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Amitia v. Metropolitan Life Ins. Co.

April 25, 2006

MICHAEL AMITIA, PLAINTIFF
v.
METROPOLITAN LIFE INS. CO., DEFENDANT



The opinion of the court was delivered by: John E. Jones III United States District Judge

MEMORANDUM AND ORDER

THE BACKGROUND OF THIS ORDER IS AS FOLLOWS:

Pending before the Court is a Motion for Summary Judgment (doc. 17) filed by Plaintiff Michael Amitia ("Plaintiff" or "Amitia") on January 25, 2006. We also have before us a Motion for Summary Judgment (doc. 19) and a Motion to Strike Exhibits Submitted with Plaintiff's Cross-Motion for Summary Judgment (doc. 20) filed by Defendant Metropolitan Life Insurance Company a/k/a MetLife ("Defendant" or "MetLife") on January 31, 2006 and February 1, 2006 respectively.

For the reasons that follow, Defendant's Motions will be granted and the case closed.

PROCEDURAL HISTORY:

On March 21, 2005, Plaintiff filed a complaint against MetLife in the United States District Court for the Middle District of Pennsylvania arising under the provisions of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. (See Rec. Doc. 1). Plaintiff's one count complaint alleges that he is entitled to short and long term disability benefits and that Defendant acted in an arbitrary and capricious manner in denying Plaintiff's claim for disability benefits. (Comp. ¶¶ 19-23).

On January 25, 2006 and January 31, 2006 respectively, both parties filed Motions for Summary Judgment, which have been fully briefed. The instant Motions are therefore ripe for disposition.

STANDARD OF REVIEW:

Summary judgment is appropriate if "there is no genuine issue as to any material fact and . . . the moving party is entitled to judgment as a matter of law." FED .R. CIV. P. 56(c); see also Turner v. Schering-Plough Corp., 901 F.2d 335, 340 (3d Cir. 1990). The party moving for summary judgment bears the burden of showing "there is no genuine issue for trial." Young v. Quinlan, 960 F.2d 351, 357 (3d Cir. 1992). Summary judgment should not be granted when there is a disagreement about the facts or the proper inferences which a fact finder could draw from them. Peterson v. Lehigh Valley Dist. Council, 676 F.2d 81, 84 (3d Cir. 1982).

Initially, the moving party has a burden of demonstrating the absence of a genuine issue of material fact. Celotex Corporation v. Catrett, 477 U.S. 317, 323 (1986). This may be met by the moving party pointing out to the court that there is an absence of evidence to support an essential element as to which the non-moving party will bear the burden of proof at trial. Id. at 325.

Federal Rule of Civil Procedure 56 provides that, where such a motion is made and properly supported, the non-moving party must then show by affidavits, pleadings, depositions, answers to interrogatories, and admissions on file, that there is a genuine issue for trial. FED. R. CIV. P. 56(e). The United States Supreme Court has commented that this requirement is tantamount to the non-moving party making a sufficient showing as to the essential elements of their case that a reasonable jury could find in its favor. Celotex Corp., 477 U.S. at 322-23.

It is important to note that "the non-moving party cannot rely upon conclusory allegations in its pleadings or in memoranda and briefs to establish a genuine issue of material fact." Pastore v. Bell Tel. Co. of Pa., 24 F.3d 508, 511 (3d Cir. 1994) (citation omitted). However, all inferences "should be drawn in the light most favorable to the non-moving party, and where the non-moving party's evidence contradicts the movant's, then the non-movant's must be taken as true." Big Apple BMW, Inc. v. BMW of N. Am., Inc., 974 F.2d 1358, 1363 (3d Cir. 1992), cert. denied, 507 U.S. 912 (1993) (citations omitted).

Still, "the mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986)(emphasis in original). "As to materiality, the substantive law will identify which facts are material." Id. at 248. A dispute is considered to be genuine only if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Id.

STATEMENT OF RELEVANT FACTS:

We initially note that we will, where necessary, view the facts and all inferences to be drawn therefrom, in the light most favorable to the nonmoving party in our analysis of the pending Motions.

On July 3, 2002, Plaintiff was involved in an automobile accident in which he sustained serious injuries. At the time of the accident, Plaintiff was a full time MetLife employee. Plaintiff filed a claim for disability benefits due to his injuries with disability benefits to commence effective September 15, 2004. Accordingly, Plaintiff worked for MetLife as a Financial Services Representative until September 14, 2004.

MetLife established and maintains an employee welfare benefit plan ("the Plan") for the benefit of its employees, including Plaintiff. (Rec. Doc. 21, bate stamp nos. 1-144). Plaintiff's claim for short-term disability benefits was approved from September 15, 2004 through November 26, 2004. Id. at 157, 169, 184. After reviewing all medical information provided to MetLife, MetLife notified Plaintiff on December 13, 2004 that it found he was no longer eligible for benefits under the Plan after November 26, 2004, and that his claim would be terminated. In that regard, MetLife concluded that there was no medical evidence to support any functional impairment in Plaintiff's ability to perform the functions of his own occupation after November 26, 2004. MetLife advised Plaintiff of his right to appeal the decision and to submit any additional comments, documents, records, or other information relating to his claim that he deemed appropriate for MetLife to give his appeal proper consideration.

Plaintiff appealed MetLife's determination to terminate his benefits by letter dated January 10, 2005, enclosing a letter report from Albert D. Janerich, M.D. ("Dr. Janerich") dated December 22, 2004. Id. at 190-93. The appeal was referred to MetLife's Appeal Unit for review. In addition to reviewing Plaintiff's complete file, MetLife's Appeal Unit also considered Dr. Janerick's December 22, 2004 letter report. In summary, the medical information made available to MetLife consisted of the following: (1) physical therapy records dated September 22, 2004 through October 26, 2004; (2) Dr. Janerich's office note of November 9, 2004; (3) an unsigned Physician Questionnaire dated November 18, 2004; and (4) a letter from Dr. Janerich to Plaintiff's counsel dated December 22, 2004. Id. at 208-211.

By letter of March 3, 2005, MetLife advised Plaintiff's counsel that it decided to uphold its decision to terminate benefits, and provided Plaintiff's counsel with the reasons that the original determination was being upheld on appeal review. Id. In support of its denial of benefits to Plaintiff, MetLife explained as follows:

Mr. Armitia is also required to provide evidence that he remains under continuous, appropriate care and treatment throughout his period of claimed disability. Benefits were approved through November 26, 2004 and the last documented treatment that Mr. Armitia received was on November 9, 2004. As such, we have not been provided with evidence of continuous, appropriate care and treatment as required by the Plan.

Based upon the limited medical documentation in the file, we find that sufficient evidence of continued disability as defined by the STD plan has not been produced. Therefore, for the reasons noted above, we find that the original decision to terminate short term disability benefits was appropriate and remains in effect.

Id. at 210-11.

DISCUSSION:

In his Motion, Plaintiff argues that he provided medical documentation in support of his claim for disability benefits confirming that he was not cleared to return to work in any capacity. In support thereof, Plaintiff points to page 173 and pages 190 through 193 of Defendant's administrative record as evidence that he is incapable of working. (Pl.'s Br. Supp. Mot. Summ. J. at 2). Plaintiff asserts that he is entitled to summary judgment as Defendant willfully and capriciously disregarded the injuries and resulting damages he suffered despite medical information which demonstrates the extent to which he is fully disabled from employment. "Moreover, there is no contradictory evidence provided by or cited to by the Defendant which in any manner disputes the medical evidence provided by the Plaintiff which confirms his full disability." Id. at 3.

In response, MetLife argues that under an arbitrary and capricious standard of review, its decision to terminate Plaintiff's short-term disability benefits was reasonable, consistent with the language of the Plan, and supported by substantial evidence. In addition, MetLife asserts in its Motion to Strike Exhibits Submitted with Plaintiff's Motion, that such exhibits should be disregarded as they were not part of the ...


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