The opinion of the court was delivered by: Lowell A. Reed, Jr., Senior District Judge.
Now before the Court is the motion of defendant Metropolitan
Life Insurance Company for summary judgment (Document No. 13).
Upon consideration of the motion, plaintiff's response (Document
No. 15), and the memoranda and evidence submitted therewith,
pursuant to Rule 56 of the Federal Rules of Civil Procedure,
defendant's motion will be granted.
Plaintiff Alisesha Vaughn ("Vaughn") was an employee of The May
Company from 1994 to 1997, and worked as a manager for a May
Company subsidiary, Strawbridge & Clothier. In March 1997, Vaughn
fell over the base of a fixture at work and twisted her back. She
was taken to an emergency room, where she was treated and
released with a neck brace. After the accident, Vaughn
experienced back pain, muscle spasms, and a limited range of
motion in her limbs. She saw a company physician, but therapy and
treatment did not alleviate the symptoms, and attempts at
resuming a light schedule at work proved too difficult for her.
The company physician cleared Vaughn to return to work on June 4,
1997, however, her personal physician, Dr. Alan Rosenzweig,
forbade her from working. Vaughn worked her last day for the May
Company on June 4, 1997. (Appendix to Defendant's Motion for
Summary Judgment ("Appendix"), Exh. 1, Statement of Claim for
Ltd. Plan Benefits, Employer Statement, at 275-77).
In August 1997, Vaughn submitted a claim under the May
Company's Long-Term Disability Plan ("Plan"). (Appendix, Exh. 1,
Long-Term Disability Claim Submission, at 273-87). Attached to
that claim was a Physician's Statement of Disability form,
completed by Dr. Rosenzweig, which identified four diagnoses:
acute cervical strain and myofascitis; acute bilateral trapezius
myositis; acute thoracic and lumbosacral strain and myofascitis;
and acute exacerbation of fractured odontoid compression fracture
at T5, and sacral fracture. (Appendix, Exh.1, Attending
Physician's Statement, at 282). Dr. Rosenzweig concluded on the
form that Vaughn was totally disabled for her occupation and any
other. (Id. at 284). The claim was forwarded to defendant
Metropolitan Life Insurance Company ("MetLife"), which
administers the May Company's Plan. (Appendix, Exh. 1, Letter to
MetLife from the May Company, at 273).
The information submitted on Vaughn's behalf included Dr.
Rosenzweig's notes, physical therapy records, and letters from
Dr. Mark J. Reiner, an orthopedic physician to whom Vaughn had
been referred by Dr. Rosenzweig. After examining Vaughn in June
1997, Dr. Reiner noted that she continued to experience back pain
and limited mobility, and concluded that Vaughn was unable to
work full duty. (Appendix, Exh. 1, Letter from Dr. Reiner, June
19, 1997, at 184). Following an October 1997 office visit, Dr.
Reiner observed that while Vaughn sensed some improvement, she
still complained of back pain and suffered from restricted
mobility. (Appendix, Exh. 1, Letter from Dr. Reiner, Oct. 9,
1997, at 187).
MetLife requested an independent medical examination of Vaughn,
which was performed by orthopedic specialist Dr. Francis Mattei.
He concluded that Vaughn had fully recovered from her March 1997
injury and reached her pre-injury level of activities, and
therefore was capable of returning to full-time work duty.
(Appendix, Exh. 1, Independent Medical Examination Report of Dr.
Mattei, Sept. 29, 1997, at 198). Dr. Rosenzweig took issue with
Dr. Mattei's conclusions in a November 1997 letter. (Appendix,
Exh. 1, Letter from Dr. Rosenzweig, Nov. 19, 1997, at 177).
MetLife then arranged for Vaughn's medical records to be
reviewed by an independent physician certified in occupational
medicine, Dr. Robert D. Petrie. In a December 1997 report to
MetLife, Dr. Petrie concluded that the medical records did not
support a finding of total disability. (Appendix, Exh. 1,
Independent Medical Review Report, Dec. 10, 1997, at 166). Aside
from Vaughn's restricted range of motion, Dr. Petrie observed,
there was no evidence of muscle atrophy, muscle weakness, or any
other serious impairment. (Id. at 167). According to Dr.
Petrie, Dr. Rosenzweig's diagnoses were largely based on Vaughn's
subjective pain complaints, and were not accompanied by objective
findings or medical evidence such as x-rays or other
In a February 1998 letter to Vaughn, MetLife summarized its
investigation of her claim and concluded that her physician had
not provided sufficient objective medical evidence to support a
claim that Vaughn was totally disabled from work. (Appendix, Exh.
1, Letter from MetLife Agent Edward Manley, Feb. 2, 1998, at
158). Her claim was therefore denied. (Id.).
In March 1998, Vaughn appealed the denial, attaching a letter
from Dr. Rosenzweig and a "Key Functional Capacity Assessment,"
prepared by Vaughn's physical therapist to measure Vaughn's
physical limitations. The assessment concluded that she was not
capable of returning to work on a full-time basis. (Appendix,
Exh. 1, Key Functional Capacity Assessment Report, Mar. 23,
1998). MetLife arranged for the additional information provided
by Vaughn to be reviewed by Dr. Petrie, who also spoke with Dr.
Rosenzweig. Dr. Petrie's conclusion that Vaughn's medical records
did not support a finding of total disability was unchanged.
(Appendix, Exh. 1, Appendix, Exh. 1, Independent
Medical Review Report, May 13, 1998, at 117).*fn1
In September 1998, MetLife informed Vaughn that her appeal had
been denied. (Appendix, Exh. 1, Letter from MetLife Agent Sal
Marchese, Sept. 14, 1998, at 8). Citing the lack of objective
medical evidence of neuromuscular impairments and Dr.
Rosenzweig's failure to provide such evidence despite numerous
requests, MetLife concluded on the evidence in its possession
that Vaughn was not totally disabled.
Vaughn then brought this suit under the Employee Retirement
Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), seeking
past and future benefits due under the Plan and attorneys fees.
This Court has jurisdiction over this case under
28 U.S.C. § 1391(a), as it presents a question arising under federal law.
According to Rule 56(c) of the Federal Rules of Civil
Procedure, "if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment
as a matter of law," then a motion for summary judgment must be
granted. The question before the Court at the summary judgment
stage is "whether the evidence presents a sufficient disagreement
to require submission to a jury or whether it is so one-sided
that one party must prevail as a matter of law." See Anderson v.
Liberty Lobby, 477 U.S. 242, 251-52, 106 S.Ct. 2505, 2511, 91
L.Ed.2d 202 (1986). The Court's role at summary judgment is not
to weigh the evidence, but ...