Reid v. Metro. Life Ins., Co.

• Decision Date: 29 March 2013
• Docket Number: Civil Action No. 1:11–cv–2422–AT.
• Citation: 944 F.Supp.2d 1279
• Parties: Sandra L. REID, Plaintiff, v. METROPOLITAN LIFE INSURANCE, COMPANY, Defendant.
• Court: U.S. District Court — Northern District of Georgia

944 F.Supp.2d 1279

Sandra L. REID, Plaintiff,

v.METROPOLITAN LIFE INSURANCE, COMPANY, Defendant.

Civil Action No. 1:11–cv–2422–AT.

United States District Court,

N.D. Georgia,

Atlanta Division.

March 29, 2013.

Heather K. Karrh; Rogers & Hofrichter & Karrh, LLC, for Plaintiff.

Elizabeth Johnson Bondurant; Smith, Moore, Leatherwood Joseph Michael English; Taylor English Duma LLP, for Defendant.

Lewis P. Janowsky; Rynn & Janowsky; Michael David Kata; Wargo & French LLP, for Defendant Kingco Promotions, Inc.

ORDER

AMY TOTENBERG, District Judge.

This case is brought under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Plaintiff Sandra Reid (“Reid”) contends that Defendant Metropolitan Life Insurance Company (“MetLife”) wrongfully terminated her long term disability benefits after 24 months despite substantial medical documentation demonstrating that Plaintiff was disabled due to dementia. Plaintiff further claims that this termination was arbitrary and capricious. This matter is before the Court on Defendant's Motion for Judgment on the Administrative Record [Doc. 24] and Plaintiff's Motion for Judgment on the Administrative Record [Doc. 25]. The Court first sets forth below its findings of fact and thereafter the legal standards of review and an analysis of the evidence in the context of applicable standards.¹

I. FINDINGS OF FACT

Plaintiff filed her Complaint against MetLife on July 25, 2011, under ERISA seeking to recover long term disability benefits under an employee welfare benefit plan offered by her former employer International Business Machines Corporation (“IBM”), plus interest, attorney's fees, and litigation expenses. (Compl., Doc. 1; AR 1–52, AR 52–88.) On October 6, 2011, Plaintiff filed an Amended Complaint to include a claim for benefits under IBM's 401(k) disability protection program, which contributes to a participant's 401(k) account in the event of disability. (Am. Compl., Doc. 12.) MetLife asserted a counterclaim for overpaid benefits in the amount of $50,806.57, relating to Plaintiff's receipt of a retroactive lump sum award of Social Security disability benefits. (Countercl., Doc. 14.) Plaintiff has exhausted her administrative appeal remedies. (Am. Compl. ¶ 25; Answer ¶ 25).

A. Pertinent Plan Provisions

Effective January 1, 2005, IBM offered its employees a long term disability benefits plan (“the LTD Plan”) and 401(k) disability protection program (“the DDP Plan”) funded by a group policy issued by MetLife. (AR 1–99.) As an eligible employee of IBM, Reid was a participant in the LTD Plan and the DPP Plan. (Affidavit of Timothy D. Suter, Exhibit 1 to Def.'s Mot., ¶ 4, Doc. 24–2.) Benefits under the Plans are insured by MetLife and MetLife is the claim administrator under the Plans. ( Id. at ¶ 5.)

The LTD Plan defines “Disabled” or “Disability” to mean that “due to Sickness or as a direct result [sic] accidental injury,” a claimant is (1) receiving “appropriate care and treatment,” and, (2) “during the elimination period and the next 12 months of sickness, unable to perform each of the material duties” of their own occupation, and (3) “after such period unable to perform the duties of any gainful occupation” for which the claimant is reasonably qualified taking into account their training, education and experience. (AR 22.) However, the LTD Plan contains the following limitation provision for “Disability Due to Mental or Nervous Disorders or Diseases”:

If you are Disabled due to a Mental or Nervous Disorder or Disease, We will limit Your Disability benefits to a lifetime maximum equal to the lesser of:

• 24 months; or

• the Maximum Benefit Period

This limitation will not apply to a Disability resulting from:

• schizophrenia;

• dementia; or

• organic brain disease.

Mental or Nervous Disorder or Disease means a medical condition which meets the diagnostic criteria set forth in the most recent edition of the Diagnostic And Statistical Manual of Mental Disorders as of the date of Your Disability. A condition may be classified as a Mental or Nervous Disorder or Disease regardless of its cause.

(AR 39 (hereinafter the “Limitation Provision”).) The DDP Plan contains a virtually identical definition of disability and the same Limitation Provision as the LTD Plan. (AR 77, AR 81.) MetLife determines eligibility for benefits under the LTD Plan and the DDP. (AR 33, AR 39, AR 77, AR 81.)

B. Plaintiff's Pre–Disability Claim Employment and Medical History

Plaintiff worked for IBM and IBM's predecessor, AT & T, from 1986 to 2006. (AR 1859–61, AR 998.) From 1999 to 2007, Plaintiff was employed by IBM as an Advisory Project Manager. (AR 1859–1861.) Her job duties included: (1) managing and leading a team on a complex small project, medium size project or significant segment of large hardware and software projects; (2) demonstrating working knowledge in business matters, finance, planning, forecasting and personnel in order to manage team staff and business issues; (3) negotiating effectively with team members to define the team's goals, work content and schedules; (4) communicating team results to immediate management/project manager; (5) establishing and maintaining communication of project status with the project team and other staff; (6) complex problem solving related to various projects or functions; (7) applying creativity and judgment in development of multiple solutions related to project objectives; (8) defining and deciding objectives related to the projects from a cost schedule, technical and quality perspective and providing guidance in these area to others; (9) working with customers/suppliers/IBM staff; (10) identifying estimates and presenting cost, schedule and business and technical risk for projects; and (11) interfacing directly with corresponding levels of customer's staff in carrying out responsibilities for customers' financial baseline of projects. (AR 1862–1862.)

In 2001, Plaintiff began complaining to her doctors that she was experiencing trouble sleeping, and problems with memory, that she had noted decreased retrieval time, slow speech and comprehension, she was mixing words, she found it took a “lot of effort to concentrate,” and that it was difficult to make simple decisions. (AR 471–472, AR 930, AR 934, AR 949, AR 952–53, AR 958–59, AR 819.) Plaintiff stated that she had always been an overachiever at work but that she felt humiliated because of these problems and was concerned about her job status. (AR 943, AR 953, AR 958.) Plaintiff was diagnosed with Attention Deficit Hyperactivity Disorder (“ADHD”) and depression and was prescribed numerous medications including Celexa, Wellbutrin, Ritaliln, Buspirone, and Ambien for her symptoms. (AR 825, AR 838.) In 2002 and 2003, her cognitive issues continued with memory and concentration problems, disorganized thoughts, disruptive sleep leading to “inconsistent performance,” and struggles with her work schedule. (AR 838, AR 843, AR 848–49, AR 852–853, AR 854, AR855, AR 856–57, AR 861, AR 878–879, AR 808, AR 812.) Plaintiff stated she wanted to improve her memory and concentration so she did not sound like a mentally challenged person. (AR 885–86.) Plaintiff began seeing a psychiatrist, Dr. Rick Stallings, M.D., in June 2002. (AR 836; AR 474.) In 2004, Dr. Stallings referred Plaintiff to Dr. Andrea Carstens, Ph.D. and Clinical Neuropsychologist, for a neuropsychological evaluation. (AR 784.)

According to Dr. Carstens's September 2004 neuropsychological evaluation, Plaintiff was referred by Dr. Stallings to evaluate her concerns regarding problems with memory and concentration that had not improved over the prior three years. (AR 466–470.) The 2004 evaluation references Plaintiff's diagnoses at that time as including Major Depressive Disorder, Single Episode, Partial Remission, and Attention Deficit Disorder. (AR 466.) Dr. Carstens's notes indicate that Plaintiff, who was 48 at the time of the evaluation, “completed the 12th grade and went on to establish an impressive career as a computer systems analyst.... [She] is self-taught regarding her computer skills and describes herself as a hands-on learner.” ( Id.) Plaintiff reported a history of being extremely well organized but had experienced a change in this area. ( Id.) Dr. Carstens reviewed Plaintiff's medical records from 2001 forward summarizing her mental health history following her husband's stroke problems and performance problems at work. (AR 467.) Dr. Cartsens noted that while Plaintiff was treated for depression and Attention Deficit Disorder, her cognitive difficulties were ongoing. ( Id.) Dr. Carstens also noted Plaintiff's family history of Alzheimer's. ( Id.)

Dr. Carstens's 2004 report reflects Plaintiff's reported problems with job performance:

Ms. [Reid] works from home for IBM, doing consulting regarding the acquisition of computer projects and system support. She works approximately 10 hours a day. Her last performance evaluation in February of 2004 for her work in 2003 had dropped from a highest category to a satisfactory category. She was noted to not be timely in her work completion. She reports this is related to a decline in her organization, and general forgetfulness. She has missed conference calls that she is hosting, despite computer reminders. She gets projects and people assigned to them mixed up. She notes that her job has always been quite stressful and demanding and that there has been an increase in her responsibilities. She reports that at times she approaches quite familiar and routine tasks and forms and draws a blank.

(AR 467.) Plaintiff reported poor concentration and problems with comprehension for both written and verbal communication. ( Id.) She indicated feeling that her “conversation is ‘all over the place,’ as though her mouth and mind are out of sync” and a possible decline in spatial processing based on recent experiences getting lost in previously familiar places. (AR 468.) Plaintiff ind...