Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Gordon v. Metropolitan Life Insurance Co.

United States District Court, N.D. California, San Jose Division

November 6, 2019

ROBERT GORDON, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.

          ORDER DENYING PLAINTIFF'S MOTION FOR JUDGMENT UNDER FRCP 52; GRANTING DEFENDANT'S CROSS-MOTION FOR JUDGMENT UNDER FRCP 52 RE: DKT. NO. 86

          Edward J. Davila United States District Judge

         I. INTRODUCTION

         In this action under the Employee Retirement Income Security Act of 1974, 29 U.S.C. §1001, et seq. (“ERISA”), Plaintiff Robert Gordon (“Plaintiff”) seeks long term disability benefits from Defendant Metropolitan Life Insurance Company (“Defendant”). Plaintiff contends that the medical records show that he was forced to leave his employment with Borland Software “Borland” due to severe depression, anxiety, and symptoms of post-traumatic stress disorder caused by harassment and threats from his immediate supervisor at Borland. Pl.'s Mot. For J. Under FRCP 52 (Dkt. No. 86). Plaintiff contends that these psychological conditions, in conjunction with spinal, knee and shoulder injuries, left him totally disabled. Id. Presently before the Court are the parties' competing motions for judgment under Federal Rule of Civil Procedure 52. Based upon all pleadings, the evidentiary record, and the comments of counsel and for the reasons set forth below, the Court DENIES Plaintiff's motion for judgment and GRANTS Defendant's motion for judgment.

         II. BACKGROUND

         Plaintiff worked as a Senior Staff Systems Programmer with Ashton-Tate starting in 1989. In 1991, Ashton-Tate was purchased by Borland and Plaintiff worked for Borland until May 1, 2002. As a Borland employee, Plaintiff was eligible for LTD benefits through the Borland Software Corporation LTD Plan (“the Plan”), which is governed by ERISA. The Plan covered Eligible Employees (active, full-time employees working 30 hours per week). Administrative Record (“AR”) at 1462, 1466, 1487. Defendant MetLife funded LTD benefits under the Plan and was also the claim administrator for the LTD claims.

         To receive LTD benefits under the Plan, Plaintiff must have been “disabled” and “unable to earn more than 80% of [his] Earnings or Indexed Predisability Earnings at [his] Own Occupation for any employer in [his] Local Economy.” AR at 1470. The Plan defines “Disabled” in pertinent part as follows:

“Disabled” or “Disability” means that, due to sickness, pregnancy or accidental injury, you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis; and
1. during your Elimination Period and the next 60 month period, you are unable to earn more than 80% of your Predisability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy . . .
2.

Id. “Appropriate Care and Treatment” means “medical care and treatment that meet all of the following: 1. it is received from a Doctor whose medical training and clinical experience are suitable for treating your Disability; 2. it is necessary to meet your basic health needs and is of demonstrable medical value; 3. it is consistent in type, frequency and duration of treatment with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies; 4. it is consistent with the diagnosis of your condition; and 5. its purpose is maximizing your medical improvement.” AR at 1471. “Elimination Period” means “90 days of continuous Disability.” AR at 1463. A participant's “Own Occupation” is defined as:

the activity that you regularly performed and that serves as your source of income. It is not limited to the specific position you held with your Employer. It may be a similar activity that could be performed with your Employer or any other employer.

         AR at 1471. The Plan provides that the claimant's loss of earnings “must be a direct result of [the claimant's] sickness, pregnancy or accidental injury.” AR at 1470. The Plan contains a 24-month limitation for disabilities due to a mental or nervous disorder or disease. AR at 1485.

         On April 19, 2002, Dr. Koopman placed Plaintiff off work for one week. AR at 1112. Plaintiff returned to Dr. Koopman's office one week later on April 26, 2002. AR at 1113. Plaintiff planned to return to work to work on April 29, 2002. Id.

         He returned to work on May 1, 2002, but was terminated that same day due to “performance issues”[1] and his behavior at a meeting with Human Resources. AR at 1412-13. Upon termination, Plaintiff ceased to be an Eligible Employee and his coverage under the Plan ended. AR at 1487. On August 22, 2005, the Social Security administration found Plaintiff disabled as of December 13, 2003. AR at 1085.

         On October 22, 2009, Plaintiff submitted a claim for LTD benefits for a disability beginning April 19, 2002. AR at 1440. He indicated on the claim form that he suffered from the following conditions that prevented him from performing his job: arthritis in the spine and joints; severe insomnia; collapsed thoracic vertebra; very large spinal osteophytes; herniated vertebral discs; severe cervical foraminal stenosis; depression; chronically active viruses; anxiety; ADD; heart palpitations; impaired short-term memory; migraine headaches; chronic system inflammation; left knee surgery; cervical spine surgery; left shoulder surgery; Apico/jaw surgery; sinus surgery; thoracic and lumbar disc disease; chronic esophagitis; and chronic sinusitis. AR at 1440-41. Accompanying Plaintiff's claim form was a note from his treating physician, Dr. Resneck-Sannes, dated October 15, 2009, which indicated that the most recent date of treatment was October 15, 2009, and stated that Plaintiff had “disabling back & neck pain for degenerative disc disease, ” “chronic migraine headaches, ” and “failed knee and shoulder surgery” since February of 2002. Id.

         Plaintiff initiated this action in November of 2010. See Compl., (Dkt. No. 1). Pursuant to stipulation, the action was stayed while Defendant resolved Plaintiff's appeal. In 2012, Defendant determined that Plaintiff had coverage under the Borland Plan through May 1, 2002 (AR at 947), and notified Plaintiff that his LTD claim was denied because the information in the claim file did not support a finding of Disability. AR at 776. Plaintiff appealed Defendant's decision. Defendant has not issued a formal decision on Plaintiff's appeal.

         The Court lifted the stay and restored the case to active litigation in January of 2015. Dkt. No. 48. The Court determined that Defendant's benefit decision was subject to review under an abuse of discretion standard. Dkt. No. 60. The parties filed cross-motions for summary judgment. Dkt. Nos. 62, 64. By order dated September 7, 2017, the Court denied Plaintiff's motion, granted Defendant's motion, and entered judgment in favor of Defendant. Dkt. Nos. 72, 73. On appeal, the Ninth Circuit reversed and remanded, holding that the denial of benefits is subject to de novo review and that the competing medical opinions regarding Plaintiff's disability created a genuine dispute of material fact. The parties now cross-move for judgment under Federal Rule of Civil Procedure 52.

         III. STANDARDS

         In conducting a de novo review, the court considers the record and then “simply proceeds to evaluate whether the plan administrator correctly or incorrectly denied benefits.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006). An ERISA de novo review is a bench trial in which the district court sits as finder of fact and determines, as a factual matter, whether the claim should have been approved. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999); Frank v.Wilbur-Ellis Co. Salaried Employees LTD Plan, No. 08-284 LJO, 2009 WL 347789, at *5 (E.D. Cal. Feb. 11, 2009) (on de novo review, court determines whether benefit decision was correct or incorrect). The court first examines the governing plan documents. Metro. Life Ins. Co. v. Parker, 436 F.3d 1109, 1113 (9th Cir. 2006); Gertjejansen v. Kemper Ins. Companies, Inc., No. 06-56329, 274 Fed.Appx. 569, 571 (9th Cir. 2008). The court then makes an independent determination of the claim on the merits. Parra v. Life Ins. Co. of North Am., 258 F.Supp.2d 1058, 1064 (N.D. Cal. 2003). When a court conducts a de novo review, the burden of proof is on the claimant. Muniz v. Amec Const. Mgmt., Inc., 623 F.3d 1290, 1295 (9th Cir. 2010).

         IV. DISCUSSION

         Having conducted a de novo review, the Court finds that the Plan correctly determined that Plaintiff was not “Disabled” from performing his “Own Occupation” prior to his May 1, 2002 termination date. Although the Administrative Record confirms that Plaintiff suffered from multiple medical conditions prior to May 1, 2002, the medical records fail to establish (1) that Plaintiff was receiving care and treatment for any of those medical conditions on a continuing basis and (2) that during the Elimination Period and the next 60 month period Plaintiff was unable to earn more than 80% of his Earnings or Indexed Predisability Earnings at his Own Occupation for any employer in his Local Economy.

         Dr. Koopman's Assessment and Notes in April of 2002

         Included in the Administrative Record is an April 19, 2002 workers' compensation report by Dr. Jane Koopman with the Santa Cruz Medical Clinic. AR at 1111-12. Dr. Koopman described Plaintiff as “a 49-year old staff systems programmer at Borland who presents complaining of emotional distress” arising out of Plaintiff's working conditions and a hostile supervisor. AR at 1111. Specifically, Dr. Koopman's notes included the following description of Plaintiff's work conditions:

History here is that there have been some changes of personnel over the last nine months at his work. This has placed a great deal of stress on his boss who has been passing some of this on to the patient. He has been threatening to fire him and berating him in public. He has been given contradictory orders. The patient has complained to Human Resources three times in the past couple of months. Yesterday, there was an episode where his boss accused him of mismanaging a project that was not even his. The patient turned around and walked away. His boss approached him in such a manner, that he actually felt physically threatened. There was no altercation, but shortly afterward the patient felt quite nauseated with his heart racing, sweating and went and informed his employer that he was leaving work for the day.

Id. Dr. Koopman noted that Plaintiff was taking blood pressure medication, Ativan and Topamax; that he was having difficulty falling asleep and waking up; that he has been having trouble concentrating and difficulty with his memory; that he reported feeling depressed; and that “heart racing episodes” have been occurring for several days, but these episodes do not involve shortness of breath, chest pain or nausea. AR at 1111-12. Dr. Koopman observed that Plaintiff initially had difficulty even starting to speak and appeared very stressed. Dr. Koopman's assessment was that Plaintiff had “1. Stress reaction with both anxiety and depressive features. 2. hypertension. 3. Complaints of palpitations-probably part of his anxiety but would like to rule out arrhythmia.” AR at 1112. Dr. Koopman wrote that she “placed [Plaintiff] off work for a week until he can return here and let me know the status with regard to the job transfer he is hoping to achieve.” Id. Testing later confirmed that Plaintiff had no heart condition. AR at 1118.

         According to a Doctor's First Report of “Occupational Injury or Illness” dated April 22, 2002, Plaintiff reported to Dr. Koopman that constant threats and harassment from his boss caused him to feel faint and nauseated, and to suffer elevated blood pressure, rapid heartbeat and sweating. AR at 1132. On April 26, 2002, Plaintiff had a follow up visit with Dr. Koopman. The notes of the visit indicate that a Worker's Compensation attorney recommended that Plaintiff return to work if he could be transferred to another department, and that Plaintiff planned to return to work the following Monday. Dr. Koopman observed that Plaintiff did not seem quite as withdrawn as on his last visit, but that he still had a “somewhat flat affect.” AR at 1113. Dr. Koopman's assessment was that Plaintiff had: “1. Stress reaction with both anxiety and depressive features. 2. Hypertension in good control today. 3. History of palpitations; pending Holter results.” Id. Dr. Koopman wrote a note for Plaintiff stating, “[Plaintiff's] anxiety and depression, secondary to work stress, is better than when I saw him 4/19/2002, but I have advised a transfer to another department if he is to avoid further flare-ups in his symptomology.” Id. Dr. Koopman's notes of the visit also indicate that Plaintiff “planned to go to work on Monday and see where things stand. He had talked to the person at work who had indicated there might be a job transfer available, and they said that was still pending.” Id. Dr. Koopman's notes also indicate that Plaintiff “did express to me today the feeling that they are trying to get him to quit.” Id.

         Dr. Zweng's April 29, 2002 Assessment

         On April 29, 2002, Plaintiff was seen by Dr. Dean G. Zweng at the Santa Cruz Medical Clinic, who noted the following:

A 49-year old who has been off work due to anxiety and job stress. He feels like he needs to get back to work, although it does not feel too much better. He did meet with his employers and some changes were made to decrease his level of stress at work. On further questioning, he has had some chronic feelings of irritability and inability to make decisions, sleep disturbance, anxiety and agitation. In low mood and tearfulness. He has a bedridden daughter for four years at home and a history of depression. He has been on different anti-depressant medications in the past mainly to control his chronic pain issues of his neck and back. He was able to tolerate Paxil in the past; however, it did not help his chronic pain. He has also been on Celexa recently which caused him too much agitation, and he could not tolerate Zoloft or try a cycle of antidepressants. He also has a history of hypertension.

AR at 1116. Dr. Zweng's notes indicate that Plaintiff's current medications were: “High blood pressure medicine, Topamax, given to him by a psychiatrist for his agitation, Ambien, Aciphex and Darvocet.” Id. Dr. Zweng's assessment was that Plaintiff had “[a]djustment reaction with anxiety and depression with probably underlying major depression.” Id. Plaintiff decided to start taking Paxil. Id. Dr. Zweng advised Plaintiff to follow up with a psychiatrist, but Plaintiff was reticent to do so. Id. Dr. Zweng released Plaintiff “back to regular work.” Id.

         The Court finds that the visits with Drs. Koopman and Zweng summarized above indicate that Plaintiff was receiving care for his mental health[2] during the month of April 2002. This evidence might satisfy the first of the two requirements to establish a Disability under the Plan: “due to sickness . . . you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis.” AR at 1470. However, the Court finds that the medical records from April of 2002 fail to establish the second requirement under the Plan: that during the 90 day Elimination Period and for the next 60 months period, Plaintiff was unable to earn more than 80% of his Earnings or Indexed Predisability Earnings at his Own Occupation for any employer in his Local Economy. Id. Neither Dr. Koopman nor Dr. Zweng opined that Plaintiff was unable to work at his Own Occupation for an employer in his Local Economy. Rather, on Friday, April 19, 2002, Dr. Koopman initially placed Plaintiff on leave for a limited duration of one week until he could return and let her know whether he was able to transfer to another position. AR at 1112. When Plaintiff returned for another visit, Koopman signed a Work Status Report form dated April 26, 2002, indicating that Plaintiff's “Work Status” was “Modified with limitations listed below” and specifying under “Work Limitations” that Plaintiff “needs to be under different manager in different dept.” AR at 1115. Dr. Zweng also released Plaintiff to return to work on Monday, April 29, 2002. Id. at 1116. That two doctors cleared Plaintiff to return to work is inconsistent with Plaintiff's assertion that as of April 19, 2002, he was unable to work at his Own Occupation during the Elimination Period and the next 60 month period.

         Dr. Mears's May 1, 2002 Assessment

         On May 1, 2002, Plaintiff was seen by Dr. William C. Mears at the Santa Cruz Medical Clinic. Dr. Mears noted that Plaintiff “continues with anxiety, rapid heartbeat, unable to sleep. . . . Also increased anxiety at work. He said that he was suspended today.” AR at 1119. Dr. Mears's assessment was that Plaintiff had: “1. Palpitations; work-up in progress. 1. Adjustment disorder with anxiety and depression related to job stressors. 3. Insomnia, possibly related to his Paxil.” Id.

         The Court concludes that Dr. Mears's notes do not support a finding of Disability within the meaning of the Plan. Instead, the notes are indicative of the same interpersonal clash with Plaintiff's supervisor that prompted Plaintiff to seek treatment with Dr. Koopman in April of 2002. AR at 1111. Dr. Mears's notes indicate that Plaintiff's anxiety and depression are related to Plaintiff's particular job. AR at 1119. There is no evidence that Plaintiff's anxiety and depression prevented him from working at a different job. To receive LTD benefits under the Plan, Plaintiff must have been unable to earn more than 80% of his Earnings at his “Own Occupation” for any employer in his Local Economy. The Plan specifies that “Own Occupation” is not limited to the specific position Plaintiff held. AR at 1471. Dr. Mears wrote that “Plaintiff can return to work but due to his job stress under one supervisor, it is recommended ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.