Guarino v. Metropolitan Life Insurance

915 F. Supp. 435, 1995 U.S. Dist. LEXIS 20243, 1995 WL 800132
CourtDistrict Court, D. Massachusetts
DecidedDecember 7, 1995
DocketCiv. A. 95-10226-DPW
StatusPublished
Cited by13 cases

This text of 915 F. Supp. 435 (Guarino 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
Guarino v. Metropolitan Life Insurance, 915 F. Supp. 435, 1995 U.S. Dist. LEXIS 20243, 1995 WL 800132 (D. Mass. 1995).

Opinion

MEMORANDUM AND ORDER

WOODLOCK, District Judge.

I.

This case involves a dispute over the termination of disability benefits. Scott Guari-no (“Guarino”) alleges that Metropolitan Life Insurance Company (“MetLife”) improperly terminated long term disability (“LTD”) benefits which were due him under his employment agreement with his former employer, the Raytheon Company. The Raytheon Long Term Disability Plan (the “Plan”) is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), codified, in part, at 29 U.S.C. §§ 1001-1461.

Guarino initiated suit in Massachusetts Superior Court on January 3, 1995, alleging breach of contract. The action was removed by MetLife to this court on February 1,1995, pursuant to 28 U.S.C. § 1441(b). 1 In response, Guarino filed an amended complaint on April 7,1995, alleging that the termination was “arbitrary, illegal, capricious, unreasonable, not made in good faith, and a violation of fiduciary duty,” as well as a violation of 26 U.S.C. §§ 401(a), 411, and 501(a) of the Internal Revenue Code. (Compl. ¶ 10.)

MetLife now moves for summary judgment, pursuant to Fed.R.Civ.P. 56, on the grounds that 1) Guarino’s claim should be dismissed because the exclusive remedies to enforce rights under a welfare benefit plan are those set forth in 29 U.S.C. § 1132(a)(1)(B) of ERISA, while 26 U.S.C. §§ 401(a), 411, and 501(a) deal with pension plans and the tax treatment thereof; and 2) even if Guarino’s claim is properly characterized as an action under ERISA, MetLife reasonably determined that Guarino was not qualified to continue receiving LTD benefits. (Def.’s Mot.Summ.J. at 1.)

*438 I will grant MetLife’s motion for summary judgment.

II. Background

A. The LTD Plan

On January 21, 1985, at age 25, Guarino began work at Raytheon as an Electronics Inspector. Raytheon maintains an LTD Plan for eligible employees, in the event of disability. (Hartz Aff.Ex. 1 (Policy).) Met-Life is the underwriter for the Plan. The Plan is a “welfare benefit plan” as defined by ERISA, see 29 U.S.C. § 1002(1), and the Summary Plan Description (pamphlet given to employees) states that it is covered by ERISA. (Hartz Aff.Ex. 2 at 12.)

For eligible employees who have elected to pay the monthly premiums, the Plan pays a percentage of the employee’s base income in the event of “total disability.” The Plan defines “total disability” in the following way:

for the first twenty-four months following the greater of (i) the first 30 days in a continuous period of disability, and (ii) the expiration of benefits under ... Accident and Sickness Insurance Program, [as] only such complete incapacity of the employee that the employee is not able to perform substantially all of the duties of the employee’s occupation, business or employment. ...

(Hartz Aff.Ex. 1 at 3 (Policy) (emphasis added).) After the first two years, “total disability” means that the employee

is able to perform none of the duties of any and every occupation, business or employment ... for which the employee is reasonably fitted by education, training or experience.

Id. (emphasis added). The Plan gives Met-Life the discretionary authority “to determine eligibility for and entitlement to LTD benefits, and to make final decisions with respect to appeals from claim denials.” (Hartz Aff. ¶ 7, Ex. 1, 2.)

In May of 1986, sixteen months after beginning work at Raytheon, Guarino sustained an injury to his lower back while working on his boat. He had previously injured his lower back in 1982. (Compl. ¶ 3-4; Hartz Aff. Ex. 12 at 2, Ex. 6 at 1.) In November of 1986, after exhaustion of accident and sickness benefits, which MetLife paid from May 30, 1986 through August 24, 1986, Guarino began receiving LTD benefits (Group No. 25792-004^014; Claim No. 086086975). (Compl. ¶ 6.) 2

B. Medical Opinions Preceding Termination

Under the Plan, MetLife shall “have the right and opportunity to have a physician it designates examine the person of the employee when and so often as it may reasonably require during the period for which the employee claims benefits....” (Hartz Aff. Ex. 1 (Policy) at 12.) Accordingly, MetLife arranged for Guarino to undergo several independent medical examinations, as well as vocational assessments, conducted by individuals who were not employees of Raytheon or MetLife. I note the following material observations: 3

Dr. St. G. Tucker Aufranc (“Dr. Aufranc”),

Orthopaedic Surgeon

June 27, 1988 (Hartz Aff.Ex. 5 (emphasis added).)

*439 ... totally disabled from his job as an electrical inspector. However, I believe he could work in any capacity which would not involve excessive lifting, [bjending, stooping, taking [sic], or squatting, and which would allow him to alternate his position.

Dr. Howard Taylor (“Dr. Taylor”)

February 14, 1990 (Hartz Aff.Ex. 6 (emphasis added).)

... I am a bit concerned about his diagnosis. [Mass. General Hospital states] that the CT scan showed bulging, but no true herniation. I reviewed Dr. Au-frane’s report, and he said that there was a large herniated nucleus pulposus, but I do not know the basis of his statement. In my opinion Mr. Guarino’s diagnosis is a sciatica, based purely upon his subjective symptoms. I reviewed his job description, and I don’t believe that he could perform, that particular job. It involves some lifting, and prolonged sitting. I believe that he could perform some type of work that did not require prolonged sitting, or bending, or lifting, or twisting. His prognosis is guarded for any future recovery.

Mr. Ralph Cavaliere (“Cavaliere”)

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Bluebook (online)
915 F. Supp. 435, 1995 U.S. Dist. LEXIS 20243, 1995 WL 800132, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guarino-v-metropolitan-life-insurance-mad-1995.