United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION & ORDER
M. Durkin United States District Judge
Susan Hennen (“Hennen”) received long-term
disability benefits from Defendant Metropolitan Life
Insurance Company (“MetLife”) under the
provisions of NCR Corporation's long-term disability
benefits plan (the “Plan”). The Plan limited
long-term disability benefits for Hennen's impairment to
24 months in the absence of objective evidence of a condition
called radiculopathy. MetLife determined that Hennen failed
to present such evidence at the end of the 24-month period
and terminated Hennen's benefits. Hennen sued MetLife
under the Employee Retirement Income Security Act
(“ERISA”) to challenge this decision.
and MetLife have filed cross-motions for summary judgment. R.
25; R. 29. Both parties seek fees and costs. Id. For
the reasons explained below, MetLife's motion for summary
judgment is granted, and Hennen's motion for summary
judgment is denied. MetLife's request for fees and costs
NCR Corporation's Long-Term Disability Benefits
material facts in this case are undisputed. While employed by
NCR Corporation, Hennen received long-term disability
(“LTD”) coverage under the Plan, which is funded
by a group insurance policy issued by MetLife. PSMF
¶¶ 17, 20; DSMF ¶¶ 8, 18.
the Plan, “‘Disability' means that due to
sickness, pregnancy, or accidental injury, you are receiving
Appropriate Care and Treatment from a Doctor on a continuing
basis.” DSMF ¶ 3; PR ¶ 3. In a section titled
“Limitation For Disabilities Due to Particular
Conditions, ” the Plan explains that “Monthly
Benefits are limited to 24 months during your lifetime if you
are Disabled due to a . . . Neuromusculoskeletal and soft
tissue disorder . . . unless the Disability has objective
evidence of . . . radiculopathies.” PSMF ¶¶
8, 9; DSMF ¶ 4.
Plan defines “[n]euromusculoskeletal and soft tissue
disorder” as “any disease or disorder of the
spine or extremities and their surrounding soft tissue;
including sprains and strains of joints and adjacent
muscles.” PSMF ¶ 8; DSMF ¶ 4. The Plan
defines “radiculopathies” as “[d]isease of
the peripheral nerve roots supported by objective clinical
findings of nerve pathology.” PSMF ¶ 9; DSMF
Hennen's Medical History
has a long history of low-back problems. She had low-back
surgeries in 2003 and 2008 while working as a sales
specialist for NCR Corporation. PSMF ¶¶ 11, 13; DR
¶¶ 11, 13.
a third surgery in September 2012 for a herniated disk,
MetLife approved Hennen's claim for LTD benefits. PSMF
¶ 20; DSMF ¶ 18. MetLife's letter to Hennen
awarding benefits explained that she satisfied the Plan's
definition of “[n]euromusculoskeletal and soft tissue
disorder” and that “the maximum benefit duration
due to th[is] limited condition will be reached on November
11, 2014 . . . . Benefits may continue after November 11,
2014 if you continue to satisfy the definition of Disability
solely due to other non-limited medical condition(s) and
other plan requirements . . . .” PSMF ¶ 20; DSMF
spine surgeon Dr. Frank Phillips noted in his operative
report for the September 2012 surgery that Hennen's
“nerves were free of compression and mobile.”
DSMF ¶ 16; PR ¶ 15. In a December 2012 office note,
Dr. Phillips stated that Hennen had “good improvement
in her back pain, ” and her continuing symptoms
“probably represent[ed] some residual nerve
pain.” PSMF ¶ 22; DSMF ¶ 20. Dr. Phillips
ordered an MRI to “rule out any recurrent or residual
neural compression.” DSMF ¶ 20; PR ¶ 20. The
MRI showed “stable” post-surgical changes
“without significant stenosis.” DSMF ¶ 21;
PR ¶ 21.
then began pain management treatment with anesthesiologist
and pain management specialist Dr. Asokumar Buvanendran. PSMF
¶ 24; DSMF ¶¶ 16, 22. In February 2013, Dr.
Buvanendran diagnosed Hennen with “[l]umbar
radiculopathy.” PSMF ¶ 28; DSMF ¶ 22.
had another low-back surgery in April 2013 to implant an
epidural spinal cord stimulator. PSMF ¶ 29; DSMF ¶
23. Hennen experienced a dramatic reduction in pain after
that surgery. PSMF ¶ 29; DSMF ¶ 23.
2014, Hennen had another surgery: a left hip arthroscopy with
orthopedic surgeon Dr. Shane Nho to repair a muscle tear
sustained during a fall. PSMF ¶ 35; DSMF ¶¶
24, 26. An MRI of Hennen's hip prior to the surgery
demonstrated the muscle tear, but also showed that
“[t]he neurovascular bundles are grossly intact, with
no extrinsic compression.” DSMF ¶ 25; PR ¶
25. After the surgery, Dr. Nho informed MetLife that he
estimated Hennen could return to work by August 15, 2014.
DSMF ¶ 26; PR ¶ 26.
Hennen continued to report shooting nerve pain down her leg.
PSMF ¶ 36; DR ¶ 36. In a questionnaire completed
for MetLife in July 2014, Dr. Buvanendran again diagnosed
Hennen with “lumbar radiculopathy.” PSMF ¶
37; DR ¶ 37.
August 2014, Dr. Nho submitted an attending physician's
statement to MetLife explaining that Hennen's hip was
“structurally sound, ” noting that Hennen's
pain was likely “back and neuropathic related, ”
and referring her care to Dr. Buvanendran. PSMF ¶ 39;
DSMF ¶ 28.
MetLife's Termination Of Hennen's Benefits
contacted Hennen by telephone on August 15, August 18, and
September 18, 2014 to explain that an MRI or electromyogram
(“EMG”) was required to determine if her
condition fell within the radiculopathies exception to the
Plan's 24-month benefit limitation for
neuromusculoskeletal and soft tissue disorders. DSMF
¶¶ 29, 30, 32; PR ¶¶ 29, 30, 32. MetLife
sent a letter to Hennen on October 13 explaining that it
planned to terminate her benefits on November 11. PSMF ¶
41; DSMF ¶ 33. The letter informed Hennen of her right
to an administrative appeal, explaining that any appeal
should include objective findings including “Current
test results (MRI, CT, EMG).” DSMF ¶ 33; PR ¶
October 17, Dr. Buvanendran sent MetLife a letter reaffirming
his diagnosis of lumbar radiculopathy. PSMF ¶ 42; DR
¶ 42. He included a copy of a recent, September 2014
MRI. PSMF ¶ 45; DSMF ¶ 35. MetLife consulted with
its medical doctor, Dr. David Peters, who found that
Hennen's September 2014 “MRI does not reveal
ongoing nerve root or spinal cord compression that would
support a current diagnosis of lumbar radiculopathy.”
PSMF ¶ 46; DSMF ¶¶ 31, 36. Hennen's LTD
benefits terminated in November 2014.
appealed MetLife's determination in July 2015. She
submitted an EMG from June 2015 in support of her appeal.
PSMF ¶¶ 47-48; DSMF ¶¶ 38-40. The
fellow-in-training, Dr. Joseph Kipta, who administered
Hennen's EMG stated in the “Impression”
section of his report that Hennen's “superficial
peroneal sensory responses” constituted “evidence
to support left lumbar motor polyradiculopathies.” PSMF
¶ 48; DSMF ¶¶ 38-40. But he commented that
“[n]o abnormal spontaneous or insertional activity was
noted in any of the muscles examined” during the EMG.
DSMF ¶ 39; PR ¶ 39. He explained that
“[f]urther clinical correlation is advised.” DSMF
¶ 40; PR ¶ 40. In July 2015, MetLife consulted its
medical doctor certified in family medicine, Dr. Dupe
Adewunmi, who opined that the EMG supported a diagnosis of
radiculopathy. DSMF ¶ 42; PR ¶ 42.
claims note later that month, MetLife's appeal specialist
observed that the Plan specifies that, during an
administrative appeal, “MetLife will consult with a
health care professional with appropriate training and
experience in the field of medicine involved in the medical
judgment.” DSMF ¶¶ 6, 43; PR ¶¶ 6,
43. Around this time, MetLife learned that the Social
Security Administration had denied Hennen's claim for
disability income benefits at the initial application stage.
DSMF ¶ 41; PR ¶ 41.
then consulted Dr. Neil McPhee, who is board certified in
physical medicine and rehabilitation. PSMF ¶ 53; DSMF
¶ 44. In August 2015, after reviewing Hennen's
medical records, Dr. McPhee submitted a 27-page report
finding that Hennen's December 2012 and September 2014
MRIs showed no radiculopathy, and that her June 2015 EMG
likewise “was negative for active radiculopathy.”
PSMF ¶ 54; DSMF ¶¶ 44-45.
sent Dr. McPhee's analysis to Hennen's attorney and
Dr. Buvanendran, who both responded with letters protesting
and disputing Dr. McPhee's conclusions. PSMF ...