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Seeman v. Metropolitan Life Insurance Co.

United States District Court, D. Delaware

July 9, 2018

TERESA A. SEEMAN, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

          MEMORANDUM

         I. INTRODUCTION

         On April 19, 2012, Plaintiff Teresa A. Seeman ("Seeman") brought this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§1001 et seq against the Defendant, Metropolitan Life Insurance Company ("MetLife"), the fiduciary and administrator of the Bank of America Long Term Disability Plan (the "Plan"), seeking the payment of allegedly past-due benefits and a determination of her rights to ongoing benefits. (D.I. 1 at ¶ 14.) On July 30, 2013, the court signed a Memorandum and Order denying MetLife's previous Motion for Summary Judgment and granting Seeman's cross-motion for Summary Judgment. (D.I. 32.) In that Memorandum, the court indicated that it needed more information "about how Seeman's physical diagnoses affected her earning capacity" and remanded the case to MetLife for further proceedings consistent with the Memorandum. (D.I. 32 at 21.) On October 12, 2016, the court reopened the case and the parties filed a Joint Status Report on October 26, 2016. (D.I. 46.) Presently before the court is Seeman's Motion for Summary Judgment (D.I. 55) and MetLife's Cross-Motion for Summary Judgment. (D.I. 59.)

         II. BACKGROUND

         The court provided an overview of the case in its previous Memorandum, thus, the court will only provide the facts necessary to decide the present motions. (D.I. 32.) Seeman asks the court to hold MetLife's final claim determination finding her ineligible for continuing long term disability ("LTD") benefits was arbitrary and capricious because they did not meet their burden of proving she is not disabled, as defined by the Plan. The Plan is an employee welfare benefit plan as defined and governed by ERISA. 29 U.S.C. § 1001, et. seq. MetLife is the claim administrator for the Plan and funds the LTD benefits., From May 14, 1990 until December 4, 2007, Seeman worked for Bank of America as a Vice President, Unit Manager. (D.I. 57 at 2.) During Seeman's final year of employment, her salary was $111, 280.00 per year. Id. On June 4, 2008, MetLife began paying monthly benefits to Seeman after she was unable to return to work following diagnoses of Chronic Fatigue Syndrome ("CFS") and Fibromyalgia ("FMS"). (D.I. 1, ¶ 6); (D.I. 57 at 2.) On December 7, 2007 Seeman claimed disability from her position at Bank of America and received LTD benefits through July 16, 2010 until MetLife terminated them. (D.I. 17 at 5.) After two years of providing Seeman benefits, the definition for "disability" under the Plan changed. (D.I. 57 at 2.) Under the Plan,

"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 unless, in the opinion of the Doctor, future and continued treatment would be of no benefit; and
1. During the first 24 months, excluding your Elimination Period, you are unable to earn more than 80% of your Predictability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy; or
2. After the first 24 month period, you are able to earn more than 60% of your Index 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.

(D.I. 18 at 27-28.) Following the initial termination, Seeman appealed and the presiding Administrative Law Judge ("ALJ") concluded that Seeman's "own testimony [wa]s inconsistent with the disabling level of physical or mental impairments." (D.I. 60 at 5.) At that time, MetLife provided Seeman with the opportunity to submit additional documentation in support of her claim, which she did. (D.I. 60 at 6.) On November 1, 2012, MetLife received a copy of the second notice of an unfavorable decision from the Social Security Administration ("SSA") where the ALJ concluded:

the claimant's medically determinable impairments could reasonably be expected to cause the alleged symptom, however the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not credible to the extent they are inconsistent with the above residual functional capacity assessment. Her credibility, as regards her mental issues, is of concern to the [ALJ]. Although alleging mental issues particular[ly] involving her concentration and memory, she refuses to consider them within the mental health context because this is why her disability coverage through work was ended.

(D.I. 60 at 7); (D.I. 50-3 at 3476.) After exhausting MetLife's administrative process, Seeman initiated the present lawsuit with the court on April 19, 2012. (D.I. 1.) On July 30, 2013, the court denied MetLife's first motion for summary judgment and granted Seeman's. (D.I. 32.) The court, however, could not "conclude whether Seeman's physical diagnoses rendered her 'disabled' under the heightened post-June 3, 2010 standard" as found in the Plan and remanded the matter to MetLife "to evaluate whether Seeman remained disabled under the post-June 3, 2010, disability standard." (D.I. 32 at 20-21.) More specifically, the court stated that "more information is required about how Seeman's physical diagnoses affected her earning capacity." (D.I. 32 at 21.)

         A. Post-Remand Events

         Following the court's July 30, 2013 Memorandum and Order, MetLife hired three Independent Physician Consultants ("IPCs") to conduct a "paper review" of Seeman's medical records. (D.I. 60 at 7.)[1] The post-remand IPCs include (1) Robert S. Friedman, M.D., board certified in anesthesiology and pain management, internal medicine, and rheumatology; (2) Jennifer Rooke, M.D., board certified in occupational medicine and general preventative medicine; and (3) Randy Rummler, M.D., board certified in adult psychiatry. (D.I. 60 at 10.) These IPCs did not meet with Seeman or physically examine her at any time. (D.I. 32.)

         First, MetLife asked Dr. Friedman to consider whether Seeman was primarily disabled from CFS or FMS. (D.I. 60 at 10.) Dr. Friedman reviewed Seeman's medical records, spoke with Dr. Reinhardt and Dr. Diaz-Stanchi, and issued a report on March 4, 2015. (D.I. 60 at 10.) Dr. Friedman concluded that the "medical information provided does not support limitations due to [CFS] or [FMS]." (D.I. 60 at 10.) Dr. Friedman reasoned that "[u]nderlying psychiatric issues have significant impact on [FMS] and the perception of pain." (D.I. 60 at 10.) He also stated that he did not believe FMS is the primary issue and that as of March 3, 2011, "Dr. Snowden [a rheumatologist] believed that FMS was not associated with impairments that would prevent return to work." (D.I. 50-3 at 2743-44); (D.I. 60 at 10.)[2] Dr. Friedman, however, did not conduct any rheumatologic evaluation in his analysis and, instead, relied solely on the paper review and conversations with treating physicians. Dr. Friedman also noted that Seeman was using an elliptical machine five days a week when she was seen by Dr. Reinhardt on April 26, 2010. (D.I. 50-3 at 2743-44.) The report by Dr. Friedman was sent to Seeman's treating physicians. Dr. Diaz- Stanchi provided updated restrictions and limitations, and Dr. Reinhardt responded with a letter dated April 1, 2015, stating that he disagreed with Dr. Friedman's report and that "Dr. Diaz-Stanchi has continued to state that Seeman is unable to return to work based upon the primary diagnosis of CFS and secondary diagnosis of FMS." (D.I. 60 at 11); (D.I. 50-3 at 2744.) Dr. Friedman, however, elected not to speak to Dr. Reinhardt about FMS or CFS because he "is not a Rheumatologist." Dr. Friedman could not get back in touch with Dr. Diaz-Stanchi to discuss his updated restrictions and limitations assessment. (D.I. 50-3 at 2744.)

         Next, MetLife asked Dr. Jennifer Rooke, an Occupational Medicine IPC, to review Dr. Sheffield's files and answer (1) whether the medical information supported functional limitations (physical or psychiatric) beyond June 16, 2010; (2) to list the types of limitations; (3) to opine as to what specifically were the impairing diagnoses or conditions; and (4) to determine what side effects resulted from medications. Dr. Rooke concluded that Seeman did not have functional limitations due to any other physical condition or combination of physical conditions as of June 4, 2010. (D.I. 60 at 10.) According to the final termination letter, the Occupational Medicine IPC did not review Seeman's file for the conditions of fibromyalgia or CFS. (D.I. 50-3 at 2746.)

         Finally, Dr. Rummler was asked to consider whether Seeman "had functional limitations as a result of schitzophrenia, bipolar disorder, dementia or organic brain disease, exclusions to the 24 month L[TD][]" benefits. (D.I. 60 at 10-11.) Dr. Rummler reviewed the administrative file and called Dr. Reinhardt before concluding that there "was no evidence of psychiatric diagnosis or treatment during the relevant time period." (D.I. 60 at 11.) Seeman agreed with Dr. Rummler's conclusions, had no comments on Dr. Rooke's, and disagreed with the conclusions of Dr. Friedman. (D.I. 60 at 11.) Dr. Friedman reviewed the additional documentation, issued a second report dated April 21, 2015, affirming his original conclusions and advising that the only treating rheumatologist, Dr. Snowden, stated on July 31, 2009, that he did not believe Seeman has "any impairments related to fibromyalgia. In the absence of any subsequent Rheumatologic evaluations, it is difficult to determine what rheumatologic impairment, if any, currently exists." (D.I. 60 at 11.)

         In addition to the three IPCs, at MetLife's request, Dr. Louise Sheffield, M.D., MPH, reviewed Seemans case. She was asked to opine on whether Seeman had functional limitations as a result of her condition. (D.I. 60 at 8.) Dr. Sheffield concluded that "the medical information supports physical function limitations beyond July 16, 2010[, ]" and that Seeman's diagnosis "is fatigue associated with CFS and FMS." (D.I. 57 at 5.) Even though Dr. Sheffield did not ever meet or examine Seeman, she concluded that multiple providers agreed on the diagnosis. (D.I. 57 at 5-6.) At MetLife's request, Sheffield issued a report on January 7, 2014, in which she concluded that Seeman could:

stand occasionally, walk occasionally (less than 1 hour per day) and sit frequently . . . climb steps less than one hour per day, bend and squat occasionally, twist less than one hour per day, reach frequently, light gripping and pinching frequently; firm gripping/pinching less than one hour per day; above shoulder reaching occasionally; and wr[i]te occasionally.

(D.I. 60 at 8.)

         Around the same time, two Vocational Experts, Robert Pare and MetLife Employee Larcetta Linear, produced reports to provide insight into Seeman's background and employability. After meeting with Seeman for two hours, Pare provided MetLife with a twelve-page Employability Assessment with a detailed analysis of whether Seeman could perform her job based on her background, education, medical opinions. (D.I. 57 at 7.) He also provided a vocational history of Seeman's recent earnings. (D.I. 57 at 7.) The Pare Report explains that Seeman's job required her to be responsible for 9 managers and 201 people, and work more than forty hours per week. (D.I. 57 at 8.) Seeman's work also required that she assume physical postures that included a combination of unplanned standing, walking, and sitting. (D.I. 57 at 8.) Pare found that no physician has medically determined that Seeman was able to resume working in her usual job or occupation. (D.I. 57 at 8.)

         Lascetta Linear noted Seeman's seventeen and a half years as First Vice President/Unit Manager at Bank of America and determined that her position was comparable to that of a Manager for Credit and Collection. (D.I. 57 at 6.) Linear did not consider fatigue, loss of concentration, or other potential factors in presenting her findings. Id.

         On April 18, 2014, MetLife issued a Termination of Benefits Letter and notified Seeman that she "[did] not satisfy the definition of disability set forth in the employer's Plan." (D.I. 60 at 9); (D.I. 57 at 6); (D.I. 50-3 at 560-69.) Specifically, MetLife found that "Seeman could earn more than 60% of her pre-disability earnings in an occupation that is comparable to her own reported occupation, taking into account her training, education, and experience." (D.I. 60 at 9.) MetLife concluded Seeman has the ability to work as a manager based on her "education, training, and experience[], considering her capabilities, restrictions, and limitations." Id. at 7. However, MetLife did not consider how Seeman's physical and cognitive limitations relating to the CFS and FMS affected her ability to function or perform the tasks of a Vice President/Manager. (D.I. 57 at 7.) On June 24, 2014, Seeman advised that she intended to appeal the decision and submitted additional medical records to MetLife. Id. In a letter dated June 10, 2015, MetLife affirmed its initial claim determination. (D.I. 60 at 11); (D.I. 50-3 at 2738-47.)

         B. MetLife's Final Termination Letter

         On June 10, 2015, MetLife issued its Final Termination of Benefits Letter. (D.I. 57 at 12); (D.I. 50-3 at 2738-47.) The Letter states that Seeman (1) "has not demonstrated that she was unable to perform her own job and, therefore[, ] any gainful occupation[] as of July 16, 2010, as a result of any condition that is not a Mental or Nervous Disorder or Disease[;]" and (2) the medical information on file for Seeman's physical condition did not support her inability to perform any gainful occupation. (D.I. 50-3 at 2738); (D.I. 57 at 12.) Additionally, MetLife states in its Final Termination Letter that "[t]he medical documentation failed to support a finding of restrictions or limitations that would prevent [Seeman] from performing her own job, and therefore any gainful occupation, as of July 17, 2OIO[]" and, thus, termination of LTD benefits beyond July 16, 2010 was appropriate. (D.I. 50-3 at 2746.) MetLife relied on the statements by its three IPCs, particularly the statements of Dr. Friedman that Seeman does not suffer from CFS and FMS, and an Employability Assessment by Ms. Linear. (D.I. 60 at 18.) In its June 20, 2015 Final Termination of Benefits Letter (D.I. 50-3 at 2738-47), MetLife made the following observations regarding Seeman's medical history:

(1) MetLife reviewed the entire file, including the medical records and opinions of medical professionals who treated Seeman (D.I. 50-3 at 2746);
(2) Seeman's failed neuropsychological testing demonstrates she failed symptom validity testing ...

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