Greene v. Metropolitan Life Insurance

924 F. Supp. 351, 1996 U.S. Dist. LEXIS 6451, 1995 WL 854582
CourtDistrict Court, D. Rhode Island
DecidedMarch 21, 1996
DocketC.A. 95-0215T
StatusPublished
Cited by6 cases

This text of 924 F. Supp. 351 (Greene v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Greene v. Metropolitan Life Insurance, 924 F. Supp. 351, 1996 U.S. Dist. LEXIS 6451, 1995 WL 854582 (D.R.I. 1996).

Opinion

*353 ORDER

TORRES, District Judge.

The Report and Recommendation of Magistrate Judge Lovegreen dated November 8, 1995, is accepted for the reasons stated by the Magistrate.

REPORT AND RECOMMENDATION

LOVEGREEN, United States Magistrate Judge.

The plaintiff, Kathleen M. Greene (“Greene”), has instituted suit pursuant to 29 U.S.C. § 1182(a)(1)(B) of the Employee Retirement Income Security Act (“ERISA”) claiming that the defendant’s, Metropolitan Life Insurance Company (“MetLife”), decision to deny her long term disability (“LTD”) benefits was “arbitrary and capricious.” Presently before me are both parties’ cross motions for summary judgment. Fed.R.Civ.P. 56. This matter has been referred to me for preliminary review, findings and recommended disposition. 28 U.S.C. § 636(b)(1)(B) and Local Rule of Court 32(e). A hearing was held on October 26, 1995. After listening to the arguments of counsel and examining the memoranda submitted, I recommend that MetLife’s motion for summary judgment be granted and, consequently, Greene’s motion for summary judgment be denied.

Facts and Travel of the Case

As a full time, salaried employee of Decorative Specialties, a division of Specialty Coatings International, Inc., Greene participated in the Specialty Coatings Group Long Term Disability Plan (“disability plan”). At all relevant times in question, MetLife served as the claim fiduciary of the disability plan, which is subject to and regulated by ERISA See 29 U.S.C. § 1003(a)(1).

The disability plan provides that “[w]hen (MetLife) receive[s] proof that you are Disabled, we will pay a Monthly Benefit in accordance with the Schedule of benefits.” The definitional section defines “disabled” as follows:

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; and
2. after the first 24 months of benefit payments, you must also be unable to perform each of the material duties of any gainful work or service for which you are reasonably qualified taking into consideration your training, education, experience and past earnings; or
3. you, while unable to perform all of the material duties of your regular job on a full-time basis, are:
a. performing at least one of the material duties of your 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.

In April, 1993, Greene filed an application for LTD benefits with MetLife under the disability plan. Sometime in July, 1993, MefrLife began acting on Greene’s application. At this juncture, Greene’s application consisted of a document she completed entitled “Statement of Claim — Long Term Disability Benefits” dated April 23, 1993, and an “Attending Physician’s Statement of Functional Capacity” completed by Dr. Vincent Armenio (“Dr. Armenio”), Greene’s treating physician. Dr. Armenio, board certified in internal medicine and oncology, stated that Greene was suffering from “infection” and “fatigue.” He also noted that plaintiffs immunoglobulin levels, speeificaEy IgG3 and IgG4, had decreased. Dr. Armenio finaEy indicated that Greene was totaEy disabled as of the date of the report and would not be able to resume work related activities untfl September 1, 1993.

In letters dated July 15, 1993, MetLife requested information concerning the diagnosis and treatment of Greene from treating physicians Armenio and Charles Faber (“Dr. Faber”). The letters also requested that the doctors complete an enclosed physical capacities form. In his response dated July 23, 1993, Dr. Faber stated that Greene suffered *354 from “chronic fatigue” and that test results revealed “EB virus titer elevated.” He also indicated treating Greene in February, 1993 and once in April, 1993. As such, Dr. Faber no longer considered himself her treating physician. He therefore offered no opinion as to whether Greene was totally disabled from performing her job.

In a letter dated August 10, 1993, MetLife informed Greene that the “information on file was not definitive enough to make a decision.” As a result, MetLife indicated that it was requesting additional information from any of the physicians who had treated Greene for her ailment.

In his August 13, 1993 response to Met-Life’s July inquiry, Dr. Armenio stated that he had treated Greene ten times in the last five months. Dr. Armenio diagnosed Greene as suffering from “Chronic Fatigue Syndrome”, (“CFS”), and “Immune Deficiency”, which he indicated were being treated with “Gammaguard” treatments. After noting particular immunoglobulin levels, Dr. Armenio indicated that Greene was not able to work at this time, but tentatively anticipated a return sometime in October, 1993.

With his response, Dr. Armenio included a completed “Physical Capacities Evaluation” of Green expressing an opinion that in an eight hour work day Greene could sit up to four hours, stand up to two hours and walk up to two hours. The evaluation indicated that Greene could lift ten pounds or less occasionally and could utilize her hands in various capacities, except for “fine manipulating.”

According to plaintiff, Dr. Armenio also sent a follow up report to defendant dated September 7, 1993. The report indicated that Greene was being “treated for Chrome Fatigue Syndrome with Immunce [sic] Deficiency.” It also noted that she was being given double doses of gammaguard and that “[s]he still has problems with tennitis [sic] and chronic sore throats.” However, Dr. Armenio found no evidence of “posterior or anterior lymthadenopathy.”

MetLife asserts that on September 29, 1993, it received laboratory reports from Dr. Faber. One report, issued by New England Pathology Services and dated March 3, 1993, states:

Results are suggestive of an Epstein-Barr virus infection at some undetermined time in the past. In infants, a similar antibody pattern may occur as a result of maternal transfer of antibody. EBV findings cannot be utilized as the sole criteria for the diagnosis of reactivated or chronic EBV-like syndromes

Finally, sometime in late September, 1993, MetLife sent all of the information it possessed to Dr. Julian Freeman, a medical consultant hired by MetLife. Dr. Freeman together with Doctors Ira Melnicoff and Karen Leone issued a report dated October 4, 1993. 1 The report in large part states:

Medical Findings

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Cite This Page — Counsel Stack

Bluebook (online)
924 F. Supp. 351, 1996 U.S. Dist. LEXIS 6451, 1995 WL 854582, Counsel Stack Legal Research, https://law.counselstack.com/opinion/greene-v-metropolitan-life-insurance-rid-1996.