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BROOKS v. NORTH AMERICAN PHILIPS CORP.

March 7, 2001

MICHAEL BROOKS, PLAINTIFF,
v.
NORTH AMERICAN PHILIPS CORPORATION, METROPOLITAN LIFE INSURANCE COMPANY, DEFENDANTS.



The opinion of the court was delivered by: David G. Larimer, Chief District Judge

DECISION AND ORDER

FACTUAL BACKGROUND

Plaintiff began working for Philips in 1983. Plaintiff worked in several capacities over the years, and was employed as a parts assembler and welder in April 1986, when he injured his back at work. In 1987, plaintiff applied for and began receiving long term disability ("LTD") benefits under the Plan. The Summary Plan Description ("SPD") for the Plan in effect at the time that plaintiff applied for benefits states that a Plan participant will be eligible for benefits when he suffers from a "total disability," which the SPD defines as follows:

"Total disability" as used in this Plan means inability, because of an injury or sickness, to engage in any gainful occupation for which you are reasonably fitted by education, training or experience. However, for the first twelve months of your absence due to disability, you will be considered totally disabled if you are unable, because of illness or injury, to perform any and every duty of your occupation. In addition, you must be under the care of a physician for any required treatment of your disability.

Declaration of Hope A. Webber (Docket Item 17) Ex. A at 10. The SPD also states that no benefits will be paid "after the date you fail to furnish satisfactory proof, as required by the insurance company, of the continuance of total disability." Id. at 4.

After it began paying benefits to plaintiff, MetLife would periodically review his claim to determine if plaintiff's condition continued to meet the definition of "total disability." In January 1997, MetLife arranged for plaintiff to be examined by Robert Siliciano, M.D., an orthopedic surgeon. In his report, Dr. Siliciano opined that plaintiff "could tolerate an occupation which would allow him to change positions from sitting, standing and walking periodically. He should also refrain from doing repetitive bending or lifting more than 10 lbs." Record at 18.*fn1

MetLife forwarded Dr. Siliciano's report to Dr. Manola Basa, plaintiff's treating physician, and invited him to respond with any comments or additional documentation. Record at 295. MetLife alleges, and plaintiff does not dispute, that MetLife received no response.

MetLife then solicited a labor market survey from Stickney Rehabilitation Services, Inc. ("Stickney"), which submitted a report on March 17, 1997, listing eleven jobs within fifty miles of plaintiff's home that, according to Stickney, were within plaintiff's work experience and physical restrictions. Record at 291.

Plaintiff then agreed to participate in job placement. To that end, MetLife retained CRA Managed Care, Inc. ("CRA"), which in a report dated April 24, 1997, described plaintiff as "not financially motivated to return to work." Record at 15. A final report dated June 4, 1997 indicated that plaintiff showed little or no interest in finding a job, and that "further vocational assistance would not be indicated." Record at 14.

Also in June 1997, MetLife sent plaintiff a letter advising him that "it has not been established that you continue to be totally disabled as defined in Philip's [sic] LTD Plan. It appears that you are able to perform some type of remunerative work. We must therefore advise you that your claim for LTD benefits is being terminated effective July, 1, [sic] 1997." Record at 272.

Plaintiff then sought review of MetLife's decision to discontinue his benefits. In the course of that review, MetLife accepted additional medical documentation from plaintiff, and sent his entire file to Network Medical Review Co. ("NMR"). In a report dated June 16, 1998, Dr. Robert Petrie of NMR opined that plaintiff was "capable of performing job duties within the parameters listed," which included some relatively moderate physical restrictions on lifting, carrying, etc. Record at 11.

On June 23, 1998, MetLife forwarded Dr. Petrie's report to Dr. Basa, plaintiff's treating physician, stating, "[i]f you are in agreement [with Dr. Petrie's findings], please sign, date and return this notice to our attention." Dr. Basa did so on June 24, 1998. Record at 190.

Plaintiff also submitted to MetLife a report dated July 10, 1998, prepared by Dr. Robert Tiso of Office of Pain Management. Dr. Tiso did not render an opinion as to whether plaintiff could work, but described plaintiff's medical history and physical condition, and stated that Dr. Tiso's "impression [wa]s that of Post laminectomy pain syndrome with a severe reactive depression." Record at 184.

MetLife forwarded Dr. Tiso's report to Dr. Petrie, who stated that "[a]fter reviewing the additional information, the previous opinion is unchanged. Mr. Brooks has mild residual symptoms and deficits. . . . It remains my opinion that he is capable of working within the parameters indicated in the report dated June 16, 1998." Record at 7.

Based on these reports, MetLife upheld its prior determination to discontinue plaintiff's benefits.

Plaintiff commenced the present action in January 1999. He alleges that he remains totally disabled and that defendants' determination that he is not disabled is arbitrary and capricious, and a breach of their fiduciary duty. The first cause of action seeks benefits pursuant to 29 U.S.C. § 1132(a)(1)(B). The second cause of action seeks a declaration that plaintiff is entitled to benefits, and the third cause of action requests an award of attorney's fees under 29 U.S.C. § 1132(g)(1). The fourth cause of action appears to assert claims under both ERISA and New York law. It alleges that defendants' discontinuation of plaintiff's benefits constituted a breach of their fiduciary duty and their implied covenant of good faith and fair dealing, and that it was capricious, arbitrary and ...


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