Collins v. Metropolitan Life Insurance

477 F. Supp. 2d 274, 2007 U.S. Dist. LEXIS 14729, 2007 WL 679888
CourtDistrict Court, D. Maine
DecidedMarch 1, 2007
DocketCivil 06-76-P-C
StatusPublished
Cited by3 cases

This text of 477 F. Supp. 2d 274 (Collins v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Collins v. Metropolitan Life Insurance, 477 F. Supp. 2d 274, 2007 U.S. Dist. LEXIS 14729, 2007 WL 679888 (D. Me. 2007).

Opinion

ORDER GRANTING DEFENDANTS’ MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD

GENE CARTER, Senior District Judge.

This is an action under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., brought by Plaintiff Julie Collins for recovery of short term disability (“STD”) benefits she alleges were wrongfully denied by Defendants Metropolitan Life Insurance Company (“MetLife”) and Sanmina-SCI USA, Inc. (“Sanmina-SCI”) under the “Sanmina-SCI Corporation Health and Welfare Benefit Plan.” The matter is before the Court on Defendants’ Motion for Judgment on the Administrative Record. Docket Item No. 26. Plaintiff Julie Collins has responded to Defendants’ Motion and *276 Statement of Material Fact via the summary judgment procedure provided for in Local Rule 56. 1 The summary judgment format is an appropriate vehicle for presenting the issue to be decided in this case. Liston v. Unum Corp. Officer Severance Plan, 330 F.3d 19, 24 (1st Cir.2003) (“In ERISA cases where the decision is to be made by the court based solely on the administrative record, summary judgment is merely a mechanism for tendering the issue.”). Having duly considered the administrative record and the arguments raised by the parties’ briefing, the Court concludes that, for the following reasons, Defendants’ decision to deny STD benefits is not arbitrary or capricious.

I. FACTS

After reviewing the statements of material fact of both sides and the responses to each, it is clear that the only relevant factual disputes between the parties center on disagreement regarding attempts by both sides to select and characterize various cited portions of the administrative record at issue in this case. The Court has resolved these disputes by conducting a first hand review of the administrative record centering on the pages cited by the parties. In accordance with this procedure, the Court lays out the material facts below as gleaned from the parties’ submissions and the Court’s review of the administrative record.

Plaintiff Julie Collins began working as a buyer at Sanmina-SCI sometime in June of 2000. Administrative Record (“AR”) at 64-66, 85. Her job was generally sedentary in nature requiring use of a computer and some walking. AR at 64-66. In this position, she performed the purchasing function for a variety of commodities and components which involved some intellectual functioning. Id. at 66 (“Essential Duties & Responsibilities: including but not limited to vendor selection, negotiation, order placement, vendor follow-up, measurement and control of vendor performance, value analysis, evaluation of new materials and processes, expediting and working with other departments.”). She was also required to “effectively handle complaints, disputes, and resolve grievances.” Id. Despite her ongoing treatment for fibromyalgia and depression, Mrs. Collins worked for Sanmina-SCI from June 2000 to January 14, 2005. 2 Id. at 85.

Mrs. Collins participated in the Sanmi-na-SCI Corporation Health and Welfare Benefit Plan (“the Plan”). Id. at 113. At all relevant times, the short term disability benefits component of the Plan was funded by a group policy of insurance issued by MetLife. Id. at 101, 167. The Plan states that “MetLife in its discretion has authority to interpret the terms, conditions, and provisions of the entire contract. This includes the Group Policy, Certificate and any Amendments.” Id. at 101. The Plan also provides:

In carrying out their respective responsibilities under the Plan, the Plan Administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to *277 determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

Id. at 171.

Under the Plan, Mrs. Collins was eligible for up to 13-weeks of short term disability benefits if she became “disabled.” Id. at 114, 122. Mrs. Collins would be considered “disabled” if, “due to sickness, pregnancy or accidental injury,” she was “receiving Appropriate Care and Treatment from a Doctor on a continuing basis” and was “unable to earn more than 80% of [her] Predisability Earnings at [her] Own Occupation for any employer in [her] Local Economy.” Id. at 123.

In December 2004, Mrs. Collins learned that the facility where she worked would be closing in March 2005 and that, as a result, her employment with Sanmina-SCI would end. Id. at 83. On January 14, 2005, Mrs. Collins stopped working and made a claim for short term disability benefits. Id. at 87. She told MetLife that “up until a year ago she [had] functioned well,” but increased pain was now prevented her from working. Id. On January 25, 2005, MetLife received two office notes— December 6, 2004 and January 11, 2005— from Christine Freme M.D., Mrs. Collins’ primary care physician. Id. at 80-83. On December 6, 2004, Mrs. Collins was seen by Dr. Freme because of headaches and “intermittent” back and leg pain as well as abdominal pain. Id. at 83. On January 11, 2005, Mrs. Collins was seen by Dr. Freme for a physical. Id. at 74-75, 81-82. At that time, Mrs. Collins reported having “chronic pain,” being depressed, and having continuing trouble sleeping despite the increase in sleep medication. Id. at 74. Dr. Freme noted that Mrs. Collins “has had several episodes of significant abdominal pain” due to constipation and had problems with her esophagus. Id. Mrs. Collins also reported for the first time that she had difficulty sitting and typing “for long periods” of time. Id. Mrs. Collins again told Dr. Freme that “her company [was] closing” and wondered “if she should be disabled.” Id Dr. Freme stated: “I suspect [she] probably needs disability.” Id. Under the “Assessment and Plan” section of the medical note it states “due to ongoing pain to apply for disability.” Id. at 75.

On or about February 5, 2005, Dr. Freme provided MetLife with additional medical records. Id. at 70-79. The records included an April 16, 2004, History and Physical, id. at 71-72, an August 19, 2004 office note, id. at 79, a September 21, 2004 office note, id. at 78, and an October 26, 2004 office note, id. at 77. Specifically, Dr. Freme’s April 16, 2004 “History and Physical” indicates that Mrs. Collins had gone to the emergency room because of “constipation with abdominal pain.” Id. at 71-72. Dr. Freme reported that Mrs.

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477 F. Supp. 2d 274, 2007 U.S. Dist. LEXIS 14729, 2007 WL 679888, Counsel Stack Legal Research, https://law.counselstack.com/opinion/collins-v-metropolitan-life-insurance-med-2007.