Archible v. Metropolitan Life Insurance

85 F. Supp. 2d 1203, 2000 U.S. Dist. LEXIS 1957, 2000 WL 222128
CourtDistrict Court, S.D. Alabama
DecidedFebruary 2, 2000
Docket99-0361-MJ-C
StatusPublished
Cited by3 cases

This text of 85 F. Supp. 2d 1203 (Archible v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Archible v. Metropolitan Life Insurance, 85 F. Supp. 2d 1203, 2000 U.S. Dist. LEXIS 1957, 2000 WL 222128 (S.D. Ala. 2000).

Opinion

MEMORANDUM OPINION AND ORDER

CASSADY, United States Magistrate Judge.

This cause is before the Court for a de novo review of the plan administrator’s decision to terminate plaintiffs long-term disability benefits. (See Doc. 32 (this Court’s December 2, 1999 determination that a de novo standard of review, rather than an arbitrary and capricious standard, was applicable to defendant’s decision to terminate plaintiffs long-term disability benefits since the benefit plan did not expressly provide the administrator discretionary authority to make eligibility determinations or to construe the plan’s terms as they relate to the issue of “general disability” as set out in the second paragraph of the plan under the general heading “TOTAL DISABILITY”)) The parties have consented to the exercise of jurisdiction by the Magistrate Judge, pursuant to 28 U.S.C. § 636(c), for all further proceedings, including disposition of this case as described above. (See Doe. 31 (“In accordance with the provisions of 28 U.S.C. 636(c) and Fed.R.Civ.P. 73, the parties in this case hereby voluntarily consent to have a United States magistrate judge conduct any and all further proceedings in the case, including the trial, order the entry of a final judgment, and conduct all post-judgment proceedings.”)) Upon consideration of the contents of the briefs, the joint evidentiary submission of the parties, and numerous exhibits filed in support of the defendant’s motion for summary judgment, 1 the Court affirms the defendant’s termination of plaintiffs long-term disability benefits.

FINDINGS OF FACT

1. The Long-Term and Partial Disability Income Plan for all U.S. employees of Bell Atlantic Enterprises Corporation became effective on January 1, 1988. (Doc. 36, Exhibit 1) The plan defines total disability as follows:

*1205 During the first 24 months of your disability, in addition to your Qualifying Period, you must be unable to perform the normal duties of your regular occupation for any employer and you must at no time engage in any occupation or employment for pay or profit. This must be due to your disability. The Travelers will decide if this is the case.
After the first 24 months of your disability, in addition to your Qualifying Disability Period, you must be completely unable to engage in any occupation or employment for which you are or become qualified. You could be qualified because of your education, training or experience.

(Id., at 20) The plan also provides that benefits will be paid to an individual only when the Qualifying Disability Period has been completed, the individual has “applied for and given all needed proofs for all Other Income Benefits” available to him, and the individual is under a physician’s care. (Id., at 6) No payment will be made, in the first instance, for total or partial disability which results from injury which is not treated by a physician. (See id., at 10) Finally, the plan provides that during the course of an individual’s total or partial disability, The Travelers Insurance Company (“Travelers”) can request written proof, from time to time as needed,-that the “Total Disability or Partial Disability has been and is continuous.” (Id., at 11)

2.Following an automobile accident in September of 1989, Archible was determined to be eligible for long-term disability benefits by Travelers. (Doc. 36, Exhibit 29, Affidavit of Lewellyn Archible; 2 see also Exhibit 1) In addition, plaintiff was determined to be disabled by the Social Security Administration and eligible for benefits as of March of 1990. (See id., Exhibit 28) Archible continues to receive disability benefits from the Social Security Administration. (See id.)

3. On May 12, 1993, Travelers notified Archible by mail that it was updating his disability claim and to that end requested that he have his doctor complete and return to it the Attending Physician’s Statement that was enclosed in the mailing. (See id., Exhibit 2) Travelers also asked plaintiff to answer several questions and to complete an enclosed Authorization to Disclose Information. (Id.)

4. Archible telephoned Travelers on May 18, 1993 and inquired about the need for a medical update. (Id., Exhibit 3) Upon being informed that the company needed ongoing documentation to support his disability claim, Archible told whoever he was speaking to that he was not seeing a doctor at the present time. (See id.) Plaintiff was told that he needed to go to a doctor and get the form filled out and returned same to Travelers as soon as possible. (See id.)

5. On August 4, 1993, Travelers requested that plaintiff return to it the forms sent to him in May. (Doc. 36, Exhibit 4) “To enable us to give further consideration to your claim, we request that you PLEASE RETURN FORMS SENT TO YOU IN MAY, 1993 WITHIN THE NEXT THIRTY DAYS. THIS IS SECOND REQUEST, PLEASE DO NOT JEOPARDIZE YOUR BENEFITS.” (Id.)

6. On August 31, 1993, Travelers sent the following letter to Archible:

In order to process your claim, we need additional medical information. We cannot secure this without your permission and authorization. Please read the enclosed Claimant’s Authorization and sign where indicated. This form will allow us to request specific medical information that relates to your claim. If you have any questions, please contact us at the above toll-free number.

(Id., Exhibit 5)

7. On September 27, 1993, Dr. Eugene A. Quindlen examined plaintiff. (Doc. 36, Exhibit 7)

*1206 On examination today he has no para-cervical muscle spasm. He has good cervical range of motion. Strength is 10/10 in all groups in his lower extremities. Deep tendon reflexes are 2+ bilaterally equal. Romberg is negative. Review of his MRI scan from 12/89 shows evidence of centrally ruptured discs at C5-6 and C6-7, which are fresh. There is a slight bulge at C3-4. His MRI from 4/93 shows old discs at C5-6 and C6-7, with some other changes at C3-4 and C4-5, and some decrease in the height of C6. There is adequate room for his cord and roots.

(Id.) Quindlen’s impression was “[o]ld discs — C5-6 and C6-7 without radiculopa-thy or myelopathy.” (Id.) At the bottom of Quindlen’s clinical notes, the doctor’s office inserted the following notation: “Travelers: We are not the attending MD[.][W]e only did one evaluation!^] see above[.] Dr. Robert White or some other[,] not us[,] to do this form.” (Id.)

8.On November 15, 1993, Dr. James C.

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Cite This Page — Counsel Stack

Bluebook (online)
85 F. Supp. 2d 1203, 2000 U.S. Dist. LEXIS 1957, 2000 WL 222128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/archible-v-metropolitan-life-insurance-alsd-2000.