Employee Retirement Income Security Act of 1974 (\u201cERISA\u201d)<\/a>, 29 U.S.C. \u00a7\u00a7 1001 et seq., seeking review of MetLife\u2019s decision to discontinue Black\u2019s long-term disability benefits as of December 15, 2014. The parties filed cross-motions for judgment based on the Administrative Record.<\/p>\n\n\n\nOther important factors: <\/strong>In a call with MetLife, the claimant\u2019s physical therapist opined she could perform sedentary occupations (desk jobs), even with her impairments.<\/p>\n\n\n\nKey Physician Opinions: <\/strong>Based on the Internet Data Investigation Report, MetLife obtained an updated clinical opinion from MetLife Senior Medical Director David S. Peters, M.D. Dr. Peters opined on the claimant\u2019s restrictions and limitations as follows:<\/p>\n\n\n\n\n[T]here are significant cervical spine MRI findings and mildly decreased shoulder [range of motion]. Dr. Salamon has documented knee crepitation. Social media sites revealed her to be active and, in my opinion, restricted fulltime (8 hours daily) primarily seated work should be possible while continuing evaluation and treatment of her conditions. In my opinion, she should not be required to climb ladders and standing\/walking should be limited to 20 minutes per hour and to a daily total of 2.5 hours. She should not be required to work at or above shoulder level on the affected side. Lifting\/carrying\/pushing\/pulling should be limited to 10 pounds or less occasionally. She should be able to shift positions when seated and have 2-3 minute \u201cstand and stretch\u201d periods at least every hour in addition to standard morning, afternoon and lunch breaks. There is no detailed description of elbow, hand or wrist impairments and constant handling, feeling, fine fingering and grasping should be possible.<\/p>\n<\/blockquote>\n\n\n\nAfter her benefits were terminated, the claimant appealed. In connection with the appeal, MetLife referred Black\u2019s claim file to Robert H. Bolt, M.D., an \u201cindependent physician consultant\u201d (IPC) board-certified in orthopedic surgery, for his opinion on Black\u2019s restrictions and limitations. Dr. Bolt issued an initial report and two supplemental reports.<\/p>\n\n\n\n
On April 29, 2015, Dr. Bolt issued his second supplemental report based on new information from MetLife regarding the course requirements for the claimant\u2019s graduate studies. Dr. Bolt stated:
This [new information] does change my opinion. It states fairly clearly what is required of Ms. Black and, since she is getting a 4.0 GPA, she must be following those requirements. From this description, it appears that Mrs. Black can sit unlimited in an 8 hour day. She should be able to change positions as needed to standing and stretching for 5 to 10 minutes. As far as standing and walking is concerned, I feel that she does have some limitations and could stand and walk no more than 2 hour [sic] cumulatively in an 8 hour day but total work time could add up to 8 hours. I reviewed the Diary Notes hoping to find a recent conversation with Ms. Black where she described exactly what she does for her classes but that did not appear to be available. Also missing from the record are clinical reports from Dr. Neuschwander [sic] and Dr. Salamon\u2019s response to my report which is still pending.<\/p>\n\n\n\n
Issues: <\/strong>\u201cThe administrative record in this case leaves no doubt that the 2008 accident exacerbated preexisting conditions that Black had in her knees, right shoulder, and neck and that these injuries caused her pain which precluded her from performing the duties of her position at Visteon. There is also no question that Black continued to suffer from the pain and effects of her injuries over the next several years. The question for this Court, however, is whether Black\u2019s functional capacity showed improvement to the point that she was able to perform the duties of a sedentary occupation at the time MetLife terminated her benefits.\u201d<\/p>\n\n\n\nHoldings: <\/strong>\u201cThe evidence MetLife received in 2014, and in 2015 after Black appealed MetLife\u2019s initial denial, showed that Black\u2019s physical condition had in fact improved sufficiently to allow her to perform sedentary work.\u201d<\/p>\n\n\n\nNoteworthy court comments: <\/strong>\u201cThe Policy required Black to submit proof, satisfactory to MetLife, that she continued to be disabled not just from performing the duties of her prior occupation with Visteon, but \u201cany gainful occupation for which [she was] reasonably qualified taking into account [her] training, education, and experience.\u201d Pursuant to this provision, Black had the burden of proving that she continued to be disabled; MetLife was not obligated to prove that Black was not disabled.\u201d<\/p>\n\n\n\n\u201cBlack argues that MetLife\u2019s reliance on the attendance requirements of the Benedictine doctoral program\u2014full days at least one weekend per month\u2014and Black\u2019s trip to Dubai as part of that program to conclude that Black is not disabled from performing full-time work is \u201cabsurd\u201d because the number of days Black spent attending class (approximately 56 per year) is much less than the approximately 250 days per year that Black would be required to spend at full-time employment. While Black is correct that her attendance at the doctoral program cannot be equated to full-time work, her class attendance (as well as the out-of-class work she did toward completion of that program) is still material to whether she was disabled. First, her participation in the program, including travel to Illinois and attendance of classes at least one weekend per month, shows that she was not as limited as she claimed. For example, in her January 15, 2015, letter to MetLife, Black said that she could not \u201cbe up for more than a few hours and must rest . . . [and was] in constant pain.\u201d The fact that Black was able to travel several hours and sit through daylong classes shows that Black was not as limited as she claimed. Second, the fact that Black was able to earn and maintain a 4.0 GPA in a doctoral program\u2014certainly no easy feat\u2014undermines Dr. Neuenschwander\u2019s opinion that Black suffered from \u2018extreme fatigue, easy fatigability [sic], brain dysfunction (consistent with traumatic brain injury) and PTSD symptoms.\u2019\u201d<\/p>\n\n\n\n
Summary: <\/strong>The Court denied the plaintiff\u2019s motion, granted MetLife\u2019s motion, and affirmed MetLife\u2019s decision to discontinue benefits.<\/p>\n\n\n\nDisclaimer:<\/strong> The Ortiz Law Firm did not handle this claim. It is merely summarized here to provide claimants with a better understanding of how Federal Courts handle long-term disability insurance claims.<\/p>\n\n\n\nHere is a copy of the decision in PDF: Black v. MetLife<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"In this case, the court found that the evidence MetLife received in 2014, and in 2015 after Black appealed MetLife\u2019s initial denial, showed that Black\u2019s physical condition had in fact improved sufficiently to allow her to perform sedentary work<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[258],"class_list":{"0":"post-7458","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-case-summary-blog","7":"tag-metlife","8":"entry"},"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7458"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=7458"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7458\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7458"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7458"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}