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Black v. Metropolitan Life Insurance Co.

United States District Court, W.D. Michigan, Southern Division

March 21, 2017

SHERRI BLACK, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

          OPINION

          GORDON J. QUIST UNITED STATES DISTRICT JUDGE.

         Plaintiff, Sherri Black, has sued Defendant, Metropolitan Life Insurance Company (MetLife), pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., seeking review of MetLife's decision to discontinue Black's long-term disability benefits as of December 15, 2014. Pursuant to the Case Management Order entered on December 15, 2015, MetLife has filed the Administrative Record and the parties have filed cross motions for judgment based upon the Administrative Record in accordance with Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998). For the reasons set forth below, the Court will deny Black's motion, grant MetLife's motion, and affirm MetLife's decision to discontinue benefits.

         I. Background

         A. The Accident

         In 2008, Black was employed as a Senior Human Relations Manager at Visteon Corporation. (ECF No. 9-7 at PageID.1058.) On July 1, 2008, Black was in her car in the parking lot at work when her car suddenly accelerated, crashed through a brick wall and a six-inch diameter tree, and hit another brick wall. (ECF No. 9-5 at PageID.920.) A doctor at the facility examined Black and drove her home. The impact from the accident exacerbated preexisting problems that Black had with her right shoulder, left knee, and neck. (ECF No. 9-8 at PageID.1133.) The following day, Black saw Robert M. Salamon, M.D., of the Orthopedic Institute of Michigan. Dr. Salamon examined Black and noted “[m]ultiple soft tissue contusions and injuries with preexisting right shoulder instability and mild degenerative arthritis of the left knee and contusions as described above.” (Id. at PageID.1134.) X-rays of Black's neck, right shoulder, and knees showed degenerative changes. Black was scheduled for surgery on her right shoulder. (Id. at PageID.1133.)

         Black saw Dr. Salamon again on July 16, 2008, complaining of pain in her neck and knees and pain in her right shoulder that radiated into her right arm and hand. (Id. at PageID.1131.) Dr. Salamon ordered MRIs of Black's cervical spine and her right shoulder. On July 23, 2008, Dr. Salamon performed surgery on Black's “unstable” right shoulder resulting from “multiple previous injuries and dislocations.” (ECF No. 9-9 at PageID.1192.) Dr. Salamon noted osteoarthritis, damage to the humeral head and the glenoid, and an anterior labral tear. (Id.) Dr. Salamon saw Black for a postop examination on July 30, 2008, at which Black reported that her shoulder felt more stable. The previous MRI study on Black's cervical spine revealed “a lot of progression of the degenerative change described at ¶ 5-C6.” Dr. Salamon started Black on physical therapy and disabled her from work. (Id. at PageID.1187.)

         B. The Policy and MetLife's Approval of Disability Benefits

         At the time of the accident, Black was covered by the Visteon Corporation Disability Income Insurance: Long Term Benefits Management and Professional Level Core Benefit Plan. The Plan is funded by a group disability insurance policy (Policy) issued by MetLife.[1] (ECF No. 8-1 at PageID.34-77.) The Policy delegates discretionary authority to MetLife to construe, interpret, apply, and administer the Plan. (Id. at PageID.85.) The Plan is a qualifying “employee welfare benefit plan” under ERISA. 29 U.S.C. § 1002 (1).

         The Policy defines “disabled” or “disability” as:

         [D]ue to Sickness or as a direct result of accidental injury:

• You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and
• During the first 24 months of Sickness or accidental injury, You are unable to perform each of the material duties of Your own job; and
• After such period, You are unable to perform the duties of any gainful occupation for which You are reasonably qualified taking into account Your training, education and experience.

(Id. at Page ID.54.) Long-term disability benefits (LTD) commence after the completion of the Elimination Period, which is defined as “the Short Term Disability Maximum Benefit Period.” (Id. at PageID.52.) To establish a claim for LTD benefits, a participant must submit “Proof of Disability” to Met Life, defined as “[w]ritten evidence satisfactory to Us that a person has satisfied the conditions and requirements for any benefit [under the Policy].” (Id. at PageID.57, 64.) A participant who is determined to be disabled may be required to submit proof of continuing disability. (Id.) LTD benefits end the date a participant is “no longer Disabled.” (Id. at PageID.70.)

         On August 5, 2008, MetLife approved Black for short-term disability benefits. (ECF No. 9-10 at PageID.1290.) On February 24, 2009, MetLife approved Black for LTD benefits commencing as of January 23, 2009. (ECF No. 9-8 at PageID.1157.) MetLife approved Black for continuing LTD benefits under the “any gainful occupation” portion of the definition of “disability” on June 17, 2010. (ECF No. 9-6 at PageID.976.) MetLife requested Black to “advise us of any changes that might affect your benefits, such as a change or improvement in your medical condition(s), a return to work, or receipt of other income.” (Id.)

         C. Black's Proof of Continuing Disability

         Following the accident and continuing through 2014, Black continued to receive treatment from Dr. Salamon, as well as her primary care physician, James Neuenschwander, M.D., and various specialists. As permitted under the Policy, MetLife periodically requested updated medical information from Black and her medical providers. For example, in May 2010, Dr. Salamon reported that Black had consulted with two other doctors about neck surgery and noted that Black was experiencing “bad headaches and memory problems, fatigue, knee pain, [and] right shoulder pain.” (ECF No. 9-6 at PageID.988.) Dr. Salamon also reported that he previously performed arthroscopic surgery on Black's right knee and found “terrible damage” and said that MRIs and x-rays showed significant arthritis in both knees. (Id.) About eighteen months later, on October 6, 2011, Dr. Salamon reported that Black was “still miserable” and “having . . . pain in the neck and shoulder, and her knees.” Black had “marked limitation of right shoulder motion and marked limitation of neck motion.” Dr. Salamon could only recommend knee replacement to Black, and refilled her prescriptions and renewed her physical therapy. (ECF No. 9-5 at PageID.919.) Dr. Salamon said that his prognosis remained “extremely guarded” because Black “may well require multiple operations in the future to manage these accident-related conditions.” (Id. at PageID.921.) On October 18, 2012, in response to MetLife's request for updated information, Black stated that she was “tak[ing] on-line classes toward masters degree and continuing certifications to have a purpose.” (Id. at PageID.908.)

         On July 22, 2014, in response to MetLife's March 24, 2014, request, Dr. Salamon sent MetLife progress reports from Black's January 15, 2014, and May 23, 2014, visits. In the January 15, 2015, report, Dr. Salamon noted that Black had seen Dr. Eltahawy, who recommended that Black consider neck surgery for relief of her cervical spine symptoms. Black also reported new symptoms of pain in her right groin, and her right shoulder was getting worse. (ECF No. 9-4 at PageID.833.) On examination, Dr. Salamon noted full range of motion and normal motor strength in Black's right hip, uncomfortable and limited motion in Black's right knee, and “quite limited” motion in Black's right shoulder. Dr. Salamon continued Black's treatment of medication and physical therapy. (Id.) The May 23, 2014, progress report showed improvement from the January examination: “Overall she is doing better. She is [sic] an excellent therapist whom she thinks is doing a terrific job. She still has pain in her right shoulder, her neck, her back, and her knees. She is walking better than before. She has lost some weight.” (Id. at PageID.832.) Physical examination revealed that Black's “active right shoulder motion is better than it has been” and “[h]er knees move reasonably well” notwithstanding “a lot of crepitation.”[2] Dr. Salamon continued Black “with therapy because it is doing so well.” (Id.)

         Also in 2014, MetLife obtained information from Black's physical therapy provider, Hands On Center. A March 9, 2014, report stated:

Mrs. Sherri Black has received physical therapy as prescribed, consisting of specific shoulder and neck mobilizations, myofascial releases, active mobilizing and stability ex. As well as coaching reconditioning, ex.
Mrs. Black reports 50% reduced pain cervical as well as in the right shoulder. Tolerance levels for ex. and ADL levels are improving. The cervical mobility has improved to 90% NL. The shoulder mobility has improved to 160 degr. flexion, 60 degr. external rotation, 60 degr. internal rotation. Rotator cuff strength is 4. Mrs. Black is making slow but consistent progress in all aspects. Continuation of the current physical therapy is recommended to maximize ROH and restore ADL capacity.

(ECF No. 9-4 at PageID.817.) The assessments in the accompanying progress notes from May 20, 2014, through July 24, 2014, stated “good tol, slowly improving all aspects[;] ROM shoulder well progressing.” (Id. at PageID.819.)

         D. MetLife's 2014 Review and Termination of Benefits

         In the fall of 2014, MetLife's Special Investigation Unit requested Ethos Risk Services to perform an Internet Data Investigation of Black's activity on social media websites. On October 21, 2014, MetLife received the Internet Data Investigation Report containing information for social media cites Facebook, MyLife, Pinterest, Google, and Linkedin. (ECF No. 9-3 at PageID.780-88.) The report, based on Black's own postings, disclosed that Black traveled from her residence in Northville, Michigan, to Chicago for dinner with friends on March 6, 2014, and attended a wedding on February 24, 2014. (Id.) In addition, the report disclosed that Black was enrolled in a doctoral program through the Center for ...


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