The opinion of the court was delivered by: Judge Mattice
Brenda Satterwhite brings this action against Metropolitan Life Insurance Company, the Long Term Disability Plan for Employees of the U.S. Enrichment Corporation, and the United States Enrichment Corporation alleging a cause of action under 29 U.S.C. § 1132(a)(1)(B).
Before the Court is the Motion for Judgment on the Pleadings [Court Doc. No. 13], pursuant to Federal Rule of Civil Procedure 7(b) and the procedures set forth by the United States Court of Appeals for the Sixth Circuit in Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998) by which the Plaintiff seeks to have the Court overrule Defendant's decision to terminate her long-term disability benefits.
For the reasons explained below, the Plaintiff's Motion for Judgment on the Pleadings is GRANTED and this case is REMANDED to Metropolitan Life for a full and fair review of the administrative record.
A claim under 29 U.S.C. § 1132(a)(1)(B) for denial benefits is to be reviewed "under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the administrator or fiduciary is afforded discretion by the plan, the decision is reviewed under the arbitrary and capricious standard. Evans v. UnumProvident Corp., 434 F.3d 866, 875 (6th Cir. 2006). The parties here agree that Metropolitan Life's Plan affords deference to the administrator. The Court will therefore conduct its review under the arbitrary and capricious standard.
Under 29 U.S.C. §1132(a)(1)(B), a court's review is limited to the administrative record as it existed when the plan administrator made its final decision. Moon v. Unum Provident Corp., 405 F.3d 373, 378-79 (6th Cir. 2005). The arbitrary and capricious standard is one of the least demanding forms of review. McDonald v. Western-Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003). "Nevertheless, merely because our review must be deferential does not mean our review must also be inconsequential." Id. A court must "review the quantity and quality of the medical evidence and the opinions on both sides of the issues." Id. at 172. If the administrative record does not show that the administrator offered a "reasoned explanation" based on substantial evidence, the decision is arbitrary or capricious. Moon, 405 F.3d at 379. Substantial evidence means "much more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." McDonald, 347 F.3d at 171.
Brenda Satterwhite worked for U.S. Enrichment Corporation's (USEC) Paducah Gaseous Diffusion Plant as a Health Physics Technician until October 12, 2001. (Administrative Record ("A.R.") 260.)
A. USEC's Long Term Disability Plan
USEC maintains a long-term disability plan ("Plan") for its employees that is administered by Metropolitan Life Insurance Company (MetLife). (A.R. 123-26, Plan 252-53.) The Plan states: Under the Long Term Disability Plan, you are considered totally disabled during your first 24 months of Long Term disability if you are unable to perform the duties of your regular job with the Company due to illness or injury and are under the regular care of a licensed practicing physician. ...
After you have received Long Term Disability benefits for 24 months, you are considered totally disabled if you remain under the regular care of a licensed practicing physician and you are unable to work at any job for which you might be qualified based on your education, training and experience. In order to continue receiving benefits, you must furnish periodic medical evidence of your illness or injury if requested by the Company. (Plan 123.)
B. Satterwhite's Initial Diagnosis, Treatment, and Disability Award
Satterwhite filed for short-term disability benefits due to depression in October 2001. (A.R. 254-55.) Her application was accompanied by the physician statement of Dr. Banister, which diagnosed her with depression and indicated that she could not work "at that time" but estimated that she could likely return to normal work in six weeks. (Id.) The next month, Dr. Meals requested that Satterwhite be excused from work until December 31, 2001 due to her treatment for depression. (Id. at 219.) Dr. Meals also referred Satterwhite to a psychiatrist, Dr. Meyer, for an evaluation. (Id. at 217.) Dr. Meyer diagnosed Satterwhite as having "Major depression, moderate to severely moderate" and found her to have a Global Assessment of Functioning Score (GAF) of 52. (Id. at 218.) He noted that she was "not psychotic" and recommended treatment with Effexor and Ambien. (Id.)
After receiving Dr. Meyer's evaluation, MetLife arranged for a non-treating psychiatrist, Dr. Frye, to conduct an Independent Psychiatric Examination (IPE) of Satterwhite. (A.R. 203-05.) Dr. Frye reviewed Satterwhite's full medical records and interviewed her in person for six hours. (Id. at 187-90.) Dr. Frye found that Satterwhite was "entrenched in her conviction that she cannot return to work at USEC" and that her conviction was "psychologically driven, rather than work related." (Id. at 191.) Dr. Frye conducted two personality tests which showed that Satterwhite was "experiencing difficulties consistent with depression, anxiety, and agoraphobia (fear of being around other people)" and that she was possibly experiencing a psychotic process. (Id. at 193.)
Dr. Frye diagnosed Satterwhite with a delusional disorder, a personality disorder, and stated that Satterwhite was "currently experiencing significant psychological difficulties which include anxious, phobic and depressive symptoms." (Id.) Dr. Frye found Satterwhite's GAF score was 50. (Id.) Dr. Frye recommended that Satterwhite's "possible psychotic process" be treated or ruled out and stated that a trial of antipsychotic medications could potentially be very effective in treating Satterwhite's delusional disorder. (Id. at 194) Ultimately, Dr. Frye found that Satterwhite was "not likely to work successfully in any capacity" for at least two to four weeks. (Id.)
Following the receipt of Dr. Frye's IPE, MetLife approved Satterwhite's short-term disability benefits. At the expiration of her short-term disability benefits, Satterwhite applied for long-term disability benefits. (A.R. 161-70.) Dr. Meyer, Satterwhite's treating physician, completed an attending physician statement that listed her diagnosis as "severe major depression." (Id. at 165.) The recommended treatment plan was a "high dose of Effexor and Wellbutrin and Lithium" with a possible trial of "MAOI." (Id. at 165.) Dr. Meyer also noted that Satterwhite was "not responding to aggressive treatment" and that she was "unresponsive to counseling." (Id.) Dr. Meyer characterized her psychological functioning as "Class 5 - Patient has significant loss of psychological, physiological, personal and social adjustment (severe limitations)" and noted that her condition was a "refractory, severe case so far." (Id.) Dr. Meyer estimated that Satterwhite could work zero hours a day and stated that he had not advised Satterwhite to return to work as she had not yet responded to treatment. (Id. at 166.) On this evidence, MetLife approved Satterwhite's long-term disability claim, stating that she would be entitled to benefits until she recovered, was denied second phase approval, died or reached age 65. (Id. at 243.)
As required by the Plan, (Plan 125) Satterwhite pursued a disability claim with the Social Security Administration. (A.R. 154-57.) Total disability was awarded to her in early 2003. (Id. at 4-5, 139-43.) Per the terms of the Plan, (Plan 125) MetLife began offsetting the amount it paid to Satterwhite by the amount that she received from Social Security. (A.R. 5.)
In August 2003, MetLife began reviewing Satterwhite's file to determine if she was eligible for phase two benefits - those awarded if a claimant is unable to perform any job -which would take effect in April 2004. (Id. at 130.) MetLife requested Dr. Meyer's office notes, testing results, recommended restrictions and limitations, and asked Dr. Meyer to complete a behavioral health form that it provided. (Id.) MetLife also asked Dr. Meyer to determine whether Satterwhite could not perform only her prior job or whether she could not perform any job. (Id.) If Dr. Meyer determined that Satterwhite could not perform any job, he was required to submit "specific clinical reasons, factors and/or complications preventing (Satterwhite) from returning to the workforce." (Id. at 131.)
Dr. Meyer completed the required behavioral health form, stating that Satterwhite's condition was "very severe; among the most severe in my large practice of > 1000 pts." (A.R. 107.) He listed her most recent GAF score as 50 and categorized her impairment as moderately severe or severe in thirteen of sixteen categories. (Id. at 108.) Dr. Meyer noted that Satterwhite had "poor concentration, anxiety, low energy" and that she was "too depressed to work with any accommodation." (Emphasis in original.) (Id. at 109.) He responded that Satterwhite could not perform her prior job in another department or division or even for another employer and estimated her return to work date as "never." (Id.) Dr. Meyer also submitted his office notes and other requested information, stating that Satterwhite's "prognosis for returning to work, unfortunately, is poor, and she is disabled and unable to perform any job." (Id. at 99.)
In January 2004, MetLife referred Satterwhite's file to a nurse consultant for a transition review. The nurse consultant noted that "med does seem to support disab[ility]." (A.R. 7.)
MetLife again requested medical information from Satterwhite in March 2004, including her most recent treatment notes and any restriction and limitations. (A.R. 91.)
Due to confusion over whether Satterwhite had relocated and was under the care of another physician, MetLife temporarily suspended her disability benefits on April 14, 2004 for lack of information. (Id. at 89-90.) Satterwhite responded with a statement indicating that Dr. Meyer was still her treating physician and included Dr. Meyer's most recent treatment notes. (Id. at 85-88.) Based on that information, MetLife approved Satterwhite's disability under the more strenuous "any job" phase two disability standard. (Plan123, A.R. 14.) MetLife noted that Satterwhite's medication supported her disability and indicated it was severe enough to prevent her from returning to work. (A.R. 14) MetLife's notes state that the administrator should follow-up in nine to twelve months for updated medical information. (Id. at 19.)
In March 2005, MetLife issued another request for information. (Id. at 78.) It asked Satterwhite to provide her treatment notes from October 2004 through March 2005, her most current restrictions and limitations, her current GAF score, and asked to have an enclosed behavioral assessment form completed. (Id. at 19, 78.) Dr. Meyer completed the requested form, noting that Satterwhite's GAF score was 45 and that her condition was "severe, chronic, refractory." (A.R. 73.) He stated that Satterwhite had "no energy", that she had to "push self to get out of bed" and that she hated to leave the house and was "not social." (Id.) Dr. Meyer claimed that Satterwhite would be "a fatigued, inattentive employee prone to absenteeism and accidents." (Id.) Dr. Meyer indicated that he was seeing Satterwhite every two to three months and estimated that Satterwhite would never be able to return to work. (Id.) MetLife called Dr. Meyer's office and confirmed the information he had submitted. (Id. at 22.) On the basis of this information, MetLife approved Satterwhite's claim stating "medical supports to 8/31/05." (Id.)
On August 11, 2005 MetLife again requested current medical information for Satterwhite. (A.R. 63.) In a fax sent directly to Dr. Meyer's office, MetLife requested Satterwhite's progress/office notes from March 2005 to August 2005, the frequency of her visits including her next scheduled office visit date, and her current treatment plan including medications and dosages. (Id.) MetLife did not include a form for Dr. Meyer or Satterwhite to complete nor did it request a GAF score or other objective ...