Garretson v. Metropolitan Life Insurance Company

Background

Steven S. Garretson brought a claim under the Employee Retirement Income Security Act of 1974 (ERISA) for long-term disability benefits under a group policy that Metropolitan Life Insurance Company issued to Kaiser Foundation Health Plan, Inc., Garretson’s former employer. MetLife initially determined that Garretson was disabled and approved benefits effective March 14, 2015. It terminated the benefits effective April 29, 2017, after concluding he could work full time with limitations and could perform his usual occupation or other jobs. MetLife denied Garretson’s appeal on July 27, 2018.

The parties agreed that the court should review the benefits decision from the beginning, rather than defer to MetLife’s decision. They also agreed to a trial based on the administrative record to determine whether Garretson was disabled under the policy. The parties did not dispute that Garretson was disabled from September 15, 2014, through April 2017. The issue was whether he remained disabled after that time.

Evidence and Analysis

Under the policy, disability after the initial period meant that the claimant could not reasonably and continuously perform any occupation in which he could reasonably be expected to work satisfactorily, considering factors such as age, education, training, experience, and physical and mental capacity. Garretson had chronic low-back pain and lumbar radiculopathy after spinal surgeries, treatment with medications, and other pain-management efforts.

The court found persuasive the opinions of Garretson’s treating physicians, Dr. Linda M. Choe and Dr. Cassandra L. Whitmore. Dr. Choe stated that Garretson could not satisfactorily perform even sedentary work, while Dr. Whitmore stated that his condition and medications made it unlikely that he could work satisfactorily or consistently. The court also relied on observations from Garretson’s wife, son, and former co-worker describing his pain, difficulty sitting, and difficulty performing ordinary activities. The court noted that the Social Security Administration had separately found Garretson disabled beginning September 15, 2014; that finding did not control the ERISA claim but was evidence of disability.

The court found weaknesses in the reports prepared by MetLife’s reviewing doctors. None had personally examined Garretson. The court also found that some of their conclusions were inadequately explained, speculative, contradictory to other evidence they cited, or improperly demanded objective testing for chronic pain, a condition that can depend on reported symptoms. The court concluded that Garretson had proved by a preponderance of the evidence that he could not sit for more than four hours in an eight-hour workday and therefore could not perform sedentary work requiring sitting most of the time.

Ruling

The court concluded that Garretson remained disabled under the long-term disability policy after MetLife terminated his benefits. It determined that he could not perform his own occupation, the other sedentary occupations MetLife identified, or other similar occupations. The court granted Garretson’s motion for judgment. It directed the parties to meet and confer about the amount of benefits due and submit a stipulation for the court’s approval by December 13, 2019. The opinion did not determine the benefits amount.