Wallace v. Metropolitan Life Insurance

332 F. Supp. 2d 1280, 2004 U.S. Dist. LEXIS 16826, 2004 WL 1900648
CourtDistrict Court, D. South Dakota
DecidedAugust 17, 2004
DocketCIV 02-4249
StatusPublished
Cited by1 cases

This text of 332 F. Supp. 2d 1280 (Wallace v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. South Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wallace v. Metropolitan Life Insurance, 332 F. Supp. 2d 1280, 2004 U.S. Dist. LEXIS 16826, 2004 WL 1900648 (D.S.D. 2004).

Opinion

MEMORANDUM OPINION AND ORDER

PIERSOL, Chief Judge.

This case involves a claim for long-term disability' benefits by the plaintiff, Sarah Byers Wallace (“Wallace”), against defendants, Metropolitan Life Insurance Company (“MetLife”) and Citigroup, Inc. (“Citigroup”). Defendants have moved for summary judgment against Wallace. Wallace disputes one of the facts in the Defendants’ Statement of Undisputed Material Facts, but Wallace moves for summary judgment in her favor in the event the Court determines that no material factual disputes exist which would preclude summary judgment. For the following reasons, this' case will be remanded to Met-Life. ■

BACKGROUND

With the one exception that is noted herein, the parties agree .that the following facts are undisputed. In April 2001, Wallace was employed as a customer service representative for Citigroup and was a qualified participant in the employee welfare benefit plan (the “Plan”) sponsored and maintained by Citigroup. MetLife is the Claims Administrator of the Plan and one of the Plan’s fiduciaries. Pursuant to the Administrative Services Agreement (“ASA”) between MetLife and Citigroup, Citigroup has delegated to MetLife the responsibility and discretionary authority for approving or denying plan benefits in whole or in part. ■

*1282 Before starting work for Citigroup, Wallace treated with Timothy Donelan, M.D., in January of 2000 for low back spasms. Wallace treated for the first time with Scott Boyens, M.D., for left low back pain on November 29, 2001, at which time Dr. Boyens noted that Wallace had begun lifting free weights two weeks prior and was taking some supplements for body shaping. Dr. Boyens authorized Wallace to return to work at his examination of December 6, 2001. According to Dr. Boyens’ exam note of December 19, 2001, Wallace returned to work on December 10 and she was “doing okay there.”

Wallace next treated with Robert R. Sei-del, M.D., on December 28, 2001. He noted that her lumbosacral back strain was “probably from weight lifting too rapidly and too heavily.” Dr. Seidel restricted her to working five hours per day beginning Monday, December 31, 2001. Wallace underwent an MRI on December 27, 2001, which Dr. Seidel read as showing some disk space narrowing and bulge between L4-5 and L5-S1, but no nerve root compression or obvious “disk herniation.”

When Wallace saw Dr. Seidel on January 3, 2002, she complained of increased pain in her low back. Dr. Seidel noted that Wallace “continued to lift some weights.... [and] I still feel that her exercise program is aggravating some of this.” Dr. Seidel’s January 3, 2002, exam note indicates that Wallace made an appointment on her own to see Dr. Alvine on January 21, and that “when I had last seen her I had indicated to her that I felt she could work half days, which would be five hours. She has not gone to work. I specifically asked her not to do any of her exercises. I even reviewed the stretching and asked her not to do that until she is seen by physical therapy and would get the recommendations.” Wallace claimed short-term disability (“STD”) benefits in December of 2001 for her back condition, and she received those benefits until she was authorized to return to work on a part-time basis on January 25, 2002.

Wallace first saw orthopedist Greg Al-vine, M.D., on February 7, 2002, and reported that her back condition came on when she was shoveling snow in November. Dr. Alvine concluded that the radiological examination of her back was “essentially unremarkable. There may be some mild retrolisthesis of L5-S1.” Dr. Alvine reviewed the MRI results from December 27, 2001, noting that Wallace had degenerative disk signals at L4-5 and L5-S1 and that he thought there was a small annular tear on the left at L5-S1 and possibly central at L4-L5. Based upon these findings, he believed that the conditions “should calm down with conservative measures.”

Wallace fell down at home and fractured a bone in her right hand on February 7, 2002. On February 8, 2002, Dr. Seidel wrote a note saying Wallace should undertake no work using her right hand “for anything heavy, pulling, gripping” for one week due to the broken bone. Wallace had surgery to repair her hand fracture on February 18, 2002. Wallace’s attending physician for her hand injury, orthopedist Robert E. VanDemark, Jr., MD, released her from work beginning February 19, 2002.

When Dr. Alvine saw Wallace for her back on February 28, 2002, he discussed the MRI results with her. He recommended that she stay with the five hour return to work limitations prescribed by Dr. Seidel in December.

Because Wallace did not return to active full-time status for more than 14 calendar days after her initial disability date of December 21, 2001, her original claim was still active when she broke her hand on February 7, 2002. By letter dated March 4, 2002, Met Life informed Wallace that *1283 salary continuance benefits had been approved from December 21, 2001 through March 7, 2002. By letter dated March 11, 2002, Dr. VanDemark released Wallace from work until March 19, 2002. By letter dated March 11, 2002, Met. Life extended Wallace’s disability. benefits through March 19, 2002. By letter dated April 3, 2002, Dr. VanDemark authorized Wallace off work from March 19, 2002 until April 22, 2002. At the April 22, 2002, examination, Dr. VanDemark prepared a physician’s questionnaire and Physical Capacities Evaluation authorizing unlimited sitting, standing and walking, but limiting Wallace’s lifting and her use of her right hand until her expected recovery date 2 months later.

At Dr. Alvine’s April 29, 2002, examination of Wallace’s back, he reported that Wallace could flex to touch her ankles, had good strength, normal sensation and negative sitting straight leg raising. Dr. Alvine recommended that Wallace continue therapy and stay off work for a few weeks. He also asked her to return for another examination in two months in light of her pregnancy. A physician’s assistant at Dr. AÍ-vine’s office signed a release from work for Wallace for four weeks dated April 29, 2002.

On June 19, 2002, Wallace told Met Life in a telephone conference that her finger was fine, but her back was keeping her out on disability. As a result of a walk-up referral with a nurse consultant, the Met-Life claims handler sought updated information from Dr. Alvine and Wallace’s physical therapist. On that same day, Met Life received Dr. Alvine’s Physical Capacities Evaluation dated June 3, 2002, wherein he described Wallace as having sitting limitations of two hours per day with frequent alteration of positions. Also on June 19, 2002, Met Life received Wallace’s personnel profile evaluation wherein Wallace stated that her job as a Customer Service Representative required her to be “confined to a desk;” that she cannot return to work at this time because sitting aggravates her back too much; that she can no longer “run, lift weights, [or do] intense cardio;” that she needs her workstation to be ergonomically correct; that she is able to do laundry and wash dishes and walks 15-20 minutes daily when possible; that bending and twisting is very painful; and that she was not interested in working with someone from Met Life to assist her with returning to work. On July 1, 2002, MetLife’s nurse consultant recommended that Wallace’s STD benefits be bridged into LTD benefits through June 30, 2002.

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Bluebook (online)
332 F. Supp. 2d 1280, 2004 U.S. Dist. LEXIS 16826, 2004 WL 1900648, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wallace-v-metropolitan-life-insurance-sdd-2004.