United States District Court, D. Massachusetts
For Selma Al-Abbas, Plaintiff: Mala M. Rafik, LEAD ATTORNEY, Socorra A. Glennon, Rosenfeld Rafik & Sullivan, P.C., Boston, MA.
For Metropolitan Life Insurance Company, Defendant: Beth G. Catenza, LEAD ATTORNEY, Concord, NH; William D. Pandolph, Sulloway & Hollis, P.L.L.C., Concord, NH.
MEMORANDUM AND ORDER ON PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT AND DEFENDANT'S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD
F. Dennis Saylor IV, United States District Judge.
This is a civil action arising under the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § 1001 et seq. Plaintiff Selma Al-Abbas was a participant in a disability plan as part of her employment with International Business Machines Corporation (" IBM" ). Defendant Metropolitan Life Insurance Company of America (" MetLife" ) is the claims administrator for the plan. Al-Abbas contends that she is totally disabled and cannot work at any occupation.
Al-Abbas has moved for summary judgment and defendant has cross-moved for judgment on the administrative record. For the reasons stated below, both motions will be denied and the case will be remanded to the plan administrator.
Selma Al-Abbas received a degree in chemical engineering from Purdue University. She then began working full-time for IBM in 1984. She was initially an engineer, but eventually became an account sales representative. That position required her to sit for three to four hours per day, stand for one to two hours, walk for one to two hours (including on uneven ground), drive a car or truck, work overtime on a routine basis, occasionally lift up to 50 pounds, and travel within the United States two times per month. It allowed her some flexibility to work from home. According to Al-Abbas, the work also required extensive computer use, ability to multi-task, ability to concentrate, and presentation and communication skills.
B. Relevant Plan Language
As part of her employment, Al-Abbas was enrolled in a long-term disability benefits plan administered by MetLife. The plan defines " disabled" as follows:
[D]uring the elimination period [26 weeks] and the first 12 months after you complete the elimination period, you cannot perform the important duties of your regular job with IBM because of a sickness or injury. After expiration of that 12 month period, disabled means that, because of a sickness or injury, you cannot perform the important duties of any other gainful occupation for which you are reasonably fit by your education, training or experience.
C. Medical History from 1998 to February 2010
In 1998, Al-Abbas was in a motor vehicle accident. After the accident, she developed a condition that her primary-care physician, Dr. Lynn Durand, eventually diagnosed as fibromyalgia. In 2006, Al-Abbas was in another motor vehicle accident. She also began experiencing problems with her eyes, including blotchy and blurred vision in her right eye and pain. She also reported difficulty sleeping, frequent light-headedness, muscle pain, and cognitive dysfunction. Opthamologist Dr. Andre d'Hemecourt and neuro-ophthalmologist Dr. Marc Dinkin both diagnosed optic neuropathy. Dr. Durand tested her for Lyme disease; the IgM Western Blot test was negative but the IgG test by IGeneX was positive. She did not definitively diagnose Lyme disease but suspected, from
that point onward, that Al-Abbas's symptoms stemmed from that disease. Al-Abbas declined treatment with antibiotics in favor of alternative methods.
Throughout 2007 and 2008, Al-Abbas reported continued symptoms, such as insomnia, cognitive dysfunction, episodes of partial vision loss, tremors in her left hand, and fasciculations. However, she reported generally that she was stronger and better overall and that her neurological symptoms were improving. She underwent testing at Brigham & Women's Hospital, from which her physicians concluded that she did not have multiple sclerosis. Al-Abbas did test positive for the fungal infection known as candidiasis, for which she received treatment by medication and by altering her diet.
In the fall of 2009, Al-Abbas began experiencing greater difficulty walking, along with cramping, heart palpitations, insomnia, fatigue, and tremors. She reports that her family members, friends, and neighbors took over cooking, cleaning, and shopping because she no longer could complete those tasks. Dr. Durand treated her for chronic fatigue and immune deficiency syndrome.
In February 2010, Al-Abbas reported increased symptoms, much worse than those she had experienced prior to this period. The record suggests that in this time period, IBM allowed Al-Abbas some accommodations, such as telecommuting, so that she could continue working.
D. Medical History from February to August 2010
On February 27, 2010, Al-Abbas took a medical leave of absence from IBM. At the time, she reported symptoms including numbness in her extremities and buttocks, generalized weakness, insomnia, jerking and tremors, heart palpitations, sensitive skin with a burning sensation, fatigue, dizziness, difficulty thinking, ear pain, night sweats, anxiety, hair loss, weight loss, and a purple left toe. She also developed a sensitivity to smells and chemicals. As a result, she had difficulty typing, walking, grasping, and carrying on a conversation, and could not drive a car or watch television.
Al-Abbas saw a number of physicians, who performed variety of tests in an attempt to determine a diagnosis. An MRI revealed no evidence of hemorrhage, infarction, or other abnormality that would explain her symptoms; there were no abnormalities in her cervical spine; an EKG test and holter monitor measured results within normal limits; and a lumbar puncture found no evidence of demyelinating disease. Dr. Durand continued to believe that Al-Abbas had active chronic Lyme disease, and thought it was the cause of her fatigue and autoimmune symptoms. Ultimately, Dr. Mark Biletch, a neurologist, remarked that it was " challenging" to come up with a " unifying diagnosis." (AR 500).
Dr. Durand referred Al-Abbas to other physicians and specialists. Dr. Biletch noted that she was anxious and somatically oriented, but that she was attentive and oriented and that her language and speech were normal. Neurologist Dr. Ann Cabot described her as symptomatic but neurologically stable, and observed that she had fluent and coherent language, no difficulty finding words, no tremor or atrophy, and no cognition problems. Neurologist Dr. Keith McAvoy noticed a mild optic pallor in her right eye and hand tremors, but likewise reported that she was alert and oriented and that she could squat and stand without use of her hands and ...