Pollini v. Raytheon Disability Employee Trust, 97-CV-12229 MEL.

54 F.Supp.2d 54

Frederick W. POLLINI and Pamela J. Pollini, Plaintiffs, v. RAYTHEON DISABILITY EMPLOYEE TRUST, The Trustees of Raytheon Disability Employee Trust and Metropolitan Life Insurance Company, Defendants.

No. 97-CV-12229 MEL.

United States District Court, D. Massachusetts.

May 11, 1999.

Robert O. Berger, III, Boston, MA, for Plaintiffs.

Rita Gylys, Blue Cross/Blue Shield of Massachusetts, Jean M. Kelley, Edward William Murphy, Morrison, Mahoney & Miller, Boston, MA, for Defendants.

LASKER, District Judge.

Frederick W. Pollini and his wife, Pamela J. Pollini, sue Raytheon Company, Raytheon Disability Employee Trust, and Metropolitan Life Insurance Company. As to the Trust and MetLife defendants, Pollini seeks reinstatement of his Long Term Disability insurance benefits ("LTD") under the Raytheon Long Term Disability Benefits Plan (the "Plan"), an employee benefit plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), as amended, 29 U.S.C. §§ 1001-1461. Pollini also asserts various state common law and state and federal statutory claims against Raytheon arising from Raytheon's allegedly wrongful termination of his employment. Mrs. Pollini alleges loss of consortium against all three of the defendants. Defendants, MetLife and the Trust, move for summary judgment on Counts V, VI, and VII. Raytheon, in a separate motion, seeks partial summary judgment on the remaining counts. This opinion addresses only the motion filed by the Trust and MetLife. That motion is denied as to Counts V and VI and is otherwise granted.

I.

On July 14, 1993, Pollini filed an application for LTD benefits with MetLife, Raytheon's claims administrator, and began receiving benefits shortly thereafter. However, on July 1, 1994, MetLife terminated his LTD benefits on the grounds that he was not "fully disabled."

Phase I of the Plan, which applies to the first two years of a disability, provides that LTD benefits are payable if the participant is "fully disabled." According to the Plan, a participant is "fully disabled" if he or she "cannot perform the essential elements and substantially all of the duties of his or her job at Raytheon even with reasonable accommodation." (R. at 274). To prove eligibility for benefits, an applicant must furnish "satisfactory medical proof" that he is "fully disabled." (R. at 340). The Plan further provides that "all determinations of the Plan Administrator and Claims Administrator with respect to any matter within their assigned responsibilities ... shall be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious."

In 1988, while working on his house, Pollini fell 15-20 feet from a scaffolding and suffered injuries to his lower back, left wrist, forearm and neck. As a result, he remained out of work and on disability leave for 20 months. In 1990, he returned to work at the instruction of Raytheon. However, on June 11, 1993, Pollini left his position at Raytheon as a design drafter/checker because of exacerbation of these injuries.

On July 14, 1993, Pollini applied for LTD benefits under the Plan. His claim for LTD benefits was based largely on the severe pain he was experiencing due to spasms in his lower back. In connection with Pollini's application, Dr. James E. Gaydos, D.O., his attending physician, completed an "Attending Physician's Statement of Disability" form regarding Pollini's injuries. Dr. Gaydos described the Pollini's symptoms as lower back spasms with pain in both legs. (R. at 1). Although Dr. Gaydos estimated Pollini could return to work in August, he also found that Pollini was "totally disabled," not only for his regular occupation but for all occupations. (R. at 1).

After Pollini began receiving LTD benefits, MetLife inquired into the severity of his physical condition. On August 19, 1993, Dr. Victor M. Parisien, M.D., an orthopaedic surgeon whom MetLife used as a consultant, performed an Independent Medical Examination ("IME") in which he found that Pollini "ha[d] quite a lot of limitation of movement of his back." (R. at 4). While Dr. Parisien considered Pollini "disabled from his work as a design drafting checker," he also concluded that Pollini "could perhaps do some light duty work with no prolonged sitting and no bending or lifting." (R. at 4-5).

On August 25, 1993, Dr. Gaydos completed an "Attending Physician's Supplementary Statement" in connection with Pollini's claim for LTD benefits. In this form, Dr. Gaydos described the nature of Pollini's illness as "chronic myofascial pain syndrome lumbar spine." (R. at 6). Additionally, he found that Pollini was "totally disabled from low back pain exacerbated by [his] long drive to work and [his] seating at work." (R. at 6).

By letter dated September 13, 1993, MetLife requested additional information from Dr. Gaydos concerning Pollini's injuries. In his response dated September 24, 1993, Dr. Gaydos, while conceding that he had not reviewed Dr. Parisien's report, characterized Pollini as "totally disabled." (R. at 12). He attributed the length of Pollini's disability to several factors, including his age, general state of deconditioning, a previous injury to his lower back, and the fact that he was diabetic. (R. at 12-13). Dr. Gaydos described Pollini as "unable to sit comfortably for more than 30 to 40 minutes at a time," and concluded that "a return to work at this time would compromise his recovery." (R. at 13). He suggested that Pollini undergo physical therapy for six to eight weeks and then "be re-evaluated for a possible return to work at that time." (R. at 13).

On February 9, 1994, Dr. Parisien reexamined Pollini and found that his condition had improved. Nevertheless, Dr. Parisien also concurred with Dr. Gaydos' observation that Pollini was "totally disabled from his customary work." (R. at 49). Dr. Parisien also noted that Pollini "still had some limitation in his range of motion," but that it was not of the considerable degree he had observed in his September 1994 examination of Pollini.

In March 1994, Pollini, upon being referred by Dr. Gaydos, was examined by Dr. Richard Day, M.D., at the New England Rehabilitation Hospital of Portland. Dr. Day completed an "Initial Outpatient Rehabilitation Medicine Consultation" form dated March 14, 1994, which reported that Pollini's MRI:

showed no herniations or bulges into neural canal ...; there were no disk herniations, significant bulges or other encroachments on neural structures ... [and] no evidence of compression fractures or their significant bone abnormalities.

(R. at 68). Nevertheless, Dr. Day's also observed that Pollini:

had not received relief with chiropractic and osteopathic manipulation ... [and] also had no relief with physical therapy.

(R. at 68).

On June 28, 1994, Dr. Azadian, a Raytheon physician, extended Pollini's medical leave of absence until July 1, 1994. On July 14, 1994, at MetLife's request, Dr. Greene examined Pollini, reviewed his MRI results, and commented that Pollini had not attended a chronic pain program recommended to him. Dr. Greene's assessment of Pollini was that:

[t]he patient presents a somewhat difficult diagnostic problem because his symptoms are obviously functionally exaggerated to a degree that is very difficult to assess objectively. I can only suggest chronic back strain, primarily low back....

Under these circumstances, and with his present mental outlook, it is very questionable that he could be employed in any capacity at the present time.

(R. at 108-9).

On August 26, 1994, after reviewing Dr. Gaydos' report of September 24, 1993 and the IME completed by Dr. Greene, MetLife wrote to Pollini notifying him of the termination of his LTD benefits. The letter stated that in reviewing:

all of the medical documentation contained in [Pollini's] file ... along with the information provided on the job duties of a Design Drafter/Checker, we feel that no objective information has been provided to support the subjective complaints of [l]ow [b]ack, shoulder, neck and wrist pain. Therefore we have no alternative but to terminate your claim effective July 1, 1994, the date your benefits were suspended.

(R. at 140). Pollini replied to Raytheon, by letter of September 9, 1994, requesting a review of his claim and giving MetLife permission to release all medical reports and IMEs to Dr. Gaydos, his primary care physician.

Upon review of the decision to terminate Pollini's LTD benefits, MetLife then solicited a further report from Dr. Gaydos. On August 31, 1994, Dr. Gaydos wrote to MetLife that:

[i]t was [his] current opinion that Mr. Pollini still suffers from the effects of his exacerbated low back, neck and shoulder symptoms that took him out of work. I feel that he is not able to return to work at the present time.

... I do not feel it will be in the immediate future that Mr. Pollini will be able to return to work, but rather I feel that a period of six months should be observed for continued physical therapy, home stretching and evaluations by myself before he can be re-evaluated for a possible return to work at that time.

(R. at 141). On September 16, 1994, MetLife wrote Dr. Gaydos requesting narrative responses to six questions relating to Pollini's condition and the completion of an Attending Physician's Statement of Functional Capacity form based on the most recent examination. (R. at 147).

Dr. Gaydos submitted a report dated October 3, 1994 and completed the "Attending Physician's Statement of Functional Capacity." In responding to MetLife's question regarding whether he concurred with Dr. Greene's findings, Dr. Gaydos stated that he agreed with Dr. Greene that Pollini experiences "`some limitation' on standing and sitting" and that he "may require a change in position from sitting to standing during the day." However, citing his experience of observing and treating Pollini during the previous year, he...