Dreyer v. Metropolitan Life Insurance

459 F. Supp. 2d 675, 2006 U.S. Dist. LEXIS 73333, 2006 WL 2788534
District Court, N.D. Illinois·Decided September 21, 2006·No. 05 C 677·Published·Cited by 4 cases

Opinion

MEMORANDUM OPINION AND ORDER

GUZMÁN, District Judge.

Plaintiff, Lynda Sue Dreyer, has sued Verizon Wireless Managed Disability Benefit Plan, Verizon Wireless, the plan administrator, and Metropolitan Life Insurance Company (“MetLife”), the claims administrator, pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et. seq. Before the Court are the parties’ cross-motions for summary judgment. For the reasons set forth below, the Court grants defendants’ motion and denies plaintiffs motion.

Facts

Plaintiff was formerly employed by Verizon Wireless as an administrative assistant, a sedentary position. (Defs.’ LR56.1(a)(3) Stmt. (“Defs.’ LR56.1(a)(3)”) ¶¶ 1, 3.) The Verizon Wireless Health and Welfare Benefits Plan, which includes the Managed Disability Plan and the short-term disability plan, is an employee welfare benefits plan operated on behalf of the employees of Verizon Wireless and governed by ERISA. (Id. ¶4; see Defs.’ Claim File, Plan Administration Summary Plan Description, VZW0021-22.) Verizon Wireless is the Plan Administrator and MetLife is the claims administrator for the short-term disability benefits plan. (Defs.’ LR56.1(a)(3) ¶¶ 4-5.)

On April 27, 2004, Dreyer sought treatment from Dr. Hong of Pro Psych Associates because she was feeling overwhelmed and having sleep disturbances. (Id. ¶¶ 12-13.) According to Dr. Hong’s notes from May 20, 2004, Dreyer’s condition had improved with therapy but her depression increased without hormone treatments. (Id. ¶¶ 16, 18; Defs.’ Claim File, Hong’s Notes, MET00007.) On May 25, 2004, Dreyer visited Dr. William Markey and complained about, among other things, her throat and a vaginal yeast infection. (Defs.’ LR56.1(a)(3) 121; Defs.’ Claim File, Markey’s Notes, MET00220.) Dr. Markey’s notes indicate that she was experiencing abdominal problems for which he *678 prescribed medicine. (Defs.’ LR56.1(a)(3) ¶ 22.)

Dreyer’s last day of work was May 28, 2004. (Id. ¶24.) On or around June 8, 2004, she filed a claim for short-term disability benefits based upon an alleged stress-related medical condition. (Id. ¶ 26; PL’s LR56.1(a)(3) Stmt. (“PL’s LR56.1(a)(3)”) ¶ 4.)

On June 9, 2004, Dreyer sought treatment from Dr. Jerry Treppa of Pro Psych Associates. (Defs.’ LR56.1(a)(3) ¶ 28.) Dr. Treppa reported that Dreyer experienced tiredness, poor concentration, poor appetite, social withdrawal, anxiety, panic attacks, and numerous symptoms of inattention. (Id. ¶ 30; Defs.’ Claim File, Trep-pa’s Notes, MET 00012.) His report states that she had been having familial problems and she complained of some physical conditions, such as a yeast infection, among other things. (Defs.’ LR56.1(a)(3) ¶¶ 32-35, 38.) During the same visit, Dr. Treppa performed a Global Assessment of Functioning (“GAF”) examination and reported that Dreyer’s GAF score was 42 and that her highest score in the past year was 59. (Id. ¶ 44.) He also reported that Dreyer’s psychomotor activity was normal, that her memory was normal, that her intellect and fund of information were above average, that her general range of expression was labile and appropriate to thought content, and that her perception and thought processes were normal. (Id. ¶ 41.) However, Dr. Treppa diagnosed Dreyer as suffering a depressive disorder, not otherwise specified. (Id. ¶ 43.) In his recommendation, Dr. Treppa suggested that Dreyer should “return to work ASAP.” (Id. ¶46.)

On June 28, 2004, MetLife arranged for Dr. Mark Schroeder, a psychiatrist, to review plaintiffs medical records, including the records of the additional visits she made to Drs. Hong and Treppa on June 10, and June 17, 2004, respectively. (Id. ¶ 58.) Based on Dr. Schroeder’s review, MetLife determined that she did not qualify for short-term disability benefits under the Managed Disability Plan and notified plaintiff on June 28, 2004. (Id. ¶ 61.) MetLife explained its determination that Dreyer was ineligible for benefits as follows:

In conclusion, the decision to deny your claim is based on the medical information that we have received and reviewed which does not substantiate your inability to work. Although you and your treatment providers reported that you are experiencing some symptoms of depression, there was no report of any functional impairments due to a psychiatric condition nor a description of how these prevent you from working. Additionally the medical information received in this claim was reviewed by an independent physician consultant psychiatrist who concluded that the medical information received does not substantiate any functional impairment due to a psychiatric condition.

(Id. ¶ 62; Defs.’ Claim File, Letter of 6/28/04 from MetLife to Dreyer, MET00023.) MetLife advised plaintiff of her right to appeal its determination that she was ineligible for benefits and informed her that she could submit additional documentation in support of her claim. (Defs.’ LR56.1(a)(3) ¶ 63.)

On June 30, 2004, plaintiff claimed to be experiencing anger, disappointment, despair, and suicidal ideation during her medical sessions with Drs. Hong and Trep-pa. (Id. ¶ 67.) However, plaintiff failed to submit to MetLife any records from Dr. Hong regarding the suicide assessment he performed on June 30, 2004 or any additional documents regarding her alleged *679 suicidal ideation. 1 (Id. ¶ 70.) The record neither contains any further information regarding plaintiffs alleged suicidal ideation nor reflects whether she was, in fact, ever hospitalized for depression or sought any further psychiatric treatment. (Id. ¶ 73.) On July 1, 2004, Dr. Treppa faxed his progress notes regarding plaintiff to MetLife and on the fax cover sheet, someone from his office wrote “Pis. Reconsider — Patient is not capable to return to work.” (Id. ¶ 74; Defs.’ Claim File, Facsimile of 7/1/04 from Treppa to MetLife, MET00018.)

On or around July 26, 2004, Dreyer appealed MetLife’s determination that she was ineligible for benefits under the terms of the Plan. (Defs.’ LR56.1(a)(3) ¶ 76.)

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Dreyer v. Metropolitan Life Insurance, 459 F. Supp. 2d 675, 2006 U.S. Dist. LEXIS 73333, 2006 WL 2788534 (N.D. Ill. 2006).

459 F. Supp. 2d 675 (Dreyer v. Metropolitan Life Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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