307 F.Supp.2d 301 (2004) | Cited 0 times | D. Massachusetts | March 9, 2004



The plaintiff, Wanda Ivy ("Ivy"), brought this action against RaytheonDisability Trust (the "Trust"), Raytheon Company ("Raytheon"), andMetropolitan Life Insurance Company ("MetLife") for reinstatement of herlong term disability benefits pursuant to the Employee Retirement IncomeSecurity Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). After hearing oralargument on January 13, 2004, the Court entered an order allowing theDefendant's Motion for Summary Judgment [Doc. No. 11]. SeeOrder of 1/14/04 [Doc. No. 22]. This memorandum sets for the analysisthat led to that order.Page 2


The undisputed facts of Ivy's employment, medical condition, andtreatment are taken from MetLife's claim file. Defs.' Ex. B [Doc. No.15].

A. Ivy's Employment History with Raytheon

Ivy began working for Raytheon on February 14, 1977. Id. at216. She was last employed as "Materials Handler C," with somewhatambiguous duties. Id. Ivy stated that she "works in shippingand receiving and does a lot of lifting sometimes up to 80-90 pounds."Id. at 86. She described herself as a "shipper" on an insuranceform and reported to her treating physician that she was involved in "boxshipping, lifting packages, load[ing] and unload[ing] trucks, singlelifting thirty to forty pounds." Id. at 40, 164. In theirrespective treatment notes, Ivy's therapist reported that she was afork-lift operator, id. at 53, but her psychiatrist noted thatshe worked at a desk job immediately prior to leaving Raytheon.Id. at 31.

Ivy stopped working on July 28, 2000 due to bursitis and an injury inher left shoulder. Id. at 113, 216. Shortly thereafter, shebegan to complain of debilitating anxiety concerning alleged maritalproblems.1 Her psychological problemsPage 3prevented her from returning to work after her physical impairmentsimproved.

B. Raytheon's Long Term Disability Plan

While employed by Raytheon, Ivy participated in the company's long termdisability benefits plan (the "Plan"). The Plan provides benefits tocovered employees who meet the defined requirements for being fullydisabled2 for eighteen months or totally disabled3 thereafter.Defs.' Ex. A [Doc. No. 15] ¶¶ 1.2, 2.19, 2.22, 5.1. The Plan receivesits funding exclusively from employees who choose to participate.Id. ¶ 1.2.

MetLife, the Claims Administrator, has a fiduciary duty to restrictPlan benefits to employees who meet the established eligibility criteria.Id. ¶¶ 2.5, 7.3. Furthermore, the Plan grants MetLife "fulldiscretion[] to interpret the Plan with respect to claims for Benefits;to determine whether a claimantPage 4is eligible for Benefits; and to resolve any other matter relatedto claims under the Plan (including appeals of denied claims)."Id. ¶ 8.5 (emphasis added).

C. Ivy's Medical Condition

While Ivy's initial disability was based on a physical injury, herclaim for long term disability is based exclusively on psychological andemotional impairments. She sought treatment from a physician,psychologist, psychiatrist, and therapist. The medical and psychiatricrecords provided by these treating doctors were reviewed by twoindependent physicians employed by MetLife.

Ivy's treating physician, Theresa Chang, M.D. ("Dr. Chang"), noted onOctober 20, 2000 that Ivy had developed an anxiety disorder and wasdisabled. Defs.' Ex. B at 184. Eight months later, Dr. Chang stated thatIvy "remains disabled at this time" but provided no further details as tothe severity or extent of Ivy's impairments. Id. at 69.

Ivy's psychologist, Paul Jansen, Ph.D. ("Dr. Jansen"), diagnosed herwith generalized anxiety on August 23, 2000. Id. at 179. Heamended his diagnosis to major depression in November, 2002.Id. at 62. He consistently opined that Ivy's attention andconcentration were impaired and that she could not return to workoperating a fork-lift. Id. at 59, 60. He noted, however, thatshe was capable of carrying out routine dailyPage 5activities such as taking care of her children and running errandsand that she might be able to return to less demanding work.Id. He stated: Ms. Ivy's disability falls within some very specific parameters. For example, a problem with attention or concentration would be dangerously disabling to an air-traffic controller, but might have a minimal impact on a person who stocks supermarket shelves. . . . Ivy's . . . inability to focus/concentrate clearly put her and her co-workers at risk for significant injury. . . . [S]he was and continues to be functionally disabled.Id. at 60 (emphasis in original).

Ivy was also treated by psychiatrist Burns Woodward, M.D. ("Dr.Woodward"), who diagnosed her with major depression with psychoticfeatures. Id. at 157. Dr. Woodward's treatment notes mentionthat Ivy exhibited features of depression including excessive crying,sleep problems, lack of energy, and poor concentration but that she coulddo chores, run errands, take care of her three children, and performother activities of daily living. Id. at 93-99. He noted thathe was unable to evaluate Ivy's work capacity, Id. at 96, andthat she was "disabled from her current job but not from any job."Id. at 97. In a discussion with Dr. Jansen, Dr. Woodwardagreed that Ivy was "not making much progress." Id.at 25. Dr. Woodward consistently noted that while Ivy suffered fromsymptoms of depression, medication was unlikely to very beneficialbecause she was "stuck" in an unhappy marital situation.Id. at 97-99.Page 6In 2002, Ivy saw a therapist, Marcia Drootin, R.N., M.S., C.S.,who stated that Ivy was not improving and her prognosis wasuncertain. Id. at 37.

To assist it in evaluating Ivy's claim, MetLife submitted her entirefile to two independent medical consultants for review. Leonard Kessler,M.D. ("Dr. Kessler"), a physician board certified in psychiatry andneurology, reviewed Ivy's file four times. He reviewed treatment notesfrom Drs. Jansen and Woodward and conducted teleconferences with bothdoctors. In a report dated December 27, 2000, Dr. Kessler summarized thefindings of Drs. Jansen and Woodward and noted that Ivy was "verydepressed, preoccupied to the point of being delusional, and impaired inher daily activities. . . . It would be expected that, with comprehensivetreatment, the duration of this impairment would be about a month."Id. at 154. On March 15, 2001, Dr. Kessler reported that therewere no objective formal mental status examinations to support Ivy'ssubjective complaints of impaired attention and concentration.Id. at 127. Dr. Kessler's final report dated May 2, 2002 notedthat during the previous year, Ivy had not exhibited psychotic symptomsor taken neuroleptic medications, had seen her psychologist andpsychiatrist each only once a month, and had exhibited merely "SOMEdepressive symptoms." Id. at 88-89 (emphasis in original). Heconcluded that "[t]here is no objective medical documentation to showsignificant functional limitations. . . . This does not supportPage 7the presence of a severe and sustained psychiatric disorderresulting in marked functional limitation." Id. at 89. Ivy'sfile was also reviewed on December 26, 2002 by Mark Schroeder, M.D. ("Dr.Schroeder"), a physician board certified in neurology and psychiatry. Dr.Schroeder concluded that Ivy's file did not contain evidence thatdemonstrated the existence of a "severe global objective psychiatricimpairment sufficient to preclude [Ivy] from performing the essentialduties of her own occupation as a Materials Handler." Id.at 17. He noted that Dr. Woodward's records did not address howIvy's preoccupation with her marital problems would affect her ability toperform the essential obligations of her job. Id.Dr. Schroeder also determined that Dr. Jansen did not provideobjective evidence of Ivy's attention or concentration deficits and thathis notes document "primarily self-reported symptoms of emotionaldistress, and describe primarily family stresses and conflicts."Id.

D. Termination of Ivy's Benefits

MetLife initially approved Ivy's short term disability benefits for theperiod August 2, through October 31, 2000. Id. at 64. At theconclusion of this period, Ivy's condition satisfied the Plan'sdefinition of "full disability" and on November 1, 2000, she began toreceive long term disability benefits. Id. Shortly thereafter,MetLife concluded that Ivy's condition had improved and terminated herbenefits on March 15,Page 82001. Id. at 64-67. In a letter to Ivy informing her ofthe termination, MetLife commented on the "lack [of] informationregarding treatment at the level of intensity indicative of a severepsychiatric disorder preclusive of work ability." Id. Ivyappealed MetLife's decision to terminate her benefits but her appeal wasunsuccessful. Id. at 10-12.


A. Standard of Review

Under ERISA, the standard of review applied to determinations ofbenefits eligibility depends on whether the claim administrator orfiduciary is vested with discretionary authority. Firestone Tire& Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). Absentdiscretionary authority, the determination is reviewed de novo.Id. Where the claim administrator has been granted discretion,however, the determination is reviewed under a more deferential"arbitrary, capricious, or an abuse of discretion" standard. Doylev. Paul Revere Life Ins., 144 F.3d 181, 183 (1st Cir. 1998) (quotingDiaz v. Seafarers Int'l Union, 13 F.3d 454, 456 (1st Cir.1994); see Sullivan v. Raytheon Co., 262 F.3d 41, 50 (1st Cir.2001) (applying the arbitrary and capricious standard to benefitsdeterminations made by MetLife under the Plan at issue here); Vlassv. Raytheon Employees Disability Trust, 244 F.3d 27, 29-30 (1st Cir.2001) (same).Page 9

Under an arbitrary and capricious standard, "the administrator'sdecision will be upheld if it was within the administrator's authority,reasoned, and `supported by substantial evidence in the record.'"Sullivan, 262 F.3d at 50 (quoting Doyle, 144 F.3d at184). Evidence is "substantial" if it is "reasonably sufficient tosupport a conclusion." Id. at 51. The claim administrator, andnot the Court, has responsibility to weigh conflicting evidence.Vlass, 244 F.3d at 32; see also Guarino v. MetropolitanLife Ins. Co., 915 F. Supp. 435, 445 (D. Mass. 1995) (Woodlock, J.).Accordingly, the question before the Court "is not which side [the Court]believe[s] is right, but whether the insurer had substantial evidentiarygrounds for a reasonable decision in its favor." Matias-Correa v.Pfizer, Inc., 345 F.3d 7, 12 (1st Cir. 2003) (quoting Brighamv. Sun Life of Canada, 317 F.3d 72, 85 (1st Cir. 2003)).

B. Summary Judgment Standard

There is arguably some tension between the arbitrary and capriciousstandard used in reviewing ERISA benefits determinations and the summaryjudgment standard, which requires the court to draw all inferences infavor of the non-moving party. See Leahy v. Raytheon Co.,315 F.3d 11, 17 (1st Cir. 2002). The First Circuit has clarified the Court'srole in applying these standards:Page 10

This respectful [arbitrary and capricious] standard requires deference to the findings of the plan administrator, and, thus, even under Fed.R.Civ.P. 56, does not permit a district court independently to weigh the proof. Rather, the district court must ask whether the aggregate evidence, viewed in the light most favorable to the non-moving party, could support a rational determination that the plan administrator acted arbitrarily in denying the claim for benefits.Id. at 18.

C. Review of MetLife's Determination

Ivy argues that MetLife's decision to discontinue her long termdisability benefits after March 15, 2001 was arbitrary and capricious inthat MetLife disregarded the prognoses of Ivy's treating doctors andrelied exclusively on the conclusions of independent medical consultants.Compl. [Doc. No. 1] ¶ 13. She contends that the conclusions of Drs.Kessler and Schroeder are not supported by any corroborating evidence anddirectly contradict the findings of her treating doctors. Id.She also contends that she was never informed of MetLife's desire forobjective medical evidence.

Ivy's argument that the opinions of her treating doctors must be givenmore weight than the conclusions of the reviewing physicians cannotstand. The Supreme Court has held that under ERISA, employee benefitsplan administrators "are not obliged to accord special deference to theopinion of treating physicians." Black and Decker Disability Plan v.Nord, 538 U.S. 822, 123 S.Ct. 1965, 1966 (2003). Even in the faceof conflicting medicalPage 11evidence, it is reasonable for the claim administrator to rely onthe conclusions of independent medical consultants rather thanconclusions of treating physicians. See Matias-Correa, 345 F.3dat 12; Lopes v. Metropolitan Life Ins. Co., 332 F.3d 1, 5-6(1st Cir. 2003) (upholding an administrator's reliance on a non-examiningphysician's report even though a treating physician had statedthat the claimant was totally disabled); Vlass, 244 F.3d at30-32 (finding a termination of benefits reasonable notwithstandingconflicting evidence provided by the treating physicians, reviewingphysicians, and vocational assessor). That MetLife based its decision toterminate Ivy's benefits on the reports of reviewing physicians and didnot accord more weight to her treating physicians and therapists is not,by itself, unreasonable.

Ivy relies on Cook v. Liberty Life Assurance Co., 320 F.3d 11(1st Cir. 2003), for the proposition that the conclusions of a claimant'streating doctors cannot be rejected. Cook, however, is distinguishable.In Cook, the claimant's benefits were terminated after her physicianfilled out an insurance form and mistakenly noted that the claimant couldwork full-time. Id. at 15-16. The First Circuit concluded thatthe administrator exaggerated the significance of the mistaken report andimproperly denied benefits. Id. at 17. In Ivy's case, whilePage 12there was a miscommunication between Drs. Jansen and Kessler,4the mistake was acknowledged by Dr. Kessler in a later report and did notresult in a different conclusion.

Conrad v. Reliance Standard Life Insurance Co., 292 F. Supp.2d 233(D. Mass. 2003) (O'Toole, J.), is also distinguishable. InConrad, Judge O'Toole held that the plan administrator actedarbitrarily and capriciously by relying on the report of an independentmedical consultant rather than the claimant's treating physicians.Id. at 237-38. The reviewing physician, who based his reportson the claimant's medical records, omitted facts favorable to theclaimant and emphasized unfavorable comments. Id. at 238. JudgeO'Toole reasoned that "[a]1though it would certainly be permissible for areviewer . . . to summarize and condense the findings of other doctors,it was incumbent on him to do so in an even-handed and fair-mindedmanner, and it is clear that he did not." Id. Again, thesefacts are not analogous to Ivy's present claim. Drs. Kessler andSchroeder accurately represented the findings of Drs. Jansen andPage 13Woodward. Specifically, Drs. Kessler and Schroeder documented notonly that Ivy had reported serious psychological and emotional problems,but also that she was able to perform activities of daily living andmight be capable of returning to work at a job that did not requireheightened vigilance. Based on their review of this evidence, theconsultants were simply unconvinced that Ivy's subjective complaints wereevidence of a severe global psychiatric disorder that would preclude herfrom performing her job.

Finally, given the nature of Ivy's impairments, it was reasonable forMetLife to request objective evidence documenting her functionallimitations. The instant case is distinguishable from Cook, in which theFirst Circuit held that it was unreasonable for the plan administrator toexpect the employee to provide objective medical evidence to document andsupport a diagnosis of chronic fatigue syndrome because there were nolaboratory tests to confirm the diagnosis. 320 F.3d at 21. Unlike themedical impairment at issue in Cook, there are accepted mental statusexaminations that could have provided objective evidence to support Ivy'sclaim. See, e.g., Conner v. Apfel, 1999 WL 495646, *1 (N.D.Ill., June 28, 1999) (listing the Zung Depression and Anxiety Scalesamong the tests administered during a mental status examination of aSocial Security claimant); Wiggins v. Apfel, 29 F. Supp.2d 486,489 n.1 (N.D.Page 14III. 1998) (listing seven tests administered to determine themental status of a Social Security claimant).

Moreover, Ivy's argument that she was never informed of the need forsuch objective evidence is unconvincing. When Ivy's benefits were firstterminated, MetLife informed her that she had failed to submit objectiveevidence of her functional limitations. Defs.' Ex. B at 66-67. She didnot submit any objective evidence to MetLife or to this Court inconnection with her appeal.


Because MetLife's benefits determination was not arbitrary andcapricious, the Defendants' Motion for Summary Judgment [Doc. No. 11] wasALLOWED.

1. The exact onset of Ivy's psychological problems is unclear. Shefirst saw a psychologist on August 23, 2000. Defs.' Ex. B at 180. A notefrom her treating physician dated August 24, 2000, however, refers onlyto her physical injuries. Id. at 198. A second note from herphysician, dated October 20, 2000, states that Ivy developed an anxietydisorder at the same time that she was being treated for her physicalinjuries. Id. at 184.

2. A plan participant is "fully disabled" if "because of a sicknessor injury which is not covered by an applicable workers' compensationstatute, a Participant: (i) cannot perform the essential elements andsubstantially all of the duties of his or her job with the Employer evenwith a reasonable accommodation; and (ii) is under the care of a Doctor."Defs.' Ex. A ¶ 2.11.

3. A plan participant is "totally disabled" if "because of sicknessor an injury which is not covered by an applicable workers' compensationstatute: (A) a Participant cannot do the essential elements andsubstantially all of the duties of his or her job with the Employer evenwith reasonable accommodations; and (B) cannot do any other job for whichhe or she is fit by education, training, or experience." Defs.' Ex. A 12.23.

4. Dr. Kessler's consultant report of December 11, 2000 misquotedDr. Jansen by stating that Dr. Jansen found "no impairments in memoryattention or concentration." Defs.' Ex. B at 104. Dr. Jansen correctedthis mistake in a February 20, 2001 letter to MetLife, acknowledging that"an important miscommunication occurred. . . .[T]he essence of Ms. Ivy'sfunctional disability is in the area of impaired attention andconcentration." Id. at 60 (emphasis in original). Dr. Kessleracknowledged the mistake in his consultant report of March 15, 2001 butnoted that Dr. Jansen did not provide any objective evidence offunctional limitations in the areas of attention and concentration.Id. at 100.

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