Wojciechowski v. Metropolitan Life Ins. Co.

• Decision Date: 01 December 1999
• Docket Number: No. 98 Civ. 1229(BDP).,98 Civ. 1229(BDP).
• Parties: Paul J. WOJCIECHOWSKI, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY and IBM Corporation, Defendants.
• Court: U.S. District Court — Southern District of New York

75 F.Supp.2d 256

Paul J. WOJCIECHOWSKI, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY and IBM Corporation, Defendants.

No. 98 Civ. 1229(BDP).

United States District Court, S.D. New York.

December 1, 1999.

Richard A. Kerner, Kerner & Kerner, New York City, for plaintiff.

Paul George Huck, Donald J. Harman, New York City, Carl Judah Schaerf, Lester Schwab, Katz & Dwyer, New York City, for defendant Metropolitan Life.

John Houston Pope, Davis, Markel & Edwards, New York City, for defendant IBM.

MEMORANDUM DECISION AND ORDER

BARRINGTON D. PARKER, Jr., District Judge.

Plaintiff Paul J. Wojciechowski brings this action against defendants Metropolitan Life Insurance Company ("Met Life") and his former employer IBM Corporation ("IBM"), under the Employee Retirement Income Security Act of 1974, as amended, ("ERISA"), 29 U.S.C. §§ 1001, et seq., alleging that his claims made pursuant to the Long Term Disability and Separation Pay plans of IBM were wrongfully denied. Plaintiff seeks money damages and a declaratory judgment that he was and still is entitled to the benefits which he was denied. Before this Court are defendants' motions for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure. For the following reasons, defendants motions are granted.

BACKGROUND

Plaintiff was hired by IBM in February of 1980. In February of 1995, he became a customer operations manager in IBM's National Service Division in White Plains, New York. His group handled support services for IBM consultants, which entailed, inter alia, inputting consultant contracts into the computer system, creating and tracking billing for each contract, creating reports relating to the contracts and otherwise assisting the financial division.

During his tenure at IBM, plaintiff was a participant in IBM's Long Term Disability Plan (the "LTD" plan) and IBM's Separation Allowance Plan (the "SAP"). IBM established and maintains both plans, which provide eligible IBM employees with certain benefits in the event of long term disability or separation, under certain circumstances, from IBM.

1. Long-Term Disability

The LTD plan is insured under a group policy issued by Met Life to IBM, wherein Met Life is the claims administrator. The Plan provides for the payment of LTD benefits in the event of a participant's total disability.

Under the plan, totally disabled,

means that during the first 12 months after you complete the waiting period, you cannot perform the important duties of your regular occupation with IBM because of a sickness or injury. After expiration of that 12 month period, totally disabled means that, because of a sickness or injury, you cannot perform the important duties of your occupation or of any other gainful occupation for which you are reasonably fit by your education, training or experience.

LTD Summary Plan Description ("SPD") § 2.4.1.

In August of 1995, plaintiff was told that his division at IBM was relocating to Raleigh, North Carolina, effective February 1, 1996. After attending several meetings in Raleigh as part of this transition, plaintiff requested not to be transferred to Raleigh so that he could continue seeing his physician who was treating him for back and spinal injuries, among other symptoms, which he suffered as a result of a car accident that occurred on December 26, 1993. IBM complied with his request, assigning him the non-managerial position of liaison between the Financial group that remained in White Plains, and the Customer Operations group that relocated to North Carolina.

Before assuming this assignment, plaintiff's medical problems, verified in medical findings by his doctor, neurologist Kailash C. Pani, resulted in two consecutive three month leaves beginning January 16, 1996, under IBM's Sickness and Accident Plan (the "S & A Plan"). On April 16, 1996, following an examination of plaintiff, IBM's consultant Dr. Elliott Gross issued a report concluding that plaintiff could return to work. In response, on June 16, plaintiff issued a six page rebuttal to Dr. Gross' report in which he refuted and corrected alleged inaccuracies and errors in the Gross report.

Plaintiff's doctor produced several reports detailing plaintiff's medical problems and advising that plaintiff abstain from full-time work. Those problems included intense photophobia or hypersensitivity to light which caused tearing, severe back and spinal injuries, severe headaches and periodic depression and insomnia. Dr. Pani's report dated May 6, 1996, concluded that "the patient is advised to refrain and abstain from working with computer terminals of any kind. He is completely and permanently disabled to perform any substantial and material duties of his job at IBM."

Following a letter dated July 25, 1996, sent to him by his supervisor Frank J. Bon advising him that if he did not report to work by August 1 he would be terminated as an employee, plaintiff returned to work at IBM on August 5, 1996. He alleges that he experienced immediate head and eye pain caused by bright lights and 10 to 15 minute stints in front of a computer. Plaintiff met with IBM's Dr. J.M. Gonzalez the next day and a week later, plaintiff resumed his S & A leave. Following this incident, plaintiff's physician, Dr. Pani performed various diagnostic procedures, tests and examinations, concluding again that plaintiff was "completely and permanently disabled." Plaintiff made a claim for LTD benefits under the Plan on October 21, 1996. His S & A leave expired on December 19, 1996.

Plaintiff was examined by other doctors, both on behalf of defendants and following referral by his physician. Dr. Robert L. Bertrand, for example, reviewed plaintiff's medical records on behalf of Met Life and determined that plaintiff suffered form a "seizure disorder." On January 7, 1997, plaintiff was examined by Dr. Orly Avitzur, a physician designated by Met Life whose diagnosis conflicted with that of Dr. Pani in that his medical problems were found to be less severe. Dr. Gross, an independent neurologist retained by IBM who examined plaintiff, also submitted a report on plaintiff's condition to Met Life concluding that there was no evidence of neurological abnormality. Plaintiff also offers the letters of four of his IBM co-workers describing personal observations of his ailments.

Plaintiff was advised of the denial of his claim on March 5, 1997. In that letter, Met Life advised that it had "thoroughly reviewed the information submitted by [plaintiff's] attending physician Dr. Pani," as well as the reports of Dr. Gross and Dr. Atvizur. March 5, 1997 Letter of David Ruiz at 2. The letter concluded: "Based on the information above, we have determined that you do not meet the definition of disability as defined in the group plan. Therefore, we have no alternative but to disallow your claim." Id. Plaintiff appealed the denial of his LTD claim to Met Life in August, 1997, which was denied by letter dated October 16, 1997.¹

2. Severance Pay

Plaintiff claims he was wrongly denied severance pay by IBM under its Separation Allowance Plan ("SAP"). While plaintiff's application for LTD benefits was pending, plaintiff alleges that he was "tacitly discharged." Plaintiff's Memorandum of Law in Opposition to Defendants' Motion for Summary Judgment at 8. He received a Consolidated Omnibus Budget Reconciliation Act ("COBRA") package of health insurance extension documents from IBM in February of 1997. Bon, plaintiff's supervisor, alleges in an affidavit that because plaintiff had not qualified for LTD benefits when his S & A leave expired on December 19, 1996 and he did not return to work nor inquire about doing so, plaintiff was deemed to have voluntarily resigned from IBM. Affidavit of Frank J. Bon at 3. Bon avers that plaintiff stopped receiving a paycheck and was sent a check for his accrued vacation days. Bon states that when plaintiff contacted him at the end of February 1997 about his termination from the company, he informed plaintiff that "he was considered to have separated himself from the company because he did not have a valid medical excuse to be out once his S & A benefits expired and he had not returned to work." Bon Aff. at 3.

In the Fall of 1997, Bon states that plaintiff inquired about the possibility of receiving separation pay. Bon informed plaintiff by letter dated January 16, 1998 that because he failed to return to work once his S & A benefits had expired he was deemed to have resigned.

On or about January 14, 1998, plaintiff commenced an action against Met Life in New York State Supreme Court, Rockland County alleging it had wrongfully denied his application for LTD benefits. Met Life removed the action to federal court. Plaintiff filed an amended complaint in this Court on August 13, 1998, adding IBM and six other companies as defendants and a second cause of action against IBM alleging wrongful denial of severance pay. By stipulation dated January 12, 1999, the action was dismissed without prejudice against all defendants other than IBM and Met Life.

Plaintiff challenges the denial of benefits under 29 U.S.C. § 1132(a)(1)(B), which provides that "a participant or beneficiary" may bring a civil action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan."

DISCUSSION

1. Summary Judgment Standard

Summary judgment may not be granted unless "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c); see also Hayes v. New York City Dept. of Corrections, 84 F.3d 614, 619 (2d Cir.1996); Bryant v. Maffucci, 923 F.2d 979, 982 (2d Cir.1991). The Court is to perform "the threshold inquiry of determining whether...