Karamshahi v. Northeast Utilities Service Co.

41 F. Supp. 2d 101, 1999 U.S. Dist. LEXIS 3737, 1999 WL 171496
CourtDistrict Court, D. Massachusetts
DecidedMarch 26, 1999
DocketNo. CIV. A. 97-30008-MAP
StatusPublished
Cited by2 cases

This text of 41 F. Supp. 2d 101 (Karamshahi v. Northeast Utilities Service Co.) 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
Karamshahi v. Northeast Utilities Service Co., 41 F. Supp. 2d 101, 1999 U.S. Dist. LEXIS 3737, 1999 WL 171496 (D. Mass. 1999).

Opinion

MEMORANDUM REGARDING OBJECTIONS TO REPORT AND RECOMMENDATION ON MOTIONS FOR SUMMARY JUDGMENT

(Docket Nos. 32 & 34)

PONSOR, District Judge.

I. INTRODUCTION

Plaintiff appeals a plan administrator’s decision denying him Long Term Disability benefits. Plaintiff claims that he is entitled to such benefits through a disability plan provided by his employer, Northeast Utilities Service Company (“ÑUS-CO”). As an employer-provided benefit, the plan is governed by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq.

[103]*103Plaintiff sought short-term benefits covering a span of two years, which were paid. He then sought extended benefits, but .the plan administrator at the time, Metropolitan Life Insurance Company (“Metlife”), denied the request. Liberty Mutual Assurance Company (“Liberty”) subsequently became the plan administrator, and it too denied the claim when it reviewed Metlife’s decision. After Liberty’s denial, plaintiff brought this action.

Motions for summary judgment by both parties were referred to Magistrate Judge Kenneth P. Neiman. On November 20, 1998, he issued a Report and Recommendation recommending denial of summary judgment as to both parties and proposing remand to the plan administrator for further consideration. Specifically, the Magistrate Judge found that the plan administrator should have utilized the services of a vocational expert before determining that plaintiff was not permanently disabled from performing any job.

For the reasons set forth below, the court will allow defendant’s motion for summary judgment. In summary, a vocational expert was not needed in this case; the facts of record, even viewed in the light most favorable to plaintiff, would be insufficient to convince any reasonable factfinder that defendant acted arbitrarily and capriciously in determining that plaintiff was not entitled to Long Term Disability benefits.

II. FACTUAL BACKGROUND

The facts set forth below'are taken from Magistrate Judge Neiman’s Report and Recommendation. Neither party has objected to these facts.

Defendant hired plaintiff as an assistant engineer in 1981. Between 1980 and 1985, plaintiff attended night school and earned a Master’s degree in Business Administration. He was promoted to engineer in 1986.

Plaintiff manifested signs of depression in 1989, as a result of which he lost much of his motivation, became easily overwhelmed and increasingly emotional. He also had difficulty sleeping and concentrating. In June of 1991, plaintiff requested and was granted a medical leave of absence, which lasted about three months, during which time he consulted a social worker. Plaintiff requested and was granted a second leave of absence in the fall of 1991, during which time he returned to his native country, Iran, to live with his mother, brother and sister. Plaintiff has not worked for defendant since June of 1991.

Upon plaintiffs return to the United States in the spring of 1992, he sought treatment from Dr. Iris Robertson of the River Valley Counseling Center (“RVCC”). Although he was diagnosed with recurrent major depression at the time, his long-term prognosis was good. Plaintiff reported that he did not feel appreciably better after being treated with one medication, Paxil. No other medications were either recommended or tried. Plaintiff terminated treatment at RVCC and subsequently returned to Iran later in 1992 and again in 1993.

As defendant’s employee, plaintiff was covered by a Long Term Disability plan. Under the plan, an employee was entitled to benefits for a twenty-four month period if he or she were unable to perform the duties of his or her regular job due to disease, accidental injury or a pregnancy-related condition. After receiving benefits for a twenty-four month period, an employee would be considered totally disabled if he or she were unable to perform any gainful work for which he or she were reasonably qualified by training, education or experience. (Docket No. 33, Exhibit E)

On September 14, 1994, three years after leaving defendant’s employ, plaintiff filed his initial claim for disability benefits. {Id., Exhibit F) Despite the three-year delay, Metlife agreed to review the claim. By letter dated March 6, 1996, it determined that plaintiff was entitled to twenty-four months of benefits as he was unable [104]*104to perform his regular job for the two years following June of 1991. (Id., Exhibit H)

On February 16, 1995, plaintiff applied for disability benefits beyond the twenty-four month period. (Id., Exhibit G) Met-life requested that plaintiff undergo an independent medical examination. As reported in a letter of October 27, 1995, Dr. Kenneth Jaffe, an independent board certified psychiatrist, determined after examining plaintiff that he was not totally disabled from “any occupation.” (Id., Exhibit I) Another medical consultant for Metlife, Dr. Marie Rigaud, reviewed the medical data supplied by plaintiffs treating sources, and concurred with Dr. Jaffe. (Id., Exhibit J) Thereafter, in the same March 6 letter that awarded plaintiff benefits for the initial twenty-four month period, Metlife denied plaintiffs claim for continued benefits and, echoing Dr. Jaffe, explained that plaintiff had a “reasonable chance of succeeding at a job with considerably less stress.” (Id., Exhibit H)

On May 2, 1996, plaintiff, through counsel, requested review of the denial. (Id., Exhibit K) After review, by letter dated June 24, 1996, defendant’s successor benefits administrator, Liberty, maintained the position originally outlined by Metlife and informed plaintiff of the decision. (Id., Exhibit L) Instead of contacting defendant’s benefits director, as suggested by Liberty, plaintiff filed a complaint in state district court on December 10, 1996. Defendant removed the action to this court on January 16,1997.

III. DISCUSSION

The Magistrate Judge made his recommendation in three parts. The first two parts, “Exhaustion of Administrative Remedies” and “Scope of Review,” will be adopted by this court. This court, however, will decline to adopt the third section, “Review of Benefits Denial.”

A. Exhaustion of Remedies and Standard of Review

In this court’s view, the Magistrate Judge’s preliminary conclusions that (a) plaintiff is not barred from bringing this suit for failure to exhaust his administrative remedies and (b) the “arbitrary and capricious” standard applies, are both correct.

To summarize, first, defendant’s notice of its decision failed adequately to inform plaintiff of his appeal rights, thus eliminating any obligation to exhaust. Second, since defendant’s 1994 plan governs and affords the plan administrator “discretionary authority to determine eligibility for benefits or to construe the terms of the plan,” the so-called “arbitrary and capricious” standard applies here. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Recupero v. New England Tel. & Tel. Co.,

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Bluebook (online)
41 F. Supp. 2d 101, 1999 U.S. Dist. LEXIS 3737, 1999 WL 171496, Counsel Stack Legal Research, https://law.counselstack.com/opinion/karamshahi-v-northeast-utilities-service-co-mad-1999.