Adams v. Metropolitan Life Ins. Co., Civil Action No. 06-301-JJB-DLD.

549 F.Supp.2d 775

Bridget ADAMS v. METROPOLITAN LIFE INSURANCE COMPANY, et al.

Civil Action No. 06-301-JJB-DLD.

United States District Court, M.D. Louisiana.

May 21, 2007.

June E. Denlinger, Baton Rouge, LA, for Bridget Adams.

Virginia N. Roddy, Jennifer M. Lawrence, Leslie N. Ladner, Preaus Roddy & Associates, L.L.C., New Orleans, LA, for Metropolitan Life Insurance Company.

RULING AND ORDER

JAMES J. BRADY, District Judge.

This matter has been submitted to the court for a Trial on the Briefs. The parties have agreed to try this action in this manner.¹ The parties have filed a stipulated administrative record² and have submitted their briefs into the record in this case.³

A trial on the briefs is treated as a bench trial rather than a motion for summary judgment and is therefore governed by Federal Rule of Civil Procedure 52(a). See Davis Oil Co. v. Mills, 873 F.2d 774, 777 (5th Cir.1989); St. Tammany Parish Tax Collector v. Barnesandnoble.com, 481 F.Supp.2d 575, 576-77 (E.D.La.2007). Pursuant to Fed.R.Civ.P. 52(a) this ruling constitutes the court's findings of fact and conclusions of law.

I. Findings of Fact

A. The Plaintiff and Her Claims

The plaintiff, Bridget Adams is a former employee of Dow Chemical Company ("Dow"). (R. 270).⁴ Prior to working at Dow, the plaintiff was a cosmetologist. (R. 183). She is 48 years old and has a highschool diploma. (R. 270, 183). The plaintiff began working with Dow in 1990 and was employed as an Operations Specialist. (R. 270, 272).

Dow created an Employee Benefits Plan and defendant, Metropolitan Life Insurance Company ("MetLife"), was a claim administrator. The plan provided long term disability insurance. The plaintiff alleges that she is disabled "because of severe vascular headaches which cause excruciating pain that may last for several days." The plaintiff contends that:

During these headaches, she is sensitive to light and noise, experiences nausea, develops muscle spasms and often can do nothing other than staying in bed. After the headaches she is weak, achy, and fatigued for days. She also suffers from anxiety, stress and panic attacks. The symptoms are so severe that she must have assistance from family and friends to do even the basic household tasks.

[She] also suffers from multi-level degenerative disk disease of her cervical spine, a bulging disk in the cervical spine, carpel tunnel syndrome, and degenerative changes and tendonitis to the shoulder. These conditions cause decreased range of motion, stiffness, weakness and radiating pain to her neck, arm and fingers, particularly in her dominant right side.⁵

The plaintiff received long term disability benefits from March 2003 through March 2005.⁶ The plaintiff brought suit against Dow and Metropolitan Life Insurance Company after a March 4, 2005 determination that the plaintiff no longer met the qualifications for being "disabled" under the policy. The plaintiff contends that "these denials were arbitrary and capricious, not supported by or consistent with the evidence presented, and a breach of the Plan terms."⁷ The parties stipulated to the dismissal of The Dow Chemical Company and an order dismissing the plaintiffs claims against Dow with prejudice was entered by the Court.⁸

B. The Policy

The Plan had two phases of eligibility for its Long Term Disability ("LTD") benefits. Phase I LTD (the Primary Benefit Period) is the 24 month period after the initial six month Waiting Period⁹ and Phase II LTD (the Second Benefit Period) starts the day after Phase I LTD ends. Each phase had its own definition of "disability." Under the plan, "disability" is defined as follows:

Phase I: You cannot, because of a sickness or an injury, perform your regular job or any other reasonably appropriate job your Employer can provide. Phase I is the same as "Full Disability" described in the Certificate of Insurance. Phase II: You cannot, because of sickness or an injury:

a. do your job; and

b. do any other job for which you are reasonably fit by your education, your training or your experience (including work with a Participating Employer, self-employment or work with another employer.

Phase II is the same as "Total Disability" described in the Certificate of Insurance.¹⁰

C. The Plaintiffs Medical Condition

1. Dr. Gerard Falgoust — Primary Treating Physician

The plaintiff has sought treatment from Dr. Gerard Falgoust since August 1994. (R. 267). In May 2002, Dr. Falgoust concluded that the plaintiff suffered from severe migraine headaches and photophobia that made it unsafe for her to climb, work at heights, or be in an environment where she was stressed or exposed to sunlight. Dr. Falgoust concluded that the plaintiff could not return to her work at Dow or any other occupation. (R. 268).¹¹

The plaintiff had several visits to Dr. Falgoust in May 2002. On May 7, 2002, Dr. Falgoust concluded that the plaintiff suffered from daily severe migraines that would prevent her from working. (R. 190, 223, 234). On May 30, 2002, Dr. Falgoust noted disabling headaches and photophobia. (R. 191, 222, 233).

On July 31, 2002 the plaintiff was seen again by Dr. Falgoust and he documented her "continued severe disabling" headaches. (R. 193, 221, 232). On that same date, Dr. Falgoust wrote to Dr. Gruwell informing him that the plaintiff remained "completely & totally disabled" due to her headaches. (R. 211).

Dr. Falgoust saw the plaintiff again on November 27, 2002;¹² he described the plaintiff as having daily headaches that worsen throughout the day. (R. 186). He noted that the drug Zomig provided the plaintiff with relief but left her weak. Dr. Falgoust concluded that the plaintiffs headaches were chronic, daily, disabling, and daylong. (R. 186).

The plaintiff visited Dr. Falgoust several times in 2003. (R. 131, 132).¹³ Each time Dr. Falgoust concluded that the plaintiff was suffering from headaches. On a May 27, 2003 visit Dr. Falgoust noted that in addition to the plaintiffs chronic headaches, the plaintiff had Degenerative Disk Disease at C5-C6 and arm and shoulder pain. (R. 116,133).

In response to a July 2003 request from MetLife for information about the plaintiff, Dr. Falgoust wrote that the plaintiffs headaches were unilateral or bilateral and were an 8-9 level of intensity on a scale of 10. Dr. Falgoust found that the headaches were worsened by activity, sunlight, or loud noises. He noted that the headaches occurred daily and were daylong. Dr. Falgoust also listed the drugs that had been prescribed to the plaintiff. Some of the drugs were ineffective, others provided only partial relief. (R. 129-130).

On a January 7, 2004 office visit, Dr. Falgoust described the plaintiff as suffering from anxiety attacks, stress attacks, and weight loss in addition to chronic migraine headaches. The plaintiff was also sent to an orthopedist for tendonitis. (R. 66). The plaintiff visited Dr. Falgoust again on April 2, 2004. On this occasion he found that the plaintiff continued to suffer from severe disabling headaches as well as Degenerative Disk Disease to her cervical spine. (R. 99).

On May 13, 2004 Dr. Falgoust wrote to MetLife informing the company that in his opinion, the plaintiffs headaches were "completely disabling, requiring bed rest and occasional narcotic analgesia." Dr. Falgoust found that the plaintiff was "unemployable" and "completely disabled for her current job." (R. 81). Dr. Falgoust also completed MetLife's "Attending Physician Statement of Functional Capacity" dated June 4, 2004. (R. 82-83, 68, 70). In the Physician's Statement, he noted that the plaintiffs severe daily headaches were worsened by noise, heat, light, or stress and were only temporarily relieved by medication. Dr. Falgoust concluded that the plaintiff was totally disabled from her work at Dow or any other occupation and that she could never resume work activities. (R. 83).

The plaintiff visited Dr. Falgoust's office on June 24, 2004. Dr. Falgoust documented that the plaintiff complained of severe continuous pain. (R. 72). According to Dr. Falgoust's summary, he "ordered MRFs which confirmed arthritis and tendonitis of the shoulder, and C-spine DDD with neuroforaminal narrowing consistent with nerve root impingement." (R. 57).

On March 22, 2005 Dr. Falgoust wrote to MetLife. He stated that in his opinion the plaintiff "is totally and permanently disabled for any occupation." (R. 58).¹⁴

2. Dr. Dennis Gruwell — Dow Chemical Company Physician

Dr. Dennis Gruwell is employed by Dow Chemical Company's Health Services. In May 2002 and July 2002, Dr. Gruwell contacted Dr. Falgoust regarding the plaintiffs medical condition. (R. 211, 215).

On September 16, 2002 Dr. Gruwell indicated that Dow could not accommodate the plaintiffs restrictions for work and that there was no other job available that could accommodate the restrictions. (R. 251).

On February 28, 2003, Dr. Gruwell summarized the plaintiffs medical history as headaches beginning when the plaintiff was 7 or 8 years old and worsening over time to the point where she now had headaches several days out of the week. (R. 158). Dr. Gruwell concluded that the plaintiff could not perform her job at Dow. He stated that "currently she is clearly unable to perform her usual and customary job. I also feel she is not able to perform any job at the present time." (R. 159).

3. Dr. William Gilbreath — River West Medical Center

On July 11, 2002 the plaintiff went the River West Medical Center Emergency Room. (R. 239, 237). The plaintiff complained of chronic headaches to the left side for six days and nausea. The plaintiff was also bothered by light. The plaintiff was referred to Dr. Falgoust for follow-up treatment. (R. 242).

4. Dr. Steven J. Cavalier — Neurology

On August 2, 2002, the plaintiff saw Dr. Steven Cavalier. (R. 196). Dr. Cavalier concluded that the plaintiff experienced headaches that could last for days at a time. She currently used Zomig, Maxalt, and Imitrex. She had tried...