Murphy v. Deloitte & Touche Group Ins. Plan
| Citation | 619 F.3d 1151 |
| Decision Date | 08 September 2010 |
| Docket Number | No. 09-2028.,09-2028. |
| Parties | Aileen MURPHY, Plaintiff-Appellant, v. DELOITTE & TOUCHE GROUP INSURANCE PLAN; Metropolitan Life Insurance Company, Defendants-Appellees. |
| Court | United States Courts of Appeals. United States Court of Appeals (10th Circuit) |
619 F.3d 1151
Aileen MURPHY, Plaintiff-Appellant,
v.
DELOITTE & TOUCHE GROUP INSURANCE PLAN; Metropolitan Life Insurance Company, Defendants-Appellees.
No. 09-2028.
United States Court of Appeals,Tenth Circuit.
Sept. 8, 2010.
COPYRIGHT MATERIAL OMITTED.
Robert J. Rosati, Fresno, CA, appearing for Plaintiff-Appellant.
Jack M. Englert, Jr., Holland & Hart, LLP, Greenwood Village, CO, (Kristina Martinez, Holland & Hart, LLP, Santa Fe, NM, with him on the brief), appearing for Defendants-Appellees.
Before KELLY, EBEL, and TYMKOVICH, Circuit Judges.
EBEL, Circuit Judge.
Plaintiff-Appellant Aileen Murphy was a participant in the Deloitte & Touche Group Insurance Plan (“the Plan”), an insurance plan governed by the Employee Retirement Income Security Act (“ERISA”). Metropolitan Life Insurance Company (“MetLife”) both insured and administered the Plan; thus, it operated under an inherent dual role conflict of interest, see Weber v. GE Group Life Assurance Co., 541 F.3d 1002, 1011 (10th Cir.2008). While a participant in the Plan, Ms. Murphy filed a claim for long-term disability benefits, which MetLife ultimately denied.
Ms. Murphy then sought judicial review of MetLife's decision pursuant to 29 U.S.C. § 1132(a)(1)(B) and all parties agreed to proceed before a magistrate judge. Soon after filing her action, Ms. Murphy moved for discovery regarding MetLife's dual role conflict of interest. The magistrate judge denied Ms. Murphy's discovery request because the conflict of interest was apparent on the face of the administrative record, which rendered discovery on that issue unnecessary. Then, upon receiving motions for summary judgment from both sides, the magistrate judge granted summary judgment in favor of the Plan and MetLife.
On appeal, Ms. Murphy challenges the magistrate judge's denial of her discovery request and its grant of summary judgment for the defendants. Exercising jurisdiction pursuant to 28 U.S.C. § 1291, we VACATE the magistrate judge's discovery and summary judgment orders and REMAND for further proceedings consistent with this opinion.
Ms. Murphy worked as a Tax Firm Director for Deloitte & Touche. Her position entailed travel, significant interaction and coordination with others, negotiations with the Internal Revenue Service and clients, advising clients on complex matters, preparation of proposals, and leading client meetings.
While at Deloitte & Touche, Ms. Murphy participated in the Plan, which was governed by ERISA and provided long-term disability benefits for plan participants. All parties agree that to receive long-term disability benefits Ms. Murphy had to satisfy the Plan's definition of “Total Disability” or “Totally Disabled”:
[D]ue to an injury or Sickness, you:
1. are completely and continuously unable to perform each of the material duties of your regular job; and
2. require the regular care and attendance of a Doctor.
However, after the first 24 months of benefit payments, you must also be completely unable to perform the duties of any gainful work or service for which you are reasonably qualified taking into consideration your training, education, experience, and past earnings.
(Aplt.App. v.2 at 152.) The Plan requires that the claimant furnish “[w]ritten proof of a claim” that “describe[s] the event, the nature, and the extent of the cause for which a claim is made.” ( Id. at 157.) To receive disability benefits, the furnished proof must “be satisfactory” to the Plan, and the Plan reserves the right to have the claimant examined by doctors of its choice. ( Id.)
In August 2006, Ms. Murphy first submitted a claim for long-term disability benefits
under the Plan. Her primary care physician, Dr. Frances Chavez, provided Ms. Murphy with two letters supporting her disability claim. In a June 2006 letter, Dr. Chavez diagnosed Ms. Murphy with “ataxic gait” and “blurred vision” and described her symptoms to include “loss of balance, parasthesias, difficulty with speech, malaise, memory loss, [and] blurry vision.” ( Id. at 344.) Dr. Chavez also described Ms. Murphy as “unable to communicate clearly” and struggling to recall and focus with numbers. ( Id.)
In a subsequent letter dated August 2006, Dr. Chavez revised her diagnosis, but explicitly restated her conclusion that Ms. Murphy could not perform any “aspect of [her] job duties.” ( Id. at 393.) Dr. Chavez now diagnosed Ms. Murphy as suffering from “[l]umbar spinal stenosis” and “[m]emory [d]isturbance.” ( Id. at 392.) She described her symptoms to include “back pain, leg pain, extreme fatigue, balance [and] vision problems” as well as memory problems, greatly diminished focus and attention, and adversely affected cognitive disabilities. ( Id.) Dr. Chavez noted that she had prescribed Ms. Murphy Oxycontin and that her “back [and] leg pain [were] currently responding to [the] painkillers.” ( Id. at 392-93.)
Ms. Murphy also submitted reports, letters, or notes from a psychiatrist, Dr. Mustafa Ziyalan, a neurologist, Dr. Elizabeth Lakind, and an orthopedic surgeon, Dr. Claude Gelinas. Dr. Ziyalan noted that Ms. Murphy had been hospitalized in 2005 for suicidal ideation and diagnosed with Major Depressive Disorder and Panic Disorder, but describes her depression as “recurrent, in full remission.” Id. at 391. Dr. Lakind explained that Ms. Murphy suffered from a “lumbar spine disease,” but that Ms. Murphy was “now on pain medications with good benefit.” Id. at 396. Dr. Lakind also noted that in June 2006 Ms. Murphy had undergone a cranial MRI, an EEG, and a Brain SPECT and each produced normal results, but a cervical MRI raised some concerns with her spinal discs. Finally, Dr. Gelinas also diagnosed Ms. Murphy as suffering from “[j]unctional stenosis and degenerative disc disease” in her spine, and he described her as suffering from antalgic gait that significantly limited her range of motion. ( Id. at 407.)
Despite this information, MetLife denied Ms. Murphy's claim in September 2006. It “found no clinical evidence to substantiate [the] restrictions and limitations” described by Dr. Chavez and “no objective clinical evidence or documentation to support [Ms. Murphy's] subjective complaints.” ( Id. at 349-50.) MetLife noted that Ms. Murphy informed it over the phone that Oxycontin controlled her pain, she no longer used a walker, and she had left her job because cognitive problems impaired her performance. MetLife further noted that Ms. Murphy's EEG produced normal results, she declined to have surgery to address her back pain, and she failed to have follow-up tests to rule out an otologic cause as the source of some of her problems, which an Ear, Nose, and Throat specialist suggested as a possibility. Therefore, MetLife found “no medical documentation to substantiate restrictions and limitations or a level of impairment of such severity” that Ms. Murphy was “preclude[d] ... from performing [her] sedentary job.” ( Id. at 350.)
Ms. Murphy appealed MetLife's decision and supplemented the administrative record with a variety of information. Dr. Chavez provided additional information confirming Ms. Murphy's disability, and she expanded her diagnosis to include ataxic gait, blurred vision, lumbar spinal stenosis, memory disturbance, Major Depressive Disorder, and Anxiety Disorder. She also submitted documentation that in October 2006 she had a suicidal ideation, was admitted to the hospital where she
remained for one week and was diagnosed with Major Depressive Disorder, though she appears not to have obtained follow-up psychiatric evaluations despite encouragement from Dr. Chavez to do so.
Additionally, a clinical neuropsychologist, Dr. Stephen Chilulli, provided an evaluation from September 2006 in which he found Ms. Murphy's “current intellectual function ... significantly above average.” ( Id. at 322.) He explained that “[t]here may be some disruption of [Ms. Murphy's] attention skills,” but he also noted that, even in the attention testing, Ms. Murphy performed “some of the more challenging task [ sic ] .... better than some simple attention tasks,” which he felt “may be related to anxiety”-a diagnosis consistent with the results of her personality tests. ( Id. at 323.) Ultimately, however, Dr. Chilulli concluded that “[t]he results of neuropsychological testing are negative for evidence of brain dysfunction, with measures of higher cortical functions often being in the high average to superior range.” ( Id.)
A separate neurologist, Dr. William Weng, also concluded that Ms. Murphy's “mental status appears to be fluidly intact,” though he expressed concern that Ms. Murphy may suffer from depression and anxiety and that her combination of medications may impact her cognitive function. ( Id. at 325.)
Metlife reviewed Ms. Murphy's additional materials but again denied her claim. It enlisted two independent physicians to review Ms. Murphy's claim-a neurologist, Dr. Bruce LeForce, and a neuropsychologist, Dr. Carol Walker. Both independent physicians reviewed Ms. Murphy's file and concluded that her records did not support her claim for disability, though neither personally examined Ms. Murphy. The independent physicians acknowledged Ms. Murphy's physical injury to her spine, but noted that her physical pain was controlled by her medication. As to Ms. Murphy's claims of cognitive impairment, the independent physicians concluded that Dr. Chilulli's and Dr. Weng's evaluations did not support Ms. Murphy's claims of cognitive impairment. Moreover, Dr. Walker spoke with Dr. Chavez by phone in March 2007, and Dr. Chavez then indicated that Ms. Murphy's “cognition appears clear and there are no signs she is over-medicated.” ( Id. at 234). As to Ms. Murphy's depression and anxiety, Dr. Walker explained that Dr. Ziyalan had previously diagnosed Ms. Murphy's depression as in full remission and that while Ms. Murphy had been subsequently hospitalized for suicidal ideation,...
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