Spangler v. Lockheed Martin Energy Systems, Inc.
| Citation | 313 F.3d 356 |
| Decision Date | 16 December 2002 |
| Docket Number | No. 01-5770.,01-5770. |
| Parties | Janice SPANGLER, Plaintiff-Appellant, v. LOCKHEED MARTIN ENERGY SYSTEMS, INC.; Metropolitan Life Insurance Co., Defendants-Appellees. |
| Court | United States Courts of Appeals. United States Court of Appeals (6th Circuit) |
Donald K. Vowell (argued and briefed), Elizabeth Kelly Johnson (briefed), Vowell & Associates, Knoxville, TN, for Plaintiff-Appellant.
John C. Burgin, Jr. (argued and briefed), Kramer, Rayson, Leake, Rodgers & Morgan, Knoxville, TN, Christopher H. Hayes (briefed), Oak Ridge, TN, for Defendants-Appellees.
Before: MARTIN, Chief Circuit Judge; RYAN, Circuit Judge; COHN, District Judge.*
This is a case under the Employee Retirement Income Security Act, 29 U.S.C. § 1001, et seq. (ERISA). Plaintiff-appellant Janice Spangler (Spangler) claims that defendants-appellees Lockheed Martin Energy Systems, Inc. (Lockheed Martin) and Metropolitan Life Insurance Co. (Met Life),1 wrongfully terminated her long-term disability (LTD) benefits. After conducting a review of the administrative record under Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609 (6th Cir.1998), the district court granted Met Life's motion for judgment on the administrative record. Spangler appeals. Based on our review of the administrative record, we find that Met Life acted arbitrarily and capriciously in denying Spangler's LTD claim. Accordingly, we reverse the district court's decision.
Spangler worked as a lead auditor/data assistant at Lockheed Martin's U.S. government facility in Oak Ridge, Tennessee. As an employee, Spangler was eligible for and a participant in Lockheed Martin's Employee Benefit Plan, governed by ERISA. Lockheed Martin is the plan sponsor, and Met Life is the plan administrator.
In October of 1997, Spangler began missing work because of spondylolisthesis.2 When she was not able to return, Spangler applied for and received short-term disability benefits for six months.
During these six months, Spangler sought treatment with Dr. Michael MacKay, an orthopedic surgeon who diagnosed her with spondylolisthesis. An office note from a January 6, 1998, visit states that Spangler
has not improved with physical therapy. She remains unable to return to work. She continues with significant back pain.... she wishes to proceed with conservative treatment and elected for a brace. We have discussed cage fusion of the lumbar spine which she will consider doing in February, if she does not respond to the brace.
A February 1998 office note states that Spangler
Spangler applied for LTD benefits in February of 1998. In March and April of 1998, Met Life wrote to Dr. MacKay and others that Spangler identified as her treating physicians and requested her medical records. On June 16, 1998, Met Life awarded Spangler LTD benefits, finding Spangler eligible as of April 13, 1998. In the award letter, Met Life explained that in order to maintain her disabled status, she would have to remain under a doctor's care and keep Met Life informed of her condition.3 To this end, a March 1998 office note in Spangler's file reports that Spangler's brace helped her mobility but that if Spangler did not improve, "surgical treatment and fusion techniques" would be "the next course of treatment."
On July 15, 1998, Met Life wrote Spangler and encouraged her to apply for social security benefits. In the letter, Met Life instructed Spangler to contact an area law firm, to whom Met Life had already given Spangler's name, to assist her in the application process. Spangler contacted the law firm and applied for social security benefits. In October of 1998, Spangler was awarded social security benefits retroactive to April 1998. The law firm representing Spangler informed Met Life of the outcome of Spangler's social security case in October of 1998.
Meanwhile, on September 21, 1998, Dr. MacKay performed a "posterolateral fusion," inserted a brace and a battery-powered "spinal fusion stimulator." On November 6, 1998, Dr. MacKay reported that Spangler could be expected to return to work January 15, 1999. That did not happen, however, and Spangler continued to provide Met Life with documents of her progress.
On February 23, 1999, Dr. Bruce Hunt, one of Spangler's treating physicians, filled out an Attending Physician Statement, a two-page form from Met Life. Dr. Hunt said that Spangler could sit for two hours, stand for one hour, walk for zero hours, could not do lifting of any kind, and could not work.
On March 12, 1999, Dr. MacKay filled out an Attending Physician Statement. He said that Spangler could sit for four hours, stand for one hour, walk for one hour, lift up to 10 pounds occasionally, but she could not work and was not expected to improve. A March 9, 1999, office visit note from Dr. MacKay also reports that Spangler
On April 16, 1999, Dr. MacKay wrote to Met Life stating that Spangler's pain continued and On April 22, 1999, Dr. MacKay again wrote to Met Life stating:
Ms. Janice Spangler is unable to return to work at the anticipated date of January 15, 1999 due to continued severe lower back pain. She is dependent on a walker and cane for ambulation. She has not improved with a spinal fusion. Her spondylolisthesis has not progressed as far as I can tell on her x-rays. Long term management as the pain continues may include a repeat imaging such as a myelogram CT, as well as possible repeat surgery.
A May 28, 1999, entry in Met Life's Diary Review Report states that "both AP [Attending Physician Dr. Rice] and Dr. MacKay indicate that [Spangler] has significant restrictions and will never [return to work]." The diary review notes that Spangler was awarded social security disability benefits. The diary review also indicates that Met Life will send Spangler for a Functional Capacity Examination to "identify what limits would prevent [Spangler] from performing her own [occupation]."
On July 21, 1999, Met Life scheduled Spangler for a whole body functional capacity examination. The Functional Capacity Evaluation Summary Report, signed by Susan Ewing, a registered physical therapist for Met Life, and Brian Moore, an Industrial Medicine Coordinator, concluded:
This patient demonstrates a functional capacity at the Sedentary physical demand level, which does not meet the stated job demands for her previously held position. She scored positively on most psychometric indicators for symptom magnification and a focus on pain. Both the examiner and physical therapist were limited in performing a complete evaluation or testing secondary to complaints of pain and inability to assume requested positions for testing.
The testing showed that Spangler could sit for "14 minutes," stand for "10 seconds," walk "4 × 30 seconds with quad cane," and climb "five steps with assist." The report ultimately found Spangler disabled and stated "Data is available on file which substantiates the findings in this report."
In September 1999, Met Life asked Dr. MacKay and Spangler's primary care physician, Dr. Mark Rice, to provide updated office notes and tests and to complete a Physical Capacities Evaluation, another form provided by Met Life. On September 14, 1999, Dr. MacKay filled out the Physical Capacities Evaluation form, which is less detailed than the Attending Physician Statements that Dr. MacKay had previously submitted to Met Life. On the form, Dr. MacKay reported that Spangler could sit for six hours, walk for two hours, and lift and carry up to ten pounds occasionally. The report to Met Life also included Dr. MacKay's office notes. The Physical Capacities Evaluation, unlike the Attending Physician Statement, does not ask whether the patient was capable of working but rather asks only for how long the patient could sit, stand, walk, lift, carry, etc. As noted above, all previous and subsequent reports Dr. MacKay provided to Met Life indicated that Spangler was totally disabled and was not capable of working.
Dr. Rice's Physical Capacities Evaluation is dated September 7, 1999. Dr. Rice said that Spangler could sit for four hours during an eight-hour workday but that she could not stand, walk, or drive. Notably, Dr. Rice also wrote:
Met Life then decided to obtain a transferable skills analysis to determine whether Spangler was capable of sedentary work. In doing so, Met Life forwarded only Dr. MacKay's September 14, 1999, Physical Capacities Evaluation to Crawford & Company Healthcare Management Services (Crawford), a consulting company, and asked it to determine if Spangler was capable of working. One of Crawford's vocational consultants, Greta Knaus,4 determined that a person in Spangler's geographical location with her training and limitations (set forth in Dr. MacKay's September 14, 1999, report) could be employed in Spangler's prior job as well as several other comparable sedentary jobs.
On December 3, 1999, Met Life terminated Spangler's LTD benefits effective January 1, 2000. The denial letter states in relevant part:
Based upon a thorough and extensive review and evaluation of all the medical information contained in your claim file, we have determined that you no longer qualify for Long Term Disability ("LTD") benefits under the Lockheed Martin Energy Systems plan. Our reasons are set forth...
To continue reading
Request your trial
-
Rodriguez v. Wal-Mart Stores, Inc., A-2 September Term 2017
...by medical experts testifying in court proceedings to describe an exaggeration of symptoms. See, e.g., Spangler v. Lockheed Martin Energy Sys., 313 F.3d 356, 359-61 (6th Cir. 2002) (concerning employee's appeal of termination of long-term disability benefits under Employee Retirement Income......
-
Rabuck v. Hartford Life and Acc. Ins. Co.
...at * 4 (6th Cir. Oct.17, 2007). The administrator must consider the entire record, not selected portions. Spangler v. Lockheed Martin Energy Sys., 313 F.3d 356, 359-62 (6th Cir.2002); Satterwhite v. Metropolitan Life Ins. Co., 2007 WL 2746886, at * 7. Furthermore, in performing a review und......
-
Crider v. Highmark Life Ins. Co.
...skills analyst was provided with an inappropriately selective portion of the claimant's medical records.); Spangler v. Lockheed Martin Energy Sys., 313 F.3d 356, 362 (6th Cir. 2002) (The decision terminating long-term disability benefits was arbitrary and capricious because the insurance co......
-
Kaferly v. Metro. Life Ins. Co.
...impairments, and other subjective reports of limiting conditions absent a stated reason for doing so. See Spangler v. Lockheed Martin Energy Sys. , 313 F.3d 356, 362 (6th Cir.2002) (insurer may not rely only on evidence "cherry picked" from the broader record); Marcus v. Califano , 615 F.2d......