Schwarzwaelder v. Merrill Lynch & Co., Inc.

606 F. Supp. 2d 546, 2009 U.S. Dist. LEXIS 19451, 2009 WL 605751
CourtDistrict Court, W.D. Pennsylvania
DecidedMarch 9, 2009
DocketCivil Action 04-1879
StatusPublished
Cited by17 cases

This text of 606 F. Supp. 2d 546 (Schwarzwaelder v. Merrill Lynch & Co., Inc.) is published on Counsel Stack Legal Research, covering District Court, W.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schwarzwaelder v. Merrill Lynch & Co., Inc., 606 F. Supp. 2d 546, 2009 U.S. Dist. LEXIS 19451, 2009 WL 605751 (W.D. Pa. 2009).

Opinion

MEMORANDUM OPINION AND ORDER

TERRENCE F. McVERRY, District Judge.

I. CONCLUSION

The Motion for Summary Judgment filed by Defendant will be denied and the Motion for Summary Judgment filed by Plaintiff will be granted, as Defendant Metropolitan Life Insurance Company’s (“MetLife” or the “Administrator”) denial of benefits on remand constituted an abuse of discretion in light of (a) the applicable Plan provisions and (b) the medical and occupational evidence of the Administrative Record (the “Record”). This Court will grant Plaintiffs request for summary judgement “on the issue of whether [Plaintiff] is entitled to a grant of long-term disability benefits commencing May 3, 2004.” Plaintiffs Motion for Summary Judgment at 1. It will also grant Plaintiffs request for “interest, fees and costs”. Id. at 2.

II. DISCUSSION

This case, which has been re-opened and is again before this Court following remand to the Administrator in December, 2006, involves the question of a long-term disability plan claim administrator’s denial of benefits to a financial consultant. The consultant sought benefits under the language of a Plan providing them — in Plaintiffs circumstances, for a maximum of twenty-four (24) months — to an employee who is “unable to perform all of the regular duties of the Merrill Lynch job [s/he] had before [the] disability began and [is] under the continuous care of a doctor treating [the employee] within the scope of his or her speciality”. 1 Presently before *549 the Court are fully-briefed cross Motions for Summary Judgment.

Because the Administrator’s denial of long-term disability benefits on remand constituted an abuse of discretion under the terms of the Plan, the Defendants’ Motion for Summary Judgment will be denied and Plaintiffs Motion for Summary Judgment will be granted. More specifically, the Court has considered MetLife’s (1) self-serving selectivity in its use and interpretation of the medical evidence, including reliance upon the solely paper-review reports of its consultants while giving scant weight to the contrary, more detailed, and consistent reports of Plaintiffs three treating/evaluating physicians, where the claim turned on Plaintiffs mental health, and MetLife had discretion to supplement the medical evidence with independent medical evaluation (“IME”); (2) rejection of evidence self-reported by Plaintiff to her physicians where (a) Met-Life had no basis for rejecting the treating/evaluating physicians’ conclusions that Plaintiffs evidence was credible and (b) the Plan did not impose an evidentiary standard that excluded, e.g., the treating psychiatrist’s office notes of observations and reported symptoms and events; (3) failure to provide the consultants relied upon with all relevant evidence, ie., an accurate and complete profile of the scope and requirements of the job Plaintiff was usually/aetually performing, (including, e.g., requirements and conditions reasonably related to the disability alleged) and to obtain meaningful assessment of Plaintiffs disability under her Plan, despite this Court’s express guidance to the contrary; (4) continued reliance on consultant’s conclusions reached with reference to a standard of disability constituting an unreasonable interpretation of the Plan language and/or one expressly refuted by Defendant, and (5) failure to respond to the treating/evaluating physicians’ conclusions regarding the impact of employment-related stress on claimant’s medical condition. 2 The Court notes that an administrator’s history of biased claims administration may also properly be considered in an abuse of discretion review, 3 but it did not *550 find it necessary, in its abuse of discretion determination, to consider what weight, if any, should be given to MetLife’s history as a long-term disability benefit claims administrator. 4 The Court also notes, in reaching its case-specific recommendation, that (a) the Plan, as now interpreted by MetLife, provides a lenient disability benefit standard {i.e., a claimant need only be unable to perform any one job function of her own position) 5 and, conversely, (b) the performance parameters of claimant’s position were quite high. 6

A. Statement of Facts and Procedural History

1. Initial Benefits Review and Denial As set forth in the November 21, 2006 Report and Recommendation adopted as the opinion of this Court (the “R & R”), the long-term disability benefit plan at issue (“the Plan”) was established by Plaintiffs employer, Defendant Merrill Lynch & Company, Inc. (“Merrill Lynch”), and is self-funded by Merrill Lynch, with claims administered by Defendant Metropolitan Life Insurance Company. The Plan confers upon the Administrator discretion as to both Plan interpretation and determinations of benefit eligibility. It is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). See Glenn, 128 S.Ct. at 2347 (noting that administrators “should consider a benefit determination to be a fiduciary act (i.e., an act in which the administrator owes a special duty of loyalty to the plan beneficiaries”)); id. at 2350 (observing that ERISA requires plan administrators to discharge their duty solely in the interest of the plan participants and beneficiaries and to provide a full and fair review of claim denials).

Plaintiff Cheryl Schwarzwaelder (“Plaintiff’ or “Claimant”) was actively employed by Merrill Lynch for approximately one year, i.e., from approximately November 14, 2002 through November 3, 2003, as a high-end broker and financial consultant responsible for approximately $400-$500 Million in assets. 7 Plaintiff represented *551 that her treating psychiatrist advised that she was unable to continue in her high-stakes, high-pressure, high-performance-requirements position owing to increasing mental health difficulties, and that she therefore ceased work and sought disability benefits. 8

The medical records initially before the Administrator indicate that Plaintiff sought treatment with Dr. Goubert, a psychiatrist, and was seen approximately every two weeks beginning November, 2003. Those records further reflect Plaintiffs Beck Depression Inventory and Initial Psychiatric Evaluation documents; Dr. Goubert’s treatment observations/notes; Plaintiffs Patient Health Questionnaires; and Dr. Goubert’s March 8, 2004 Attending Physician Statement. 9 Dr. Goubert diagnosed Plaintiff with severe depression.

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Bluebook (online)
606 F. Supp. 2d 546, 2009 U.S. Dist. LEXIS 19451, 2009 WL 605751, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schwarzwaelder-v-merrill-lynch-co-inc-pawd-2009.