Bauer v. Metropolitan Life Insurance

397 F. Supp. 2d 856, 2005 U.S. Dist. LEXIS 25892, 2005 WL 2769003
CourtDistrict Court, E.D. Michigan
DecidedOctober 25, 2005
Docket04-10135-BC
StatusPublished

This text of 397 F. Supp. 2d 856 (Bauer v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bauer v. Metropolitan Life Insurance, 397 F. Supp. 2d 856, 2005 U.S. Dist. LEXIS 25892, 2005 WL 2769003 (E.D. Mich. 2005).

Opinion

OPINION AND ORDER GRANTING DEFENDANTS’ MOTION TO AFFIRM PLAN ADMINISTRATOR’S DECISION AND DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT

LAWSON, District Judge.

The plaintiff, Laura Bower, has brought this action against the defendants in their capacity as administrators of an employee welfare benefit plan as defined by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq., because they terminated the plaintiffs benefit payments under a long-term disability plan. The plaintiff began receiving benefits for a time based on disability due to peripheral neuropathy, fibromyalgia, Sjogren’s syndrome, and depression. Metropolitan Life Insurance Company (Met Life) terminated those monthly benefit payments when it determined that Bauer was no longer disabled under the terms of the plan. Bauer argues that Met Life arbitrarily denied her benefits in violation of ERISA. Met Life claims Bauer has presented no objective evidence supporting her disability; rather, it contends that she is capable of performing her job, which is sedentary in nature, and therefore does not qualify for benefits under the plan. The parties have filed cross motions on the administrative record, and the Court heard oral argument in open court on October 20, 2005. The parties agree that the administrator’s decision must be reviewed against the arbitrary and capricious standard. The Court finds that the plan administrator’s decision was neither arbitrary nor capricious and therefore will deny the plaintiffs motion to reverse the administrator and grant the defendants’ motion to affirm the plan administrator’s decision.

I.

The plaintiff, now fifty-one years old, worked for Dow for .over 30 years, most recently as a client service, associate, a sedentary position. She was responsible for troubleshooting and paying difficult invoices, making purchases of items under $10,000, training, correcting entries, and “leading adherence to the work process.” A.R. at 78. According to the defendants, in an eight hour day the plaintiffs job required the following: use of both hands repeatedly for 5 to 6 hours; sitting for 5 to 6 hours; grasping with both hands for 5 to 6 hours; fine finger dexterity in both hands for 5 to 6 hours; twisting her head and neck, looking up and down, for 1 to 2 hours; and standing, walking, or bending over for 1 to 2 hours.

On January 11, 2002, the plaintiff began a medical leave of absence from work. For several months prior, she experienced numbness in her arms and wrists accompanied by neck and back pain. The pain worsened to the point that the. plaintiff felt that she could no longer work. Since then, she has seen five doctors and a social worker: Dr. Leslie Schütz, a rehabilitation specialist; Dr. Michael Beaulieu, family physician; Dr. Mark Adams, a neurosurgeon; Dr. Steven Beall, a neurologist; Dr. Sanjeev Prakash, a rheumatologist; and Laurie Clements, a clinical social worker.

As an employee, the plaintiff was covered by Dow’s long-term disability benefit *858 plan. The plan includes a six-month waiting period and an evolving disability definition. In the first phase, which lasts for twenty-four months after the waiting period, to qualify for benefits an employee “cannot, because of a sickness or an injury, perform [her] regular job or any other reasonably'appropriate job [her] Employer can provide.” A.R. at 6. The phase two disability definition requires an employee to establish that “because of sickness or an injury [she cannot]: a. do [her] job; and b. do any other job for which [she is] reasonably fit by [her] education, ... training[,] or ... experience (including work with a Participating Employer, self-employment or work with another employer).” A.R. at 6. Met Life is both the insurer and administrator of phase one of the plan, which is at issue here.

On May 9, '2002, Dr. Schütz, to whom the plaintiff was referred by her family doctor, completed a form labeled “Disability Claim Attending Physician Statement.” Dr. Schütz wrote that the plaintiff suffered from degenerative disc disease, cervical disc herniation, thoracic myofacial pain, and carpal tunnel syndrome. Dr. Schütz opined that the plaintiff could sit, stand, or walk intermittently for six hours, but she needed “frequent position changes, including reclining at times.” A.R. at 62. Dr. Schütz stated the plaintiff “could try” working two to four hours per day, to be increased “as tolerated.” Ibid.

Also some time in May 2002, Dr. Beau-lieu completed a “Disability Claim Attending Physician Statement.” He diagnosed the plaintiff with myofacial thoracic pain, bilateral carpal tunnel syndrome, and adjustment-reaction with anxiety. He also deferred to Dr. Schutz’s opinion as to the plaintiffs physical limitations.

On May 15, 2005, the plaintiff applied to the defendants for long term disability benefits under the plan. The forms from Dr. Schütz and Dr. Beaulieu were submitted to the defendants in support of her claim for benefits. The defendants approved the plaintiffs application, apparently accepting Dr. Schutz’s opinion of the plaintiffs limitations and concluding that she could not perform the requirements of her job. The plaintiff was notified of the approval on July 11, 2002.

On September 12, 2002, Dr. Beaulieu completed another “Attending Physician Statement.” He again indicated that the plaintiff suffered from degenerative disc problems, myofacial thoracic pain, and carpal tunnel syndrome. Dr. Beaulieu wrote that the plaintiff “requires frequent posture changes. Ability to sit or stand for long periods is very limited.” A.R. at 101. Dr. Beaulieu stated that the plaintiff could work less than four hours per day.

In September 2002, Dr. Beaulieu referred the plaintiff to Dr. Beall, a neurologist. The plaintiff reported to Dr. Beall that she was experiencing numbness and tingling from her shoulder to her fingers. She also had blurred vision and decreased sensation in her legs and forearms. Dr. Beall’s notes, state that “this may very well be carpal tunnel syndrome or thoracic syndrome. The upgoing toes and tingling that she has, as well as the blurring of .the vision makes diagnosis of multiple sclerosis a possibility.” A.R. at 110. Dr. Beall recommended additional tests.

On December 20, 2002, Dr. Beall saw the plaintiff again. She reported numbness and tingling in her shoulder and arm, and “every joint in her body hurts due to pain.” A.R. at 114. Dr. Beall concluded that she could have a “mild case of carpal tunnel syndrome on the left hand,” and “peripheral neuropathy with features of demyelination and mild axonal degeneration.” A.R. at 115. He noted that the results of an MRI (presumably the test completed on October 14, 2002, A.R. at *859 112) “showed only mild degenerative changes” in the thoracic and cervical spine. Ibid. He decided to perform more tests for peripheral neuropathy and rheumatological disorders.

The terms of the defendants’ long term disability plan required the plaintiff to apply for Social Security disability benefits, which she did on September 18, 2002. On January 24, 2003, the Social Security Administration denied her claim, explaining that it had “determined that [the plaintiffs] condition is not severe enough to keep [her] from working....

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
Black & Decker Disability Plan v. Nord
538 U.S. 822 (Supreme Court, 2003)
Williams v. International Paper Co.
227 F.3d 706 (Sixth Circuit, 2000)
Shields v. Reader's Digest Ass'n
331 F.3d 536 (Sixth Circuit, 2003)
Angiulo v. United States
867 F. Supp. 2d 990 (N.D. Illinois, 2012)

Cite This Page — Counsel Stack

Bluebook (online)
397 F. Supp. 2d 856, 2005 U.S. Dist. LEXIS 25892, 2005 WL 2769003, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bauer-v-metropolitan-life-insurance-mied-2005.