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WHITE v. AIRLINE PILOTS ASSOCIATION

April 8, 2005.

KATHLEEN WHITE, Plaintiff,
v.
AIRLINE PILOTS ASSOCIATION, INTERNATIONAL and METROPOLITAN LIFE INSURANCE COMPANY, Defendants.



The opinion of the court was delivered by: MORTON DENLOW, Magistrate Judge

MEMORANDUM OPINION AND ORDER

Plaintiff Kathleen White ("Plaintiff" or "White") seeks judicial review of a final decision denying her Long Term Disability ("LTD") benefits pursuant to the terms of an Employee Welfare Plan ("the Plan") sponsored by her former employer, defendant Airline Pilots Association International ("ALPA"). The Plan was insured by the defendant Metropolitan Life Insurance Company ("MetLife"). The issue before this Court is whether MetLife was arbitrary and capricious in denying White's claims for LTD benefits.

This case comes before the Court by means of a trial on the papers in which the parties have submitted briefs and supporting exhibits which constitute the record in this case. See Sullivan v. Bornemann, 384 F.3d 372, 375 (7th Cir. 2004) (noting that a district court decision, rendered after reviewing the stipulated facts of the parties, was more akin to a bench trial than summary judgment, and was thus governed by Federal Rule of Civil Procedure 52(a)); Hess v. Hartford Life & Accident Ins. Co., 274 F.3d 456, 461 (7th Cir. 2001) (entering a judgment based upon a stipulation of facts that made up an administrative record was treated as a bench trial governed by Fed.R.Civ.P. 52(a)); La Barge v. Life Ins. Co. of N. Am., 2001 WL 109527, *1 (N.D.Ill.Feb. 6, 2001) (conducting a trial on the papers in an ERISA case); Morton Denlow, Trial on the Papers: An Alternative to Cross-Motions for Summary Judgment, Fed. Lawyer, Aug. 1999, at 30. The parties agreed to proceed in this manner and to waive their right to present oral testimony. Oral argument was held on March 28, 2005.

  The following constitute the Court's findings of fact and conclusions of law pursuant to Rule 52(a) of the Federal Rules of Civil Procedure. To the extent certain findings may be deemed to be conclusions of law, they shall also be considered conclusions of law. Similarly, to the extent matters contained in the conclusions of law may be deemed findings of fact, they shall be considered findings of fact.

  I. FINDINGS OF FACT

  A. THE PLAINTIFF: KATHLEEN WHITE

  White was employed by ALPA for fifteen years, from January, 1987 to May, 2002. R. 74. Her position with ALPA was "Senior Communications Specialist," R. 26, where she provided support and counsel to ALPA's Director of Communication and to the Master Executive Counsel for the United Air Lines Pilots regarding member relations, media relations, public relations, editorial services, and video production. White Aff. ¶ 7, Exh. A.*fn1 White has two Bachelor of Arts Degrees, one in Journalism and Marketing from Lewis University and a second in Labor Studies from Antioch College, as well as a Master's Degree in Business Administration, also from Lewis University. White Aff. ¶ 3.

  B. PROCEDURAL HISTORY

  As an insurance benefit of her employment, White was insured under a long term disability insurance policy underwritten by MetLife. R. 47-73. On May 17, 2002, White stopped working at ALPA. R. 28. White claimed that she was disabled and unable to return to work as a result of physical pain and mental depression resulting from a thoracotomy*fn2 on her right lung, an incurable blood disease called porphyria cutanae tardia ("PCT"),*fn3 mitral valve prolapse,*fn4 and carotid arteriosclerosis.*fn5

  White filed her application with MetLife for LTD benefits on September 10, 2002 through ALPA's Benefits/HRIS Administrator, Matthew Szlapak. R. 25-45. MetLife denied her application on November 1, 2002. R. 210-12. White appealed the decision on November 22, 2002. R. 17-18. Included in her appeal was a letter dated November 8, 2002, prepared by her treating physician, Dr. Adam Milik, in which he opined that White was unable to return to work. R. 19-20. This appeal was denied on December 12, 2002. R. 214-17. Plaintiff sent MetLife more documents in support of her appeal on January 30, 2003, March 20, 2003, and on April 10, 2003. R. 119-22, 204, 224. MetLife again denied her claim. R. 213, 204.

  White brought this lawsuit on May 10, 2004. This case is before the Court on a trial on the papers. The record before the Court consists of the MetLife administrative record compiled by MetLife in reviewing White's claim. R. 1-237.*fn6 On December 19, 2003, the Social Security Administration approved White's claim for disability insurance benefits, R. 193-95, commencing in January, 2004. R. 195.

  C. THE METLIFE DISABILITY PLAN

  The MetLife Disability Policy ("the Plan") provides long term disability benefits to otherwise eligible Plan participants deemed "totally disabled". R. 68. The Plan covers "all active full time senior managers and directors." R. 72. It provides that a participant must first be continuously disabled for a 90 day "Elimination Period" before he or she may become eligible for benefits. R. 68. The Plan defines "disability" as:
"Disable" or "Disability" means that, due to sickness, pregnancy or accidental injury, you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis; and
1. during your Elimination Period and the next 36 month period, you are unable to earn more that 80% of your Predisability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy; or
2. after the 36 month period, you are unable to earn more than 60% of your Indexed Predisability Earnings from any employer in your Local Economy and any gainful occupation taking into account your training, experience and Predisability Earnings.
R. 68.
  MetLife reviewed Plaintiff's claim during the "Own Occupation" phase. The Plan defines "Own Occupation" as:
"Own Occupation" means the activity that you regularly perform and that serves as your source of income. It is not limited to the specific position that you held with your Employer. It may be a similar activity that could be performed with your Employer or with any other Employer.
R. 67. The Plan also provides the following definition of the term "Local Economy":
"Local Economy" means the geographic area surrounding your place of residence which offers reasonable employment opportunities. It is an area within which it would not be unreasonable for you to travel to secure employment. If you move from the place you resided on the date you became Disabled, we may look at both the former place of residence and your current place of residence to determine the local economy.
Id.
  The Plan vests MetLife, as Plan fiduciary, with discretionary authority to make determinations of eligibility for LTD benefits. Specifically:
In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.
R. 50.

  D. WHITE'S MEDICAL CONDITION AND TREATMENT RECORDS

  1. Dr. Adam W. Milik — Primary Treating Physician Before Surgery

  On May 15, 2002, White began experiencing a severe pain in her right side. R. 120, 123. After the pain did not subside within a few days, White consulted her primary care physician, Dr. Adam Milik. R. 120, 123. Dr. Milik thought that White may be suffering from a gallbladder problem, but testing of her liver, gallbladder, and pancreas revealed nothing. R. 123, 39. 2. Dr. Raju Z. Abraham — Emergency Room Doctor

  On May 24, 2002, when the pain persisted, White presented herself to the emergency room at Riverside Medical Center where she was seen by Dr. Raju Abraham. R. 123. Dr. Abraham prepared a "History of Present Illness" which noted that an x-ray had revealed an increasing right effusion*fn7 and infiltration in her chest. R. 123-26. Dr. Abraham noted that White had increased pain in her right lower chest, shortness of breath, and shallow respirations. R. 123. Dr. Abraham also noted that White had a history of medical problems including PCT, mitral valve prolapse, and carotid arteriosclerosis. R. 123-25.

  3. Dr. Paul E. Rowland — Surgeon

  White was eventually diagnosed with "right lower lobe pneumonia with multiloculated pleural effusions and entrapped right lower and middle lobes of the lung." R. 129. On May 29, 2002, White underwent a thoracotomy*fn8 on her right lung which was performed by Dr. Paul Rowland. R. 127-32. Following the surgery, White remained under the care of Dr. Roland until July 16, 2002. R. 21. On July 16, 2002, Dr. Rowland wrote to Dr. Milik, updating him on the condition of his patient and noting that White's "wounds have healed normally and she is doing well. The chest wall discomfort is improving fairly rapidly." R. 21. 4. Dr. Adam W. Milik — Primary Treating Physician After Surgery

  On August 5, 2002, White returned to Dr. Milik complaining of "atypical" right sided chest pains and shortness of breath. R. 23. Dr. Milik noted that the pains were on and off, sometimes lasting the entire day. Id. Dr. Milik noted that White was very emotional and cried easily. White's EKG was normal; there were no signs of ischemia, and she had a normal sinus rhythm. Id. Dr. Milik reported that White "does not really want to go back to her previous job." Id. He diagnosed her with major depression, gave her a prescription for Paxil and pain medication, and ordered a chest x-ray to rule out pleural effusion. Id.

  Dr. Milik saw White again on August 27, 2002. R. 22. Although she denied chills, fever, nausea or vomiting, Dr. Milik observed that there was no difference in White's right chest wall pain and she still experienced occasional shortness of breath. Id. The chest area pain was somewhat improved with physical therapy, but there had been no response to the pain medication, so he stopped her prescription. Instead, Dr. Milik prescribed Mobic and Neurontin because he suspected a "neuropathic component" to her pain. Id. As far as White's mental stability, Dr. Milik noted that her depression seemed to be improving with the Paxil, so he continued her prescription. He also thought that White's continued shortness of breath was "secondary very likely to major depression." Id.

  Dr. Milik saw White again on September 9, 2002. R. 24. His notes reflect that White still suffered from right sided chest pain and that it was "getting worse." Id. He also noted that she continued to have shortness of breath. Dr. Milik gave White a referral to a pain clinic. Her major depression was "very well controlled" and Dr. Milik concluded that White should continue taking the Paxil. R. 24. Dr. Milik's opinions regarding White's ability to return to work are discussed infra, in connection with MetLife's processing of White's claim. See Parts I.E.1-3.

  5. Dr. Robert A. Menotti — Independent Physician Consultant

  During the review process, MetLife forwarded Plaintiff's medical records to Dr. Robert A. Menotti, an independent physician consultant ("IPC"), for a "Physician Consultant Review". R. 208-09. Dr. Menotti gave his opinion of Plaintiff's ability to return to work by summarizing what he found to be important in Drs. Rowland's and Dr. Milik's records. R. 208. First, Dr. Menotti noted that Dr. Rowland's records indicated that Plaintiff was healing normally after her surgery and that her chest discomfort was improving fairly rapidly. Id. Next, Dr. Menotti discussed Dr. Milik's conclusions that Plaintiff had not yet returned to her presurgical condition, citing shortness of breath and major depression. Id. Dr. Menotti noted that Dr. Milik's records indicated that Plaintiff also suffered from a skin condition, had some narrowing of her left internal carotid artery, and suffered from mitral valve prolapse. Id.

  Dr. Menotti summarized, "the claimant had an acute episode of pneumonia that was complicated by pleural effusion and later entrapment of the right lung . . . [but] there were no complications of a serious nature one normally sees as a result of this. . . ." Id. Dr. Menotti concluded:
There is simply not enough medical documentation from Dr. Milik to lead this reviewer to believe at this point in time that the claimant is not medically able to return to the essential duties of her own occupation following her acute lung surgery. I would expect there to be more medical to flow into this chart regarding the management of the other chronic conditions. However, the documentation at this point in time relating to these chronic conditions does not appear to be enough to preclude her from performing the essential duties of her own occupation at this point in time.
R. 209 (emphasis added).

  6. Toni Blumenthal — White's Therapist

  On March 5, 2003, White met with a therapist at Riverside Behavioral Services, Toni Blumenthal. R. 229-237. Blumenthal's report indicates that White had a functional impairment associated with her symptoms of depression, in the areas of "self care and maintenance" and "role functions in job or home/daily living skills." R. 230. Blumenthal indicated that he did not believe White could work as it was difficult to do any ...


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