Majeski v. Metropolitan Life Ins. Co.
| Decision Date | 29 December 2009 |
| Docket Number | No. 09-1930.,09-1930. |
| Citation | 590 F.3d 478 |
| Parties | Kirsten MAJESKI, Plaintiff-Appellant, v. METROPOLITAN LIFE INSURANCE CO., Defendant-Appellee. |
| Court | U.S. Court of Appeals — Seventh Circuit |
Mark D. Debofsky (argued), Daley, Debofsky & Bryant, Chicago, IL, for Plaintiff-Appellant.
Teresa W. Roseborough (argued), Metropolitan Life Insurance Company, New York, NY, for Defendant-Appellee.
Before WOOD, EVANS, and TINDER, Circuit Judges.
Kirsten Majeski was employed by Metropolitan Life Insurance Company ("MetLife") and participated in MetLife's Short Term Disability Plan, which is governed by the Employee Retirement Income Security Act ("ERISA"). This appeal concerns MetLife's decision to reject Majeski's claim for short-term disability benefits. MetLife determined that Majeski had failed to submit enough evidence to support her claim. Majeski filed suit, but the district court granted summary judgment against her. Although MetLife's determination is entitled to deferential review, we conclude that there are such significant gaps in the evidence supporting its decision that further proceedings are necessary.
Majeski worked for MetLife as a nurse consultant, which required her to sit at a desk and use a computer and telephone throughout the normal eight-hour workday. In June 2006, after complaining of pain and numbness in her shoulders, arms, and hands, Majeski was diagnosed with cervical radiculitis, a disorder of the spinal nerve roots. See STEDMAN'S MEDICAL DICTIONARY 1622 (8th ed.2006). She applied for benefits from MetLife's Short Term Disability Plan, which defines a participant as "disabled" when, as the result of "illness or accidental injury," she is "receiving appropriate care and treatment from a doctor on a continuing basis" and "unable to earn more than 80% of [her] pre-disability earnings at [her] own occupation for any employer in [the] local economy." The plan grants discretionary authority to the plan administrator to interpret its terms and determine a participant's entitlement to benefits. MetLife initially approved a temporary award of short-term disability benefits to allow Majeski to pursue treatment, but eventually it determined that she was not eligible for benefits beyond August 25, 2006, because, in its view, her medical records did not objectively establish any functional impairments that would prevent her from continuing her work as a nurse consultant.
Majeski appealed. In response to MetLife's assertion that she had not presented objective evidence establishing any functional impairments, she submitted newly obtained medical evidence. David Weiss, a physiatrist (that is, a rehabilitation specialist), completed a five-page Cervical Spine Residual Functional Capacity Questionnaire that documented Majeski's "significant limitations" in repetitive reaching, handling, and fingering. Dr. Weiss indicated that Majeski could use her hands to grasp, turn, and twist objects for 25 percent of the workday, that she could use her fingers for fine manipulation 100 percent of the time, and that she could not use her arms for reaching. Dr. Weiss also reported that Majeski could not sit in a "competitive work situation" any longer than 45 minutes without needing to take a break. But in another part of the questionnaire, Dr. Weiss reported that Majeski did not have significant limitation of motion. Majeski later explained to MetLife that Dr. Weiss had misinterpreted the part of the questionnaire where he was asked to document Majeski's limitations in repetitive reaching, handling, and fingering. Dr. Weiss amended the questionnaire simply by crossing out "100 percent" under the column "Fingers: Fine Manipulation" and writing instead "0 percent," indicating that Majeski could not use her fingers for fine manipulation at all.
In addition, Susan Hardin, a physical therapist, examined Majeski, tested her functional capabilities, and then submitted a Functional Capacity Evaluation Summary that documented her findings. Hardin concluded that Majeski's limitations on sitting and typing made it impossible for her to return to her job as a nurse consultant. Hardin's conclusion was based on a Physical Work Performance Evaluation, which consists of 36 tasks, including a 30-minute "sitting test." The evaluation revealed that, although Majeski was capable of performing physical work at the medium level of exertion, she could sit only occasionally and could not type more than eight-and-a-half minutes without experiencing significant pain. (In other words, in Hardin's view, although Majeski was able to perform at the greater exertional level of "medium," she could not — perhaps unlike most people — handle a more sedentary position.) Hardin also observed that Majeski's cervical spine, shoulders, wrists, and elbows were capable of a range of motion within functional limits.
MetLife then asked Phillip Marion, an independent physician consultant who is board-certified in physical medicine, rehabilitation, and pain management, to review Majeski's medical records and evaluate whether she had any functional limitations that would preclude sedentary work, particularly sitting and using a telephone and computer. Dr. Marion responded on March 1, 2007, that there were "minimal objective findings on physical and neurological examination" to support a finding of functional limitations. He added that Majeski was "otherwise independent with activities of daily living, ambulation, and not restricted from driving a motor vehicle." Although Dr. Marion acknowledged Hardin's finding that Majeski could perform medium-level work, he did not address either the limitations Hardin had identified on Majeski's ability to sit and type or Hardin's conclusion that Majeski could not work as a nurse consultant. Nor did Dr. Marion mention Dr. Weiss's questionnaire, which is not listed among the medical records MetLife submitted to Dr. Marion. Dr. Marion issued a second report on March 27 in which he concluded that additional medical evidence submitted by Majeski's neurologist did not change his opinion.
On March 28, MetLife forwarded Dr. Marion's reports to Dr. Weiss and asked him to respond with comments by April 10. MetLife also alerted Majeski's counsel to the deadline. Dr. Weiss responded unhelpfully on April 6 with a single sentence: "I disagree with the decision of Dr. Marion." On April 12, after MetLife's deadline for comment on Dr. Marion's reports had passed, Majeski's counsel faxed a letter to MetLife seeking to introduce deposition testimony that Dr. Marion had recently given in an unrelated case; allegedly this testimony revealed Dr. Marion's predisposition to rule in favor of employers and against claimants, regardless of the evidence. Because the deposition testimony ran more than 200 pages, the attachment did not accompany the fax but was instead contained on a CD that Majeski's counsel mailed that same day. But without reviewing (and possibly before receiving) Dr. Marion's deposition testimony, MetLife determined on April 18 that Majeski was not disabled. MetLife cited Dr. Marion's conclusion that Majeski's medical records neither contained objective findings nor supported an inference of functional impairments.
Under the terms of MetLife's plan, Majeski's disability benefits could be reduced by the amount of Social Security disability benefits she was eligible to receive, whether or not she actually applied for those benefits. Majeski accordingly submitted an application to the Social Security Administration in May 2007 and received a favorable determination in March 2008.
Majeski sued MetLife in federal court, challenging the denial of disability benefits under ERISA. See 29 U.S.C. § 1132(a)(1)(B). After the parties agreed that a magistrate judge could handle the case, the district court granted summary judgment against Majeski. Because MetLife's plan grants discretionary authority to the plan administrator, the district court ruled that it would review MetLife's determination under the arbitrary-and-capricious standard. In so doing, it rejected Majeski's argument that Metropolitan Life Insurance Co. v. Glenn, ___ U.S. ___, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), requires a heightened standard of review in light of MetLife's conflict of interest as both the plan administrator and payor of benefits. The district court also rejected Majeski's attempt to introduce Dr. Marion's deposition testimony and Majeski's Social Security award, neither of which was part of the administrative record. But the district court did consider "general evidence that Dr. Marion had an ongoing financial relationship with MetLife," reasoning that this must have been known to MetLife. Even so, the district court determined that there was no evidence that Dr. Marion was predisposed to rule against claimants and that it was not unreasonable for MetLife to have asked him to review Majeski's medical records. After considering all the medical evidence that was before MetLife, as well as MetLife's conflict of interest, the district court concluded that it was reasonable for MetLife to determine that Majeski was not disabled.
Majeski begins with an argument that we have rejected: Glenn, she urges, requires a reviewing court to apply a heightened standard of review whenever a plan administrator is, like MetLife, also the payor of benefits. See Black v. Long Term Disability Ins., 582 F.3d 738, 744-45 (7th Cir.2009); Love v. Nat'l City Corp. Welfare Benefits Plan, 574 F.3d 392, 396 n. 1 (7th Cir.2009); Leger v. Tribune Co. Long Term Disability Benefit Plan, 557 F.3d 823, 831 (7th Cir.2009). But see Montour v. Hartford Life & Accident Ins. Co., 582 F.3d 933, 936 (9th Cir.2009) (). Counsel has done what is necessary to preserve this question for further review, and so we proceed to the specifics of...
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