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Vonhagn v. Corning Inc.

November 25, 2008


The opinion of the court was delivered by: David G. Larimer United States District Judge


Plaintiff Margaret Vonhagn filed this action against her former employer, Corning Incorporated ("Corning") and Metropolitan Life Insurance Co., Inc., ("Metlife"), the Plan Administrator ("Administrator") of Corning's benefit program, alleging that defendants wrongfully denied her application for short term disability benefits ("STD"). Plaintiff proceeds under the provisions of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1).

Corning, Metlife and other defendants now move for summary judgment (Dkt. #13, 14), and plaintiff cross moves for summary judgment (Dkt. #22).*fn1

I. Standard of Review.

Where, as here, the terms of an ERISA Plan give its Administrator the sole and absolute authority to interpret the Plan and determine claimants' eligibility for benefits, a determination by the Administrator is subject to a deferential standard of review, which examines only whether the Administrator's decision was arbitrary or capricious. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); Darling v. DuPont deNemours & Co., 952 F.Supp. 162, 163 (W.D.N.Y. 1997). Under this standard, this Court may only overturn the final decision of the Administrator to deny benefits if it was "without reason, unsupported by substantial evidence or erroneous as a matter of law." Darling, 952 F.Supp. 162 at 165 (quoting Pagan v. Nynex Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995)). Stated differently, the focus of the reviewing court is "whether the decision was based on a consideration of the relevant factors and whether there has been a clear error of judgment." Jordan v. Retirement Committee of Rensselaer Polytechnic Inst., 46 F.3d 1264, 1271 (2d Cir. 1995).

Furthermore, with respect to the evaluation of medical evidence by a Plan Administrator, ERISA mandates only that the Plan procedures afford a reasonable opportunity for a full and fair review. See 29 U.S.C. § 1133(2). The heart of the issue now before the Court is whether plaintiff had a reasonable opportunity for full and fair review of her claimed disability. The existence of conflicting evidence, even a conflicting opinion from a claimant's treating physician, does not necessarily render the Plan Administrator's decision arbitrary and capricious. See Baker v. Broadspire National Services, Inc., 2007 U.S. Dist. LEXIS 5780 (W.D.N.Y. 2007). Furthermore, "courts have no warrant to require [ERISA Plan] administrators automatically to accord special weight to the opinions of a claimant's treating physician; nor may courts impose a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's opinion." Black & Decker Disability Plan v. Nord, 548 U.S. 822, 830-831 (2003). See also Baker, 2007 U.S. Dist. LEXIS 5780 at *16 (same).

II. Plaintiff's Claims.

At the time the disputed disability period, plaintiff was fifty years old and had worked as an accountant at Corning since September 1998. Beginning in or around November 2004, plaintiff began complaining of lower back pain. Corning responded by modifying her work station to include ergonomic accommodations, including a sit-stand desk and a coccyx-cut-out chair. Despite these accommodations, plaintiff stopped working due to low back pain on February 10, 2005.

On February 11, 2005, plaintiff contacted Metlife and initiated a claim for STD benefits.*fn2

By letter dated February 18, 2005, Metlife informed plaintiff that her claim for benefits had been denied because Metlife had been unable to obtain medical documentation to support plaintiff's claim of disabling back pain. Plaintiff's primary care physician, Dr. Michael Cilip, thereafter completed and submitted to Metlife a physician questionnaire concerning a February 10, 2005 office visit by plaintiff. Dr. Cilip opined that plaintiff was "disabled" with a primary diagnosis of "back pain" with findings of "tender low back," and noted that although plaintiff was not in any acute distress, she felt unable to continue working at her current level. Upon review of the questionnaire by a Metlife nurse consultant, Metlife informed plaintiff on February 25, 2005 that her claim had once again been denied.

Plaintiff appealed the denial and submitted additional medical records. Metlife forwarded plaintiff's complete records to an outside orthopedic surgeon, Dr. William D. Abraham, for a Network Medical Review. After reviewing the records, Dr. Abraham determined that plaintiff's subjective complaints of pain were "out of proportion" to the relevant imaging studies and objective evidence, and he believed that plaintiff failed to establish that she was unable to perform the requirements of her sedentary position at Corning. He estimated that plaintiff had the physical capacity to sit continuously for two hours, for a cumulative total of up to seven hours, and to stand for two hours, for a cumulative total of up to five hours, in an eight-hour work day.

Based upon Dr. Abraham's conclusions, Metlife informed plaintiff on July 18, 2005 that its original decision to deny her STD claim would be upheld, based upon objective evidence including her medical records, and Dr. Abraham's report. Plaintiff's subjective reports of incapacitating pain were found to be unsupported by any objective physical examination findings or testing.

I have considered the record evidence as well as the parties' submissions on the pending motions. I find that Metlife's determination was reasonable, supported by substantial evidence in the record, and was not arbitrary and capricious.

First, plaintiff claims that Metlife overlooked record evidence concerning her physical limitations and subjective complaints of pain, including Dr. Cilip's opinion that plaintiff was incapable of sitting, standing or walking for more than one hour each in an eight-hour work day. However, the evidence concerning plaintiff's reports of pain was included in the materials reviewed by Dr. Abraham, who expressly noted that he found plaintiff's complaints to be "out of proportion" and "not supported" by objective evidence in the record. Dr. Abraham also sought to consult with Dr. Cilip concerning his report of plaintiff's physical limitations, but Dr. Cilip refused to do so. Based on these facts, I cannot conclude that Dr. Abraham's determination was erroneous. See Maniatty v. UNUMProvident Corp., 218 F. Supp. 2d 500, 504 (S.D.N.Y. 2002) (it was not arbitrary and capricious for ...

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