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Leger v. Tribune Co. Long Term Disability Benefit Plan

January 18, 2008

LISA M. LEGER, PLAINTIFF,
v.
TRIBUNE COMPANY LONG TERM DISABILITY BENEFIT PLAN, DEFENDANT.



The opinion of the court was delivered by: Judge Robert W. Gettleman

MEMORANDUM OPINION AND ORDER

Plaintiff Lisa M. Leger filed a complaint against defendant Tribune Company Long Term Disability Benefit Plan (the "Plan") for wrongful denial of disability benefits under § 502(a)(1)(B) of the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). Both parties have filed motions for summary judgment pursuant to Fed. R. Civ. P. 56. For the reasons discussed below, the court denies plaintiff's motion and grants defendant's motion.

FACTS*fn1

Plaintiff was employed by the Tribune Company ("Tribune") as a manager of program planning for WGN-TV from November 12, 1985 to June 29, 1990. At that time, plaintiff ceased working because of bilateral osteoarthritis of the knees, which required her to undergo multiple knee surgeries. Plaintiff applied for disability benefits under the Plan, which was at that time administered by CNA Insurance Companies ("CNA"). CNA, in an exercise of its discretionary authority, found that plaintiff met the requirements for disability benefits and paid her monthly benefits equal to 60% of her salary beginning June 30, 1990.*fn2

In 1996, plaintiff began seeing Dr. Hill, an orthopedic physician. In February 1996, Dr. Hill diagnosed plaintiff with bilateral patellofemoral arthritis and put her on a strengthening program of leg curls and aquatic exercises. In May 1998, Dr. Hill performed a right knee arthroscopy, at which point plaintiff's right knee improved significantly. In May 2001, Dr. Hill performed an arthroscopic debridement of plaintiff's right knee. He determined that plaintiff regained "full range of motion" in her right knee after the surgery and noted in plaintiff's medical file, "At this time the patient is doing well having minimal problems with her right knee."

In October 2001, plaintiff visited Dr. Hill for knee problems she was experiencing after acquiring and walking a new dog. From 2001 to 2004, plaintiff saw Dr. Hill for regular examinations, which demonstrated that her knee condition did not change in any "appreciative" way. In August 2004, plaintiff traveled to Greece to attend the Olympics. When she returned, she visited Dr. Hill because "the walking [in Greece] aggravated her knees."

In 2004, Tribune transferred administration of the Plan to Hartford Insurance Company ("Hartford"). Hartford continued to pay plaintiff monthly disability benefits; according to defendant, there is no evidence that Hartford performed "any significant review" of plaintiff's medical records during its time as administrator of the Plan.

Beginning January 1, 2005, Metropolitan Life Insurance Company ("MetLife") took over as administrator of the Plan. MetLife requested that plaintiff provide updated medical information. Plaintiff sent to Metlife an activities log that stated she had had sixteen knee surgeries and three foot surgeries and that she took daily narcotics for pain management, as well as sleep medication. Plaintiff stated that her activities consisted of physical therapy, reading, and helping her children with their homework; she told MetLife that she had installed handicap bars throughout her home and needed to be seated while showering. She also informed MetLife that sitting longer than fifteen minutes was very painful and that she occasionally required one to two days at a time of bed rest. Plaintiff submitted an Attending Physician Statement "APS" written by Dr. Hill, stating that plaintiff could perform sedentary work activities.

Plaintiff saw Dr. Hill on January 31, 2005. He noted in her file that she had "minimal problems with her right knee" and "ambulatory without any external aid." On March 28, 2005, Dr. Hill informed MetLife that plaintiff was "wheelchair bound" and "essentially unable to walk." He also stated, somewhat inconsistently, that plaintiff could not sit for more than one hour per day, and that she could not sit for more than thirty minutes at a time.

On July 6, 2005, R. Kevin Smith, D.O., conducted a review of plaintiff's claim for MetLife. Dr. Smith, who did not examine plaintiff, reported to MetLife that her records were consistent with bilateral osteoarthritis of the knee. Dr. Smith also acknowledged that Dr. Hill reported that plaintiff was unable to walk and could sit for only one hour a day. Dr. Smith stated to MetLife that plaintiff was capable of performing sedentary work. MetLife provided a copy of Dr. Smith's report to Dr. Hill and solicited his comments, but he did not respond.

On October 6, 2005, Grace Choi, a Vocational Rehabilitation Consultant, performed an employability assessment of plaintiff for MetLife. Ms. Choi determined that plaintiff was capable of performing work as a Customer Complaint Clerk, Bookkeeper, or Collection Clerk.

On October 12, 2005, MetLife informed plaintiff via letter that it was terminating her disability benefits.

Plaintiff informed MetLife of her intent to appeal the benefits denial on October 19, 2005. Plaintiff submitted an appeal of the denial of benefits, along with medical documentation of her condition. Plaintiff also included documentation of inaccuracies in Dr. Smith's review of her file. On April 22, 2006, plaintiff filed a more detailed appeal letter, complaining that MetLife's review of her condition was incomplete and inaccurate. She stated that her treating physicians were not given an opportunity to comment on MetLife's findings, and she supplied additional information, including witness statements, office notes, physical capacity evaluations, and a functional capacity evaluation ("FCE"), which showed that plaintiff was limited in her ability to sit, stand, or walk continuously for more than twenty-nine minutes.

After receiving plaintiff's appeal, MetLife sent her claim to Dr. Michael Chmell for review. Although plaintiff claims that Dr. Chmell did not review her FCE, Dr. Chmell discusses the FCE specifically in his physician review report (at p. 4), finding that it was based primarily on plaintiff's subjective complaints of pain. Dr. Chmell agreed with plaintiff's doctors that she was able to stand or walk only for brief periods. Dr. Chmell also found, however, that plaintiff was unrestricted in the use of her arms and was able to sit for an unlimited period of time. Dr. Chmell did not examine ...


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