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Brangman v. AstraZeneca, LP

United States District Court, E.D. Pennsylvania

June 24, 2013

DEBORAH BRANGMAN, Plaintiff,
v.
ASTRAZENECA, LP, ASTRAZENECA PHARMACEUTICALS, LP and METROPOLITAN LIFE INS. CO. PARTNERS, LP, et al., Defendants

For DEBORAH J. BRANGMAN, Plaintiff: NEIL J. HAMBURG, LEAD ATTORNEY, JANE C. SILVER, KAREN C. MCRORY-NEGRIN, HAMBURG & GOLDEN, P.C., PHILADELPHIA, PA.

For ASTRAZENECA, LP, ASTRAZENECA PHARMACEUTICALS, LP, Defendants: ELIZABETH TEMPIO CLEMENT, LEAD ATTORNEY, LITTLER MENDELSON, PHILADELPHIA, PA; THOMAS J. BENDER, LEAD ATTORNEY, LITTLER MENDELSON PC, PHILADELPHIA, PA.

For METROPOLITAN LIFE INSURANCE COMPANY, Defendant: VERONICA W. SALTZ, SALTZ MATKOV PC, WAYNE, PA.

OPINION

Page 729

ANITA B. BRODY, JUDGE.

MEMORANDUM

Plaintiff Deborah Brangman brings suit against Defendant Metropolitan Life Insurance Co. (" MetLife" ) for its adverse determination of her claim for long-term disability (LTD) benefits under the AstraZeneca Long Term Disability Insurance Plan (the " Plan" ). The Plan is governed by the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § 1001, et seq. MetLife moves for summary judgment on the grounds that its determination was reasonable, proper, and based on substantial evidence in the administrative record, and that Brangman was not entitled to LTD benefits. MetLife subsequently moved to strike portions of Brangman's statement of undisputed facts and certain exhibits because they reside

Page 730

outside of the administrative record. [1] Jurisdiction is proper pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § § 1132. For the reasons set out below, I will grant MetLife's Motion for Summary Judgment and deny MetLife's Motion to Strike.

I. BACKGROUND

Plaintiff Deborah Brangman was employed at AstraZeneca Pharmaceuticals, LP (" AstraZeneca" ) as a Marketing Skills Development Director. Brangman filed a lawsuit against AstraZeneca alleging that it discriminated and retaliated against her. She stopped working at AstraZeneca as of April 1, 2010, and went out on short term disability leave for anxiety and depression. She received extensions for her short term disability leave until July 8, 2010. When her request for another extension was denied by AstraZeneca, she sought to apply for LTD benefits through AstraZeneca's insurer, MetLife.

As an employee of AstraZeneca, Brangman was a participant in the Plan, an employee welfare benefit plan governed by ERISA. The Plan is funded through a group policy issued by MetLife to AstraZeneca. Although AstraZeneca is the Plan administrator, it delegated the authority to administer and decide claims for benefits to MetLife. Def's. App. of Exs. at 059. The Plan dictates that

In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the plan and to determine eligibility and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the Interpretation or determination was arbitrary and capricious.
The Plan Administrator may delegate any or all of this authority to a third party, including the claims or benefits administrators designated under the Plan. To the extent that the Plan Administrator has delegated such authority, the third party or the claims or benefits administrator has all the powers and responsibility of the Plan Administrator.
The authority to administer and decide initial and continuing claims for benefits has been delegated to the Insurer that Insures the Plan.

Id. Relevant provisions of the Plan provide that:

- A claimant is to provide " Proof," or " Written evidence satisfactory to [MetLife] that a person has satisfied the conditions and requirement for any benefit described in this certificate." Def's. App. of Exs. at 26.
- " Disability" means that due to sickness or the result of an accidental injury, " [y]ou are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and [y]ou are unable to earn during the Elimination period and the next 24 months of Sickness or accidental injury, more

Page 731

than 80% of Your Predisabiilty Earnings at Your Own Occupation for any employer in Your Local Economy. . ." Id. at 023.
- " Local Economy" " means the geographic area within which You reside; and which offers suitable employment opportunities within a reasonable travel distance." Id. at 024-025.
- For a " Disability Due to Mental or Nervous Disorders or Diseases," MetLife " will limit Your Disability benefits to a lifetime maximum equal to the lesser of 24 months; or the Maximum Benefit Period." Id. at 043. " [MetLife] will determine if a Disability is the result of a Mental or Nervous Disorder or Disease." Id.
- " 'Mental or Nervous Disorder or Disease' means a medical condition which meets the diagnostic criteria set forth in the most recent edition of the Diagnostic And Statistical Manual of Mental Disorders as of the date of Your Disability. A condition may be classified as a Mental or Nervous Disorder or Disease regardless of its cause." Id. at 043.

On August 31, 2010, AstraZeneca's Occupational Health Nurse Betsy Rizzuto initiated the process for Brangman to apply for LTD benefits with MetLife. Def's. App. of Exs. at 368. MetLife sent Brangman a letter informing her that it received her claim request. On her Long Term Disability Claim Form, Brangman stated that she could no longer do her job due to anxiety, lack of focus, and depression. Id. at 295. On September 2, 2010, Rizzuto's records state that AstraZeneca's senior counsel John Bogan requested that Rizzuto call MetLife and expedite Brangman's claim. [2] On September 3, 2010, MetLife wrote to Brangman requesting additional documents, including her medical office visit notes, progress and/or therapy notes, and any test results related to her condition by October 2, 2010. Id. at 345. Also on September 3, MetLife spoke with Rizzuto, who explained that AstraZeneca denied Brangman's request to extend her short-term disability benefits because " the med info did not support EE [employee] being totally disabled." Id. at 062.

On September 8, 2010, a MetLife Claims Specialist spoke with Brangman on the phone. Brangman asked if AstraZeneca's denial of ...


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