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Carty v. Metropolitan Life Insurance Co.

United States District Court, M.D. Tennessee, Nashville Division

December 16, 2016

GARY CARTY, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, EASTMAN CHEMICAL COMPANY WELFARE BENEFIT PROGRAM, and EASTMAN CHEMICAL COMPANY, as Plan Administrator for the EASTMAN CHEMICAL COMPANY WELFARE BENEFIT PROGRAM, Defendants.

          MEMORANDUM

          ALETA A. TRAUGER United States District Judge.

         Before the court are three motions for judgment on the administrative record. Two of the defendants, Eastman Chemical Company and the Eastman Chemical Company Welfare Benefit Program (collectively, “Eastman”), have filed a Motion for Judgment on the Administrative Record (Docket No. 38), to which plaintiff Gary Carty has filed a Response (Docket No. 49) and Eastman has filed a Reply (Docket No. 50). The third defendant, Metropolitan Life Insurance Company (“MetLife”), has filed a Motion for Judgment on the Administrative Record, in which it adopts and incorporates by reference the arguments raised by Eastman (Docket No. 40), along with a Reply (Docket No. 51) adopting and incorporating Eastman's Reply to Carty's Response. Finally, Carty has filed a Motion for Judgment on the ERISA Record (Docket No. 41), to which Eastman has filed a Response (Docket No. 47) and MetLife has filed a Response adopting and incorporating Eastman's Response (Docket No. 48), and Carty has filed a Reply (Docket No. 52). For the reasons discussed herein, the motions filed by Eastman and MetLife will be denied, Carty's motion will be granted, and Carty's claim will be remanded to MetLife for further consideration.

         BACKGROUND

         This action - brought under the civil enforcement provisions of the Employee Retirement Income Security Act, 29 U.S.C. § 1132 et seq. (“ERISA”) - concerns the discontinuation of Carty's long term disability (“LTD”) benefits. Carty, as a former Eastman Chemical Company employee, is a beneficiary under the self-funded LTD Plan of the Eastman Chemical Company Welfare Benefit Program. (Docket No. 1 ¶¶ 4, 6, 9.) MetLife is the claims administrator of the LTD Plan. (Id. at ¶ 5.) Carty stopped working for Eastman on November 28, 2013, and was approved for LTD benefits beginning on June 8, 2013. (Id. at ¶¶ 14, 17.) MetLife terminated Carty's benefits by letter dated April 17, 2015. (Id. at ¶ 18.) Carty exhausted his administrative appeals and filed the instant action challenging the cessation of his benefits. (Id. at ¶¶ 20-21.)

         I. Applicable Plan Provisions

         The LTD Plan states that its purpose is to “provide[] continuing income when you are unable to work due to an extended disability.” (Administrative Record (“AR”) (Docket Nos. 18- 27, 33) at 1070.) The Plan lists a number of requirements, all of which must be met, “[t]o be considered disabled under the LTD [Plan].” (Id. at 1071.) After the first eighteen months of benefits, the Plan provides that, to continue to be considered disabled, “you may not earn more than 50% of your pre-disability earnings from any employer in your local economy at any gainful occupation for which you are reasonably qualified taking into account your training, education and experience.” (Id.)

         The Plan also requires that the recipient be receiving “appropriate care and treatment, ” defined as follows:

         Appropriate care and treatment means medical care and treatment that is:

o given by a licensed physician whose medical training and clinical specialty are appropriate for treating your condition;
o consistent in type, frequency, and duration of treatment with relevant guidelines of national medical research, health care coverage organization and governmental agencies applicable to your condition;
o consistent with a licensed physician's diagnosis of your condition; and
o intended to maximize your medical and functional improvement.

(Id.)

         The plan provides for ongoing review and reconsideration of eligibility: “The Claims Administrator periodically reviews your continued eligibility for LTD Plan benefits. You must cooperate with and respond to any request that the Claims Administrator makes relating to your claim.” (Id. at 1077.) “If the Claims Administrator determines that you are no longer eligible for LTD benefits, your benefits will terminate at the end of the month that determination is made.” (Id.) However, “benefits will terminate immediately on . . . the date you are no longer disabled because you are engaging in gainful work[, or] the date the Claims Administrator determines that you are not receiving Appropriate Care and Treatment.” (Id. at 1078.)

         The Plan grants MetLife discretion in construing the Plan and determining eligibility:

[MetLife] shall have the complete discretionary authority to control the operation and administration of this Program, with all powers necessary to enable it to properly carry out such responsibilities, including, but not limited to, the power to construe the terms of this Program, to determine status, coverage and eligibility for Benefits and to resolve all interpretive, equitable and other questions that shall arise in the operation and administration of the Program.

(Id. at 1062.) Among the powers expressly granted MetLife are the power “to exercise discretion in interpreting the Program, its interpretation thereof in good faith to be final and conclusive on all persons claiming Benefits under the Program.” (Id.) Eastman is ultimately responsible for funding any benefits awarded under the program. (Id. at 1014.)

         II. Carty's Medical and LTD History

         Before leaving work due to his disability, Carty was a manager in Eastman's information technology department. (AR at 628.) According to Eastman's job description for the position, Carty's responsibilities “include[d] understanding how IT-related capabilities enable business processes” and “design[ing], develop[ing] and deploy[ing] the necessary software and/or hardware solution to fulfill [business] requirements.” (Id. at 620.) His salary was $126, 200 per year. (Id. at 592.) His long-term disability claim form indicates that he suffered from bipolar disorder, anxiety, and depression, for which he was first treated in October of 2011 and which resulted in his eventual disability on November 28, 2012. He identified his treating physician for the disabling conditions as Dr. Ronald Smith of Kingsport, Tennessee. (Id. at 628.)

         A. Treatment by Dr. Smith

         Ronald Smith is a physician who is board certified in psychiatry. (AR at 173-74.) On August 6, 2015, Dr. Smith gave a statement in which he testified that he began seeing Carty in November of 2011 and that Carty has a diagnosis of “bipolar type two disorder most often in depressed phase, and generalized anxiety disorder with episodes of panic.” (Id. at 174-75.)

         When asked if Carty had been compliant with his treatment regiment, Dr. Smith testified:

He's attended therapy sessions as scheduled. In the years I've seen him he has missed an occasional appointment, but he has been compliant. He's taking - he has taken the medicine I've given him or at least tried to take them and ran into side effects and make [sic] alterations in the regimen so he could tolerate it.

(Id. at 176.) Dr. Smith conceded that, when he “first saw [Carty, ] the bipolar diagnosis wasn't clear, ” but that Dr. Smith eventually identified “mood cycling” indicative of bipolar disorder. (Id. at 177.) According to Dr. Smith, Carty continued to exhibit at least periodic uncertainty about the ...


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