Furey v. Metropolitan Life Insurance Company

Background

Hans Furey sued Metropolitan Life Insurance Company (MetLife) under the Employee Retirement Income Security Act of 1974 (ERISA) to recover long-term disability benefits. Furey had worked as an Account Executive, Business Sales for Verizon Wireless and was covered by Verizon’s long-term disability plan, for which MetLife was the claims administrator. The plan provided benefits if a claimant was unable to earn the required percentage of predisability earnings because of sickness or accidental injury and was receiving appropriate care.

The plan limited benefits for a disability caused by a mental or nervous disorder to a lifetime maximum of the lesser of 24 months or the maximum benefit period. Furey began receiving long-term disability benefits on August 27, 2015. MetLife later stated that it had approved the claim based on Bipolar Disorder II, attention deficit hyperactivity disorder, and Generalized Anxiety Disorder, and terminated benefits effective August 27, 2017, after the 24-month limit.

Furey appealed, arguing that he remained disabled because of hemochromatosis and related physical impairments, including severe fatigue. The record included evidence concerning hemochromatosis, liver disease, nonalcoholic fatty liver disease and steatohepatitis, low testosterone, medical providers’ observations, Furey’s testimony, his wife’s testimony, and a January 2018 cardiopulmonary exercise test. MetLife obtained reviews from Judy Schmidt, M.D., and Benjamin Basseri, M.D., who concluded that the medical information did not support functional limitations from Furey’s physical conditions. MetLife denied his appeals.

A Social Security Administration administrative law judge later found Furey disabled under Social Security rules. The administrative law judge identified hemochromatosis and another blood disorder, an endocrinological disorder involving testosterone irregularity, depression, and bipolar disorder as severe impairments, and stated that Furey’s physical limitations were primarily due to fatigue and malaise. MetLife maintained that the Social Security decision applied different standards and did not establish entitlement under the employer’s plan.

Parties’ Positions and Legal Standard

The parties agreed that the court should review Furey’s claim de novo, meaning the court would independently decide whether he established disability under the plan rather than defer to MetLife’s decision. Furey argued that the mental-health limitation did not apply when his physical conditions independently disabled him. MetLife agreed that the limitation required a mental condition to be a but-for cause of the disability, but argued that the medical evidence did not show that Furey’s physical conditions caused disabling functional limitations.

The court stated that Furey had the burden of proving by a preponderance of the evidence that he was disabled under the plan. The parties had agreed to resolve the case on the merits through cross-motions for judgment under Federal Rule of Civil Procedure 52.

Court’s Analysis

The court found that Furey’s physical medical conditions independently disabled him. It relied on consistent documentation of fatigue by Furey’s treating physicians, evidence that fatigue began before his reports of social anxiety and depressed mood, and medical evidence connecting the fatigue to hemochromatosis, liver disease, and hormonal disturbances.

The court also considered the cardiopulmonary exercise test, which reported abnormal results and led Dr. Christopher R. Snell to conclude that even sedentary work required more energy than Furey could safely sustain. Dr. Robert Robles stated that the testing was consistent with Furey’s reported fatigue. Furey and his wife provided sworn descriptions of fatigue that caused him to rest or nap frequently and made minor tasks exhausting.

The court found the opinions of Drs. Robles, Karamlou, and Snell more reliable on the cause and effect of Furey’s physical limitations than the opinions of Drs. Schmidt and Basseri. The court emphasized that Schmidt and Basseri had not examined Furey in person. It also found deficiencies in their treatment of the exercise-test results and other evidence of Furey’s functional limitations. The court noted that neither reviewer disputed Furey’s documented fatigue or offered evidence showing that his mental-health conditions, rather than his physical conditions, caused the disabling fatigue.

The court further stated that the Social Security award supported its conclusion, although such an award did not bind MetLife. The court rejected MetLife’s characterization of the administrative law judge’s decision, finding that the decision attributed Furey’s physical limitations primarily to fatigue and malaise and concluded that no jobs existed in significant numbers that he could perform given his limitations.

Disposition

The court concluded that Furey proved by a preponderance of the evidence that his physical condition was independently disabling. Therefore, the mental-health limitation did not apply, and MetLife’s contrary determination was reversed. The court granted Furey’s motion for judgment. It ordered the parties to meet and confer about the amount of outstanding long-term disability benefits due to Furey and submit a stipulated proposed judgment within 21 days of the order. The opinion did not state the final dollar amount of benefits.