Vlass v. Raytheon Employees Disability Trust

96 F. Supp. 2d 51, 2000 U.S. Dist. LEXIS 6531, 2000 WL 620031
CourtDistrict Court, D. Massachusetts
DecidedMay 2, 2000
DocketCiv.A. 99-10146-JLT
StatusPublished
Cited by1 cases

This text of 96 F. Supp. 2d 51 (Vlass v. Raytheon Employees Disability Trust) 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
Vlass v. Raytheon Employees Disability Trust, 96 F. Supp. 2d 51, 2000 U.S. Dist. LEXIS 6531, 2000 WL 620031 (D. Mass. 2000).

Opinion

MEMORANDUM

TAURO, District Judge.

Defendants move for summary judgment on grounds that MetLife’s determination that Plaintiff was not “totally disabled” is supported by “substantial evidence.” For reasons set forth below, the motion is DENIED.

I.

Plaintiff, Clyde Vlass, began working for Defendant, Raytheon Company (“Raytheon”), in October 1985 as a “unit person.” In February 1995, Vlass was diagnosed with diabetic neuropathy and secondary chronic pain. In March 1995, he was deemed “fully disabled,” and began receiving disability benefits under Raytheon’s employee benefits plan (the “Plan”). See Claim File of Metropolitan Life Insurance Company (“Claim File”), MET095-119. The Plan provides that benefits are payable during the first eighteen months of disability -to an employee who is “fully disabled,” i.e., an employee who “cannot perform the essential elements and substantially all of the duties of his or her job at Raytheon *52 even with a reasonable accommodation.” Id. at MET098. Benefits thereafter are payable only to an employee who is “totally disabled,” i.e., an employee who “cannot do any other job for which he or she is fit by education, training or experience.” Id. at MET100. In September 1996, Defendant Metropolitan Life Insurance Company (“MetLife”), the plan claims administrator, determined that Vlass was not “totally disabled,” and terminated his benefits.

II.

The parties agree that ERISA governs Plaintiffs claims, that MetLife had discretionary authority to determine whether Plaintiff was eligible for disability benefits under the Plan, and that the court must determine whether MetLife’s decision that Plaintiff was not entitled to such benefits is supported by “substantial evidence.” “Substantial evidence” means “evidence reasonably sufficient to support a conclusion.” Doyle v. Paul Revere Life Ins. Co., 144 F.3d 181, 184 (1st Cir.1998).

Defendants assert that four categories of evidence support MetLife’s determination denying Plaintiff further disability benefits: (1) the August 7,1996 physician’s report of Dr. Elizabeth Buchanan, M.D., Plaintiffs family practitioner; (2) the May 24, 1996 physician’s report of Dr. Robert Levine, M.D., the endocrinologist who conducted an “independent medical examination” of Plaintiff; (3) the August 28, 1996 vocational assessment report of Crawford & Co.; and (4) the November 6, 1996 surveillance report of Absolute Investigations, Inc. This court disagrees.

A fair reading of the cited reports, in conjunction with additional information in Plaintiffs case file, causes this court to conclude that MetLife’s determination that Plaintiff was not “totally disabled” was unreasonable. At a minimum, the evidence establishes that Plaintiff was incapable of performing “his prior and all occupations,” Claim File, MET072 (March 4,1996 letter of Dr. Richard Levy, M.D.), at the time MetLife terminated his benefits. Moreover, the reports in the file suggest that Plaintiff may be “permanently” disabled from all present and future employment.

A.

In supporting MetLife’s termination of Plaintiffs benefits under the Plan, Defendant relies on selected medical observations from the August 7, 1996 physician’s report of Dr. Elizabeth Buchanan and the May 24, 1996 physician’s report of Dr. Robert Levine. Defendants note that Dr. Buchanan’s report indicates that Plaintiff, with some restrictions, can work five to six hours per day, and can perform, to varying degrees and for varying lengths of time, all physical tasks except lifting or carrying more than fifty pounds. Defendants observe that Dr. Levine’s report opines that Plaintiff suffers “no signs of motor dysfunction” or limitations on his ability to sit, change position, reach, pull, push, twist, or operate a truck/dolly/small vehicle, among other activities. Defendants contend, therefore, that Dr. Buchanan and Dr. Levine concur that Plaintiff is not “totally disabled” under the Plan.

Read in full, however, the reports of Dr. Buchanan and Dr. Levine actually undermine Defendants’ position. Dr. Buchanan’s August 7th report, in fact, is not an independent, written report at all, but instead Defendant’s block form which Dr. Buchanan completed at its request. See Claim File, MET087. Additional documentation of Dr. Buchanan’s medical examination of Plaintiff is more instructive as to her opinion of Plaintiffs functional capacity. Indeed, in a September 11, 1995 report to the case management specialist at MetLife, Dr. Buchanan opines that Plaintiff is “currently totally disabled.” Id. at MET481. In a July 8, 1996 report to Raytheon, she adds: “Given the intensity of his description, [Plaintiff] certainly sounds fully disabled....” Id. at MET386.

*53 Dr. Levine s physician s report similarly is unsupportive of Defendants’ position when read in totem. Recognizing Plaintiffs complaints of “severe” and “unrelenting pain,” and an “inability to do work or concentrate due to this pain,” the report states that Plaintiff exhibits “characteristic findings for a painful diabetic radiculopa-thy” that, while typically lasting six to eighteen months, may last longer. Id. at MET089. Dr. Levine thus concludes: “I would hesitate to recommend permanent disability.... If [Plaintiffs] degree of pain is felt to prohibit his employment at the present time, I would recommend continuation of temporary disability, with the hope and expectation that ultimately this pain syndrome should resolve!” Id. at MET094. Fairly read, Dr. Levine’s report indicates his opinion that Plaintiff, as of May 24, 1996, was “totally,” if not “permanently,” disabled.

In addition to Dr. Buchanan and Dr. Levine, Dr. Richard Levy, a neurologist, also examined and treated Plaintiff for “painful diabetic neuropathy.” In nine reports contained in Plaintiffs case file, Dr. Levy unambiguously states his opinion of Plaintiffs condition, which his March 4, 1996 report to Raytheon best summarizes:

I am writing with reference to your letter of 02/27/96 concerning Clyde Vlass. Mr. Vlass has a painful diabetic neuropathy. It is predominantly in the thoracoabdominal region. He suffers from chronic pain, as is documented in my office notes. The neuropathy and consequent pain interfere with his ability to function at work. He has to take pain medication which potentially could interfere with his cognitive function. ■ Likewise, his pain interferes with his concentrating abilities. By virtue of his pain and usage óf medication, it is my opinion that he is disabled from his prior and all occupations. I anticipate that this mil be permanent, (emphasis added). ;

MetLife’s reliance solely on extracted medical observations, taken out of the context of the medical opinions of Dr. Buchanan and Dr. Levine, and in disregard of the express, repeated opinion of Dr. Levy, was unreasonable. Such unduly selective consideration of medical evidence does not amount' to “substantial evidence.” See generally Adie v. Commissioner, Social Security Admin., 941 F.Supp.

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Related

Vlass v. Raytheon Employees Disability Trust
244 F.3d 27 (First Circuit, 2001)

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Bluebook (online)
96 F. Supp. 2d 51, 2000 U.S. Dist. LEXIS 6531, 2000 WL 620031, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vlass-v-raytheon-employees-disability-trust-mad-2000.