U.S.C. § 1132(g). Id. ¶¶ 68-73. The parties have filed cross-motions for judgment on the Administrative Record (##54, 56),² which have been fully briefed. (##55, 57, 62-66.) The competing motions stand ready for decision.

II. Procedural history.

Ehlert began working at Towers Watson on September 8, 2003, and her last day of work was December 23, 2015. (AR at 97, 119, 448, 2357.) She applied for benefits under the LTD Plan in August 2016, stating that she was unable to perform the duties of her job due to "fatigue, short term memory and cognitive/organizational issues, [and] headaches." (AR at 97, 118-38.) Her LTD claim was denied on November 21, 2016. (AR at 2224-28.) On May 9, 2017, Ehlert appealed the denial of the claim. (AR at 2001-2162.) The denial was upheld on November 9, 2017. (AR at 507-19.) This case was filed on February 24, 2018. (#1.)

III. The Facts.

Ehlert was employed as a consulting pension actuary for pension plans of large and medium size companies. (AR at 1071, 2030.) According to plaintiff, "[t]he work was intellectually demanding and physically demanding when there were many or large projects going on at once . . . and required strong organizational skills and the ability to juggle multiple demands." (AR at 2311.) Her job was sedentary; Ehlert reported that she spent 7¾ hours per day sitting, and fifteen minutes per day walking. (AR at 1072; 1380-81.) In about 2000 or 2001, she developed chemical sensitivities which impacted her ability to work in large office buildings, so she worked from home for all or part of most days. (AR at 2034.)

A. The LTD Plan.

The LTD Plan provides benefits to participants who are disabled within the terms of the plan. (AR at 7.) By definition:

Disabled means that due to sickness, or as a direct result of accidental injury, you are receiving appropriate care and treatment and that you are complying with the requirements of such treatment and that you are:

• Unable to earn more than 80% of your predisability earnings at your own occupation for any employer in your local economy after a 26[-]week elimination period and during the 24 months of sickness or accidental injury, and

• After such period, that you are unable to earn more than 60% of your predisability earnings from any employer in your local economy at any gainful occupation for which you are reasonably qualified taking into account your training, prior education[,] and experience.

(AR at 12.) Under the terms of the LTD Plan, the burden is on the claimant to provide proof³ to the Claims Administrator that she has a disability. (AR at 65, 71, 77, 81.) While receiving LTD benefits, a claimant is entitled to continuing coverage for health and life insurance as well as pension benefits. (AR at 27.)

MetLife is the Claims Administrator of the LTD Plan. (AR at 91-93.) The LTD Plan provides:

In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given fullforce and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

AR at 93.

B. Medical History.⁴

Ehlert's medical records show that she reported developing a chemical sensitivity around 2000, and that she has a history of attention deficit disorder. (AR at 356, 420, 606, 2034.)⁵ In June 2012, laboratory testing showed negative anti-Lyme antibodies, and in August 2012 Elhert denied any recent contact with ticks. (AR at 610, 2522.)⁶ In November 2012 Elhert told Dr. Long at Massachusetts General Hospital⁷ that she had a number of chemical sensitivities that made her "tired and experience[] unclear thinking." (AR at 2508.) Notes from her annual physical in February 2014 again indicate that cleaning chemicals and fragrances made her disoriented and tired. (AR at 2483.)

After an automobile accident, Elhert saw her doctor, Lela Caros, M.D., on July 28, 2014, with a complaint of joint pain in her hands. (AR at 2477.) The doctor found no swelling, and her hands were not warm nor did they look red. Id. Ehlert mentioned that her neighbors had Lyme disease and she thought that might be the cause of her joint pain, but she had not seen any ticks on her body. Id. Plaintiff was tested for Lyme disease; the results were negative, but the microbiologyreport indicated the possibility of low or undetectable antibody levels. (AR at 388, 612.) Elhert started a two-week course of antibiotics. (AR at 612.)

In October 2014 plaintiff began seeing Dr. Jeanne Hubbuch; her care with Dr. Hubbuch continued through mid-July 2016. (AR at 366, 838.) Dr. Hubbuch's notes from her initial visit reflect that Ehlert stated that she may have had a tick bite in 2013. (AR at 367.) Ehlert had been rear-ended in a car accident in July 2014 which caused neck stiffness and back pain. Id. At about the same time plaintiff reported her joints and knuckles were tender, she was very tired, she had some short-term memory issues, and her balance felt off. Id. According to Ehlert, her memory, joint pain, and fatigue were better following a course of doxycycline at the end of August. (AR at 368.) She slept 6-8 hours nightly and felt okay exercising for 30 minutes, either biking or walking. Id.

On February 12, 2015, Ehlert's "Western blot" test was interpreted as consistent with Borrelia burgdorferi infection at some time in the past. (AR at 428.) Dr. Caros, who had ordered the test, explained that the Lyme testing showed evidence of past Lyme infection, but no current or active disease (IGM testing was negative). (AR at 431.)

Plaintiff had an appointment with Dr. Hubbuch in April 2015. (AR at 339-41.) Among other things, Ehlert complained about getting only 5-6 hours of sleep nightly due to worries and ruminating, being depressed and overwhelmed, and having a memory problem. (AR at 340.) Ehlert stated that her job was in jeopardy and she was not doing well. Id. Plaintiff reported she exercised by walking the dog and going to the gym two or three times a week. Id.

In June 2015, Dr. Hubbuch had Elhert tested for Babesiosis, which came back negative; she was not tested for a Bartonella infection. (AR at 342, 613, 1220-21.) Plaintiff still had the same reported memory and cognitive problems, especially short-term memory. (AR at 342.) Shereported doing a 3-hour hike, which was difficult for her, going to the gym for 15-20 minutes two or three times a week, and walking her dog for thirty minutes. Id. Dr. Hubbuch noted Ehlert's Lyme and Bartonella symptoms to be better. (AR at 343.)

At an appointment on September 30, 2015, Dr. Hubbuch noted plaintiff's chief complaints were memory and fatigue. (AR at 345.) Ehlert described having trouble accomplishing tasks at work as well as difficulty with her memory and organization, and related that her work was stressful. Id.

On October 20, 2015, Ehlert had an appointment with Dr. Cary York-Best for a routine gynecological examination. (AR at 1120-22.) Dr. York-Best's notes reflect that plaintiff reported that over the prior two years she had had memory difficulties, joint pain, numbness, and tingling, and had been diagnosed by an alternative provider as having Lyme disease; she had been treated with antibiotics, which she stopped taking. (AR at 1120.)

Notes from a visit with Dr. Hubbuch on November 2, 2015, state that plaintiff was being laid off from work. (AR at 347.) Dr. Hubbuch's plan was for Ehlert to have a PET scan of her brain, neuropsychological testing, and undergo a sleep study. (AR at 348.) None of the recommended testing had been done by plaintiff's next appointment with Dr. Hubbuch on December 16, 2015. (AR at 350.) At that visit, Dr. Hubbuch indicated that Ehlert was unable to continue full-time work due to fatigue and cognitive issues. Id.

On December 21, 2015, Dr. Hubbuch completed a Certification of Health Care Provider with respect to Ehlert in which she stated that plaintiff had had chemical sensitivity since 2000. (AR at 356.) Dr. Hubbuch asserted that plaintiff was diagnosed with Lyme disease since June 2014 with resultant joint pain, stiffness, fatigue which was worse with exercise or exertion, tinnitus, trouble problem solving, memory issues, and anxiety, and that all of her symptoms had worsenedover the last 3-4 months. (AR at 357.) Ehlert was also said to have dizziness, sleep disturbance, and headaches which had been constant in the last month. Id. Dr. Hubbach stated that plaintiff would be incapacitated from December 24, 2015 to March 24, 2015, and that after March 15th, she would be able to work eight hours per day, three days per week. Id.

Ehlert's last day working for Towers Watson was December 23, 2015. On January 4, 2016, Dr. Hubbuch completed a report for MetLife regarding her...