Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Leccese v. Metropolitan Life Insurance Co.

April 12, 2007

THERESE LECCESE, PLAINTIFF,
v.
METROPOLITAN LIFE INSURANCE CO., DEFENDANT.



The opinion of the court was delivered by: Siragusa, J.

DECISION and ORDER

INTRODUCTION

This ERISA disability insurance case is before the Court for decisions on both parties' motions for summary judgment. For the reasons stated below, the Court grants defendant's application, and dismisses the case.

BACKGROUND

At the outset, the Court applies Local Rule of Civil Procedure 56.1. That rule requires that the moving party include with its motion for summary judgment a "separate, short, and concise statement of the material facts to which the moving party contends there is no genuine issue to be tried." W.D.N.Y. Loc. R. Civ. P. 56.1(a). Defendant Metropolitan Life Insurance Co. ("MetLife") has complied with this rule. (Def.'s Statement of Facts (# 16).)The rule also imposes a duty on the opposing party, in this case, the plaintiff, Therese Leccese ("Leccese"). In that regard, it states, "[t]he papers opposing a motion for summary judgment shall include a separate, short, and concise statement of the material facts as to which it is contended that there exists a genuine issue to be tried." W.D.N.Y. Loc. R. Civ. P. 56.1(b). Since Leccese has failed to comply with Rule 56.1(b), the third paragraph of the rule comes into play. It reads: "[a]ll material facts set forth in the statement required to be served by the moving party will be deemed to be admitted unless controverted by the statement required to be served by the opposing party." W.D.N.Y. Loc. R. Civ. P. 56.1(c) (emphasis added). In view of this provision, the Court deems admitted all of MetLife's statements of material fact contained in its December 18, 2006, Statement of Facts Pursuant to Local Rule 56.1 (# 16). Accordingly, the undisputed facts are as follows..

1. Leccese was an employee of Verizon Wireless and a participant in the Plan. (Compl. ¶¶ 5, 6.)

2. The Plan is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), as amended. (Compl. ¶¶ 2.)

3. The Plan is sponsored by Verizon Wireless and Metropolitan Life Insurance Company ("MetLife") is the claims administrator. (Sullivan Aff., Oct.24, 2006, attaching the administrative record (hereinafter cited as "L __."), (L. 000006).)

4. Under the terms of the Plan, "Verizon Wireless has delegated to MetLife discretionary authority as to all aspects of claims administration for the STD*fn1 portion of the Managed Disability Plan. This delegation includes the ability to render initial decisions on claims, render decisions on all appeals of denied claims, and to otherwise interpret the terms of the STD Portion of the Plan. The decision of MetLife is final and binding to the extent permitted by law." (L. 000013.)

5. On July 21, 2004, Leccese had an abdominal dermatolipectomy to remove excess abdominal skin due to weight loss. (L. 000154.)

6. In a letter dated October 8, 2004, MetLife notified Leccese that she was not eligible to receive STD benefits beyond September 14, 2004. (L. 000131-32.)

7. The letter noted that Leccese had been required to provide additional information in support of her claims by September 28, 2004, but that she had failed to do so. (L. 000131-32.)

8. The STD component of the Plan provides, in relevant part, that an employee is "disabled.when the employee is absent from work because of impairment for which there is material medical evidence that.the employee cannot perform the Essential Functions of his or her job at Verizon Wireless." (L. 000008.)

9. The Plan further provides as follows:

You and your Physician may agree that you are unable to work, but MetLife is the Claim Administrator and has discretionary authority to determine whether you are disabled and entitled to STD benefits..Your STD benefit checks may also be suspended if your Physician does not provide MetLife with continued information about your disability.

(L.000030 (emphasis is original).)

10. By letter dated October 18, 2004, MetLife informed Leccese she was not eligible for STD beyond September 14, 2004 based upon a review of the office visit notes of Leccese's doctor. (L. 000358.)

11. According to the September 14, 2004, office notes of Dr. Ralph P. Pennino, plaintiff's treating physician, Leccese's "flaps were 100% viable and the small opening at the inferior aspect of [her] wound was granulating in a very nice manner." (Id.)

12. In addition, Dr. Pennino's notes from Leccese's October 1, 2004 office visit indicated her wound was "half of what it was" ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.