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VAUGHN v. METROPOLITAN LIFE INS. CO.

March 14, 2000

ALISESHA VAUGHN, PLAINTIFF,
V.
METROPOLITAN LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Lowell A. Reed, Jr., Senior District Judge.

MEMORANDUM

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.

I. BACKGROUND

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 documentation. (Id.).

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.

II. ANALYSIS

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 ...


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