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Brown v. Metropolitan Life Insurance Co.

November 22, 2006

PATRICIA BROWN, PLAINTIFF,
v.
METROPOLITAN LIFE INSURANCE COMPANY, ET AL., DEFENDANTS.



The opinion of the court was delivered by: Milton I. Shadur Senior United States District Judge

MEMORANDUM OPINION AND ORDER

Patricia Brown ("Brown") brings this action under a provision of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §1132(a)(1)(B).*fn1 Brown seeks reinstatement of disability payments under that ERISA section pursuant to the employee welfare benefit plan ("Plan") sponsored by Columbia College, under which the College is the plan administrator and Metropolitan Life Insurance Company ("MetLife") is the claims administrator.*fn2

Each of Brown and MetLife has now moved for summary judgment under Fed. R. Civ. P. ("Rule") 56 and has relatedly complied with this District Court's LR 56.1.*fn3 Their cross-motions are fully briefed and ready for decision. For the reasons stated in this memorandum opinion and order, MetLife's motion is granted, Brown's motion is denied and this action is dismissed.

Summary Judgment Standard

Every Rule 56 movant bears the burden on her or its Rule 56 motion of establishing the absence of any genuine issue of material fact (Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986)). For that purpose courts consider the evidentiary record in the light most favorable to nonmovants and draw all reasonable inferences in their favor (Lesch v. Crown Cork & Seal Co., 282 F.3d 467, 471 (7th Cir. 2002)).

As this Court has said in such cases as Coles v. LaSalle Partners Inc. Disability Plan, 287 F.Supp.2d 896, 900 (N.D. Ill. 2003), those requirements--looking in opposite directions as they do when applied to cross-motions for summary judgment--sometimes present an insurmountable hurdle. Moreover, the review of an ERISA plan under the requisite deferential standard in the summary judgment context creates a unique situation, for it requires a determination of the reasonableness of the Plan's decision even while all reasonable inferences are drawn in favor of Brown. But as the ensuing discussion reflects, those factors do not operate to defeat a decision here.

Statement of Facts

Brown began working for Columbia College in March 1989, and by June 2000 she was working in an accounts payable position (R. 170). On June 29, 2004 Brown had surgery performed on her back for a lumbar spine decompression, and she then experienced complications from that surgery that required her to seek treatment for an infection in the surgical wound in July 2004 (R. 177). To remedy the infection Brown had follow-up surgery for irrigation of her wound (R. 176). Brown was eventually diagnosed with a condition known as lumbosacral neuritis on October 7, 2004 (R. 174-75, 34).

For post-operative care Brown began to visit several doctors to treat her back pain and oversee her rehabilitation, including orthopedic surgeon Dr. Anis Mikhail, pain management specialist Dr. Ebby Jido and infectious disease specialist Dr. Shamse Tabriz (R. 161, 53). Throughout the early fall of 2004, Brown complained of pain across both her lower abdomen and back (R. 161, 53).

Notes from Brown's doctors memorializing their visits with her reveal a conflict between their optimistic predictions for her imminent return to work and her own subjective complaints of persistent somatic pain. For example, on November 1, 2004 Dr. Mikhail noted that Brown's "pain is significantly subsided now" and that "lateral X-rays of the lumbosacral spine today shows the hardware in good position as well as alignment of the spine" (R. 159). Dr. Mikhail's notes set out his positive prediction that in four weeks' time "we will be able to send her to some work status using some restrictions" (id.). That same day, however, Dr. Mikhail also noted Brown's subjective complaints of joint pain as well as her statement that she could not return to work because "[s]he feels she cannot sit for a long time, which is most of her job" (R. 159).

Four weeks later Dr. Mikhail again examined Brown, wrote with cautious optimism that Brown's infected wound is "well healed" and added: "I told the patient she should be able to go back to work, but we will get the CT and MRI done first" (R. 57). Again the doctor's notes contain references to Brown's subjective complaints of pain: "She says she also has back pain" and "She does not feel she can go back to her job" (id.).

During the same period Dr. Tabriz ordered several tests, including a liver function panel and a test to measure Brown's inflammation levels, both of which came back normal (R. 59, 61). In early 2005 an MRI of Brown's lumbar spine showed no disc herniation or spinal stenosis, though there was mild annular bulging on one disc and there was some fluid in two of the bilateral facet joints (R. 133). Interpreting Brown's MRI results in March 2005, Dr. Jido observed that the MRI was not helpful in ascertaining an objective basis for Brown's pain (R. 76).

Brown also sought treatment from physical therapist Frank Vlk ("Vlk")(R. 139). Vlk noted that Brown ranked her low back pain at 5 or 6 out of 10 before his evaluation, but she decreased the pain factor to 3 out of 10 after the evaluation, indicating that the evaluation had provided some measure of relief (R. 139). Vlk's long-term goals for Brown, which echoed the optimistic predictions of her doctors, included enabling her to "perform normal daily activity with decreased limitation or deviation."

In summary, his long-term prognosis for Brown achieving her treatment goals was "good" (R. 139).

As her doctors examined Brown throughout 2005, they observed that the basis of the back pain was unclear, as there appeared to be no objective cause (R. 49, 141). When Brown complained of shortness of breath in March 2005, her family physician Dr. Bruno ordered a battery of tests to rule out congestive heart failure (R. 129). Those tests came back normal. Similarly, a CT scan of Brown's abdomen and pelvis came back normal as well (R. 107).

In June 2005 Dr. Tabriz examined Brown and found that while she was still complaining of back pain, her "lumbar spine wound [was] well healed," and he characterized the "etiology of ongoing pain" as "unclear" (R. 48). Consistently with the first of those findings, the June 2005 MRI of Brown's cervical spine showed a "mild degree of posterior and central protrusion of the discs" and a "mild effacement to the anterior part of the epidural sac," but on the whole her "[s]pinal cord per se is not remarkable" (R. 70). Brown's rheumatologist Dr. Hirsen also observed that Brown's x-rays revealed "trace swelling" and "very mild degenerative changes in the medical compartments" (R. 80), and also that "[t]he most recent lumbar spine MRI from January showed no evidence of infection" (R. 110).

Despite Brown's tenacious efforts to locate a doctor to find some objective reason why her lower back pain was so persistent, none of them was able to do so. In fact, the notes of Brown's rheumatologist from a June 2005 examination concluded that there was no evidence of inflammatory disease or infection and that "her problem is all due to continued degenerative changes and post-operative ...


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