Miller v. Metropolitan Life Ins. Co.

Decision Date15 February 1991
Docket NumberNo. 90-1533,90-1533
Citation925 F.2d 979
PartiesConnie M. MILLER, Plaintiff-Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant-Appellee.
CourtU.S. Court of Appeals — Sixth Circuit

Patrick J. Brennan (argued), O'Connell, Roeser & Brennan, Pontiac, Mich., for plaintiff-appellant.

William J. Toppeta, Joseph Trovato (argued), New York City, for defendant-appellee.

Before KEITH and MILBURN, Circuit Judges; and CONTIE, Senior Circuit Judge.

CONTIE, Senior Circuit Judge.

Plaintiff-appellant, Connie M. Miller, appeals the district court's grant of summary judgment to defendant-appellee, Metropolitan Life Insurance Co., in her suit against Metropolitan for the termination of disability benefits under a disability insurance policy issued by Metropolitan as a benefit to employees of General Motors Corp.

I.

Plaintiff began employment with General Motors in 1967. As an eligible employee, she participated in the General Motors employee welfare benefit plan (the "Plan") that provided for disability benefits. The Plan was established by General Motors pursuant to ERISA. Disability benefits were funded, in part, by Metropolitan Life Insurance Company. The Plan defined disability as follows:

An Employe shall be deemed to be totally disabled only if that Employe is not engaged in regular employment or occupation for remuneration or profit and, on the basis of medical evidence satisfactory to the Insurance Company, the Employe is found to be wholly prevented, as a result of bodily injury or disease, either occupational or non-occupational in cause, from engaging in regular employment or occupation, for remuneration or profit, with the Employer at the location where the Employe last worked.

Under Part XII(c) of the Plan (cessation of insurance), the Plan stated:

The Employe will be totally disabled, for the purposes of this Part XII, if, while insured under the Group Policies, the Employe becomes wholly and continuously disabled as a result of any injury or any sickness so as to be prevented thereby from performing any and every duty of the Employe's occupation, and during the period of such disability such Employe shall have been under treatment therefor by a physician legally licensed to practice medicine, subject to the following conditions:

(i) Initial proof, in writing, of total disability must be submitted to the Insurance Company by or on behalf of the Employe within 3 months after the date of commencement of the total disability and at any time thereafter on demand from the Insurance Company further satisfactory proof, in writing, must be submitted to the Insurance Company that the total disability continues.

(ii) Whenever proof of the Employe's total disability is submitted, the Insurance Company, at its own expense, shall have the right and opportunity to have the Employe examined by a physician designated by it.

(iii) If the Employe ceases to be so totally disabled or fails to submit any required proof within the time prescribed therefor, the Employe's rights under the exception (A) specified above shall automatically and immediately cease and unless the Employe returns to active work with the Employer or meets the requirements for further continuance of such insurance under the other provisions of the Group Policies referred to in exception (C) above, the Employe's termination of employment shall be deemed to have occurred on the earlier of (a) the date of such cessation of total disability, and (b) failure to submit the required proof.

In June of 1979, plaintiff reported a psychiatric disorder, had a "breakdown" at work, and ceased coming to work. Plaintiff provided medical evidence of her total disability by her treating physician, Dr. Lawrence A. Cantow, a psychiatrist, to Metropolitan. Dr. Cantow stated that plaintiff was totally disabled for her regular occupation because of "prolonged depressive reaction." Metropolitan initiated payment of extended disability benefits under the Plan and continued payment through February 29, 1984.

After leaving her employment, plaintiff also filed a workers' compensation claim against General Motors, alleging that her psychiatric disability was work-related. This claim was settled on December 4, 1980 for $30,000.00. Plaintiff signed a voluntary quit form at the time of settlement. 1

On September 21, 1983, Metropolitan mailed a Supplemental Statement of Claim form to plaintiff and the completed form was received by Metropolitan from plaintiff's treating physician on November 11, 1983. In his remarks on the form, dated November 3, 1983, Dr. Cantow noted that plaintiff's depressive reaction was in partial remission and that "[the p]atient is now slowly returning to employability. She has a 2 day part-time job in a stained-glass shop as a creator-aide. With more time, she will be employable."

Based on this report, defendant scheduled an examination for plaintiff with Dr. N. Murthi, a psychiatrist. Prior to the examination, defendant also contacted Dr. Cantow's office, requested updated medical information and requested that he send appropriate treatment information to Dr. Murthi. Dr. Cantow advised Metropolitan that he last treated plaintiff on November 3, 1983, that plaintiff was not on medication, and that plaintiff was neither recently hospitalized nor was she scheduled to be hospitalized.

Following his examination of plaintiff, Dr. Murthi sent Metropolitan a three page report, consisting of a two-page narrative evaluation of plaintiff in which he recommended that plaintiff "return to work on a trial basis." The report also stated that plaintiff's "bipolar affective disorder, depressed type, [was] in remission." The third page of the report consisted of an examination results form in which Dr. Murthi indicated that on the basis of his examination, plaintiff was "not totally disabled so as to be wholly prevented, as a result of bodily injury or disease, either occupational or non-occupational in cause, from engaging in regular employment or occupation with the General Motors Corporation at the plant or plants where [she] has or had seniority" (emphasis added).

As a result of Dr. Murthi's conclusion of no disability and the remarks by Dr. Cantow, plaintiff's extended disability benefits were discontinued by defendant effective March 1, 1984. Plaintiff was notified of the claims decision by a letter dated March 5, 1984. Metropolitan contacted General Motors that they had terminated plaintiff's benefits.

Plaintiff contacted defendant and requested reconsideration of Dr. Murthi's determination of non-disability. She asserted that she was too ill to work, stated that Dr. Cantow refused to treat her or issue more reports on her behalf because of a dispute about the payment of a bill, and requested that she be sent to a second independent examiner.

In an April 3, 1984 letter, Metropolitan notified plaintiff that in order to obtain additional benefits, it would be necessary for her to submit an additional narrative report from a physician verifying her disability. During the following months, Metropolitan personnel had numerous telephone conversations with plaintiff. In each case, she was advised that due to Dr. Murthi's determination that she was not disabled and could work, she must submit additional medical evidence in writing to substantiate her disability. A final letter, dated July 11, 1984, advised plaintiff that under the terms of the Plan, it was plaintiff's responsibility to provide medical evidence of continuing disability and suggested that she go to a new attending physician for a narrative report. To this date, plaintiff has failed to provide Metropolitan with any medical evidence that her disability has continued.

Plaintiff last saw Dr. Cantow on November 3, 1983. Between that date and May 1986, plaintiff did not see a physician for her alleged psychiatric disability, and since 1984, she has been employed as follows:

a) Proctor Realtors, as a Real Estate Salesperson, March, 1985 to May, 1987;

b) Pontiac School District, as a bus driver, December, 1987 to June, 1988;

c) Glysson Realty, Inc., as a Real Estate Salesperson, July, 1988 to December, 1988;

d) Kingsley Inn, as a part-time banquet server, February, 1989 to present.

In May 1986, plaintiff started seeing Dr. Michael Short, a psychiatrist. Dr. Short testified that based upon a reasonable degree of medical certainty, it was his opinion that from January 1984 through May 1986, plaintiff would not have been able to return to work at her regular occupation at General Motors. However, he stated that he could not absolutely state that plaintiff was continually disabled from March 1, 1984 through May 6, 1986.

On April 28, 1989, plaintiff filed a complaint in the Circuit Court of Oakland County, asserting a state-law breach of contract claim and violations of the Michigan Uniform Trade Practices Act. Defendant removed the case to the federal district court for the eastern district of Michigan pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. Secs. 1001 et seq. After removal, a scheduling conference was held on August 15, 1989, and the district court issued a scheduling order in which the court stated that the cut-off dates for motions was March 1, 1990.

On March 1, 1990, defendant Metropolitan filed a motion to dismiss and motion for summary judgment. On March 28, 1990, plaintiff filed an answer to the defendant's motions together with a motion for leave to file a first amended complaint to add a cause of action under ERISA.

On April 5, 1990, a hearing was held before the district court. The court denied plaintiff's motion for leave to file a first amended complaint as untimely because it was filed 27 days after the cut-off date. Even though plaintiff was not given leave to amend her complaint, the court addressed the merits of plaintiff's action under ERISA. The court then granted defendant's ...

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