Schindler v. Metropolitan Life Insurance

141 F. Supp. 2d 1073, 2001 U.S. Dist. LEXIS 13091
CourtDistrict Court, M.D. Florida
DecidedApril 30, 2001
Docket2:99CV150FRN29NF
StatusPublished
Cited by7 cases

This text of 141 F. Supp. 2d 1073 (Schindler v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schindler v. Metropolitan Life Insurance, 141 F. Supp. 2d 1073, 2001 U.S. Dist. LEXIS 13091 (M.D. Fla. 2001).

Opinion

MEMORANDUM-DECISION AND ORDER

McCURN, Senior District Judge.

Plaintiff Robert T. Schindler brings this action against his former employer, Sears Roebuck and Co., and Metropolitan Life Insurance Company (MetLife), the insurer and administrator of Sears’ Group Life and Long Term Disability Insurance Plan (the Plan). 1 MetLife terminated Schindler’s long term disability (LTD) benefits after concluding that insufficient evidence existed to support Schindler’s claim that he was “totally disabled.” Schindler challenges MetLife’s termination of his LTD benefits and seeks recovery of those benefits from the date of the allegedly wrongful termination. This court held a bench trial on the matter on March 15, 2001.

After carefully considering the administrative record and the parties’ submissions, the court agrees with MetLife’s decision to terminate Schindler’s LTD benefits on the ground that Schindler is no longer “totally disabled” within the meaning of the Plan. In accordance with Fed.R.Civ.P. 52, the following constitutes the court’s findings of fact and conclusions of law.

BACKGROUND

Schindler worked for Sears as a commission sales person from approximately 1971 until 1988. In 1979, Schindler allegedly sustained severe injuries to his left ankle, upper left leg and right groin area as a result of a non-work related accident with a “roto spader.” After recovering from the roto spader accident, Schindler continued in his occupation at Sears.

In the Fall of 1988, Schindler applied for LTD benefits under the Plan, claiming that the injuries he had received in 1979 to his ankle, leg and groin had worsened to the point where he could no longer perform his job as a furniture salesman. 2 Specifically, Schindler claimed that since June 4, 1988, the pain associated with his injuries had grown so constant and intense that he was unable to stand on his feet for any sustained period of time (see Employee’s Stmnt. of Claim (9-19-88), Joint Exh 1, § B).

As part of his claim for disability benefits, Schindler submitted an “Attending Physician’s Statement of Disability” (APS) from Dr. Michael D. Horowitz. As reflected in the APS, Dr. Horowitz diagnosed Schindler with post traumatic neu-ropathy, depression and chronic pain. Under the category “subjective symptoms,” Dr. Horowitz noted “Severe Pain, paresthesias — with prolonged standing/standing in general. Patient virtually always in some discomfort. Presently, *1076 this is worsened with even brief standing” (APS (10-10-88), id.). Dr. Horowitz further stated that Schindler’s condition had retrogressed, and that be would not benefit from any therapy (see id.). Finally, Dr. Horowitz indicated that while Schindler was totally disabled from his job with Sears, he could work at a job that did not require any standing (see id.).

In addition to the APS, Schindler submitted a statement indicating his sales job required him to spend eight hours a day on his feet selling, moving and stocking furniture (see Training Education and Experience Stmnt. (9-19-88), id.). With respect to his education, Schindler stated that he had completed two years of college, majoring in communications and radio-television-film (see id.). Under “special skills”, Schindler wrote that “ ‘in house’ commission sales is all that I have done in 17 years” (id.).

In response to a letter request from MetLife, 3 Dr. Horowitz submitted further documentation in December of 1988, confirming both his diagnosis of Schindler and that Schindler’s condition was retrogressed, permanent, and not susceptible to any therapy (see Completed Questions to Bach Ltr, id., § C). Additionally, Dr. Horowitz completed a Physical Capacities Evaluation (PCE) stating that Schindler was unable to stand or walk during a eight hour workday, but that he was able to sit for eight hours (see PCE (12-15-88), id.).

By letter dated January 5, 1989, Met-Life approved Schindler’s application for LTD benefits effective from October 23, 1988, 4 continuing for as long as Schindler met the definition of total disability as defined in the Plan (see Bach Ltr 1-5-89), id., § D. Shortly thereafter, apparently acting upon his doctor’s advice, Schindler relocated from Pennsylvania to Cape Coral, Florida. On August 4, 1989, MetLife requested that Schindler’s new primary care physician, Dr. Jane L. Simenson, complete an APS. A month later, Dr. Si-menson submitted the requested APS, diagnosing Schindler with post traumatic neuropathy (see APS (9-11-89), id., § F). Dr. Simenson described Schindler’s condition as improved, indicating that Schindler had some limitation with respect to standing, sitting, balancing, bending, stooping and squatting, among other things (see id.). Dr. Simenson further stated that while Schindler was totally and permanently disabled from his previous occupation, she could not determine whether he was disabled from “any occupation” (id.). A few months later, however, Dr. Simen-son indicated on a subsequent APS that Schindler’s condition was “unimproved” and that he was totally disabled from “any occupation” (APS (12-28-89), id., § X).

Schindler continued to supply MetLife with annual APSs completed by Dr. Si-menson from 1990 through 1996. 5 In the *1077 September 1990 APS, Dr. Simenson again diagnosed Schindler with post traumatic neuropathy and determined that he was totally and permanently disabled from his previous or any occupation (see APS (9-4-90), id, § G). Dr. Simenson also modified her earlier assessment of the limitations on Schindler’s activities, indicating that he should now completely avoid any standing or sitting (see id.). For the next six years, Schindler’s condition and limitations remained essentially unchanged according to the submitted statements (see APS (12-2-91), id., § X; APS (11-27-92), id.; APS (11-8-93), id; APS (10-6-94), id; APS (11-1-95); id; APS (12-16-96), id).

On January 12, 1998, MetLife requested that Schindler complete a Personal Profile Evaluation (PPE), and that Dr. Simenson complete a Report of Physical Capacity accompanied by her medical records on Schindler.

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Cite This Page — Counsel Stack

Bluebook (online)
141 F. Supp. 2d 1073, 2001 U.S. Dist. LEXIS 13091, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schindler-v-metropolitan-life-insurance-flmd-2001.