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DeCurtis v. Metropolitan Life Ins. Co.

May 16, 2006


The opinion of the court was delivered by: Magistrate Judge Blewitt


This action, which arises under the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. Section 1001, et seq. ("ERISA"), was filed on January 18, 2005. (Doc. 1). Plaintiff, George M. DeCurtis, Jr., alleges that he had a long term disability ("LTD") policy with Defendant Metropolitan Life Insurance Company ("Metropolitan"), and that Defendant wrongfully terminated his benefits by finding that he was capable of performing some types of work. Plaintiff seeks the reinstatement of his disability benefits by Defendant and for the back- payment of all unpaid disability benefits. Defendant filed an Answer to the Complaint on March 11, 2005. (Doc. 4). Defendant essentially asserts that it properly terminated Plaintiff's long-term disability benefits on August 26, 2002.

On January 13, 2006, Plaintiff filed a Motion for Summary Judgment along with a support Brief and exhibits. (Docs. 22 & 23). On January 13, 2006, Defendant filed a Motion for Summary Judgment along with its support Brief. (Docs. 18 & 19).*fn1 Defendant filed exhibits on January 17, 2006. (Doc. 25). Both parties have filed Statements of Undisputed Material Facts ("SMF") as well as responses to each other's SMF's. (Docs. 20, 21, 27 & 29). Both parties also responded to each's other Summary Judgment Motions. (Docs. 26 & 30).

The cross-Motions for Summary Judgment have been briefed and are presently ripe for disposition.*fn2

I. Summary Judgment Standard

A motion for summary judgment may not be granted unless the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56. The court may grant a motion for summary judgment if the pleadings, depositions, answers to interrogatories, admissions on file, and any affidavits show that there is no genuine issue as to any material fact. Fed.R.Civ.P. 56(c). An issue of fact is "'genuine' only if a reasonable jury, considering the evidence presented, could find for the nonmoving party." Childers v. Joseph, 842 F.2d 689, 693-694 (3d Cir. 1988) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986)).

The burden of proving that there is no genuine issue of material fact is initially upon the movant. Forms, Inc. v. American Standard, Inc., 546 F. Supp. 314, 320 (E.D. Pa. 1982), aff'd mem. 725 F.2d 667 (3d Cir. 1983). Upon such a showing, the burden shifts to the nonmoving party. Id. The nonmoving party is required to go beyond the pleadings and by affidavits or by "depositions, answers to interrogatories and admissions on file" designate "specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e).

In determining whether an issue of material fact exists, the court must consider the evidence in the light most favorable to the nonmoving party. White v. Westinghouse Electric Company, 862 F.2d 56, 59 (3d Cir. 1988). In doing so, the court must accept the non-movant's allegations as true and resolve any conflicts in his favor. Id., quoting Gans v. Mundy, 762 F.2d 338, 340 (3d Cir. 1985), cert. denied, 474 U.S. 1010 (1985); Goodman v. Mead Johnson & Co., 534 F.2d 566, 573 (3d Cir. 1976) cert. denied, 429 U.S. 1038 (1977).

II. Undisputed Material Facts

Plaintiff and Defendant have filed their respective Statements of Undisputed Material Facts (SMF's) in support of their Summary Judgment Motions as required. (Docs. 20 & 21). See Local Rule 56.1, M.D. Pa. Plaintiff has responded to Defendant's SMF. (Doc. 29). Defendant has also responded to Plaintiff's Statement of Material Facts in support of his Summary Judgment Motion. (Doc. 27).

The parties agree upon the following material facts in this case as detailed in Plaintiff's SMF. (See Doc. 21 & corresponding ¶'s from Doc. 27).*fn3

1. On or about September 14, 1994, the Plaintiff became employed by Sears-Roebuck & Company, where he was a member of the Customer Appliance Sales and Service Department.

4. The Plan unambiguously grants MetLife discretionary authority to determine eligibility for and entitlement to benefits and to interpret Plan Terms.

9. Plaintiff filed his application for LTD benefits on September 30, 1998, which application claimed disability due to chronic back pain secondary to his lumbar laminectomy and depression.

11. The same plan provides for payment of LTD benefits for a maximum of twelve consecutive months if the disability results from a mental and nervous disorder.

13. By letter dated December 29, 1998, MetLife denied Plaintiff's claim and after receiving Plaintiff's appeal letter and the psychiatric medical records of Dr. Gazda, the claim was approved on 3/1/99 after a Board-certified psychiatrist for MetLife recommended the approval of benefits based on sufficient data of depression and panic attacks rendering Plaintiff totally disabled per MetLife's definition of disability effective October 2, 1998.

14. The claim was approved for twelve months in accordance with the 12-month provision of MetLife's LTD Plan.

16. The Plaintiff applied for Social Security Disability Benefits on March 3, 1999, alleging disability beginning May 14, 1998, the day he last worked, due to back and left leg pain and major depression.

17. The Social Security Administration ("SSA") found that the Plaintiff was under a disability as defined by the Social Security Act and Regulations, commencing May 14, 1998, and continuing to the date of the Decision which was April 28, 2000. (A.R. 325-337).*fn4

26. Based on the reporting of Dr. Sanitate, MetLife recommended a Transferable Skills Assessment to determine if commensurate jobs could be found within the functional limitations established by the doctor.

27. On 7/19/01, occupations were identified in the Transferable Skills Analysis Report.

29. By letter dated August 28, 2001, MetLife terminated Plaintiff's benefits effective 10/1/01.

32. On 10/24/01 an appeal of the termination was received by MetLife and benefits were reinstated effective 10/1/01.

33. Following Plaintiff's surgery of 9/7/01, MetLIfe requested all records of Plaintiff's post-operative care and treatment by Dr. Sedor.

35. In June of 2002, MetLife had Plaintiff's medical records reviewed by Robert C. Porter, M.D., whose specialty is occupational medicine.

37. On August 16, 2002, a Transferable Skills Analysis was done by a vocational expert identifying jobs that Plaintiff could perform. The consultant who authored the Analysis never interviewed the Plaintiff nor was made aware of his physical or mental complaints other than to know that according to Dr. Porter, that Plaintiff's complaints "are out of proportion to his pathology."

38. A Transferable Skills Analysis done by the vocational expert on August 16, 2002 was based solely upon the information supplied to the vocational consultant by Dr. Porter dated June 27, 2002 and August 8, 2002.

39. The reports of Dr. Sedor were never reviewed by the vocational consultant performing the Transferable Skills Analysis.

40. The Transferable Skills Analysis performed on or about August 16, 2002 makes no reference to the effect of Plaintiff's depression/anxiety disorder, or did the report of July 19, 2001.

42. Plaintiff appealed the decision to terminate his benefits on 12/15/02.

43. MetLife had Plaintiff's records reviewed by Dr. James Sarno, a neurosurgeon, following Plaintiff's request for an appeal.

44. Dr. Sarno's report refers to 59 separate documents reviewed by him at the request of MetLife, all dealing with Plaintiff's medical management dating back as far as 1993.

45. The records reviewed by Dr. Sarno included extensive references to the Plaintiff's psychiatric and physical impairments.

47. MetLife's last payment of Plaintiff's LTD benefits was made in August of 2002.*fn5 The parties also agree upon the following material facts in this case as detailed in Defendant's SMF. (See Doc. 20 & corresponding ¶'s from Doc. 29).*fn6

1. Plaintiff, George DeCurtis, Jr., began his employment with Sears on September 26, 1994 and worked for Sears as a sales associate in its major appliance department until May 14, 1998. (Employer's Statement of LTD Claim; A.R. 566-576).

2. As a Sears employee, plaintiff participated in the Plan. (A.R. 566).

3. The Plan provides long-term disability benefits to certain employees of Sears who ...

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