Case Story: Our Client v. BWXT Y-12, LLC
Our client, the plaintiff, was an Accounting Support Specialist at Lockheed Martin for nine years. In 2000, they stopped working due to fibromyalgia and osteoarthritis. The severe muscle spasms and chronic pain these conditions caused made it impossible for them to work. Based on the reports from their treating physician, Dr. Burns, and also on their self-reports, MetLife granted our client LTD benefits. After two years, MetLife’s plan required our client to prove they were disabled from any occupation (as opposed to their own occupation) in order for our client to continue receiving LTD. MetLife reviewed the information provided by Dr. Burns and also relied on a Transferable Skills Analysis by Stephanie Seely, which asserted that the plaintiff could perform other sedentary work. Based on their review of these two sources, MetLife terminated their LTD.
The plaintiff appealed and submitted additional notes from Dr. Burns as well as treatment notes from Dr. Koelsch, a chiropractic physician, and Dr. Hauge, who performed a neurological/neurosurgical evaluation. Also during this time period SSA determined that the plaintiff was disabled and began receiving benefits. In their SSA case, the ALJ concluded that they suffered from “debilitating levels of fatigue and pain.” MetLife had a non-examining consultant, Dr. Lieberman, review the file and he concluded that the plaintiff was able to perform sedentary work. MetLife relied on Dr. Lieberman’s opinion and upheld its decision to terminate the plaintiff’s LTD in April 2003. The plaintiff then brought this action and asserted that MetLife’s denial was arbitrary and capricious.
This court agreed with us and found in favor of the plaintiff. The court found that MetLife’s decision to deny their LTD was indeed arbitrary and capricious. In the final termination letter, MetLife made no mention of the plaintiff’s favorable SSA decision. Rather, MetLife stated that they relied on the evidence provided by Dr. Burns’ medical records, Seely’s TSA, notes from Koelsch and Hauge, and the opinion of Lieberman. The court acknowledged that an ERISA plan fiduciary is not bound by what the SSA finds. Bass v. TRW Employee Welfare Benefits Trust, 2004 WL 103001 at *3(6th Cir. Jan. 21, 2004). However, since the ALJ relied on the opinion of both Dr. Burns and the credibility of the plaintiff’s self-reports of their ability to work, the court concluded it was arbitrary and capricious for MetLife to not consider and discuss the SSA decision in its final termination letter.
