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Parnagian v. Metlife Disability Insurance Co.

United States District Court, D. Massachusetts

September 29, 2017




         I. Introduction

         Plaintiff Elaine Parnagian brings this action requesting judicial review of Defendant Metlife Disability Insurance Company's (“MetLife”) denial of long-term disability (“LTD”) benefits under the Raytheon Company Disability Plan Income Policy (“Plan”). Complaint [#1]. Before the court are cross-motions for summary judgment. Defs.' Mot. J. on the R. [#58]; Pl.'s Cross Mot. J. on the R. [#63].

         II. Legal Framework and Standard of Review

         The Plan is covered by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B). “Among its panoply of remedial devices for plan participants, ERISA provides for suits to enforce rights conferred under the terms of an ERISA-regulated plan.” Denmark v. Liberty Life Assur. Co. of Boston, 566 F.3d 1, 5 (1st Cir. 2009). The parties here agree that in such suits, “summary judgment is merely a mechanism for tendering the issue and no special inferences are to be drawn in favor of a plaintiff resisting in summary judgment.” Liston v. Unum Corp. Officer Severance Plan, 330 F.3d 19, 24 (1st Cir. 2003). Instead, this court “sits more as an appellate tribunal than as a trial court. It does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.”[1] Leahy v. Raytheon Co., 315 F.3d 11, 17-18 (1st Cir. 2002).

         The parties further agree that because the Plan grants MetLife-as the Plan's Claims Administrator-discretionary authority to construe the Plan and to make determinations as to benefit eligibilities, “a decision made under the plan will be upheld unless it was ‘arbitrary, capricious, or an abuse of discretion.'” Niebauer v. Crane & Co., Inc., 783 F.3d 914, 923 (1st Cir. 2015) (quoting Cusson v. Liberty Life Assur. Co. of Boston, 592 F.3d 215, 224 (1st Cir. 2010). Under this “generous” standard, the court determines whether the plan administrator's decision based on the record before it was “reasoned and supported by substantial evidence.” See Medina v. Metro. Life Ins. Co., 588 F.3d 41, 45 (1st Cir. 2009) (citing Stamp v. Metro. Life Ins. Co., 531 F.3d 84, 88 (1st Cir. 2008)). Evidence is substantial when it is “reasonably sufficient to support a conclusion.” Ortega-Candelaria v. Johnson & Johnson, 755 F.3d 13, 20 (1st Cir. 2014) (citing Cusson, 592 F.3d at 230).

         The “mere existence” of contradictory evidence does not render a plan administrator's decision arbitrary and capricious. “Indeed, when the medical evidence is sharply conflicted, the deference due to the plan administrator's determination may be especially great.” Leahy, 315 F.3d at 19. Additionally, courts cannot require administrators automatically to accord special weight to the opinions of a claimant's treating physician; “nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003) (rejecting importation of the Social Security Administration's “treating physician rule” into the ERISA context).

         Thus, the “single question” before this court is whether MetLife “exercised its discretion reasonably, ” or abusively. See Colby v. Union Sec. Ins. Co. & Mgmt. Co. for Merrimack Anesthesia Assocs. Long Term Disability Plan, 705 F.3d 58, 61 (1st Cir. 2013).

         III. Factual Background and Administrative Decisions

         Plaintiff began working at Raytheon Company (“Raytheon”) in Tewksbury, MA, as a Senior Electrical Engineer II around December 8, 2008. See MET-01068-01069; Am. Compl. [#4] ¶¶ 17-20 [“Am. Compl.”]. In March 2010, Plaintiff began to experience a variety of symptoms including but not limited to headaches, fatigue, muscle and joint pain, and focus issues. See MET-00322-00323; MET-00752. For the next six months, Plaintiff was permitted to work from home. MET-01063-01064. On or about October 13, 2010, when Raytheon no longer permitted Plaintiff to work from home, she stopped working, and filed a claim for short-term disability (“STD”) under Raytheon's STD benefit plan. Am. Compl. [#4] ¶ 23; Defs.' Statement Undisputed Facts ¶ 5 [“Defs.' St. Undisp. Facts”] [#60]. MetLife initially denied Plaintiff's STD claim and confirmed its denial on administrative appeal. MET-01097, 01098. After she had exhausted the administrative review process, Plaintiff sued MetLife in this court on February 8, 2012, seeking to recover both LTD and STD benefits. Am. Compl. [#4] ¶ 34. In a settlement of that action, MetLife agreed to pay Plaintiff STD benefits, and to reconsider her LTD claim under the Plan for the period starting in December 2010. Am. Compl. [#4] ¶ 35.

         As part of the reconsideration process, Ms. Parnagian submitted additional documentation of her illness to MetLife, including her claim file with the Social Security Administration (“SSA”). See MET-00414.[2] Plaintiff also submitted updated medical records from her primary care physician, Dr.___ Silver, and from Dr. ___LaCava, her “long standing treating doctor and a specialist in chemical sensitivity.” Am. Compl. [#4] ¶ 22; see MET-01757 (MetLife's summary of documentation received in support of benefits application). In a letter to MetLife dated April 1, 2011, Dr. LaCava summarizes Plaintiff's relevant medical history, and his recommendations for treatment. See MET-00370-00372. He asserts that she “has a personal history of having been frequently sick from childhood and hypersensitive to various exposures” and that she suffers from severe “chemical sensitivities.” MET-00370. He also describes a variety of lab tests and their results which, in his opinion, demonstrate physical reactions to a variety of chemicals. See MET-00371. He asserts that:

[b]ecause Ms. Parnagian cannot drive to work, cannot work with anyone else, and cannot work in any building but very old, but clean buildings . . . without experiencing debilitating headaches, respiratory irritant effects, fatigue, and cognitive dysfunction . . . she is totally and permanently disabled from all gainful employment. The ubiquitous presence of the chemicals to which she reacts and her debilitating physical and neurological symptoms after such exposures would render her an unreliable employee in any capacity and therefore unemployable.


         At this point in the claims process, MetLife enlisted two physicians to evaluate Plaintiff's medical records. MET-00864-00879; 00828-00834. Dr. Stefanos Kales, a Diplomat on the American Board of Preventive Medicine (specializing in Occupational Medicine), opines that “there is no objective evidence of any occupational or environmental disorder in the records provided for Ms. ...

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