Guarino v. Metropolitan Life Ins. Co.

• Decision Date: 07 December 1995
• Docket Number: Civ. A. No. 95-10226-DPW.
• Citation: 915 F. Supp. 435
• Parties: Scott GUARINO, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — District of Massachusetts

915 F. Supp. 435

Scott GUARINO, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

Civ. A. No. 95-10226-DPW.

United States District Court, D. Massachusetts.

December 7, 1995.

COPYRIGHT MATERIAL OMITTED

William H. Shaughnessy, James A. McDonald, Jr., Boston, MA, for Plaintiff.

Rita Gylys, Morrison, Mahoney & Miller, Boston, MA, for Defendant.

MEMORANDUM AND ORDER

WOODLOCK, District Judge.

I.

This case involves a dispute over the termination of disability benefits. Scott Guarino ("Guarino") alleges that Metropolitan Life Insurance Company ("MetLife") improperly terminated long term disability ("LTD") benefits which were due him under his employment agreement with his former employer, the Raytheon Company. The Raytheon Long Term Disability Plan (the "Plan") is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), codified, in part, at 29 U.S.C. §§ 1001-1461.

Guarino initiated suit in Massachusetts Superior Court on January 3, 1995, alleging breach of contract. The action was removed by MetLife to this court on February 1, 1995, pursuant to 28 U.S.C. § 1441(b).¹ In response, Guarino filed an amended complaint on April 7, 1995, alleging that the termination was "arbitrary, illegal, capricious, unreasonable, not made in good faith, and a violation of fiduciary duty," as well as a violation of 26 U.S.C. §§ 401(a), 411, and 501(a) of the Internal Revenue Code. (Compl. ¶ 10.)

MetLife now moves for summary judgment, pursuant to Fed.R.Civ.P. 56, on the grounds that 1) Guarino's claim should be dismissed because the exclusive remedies to enforce rights under a welfare benefit plan are those set forth in 29 U.S.C. § 1132(a)(1)(B) of ERISA, while 26 U.S.C. §§ 401(a), 411, and 501(a) deal with pension plans and the tax treatment thereof; and 2) even if Guarino's claim is properly characterized as an action under ERISA, MetLife reasonably determined that Guarino was not qualified to continue receiving LTD benefits. (Def.'s Mot.Summ.J. at 1.)

I will grant MetLife's motion for summary judgment.

II. Background

A. The LTD Plan

On January 21, 1985, at age 25, Guarino began work at Raytheon as an Electronics Inspector. Raytheon maintains an LTD Plan for eligible employees, in the event of disability. (Hartz Aff.Ex. 1 (Policy).) MetLife is the underwriter for the Plan. The Plan is a "welfare benefit plan" as defined by ERISA, see 29 U.S.C. § 1002(1), and the Summary Plan Description (pamphlet given to employees) states that it is covered by ERISA. (Hartz Aff.Ex. 2 at 12.)

For eligible employees who have elected to pay the monthly premiums, the Plan pays a percentage of the employee's base income in the event of "total disability." The Plan defines "total disability" in the following way:

for the first twenty-four months following the greater of (i) the first 30 days in a continuous period of disability, and (ii) the expiration of benefits under ... Accident and Sickness Insurance Program, as only such complete incapacity of the employee that the employee is not able to perform substantially all of the duties of the employee's occupation, business or employment. ...

(Hartz Aff.Ex. 1 at 3 (Policy) (emphasis added).) After the first two years, "total disability" means that the employee

is able to perform none of the duties of any and every occupation, business or employment ... for which the employee is reasonably fitted by education, training or experience.

Id. (emphasis added). The Plan gives MetLife the discretionary authority "to determine eligibility for and entitlement to LTD benefits, and to make final decisions with respect to appeals from claim denials." (Hartz Aff. ¶ 7, Ex. 1, 2.)

In May of 1986, sixteen months after beginning work at Raytheon, Guarino sustained an injury to his lower back while working on his boat. He had previously injured his lower back in 1982. (Compl. ¶ 3-4; Hartz Aff. Ex. 12 at 2, Ex. 6 at 1.) In November of 1986, after exhaustion of accident and sickness benefits, which MetLife paid from May 30, 1986 through August 24, 1986, Guarino began receiving LTD benefits (Group No. 25792-004-4014; Claim No. XXXXXXXXX). (Compl. ¶ 6.)²

B. Medical Opinions Preceding Termination

Under the Plan, MetLife shall "have the right and opportunity to have a physician it designates examine the person of the employee when and so often as it may reasonably require during the period for which the employee claims benefits...." (Hartz Aff. Ex. 1 (Policy) at 12.) Accordingly, MetLife arranged for Guarino to undergo several independent medical examinations, as well as vocational assessments, conducted by individuals who were not employees of Raytheon or MetLife. I note the following material observations:³

Dr. St. G. Tucker Aufranc ("Dr. Aufranc"),

Orthopaedic Surgeon

June 27, 1988 (Hartz Aff.Ex. 5 (emphasis added).) ... totally disabled from his job as an electrical inspector. However, I believe he could work in any capacity which would not involve excessive lifting, bending, stooping, taking sic, or squatting, and which would allow him to alternate his position.

Dr. Howard Taylor ("Dr. Taylor")

February 14, 1990 (Hartz Aff.Ex. 6 (emphasis added).)

... I am a bit concerned about his diagnosis. Mass. General Hospital states that the CT scan showed bulging, but no true herniation. I reviewed Dr. Aufranc's report, and he said that there was a large herniated nucleus pulposus, but I do not know the basis of his statement. In my opinion Mr. Guarino's diagnosis is a sciatica, based purely upon his subjective symptoms. I reviewed his job description, and I don't believe that he could perform that particular job. It involves some lifting, and prolonged sitting. I believe that he could perform some type of work that did not require prolonged sitting, or bending, or lifting, or twisting. His prognosis is guarded for any future recovery.

Mr. Ralph Cavaliere ("Cavaliere")

IRP Medical and Rehabilitation Group ("IRP"), Vocational Assessment

March 13, 1990 (Hartz Ex. 7 (emphasis added).)

Mr. Guarino is not totally disabled from engaging in any and every gainful occupation for which he is reasonably fitted ... the claimant is capable of performing sedentary work activities provided they do not require any type of strenuous physical activity, including lifting, pushing, pulling and offer the individual the opportunity to alternate between a sitting and standing position through the course of a work day.

In addition, on April 1, 1990, IRP submitted an addendum which listed possible alternative jobs and descriptions, along with the applicable physical requirements. (Hartz Aff.Ex. 8.)

Nevertheless, in June of 1990, January of 1991, February of 1992, and January of 1993, Dr. Eugene Brady ("Dr. Brady"), an orthopaedic surgeon — and Guarino's personal physician from 1989 to 1993 — examined Guarino and concluded each time that his condition was "unimproved" and that he remained "totally disabled." (Hartz Aff.Ex. 9.) During this period, MetLife continued to pay Guarino benefits.

On March 22, 1993, MetLife requested an additional independent examination by another orthopaedic surgeon, Dr. Philip Salib ("Dr. Salib"). (Hartz Aff.Exs. 10, 11.) Dr. Salib reported:

From the very long history and many attacks of low back pain and right sciatica, it is clinically clear that his symptoms are discogenic in origin. None of the attacks was related to his kind of work except the very first one that took place in 1983-84 ... Although he is unable to do heavy work, the nature of his duties at Raytheon is relatively light. Therefore, it appears to me that he is capable of doing his normal work at Raytheon. However, it is preferable to allow him to get up and move around frequently during the working hours.

(Hartz Aff.Ex. 12 (emphasis added).) Dr. Salib based his report on an examination, records of Guarino's medical history, and copies of the 1989 and 1992 MRI results, the latter MRI showing "a more advanced stage than the former." Id. Dr. Salib did not see any "radiograms or the myelogram to comment upon," nor did he see the results of a third MRI scheduled for the coming week. Id.

Based on this report, MetLife wrote to Dr. Brady on April, 15, 1993, asking his opinion whether Guarino could perform the job of Electronics Inspector. (Hartz Aff.Ex. 13.) On May 7, 1993, Dr. Brady responded that because the job description involved "for the most part sitting for prolonged periods of time, and a certain amount of bending and stooping," he doubted Guarino would be able to perform the duties, even though it was "sedentary work." (Hartz Aff.Ex. 15.) Dr. Brady noted that Guarino "has never been able to do anything other than very sedentary activities," but also observed that his "sitting tolerance is limited." Id.

On May 20, 1993, MetLife again requested an independent vocational assessment, this time from the firm Crawford & Company ("Crawford"). (Hartz Aff.Ex. 16.) On June 8, 1993, having considered all the medical reports and possible job classifications, Crawford responded:

It would appear Mr. Guarino does retain the residual functional capacity to perform sedentary to light duty work that allows frequent alternate changes of position and avoids forward flexion activities and sitting for prolonged periods of time. Mr. Guarino should be allowed to get up and move around frequently during the working hours.

(Hartz Aff.Ex. 17.) While the Crawford report found that Guarino would be unable to perform the job of Electronics Inspector, it suggested the alternate jobs of "Automobile Accessories Salesperson," "Electronics Tester," and "Parts Lister." Id.

Consequently, on June 23, 1993, MetLife notified Guarino that the LTD benefits would terminate on July 9, 1993 because Guarino no longer satisfied the definition, applicable after two years of disability, of "totally disabled." (Compl. ¶ 7; Hartz Aff.Ex. 1 at 3 (Policy).) The letter explained:

We have reviewed the medical

...