United States District Court, N.D. California, San Francisco Division
KERILEI R. OLDOERP, Plaintiff,
WELLS FARGO & COMPANY LONG TERM DISABILITY PLAN; METROPOLITAN LIFE INSURANCE COMPANY, Defendants
For Kerilei R. Oldoerp, Plaintiff: John Christopher Breslo, LEAD ATTORNEY, The Breslo Law Firm, Scottsdale, AZ; Russell George Petti, LEAD ATTORNEY, Law Offices of Russell G. Petti, La Canada, CA.
For Wells Fargo & Company Long Term Disability Plan, Metroplitan Life Insurance Company, Defendants: Rebecca A. Hull, LEAD ATTORNEY, Erin A. Cornell, Sedgwick LLP, San Francisco, CA.
RICHARD SEEBORG, UNITED STATES DISTRICT JUDGE.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
This action began in November 2008 when Kerilei Oldoerp sued Wells Fargo & Company Long Term Disability Plan and Metropolitan Life Insurance Company (" MetLife" ), challenging the denial of her claim for long-term disability benefits. Following a bench trial in 2011, an order was issued finding that MetLife had not abused its discretion in denying Oldoerp's claim. The order applied an " abuse of discretion" standard because certain MetLife Summary Plan Description (SPD) documents confer significant discretionary authority upon MetLife. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989) (courts review denial of benefits " under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." ). Subsequent to that decision, the Supreme Court in a separate action determined that extraneous documents, like SPDs, " [are] not [themselves] part of the plan." CIGNA Corp. v. Amara, 131 S.Ct. 1866, 179 L.Ed.2d 843 (2011). Accordingly, in this case, the Ninth Circuit reversed on appeal, holding that MetLife's decision is subject to de novo review, not an abuse of discretion standard. Based on subsequent oral argument, the parties' written submissions, the administrative record, and some additional extrinsic evidence, the court finds that MetLife erred in denying Oldoerp's claim. This order comprises the findings of fact and conclusions of law required by Federal Rule of Civil Procedure 52(a).
II. EVIDENTIARY RULINGS
Ordinarily, cases arising under the Employee Retirement Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., are
decided solely on the basis of the administrative record that was before the plan administrator at the time its decision was made. See Kearney v. Standard Ins. Co., 175 F.3d 1084 (9th Cir. 1999) (en banc) (" If a court reviews the administrator's decision, whether de novo . . . or for abuse of discretion, the record that was before the administrator furnishes the primary basis for review." ). In some cases, however, additional evidence may be admitted " to enable the full exercise of informed and independent judgment." Mongeluzo v. Baxter Travenol Long Term Disability Ben. Plan, 46 F.3d 938, 943 (9th Cir. 1995). At trial, both Oldoerp and MetLife moved to admit extrinsic documents. Oldoerp proffered her Social Security Administration (SSA) file, which contains additional medical records not included in the administrative record. The file was admitted, as it is " necessary . . . for an adequate de novo review." (ECF No. 72, Nov. 25, 2013) (quoting Mongeluzo, 46 F.3d at 943). MetLife submitted extrinsic documents allegedly showing that, during the pendency of Oldoerp's disability claim, she opened a dance studio with her husband. This evidence was excluded, as MetLife failed to explain why it was admissible under Mongeluzo. See 46 F.3d at 943.
In light of the admission of Oldoerp's SSA file, the parties were instructed to submit supplemental briefing addressing the significance of the newly-admitted evidence. Id. MetLife's supplemental briefs rely in significant part on two additional pieces of extrinsic evidence: a vocational report by Susan Simoni and an Independent Physician Consultant (IPC) report by Dr. Clayton Hauser. The Hauser and Simoni reports, both of which were prepared in December 2013 following the request for supplemental briefing, purportedly serve to undermine Oldoerp's claim that she was entitled to additional benefits under the MetLife LTD plan. As in its prior attempt to rely on extrinsic evidence, MetLife does not explain why these documents should be admitted. In any event, this newly-proffered evidence plainly is not necessary for an adequate de novo review. See id. (circumstances must " clearly establish" that extrinsic evidence is necessary for an adequate de novo review). Accordingly, the Huser and Simoni reports are excluded as inadmissible. Any references thereto will not be considered and are hereby stricken from MetLife's supplemental briefs.
III. FINDINGS OF FACT
A. Oldoerp's Occupation
Kerilei Oldoerp began working for Wells Fargo after graduating from college in 1994. By 2007, she had risen to the position of Operations Manager. In this capacity, she engaged in various tasks pertaining to management, sales, budgeting, and development. (AR 825). According to a job description form completed by her employer, Oldoerp's position entailed the following:
Directs a team of implementation consultants and/or operations analysts in the successful implantation planning, solution preparation, delivery to the field, and measurement of initiatives that are the most highly complex and strategic in nature. Works with project managers to define projects/goals and design the appropriate communications, learning, business process model and/or timing/bundling for implementation. Assists or determines size, scope, impacts, risk, budget and strategy for initiatives that are corporate wide and have substantial
impact to bottom line. Provide requirements, tools, direction and oversight to business units performing their own solution preparation (for less complex projects) to ensure standards are met[.]
(AR 778). According to Wells Fargo, this position required approximately five to six hours of sitting, one to two hours of standing, one to two hours of walking, three to four hours of repetitive hand use, and occasional lifting of up to twenty pounds. (AR 776).
B. The Wells Fargo LTD Plan
Oldoerp was a participant in her employer's long-term disability (LTD) benefits plan, for which Wells Fargo is the sponsor and MetLife is the provider and insurer. (AR 109; AR 118). The terms of the plan are laid out in the Wells Fargo Benefits Book, which describes a number of benefits available to the company's employees. (AR 98-506). Chapter 1 covers Administrative Information and states that the Benefits Book includes Summary Plan Descriptions (SPDs) for most of the benefit plans offered by Wells Fargo. (AR 105-06). Chapter 14 of the Benefits Book is devoted to the LTD Plan. (AR 358-75). The first page of that chapter states that, along with the Administrative Information from chapter 1 and the glossary, it constitutes the SPD for the Wells Fargo & Company Long Term Disability Plan. (AR 358).
According to the SPD, a claimant is " disabled" or has a " disability" when " due to sickness (including a mental or nervous condition), pregnancy or accidental injury, you are receiving appropriate care and treatment from a doctor on a continuing basis . . . and you are unable to earn more than 80 percent of your predisability covered pay or indexed covered pay at your own occupation for any employer in your local economy." (AR 361). After two years, the continuation of LTD benefits depends on the claimant being able to earn more than 60 percent of prior income in " any gainful occupation." Id. The Benefits Book sets forth procedures for submission of claims, determinations approving or denying claims, review of claims that have been denied, and information regarding the participant's rights under ERISA. (AR 371-373). A claimant must submit proof in support of her claim. (AR 371).
C. Oldoerp's Condition and Treatment
Oldoerp stopped working in August 2007, reporting a host of symptoms including pain, fatigue, and depression. Throughout the following ten months she sought treatment from a variety of medical professionals. As time passed, the attending professionals developed various theories explaining Oldoerp's symptoms. They were also asked, at various points, to provide information to MetLife in response to inquiries about Oldoerp's condition.
i. Mayo Clinic
Oldoerp was examined by several doctors at the Mayo Clinic in August 2007. On August 13, 2007, Dr. Timothy Daley reported that Oldoerp had " subacute onset of fatigue, sore throat, and malaise, with a severely disabling form of fatigue over the last week." (SSA 85). Her lymph nodes were observed as being swollen and tender. See id. (" There is marked posterior occipital lymphadenopathy with multiple swollen and tender nodes." ). Two days later, Mayo Emergency Room Doctor Roland Petri observed that Oldoerp's symptoms persisted. He concluded that " the patient likely has an underlying viral etiology causing her symptoms." (SSA 83). On August 17, Oldoerp met with Dr. Cynthia Stonnington, a Mayo psychiatrist. Stonnington noted that Oldoerp filled out a Beck II Depression Inventory and scored
a 45, which is " indicative of quite severe depression." (SSA 81). She concluded that Oldoerp was experiencing " Major depression, single episode." (SSA 82). Stonnington prescribed psychiatric medications and concluded that " it would be counterproductive for Ms. Oldoerp to be going to work, given the level of her depression and fatigue." Id. On August 20, Oldoerp was examined by Doctor Sophie Bersoux. Bersoux provided Oldoerp with a note recommending that she stay home from work until August 31, 2007 while acclimating to her new medication regimen. (SSA 80).
ii. Michelle Onacki
Michelle Onacki, a psychiatric nurse practitioner, began treating Oldoerp in August 2007. In a report provided to MetLife in October 2007, Onacki reported that Oldoerp had a psychiatric disability beginning in August. (AR 859). She observed that Oldoerp suffered from extreme exhaustion. (AR 857). In a document sent to MetLife on October 1, 2007, Onacki indicated that Oldoerp could not return to work because she had extremely low energy and suffered from depression. (AR 866-69). Onacki estimated that Oldoerp could return to work part time, for four hours per day for two weeks, on November 1, 2007. Id. As to the severity of her depression, Onacki rated Oldoerp an " eight" on a ten-point scale, where higher numbers corresponded to higher levels of functionality. Id. Attached to Onacki's evaluation was a " mental status examination" from August 30, 2007, where Oldoerp was rated as having a well-groomed appearance, an alert level of consciousness, cooperative behavior, good eye contact, normal speech, coherent thought process, and relevant thought content. (AR 869). Onacki further reported that Oldoerp's cognitive functions were intact, her intelligence was above average, and her abstract thought, capacity to form good judgment, and insight were all fair. Id. Oldoerp's mood/affect, however, was described as " depressed." Id.
Onacki's reports indicate that, as time passed, Oldoerp's condition was declining. On October 9, 2007, in responses on a questionnaire from MetLife, Onacki reported that Oldoerp was unable to perform work duties due to her exhaustion and inability to maintain personal hygiene without assistance. (AR 857). She stated that it was unknown, at that time, when Oldoerp would be able to return to work. Id. On an " initial functional assessment form," Onacki indicated that she observed the primary psychiatric symptoms of depression and fatigue. (AR 859). She rated Oldoerp's functional capabilities at the lowest level on the form, indicating " extreme inability to function in most areas due to continuous impairment." (AR 860). On the " mental status examination" form, Onacki remarked that Oldoerp " appears very tired," but her general appearance was rated as " well-groomed." (AR 863). She assessed all other categories the same as she had in her August report, including behavior, thought process and content, and cognitive functions. (AR 863; 869). On January 31, 2008, Onacki reported that Oldoerp was presently incapacitated and declined to specify a return to work date. (AR 781-85). According to Onacki, medical facts relevant to Oldoerp's apparent inability to work included extreme exhaustion, feeling the need for more sleep, disinterest in daily activities, panic attacks, difficulty concentrating, generalized anxiety, and depression. (AR 784).
iii. Dana Rosdahl
On October 20, 2007, Dana Rosdahl, Ph.D., a nurse practitioner specializing in internal medicine, provided information to MetLife about an office visit with Oldoerp. (AR 848-49). Rosdahl indicated that Oldoerp's
extreme fatigue was a functional limitation preventing her from working. (AR 848). In describing Oldoerp's mental status, Rosdahl stated that she had a pleasant affect, was able to answer questions appropriately, and showed logical thought content and flow. Id. At that time, ...