Wright v. Metropolitan Life Insurance

618 F. Supp. 2d 43, 2009 U.S. Dist. LEXIS 66297
CourtDistrict Court, District of Columbia
DecidedMay 26, 2009
DocketCivil Action 07-1808 (RBW)
StatusPublished
Cited by12 cases

This text of 618 F. Supp. 2d 43 (Wright v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wright v. Metropolitan Life Insurance, 618 F. Supp. 2d 43, 2009 U.S. Dist. LEXIS 66297 (D.D.C. 2009).

Opinion

MEMORANDUM OPINION

WALTON, District Judge.

The plaintiff, Peter Wright, brings this action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1132(a)(1)(B), (a)(3)(2006), against defendants Metropolitan Life Insurance Company, doing business as Met-Life Disability (“MetLife”), and Bearing-Point Inc. (“BearingPoint”) Long Term Disability Plan (“Plan”), 1 alleging that the defendants violated the ERISA by breaching the fiduciary duty they owed him under § 1132(a)(3) and wrongfully denying him benefit coverage under § 1132(a)(1)(B) when they terminated his long-term disability benefits following his receipt of those benefits for approximately thirty months. See generally Complaint (“Compl.”). The plaintiff also alleges that MetLife did not properly provide to him upon his request documents relevant to his ERISA claim, which he contends is a violation of 29 C.F.R. § 2560.502-l(g)(2008). 2 Compl. ¶ 24. In response, the defendants maintain that they acted in accordance with the express terms of the Plan when they made the decision to terminate the plaintiffs benefits after his receipt of over twenty-four months of benefits, and that defendant MetLife provided the plaintiff all documents he was entitled to receive under the ERISA. See Defendants’ Joint Answer (“Answer”) at 4-7. Currently before the Court are the parties’ cross-motions for summary judgment. Defendants’ Motion for Summary Judgment (“Defs.’ Mot.”); Plaintiffs Cross Motion for Summary Judgment (“Pl.’s Mot.”). 3 Upon eon *46 sideration of the parties’ written submissions and the administrative record in this case, and for the reasons set forth below, the Court must grant summary judgment to the defendants.

I. BACKGROUND

A. The Terms of the Plan

At all times relevant to this litigation, BearingPoint sponsored an insurance package for its employees as a benefit of their employment 4 — the defendant Plan— the only component of the package pertinent to this action being the provision for long-term disability coverage. Compl. ¶ 7; Answer ¶ 7. See generally Defs.’ Mem. at 17, Ex. A at ML00069 (Your [Bearing-Point] Employee Benefit Plan ... [,] Long Term Disability Benefits (“Long-Term Disability Benefits Plan”)). The Plan provides that BearingPoint, as the employer, is the Plan administrator. Defs.’ Mem. at 17, Ex. A at ML00099 (Long-Term Disability Benefits Plan). The Plan also provides that MetLife serves a dual role, both as the insurer of the policy and as the processor of claims for benefits under the policy. Id. at ML00099-100. Specifically, the Plan details a process by which a participant seeking long-term disability benefits must submit evidence of a qualified disability to MetLife in order to establish entitlement to monthly benefits. Id. at ML00079-80, ML00099-100.

Under the Plan, monthly long-term disability benefits were only awardable if a participant had a qualifying disability, which requires that the participant be

unable to perform the material and substantial duties of [a participant’s] Own Occupation, [be] under the regular care of a Doctor and [be unable to] work[] at any job for wage or profit, unless in an approved Rehabilitation Program; [and]
2. after the first 36 month period, [the participant is] unable to perform any job for which [the participant is] qualified or for which [the participant] may become reasonably qualified taking into account [the participant’s] training, education or experience[.]

Id. at ML00081. The Plan states that monthly benefits can be terminated for various reasons, including “the end of the period specified in the Limitation for Disabilities Due to Particular Conditions,” id. at ML00080, and it expressly includes a twenty-four month limitation period for *47 the receipt of benefits for certain disabilities, with exceptions. Regarding the plaintiffs challenge to the termination of his benefits, the only relevant provision of the Plan states that the receipt of benefits arising from a “[njeuromusculoskeletal and soft tissue disorder including, but not limited to, any disease or disorder of the spine or extremities and their surrounding soft tissue[,j including sprains and strains of joints and adjacent muscles, [are limited to twenty-four months] unless the Disability has objective evidence of ... seropositive arthritis.” Id. at ML00088. Rheumatoid arthritis is an example of a neuromusculoskeletal and soft tissue disorder, which can be classified as either seronegative or seropositive. 5 Defs.’ Mem. at 6; Pl.’s Mem. at 12. Therefore, under the provisions of the Plan applicable to this case, a person with rheumatoid arthritis can receive coverage for only twenty-four months for claims arising from a neuromusculoskeletal and soft tissue disorder, unless the participant can prove that the condition is seropositive, which is an exception to the coverage limitation. Defs.’ Mem., Ex. A at ML0008788 (Long-Term Disability Benefits Plan). The Plan defines “Seropositive Arthritis” as “[a]n inflammatory disease of the joints supported by clinical findings of arthritis plus positive serological tests for connective tissue disease.” Id. at ML00088.

With respect to MetLife’s dual role under the Plan as both the insurer and claims processor, id. at ML00099-100, the Plan delegates this authority to MetLife in two separate provisions, id. at ML00071, ML00101. The first provision, titled “Certificate of Insurance,” states: “MetLife in its discretion has authority to interpret the terms, conditions, and provisions of the entire contract. This includes the Group Policy, Certificate and any Amendments.” Id. at ML00071. The second provision, contained within a subsection under the heading “Claims Information,” states:

Discretionary Authority of Plan Administrator and Other Plan Fiduciaries
In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force *48 and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

Id. at ML00100-01.

B. The Plaintiffs Disability

The plaintiff, an employee of Bearing-Point, is a participant in the Plan. Compl. ¶ 6; Answer ¶ 6; Defs.’ Mem. at

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Nytes v. Trustify, Inc.
District of Columbia, 2018
Nytes v. Trustify, Inc.
297 F. Supp. 3d 191 (D.C. Circuit, 2018)
United States v. Bos. Heart Diagnostics Corp.
296 F. Supp. 3d 155 (D.C. Circuit, 2017)
Lewis v. Pension Benefit Guaranty Corporation
197 F. Supp. 3d 16 (District of Columbia, 2016)
Brown v. Hartford Life & Accident Insurance
12 F. Supp. 3d 88 (District of Columbia, 2014)
Zalduondo v. Aetna Life Insurance
941 F. Supp. 2d 125 (District of Columbia, 2013)
Clark v. Feder Semo and Bard, P.C.
District of Columbia, 2011
Clark v. Feder, Semo & Bard, P.C.
808 F. Supp. 2d 219 (District of Columbia, 2011)
Pettaway v. Teachers Insurance & Annuity Ass'n of America
699 F. Supp. 2d 185 (District of Columbia, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
618 F. Supp. 2d 43, 2009 U.S. Dist. LEXIS 66297, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wright-v-metropolitan-life-insurance-dcd-2009.