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Huffaker v. Metropolitan Life Insurance Co.

March 8, 2007

KAREN M. HUFFAKER, PLAINTIFF,
v.
METROPOLITAN LIFE INSURANCE COMPANY, ET AL., DEFENDANTS.



The opinion of the court was delivered by: Thomas W. Phillips United States District Judge

(Phillips/Guyton)

MEMORANDUM OPINION

This civil action is brought pursuant to the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §1001 et seq., and is before the Court for consideration of defendants' motion for judgment as a matter of law [Doc. 18]; plaintiff's motion for judgment on the pleadings [Doc. 25]; and defendants' cross motion for judgment on the pleadings [Doc. 28]. Responses and replies have been received. For the reasons that follow, defendants' motion for judgment as a matter of law [Doc. 18] is GRANTED; plaintiff's motion for judgment on the pleadings [Doc. 25] is DENIED; and defendants' cross motion for judgment on the pleadings [Doc. 28] is GRANTED.

I. Administrative Record

Plaintiff Karen M. Huffaker ("Huffaker") worked for Campbell Soup Company as a store manager in a Pepperidge Farm Thrift Store until January of 2004. The Campbell Soup Company maintains a long-term disability benefits plan for its employees (the "Plan"). Metropolitan Life Insurance Company ("MetLife") is the claim administrator of the Plan. Under the Plan, in order for an individual to be considered "disabled" for the first 24 months after the sixth month Elimination Period, he or she must receive, due to a sickness, pregnancy, or accidental injury, appropriate care and treatment from a doctor on a continuing basis, be unable to perform each of the material duties of his or her occupation, and be unable to earn 80% of the predisability income at the claimant's own occupation. After benefits under the Plan have been paid for the first 24 months, to be considered "disabled," a claimant must be unable to earn more than 80% of his or her predisability income from any employer in the claimant's local economy at any gainful occupation for which the claimant is reasonably qualified taking into account the claimant's education, training, experience, and predisability earnings.

On January 2, 2004, Huffaker sustained a rib fracture due to coughing. On January 21, 2004, she applied for short-term disability benefits. Treating physician, Dr. William Fry, noted that, although Huffaker was capable of working an eight hour work day, she was unable to perform heavy lifting. Huffaker's employer would not allow her to return to work with this restriction. The following week, Huffaker would be released to full duty with no work restriction. Nevertheless, MetLife approved short-term disability benefits for Huffaker with beginning date of January 3, 2004.

In February of 2004, Huffaker aggravated her rib injury and, at that time, the co- practitioner of Dr. Fry, Dr. Charles Bozeman, submitted an attending physician statement indicating a primary diagnosis of a fractured rib and secondary diagnoses of bronchitis and fibromyalgia. Dr. Bozeman stated that Huffaker was "able to perform most of her job part of the time;" that she was still recovering from her rib injury; and that Huffaker would be reevaluated in four to five weeks. On March 24, 2004, Dr. Bozeman submitted a treatment note indicating a worsened condition, stating that "[t]here is really hardly any place that she doesn't hurt;" that she was tender over her shoulders, arms, chest wall, abdomen, calves, thighs, and feet; and that Huffaker had fibromyalgia, hyperlipidemia, arthritis, myalgias, and an elevated level of CPK (an enzyme that can be suggestive of a variety of muscle disorders). Dr. Bozeman's treatment notes thereafter essentially are consistent in Huffaker's diagnosis of fibromyalgia and/or myfascial pain syndrome.

Huffaker was also evaluated by a neurologist, Dr. Darrell Thomas. Dr. Thomas noted Huffaker's complaints of pain, but noted normal results to physical testing. For example, Dr. Thomas found Huffaker's reflexes to be normal and symmetric in all four extremities. He found her gait and station to be normal. It appears that the parties dispute whether Dr. Thomas actually diagnosed Huffaker with fibromyalgia. However, in a submitted medical opinion form dated June 12, 2004, Dr. Thomas reported that plaintiff suffered moderately severe pain and that Huffaker would have reasonable medical necessity to be absent from work on a chronic basis. Further, Dr. Thomas believed plaintiff could sit for four hours in an eight hour work day, one hour at a time and could stand or walk for one hour per day, ten minutes at a time. He also stated that Huffaker could lift up to 5 pounds occasionally and up to 20 pounds infrequently.

At Dr. Bozeman's request, Huffaker was also seen on April 22, 2004 by a physical medical and rehabilitation doctor, Dr. Lisa Bellner, who found that Huffaker had generalized muscle pain. In particular, Dr. Bellner stated that "Ms. Huffaker has a constellation of symptoms not clearly identified. They are not entirely consistent with a diagnosis of fibromyalgia and the elevated CPK is suspicious for an underlying myopathic or metabolic process ...."

On May 6, 2004, Dr. Marcin Gornisiewicz, a rheumatologist, conducted an "exam [which] disclosed no evidence of inflammatory arthropathy and no evidence of neurological focal or motor deficits. The doctor noted that there were "a few tender points that suggest a myofasical component of her symptoms." As to his impression, Dr. Gornisiewicz believed that the most likely diagnosis would be fibromyalgia or chronic fatigue syndrome; however, he did not actually diagnose the plaintiff with any of these conditions. He stated that he would like to obtain additional records and additional laboratory tests to make sure that he is not missing any type of systemic involvement. Later, Dr. Gornisiewicz stated in a medical note that he felt that Huffaker did have fibromyalgia.

On April 1, 2004 and April 16, 2004, cardiologist, Dr. Roger Reidel, examined Huffaker. He stated as follows: "I am actually not sure what is going on with this lady. It seems like it is a little more than fibromyalgia. It should not cause abnormal CPK levels. I agree that she has some of the features of fibromyalgia, but boy I think she really does need a full evaluation by a rheumatolgy and neurolgy [sic] to see if we are not missing something." A later complete cardiac work-up revealed normal findings. Medical records from Dr. Bozeman's office dated April 26, 2004 state that Dr. Riedel "had encouraged her to discontinue her medicine ...."

On June 1, 2004, MetLife arranged for a review of Huffaker's file by Dr. Tracy Schmidt, a physician board certified in internal medicine and rheumatolgy. Dr. Schmidt recommended considering a physical functional capacity impairment to Huffaker's own occupation until such time as updated neurology records from Dr. Thomas and certain testing results could be obtained. MetLife extended the claim in accordance with Dr. Schmidt's recommendation.

Additional medical documentation from Dr. Thomas reflected "continued muscle cramping, etiology unknown." Testing with respect to muscle biopsy, blood chemistries, urinalysis, nerve condition studies, and studies of muscle electrical signals were all normal. Further, the physical examination, including motor strength, reflexes, gait and station, of Huffaker were all normal with the exception of decreased vibratory response in the lower extremities. Dr. Bellner submitted MRI results, which noted some disc bulging and degenerative changes. In records dated May 24, 2005, Dr. Bellner repeated her impression of "generalized body pain," remarking that the etiology was unclear. Dr. Bellner felt that no further radiology studies were necessary. Likewise, Dr. Reidel recommended no further cardiac evaluation were needed. Dr. Reidel commented as follows: "I am certainly not sure what exactly is causing all her ills .... It certainly fits along the line of fibromyalgia and chronic fatigue syndrom with some type of mood disorder." Dr. Bozeman repeated his opinion that Huffaker's pain and aliments were due to fibromyalgia. Further, it appears that many of the Huffaker's physicians thereafter began listing fibromyalgia in their treatment and assessment notes.

MetLife extended Huffaker's short-term disability benefits to July 9, 2004. Huffaker submitted a long-term disability claim, complaining of chronic pain. With the claim, Dr. Bozeman submitted an attending physician statement, diagnosing Huffaker with fibromyalgia and myofascial pain, as well as stating that Huffaker could only work one hour per day and that she had severe limitations in psychological functioning.

In response, on July 6, 2004, MetLife referred the matter to Dr. Schmidt for review. Dr. Schmidt recommended an independent medical examination by a rheumatologist. MetLife extended the claim by letter dated August 18, 2004, noting that continued benefits were dependant upon the outcome of the independent medical examination. Huffaker submitted notes of a "new patient consultation" with Dr. Kenny Sizemore, dated September 10, 2004. He felt that Huffaker's condition was "probable fibromyalgia" and stated that Huffaker was "so tender diffusely, I think even control points are positive." He also felt that it was impossible to determine accurately ...


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