Claude J. Stiltz v. Metropolitan Life Insurance Co

244 F. App'x 260
CourtCourt of Appeals for the Eleventh Circuit
DecidedJune 5, 2007
Docket06-15180
StatusUnpublished
Cited by11 cases

This text of 244 F. App'x 260 (Claude J. Stiltz v. Metropolitan Life Insurance Co) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Claude J. Stiltz v. Metropolitan Life Insurance Co, 244 F. App'x 260 (11th Cir. 2007).

Opinion

PER CURIAM:

Claude J. Stiltz appeals the summary judgment against his suit for long-term disability benefits under the Employment Retirement Income and Security Act of 1974 (ERISA), 29 U.S.C. §1001 et seq. Stiltz argues that the plan administrator, Metropolitan Life Insurance Company (MetLife), acted arbitrarily and capriciously when it denied his claim for benefits. MetLife responds that its decision to terminate Stiltz’s disability benefits based on a functional capacity evaluation and reviews by two independent physicians was not wrong. We affirm.

I. BACKGROUND

Stiltz, a senior manager for a consulting firm, received disability insurance through his employer, who obtained a group policy from MetLife. In November 2001, Stiltz became ill and was hospitalized after a business trip to India. In December, Stiltz applied for and eventually received short-term and long-term disability benefits from MetLife.

In the following months, Stiltz’s treating physician, Dr. Anthony Captain, made *262 diagnoses that included fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. By October 2002, Dr. Captain’s notes remarked that Stiltz was “doing well,” but that same month, Dr. Captain submitted to MetLife a statement regarding Stiltz’s claim, and stated that Stiltz could only work less than three to four hours per day. Dr. Captain’s office notes from early 2003 reflect that Stiltz was reporting complaints of chronic pain and an inability to function for more than an hour at a time. Through 2004, Stiltz continued to see Dr. Captain and various specialists for ongoing treatment of his various complaints.

In May 2003, MetLife referred Stiltz’s claim for an independent physician review. Dr. Tracey Schmidt reviewed Stiltz’s medical records and concluded that his file contained only subjective complaints of fatigue and lacked “sufficient medical [evidence] to support objective evidence of physical functional capacity impairment to any occupation.” Dr. Schmidt also remarked that the limitations Stiltz reported to Dr. Captain were inconsistent with Stiltz’s statements on his application for benefits that he regularly coached soccer, performed housework and yardwork, and helped his teenaged daughters with their studies. In September 2003, MetLife asked Dr. Schmidt to review Stiltz’s file again. Dr. Schmidt reviewed newly submitted medical records and again concluded that the file lacked objective evidence of Stiltz’s physical impairment.

On October 6, 2003, Dr. Captain wrote to Dr. Schmidt and objected to her conclusions. He asserted that Stiltz’s tender point joint tenderness was objective evidence of his diagnosis of fibromyalgia and stated that Stiltz could not sustain activity for more than an hour at a time. Dr. Schmidt undertook a third review of Stiltz’s file for MetLife and concluded that her opinion had not changed. Dr. Schmidt spoke with Dr. Captain on November 3 and encouraged Dr. Captain to substantiate Stiltz’s subjective complaints of inability to work and concentrate by submitting the results of a mental status examination and a functional capacity evaluation.

On February 4, 2004, Stiltz underwent a functional capacity evaluation. The report concluded, based on a series of tests evaluating Stiltz’s actual ability to sit, stand, walk, climb stairs, stoop, reach, squat, kneel, and lift, that Stiltz was capable of performing a light-duty occupation, as defined in the Department of Labor’s Dictionary of Occupational Titles, for an eight-hour workday. The evaluation reflected that, in an eight-hour day, Stiltz could sit, walk, stand, and climb “frequently,” that is, one-third to two-thirds of the time.

On March 15, Dr. Schmidt reviewed Stiltz’s file for a fourth time. She noted that a job description submitted by Stiltz’s employer included sitting three hours, standing three hours, walking three hours, and occasionally lifting and carrying up to 20 pounds. Dr. Schmidt concluded that this was a “light” occupation and, based on the functional capacity evaluation, the file lacked objective evidence of a physical functional capacity impairment to a full-time light-duty occupation. On April 27, 2004, MetLife completed its review of Stiltz’s claim and terminated benefits. Stiltz appealed.

During the appeal process, MetLife submitted Stiltz’s file to a second independent physician for review. On January 4, 2005, after reviewing Stiltz’s file, Dr. Dennis Gordan concluded that Stiltz was capable of light-duty work. Dr. Gordan criticized Dr. Captain for “giving undue weight to symptoms,” and concluded that “[Stiltz] has overreported symptoms and [Dr. Captain] has overrated symptoms.” Dr. Gordan stated that the functional capacity *263 evaluation, with its “empiric basis,” gave a better estimate of Stiltz’s actual capabilities. On January 5, MetLife upheld its decision to deny benefits. MetLife agreed to conduct one further review.

On September 12, 2005, MetLife again concluded that Stiltz was not entitled to benefits. MetLife relied on the definition in the Dictionary of Occupational Titles to conclude that, despite Stiltz’s insistence that his actual job requirements were more than light, his “own occupation” required only light exertional capacity. The functional capacity evaluation supported the conclusion that Stiltz could perform a “light” occupation, and no objective findings in the medical file precluded this finding.

Stiltz sued MetLife in Georgia state court. After removing this action to federal court, MetLife moved for summary judgment. The district court granted that motion and denied Stiltz’s cross-motion for summary judgment.

II. STANDARD OF REVIEW

We review a summary judgment de novo, applying the same legal standards as the district court. Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1134 (11th Cir.2004). The review of a denial of benefits in an ERISA case follows a series of steps. “At each step, the court makes a determination that results in either the progression to the next step or the end of the inquiry.” Tippitt v. Reliance Standard Life Ins. Co., 457 F.3d 1227, 1232 (11th Cir.2006). The six steps are as follows:

(1) Apply the de novo standard to determine whether the claim administrator’s benefits-denial decision is “wrong” (i.e., the court disagrees with the administrator’s decision); if it is not, then end the inquiry and affirm the decision.
(2) If the administrator’s decision in fact is “de novo wrong,” then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.
(3) If the administrator’s decision is “de novo wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).

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Bluebook (online)
244 F. App'x 260, Counsel Stack Legal Research, https://law.counselstack.com/opinion/claude-j-stiltz-v-metropolitan-life-insurance-co-ca11-2007.