Earnest v. Metropolitan Life Insurance

291 F. Supp. 2d 1327, 2003 U.S. Dist. LEXIS 24078
CourtDistrict Court, M.D. Florida
DecidedOctober 7, 2003
Docket2:02-cv-00468
StatusPublished
Cited by5 cases

This text of 291 F. Supp. 2d 1327 (Earnest v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Earnest v. Metropolitan Life Insurance, 291 F. Supp. 2d 1327, 2003 U.S. Dist. LEXIS 24078 (M.D. Fla. 2003).

Opinion

ORDER

LAZZARA, District Judge.

This cause comes before the Court on Defendants Metropolitan Life Insurance Company and Home Depot U.S.A.’s Motion for Summary Judgment (dkt.32) and supporting memorandum and exhibits (dkt. 33 & 34) and Plaintiff James Earnest Jr.’s Memorandum in Opposition thereto (dkt.36).

FACTUAL BACKGROUND

Plaintiff, James Earnest, Jr. (“Earnest”), brings this action under the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001 et seq. (“ERISA”). Plaintiff, a 61-year old male, was employed by Defendant Home Depot U.S.A., Inc. (“the Company”) as a telephone sales person from 1990 until December 1, 1998, when he left his employment at the recommendation of his psychiatrist, Dr. Robert A. Buchholz (“Buchholz”) 1 The Company provided its employees with a Home Depot Welfare Benefit Plan (“the Plan”), which included a component Long Term Disability (“LTD”) Plan, which covered Earnest. (See LTD Policy, dkt. 34, Ex. A.) The Company is the Plan Sponsor and Plan Administrator, but it delegates all responsibilities for claims administration of LTD benefits to MetLife. (See dkt. 34, Ex. B, Certificate of Insurance, pp. 24-25.)

The Certificate of Insurance contains the following definition of disability:

“Disability” or “Disabled” means that, due to an Injury or Sickness, you require the regular care and attendance of a Doctor and:

1. You are unable to perform each of the material duties of your regular job or any gainful occupation on a full time basis, and
2. You, while unable to perform all of the material duties of your regular job or any gainful occupation on a full-time basis, are:
a. performing one of the material duties of your regular job or any other gainful work or service on a part-time or full-time basis; and
b. earning currently at least 20% less per month than your Indexed Basic Monthly Earnings due to that same Injury or Sickness.

(See Certificate, dkt. 34, Ex. B, p. 10.) The Plan provides for a 180-day waiting period. Earnest’s first day of potential eligibility for LTD benefits was June 1, 1999. (See LTD Policy, dkt. 34, Ex. A.)

Earnest sought LTD benefits by a Statement of Claim dated May 10, 1999. (See A.R. 121-22.) 2 Earnest attached an Attending Physician Statement of Buch-holz, who diagnosed Earnest with bipolar mood disorder and narcissistic personality disorder. (See id.) Buchholz concluded that Earnest was disabled from his own job indefinitely, but that Earnest was anticipated to be able to return to “any occupation” on June 1, 1999, and that Earnest was a candidate for vocational rehabilitation. (See id.) Buchholz’s medical records show that he treated Earnest in 1997 and 1998 for mood swings, depression, marital problems caused by an extra-marital affair, and problems at work. (See A.R. 78-86.) Buchholz concluded on December 2, *1331 1998, that Earnest needed “medical leave and short-term disability.” (See A.R. 87.) However, in a December 15, 1998 letter, in connection with Earnest’s earlier Short-Term Disability Claim 3 , Buchholz limited the expected period of disability to “three to six months.” (See A.R. 71.) Consistent with this limited period of disability, Buch-holz’s office note for April 29, 1999 states: “I informed him that I do not feel he will qualify for long term disability. I told him he needs to get back to work.” (See A.R. 89.)

The Certifícate of Insurance provides that MetLife has the right “while a claim is pending ... to have [a claimant] examined by Doctors of [MetLife’s] choice when and as often as [MetLife may] reasonably choose.” (See Certificate, dkt. 34, Ex. B at 18.) During the STD phase of Earnest’s claim, MetLife had an independent psychiatric consultant, Dr. Ernest Gosline (“Gos-line”), contact Buchholz and review the file. (See A.R. 57-62.) On April 29, 1999, Gosline reported, among other things, that Earnest’s psychiatrist and psychologist “are assured that this man is tending to exaggerate his symptoms to the point that he is presenting himself sicker than he really is.” (See id.) Gosline concluded, “there is medical documentation that this patient cannot return to his own job, but there is insufficient medical documentation at the present time that he cannot work at some other job commensurate with his skills, experience, background, and training.” (See id.) Based on the information provided by Buchholz and Gosline’s review, MetLife denied Earnest’s claim on initial review on June 8, 1999, on grounds that he was not “disabled” as that term is defined in the Plan documents. (See A.R. 124-125.)

Through counsel, Earnest appealed the denial on June 18, 1999. (See A.R. 127.) MetLife agreed to hold the claim open until August 19, 1999 for Earnest’s counsel to submit additional information. (See A.R. 133.) By letter dated August 19, 1999, Earnest’s counsel submitted additional medical records and a memoranda regarding Earnest’s claim for benefits. (See A.R. 134-208, 209-211, & 212-213.) Counsel contended that Earnest suffered neurological symptoms from an inappropriate combination of medication, including stuttering, dizziness, and tremors (see A.R. 211-212); memory difficulties or amnesia (see A.R. 210); Parkinson’s disease (see A.R. 210); and various physical problems with his knees, including bilateral knee replacement (see A.R. 210). 4 In order to corroborate his claim of disability, counsel submitted the medical records of Earnest’s psychologist Beverly Barbato (“Barbato”), from June 18, 1999, forward, which assert that Earnest is disabled by organic brain dysfunction and loss of cognitive function (see A.R. 134-143) and a psychiatric review technique form filled out by Barbato which asserts that Earnest is disabled from December 2, 1998, forward (see A.R. 144-146). She also offered Earnest’s Social Security award as evidence of total disability. (See A.R. 233.) Evidently, on September 14, 1999, Earnest was found disabled, dating from December 2, 1998, and was awarded disability benefits by the So *1332 cial Security Administration retroactive to that same date. (See id.)

However, the additional medical records submitted by Earnest in support of his claim for disability showed significant concerns by his treating physicians, Buchholz and Dr. Ivan Mazzorana (“Mazzorana”), a psychiatrist. (See A.R. 201, 204, 205, & 206.) Dr. David S.

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Bluebook (online)
291 F. Supp. 2d 1327, 2003 U.S. Dist. LEXIS 24078, Counsel Stack Legal Research, https://law.counselstack.com/opinion/earnest-v-metropolitan-life-insurance-flmd-2003.