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Gail Williams v. Metropolitan Life Insurance Company C/O

March 21, 2011


The opinion of the court was delivered by: John T. Curtin United States District Judge

This case was transferred from the docket of the Hon. Richard J. Arcara, United States District Judge, to that of the Hon. John T. Curtin, Senior United States District Judge by an order filed November 5, 2010 (Item 54). It is presently before the court on the defendants' motions for summary judgment (Items 31, 36).


Plaintiff was employed as a Customer Account Manager ("CAM") for Verizon Communications, Inc. ("Verizon") from 2000 until August 2005 (Item 44, ¶ 1). On or about August 17, 2005, she became unable to continue to perform the duties of her position due to injuries she suffered in 2002 when the trunk door of a sport utility vehicle closed on her head, knocking her to the ground. Id., ¶ 2. Plaintiff was diagnosed with cerebral concussion, post-concussion syndrome, and mild traumatic brain injury (Item 1, ¶ 10). She applied for and received 12 months of short-term disability ("STD") benefits pursuant to Verizon's employee welfare benefit plan. Id., ¶ 11. Thereafter, plaintiff applied for and received an additional 12 months of long-term disability ("LTD") benefits under the plan, through August 17, 2007 (AR 1067). Defendant Metropolitan Life Insurance Company ("MetLife") determined that she was totally disabled and, in accordance with the plan, unable to earn more than 80 percent of her pre-disability compensation at her own occupation (AR 1068).

On February 12, 2007, MetLife notified the plaintiff that it would evaluate her claim under a different standard of disability that applied after payment of 24 months of short and/or long term benefits (AR 1055). According to the plan, a person is totally disabled after the 24-month period if "due to sickness, pregnancy or accidental injury" she is receiving appropriate medical care and is "unable to earn more than 60% of [her] annual benefits compensation from any employer at any gainful occupation for which [she is] reasonably qualified, taking into account [her] training, education, experience and annual benefits compensation." Id.

MetLife forwarded plaintiff's medical records for review by two independent physician consultants. Dr. Derrick Bailey, board certified in internal medicine, stated in a report that plaintiff complained of numerous symptoms, including nausea, headaches, dizziness, phonophobia, photophobia, sleep dysfunction, irritability, difficulty reading, disequilibrium, and feelings of confusion (AR 929). Dr. Bailey also stated that plaintiff's symptoms were predominantly self-reported and that he saw no physical support for an inability of the plaintiff to return to work (AR 928). Likewise, Dr. Kevin Murphy, a licensed psychologist with a specialty in neuropsychology, stated that the medical records did "not support the presence of significant cognitive impairment" that would prevent the plaintiff from returning to work (AR 924). In a letter dated August 17, 2007, MetLife notified plaintiff that her claim for LTD benefits had been denied because she no longer met the definition of disability in the plan (AR 862). Defendant stated that the medical information plaintiff submitted did "not support a functional impairment from a medical condition or a cognitive impairment of a severity that would prevent [her] from returning to work" (AR 864).

Plaintiff appealed the denial of LTD benefits and submitted additional medical records from her health care providers. These records included a letter from one of her treating physicians, Dr. Gary Wang, in which he stated that plaintiff had an intolerance for "noise, prolonged reading or focusing and occasional anxiety/panic," and was only able to perform "part time light and sedentary work" (AR 589). Dr. Lisa Keenan, plaintiff's treating psychologist, stated in a letter that plaintiff "is unable to sustain the mental energy necessary to complete an 8-hour day" due to "visual impairment, poor attentional skills, reduced retention of information and increased irritability" (AR 591).

Following receipt of the records, MetLife requested a review by two additional independent consultants. Dr. Albert Fuchs, board certified in internal medicine, stated that plaintiff's medical records do not support any functional limitations and concluded that her "subjective reports of fatigability and difficulty with memory and concentration have not been reproduced on clinical neuropsychological testing" (AR 567). Dr. Peter Mosbach, a neuropsychologist, noted that plaintiff had undergone a vocational evaluation and scored in the 95.99th percentile on the Wonderlic Personnel test, equivalent to a score of 125 on the Wechsler Adult Intelligence Scale (AR 453). Additionally, she was able to type 31 words per minute at 99 percent accuracy and to word process paragraphs read to her (AR 552). Dr. Mosbach opined that while plaintiff "has numerous subjective complaints, . . . there is no objective evidence of functional impairments from a cognitive or psychological perspective" (AR 553).

On November 29, 2007, Dr. Keenan submitted a Mental Residual Functional Capacity Assessment completed by the Social Security Administration ("SSA") on April 2, 2007 (AR 517-534). The SSA had determined that while plaintiff could perform some work-related tasks, she could not sustain these activities "for any meaningful period of time" (AR 533). Accordingly, plaintiff was found to be disabled and was awarded disability benefits by the SSA retroactive to December 1, 2005 (AR 269). The functional assessment was reviewed by Dr. Mosbach, who found no new evidence of "objective cognitive or psychological symptoms that would support functional limitations in the ability to work full-time" (AR 497).

In a letter dated December 21, 2007, MetLife notified plaintiff that it was upholding its prior denial of LTD benefits because the medical evidence did not contain information sufficient to support a continuous impairment that would prevent her from engaging in "a sedentary occupation" (AR 494).

On February 8, 2008, plaintiff advised MetLife that she was appealing the adverse determination (AR 486). Again, MetLife requested review of plaintiff's medical records by independent consultants. Dr. Philip Marion, board certified in physical medicine and rehabilitation, opined that there was "no objective impairment" to support plaintiff's occupational restrictions and limitations (AR 416). Dr. Alexander Chervinsky, a clinical neuropsychologist, also reviewed plaintiff's records and noted that her scores on the vocational assessment from 2007 were within normal limits (AR 423). He also concluded that the records provided did not offer support for plaintiff's complaints of cognitive dysfunction (AR 423).

In a letter dated June 5, 2008, MetLife denied plaintiff's final appeal stating that, based on its review, the medical information submitted did not support functional limitations that would preclude plaintiff from performing "any occupation" beyond August 17, 2007 in accordance with the plan's definition of disability (AR 402).

Plaintiff filed the complaint in this action, pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA"), on March 27, 2009 (Item 1). She brought suit against MetLife, the issuer of the group LTD insurance policy issued to Verizon. Id., ¶¶ 5, 7. She also named Verizon Communications, Inc. as a defendant as the plan sponsor, id., ¶ 6, and the Verizon Employee Benefits Committee as the plan administrator. Plaintiff alleged that defendants failed to take into account that in order not to be considered disabled under the plan she must be able to return to work in some gainful occupation wherein she can earn greater than sixty percent of the annual compensation earned by her in her position with Verizon. As such, plaintiff contends that defendants must show that she is able to earn in excess of approximately $83,500 per year in order to find her not disabled. Item 1, ¶ 16.

The Verizon defendants filed their answer on June 1, 2009 (Item 9). MetLife filed its answer on June 5, 2009 (Item 11). On June 7, 2010, the defendants filed motions for summary judgment (Items 31, 36). Plaintiff filed a response to the motions on July 23, 2010 (Items 42-44). MetLife filed a reply on September 24, 2010 (Item 51). The court declined to hear oral argument. For the reasons that follow, the motion of the Verizon defendants is granted in part and denied in part and the motion of MetLife for summary ...

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