Hallford v. Metropolitan Life Insurance

367 F. Supp. 2d 1353, 2005 U.S. Dist. LEXIS 8371, 2005 WL 1006218
CourtDistrict Court, N.D. Florida
DecidedMarch 11, 2005
Docket3:04CV109RVMD
StatusPublished

This text of 367 F. Supp. 2d 1353 (Hallford v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hallford v. Metropolitan Life Insurance, 367 F. Supp. 2d 1353, 2005 U.S. Dist. LEXIS 8371, 2005 WL 1006218 (N.D. Fla. 2005).

Opinion

ORDER

VINSON, District Judge.

Pending is the defendant’s motion for summary judgment. (Doc. 15).

The plaintiff, Wendy L. Hallford, brought an action in this court pursuant to Title 29, United States Code, Section 1132, for violation of the Employee Retirement Income Security Act of 1974 (“ERISA”) [29 U.S.C. 1001 et seq.] based on a denial of disability benefits by the defendant, the Metropolitan Life Insurance Company. The defendant now moves for summary judgment, pursuant to Rule 56 of the Federal Rules of Civil Procedure. Unless otherwise noted, the following facts appear to be undisputed.

I. FACTUAL BACKGROUND

This case involves a claim for long-term disability (“LTD”) benefits under the AT & T Corporation (“AT & T”)’s Long Term Disability Plan for Occupational Employees (“the Plan”), an employee welfare benefits plan sponsored by AT & T and governed by ERISA. The defendant, Metropolitan Life Insurance Company (“MetLife”), is the administrator for the Plan and decides claims and appeals for benefits under the Plan. The Plan is self-funded by AT & T.

To receive LTD benefits under the Plan, an employee must apply for benefits after exhausting the 52 weeks of paid sickness disability benefits provided by AT & T’s Sickness and Accident Disability Benefits Program (“SADBP”), and must be totally disabled under the terms of the Plan. Total disability under the Plan is defined as being unable to do any job for any employer for which the employee is either qualified or may become reasonably qualified by training, education, or experience. Jobs paying less than 50% of the employees Eligible Base Pay at the time of the disability are not counted for this requirement. (Doc. 26, attach. 1, at 9). Once a person applies for LTD benefits, they are no longer considered an employee of AT & T, and if benefits are denied, they cannot return to their old job.

MetLife serves “as the final review committee under the Long Term Disability Plan”, and has “sole and complete discretionary authority” to conclusively determine all the following:

* Administration of the Long Term Disability Plan and interpretation of all Long Term Disability Plan provisions;
* Determination of all questions relating to participation of eligible employees and eligibility for benefits;
* Determination of all relevant facts;
* Determination of the amount and type of benefits payable to any participant or beneficiary; and
*1356 * Construction of all terms of the Long Term Disability Plan.

(Doc. 26, attach. 1, at 14).

The plaintiff, Wendy L. Hallford (“Hall-ford”), was employed as a telephone operator for AT & T from November 1972 until July 2002. As an employee of AT & T, Hallford was enrolled in the Plan. In 1985, Hallford overextended her wrists while getting up from her waterbed. After receiving Cortisone injections, she eventually had carpal tunnel release surgery on her right hand. 1 After the surgery, Hallford’s condition improved and she returned to work. The surgery was performed by Dr. Douglas Tappan. She reports that she experienced increased pain in 1994, and at Dr. Tappan’s recommendation, her employer assigned her to activities that did not require keyboarding. Then, in 1998 Hallford sought medical attention for severe numbness in her hands. Hallford’s physician, Dr. Tappan, conducted a needle electromyography and nerve conductive studies of Hallford’s upper extremities. Both tests came back normal. Based on Hallford’s symptoms and previous medical history; Dr. Tappan diagnosed her with carpal tunnel syndrome in her left and right hands. A second opinion from Dr. Robert Cameron confirmed this diagnosis and recommended carpal tunnel release surgery. In his evaluation, Dr. Carmeron also stated that Hallford “should not be returned post operatively to repetitive computer work.” Administrative Record, at 7.

Hallford’s second carpal tunnel release surgery was conducted on her right hand on January 12, 1999. The surgery revealed no excessive pressure on the nerve, but did reveal some scarring around the nerve area. As part of her post operative care, Hallford was sent to Mary Ball for occupational therapy. Ball’s initial evaluation noted that Hallford had a loss of function and sensation in her right hand, with a functional capacity of 30%. By March of 1999 this had risen to a functional capacity of 50%. Hallford continued to complain of numbness and pain, however, and by April, Dr. Tappan indicated that she had reached a level of maximum medical improvement.

According to medical records, in July of 2002 one of Hallford’s fingers turned blue and became excessively sensitive to the touch. This was apparently due to a blood clot in her hand, which impeded circulation. Upon seeking medical attention, Hallford was sent to the emergency room, and underwent an emergency subclavian percutaneous transluminal angioplasty performed by Dr. John A. Tucker. In his post operative notes, Dr. Tucker indicated that Hallford “is not going to lose any tissue on the finger, and this is an outstanding result.” Administrative Record, at 180.

Hallford stopped work on July 28, 1999. She initially received a year of “accident” disability benefits under SADBP, 2 followed by two years of worker’s compensation benefits. On May 23, 2001, she was given an independent medical examination (“IME”) by Dr. Michael Rappa, who concluded that Hallford’s injuries were not work related. Shortly thereafter, she was reclassified and received 52 weeks of “sickness” benefits under SADBP. On June 5, *1357 2002, Hallford completed an application for LTD benefits under the Plan. Hallford listed “carpel tunnel syndrom” as the cause of her disability, and said that she was “unable to use hands” because doing so was “painful.” Administrative Record, at 68.

In support of her application for LTD benefits, Hallford submitted an attending physician statement (“APS”), a standard form prepared by her treating physician, Dr. Douglas Tappan. Administrative Record, at 81-84. In the APS, Dr. Tappan indicated that Hallford suffered from carpal tunnel syndrome resulting from a work-related injury. Dr. Tappan restricted Hallford from climbing, engaging in repetitive fine finger movements or pushing and pulling with either hand. Dr. Tappan also indicated that Hallford was able to sit, stand, or walk over the course of a normal eight hour work day, that she could lift up to 10 pounds occasionally, reach above shoulder level, twist, bend, stoop, and engage in repetitive eye hand movements. Dr. Tappan did not complete the prognosis section of the APS form, and thus did not indicate his opinión whether Hallford could work in her own or another occupation.

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Bluebook (online)
367 F. Supp. 2d 1353, 2005 U.S. Dist. LEXIS 8371, 2005 WL 1006218, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hallford-v-metropolitan-life-insurance-flnd-2005.