Gorski v. ITT Long Term Disability Plan for Salaried Employees

314 F. App'x 540
CourtCourt of Appeals for the Fourth Circuit
DecidedNovember 3, 2008
Docket07-1063
StatusUnpublished
Cited by5 cases

This text of 314 F. App'x 540 (Gorski v. ITT Long Term Disability Plan for Salaried Employees) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gorski v. ITT Long Term Disability Plan for Salaried Employees, 314 F. App'x 540 (4th Cir. 2008).

Opinions

Reversed and remanded by unpublished PER CURIAM opinion. Judge TRAXLER wrote an opinion concurring in part and dissenting in part.

Unpublished opinions are not binding precedent in this circuit.

PER CURIAM:

Janet R. Gorski appeals a district court order denying her motion for summary judgment and granting summary judgment against her in her action against the ITT Long Term Disability (“LTD”) Plan for Salaried Employees (“the Plan”) and Metropolitan Life Insurance Company (“MetLife”), alleging wrongful termination of her LTD benefits. We reverse and remand to the district court with instructions to reinstate Gorski’s benefit award and consider her claims for prejudgment interest and an award of attorney’s fees and costs.

I.

Gorski worked as a secretary at ITT Automotive in Auburn Hills, Michigan, until February 1998. While at ITT, she participated in the Plan, which provides LTD benefits. MetLife insures the Plan and serves as claims administrator with “discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan.” J.A. 500. To qualify for LTD benefits, participants must be “Totally Disabled,” which the Plan defines as follows:

1) During the six-month qualifying period plus the first 12 months in which you receive LTD benefits, you are considered Totally Disabled if you are unable to perform the regular duties of your occupation while under the continuous and appropriate care of a licensed physician and you are not employed elsewhere.
2) After the first 12 months in which you receive LTD benefits, Total Disability means you are unable to engage in any and every duty pertaining to any occupation or employment for wage or profit for which you are qualified, or become reasonably qualified by training, education or experience.

J.A. 490. In order to continue to receive LTD benefits under the Plan, participants must regularly submit proof of continued disability.

In October 1997, Gorski received treatment from Dr. Young Seo for “severe lower back pain” that she reported as resulting from lifting her leg as she tried to put on her pants. J.A. 79. She claims this injury was a reaggravation of a previous injury that happened in early 1977 when she fell outside of ITT. Dr. Seo diagnosed Gorski as having L5 nerve root irritation, a bulging disc, and inflammation of the joint between L4 and L5, and he treated her with spinal injections. Gorski missed approximately one month of work, then returned to work for approximately nine weeks before suffering a recurrence of her symptoms on February 6, 1998. An MRI dated that day showed two herniated discs. As a result, she received special injections, [542]*542pain medication, and physical therapy. She did not return to work again.

Gorski applied for LTD benefits on August 11, 1998. Dr. George R. Shell, a neurosurgeon, stated in an Attending Physician Statement (“APS”) that Gorski had two herniated discs and was scheduled for “lumbar cage fusion” surgery on August 18, 1998, which would render her “unable to perform any type of work for at least 6 months.” J.A. 133-34. Shortly thereafter, MetLife approved Gorski’s claim, as of August 11,1998.

Nearly two months after the surgery, Gorski informed MetLife that she was experiencing “[n]umb feet, legs & low back nerve spasms [with] shooting pain down both legs” and that she could not lift more than two pounds, sit for more than 30 minutes, or walk for a very long time without “excessive pain” in her legs and lower back. J.A. 136. Dr. Schell reported that Gorski had been doing very well until December 1998, when during a bout with vomiting, she “felt something pop in her back” and began having pain in her right leg and back. J.A. 310. On March 19, 1999, Dr. Schell noted that Gorski “still seems quite symptomatic.” J.A. 177. In that regard, Gorski reported that although her legs were feeling better, she had burning pain in her hips when she walked and discomfort when she sat as well. Gorski underwent an MRI examination on June 22,1999.

Meanwhile, Dr. Schell had provided MetLife in May 1999 with his office notes, discharge records relating to the August 1998 surgery, and radiological reports. This prompted MetLife, on July 27, 1999, to approve a continuance of Gorski’s LTD benefits on the basis that she was unable to perform any occupation for which she was qualified. Dr. Schell treated Gorski with epidural injections and physical therapy until she moved to North Carolina in December 1999.

In September 1999, MetLife arranged for an independent medical examination of Gorski by Dr. Robert S. Levine, an orthopedic surgeon. After examining Gorski and reviewing her medical records, Dr. Levine diagnosed “status post laminectomy and anterior fusion (cages) for ruptured disc” and “chronic pain syndrome with significant depression.” J.A. 212. He recommended that Gorski receive treatment at a multidisciplinary pain center offering pain management, that she participate in a functional reactivation program, and that she receive psychological therapy. He determined that Gorski should be capable of performing sedentary activities that involve no bending and do not require her to lift more than five pounds. He believed that she could have a functional capacities evaluation and noted that he “felt that there are significant ongoing psychological factors which would interfere with her ability to perform and to return to gainful employment.” J.A. 212. Responding to Dr. Levine’s opinion, Dr. Schell informed MetLife that while he did not reject Dr. Levine’s treatment recommendations, he believed that Gorski might also need further surgery sometime in the future.

When Gorski subsequently moved to North Carolina, she began receiving treatment from Dr. George Huffmon, a neurosurgeon. On June 15, 2000, Gorski underwent a CT scan, flexion/extension scan, and bone scan. Reviewing the results, Dr. Huffmon concluded that Gorski’s “4/5 right cage is kicked out laterally” and seemed to be compressing at least one nerve root and possibly two. J.A. 348. He recommended physical therapy and surgery to have “ped-icle screws from 4 to SI and attempt to get the cage out if we can’t clamp it down and put it back in position.” J.A. 348. He noted, though, that Gorski was “very reluctant” to undergo another surgery. J.A. 347. After examining Gorski again on December 28, 2000, Dr. Huffmon concluded [543]*543that her pain was still preventing her from returning to work. He sent her for a second opinion regarding possible surgery to Dr. Mark Rodger, who determined that she was not a good candidate for surgery and turned her care over to a primary care physician and pain management specialist.

On May 25, 2001, MetLife asked Gorski for additional information concerning her treatment. Gorski wrote that she suffered from “spas[]ming in [her] low[er] back, shooting pain into [her] right leg, [a] numb right foot, [and] stinging pain in [her] toes.” J.A. 259. She also reported that her right leg was weak, she could not lift it very much, and that it would give out, causing her to fall if she did not have someone or something to support her. She noted that, since her surgery, she had been depressed and suffered irritable bowel syndrome, increased occurrences of dizziness, and urinary incontinence.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Vetter v. Am. Airlines, Inc.
299 F. Supp. 3d 714 (D. Maryland, 2018)
Cline v. Aetna Life Ins. Co.
290 F. Supp. 3d 425 (W.D. North Carolina, 2017)
Coleman v. Metropolitan Life Insurance Co.
262 F. Supp. 3d 295 (E.D. North Carolina, 2017)
Voltz v. Chrysler Group LLC-UAW Pension Plan
63 F. Supp. 3d 770 (N.D. Ohio, 2014)
Williams v. Metropolitan Life Ins. Co., Inc.
632 F. Supp. 2d 525 (E.D. North Carolina, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
314 F. App'x 540, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gorski-v-itt-long-term-disability-plan-for-salaried-employees-ca4-2008.