Satterwhite v. Metropolitan Life Insurance Company
No. 1:06-CV-165, 2007 WL 2746886 (E.D. Tenn. Sept. 19, 2007)
Our client, a health physics technician at USEC’s Paducah Gaseous Diffusion Plant, became disabled from depression and anxiety in October 2001. Satterwhite v. Metro. Life Ins. Co., 2007 WL 2746886 at *2. She filed for and was granted short-term disability benefits. Id. at *2,*3. When her short-term benefits expired, Ms. Satterwhite applied for and was granted long-term disability benefits. Id. at *3. After the Social Security Administration deemed Ms. Satterwhite to be totally disabled and awarded her benefits in 2003, MetLife began reviewing Satterwhite’s file to determine her further eligibility for long-term benefits. Id. at *3. For the first couple of years, the insurance company looked at whether she could do her own previous job as a health physics technician. Id. at *2. After two years, the definition of disability changed to “any occupation,” meaning they would grant her claim for benefits only when they found her unable to do any job that matched her education, training, and experience. Id. at *3.
In March 2005, MetLife asked Satterwhite to provide treatment notes from October 2004 through March 2005, her most current restrictions and limitations, and asked to have an enclosed behavioral assessment form completed. Id. at *4. The notes of Dr. Meyer, Ms. Satterwhite’s treating physician, stated that Satterwhite had “no energy” and that she had to “push self to get out of bed.” Id. at *4. Dr. Meyer also stated that Satterwhite would be a “fatigued, inattentive employee prone to absenteeism and accidents.” Id. at *4. MetLife called Dr. Meyer to confirm this, then approved her long-term disability benefits until August 31, 2005. Id. at *4.
On October 4, 2005, MetLife notified Satterwhite that it was terminating her benefits effective August 31, 2005. Id. at *5. The denial letter stated that Dr. Meyer had not provided objective findings that indicate[d] an inability to function, no mental status exam, and no global assessment of functioning score. Id. at *5. However, according to the Plan, the burden was not on Satterwhite to provide any information that was not requested, and MetLife had not requested that information. Id. at *5.
Ms. Satterwhite appealed the denial of her disability benefits and included a letter written by Dr. Meyer on October 15, 2005 in support of her appeal. Id. at *5. He stated Satterwhite had tried every medication, alone and in combination, that he had recommended, but that she remained seriously depressed and functionally impaired. Id. at *5. Dr. Meyer emphasized that she was not a patient who exaggerated her symptoms and that she preferred social isolation, even at times to the exclusion of her own children. Id. at *5.
The court determined that MetLife’s initial denial of her benefits on October 4, 2005 was not based on an appropriate review of her file. Id. at *7. MetLife “faulted Satterwhite and Dr. Meyer for not providing information that it did not seek.” Id. at *8. “There [was] no burden on Satterwhite to proactively prove her disability on a continuing basis.” Id. at *8. MetLife arbitrarily and capriciously relied on a supposed lack of information to revoke Satterwhite’s disability benefits. Id. at *8.
MetLife hired Dr. Kessler, a board certified psychiatrist, for a file-only review. Id. at *5. Dr. Kessler said Satterwhite had received minimal and incomplete treatment. Id. at *6. The court said there was no reasoned, rational basis for crediting Dr. Kessler over Dr. Meyer and to do so meant that MetLife was acting arbitrarily and capriciously. Id. at *11 (referencing Kalish v. Liberty Mutual, 419 F.3d 501, 510 (6th Cir. 2005) (discrediting non-examining physician who failed to rebut treating physician’s diagnosis and conclusions)); Elliott v. Metropolitan Life Ins. Co., 473 F.3d 613, 620 (6th Cir.2006) (“that MetLife gave ‘greater weight’ to a non-treating physician’s opinion for no apparent reason lends force to the conclusion that MetLife acted arbitrarily and capriciously.”). “Failure to conduct a physical examination — especially where the right to do so is specifically reserved in the plan — may, in some cases, raise questions about the thoroughness and accuracy of the benefits determination.” Satterwhite v. Metro. Life Ins. Co., 2007 WL 2746886 at *12 (citing Calvert v. Firstar Fin., Inc., 409 F.3d 286, 295-96 (6th Cir. 2005)).
MetLife also apparently disregarded the Social Security Administration’s (SSA) determination that Satterwhite was completely disabled. Satterwhite v. Metro. Life Ins. Co., 2007 WL 2746886 at *15. Under the terms of the Plan, a beneficiary was required to apply for SSA benefits, and, if benefits were awarded, the amount paid out by the plan was reduced by the amount received from the SSA. Id.
MetLife prompted Satterwhite to apply for SSA benefits and even referred her to an attorney to assist her. MetLife offset its payment to her in the amount of her SSA award from 2002 until it revoked her benefits in 2005. There was nothing in the record showing that Satterwhite’s SSA benefits [had] been revoked. MetLife therefore benefitted from Satterwhite’s SSA disability determination for four years before declaring her not to be disabled and revoking her disability award.
Satterwhite v. Metro. Life Ins. Co., 2007 WL 2746886 at *15.
The court concluded that MetLife’s denial of Satterwhite’s benefits was arbitrary and capricious and sent the case back to MetLife for a full and fair review of Satterwhite’s disability claim. Id. at *16.