Williams v. Metropolitan Life Insurance

609 F.3d 622, 49 Employee Benefits Cas. (BNA) 1632, 2010 U.S. App. LEXIS 13328, 2010 WL 2599676
CourtCourt of Appeals for the Fourth Circuit
DecidedJune 30, 2010
Docket09-1025, 09-1568
StatusPublished
Cited by144 cases

This text of 609 F.3d 622 (Williams v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Williams v. Metropolitan Life Insurance, 609 F.3d 622, 49 Employee Benefits Cas. (BNA) 1632, 2010 U.S. App. LEXIS 13328, 2010 WL 2599676 (4th Cir. 2010).

Opinion

Affirmed by published opinion. Judge KEENAN wrote the opinion, in which Judge DUNCAN and Senior Judge ALARCÓN joined.

OPINION

KEENAN, Circuit Judge:

In this consolidated appeal, we consider whether the district court erred in holding that an administrator of an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461, abused its discretion when the administrator terminated the plaintiffs long-term disability benefits. We also consider whether the district court abused its discretion by awarding attorneys’ fees to the plaintiff. For the reasons stated below, we affirm.

I.

Plaintiff-Appellee Gloria Williams was employed by Cingular Wireless as a customer services clerk from September 2000 until the middle of 2003. In this capacity, Williams’ daily responsibilities consisted primarily of speaking with customers on the telephone and typing data into a computer. Williams enrolled in Cingular’s insurance plan (the plan), which was issued by Defendanb-Appellant Metropolitan Life Insurance Company (MetLife). The plan includes both short-term disability benefits and long-term disability benefits. Met-Life, as the claims administrator, serves in the dual role of evaluating benefit claims and paying approved claims. The terms of the plan grant MetLife the discretionary authority to interpret the plan and to determine benefit eligibility.

In the middle of the 1990s, Williams began suffering from medical issues with her hands and wrists, and was diagnosed with “trigger finger” disorder, 1 tendinitis, and carpal tunnel syndrome. Williams has had nine medical procedures to treat these conditions, including six operations to treat her trigger finger disorder, one operation *627 to remove infected tissue resulting from the surgeries to relieve her trigger finger condition, and two procedures to address her carpal tunnel syndrome. According to Williams and her treating physicians, these conditions made it very difficult for Williams to use her hands without experiencing severe pain for work activities such as typing on a computer.

In April 2003, Williams left work due to these conditions and filed a claim with MetLife for short-term disability benefits. MetLife approved short-term disability benefits for a five-week period but then terminated those benefits, at which point Williams returned to work. About this time, Williams also was being treated for neck and back pain.

After returning to her job, Williams worked for about one week before leaving work again. MetLife renewed Williams’ short-term disability benefits after her doctor advised her to “avoid repetitive[] computer work and hand use.” Williams’ short-term disability benefits lapsed in September 2003, after one of her physicians concluded that she was able to return to her job on a reduced schedule. Williams returned to her job for one day, and worked for about four hours before stopping because she was unable to perform her job duties without severe pain.

After leaving work, Williams again applied for short-term disability benefits. MetLife approved short-term disability benefits for Williams through October 30, 2003, which was the maximum period allowable for those benefits under the plan. MetLife then referred Williams’ claim for consideration for long-term disability benefits. MetLife approved long-term disability benefits for Williams in December 2003.

For about the next 18 months, Williams continued to experience neck, back, and hand pain. During this period, MetLife periodically requested and reviewed Williams’ medical records, informing her in February and March of 2005 that her long-term disability benefits would continue.

In August 2005, MetLife terminated Williams’ long-term disability benefits. MetLife sent Williams a letter explaining that it was terminating her long-term disability benefits “because medical documents do not substantiate [her] inability to perform [her] customary occupation.” In support of its decision, MetLife appeared to rely on a report from Dr. Carl L. Smith, one of Williams’ treating physicians, reflecting Williams’ April 1, 2005 visit with Dr. Smith. Dr. Smith’s report related Williams’ statements that she was having “good and bad days,” and that her pain averaged a three on a ten-point scale. Dr. Smith’s report did not specifically address Williams’ hand and wrist pain, nor did the report conclude that Williams was able to return to work.

After MetLife’s termination of her long-term disability benefits in August 2005, Williams exercised her appeal rights under the plan in September 2005 and submitted additional medical evaluations in support of her appeal. MetLife referred Williams’ file to Dr. John D. Thomas II, an independent Certified Disability Evaluator and board-certified physical medicine and rehabilitation specialist, and to Dr. Lee Becker, an independent physician consultant and certified psychiatry specialist.

Dr. Thomas reviewed the information in Williams’ file at the time of the initial denial of benefits, as well as updated information submitted after that denial. Dr. Thomas’ analysis focused on Williams’ medical issues with her neck and back. With regard to Williams’ medical issues with her hands and wrists, Dr. Thomas’ concluded that:

Certainly ... there is ample medical record support for inability to use the *628 hands, over time, during the 90s and again in the early 2000s, these issues appear to retreat with a 05/28/03 C-spine MRI.... It is not clear to me how these findings correlate with Ms. Williams’ complaints on exam. It does not appear that any of her providers really lined the clinical picture up well.

Dr. Thomas issued a report on September 22, 2005, agreeing with MetLife’s determination that the medical information in Williams’ file did not show that Williams was unable to work after August 9, 2005. Similarly, Dr. Becker concluded on September 19, 2005 that from a psychiatric perspective, the information in Williams’ file did not support an inability to perform her job duties after August 9, 2005.

In October 2005, after Dr. Thomas and Dr. Becker concluded that Williams’ file did not substantiate her asserted inability to function at work, MetLife upheld its decision terminating Williams’ long-term disability benefits. In its letter to Williams informing her of this decision, MetLife stated that the information in her claim file “[did] not support the existence of a totally disabling condition severe enough to keep [her] from performing [her] customary occupation as of August 9, 2005.” As evidenced by this letter, Met-Life’s review focused on the medical records relating to Williams’ neck and shoulder trouble, while failing to address in substance Williams’ well-documented problems with her hands and wrists.

Although this decision exhausted Williams’ appeal rights under the plan, MetLife received and reviewed additional medical information that Williams submitted in the months that followed. MetLife sent this additional information to Dr. Thomas, who issued a supplemental report on November 21, 2005 restating his previous conclusion. In his supplemental report, Dr.

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609 F.3d 622, 49 Employee Benefits Cas. (BNA) 1632, 2010 U.S. App. LEXIS 13328, 2010 WL 2599676, Counsel Stack Legal Research, https://law.counselstack.com/opinion/williams-v-metropolitan-life-insurance-ca4-2010.