United States District Court, E.D. Michigan, Southern Division
OPINION AND ORDER DENYING PLAINTIFF'S MOTION TO
REVERSE DEFENDANT'S BENEFITS DETERMINATION AND GRANTING
DEFENDANT'S CROSS-MOTION TO AFFIRM (DKT. 9, 10)
TERRENCE G. BERG, UNITED STATES DISTRICT JUDGE
Kristina Osobka challenges Defendant Metropolitan Life
Insurance Company's ("MetLife's") denial of
her long-term disability benefits application. Plaintiff is a
former Comcast Corporation ("Comcast") customer
service representative who contends she suffered from chronic
fatigue syndrome ("CFS") and was unable to work.
She filed for benefits under Comcast's long-term
disability plan, which Defendant administered. After
Defendant denied both her initial application and her appeal,
Plaintiff filed this lawsuit under the Employee Retirement
Income Security Act ("ERISA"), 29U.S.C. §
the Court are two motions: (1) Plaintiffs motion to reverse
Defendant's denial of her long-term disability (LTD)
benefits application, and (2) Defendant's cross-motion to
affirm its denial. The dispositive question is whether
Defendant abused its discretion in crediting the opinions of
independent physician consultants rather than those of
Plaintiffs treating physicians. For the reasons outlined
below, the Court finds that Defendant was within its
discretion in denying Plaintiffs application for long-term
disability benefits. Therefore, Plaintiffs motion to reverse
Defendant's decision must be DENIED, and
Defendant's motion to affirm must be
worked for Comcast as a customer service representative from
June 23, 2013 until August 6, 2014. At Comcast, she
participated in the Comprehensive Health and Welfare Benefit
Plan ("the Plan"), a long term disability policy
that Defendant provided and administered.
makes initial eligibility determinations on claims for
disability benefits under the Plan. If denied, employees may
appeal to Defendant for further review of their claim.
Plaintiff claimed she suffered from various viral infections,
which caused chronic fatigue syndrome (CFS), rendered her
disabled, and forced her to take leave from her job at
Comcast on August 6, 2014. On July 13, 2015, Defendant denied
Plaintiffs initial application for LTD benefits and on May
25, 2016, Defendant denied Plaintiffs appeal.
MetLife's LTD Plan
Plan defines "disability" as the inability to earn
more than eighty percent of prior earnings in one's
occupation due to sickness or injury. Dkt. 6-1, Pg. ID 47. To
qualify for LTD benefits, a claimant must first continuously
meet this definition for 180 days (the "Elimination
Period"). Dkt. 6-1, Pg. ID 47. Plaintiff stopped working
at Comcast on August 7, 2014. Thus in order to qualify for
LTD benefits she must have been disabled from August 7, 2014,
to February 8, 2015. Dkt. 6-5, Pg. ID 354.
Plan also excludes pre-existing conditions from LTD coverage
if the claimant has not been "Actively at Work" for
12 months. Dkt. 10-2, Pg. ID 2056. Pre-existing conditions
are defined as any "sickness or accidental injury"
for which a claimant received care, or experienced symptoms
"that would cause a person to seek diagnosis, care or
treatment, " in the 3 months before claimant's
coverage took effect. Dkt. 10-2, Pg. ID 2056.
Summary Plan Description, a document that explains a
claimant's rights and obligations under the Plan,
designates Defendant as the Plan administrator and delegates
to Defendant the "sole discretion to interpret plan
provisions and to determine questions of fact and eligibility
for benefits." Dkt. 6-3, Pg. ID 145.
Initial Denial of LTD Benefits
Comcast customer service representative, Plaintiff worked at
a desk and communicated with clients who were dissatisfied
with Comcast's telecommunications services. Dkt. 7-6, Pg.
ID 1786. Claiming she could no longer perform these tasks,
Plaintiff took leave from Comcast beginning on August 7,
2014. Dkt. 6-6, Pg. ID 362. Plaintiff then applied for LTD
benefits with Defendant. Dkt.7-5, Pg. ID 1636-52.
Additionally, Plaintiff applied for and was denied Social
Security Disability Insurance Benefits. Dkt. 7-6, Pg. ID
of its LTD benefit determination, Defendant requested medical
records from Plaintiffs treating physicians. Dkt. 7-2, Pg. ID
1287-88, 1292-93; Dkt. 7-5, Pg. ID 1603-32. Dr. Brian
Massa-ro's records indicate that Plaintiff was diagnosed
with anxiety in or prior to 2011 and chronic fevers and
fatigue since November 2013. Dkt. 6-6, Pg. ID 453.
Plaintiff visited CFS specialist Dr. Martin Lerner on
September 29, 2014. Dkt. 6-6, Pg. ID 496. Dr.
Lerner's October 21, 2014, report informed Defendant that
Plaintiff was unable to ...