Morris v . MetLife CV-03-265-PB 05/25/05 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Kim Morris
v. Case N o . 03-cv-265-PB Opinion N o . 2005 DNH 086 Metropolitan Life Insurance Company
MEMORANDUM AND ORDER
Kim Morris is a participant in AT&T Corporation’s Long-Term
Disability Plan for Management Employees (“Plan”). She has sued
the Plan’s administrator, Metropolitan Life Insurance Company
(“MetLife”), arguing that MetLife arbitrarily denied her claim
for long-term disability (“LTD”) benefits in violation of the
Employee Retirement Income Security Act of 1974 (“ERISA”) as
amended, 29 U.S.C. § 1132(a)(1)(B). MetLife has moved for
summary judgment.
I. BACKGROUND1
Morris worked as a customer service representative for AT&T
for just over one year. Admin. R. 1 4 2 , 205. Prior to that,
1 The background facts set forth herein are taken from the Administrative Record (“Admin. R.”) filed by MetLife as an Appendix in support of its motion for summary judgment. Where appropriate, additional facts are taken from the pleadings. Morris, a high school graduate, held jobs as a cashier, a
telemarketer, and a secretary. Admin. R. 142. On July 2 , 2001,
Morris stopped working because she experienced swelling in her
hands, urinary frequency, nausea, and tenderness in her neck and
lower extremities. Admin. R. 133, 5 8 1 , 591. Morris received
short-term disability benefits (“STD”) from July 8 , 2001 through
July 7 , 2002. Def.’s Mot. for Summ. J. at 2 ; Pl.’s Opp’n. to
Def.’s Mot. for Summ. J. (“Pl.’s Opp’n.”) at 1 .
A. The Plan
The Plan provides that a participant must be “totally
disabled” to receive LTD benefits. During the first year in
which a participant is eligible for LTD benefits, a participant
is deemed to be “totally disabled” if she is “unable to perform
all of the duties of [her] job because of illness or injury . .
. .” Admin. R. 241.
The Plan gives MetLife “sole and complete discretionary
authority to determine conclusively . . . any and all questions
arising from: [a]dministration of the [LTD] Plan and
interpretation of all [LTD] provisions[,] [d]etermination of all
questions relating to participation of eligible employees and
eligibility for benefits.” Admin. R. 249. MetLife pays LTD
-2- benefits to eligible participants and obtains reimbursement from
AT&T. Admin. R. 45-49.
B. Morris’s Medical History
Morris has been diagnosed with Crohn’s disease,2
gastroesophageal reflux disease (“GERD”), 3 and fibromyalgia.
Admin. R. 143, 170-72. Since leaving AT&T, Morris’s medical
history also includes various surgeries and infections.5
2 Crohn’s disease causes inflammation in the small intestine. See National Digestive Diseases Information Clearinghouse, Crohn’s Disease, at http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ (last visited April 2005). 3 GERD is caused by the abnormal backflow, or reflux, of stomach acids and juices into the esophagus. See WedMDHealth, GERD, at http://my.webmd.com/hw/heartburn/hw99179.asp (last visited May 2005). 4 Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. See National Institutes of Health, Questions and Answers About Fibromyalgia, at http://www.niams.nih.gov/hi/topics/fibromyalgia/Fibromyalgia.pdf (last visited April 2005). 5 Morris suffered from urinary tract infections in November 2001 and September 2002. Admin. R. 163, 5 3 7 , 558. She also has a history of sinusitis, which is inflammation of the lining membrane of any sinus. See Stedman’s Medical Dictionary (“Stedman’s”) 1426 (25th ed. 1990). A surgeon, D r . Christopher Smith, performed nasal septal deviation on Morris in June 2002. Admin. R. 405-6, 492.
-3- 1. Hand Symptoms
Just prior to leaving her job at AT&T, Morris developed hand
pain. Her hands were burning, swelling, and blistered. Admin.
R. 595. On June 1 6 , 2001, D r . Paul Ernsting observed that Morris
could barely close her hands and treated her with antibiotics and
antihistamines. Morris’s primary care physician, D r . William
Hassett, noted that the itching was resolving and that Morris
felt “remarkably better” at two check-ups during the following
week. Admin. R. 5 8 7 , 591-93. On July 2 , 2001, D r . Hassett,
again noted that her hands had “improved dramatically,” and that
she had “[f]ull range of motion of the fingers.” Admin. R. 581.
On January 1 9 , 2002, Morris again developed blisters on her
hands. She applied Silvadene cream and saw D r . Hassett four days
later.6 The blisters had cleared up and there were areas of
pinkish erythema, but no cyanosis or clubbing.7 Admin. R. 526.
6 Silvadene cream is a topical cream used to prevent and treat skin infections associated with burns. See www.wedmd.com (last visited May 2005). 7 Erythema is inflammatory redness of the skin. Stedman’s 533. Cyanosis is a dark bluish or purplish coloration of the skin and mucous membrane due to deficient oxygenation of the blood. Id. at 383. Clubbing is a condition affecting the fingers and toes in which proliferation of distal tissues, especially the nail-beds, results in broadening of the extremities of the digits. Id. at 320.
-4- In September 2002, Morris saw D r . Ernsting after developing
soreness and vein prominence in her hands. D r . Ernsting observed
that Morris’s hands had good radial and ulnar pulses and good
perfusion, but also had mild distal clubbing. He further
observed that Morris had difficulty closing her hands due to
pain. D r . Ernsting again prescribed Silvadene cream. Admin. R.
163.
2. Fibromyalgia
In July 2001, Morris experienced back pain, neck pain,
tenderness in her lower left quadrant, as well as foot and hip
discomfort. Admin. R. 5 6 8 , 5 7 2 , 581. Given Morris’s generalized
pain, D r . Hassett referred her to a rheumatologist, D r . Shearman.
Admin. R. 581. D r . Shearman conducted a series of tests to
determine the nature of her pain and to treat her symptoms.
Radiologic exams of Morris’s hands and feet revealed no
abnormalities. Admin. R. 566-67. D r . Shearman first diagnosed
Morris with systemic vasculitis8 on August 1 5 , 2001, then
suspected inflamation due to a viral infection, and ultimately
diagnosed her with fibromyalgia. Admin. R. 5 4 8 , 5 5 2 , 5 6 1 , 154.
8 Vasculitis is inflammation of a blood vessel or of a lymphatic vessel. Stedman’s 7 9 , 1690.
-5- Dr. Shearman prescribed prednisone, an anti-inflammatory, on
August 1 5 , 2001, and on September 5 , 2001, determined that Morris
could not work. Admin. R. 2 7 8 , 561. However, on October 7 ,
2001, D r . Shearman concluded that Morris could return to work on
a limited basis and gradually increase her hours. Admin. R. 267.
Morris saw D r . Kovacs on November 2 0 , 2001, for further
diagnostic testing and a second opinion. Admin. R. 538-40, 548.
Blood tests and antibody levels were normal. Admin. R. 536.
Vasculitis of the skin and joints was diagnosed clinically, but
not proven by biopsy. Admin. R. 536. After additional tests, on
December 2 1 , 2001, D r . Kovacs diagnosed Morris with fibromyalgia.
Admin. R. 529-30.
On January 2 5 , 2002, Morris described “scraping, searing
pain” in the back of her right thigh. Admin. R. 521. D r .
Hassett prescribed Vioxx, a pain medication for arthritis. One
month later, Morris reported a “reasonable resultant decrease in
pain,” but still felt joint pain and burning sensations on her
skin. Admin. R. 517. In mid-March 2002, she developed pain in
her left leg and limped as a result. Admin. R. 515. On April
2 3 , 2002, Morris reported that her fibromyalgia had improved, but
that she had shooting pain in her upper and lower extremities.
-6- Admin. R. 485. On September 5 , 2002, D r . Hassett identified
multiple trigger points where Morris felt tenderness or pain, and
opined that she was disabled from any occupation. Admin. R. 161-
62.
3. Crohn’s Disease
Morris has a history of Crohn’s disease for which she has
routinely seen D r . Robert Ruben, a gastroenterologist. Admin. R.
170. In examinations in June and November 2001, D r . Ruben noted
that Morris was doing well in terms of Crohn’s disease, with
occasional diarrhea but regular bowel movements, and no
dysphagia, odynophagia, nausea, or vomiting.9 Admin. R. 536,
596. However, on March 1 8 , 2002, Morris saw D r . Ruben with joint
pain and frequent bowel movements for which he prescribed
Remicade. Admin. R. 508. Two weeks later, on April 4 , Morris
saw D r . Doucet for strep throat and he noted that her Crohn’s was
doing well. Admin. R. 497.
On May 1 3 , 2002, Morris began feeling nauseous and vomited
every day or every other day. D r . Ruben diagnosed her with GERD
and prescribed Prilosec. Admin. R. 479, 465-66. Morris lost
four pounds in May 2002, and D r . Ruben noted that the Remicade
9 Dysphagia is difficulty in swallowing. Stedman’s, 478. Odynophagia is pain on swallowing. Id. at 1081.
-7- was not helping her bowel problems. At that time, Morris
reported feeling mild abdominal discomfort and moving her bowels
twice per day. Admin. R. 479. On August 2 8 , 2002, D r . Ruben
noted that while her bowel movements were normal, she continued
to feel nauseous and vomited twice a day and had lost a total of
twelve pounds. Admin. R. 165.
4. Mental Health
On May 2 1 , 2002, Morris mentioned to D r . Hassett that she
was forgetting small things. Admin. R. 452. Her application for
LTD, completed on May 8 , 2002, also reflected that she was having
difficulty concentrating. Admin. R. 143. A medical consultant,
M s . Cheryl Searles, reviewed Morris’s files and completed a
Mental Residual Functional Capacity assessment (“RFC”) for Morris
on September 2 6 , 2002. Admin. R. 361-65. Searles determined
that Morris was “unable to maintain concentration, persistence,
and pace required for substantial gainful activity.” Admin. R.
363. Searles based her determination primarily on the
comprehensive psychological profile completed by psychologist D r .
Sibylle Carlson, because Morris’s record did not contain any
other mental health assessment. Admin. R. 363.
-8- On August 2 7 , 2002, D r . Carlson met with Morris, conducted a
mental status examination, and reviewed her records. Admin. R.
389. Carlson stated that Morris had no thought disorder or
comprehension problems, and that she had appropriate social
functioning. Admin. R. 392-93. However, D r . Carlson also noted
that Morris’s memory was unreliable and that she had difficulty
concentrating. Admin. R. 393. D r . Carlson stated that Morris
was unable to tolerate work stressors and noted that she became
nauseous during their meeting. Admin. R. 393. Her diagnosis was
“pain disorder with both a medical condition and psychological
factors” and “depressive disorder.” Admin. R. 393.
5. Social Security Claim
On August 8 , 2002, D r . Nault reviewed Morris’s medical
records and completed an RFC for the purpose of evaluating her
claim for Social Security disability benefits. Admin. R. 380-88.
The RFC noted that none of Morris’s treating physicians offered
an opinion as to her functional capacity, but D r . Nault opined
that Morris “adequately retains the ability to occasionally lift
10 pounds . . . to be able to stand and ambulate for at least two
hours out of an eight-hour workday and to be able to sit for at
least six hours out of an eight-hour workday.” Admin. R. 386.
-9- C. Morris’s LTD Claim
Morris applied for LTD benefits on May 8 , 2002. Admin. R.
133. MetLife denied her claim on July 1 7 , 2002, because it
concluded that she was not totally disabled from her own
occupation. Admin. R. 168-69. This denial was based on a review
of Morris’s records and an assessment by an independent medical
examiner (“IME”) D r . Robert C . Porter, who also reviewed her
file. Admin. R. 169. D r . Porter noted that Morris’s Crohn’s
disease was “doing well” as of April 4 , 2002, and that her
fibromyalgia-related pain did not prevent her from “easily”
getting onto a medical examination table. Admin. R. 170. D r .
Porter thus recommended that Morris should avoid repetitive work,
but that her job responsibilities “should be considered
therapeutic in nature.” Admin. R. 171.
Morris appealed MetLife’s decision on September 1 0 , 2002,
and submitted additional medical records from August and
September 2002. Admin. R. 160-65. On October 2 9 , 2002, MetLife
again denied Morris’s application for LTD benefits. Admin. R.
121. Just prior to making that decision, MetLife had another
independent examiner, D r . Lieberman, review Morris’s records and
contact her physicians. Admin. R. 154-57. D r . Lieberman, who
-10- specializes in internal medicine and rheumatology, opined that
Morris could return to her job despite her fibromyalgia. Admin.
R. 156. D r . Lieberman noted that Morris’s bowels were reported
as normal on multiple occasions. Admin. R. 155. However, D r .
Lieberman suggested that MetLife contact D r . Ruben to determine
whether Morris had active Crohn’s disease, as she had lost
fifteen pounds over a period of four months. Admin. R. 156.
On April 3 , 2003, Morris submitted additional medical
records including an October 2 8 , 2002 Social Security
Administration determination that she was disabled. Pl’s Opp’n.
at 2 , 7 . MetLife declined to consider this evidence because it
had already issued a final decision denying her appeal.
II. STANDARD OF REVIEW
The parties’ initial dispute is over the appropriate
standard of review. When the denial of benefits is challenged
under ERISA, § 1132(a)(1)(B), “the standard of review depends
largely upon whether ‘the benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility for
benefits or to construe the terms of the plan.’” Leahy v .
Raytheon Co., 315 F.3d 1 1 , 15 (1st Cir. 2002)(quoting Firestone
-11- Tire & Rubber C o . v . Bruch, 489 U.S. 1 0 1 , 115 (1989)). If the
benefit plan clearly grants the plan administrator discretionary
authority, a deferential “arbitrary and capricious” or “abuse of
discretion” standard of review is mandated.10 See id.; see also
Terry v . Bayer Corp., 145 F.3d 2 8 , 37 (1st Cir. 1998). This
standard means that “the administrator’s decision will be upheld
if it is reasoned and supported by substantial evidence in the
record.” Vlass v . Raytheon Employees Disability Tr., 244 F.3d
2 7 , 30 (2001)(internal quotations omitted); see also Cook, 320
F.3d at 1 9 . Substantial evidence means evidence that is
“reasonably sufficient to support a conclusion,” and the presence
of contradictory evidence “does not, in itself, make the
administrator’s decision arbitrary.” Vlass, 244 F.3d at 3 0 .
Finally, in reviewing a decision to terminate benefits, “a court
is not to substitute its judgment for that of the [decision-
maker].” Terry, 145 F.3d at 40 (internal quotations omitted).
Morris concedes, as she must, that the Plan vests MetLife
with the discretionary authority to both construe the terms of
10 In the First Circuit, there is no substantive difference between “arbitrary and capricious” and “abuse of discretion” review in the ERISA context. Cook v . Liberty Life Assurance C o . of Boston, 320 F.3d 1 1 , 17 n.7 (1st Cir. 2003).
-12- the Plan and to make benefits determinations. Nevertheless, she
argues that MetLife’s judgments are subject to a heightened
standard of review because it operated under a conflict of
interest. The alleged conflict on which this argument is based
arises from the fact that AT&T, the company that retained MetLife
as Plan administrator, is self-insured. This argument does not
require extensive analysis as the First Circuit has determined
that such structural arguments do not justify a heightened
standard of review. Wright v . R.R. Donnelly & Sons Co., 402 F.3d
6 7 , 75 (1st Cir. 2005).
Finding no conflict of interest, I must apply an arbitrary
and capricious standard of review and proceed to ensure that the
termination of LTD benefits was not “objectively unreasonable in
light of the available evidence.” Pari-Fasano v . ITT Hartford
Life and Accident Ins. Co., 230 F.3d 415, 419 (1st Cir. 2000).
III. ANALYSIS
MetLife argues that it is entitled to summary judgment
because its decision to deny Morris’s claim is supported by
substantial evidence. Morris’s principal counter-argument is
that MetLife acted arbitrarily because it failed to consider
-13- additional evidence that she submitted after it had issued a
final decision denying her appeal. Morris also argues that
MetLife erred in relying on D r . Lieberman’s independent medical
evaluation because that evaluation did not cite D r . Ernsting’s
medical notes concerning her hand condition and left unanswered
other questions concerning the impact of Morris’s Crohn’s disease
on her ability to work.
A. Post-Appeal Evidence
Morris is mistaken when she argues that MetLife acted
arbitrarily when it refused to consider information she provided
after its rejection of her appeal became final. The Plan
expressly states that “[d]uring its review of an appeal of an
Adverse Benefit Determination, the Claims Administrator shall:
[t]ake into account all comments, documents, records, and other
information submitted by the claimant.” Admin. R. 249 (emphasis
added). The Plan later states, with respect to an appeal, that
“decisions by the Claims Administrator and AT&T shall be
conclusive and binding on all parties and not subject to further
review.” Admin. R. 250. Here, MetLife properly followed the
Plan, reviewed Morris’s appeal and issued a final decision on
October 2 9 , 2002. MetLife did not act arbitrarily in refusing to
-14- reopen its decision to consider evidence submitted after that
decision became final.11
B. Dr. Lieberman’s Evaluation
Morris next argues that MetLife improperly relied on D r .
Lieberman’s independent evaluation because he failed to
specifically cite D r . Ernsting’s medical notes and failed to
properly consider the possibility that Crohn’s disease was
affecting her ability to work. I reject both arguments.
Morris complains that D r . Lieberman failed to specifically
cite to D r . Ernsting’s medical notes, but she does not identify
any new information in those notes that warranted specific
citation. The notes in question are a very small part of an
extensive medical record and the information contained in those
notes is cumulative of other evidence that D r . Lieberman did
specifically cite. Moreover, in denying Morris’s appeal, MetLife
quoted extensively from one of D r . Enersting’s notes, thus
indicating that it was aware of the note when it rejected her
appeal. D r . Lieberman’s failure to specifically cite the note in
his evaluation thus is of no consequence.
11 Morris has not explained the significance of the post- appeal evidence and I have not attempted to assess the significance of the evidence on my own.
-15- Nor is it significant that D r . Lieberman raised questions in
his evaluation concerning D r . Rubin’s treatment of Morris for
Crohn’s disease. In addressing these question in its decision
rejecting Morris’s appeal, MetLife explained that it did not
regard the questions as determinative because D r . Ruben did not
indicate either that Morris suffered from active Crohn’s disease
or that her Crohns’s disease imposed any restrictions on her
ability to work. Under these circumstances, MetLife did not act
arbitrarily in relying on D r . Lieberman’s evaluation.12
IV. CONCLUSION
For the foregoing reasons I grant MetLife’s motion for
summary judgment (Doc. N o . 1 1 ) . The clerk shall enter judgment
accordingly.
SO ORDERED.
Paul Barbadoro May 2 4 , 2005 United States District Judge
cc: Richard Bell, Esq. Eugene A . DiMariano, Esq. James J. Ciapciak, Esq. 12 I do not consider the evidence in the record concerning Morris’s Mental RFC as Morris has not based her opposition to MetLife’s motion for summary judgment on this evidence.
-16-