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Harden v. Metropolitan Life Insurance Co.

September 27, 2007

BILLY HARDEN PLAINTIFF
v.
METROPOLITAN LIFE INSURANCE COMPANY DEFENDANT



The opinion of the court was delivered by: Garnett Thomas Eisele United States District Judge

ORDER

Presently before the Court are the parties' Motions for Judgment on the Record and Defendant's Motion to Dismiss.

I. Background

Plaintiff worked for American Express (now, Ameriprise) as a financial advisor from May 27, 1992, until resigning effective December 31, 1999. He was 62 years old when he resigned. Plaintiff participated in a Long Term Disability Plan ("Plan"), which is an employee welfare benefit plan established pursuant to the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), administered by Defendant Metropolitan Life Insurance Company ("MetLife").

Plan participants are eligible for LTD benefits if they suffer from a "disability" or "are disabled." The Plan provides:

For purposes of LTD benefits, totally disabled means:

* You are completely unable to perform any and every material duty of your own occupation, and you require the regular care and attendance of a doctor, both during the 26 week elimination period and for the first 24 months that LTD benefits are payable

* After both the elimination period and the first 24 months, you're unable to perform each of the material duties of any gainful work or service for which you are reasonably qualified due to training, education or experience. You also must be under a doctor's care before, during and after the elimination period.

The Plan also provides that MetLife "decides whether your condition qualifies as a total disability based on medical evidence." MetLife, as the plan administrator, holds complete discretion to determine eligibility and entitlement to Plan benefits in accordance with the Plan's terms.

On October 12, 2001, Plaintiff Billy Harden filed suit*fn1 against American Express Financial Corporation d/b/a American Express Financial Advisors, American Express Financial Corporation (AEFA) Long Term Disability Plan, Metropolitan Life Insurance Company, and John Does 1 through 50, alleging three separate causes of action: (1) the Defendants denied disability benefits in violation of ERISA; (2) the ERISA plan discriminated between employees in violation of Title I of the Americans with Disabilities Act ("ADA"); and (3) a state law breach of contract claim.

In the Court's Order dated August 2, 2000, granting Defendants' Motion for Partial Summary Judgment and dismissing the ERISA claim in the previous action,*fn2 the Court noted the background facts, which are also applicable to this case:

On March 12, 2000, Plaintiff filed a claim for Plan LTD benefits. On the claim form he indicated that his financial advisor position had been "very stressful" and that he was unable to return to work. When requested to describe his present condition as regards limitations on his ability to return to work, he answered: "I have had two heart surgeries (1) 5 by-passes (2) 2 by-passes and a valve replaced. Can no longer tolerate the stress and rigorous regimen associated with financial planning. Became too shaky to fill out clients paperwork." When asked to provide a description of his daily routine, he wrote: "Very limited physical activity--reading." He also opined that he would be unable to return to work: "I will not be returning. Can no longer meet clients needs. Was experiencing fainting spells during consultations and too shaky to do paper work."

On his claim form, the Plaintiff noted that he was under the care of the following physicians: Dr. Charles Barg, a family practitioner; Dr. Charles Fitzgerald, a cardiologist; Dr. Stephen Broughton, a psychiatrist; Dr. David Hicks, a cardiologist; and Dr. William Fiser, a heart surgeon.

In order to determine whether the Plaintiff was "totally disabled" under the Plan definition, MetLife contacted each of the physicians listed on Plaintiff's claim form in an effort to obtain his medical records and other documentation regarding his physical status. Dr. Fitzgerald indicated that he had only seen the Plaintiff once to perform an echocardiogram in association with his application for Social Security disability benefits. Other than the echocardiogram results, Dr. Fitzgerald did not have any medical records pertaining to the Plaintiff. MetLife obtained a copy of the echocardiogram results. Dr. Broughton also indicated that he did not have any medical records pertaining to the Plaintiff.

Dr. Hicks, a cardiologist, provided Plaintiff's medical records and completed an "Attending Physician's Statement" form and a "Physical Capacities Evaluation" form concerning Plaintiff. According to the medical records, the Plaintiff had bypass surgery in 1989 and "subsequently presented with syncope and had developed severe aortic stenosis." In 1998 he had a reoperative coronary artery bypass and his aortic valve replaced. Three months after his second surgery Dr. Hicks noted that the Plaintiff "is doing well and having no problems. He has recovered nicely from [the second surgery]." In July 1999, Dr. Hicks opined that Plaintiff is doing well with no real problems, and is stable from a cardiac standpoint. In September 1999, Dr. Hicks noted that Plaintiff visited his office "just to talk about retirement and possible disability." Dr. Hicks advised that his left ventricle was normal and his valve was functioning normally. Dr. Hicks noted: "He seems to be doing well and I didn't encourage him or discourage him from filing disability."

Six weeks after Plaintiff's resignation, in February 2000, Dr. Hicks determined that the Plaintiff had no anginal symptoms and no syncope. Dr. Hicks surmised that the Plaintiff had no heart failure or angina, and was stable from a cardiac standpoint.

Dr. Hicks performed several tests on the Plaintiff in April 2000 after he had complained of feeling dizzy and shaky. An echocardiogram indicated that there was "normal ejection fraction with mild hypokinesis at the apex. Aortic valve function is normal." A stress echo test revealed "a clinically negative, near-maximum stress echo with less-than-optimal exercise tolerance, no symptoms, and no objective evidence for ischemia." Dr. Hicks concluded:

[The Plaintiff] is stable from a cardiac standpoint. He has no angina and no congestive heart failure. He has mild left ventricular dysfunction with apical hypokinesis, but a low-normal ejection fraction. His valve function is normal. He has episodes where he feels as if he might have syncope, but he has no frank syncope. The etiology of these episodes is unclear. . . I feel that a heads-up tilt is warranted in this gentleman who is having near-syncopal episodes. Depending on the results of this, we can go further with his dizziness work-up to include neurology evaluation. I think from a cardiac standpoint, other than the heads-up tilt, nothing else needs to be done at this time. He has no objective evidence for ischemia and his aortic valve functions appropriately.

Dr. Eleanor Kennedy conducted a heads-up tilt in May 2000. The results were negative.

On the "Attending Physician's Statement" and "Physical Capacities Evaluation" forms, Dr. Hicks noted that Plaintiff is now able to engage in only limited stress situations. Dr. Hicks noted that Plaintiff's "tremors" prevented him from performing his job duties, and that he had not advised the Plaintiff to return to work. However, Dr. Hicks also indicated that the Plaintiff had only a slight limitation with respect to his cardiac functional capacity. Dr. Hicks estimated that in an eight-hour workday, the Plaintiff could sit for eight hours, stand for two hours, and walk for one hour. Dr. Hicks also opined that: the Plaintiff should not lift anything over twenty pounds, but that he could lift up to twenty pounds occasionally; he was capable of using both hands for grasping, pushing and pulling, but not "fine manipulating"; he could use both feet for repetitive movements; he should not squat, crawl or climb, but could occasionally bend and reach above shoulder level.

Dr. Barg, a family practitioner, also provided Plaintiff's medical records. He had examined the Plaintiff in March 2000, April 2000 and July 2000. Dr. Barg observed some changes in Plaintiff's handwriting consistent with a possible neurological disorder; however, he did not recommend any course of treatment. Dr. Barg placed him on a 24-hour houlter monitor, and gave him Pravachol for his high cholesterol, and Atenolol as a precaution due to his history of cardiac problems. Plaintiff discontinued using Atenolol on his own accord. No discussion pertaining to Plaintiff's alleged near-syncope episodes is included in Dr. Barg's records.

In July 2000 Dr. Barg completed an Attending Physician Statement of Disability form for MetLife. Dr. Barg opined that the Plaintiff suffered from a non-work-related illness, and that he had advised the Plaintiff to cease working. He noted that the Plaintiff suffered from fatigue, heart palpitations, high blood pressure, high cholesterol and syncope. He opined that the Plaintiff could sit for three hours, stand for one hour, and walk for one hour; could reach above shoulder level; and could occasionally lift up to ten pounds. Dr. Barg noted that the Plaintiff was unable to perform fine finger movements with his right hand or push/pull with either hand. Dr. Barg did not expect the Plaintiff to improve, and speculated that his health problems may be caused by a neurological disorder such as Parkinson's disease. In terms of his cardiac function ...


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