Piscottano v. Metropolitan Life Insurance

118 F. Supp. 2d 200, 25 Employee Benefits Cas. (BNA) 1785, 2000 U.S. Dist. LEXIS 16290, 2000 WL 1658512
CourtDistrict Court, D. Connecticut
DecidedSeptember 22, 2000
Docket3:99CV500 (JBA)
StatusPublished
Cited by4 cases

This text of 118 F. Supp. 2d 200 (Piscottano v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Piscottano v. Metropolitan Life Insurance, 118 F. Supp. 2d 200, 25 Employee Benefits Cas. (BNA) 1785, 2000 U.S. Dist. LEXIS 16290, 2000 WL 1658512 (D. Conn. 2000).

Opinion

RULING ON CROSS-MOTIONS FOR SUMMARY JUDGMENT [DOC. #27, 31]

ARTERTON, District Judge.

I. Overview

This case arises out of defendant Metropolitan Life Insurance Company (“Met-Life”)’s decision to terminate Antoinette Piscottano’s long term disability benefits after she ran for Mayor of the City of New Haven. MetLife provided a Long Term Disability (“LTD”) Benefits Plan to Southern New England Telephone Company (“SNET”). The Plan is an employee welfare benefit plan subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”). See Compl. ¶ 1.

Ms. Piscottano was employed by SNET as a customer service representative from March 1981 until June 1988, when she became totally disabled within the meaning of the LTD plan. Her LTD claim was approved on March 9, 1989. See Compl. ¶ 4. Ms. Piscottano received LTD benefits from March 9, 1989 until December 31, 1997, when MetLife determined that she was no longer eligible. See id. ¶ 6. Ms. Piscottano appealed MetLife’s termination decision and, on March 30, 1998, MetLife concluded the review process and upheld the termination of her benefits. See *202 3/30/98 MetLife Letter, Defendant.’s Ex. 47.

Plaintiff now moves for summary judgment on Count One of the Complaint on the grounds that “based on the record, MetLife’s decision to deny the plaintiffs long term disability benefits was arbitrary and capricious, and thus the plaintiff is entitled to judgment on her claim of violation of ERISA as a matter of law.” Plaintiff’s Mot. for Summ.J. [Doc. # 31] at 2-3. MetLife argues that its decision to terminate Plaintiffs benefits was reasonable given the “ample evidence upon which to conclude that the Plaintiff is not disabled under the terms of the Plan,” ■ and has cross-moved for summary judgment on the claim of improper termination. Defendant’s Mem. in Supp. of Mot. for Summ.J. [Doc. # 28] at 2.

II. Background

A. The Disability Plan

A participant in the LTD Plan is considered “disabled” if, due to a non-SNET-job-related illness or injury, the participant is “unable to perform the duties of any job for which he or she is qualified or may reasonably become qualified based on training, education, or experience.” Defendant’s Ex. 1, LTD Plan, LTD-11. The plan also provides benefits for an individual who is only capable of working in a job for which she might reasonably become qualified, as long as the only jobs for which she could become qualified would pay less than half of the income she had previously earned at SNET. See id. This provision does not apply if the claimant is determined to be capable of working in a job for which she is already qualified. See id.

The plan provides that LTD benefits may be terminated for a variety of reasons, including the recipient’s failure to supply adequate medical information to the insurance company to substantiate the disability claim, failure to see another physician if requested by the insurance company, and performing activities which are inconsistent with her diagnosis or disability, without prior approval from the insurance company. See id. at LTD-7.

B. The Administrative Record

As noted above, Ms. Piscottano began receiving LTD benefits in March 1989. She has been diagnosed with spondyloly-sis, and has undergone multiple spinal surgeries to treat her back pain. She has had a posterior spinal fusion, a cervical fusion, and a lumbar laminectomy, and anterior interbody spine fusion over multiple levels, as well as surgeries for the insertion and removal of instruments that required bone grafting. As a result of these severe back problems, Plaintiff has been diagnosed with a chronic pain syndrome. See PI. Reply in Supp. of Mot. for Summ.J. [Doc. # 38], at 10.

In the summer of 1995, the New Haven Register published an article that described Ms. Piscottano’s campaign for Mayor of New Haven, Connecticut. See Def.’s Ex. 7. In response to the article, The Travelers, the former plan administrator, wrote to Dr. Lieponis, Plaintiffs treating physician on July 31, 1995, asking how Plaintiff could campaign for mayor and perform mayoral duties if she is incapable of employment. See Def.’s Ex. 9. Dr. Lieponis replied that the medical information he had provided to.Travelers in support of Plaintiffs disability is “both accurate and reliable” and that he did not feel any responsibility “to review any material published in the lay press.” 1 8/16/95 Liep-onis Letter, Def.’s Ex. 10. 2

*203 Concerned that Piscottano’s reported campaign activities might conflict with Dr. Lieponis’ diagnosis, Travelers arranged a Functional Capacity Evaluation (“FCE”) for Piscottano in October 1995 to verify the extent of her disability. The FCE concluded that “[i]t is likely that the client can complete an 8-hour work day at a light level.” 10/95 FCE Report, Def.’s Ex. 12. The FCE recommended that Piscottano gradually transition to full-time work.

In late September 1995, MetLife scheduled Ms. Piscottano for an Independent Medical Evaluation (IME) to be conducted by Dr. Buza. Dr. Buza’s report concluded that Piscottano was “capable of sedentary and probable light category of work with restrictions for lifting and bending.” 10/95 IME Report, Def.’s Ex. 14. Dr. Buza’s evaluation summary ended with the suggestion that Piscottano should enter a multi-disciplinary program of physical, occupational, and psychological therapy to “maximize functional status.” Id.

On December 6, 1995, Dr. Lieponis wrote to Travelers, agreeing with both the FCE and Dr. Buza that Piscottano has some work capacity and that she needed to transition gradually back to employment. Dr. Lieponis also noted that after the FCE, Piscottano had “an acute flare-up of symptoms which resulted in incapacitating pain with complete cessation of even daily activities for a period of weeks.” 12/6/95 Lieponis Letter, Def.’s Ex. 16. Lieponis stated that Piscottano’s work capacity on an extended basis “is far less” than that determined by the FCE. However, he concluded that a sedentary job that allowed her to change positions frequently and that did not involve lifting, bending, pulling or pushing “would appear to be within her capabilities.” Id.

Travelers responded to Dr. Lieponis on February 8, 1996, noting that because the recent medical information indicated that Piscottano had a full-time capacity for sedentary work, she “no longer meets our definition of disability.” Travelers acknowledged that Piscottano suffered “discomfort” following the FCE, but added that “the testing did ask her to perform certain physical tasks which would not be required in a sedentary job.” 2/8/96 Met-Life Letter, Def.’s Ex. 18. Travelers gave Dr.

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Bluebook (online)
118 F. Supp. 2d 200, 25 Employee Benefits Cas. (BNA) 1785, 2000 U.S. Dist. LEXIS 16290, 2000 WL 1658512, Counsel Stack Legal Research, https://law.counselstack.com/opinion/piscottano-v-metropolitan-life-insurance-ctd-2000.