Hailey v. Verizon Communications Long Term Disability Plan
Filing
27
MEMORANDUM OPINION in 17 MOTION for Summary Judgment by Latoshia Hailey. Signed by District Judge Gerald Bruce Lee on 10/22/2014. (jlan)
IN THE UNITED STATES DISTRICT COURT FOR THE
EASTERN DISTRICT OF VIRGINIA
ALEXANDRIA DIVISION
LATHOSHIA HAILEY,
Plaintiff,
V.
Case No. l:13-cv-001528-GBL-JFA
VERIZON COMMUNICATIONS
LONG TERM DISABILITY PLAN,
Defendant.
MEMORANDUM OPINION AND ORDER
THIS MATTER is before the Court on Plaintiff Latoshia Hailey's ("Hailey") and
Defendant Verizon Communications Long Term Disability Plan's ("Verizon") Cross-Motions
for Summary Judgment (Docs. 17 and 20). This case involves a denial of disability benefits by
Defendant Verizon, through its Plan administrator MetLife under the Employee Retirement
Income Security Act ("ERISA"), after previously granting Plaintiff benefits for a limited number
of days.
The issue before the Court is whether the Court should deny Plaintiffs Motion for
Summary Judgment, and grant Defendant Verizon's Motion for Summary Judgment, where
Plaintiff argues that Verizon, through its plan administrator MetLife, abused its discretion by
unreasonably interpreting the Plan and improperly terminating Ms. Hailey's disability benefits in
a manner contrary to ERISA. The Court DENIES Plaintiff Latoshia Hailey's Motion for
Summary Judgment, and GRANTS Defendant Verizon's Motion for Summary Judgment,
because Defendant did not abuse its discretion in determiningthat Plaintiff did not qualify for
short-term or long-term disability benefits. First, Verizon, through MetLife, properly exercised
its authority in determining that Ms. Hailey was not eligible for short-term or long-term benefits
based on its interpretation of its policy language and medical findings. The Court affords
deference to the claim administrator's findings that Ms. Hailey's various medical conditions did
not amount to functional incapacity. Second, MetLife's decision-making process was deliberate
and principled. MetLife's review process was exhaustive and included the opinion of a
physician retained by the insurance company and follow-up communications with Ms. Hailey's
attending physicians. Third, MetLife's decision was supported by substantial evidence.
Accordingly, the Court DENIES Plaintiff Latoshia Hailey's Motion for Summary
Judgment, and GRANTS Verizon's Motion for Summary Judgment.
L
BACKGROUND
Ms. Hailey began working for Verizon Communications as a service specialist in 1997
and became a manager in December 2005. (Verizon's Brief in Support of it Motion for
Summary Judgment H 13, Doc. 20.) ("Verizon Brief) Verizon Communications Long Term
Disability Plan (the "Plan") is administered by MetLife ("MetLife"). {Id. at H12.) The plan
constitutes an "employee welfare benefit plan" and is subject to various provisions of ERISA.
{Id. at p.1.) Ms. Hailey was a participant in the Plan during all relevant periods. {See generally
id.) Verizon is the Plan's fiduciary, however MetLife made all final determinations regarding
disability. {Id. at ^ 12.) There is no conflict of interest between the fiduciary Verizon and the
claims administrator MetLife. {Id. at p. 19.)
Ms. Hailey suffers from a menagerie of ailments including fibromyalgia. (Plaintiffs
Brief ISO Motion for Summary Judgment p. 1, Doc. 17.) ("Hailey Brief) On April 11, 2012,
Ms. Hailey underwent a hysterectomy to which she was entitled to short-term disability ("STD")
benefits from April 11, 2012 through June 20, 2012. (Verizon Brief at ^^14-15.) Subsequently,
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Ms. Hailey was also approved for STD benefits from August 20, 2012 through October 7,2012,
for self-reported pain related to her fibromyalgia, which was unrelated to her previous claim.
{Id. 111117-23.) In its approval letter for Ms. Hailey's second claim. Defendant stated that medical
information supported functional impairment. (Hailey Brief p. 11.) Ms. Hailey's STD benefits
from her second claim were retroactively terminated from October 7, 2012 onwards by letter
dated November 8, 2012, after MetLife received additional information and continued its
investigation of Plaintiffs claims. (Verizon Briefs 30.)
During its investigationMetLiferetained a physician and had follow-up conversations
with Ms. Hailey's treating physicians. {Id. at
33-40.) Dr. Dennis Gordan, MetLife's
physician, recognized Ms. Hailey's fibromyalgia, but found that there was no medical evidence
to corroborate Ms. Hailey's self-reported pain and inability to perform sedentary work. {Id. at H
30.) Notably, Ms. Hailey's records indicate that she reported having the "same," "unchanged"
pain for many years, as early as March 2012. {Id. at H25.) Ms. Hailey not only continued to
work, but was promoted duringthis time period. (Defendant's Opposition to Plaintiffs Motion
for Summary Judgment p. 3.) ("Verizon Opposition") Additionally, Ms. Hailey reported to her
physicians that she felt overwhelmed due to her promotion, adoption of a three-year-old child,
and long commute. (Verizon Briefs 19.)
Long-term disability (LTD) was denied to Ms. Hailey by letter dated November 9, 2012.
{Id. at p. 31.) Ms. Hailey timely appealed on May 7, 2013. {Id. at H32.) By letters dated August
22 and 28, 2013, Defendant denied Ms. Hailey's appeal of its termination of STD and LTD
benefits, respectively. {Id. at p. 21.) Ms. Hailey has complied with and exhausted all
administrative appeals. (Hailey Briefp. 4.) Ms. Hailey filed a timely Complaint in this Court on
December 13, 2013. (Doc. 1.)
On June 6,2014 both parties filed motions for summary judgment. On July 9, 2014, both
parties filed their respective oppositions. On September 5, 2014, oral argument was held on the
Parties' Cross Motions for Summary Judgment.
II.
A.
STANDARD OF REVIEW
Rule 56 Summary Judgment Motion
Pursuant to Federal Rule of Civil Procedure 56, the Court must grant summary judgment
if the moving party demonstrates that there is no genuine issue as to any material fact, and that
the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c) (2014).
In reviewing a motion for summary judgment, the Court views the facts in a light most
favorable to the non-moving party. Boitnott v. Corning, Inc., 669 F.3d 172, 175 (4th Cir. 2012)
{citingAnderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986)). Once a motion for summary
judgment is properly made and supported, the opposing party has the burden of showing that a
genuine dispute exists. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87
(1986); Bouchat v. Baltimore Ravens Football Club, Inc., 346 F.3d 514, 522 (4th Cir. 2003)
(citations omitted). "[T]he mere existence of some alleged factual dispute between the parties
will not defeat an otherwise properly supported motion for summaryjudgment; the requirement
is that there be no genuine issue of material fact." Emmett v. Johnson, 532 F.3d 291, 297 (4th
Cir. 2008) (q\xoXm% Anderson, 477 U.S. at 247-48).
A "material fact" is a fact that might affect the outcome of a party's case. Anderson, 477
U.S. at 248; JKC HoldingCo. v. Wash. Sports Ventures, Inc., 264 F.3d 459, 465 (4th Cir. 2001).
Whether a fact is considered to be "material" is determined by the substantive law, and "[o]nly
disputes over facts that might affect the outcome of the suit under the governing law will
properly preclude the entry of summary judgment." Anderson, All U.S. at 248; Hooven-Lewis v.
Caldera, 249 F.3d .259, 265 (4th Cir. 2001).
A "genuine" issue concerning a "material" fact arises when the evidence is sufficient to
allow a reasonable jury to return a verdict in the nonmoving party's favor. Resource Bankshares
Corp. V. St. Paul Mercury Ins. Co., 407 F.3d 631, 635 (4th Cir. 2005) {citingAnderson, 477 U.S.
at 248). Rule 56(e) requires the nonmoving party to go beyond the pleadings and by its own
affidavits, or by the depositions, answers to interrogatories, and admissions on file, designate
specific facts showing that there is a genuine issue for trial. Celotex Corp. v. Catrett, 477 U.S.
317, 324(1986).
B.
District Court's Review of Administrative Record
District courts have a framework for reviewing the denial of benefits under ERISA plans.
Where the terms of an employee benefit plan provide discretionary authority to determine a
claimant's entitlement to benefits or to construe the terms of a plan, the fiduciary's decision is
granted deference and will be overturned only where there is an abuse of discretion. Firestone
Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 (1989). In such a case, the court will apply an
abuse of discretion standard of review. Feder v. Paul Revere Life Ins. Co., 228 F.3d 518, 522
(4th Cir. 2000). In an abuse of discretion standard of review, evidence to be considered by a
district court is limitedto the administrative record, which consists of the claim file and the plan
documents. Williams v. Metropolitan Life Ins. Co., 609 F.3d 622, 631 (4th Cir. 2010).
In reviewing the administrative record, a district court should not disturb a reasonable
administrative decision, even if the court itself would have reached a differentconclusion. Haley
V. Paul Revere Life Ins. Co., 11 F.3d 84, 89 (4th Cir. 1996). District courts assess reasonableness
by determining whether the administrative decision is the result of a deliberate, principled
reasoning process supported by substantial evidence. Evans v. Eaton Corp., 514 F.3d 315, 322
(4th Cir. 2008). Accordingly, the district court reviews a denial of benefits deferentially to
determine if an abuse of discretion occurred, such that it can be shown that the determination
was arbitrary and capricious. Firestone Tire & Rubber Co., 489 U.S. at 113. The non-exclusive
factors a court may consider when determining whether an abuse of discretion occurred include:
(1) the language of the plan; (2) the purpose and goals of the plan;
(3) the adequacy of the materials considered to make the decision
and the degree to which they support it; (4) whether the fiduciary's
interpretation was consistent with other provisions in the plan and
with earlier interpretations of the plan; (5) whether the decisionmaking process was reasoned and principled; (6) whether the
decision was consistent with the procedural and substantive
requirements of ERISA; (7) any external standard relevant to the
exercise of discretion; and (8) the fiduciary's motives and any
conflict of interest it may have.
Champion v. Black & Decker (U.S.) Inc., 550 F.3d 353, 359 (4th Cir. 2008) (citing Booth v. WalMart Stores, Inc. Assocs. Health
Welfare Plan, 201 F.3d 335, 342-343 (4th Cir.2000)). A
discretionary determination will be upheld if reasonable. Champion, 550 F.3d at 359.
III.
DISCUSSION
The Court DENIES Plaintiff Latoshia Hailey's Motion for Summary Judgment and
GRANTS Defendant Verizon's Motion for Summary Judgment, because Defendant Verizon did
not abuse its discretion in terminating Ms. Hailey's benefits. MetLife's decision was the result
of a deliberate and principled reasoning process and supported by substantial evidence. Verizon,
through its plan administrator MetLife, properly exercised its authority in determining that Ms.
Hailey is not eligible for short-termor long-term benefits based on its interpretation of the Plan
policy language and its outside consultant's medical findings. The Court affords deference to
MetLife's determination that Ms. Hailey's various medical conditions did not amount to
functional incapacity.
In reviewingthe decision of an administrator with discretionary authority, the fiduciary's
decision is granted deference. The administrator's decision will be overturned only where there
is an abuse of discretion. Firestone^ 489 U.S. at 109. An abuseof discretion is determined by a
standard where the court analyzes whether the administrative decision is reasonable. Haley, 11
F.3d at 89. The Court analyzes reasonableness using non-exclusive factors including:
(1) the language of the plan; (2) the purpose and goals of the plan;
(3) the adequacy of the materials considered to make the decision
and the degree to which they support it; (4) whether the fiduciary's
interpretation was consistent with other provisions in the plan and
with earlier interpretations of the plan; (5) whether the decisionmaking process was reasoned and principled; (6) whether the
decision was consistent with the procedural and substantive
requirements of ERISA; (7) any external standard relevant to the
exercise of discretion; and (8) the fiduciary's motives and any
conflict of interest it may have.
Champion, 550 F.3d at 359 (4th Cir. 2008). In this case, Ms. Hailey, a plan participant in an
ERISA-established plan, was denied short-term and long-term benefits after being awarded
benefits for a period of time. Ms. Hailey alleges that she suffers from a variety of illnesses,
including fibromyalgia. In analyzing the reasonableness of the administrator's decision, the
parties numerous arguments primarily relate to four Booth factors, namely (3) the adequacy of
the materials considered to make the decision and the degree to which they support it; (4)
whether the fiduciary's interpretation was consistent with other provisions in the plan and with
earlier interpretations of the plan; (5) whether the decision-making process was reasoned and
principled; (6) whether the decision was consistent with the procedural and substantive
requirements of ERISA. Accordingly, the Court looks at these four factors in reviewing the
parties' Motions for Summary Judgment.
A.
The Adequacy of the Materials (3)
The court finds that MetLife's claim decision did not abuse its discretion because the
materials considered were adequate and support its findings. The third Booth factor requires that
the decision be supported by substantial evidence. Helton v. AT&T Inc., 709 F.3d 343, 358-59
(4th Cir. 2013). Substantial evidence is evidence that "a reasoning mind v^ould accept as
sufficient to support a particular conclusion." Donnell v. Metropolitan Life Ins. Co., 165 Fed.
Appx. 288,295 (4th Cir. 2006) (unpublished opinion)'; LeFebre v. Westinghouse Elec. Corp.,
747 F.2d 197,208 (4th Cir. 1984). Substantial evidence consists of "more than a scintilla but
less than preponderance" of evidence. LeFebre, 747 F.2d at 208.
Ms. Hailey argues that MetLife's decision was not based on substantial evidence because
MetLife unreasonably relied on an insurance company retained physician's findings instead of
the opinions of her treating physicians whom were more "qualified." (Hailey Brief p. 25.)
Additionally, Ms. Hailey argues that MetLife failed to recognize chronic pain as a legitimate
disabling condition, ignored the sum of the conditions she suffers from, and further ignored the
effects of her prescriptions.
In Donnell plaintiffs claim for disability was also based on fibromyalgia and chronic
fatigue. MetLife, also the claim administrator there, denied plaintiffs claim finding that the
illnesses were not disabling under the plan's definition. There, a fimctional capacity evaluation
of plaintiffconcluded that Donnell could "perform up to five hours per day of light work or six
hours per day of sedentary work." The Fourth Circuit found this evidence sufficient, and held
' The Courtrecognizes that this is an unpublished opinion issued by the FourthCircuitCourt of
Appeals prior to January 1, 2007. However, the Donnell case has precedential value in relation
to the material issues in this case and there is no publishedopinion that would serve as well.
that MetLife's claim decision was not unreasonable in finding that Donnell did not qualify for
benefits.
Here, MetLife considered all the documentation provided by Ms. Hailey and her treating
physicians, and further retained a physician to review her claim and follow-up with her treating
physicians. Unlike, the plaintiff in Donnell, here Ms. Hailey presents no evidence of any
functional capacity evaluations but asserts that her pain and tiredness render her unable to
perform her job. Courts have found that "[i]t is not an abuse of discretion for an administrator to
adopt the reasonably formed opinion of one doctor over another." Frankton v. Metropolitan Life
Ins. Co, Civil No. 1:08-cv-2209,2009 WL 3215954, *9 (D. Md. Sept. 30,2009); Elliott v. Sara
Lee Corp., 190 F.3d 601, 606 (4th Cir. 1999). Accordingly, MetLife was justified in choosing to
rely on its physician's findings even if they conflicted with the opinions of Ms. Hailey's treating
physicians.
Ms. Hailey's arguments that MetLife failed to recognize chronic pain as a legitimate
disabling condition, ignored the sum of her conditions, and further ignored the effects of her
prescriptions also fails. MetLife's physician. Dr. Dennis Gordan, whose opinion MetLife could
rely, considered this evidence and found that it did not warrant the provision of benefits. It is
evidentthat MetLife considered Ms. Hailey's chronic pain as potentially disabling. Their
finding was that there was no evidence to support such a claim. Additionally, Dr. Gordan
specifically asked one of Ms. Hailey's treating physicians if any other illness besides
fibromyalgia contributed to Ms. Hailey's lackof capacity, to which her physician replied in the
negative. (AR-H00053.) Even had the treating physician answered differently, asking the
question meant that MetLife considered the sum of Ms. Hailey's conditions. During MetLife's
review of Ms. Hailey's appeal Dr. Gordan reviewed a letter written by Ms. Hailey's treating
physician documenting Ms. Hailey's "decreased cognitive ability" due to her various
medications. MetLife found this letter to be unpersuasive because no cognitive tests were done
to support this conclusion. Accordingly, the Court finds that Defendant Verizon, through its plan
administrator MetLife, made a decision that was based on adequate materials that supported its
decision.
B.
Fiduciary's interpretation was consistent with other provisions in the plan
and with earlier interpretations of the plan (4)
The Court finds that Verizon, through its plan administrator MetLife, has not abused its
discretion because its interpretation of the Plan was consistent with other provisions and its
earlier interpretations of the Plan. The fourth Booth factor requires that the fiduciary's
interpretation be consistent with provisions of the plan and with any earlier interpretations.
Booth, 201 F.3d at 342. Where there is an allegation of different treatment of claims
substantively or procedurally, a court will balance these assertions against the plan provider's
denial. Wasson v. Media General, Inc., 446 F. Supp. 2d 579, 601 (E.D. Va. 2006). First, it must
be noted that Ms. Hailey does not contend that she was treated differently than any other
participant in the Plan, but only that Verizon and MetLife's earlier interpretation of her claims
are inconsistent. Specifically, Ms. Hailey points to MetLife's original acceptance of her medical
documentation as evidence of functional incapacity and then its later finding that the same
evidence was insufficient as support for her claim. Ms. Hailey also alleges that Defendant only
considered functional impairment as a disability, when the policy at issue only required an
inability to do the essential functions of her job. Ms. Hailey further asserts that Defendant
impermissibly ignored that she was awarded Social Security benefits and that Defendant
incorrectly assumed that the capacity for isolated work is the same as the ability to work fulltime consistently—^which she argues is inconsistent with the Plan.
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First, while Plaintiff did receive benefits for forty-eight (48) days based on her claim of
pain and fatigue due to fibromyalgia, the awarding of benefits for a limited time does not
invalidate a later determination that Ms. Hailey did not qualify for further benefits under the
Plan. The Plan provides that "STD benefits generally are payable for up to 30 days" for
disabilities with subjective diagnosis that are based on self-reported pain. (AR-H00665.)
Further, the Plan states that benefits are payable beyond that 30 days if you have self-reported
pain and you "are receiving appropriate care and treatment from a doctor" and you also "provide
objective clinical evidence or findings that support a medical or psychiatric condition." {Id.)
(emphasis added) The Plan itself thus contemplates that after thirty (30) days additional
information is required.
Ms. Hailey argues that because her evidence was initially accepted, any later
determination was improper. This is contrary to the Plan and the September 13,2012 letter Ms.
Hailey received which stated that "In the event that your disability extends beyond [October 7,
2012], you are required to contact MetLife .... Please have your health care provider fax ...
specific medical information in order to consider the claim for possible continuation benefits."
(AR-H00495). This letter clearly indicates that in order to receive continued benefits more
information would need to be reviewed. Ms. Hailey's argument thus fails because MetLife's
initial provision of benefits for forty-eight (48) days did not entitle her to an award of STD or
LTD benefits. Accordingly, there was no inconsistent interpretation of the Plan.
Similarly, Ms. Hailey's argument that the Plan only considered fimctional impairment
does not provide evidence of inconsistency in the Plan's interpretation. The record indicates that
MetLife considered whether plaintiff could perform the functions of her sedentary job. (ARH00283.) Ms. Hailey's assertion that MetLife impermissibly ignored that she was awarded
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Social Security benefits also does not provide a basis for a finding of inconsistency. The Plan
clearly states that "an approved SSDI claim does not automatically result in an approved or
denied LTD claim," so the consideration of SSDI benefits is within the discretion of the claims
administrator, (AR-H00665.) Additionally, the record is not clear as to whether the documents
were ever submitted to or received by Verizon. Ms. Hailey's argument that Defendant
incorrectly assumed that the capacity for isolated work is the same as the ability to work full-
time consistently does not warrant a finding of inconsistencies in the Plan's interpretation.
C.
Whether the Decision-making Process was Reasoned and Principled (5)
The Court also finds that Verizon, through its plan administrator MetLife, has not abused
its discretion because its decision-making process was reasoned and principled. "An
administrator's decision is reasonable if it is the result of a deliberate, principled reasoning
process and if it is supported by substantial evidence." Evans, 514 F.3d at 322. A principled
reasoning process can be determined by consideration of the complete record, reliance on
independent medical evaluations, and assessment of the claimant's vocational capacity amounted
to a principled reasoning process. Donnell, 165 F. App'x. at 294-95.
In Donnell, plaintiff similarly appealed the decision of MetLife, the administrator of her
long-term disability benefits. Donnell, 165 F. App'x at 292. Upon appeal, MetLife
commissioned a physician not affiliated with Metlife to review the medical evidence in
Donnell's file. Donnell, 165 F. App'x at 291. The court found that Metlife's decision-making
process was principled and reasonable because it was a genuine and thorough consideration of all
the evidence before it. Donnelly 165 F. App'x at 295. Additionally, Metlife reviewed all
medical evidence that Donnell submitted, measured Donnell's vocational abilities, procured an
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independent evaluation of the medical evidence, and considered all of the conditions that
Donnell claimed contributed to her disability. Id.
Ms. Hailey argues that MetLife's decision-making process in denying her appeal was not
reasoned and principled. (Hailey Opposition p. 2.) Ms. Hailey contends that MetLife did not
give fair consideration to the opinions of her treating physicians and that MetLife did not rely on
substantial evidence in terminating her benefits. {Id at pp. 2-7.) The Court finds that MetLife
did not abuse its discretion because their decision-making process was reasoned and principled
based on the guidelines set forth in Donnell. MetLife's evaluation of Ms. Hailey's appeal
included an evaluation of Plaintiffs MRIs, X-ray, nerve condition test results, and a variety of
medical records from Ms. Hailey's physicians.
MetLife retained an outside consultant physician. Dr. Gordan, to conduct a review of Ms.
Hailey's appeal, which included reviewing the medical records of Ms. Hailey's treating
physician as well as follow-up discussions with them in order to make the most principled
decision. (AR 00041-58.) The reviewing physicians' statements in large part confirmed the Dr.
Gordan's findings. (Id.) For instance, one of Ms. Hailey's treating physicians confirmed that
fibromyalgia was the only illness that contributed to her impairment. (AR-H00053.) Further,
her treating physician acknowledged that she was not aware that any strength or range of motion
measurements had ever been taken. (Id.) Ms. Hailey's physician did however report in response
to an inquiry from MetLife's physician, that it might be difficult for Ms. Hailey to perform her
work duties due to "decreased cognitive ability." (AR-H00071.)
The Court finds that like Donnelly MetLife's decision-making process was reasoned and
principled because upon review of Ms. Hailey's appeal of MetLife's decision, MetLife carefully
and thoroughly investigated Ms. Hailey's claim using both the information that Ms. Hailey
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claimedcontributed to her disability and the evaluations of a board-certified physician. MetLife
followed the terms of the Plan and determined that Ms. Hailey had not met her burden of
establishing that she was disabled. Thus, the Courtfinds that MetLife's decision-making process
was not arbitrary and capricious.
D,
Consistent with the procedural and substantive requirements of ERISA (6)
The Court also finds that Verizon, through its plan administrator MetLife, has not abused
its discretion because its decision was consistent with the procedural and substantive
requirements of ERISA. ERISA requires that each employee benefit plan "(1) provide adequate
notice in writing to any participant or beneficiary whose claim for benefits under the plan has
been denied, setting forth the specific reason for such denial" and that each person be given a
reasonable opportunity to appeal the decision denying their claim for benefits. 29 U.S.C. § 1133.
ERISA's purpose is to protect "contractually defined benefits," however, it does not "regulate
the substantive content of health plans. Massachusetts Mut. Life Ins. Co. v. Russell, 473 U.S.
134, 148 (1985); Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 752 (1985).
Donnell, is also instructive in an analysis of the sixth Booth factor. There, Donnell
similarly asserted that MetLife violated procedural regulations governing benefits claims under
ERISA, because its denial letters did not outline the evidence necessary to perfect her appeal.
Donnell, 165 Fed. Appx. at 296. Donnell, also claimed, like Plaintiff does here, that her claim
was decided outside the regulation's time for appeal. Id. In Donnell, the Court of Appeals
Fourth Circuit held that "none of these arguments persuades [the court] to find that MetLife
abused its discretion.. .[ERISA] does not direct [] plan administrators to provide claimants with
a formula for obtaining benefits." Id. There the Court also recognized that MetLife decided
Donnell's appeal outside of the allotted days but held that "we have made clear that we will not
14
find an abuse of discretion based on ERISA procedural violations absent 'a causal connection.'"
Id.
Here, similar to Donnell, Plaintiff argues that Defendant failed to provide her with a
description of any additional material or information necessary for her to perfect her claim.
However, it is clear from the record, as well as Ms. Hailey's own brief, that MetLife found that
there was "no objective evidence" to support Ms. Hailey's claim. (AR-H00283.) Ms. Hailey
sites to several cases from the Second Circuit Court of Appeals, in support of the position that
"[a] denial of an appeal that is based on insufficient notice as to how the claim might be
perfected fails to meet the requirements of ERISA." (Hailey Opposition p. 12. citing Cook v.
New York Times Co. Long-Term Disability Plan, 2004 WL 203111 (S.D.N.Y. Jan. 30, 2004);
Juliano v. Health Maintenance Organization ofNew Jersey, Inc., 221 F.3d 279, 287 (2nd Cir.
2000); Omara v. Local 32B-32-J Health Fund, 1999 WL 184114 (E.D.N.Y. March 30, 1999)))
However, this argument fails because MetLife did exactly that and further, the Fourth Circuit has
previously held that a formula need not be given. See Donnell, 165 Fed. Appx. at 296. In its
November 8,2012 denial letter, which Plaintiff cites in her brief, MetLife states "[p]Iease submit
medical documentation that includes current office notices with test results that substantiate your
medical condition as being physically disabling." (AR-H00283) (emphasis added) Here,
MetLife clearly sets out that test results that substantiate the medical conditions asserted are
necessary to perfect the claim and had no need to provide a formula. Accordingly, Defendant's
decision was consistent with the procedural and substantive requirements of ERISA.
The Court need not consider Ms. Hailey's claim that Defendant's post hac arguments are
irrelevant. The record provides sufficient evidence to conclude that Defendant did not abuse its
discretion in denying Ms. Hailey STD or LTD benefits.
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V. CONCLUSION
For the foregoing reasons, IT IS HEREBY ORDERED that Plaintiff Latoshia Hailey's
Motion for Summary Judgment (Doc. 17) is DENIED; and it further
ORDERED that Defendant Verizon Communications Long Germ Disability Plan's
Motion for Summary Judgment (Doc. 20) is GRANTED.
IT IS SO ORDERED.
ENTERED this
day of October, 2014.
Alexandria, Virginia
10/^^2014
Gerald Bruce Lee
United States District Judge
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