The opinion of the court was delivered by: SUSAN WRIGHT, Chief Judge, District
MEMORANDUM OPINION AND ORDER
Plaintiff Patti Langley filed this complaint on January 31,
2005, in the Circuit Court of Pulaski County, Arkansas, seeking a
review of a decision denying her claim for Long-Term disability
("LTD") benefits under a plan offered through her employer,
defendant Sears, Roebuck & Company ("Sears"). Sears removed the
action to federal court on the basis that the claim is covered by
the provisions of the Employee Retirement Income Security Act of
1974 (as amended), 29 U.S.C. § 1001 et seq. ("ERISA"). The
administrative record has been filed with the Court and the
parties have filed their briefs. For the reasons stated below,
the Court finds that the decision to deny plaintiff benefits
should be reversed.
Sears provides disability benefits, both short term and long
term, to eligible employees through a program funded by Sears and
administered by Metropolitan Life Insurance Company ("MetLife").
At the relevant time period, Langley worked as a store general
manager. She had been employed at Sears for thirty years. In April 2004, Dr. Jeff Carfagno referred plaintiff to Dr. C.
Lowry Barnes, an orthopedist, after plaintiff complained of left
knee pain. After their first visit, Barnes reported that
plaintiff had been diagnosed by Dr. Michael Jones "as having
acute atypical rheumatoid arthritis." Dr. Barnes reported that
plaintiff complained of increasing left knee pain over the past 3
months, but that Prozac, prescribed by Dr. Carfagno, "gave her
excellent relief from her chronic pain." Dr. Barnes reported that
on examination, plaintiff was "neurologically intact distally,"
"[s]traight leg raising is negative," and [h]ip exam is normal."
He noted moderate effusion but indicated her "patella tracks
centrally and her knee is stable." Dr. Barnes noted she lacked 15
degrees of extension and flexed to 100. Radiographs showed no
acute bony abnormality. She did "have some arthritis in her right
knee on the lateral aspect." Dr. Barnes ordered a MRI of her left
On May 5, 2004, following the MRI, plaintiff returned to
Barnes. He noted that the MRI showed a "medial and lateral
meniscus tear," and reported that "[w]e are going to proceed with
arthroscopy of her left knee." AR-0257 Plaintiff had surgery on
her left knee on May 14, 2004. AR-00261 She submitted a claim for
Short-Term disability ("STD") benefits after her surgery. AR0-005
On May 18, 2004, plaintiff returned to Barnes for a follow-up
after surgery. He reported her knee was stable and in excellent
alignment. He recommended an "aggressive therapy program, 3x a
week for the next 3 weeks." Dr. Barnes noted plaintiff was
working 10 hours per day and was on her feet most of the day. He
stated: "I do not think she has a knee that is going to allow her
to continue to do that." Dr. Barnes noted he would see plaintiff
in three weeks for a re-evaluation. AR-0256 On May 20, 2004, plaintiff visited physical therapist Greg
Calaway. He noted plaintiff was "ambulating at this time with no
obvious gait deviation," and was "able to do a straight leg raise
at this time with no extensor lag seen." He recorded plaintiff
had done very well following her surgery, and his long-term goal
was to return plaintiff to "full function and activity with no
pain or limitations in her left knee within 8 weeks." AR-0273-74
On May 21, 2004, MetLife wrote plaintiff a letter, approving
her claim for STD benefits effective May 14, 2004 through June
17, 2004. MetLife explained what information it would need in
order to consider extending her benefits. AR-0005
On May 24, 2004, plaintiff began physical therapy under the
supervision of a number of physical therapists, including Greg
Calaway. AR-268-70 On May 24 and 26, the physical therapists
reported that plaintiff had no new complaints or increases in
pain. During those sessions, plaintiff engaged in a number of
exercises including quad sets, straight leg raises, and leg
swings. At the May 26 session, plaintiff indicated that she
wanted to continue her therapy on her own at home. AR-271-72 On
June 2, 2004, plaintiff returned and reported experiencing "some
increased discomfort over the weekend when she attempted to do
her exercises on her own. For that reason she came back for
treatment. She felt she could do her exercises at home but after
experiencing problems decided to come back to therapy." She did
quad sets, straight leg raises, leg swings for five minutes, and
biking for five minutes. Calaway noted she tolerated her
treatment well. AR-270 On June 3 and 4, plaintiff engaged in
approximately 35 minutes of physical therapy under the
supervision of Calaway. Each time he noted she tolerated her
treatment well. AR-268-69.
At some point in late May or early June 2004, Barnes
recommended that plaintiff have right knee arthroscopy. On June
8, 2004, Barnes performed the surgery. In his operative notes, he
stated that plaintiff had "done well" with her left knee arthroscopy.
AR-0259 On June 10, plaintiff returned to Barnes for a follow-up.
He noted she was "doing well" and would again undergo "an
aggressive therapy program." AR-0255 In a brief note that same
day, Barnes said plaintiff should not return to work until
September 1, 2004. AR-315
On June 11, 2004, MetLife wrote plaintiff a letter reminding
her that her STD benefits would terminate effective June 17,
2004, if she did not supplement her claim with the following
information by June 25, 2004:
1. Copies of the two most recent:
Diagnostic test results.
Operative reports and discharge summaries, if
Rehabilitation or therapy notes, if applicable.
2. Names and dosages of all current medications.
3. Functional abilities.
4. Expected return to work date.
On June 14, 2004, plaintiff returned to physical therapy. She
reported to Calaway that her left knee continues to be a little
stiff and sore but she had more pain from her right knee having
just undergone surgery. She participated in a number of exercises
and Calaway indicated plaintiff tolerated her treatment well.
AR-0266 On June 16, 2004, plaintiff returned to Calaway and
reported no significant problems since her last visit. She
participated in exercises and "tolerated her treatment well."
Throughout this time period, plaintiff and MetLife communicated
regarding the need for additional medical records. AR-0012-13
However, as of June 21, 2004, plaintiff had not provided MetLife
with supplemental information requested in two previous letters.
Therefore, on June 21, 2004, MetLife wrote plaintiff explaining that it closed her STD
benefit claim as of June 17, 2004. MetLife informed her of her
right to appeal the decision. AR-0003
A few days after writing the June 21 letter, MetLife received
up-to-date information from Barnes. The records included
information pertaining to plaintiff's June 8 surgery. AR-0014
Based on the new information, MetLife reversed its decision to
terminate plaintiff's STD benefits. In a June 30, 2004 letter to
plaintiff, MetLife explained that it had approved plaintiff for
benefits from May 14, 2004 through July 1, 2004. MetLife again
recited the documents needed to extend benefits beyond
plaintiff's expected return to work date of July 1, 2004. AR-0002
Plaintiff returned to Barnes on July 1, 2004. He reported that
she was "slowly making progress," "still has crepitance, but less
pain," and "good range of motion of her knees today." AR0-253
Also on July 1, 2004, physical therapist Mike Adkins completed a
"Progess Report/Plan of Care" pertaining to plaintiff. He noted
that plaintiff had a total 14 scheduled physical therapy
sessions, 4 of which were cancelled, 2 were no-shows, and 8 were
kept. He ...