Vochaska v. Metropolitan Life Insurance

995 F. Supp. 2d 801, 2014 WL 222116, 2014 U.S. Dist. LEXIS 7271
CourtDistrict Court, W.D. Michigan
DecidedJanuary 21, 2014
DocketCase No. 1:12-CV-1070
StatusPublished

This text of 995 F. Supp. 2d 801 (Vochaska v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Vochaska v. Metropolitan Life Insurance, 995 F. Supp. 2d 801, 2014 WL 222116, 2014 U.S. Dist. LEXIS 7271 (W.D. Mich. 2014).

Opinion

OPINION

GORDON J. QUIST, District Judge.

Plaintiff, Jeffrey Vochaska, has sued Defendant, Metropolitan Life Insurance Company (MetLife), under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., seeking review of MetLife’s February 23, 2012 final decision denying him long-term disability benefits beyond November 14, 2011. Defendant has filed the Administrative Record and the parties have filed cross motions for judgment on the Administrative Record in accordance with the procedures set forth in Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir.1998). For the reasons set forth below, the Court will grant Vochaska’s motion, deny MetLife’s motion, and remand to MetLife to review Vochaska’s eligibility for benefits.

I. Background

Vochaska was employed by Lane Automotive as a Product Manager, Circle Track Sales. (AR 614-15.) On August 14, 2010, Vochaska ceased working full-time due to a head injury that he received in an automobile accident. (AR 606.) After his injury, Vochaska worked intermittently with a reduced workload. (AR 538.) Vochaska received his last paycheck from Lane Automotive on December 30, 2010. (Id.)

As a Product Manager of the circle track product line, Vochaska was responsible for, among other things, developing strategic marketing programs and coordinating the development of sales objectives and strategies. (AR 614-15.) Vochaska’s duties included analyzing market data, calling on customers, and responding to product-related information requests. (Id.) The position required a knowledge of computers and business software. (Id.) The physical demands of the position included sitting four hours per day, standing three hours per day, walking one hour per day, and occasionally lifting up to 50 pounds. (AR 638.) The position required continuous interpersonal interactions and frequent exposure to stressful situations. (Id.)

As a Lane Automotive employee, Vochaska was a participant in the Michigan Manufacturers Association Welfare Benefit Plan (the Plan), which provided long-term disability (LTD) benefits through a group disability insurance policy (Policy) issued by MetLife. (AR 1-38.) MetLife administered claims for LTD benefits. The Policy contains the following two-tiered definition of disability for purposes of LTD benefits:

“Disabled” or “Disability” means that, due to sickness, pregnancy or accidental injury, you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis; and
1. during your Elimination Period and the next 24 month period, you are unable to earn more than 80% of [805]*805your Predisability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy; or
2. after the 24 month period, you are unable to earn more than 80% of your Indexed Predisability Earnings from any employer in your Local Economy at any gainful occupation for which you are reasonably qualified taking into account your training, education, experience and Predisability Earnings.

(AR 13.)

Vochaska applied for LTD benefits on January 4, 2011. (AR 605-07.) In his application, he stated that the following conditions prevented him from performing the duties of his job: double vision, nausea, hypersensitivity to light and sound, and post-concussion syndrome. (AR 606.) Vochaska included with his application a statement from his treating physician, Dr. David M. Liscow. (AR 610-12.) Dr. Liscow stated that Vochaska suffered from concussion syndrome and recurrent migraine headaches, and that Vochaska experienced photosensitivity (sensitivity to light), phonosensitivity (sensitivity to sound), confusion, headaches, word-finding difficulties, dizziness, and stuttering. (AR 610.) Dr. Liscow concluded that Vochaska could not return to work full-time, in part because he could not focus on computers or communicate appropriately. (AR 611.)

Upon MetLife’s request, Dr. Liscow provided medical records dating back to the date of Vochaska’s accident. (AR 541-82.) Dr. Liscow’s notes from office visits during that time period indicated that Vochaska was experiencing sensitivity to sound and light, dizziness, short-term memory loss, nausea, and depression. (AR 541, 552.) A CT scan and MRI performed on Vochaska’s brain following his accident yielded normal results. (AR 545, 551, 566.)

On February 4, 2011, MetLife approved Vochaska’s claim for LTD benefits. (AR 535.) MetLife determined that the date of disability was August 16, 2010, and benefits became payable on November 14, 2010, following the 90 day Elimination Period. (Id.)

On February 21, 2011, Dr. Gretchen Barnas, a psychiatrist, submitted a report from a recent visit with Vochaska. (AR 453-458.) The report stated that Vochaska suffered from photophobia and phonophobia, but that those conditions were beginning to improve. (AR 457-58.) Vochaska reported listening to music and watching television, working on a race car, fixing things around the house, welding, and exercising daily. (AR 453.) Vochaska also told Dr. Barnas that he had been suffering from “white outs,” in which his ears would buzz and he would pass out. (AR 455.) Dr. Barnas concluded that Vochaska suffered from post-concussion disorder and had a GAF (Global Assessment of Functioning) sore of 45. (AR 458.)

On April 6, 2011, in response to a request from MetLife, Dr. Liscow submitted a completed questionnaire and updated records from three office visits with Vochaska. (AR 493-510.) In the questionnaire, Dr. Liscow stated that he believed Vochaska was unable to return to work because he could not sustain focus or tolerate a lighted and noisy environment. (AR 494.) In the office notes, Dr. Liscow noted that Vochaska continued to complain of sensitivity to light and noise, short-term memory loss, and nausea. (AR 499, 503, 507.) Vochaska also said that he was exercising, and that his headaches were improving. (AR 499, 503.)

On April 15, 2011, Dr. Sandra Bowker, a neuropsychologist, submitted the results of a neuropsychological examination conducted several months earlier. (AR 472-76.) [806]*806Although test results indicated “substantial inconsistencies in functioning with severely impaired performance on some tasks and normal performance on other, similar tests,” Dr. Bowker stated that test results likely did not represent an accurate assessment of Vochaska’s cognitive functioning. (AR 475.) Rather, Dr. Bowker noted that Vochaska might be exaggerating symptoms as a “cry for help.” (Id.) She went on to explain, however, that she believed Vochaska experienced high levels of anxiety and developed physical symptoms in response. (Id.) Dr. Bowker concluded that Vochaska’s “history does not support a brain injury that would preclude a return to full-time employment.” (AR 475.) Dr. Bowker noted that there might be “psychiatric issues that would prevent return to work,” but deferred on that question. (Id.)

On April 22, 2011, Dr. Dennis A. Jewett, Vochaska’s treating neurologist, submitted a completed questionnaire and narrative report. (AR 459, 467.) Dr. Jewett stated:

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Cite This Page — Counsel Stack

Bluebook (online)
995 F. Supp. 2d 801, 2014 WL 222116, 2014 U.S. Dist. LEXIS 7271, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vochaska-v-metropolitan-life-insurance-miwd-2014.