Gelfand v. Metropolitan Life Insurance

28 F. Supp. 3d 903, 2014 U.S. Dist. LEXIS 88390, 2014 WL 2945760
District Court, D. Minnesota·Decided June 30, 2014·No. Case No. 13-CV-1290 (PJS/JJK)·Published·Cited by 2 cases

Opinion

ORDER

PATRICK J. SCHILTZ, District Judge.

Plaintiff Michael H. Gelfand participated in an employee welfare benefit plan (“the Plan”) sponsored by his employer, defendant Citadel Broadcasting Company (“Citadel”),1 and established pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Defendant Metropolitan Life Insurance Company (“MetLife”) insures the Plan. Gelfand brings this lawsuit seeking review of MetLife’s decision to deny his claim for long-term disability benefits under the Plan. Gelfand also seeks equitable relief from MetLife, Citadel, and Citadel’s parent company, defendant Cumulus Media, Inc. (“Cumulus”).

This matter is before the Court on the parties’ cross-motions for summary judgment. For the reasons explained below, the Court concludes that MetLife abused its discretion in denying Gelfand’s claim for long-term disability benefits. Accordingly, the Court grants the bulk of Gel-fand’s motion for summary judgment with respect to MetLife and remands this case to MetLife for further proceedings consistent with this order. But the Court grants defendants’ summary-judgment motion with respect to Citadel and Cumulus.

I. FACTS

The parties are mostly in agreement as to the relevant facts of this case, which are briefly as follows:

Gelfand suffers from delayed sleep-phase syndrome (“DSPS”). Gelfand does [906] not feel tired during nighttime hours, when most people experience the need to sleep. Instead, Gelfand’s natural sleep rhythm causes him to feel tired during the morning and early afternoon. See Defs’ Ex. A (“Ex.”) at 521-22.2 The date of the onset of Gelfand’s DSPS is not clear, but his condition was serious enough in 2010 that he sought treatment from Dr. John Damergis, Jr. and Dr. Richard E. Golden. See id. at 227-29. Those doctors noted that, at that time, Gelfand’s “typical sleep/ wake cycle is to sleep from 7:00 a.m. to 4:00 p.m.” Id. at 227. Damergis and Golden also described Gelfand’s DSPS as “severe.” Id. at 228. Other doctors have since substantially confirmed the findings of Damergis and Golden. See, e.g., id. at 496-98 (attending physician statement of Dr. Ronald Groat); id. at 509-16 (attending physician statement and supporting documentation of Dr. Paul Sutter).

At the time of the 2010 diagnosis, Gel-fand was employed by Citadel as a radio announcer on the KQRS-FM morning show in the Twin Cities region of Minnesota. See Compl. ¶ 5 [ECF No. 1]. Because Gelfand worked during a morning show, his job required him to be alert at precisely the time that his DSPS was causing him to fall asleep. By December 30, 2011, Gelfand’s DSPS had become so severe that he quit his job at Citadel. See Ex. at 482. Shortly thereafter, Gelfand filed a claim with MetLife for long-term disability benefits pursuant to the Plan. See id. at 538 (acknowledging receipt of Gelfand’s claim). Gelfand alleged a disability onset date of December 31, 2011. Id. at 482.

Whether a claimant is “Disabled” under the Plan turns on the extent of the claimant’s residual earning capacity following the onset of his illness or injury. To be eligible for long-term disability benefits during the 24 months following the Plan’s elimination period,3 a claimant must be unable to earn more than 80% of his pre-disability earnings at his “Own Occupation” from any employer in his local economy. Ex. at 625. (Gelfand earned $66,000 per year from Citadel at the time that his employment with Citadel ended. See id. at 187.) Claimants may also receive long-term disability benefits after the conclusion of the 24 months following the elimination period, but the Plan is significantly more restrictive with respect to such benefits. First, the income threshold' is reduced from 80% of predisability earnings to 60% of predisability earnings. Id. at 625. Second, the scope of relevant employment is expanded from the claimant’s “Own Occupation” to “any gainful occupation for which You are reasonably qualified ....” Id. (emphasis added).

MetLife denied Gelfand’s claim for long-term disability benefits in a letter dated August 7, 2012. See id. at 482-85. According to MetLife, Gelfand had not submitted sufficient medical documentation to support his claim that “unpredictable sleep patterns” had prevented him from working at his occupation, which MetLife defined as “Announcer.” Id. at 483-84. MetLife noted in its denial letter that individuals in Gelfand’s occupation of “Announcer” were not limited to morning work, but instead “may be hired to perform any shifts.” Id. at 484. MetLife’s denial letter said noth[907] ing about Gelfand’s residual earning capacity after the onset of his DSPS; it focused solely on his medical condition.

Gelfand appealed the denial of his claim for benefits to MetLife’s appeals department. See Ex. at 220-26. In his appeals letter, Gelfand argued that MetLife had wrongly defined his occupation as “Announcer.” Gelfand argued that his “position was that of a morning show radio personality — not a local disc jockey who would merely plug the space between records and commercials.” Id. at 224. Gel-fand further argued that the medical evidence in the record overwhelmingly showed that his DSPS caused him to be unable to work during the morning, and thus argued that he was completely unable to perform his occupation of “morning show radio personality.” Id. at 225-26.

MetLife determined on appeal that “the medical documentation does establish that Mr. Gelfand has some restrictions and limitations that would preclude him from performing his own job as a morning show personality from 5:00 a.m. to 9:00 a.m.” Id. at 134. Despite those “restrictions and limitations,” however, MetLife concluded that Gelfand remained capable of finding employment as a radio announcer earning more than 80% of his predisability income. Id. MetLife’s sole evidence as to Gelfand’s residual earning capacity was an “Own Occupation Analysis and Labor Market Analysis” prepared by Vocational Rehabilitation Consultant Susan M. Sineni. Id. at 187-191. In her report, Sineni concluded that “[gjiven Mr. Gelfand has worked as a Radio Announcer for 25 years, it is reasonable that he would qualify for earnings at the 90th percentile and be able to negotiate this wage and higher given his experience and notoriety.” Id. at 190. Purporting to cite wage data from the Bureau of Labor Statistics’s Occupational Employment Statistics (“OES”), Sineni placed Gel-fand’s reasonable future earnings at $100,000 per year — that is, $34,000 per year more than Gelfand had earned working at Citadel. Id.

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Gelfand v. Metropolitan Life Insurance, 28 F. Supp. 3d 903, 2014 U.S. Dist. LEXIS 88390, 2014 WL 2945760 (mnd 2014).

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