Giannone v. Metropolitan Life Insurance

311 F. Supp. 2d 168, 2004 U.S. Dist. LEXIS 5043, 2004 WL 626547
CourtDistrict Court, D. Massachusetts
DecidedMarch 30, 2004
DocketCIV.A. 02-11119-RGS
StatusPublished
Cited by12 cases

This text of 311 F. Supp. 2d 168 (Giannone v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Giannone v. Metropolitan Life Insurance, 311 F. Supp. 2d 168, 2004 U.S. Dist. LEXIS 5043, 2004 WL 626547 (D. Mass. 2004).

Opinion

MEMORANDUM AND ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

STEARNS, District Judge.

Plaintiff Victoria Giannone received a long term disability allowance from the General American Life Insurance Company (GenAm) from January 31, 1987, until December 1, 2000, when the defendant successor insurer, Metropolitan Life Insurance Company (MetLife), terminated her benefits. Giannone brought suit seeking de novo review of MetLife’s benefits revocation under the Employment Retirement Income Security Act (ERISA), 29 U.S.C. § 1132(a). MetLife insists that because the Long Term Disability Plan (Plan) documents grant it discretionary authority over the award of benefits the court must apply an arbitrary and capricious standard of review. The dispute over the appropriate standard of review, while it occupies the bulk of the parties’ attention, is ultimately of less significance than the issue of whether under either standard MetLife’s decision is supported by substantial evidence.

BACKGROUND

Giannone began working as a sales representative for Unitax, a subsidiary of McDonnell Douglas Corporation, on July 29, 1985. Her duties included calling on prospective and existing clients to solicit business; analyzing client service requirements; presenting sales proposals to prospects and customers; representing Unitax at meetings, conferences, and trade shows; and ensuring customer satisfaction. Gian-none has a bachelor’s degree and prior work experience in sales.

Giannone filed a claim for benefits on February 25, 1987, stating that she had become disabled after the birth of her first child on August 6, 1986. Giannone listed her disabilities as de Quervain’s disease (thyroiditis) and bilateral carpal tunnel syndrome. While the contemporaneous medical records from Giannone’s many treating physicians — Dr. Leffert (orthopedic surgeon), Dr. Miller (rheumatologist), Dr. McCarthy (radiologist), Dr. Aro-noff (Director of the North Shore Pain Clinic), and Dr. Margies (orthopedist), report Giannone’s complaints of severe hand pain and weakness, they also note “minimal clinical findings” and no “clinical evidence of carpal tunnel syndrome.” The doctors, while persuaded of the genuineness of Giannone’s complaints and her desire to heal, had difficulty identifying an appropriate diagnosis. Dr. Margies and Dr. Aronoff recommended psychotherapy to assist Giannone in coping with stress and possible postpartum depression.

GenAm approved Giannone’s claim, and she began receiving benefits as of January 31, 1987. GenAm thereafter required Dr. Stoeckle, Giannone’s internist, to submit an annual Attending Physician’s Statement attesting to her continued disability. In August of 1988, Giannone was evaluated by Jack Strader, a GenAm rehabilitation *171 consultant. Strader reported that he doubted that rehabilitation therapy

would be productive. I do think that she should be seen by a good psychiatrist, doctor of rehabilitation medicine. However, I’m not too optimistic since she’s seen some very good doctors who are basically stumped by her illness. I do feel that she continues to be totally disabled.

In June of 1989, GenAm initiated a claims investigation, which included surveillance of Giannone. The investigator reported that Giannone appeared disabled, and that she relied on her mother and husband to cope with child care, laundry, and house cleaning. After introducing himself to Giannone and conducting an interview, the investigator concluded that Giannone seemed “genuinely frustrated with her condition and [was] looking forward to returning to work.” Dr. Stoeckle told the investigator that Giannone had “an enormous disability which is out of proportion to the clinical findings, but [that] he [was] certain that she is not malingering — there is no conscious avoidance of work to collect disability benefits— and her pain is quite real.”

In his 1990 Attending Physician’s Statement, Dr. Stoeckle changed his diagnosis from carpal tunnel syndrome to chronic fatigue syndrome. In October of 1990, Bernard Randolph, a GenAm rehabilitation specialist, reported that Giannone showed marked physical impairments and that because of “chronic pain and secondary gain factors (psychological], monetary, and other) ... it will be extremely difficult to return her to the workplace.” Randolph recommended a multi-disciplinary pain management program “in which organic diseases can be sorted out from behavioral and psychological] issues and an effective, coordinated plan of action can be pursued.” In June of 1993, a GenAm vocational consultant recommended that Giannone undergo a functional capacity examination and a vocational evaluation and be seen by a psychiatrist. Giannone expressed interest, but stated that she would be spending the summer in Florida with her parents and children. On September 22, 1993, the vocational consultant reported that Gian-none had declined to cooperate with the proposed rehabilitation plan.

On October 12, 1993, William Kermond, an orthopedic surgeon, conducted an independent medical examination on behalf of GenAm. Dr. Kermond concluded, “I do not believe that [Giannone] could return to her previous position as a sales representative because of the difficulty in the use of her hands.” He continued, “[t]his may not be a permanent phenomen[on] and with further investigation and further treatment, she may be capable of returning to work sometime in the future.” 1 On October 19, 1993, Dr. Robert Weiner, a psychiatrist engaged by GenAm, examined Giannone. Dr. Weiner concluded that Giannone’s physical symptoms were psychological in origin and that she “may benefit from psychiatric treatment and hypnotherapy.” Giannone did not seek psychiatric counseling. From 1994 through 2000, GenAm received yearly updates from Dr. Stoeckle. He reported that Giannone was disabled by chronic fatigue syndrome, or variously Raynaud’s syndrome, fibromyalgia, and migraine headaches. He was also of the opinion that Giannone did not have a disabling psychiatric impairment.

On October 28,1999, Dr. Jeffrey Guy, an orthopedic surgeon, examined Giannone after she complained of neck pain. He *172 found a full range of motion in Giannone’s neck, “mild tenderness” along her trapezi-us, full strength in her arms and hands, no pain as a result of forward or lateral bending, and normal sensation and reflexes. In May of 2000, Giannone sought treatment at the Canyon Ranch Resort in the Berkshires. In a personal assessment completed for Canyon Ranch, Giannone indicated that she had begun exercising regularly on January 1, 2000. Her reported exercise regime included 30 minutes of cardiovascular exercise, 30 minutes of strength training, and 5 minutes of stretching, three times a week.

MetLife replaced GenAm as the administrator of the Plan in 2000.

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Bluebook (online)
311 F. Supp. 2d 168, 2004 U.S. Dist. LEXIS 5043, 2004 WL 626547, Counsel Stack Legal Research, https://law.counselstack.com/opinion/giannone-v-metropolitan-life-insurance-mad-2004.