Welsh v. Metropolitan Life Insurance Company et al, No. 3:2004cv05143 - Document 112 (W.D. Wash. 2010)
Court Description: ORDER granting 103 Defendants' Motion for Summary Judgment; Plaintiff's Amended Complaint is DISMISSED. Signed by Judge Ronald B. Leighton.(DN)
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Welsh v. Metropolitan Life Insurance Company et al Doc. 112 1 HONORABLE RONALD B. LEIGHTON 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT TACOMA 9 10 11 PAULA J. WELSH, Personal Representative of the ESTATE OF DAVID L. WELSH, and Successor, 12 Plaintiff, ORDER GRANTING SUMMARY JUDGMENT 13 v. 14 15 16 Case No. C04-5143RBL METROPOLITAN LIFE INSURANCE COMPANY; and DELOITTE & TOUCHE GROUP INSURANCE PLAN, 17 Defendants. 18 19 20 THIS MATTER comes before the Court on Defendants’ Motion for Summary Judgment [Dkt. 21 #103]. The Court has reviewed the materials for and against said motion. Oral argument is not necessary 22 to resolve the issue before the Court. For the following reasons, the motion is GRANTED. 23 PROCEDURAL HISTORY 24 The tortured history of this case spans more than a decade. Plaintiff was terminated from his 25 26 employment with Deloitte & Touche in 1994. He submitted a claim for long-term disability benefits to 27 Metropolitan Life Insurance Company (“MetLife”), the claims administrator of the Deloitte & Touche 28 Group Insurance Plan. He claimed that he was disabled as of July 13, 1994. Following an extensive ORDER Page - 1 Dockets.Justia.com 1 2 review of medical records, MetLife denied the claim finding that the medical records did not support a finding that plaintiff was disabled from his job. 3 Plaintiff appealed the decision and MetLife advised him, on August 14, 1995, that the prior 4 5 decision would be upheld because he did not satisfy the definition of “disabled” under the Plan. Plaintiff 6 submitted more information and MetLife conducted an additional review. That review recommended 7 upholding the denial of benefits. MetLife notified plaintiff’s attorney of its final decision on December 5, 8 1995. 9 Plaintiff filed a lawsuit in the U.S. District Court for the Central District of California. The Court 10 11 granted summary judgment to MetLife, and Deloitte & Touche and plaintiff appealed to the Ninth Circuit. 12 The Ninth Circuit remanded the case back to the District Court with instructions to remand the matter to 13 MetLife to re-examine plaintiff’s claim applying the correct definition of “disability.” 14 15 After review of the new evidence provided by plaintiff and the examining physicians, MetLife again denied the claim on May 17, 2002, stating that plaintiff did not meet the Plan definition of 16 17 “disability” or “disabled” as of the day he stopped working for Deloitte & Touche (August 31, 1994). 18 Plaintiff appealed that decision on June 27, 2001, claiming that his job required additional 19 “abilities,” which had not been mentioned in his initial claim, and which therefore had not been evaluated 20 by the Plan Administrator when considering the issue of “disability.” MetLife had the new information 21 evaluated by a retained physician. On September 23, 2002, MetLife again upheld the decision that 22 plaintiff was not disabled when he left the employ of Deloitte & Touche. Plaintiff filed this suit seeking 23 24 25 26 27 28 judicial review of that decision on March 16, 2004. On May 4, 2005, this Court denied cross-motions for summary judgment, but established the applicable standard of review as abuse of discretion. [Dkt. #30]. On November 1, 2005, a bench trial on the administrative record was conducted. The Court examined the record, reviewed briefing, and heard extensive argument from counsel. Findings of Fact and Conclusions of Law were entered by the Court. ORDER Page - 2 1 2 [Dkt. #41]. The Court found that MetLife did not abuse its discretion in denying plaintiff’s claim for benefits, and the claim was dismissed. Plaintiff appealed. 3 In a memorandum opinion, the Circuit confirmed that abuse of discretion was the correct standard 4 5 of review to apply to MetLife’s denial of benefits. Welsh v. Metropolitan Life Insurance Company, et al., 6 No. 05-36166 (9th Cir. 2007). The Court remanded the case back to this Court, however, to permit a re- 7 evaluation of MetLife’s denial in light of a decision of the Ninth Circuit rendered after this Court’s 8 decision (Abatie v. Alta Health & Life Ins. Co, 458 F.3d 955 (9th Cir. 2006). That case focuses on the 9 inherent, structural conflict of interest of a plan administrator possessed of the dual role as payor of 10 11 benefits and decision-maker regarding eligibility for plan benefits. 12 Upon remand plaintiff immediately sought broad-ranging discovery into Met Life’s claims 13 handling process. The Court tailored the request and ordered limited discovery deemed appropriate given 14 the Court’s previously expressed conviction that the administrative record provides compelling support 15 for the decision to deny plaintiff’s claim. [Dkt. #62]. 16 17 In February, 2010, the Court issued a Notice of Intent to Dismiss the Complaint for Failure to 18 Prosecute the Case [Dkt. #78]. In May, 2010, a statement noting the death of plaintiff David Welsh was 19 filed with the Court [Dkt. #83]. Later that month, the complaint was amended to substitute Paula Welsh, 20 Personal Representative for the Deceased, David Welsh [Dkt. #99]. 21 Defendants filed the current motion for summary judgment asking the Court to dismiss plaintiff’s 22 claim a second time. 23 SUMMARY JUDGMENT STANDARD 24 25 Summary judgment is appropriate when, viewing the facts in the light most favorable to the 26 nonmoving party, there is no genuine issue of material fact which would preclude summary judgment as a 27 28 matter of law. Once the moving party has satisfied its burden, it is entitled to summary judgment if the non-moving party fails to present, by affidavits, depositions, answers to interrogatories, or admissions on ORDER Page - 3 1 2 3 file, “specific facts showing that there is a genuine issue for trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986). “The mere existence of a scintilla of evidence in support of the non-moving party’s position is not sufficient.” Triton Energy Corp. v. Square D Co., 68 F.3d 1216, 1221 (9th Cir. 1995). Factual 4 5 disputes whose resolution would not affect the outcome of the suit are irrelevant to the consideration of a 6 motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). In other 7 words, “summary judgment should be granted where the nonmoving party fails to offer evidence from 8 which a reasonable [fact finder] could return a [decision] in its favor.” Triton Energy, 68 F.3d at 1220. 9 ANALYSIS 10 11 The Court in Abatie acknowledged that abuse of discretion review applies to a discretion - 12 granting ERISA plan even if the administrator has a conflict of interest. Id. at 965. The Court went on to 13 interpret the Supreme Court decision in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), to 14 require abuse of discretion review whenever an ERISA plan grants discretion to the plan administrator, 15 but that review is informed by the nature, extent, and effect on the decision-making process of any 16 17 conflict of interest that may appear in the record. Id., at 967. In performing this task, the Court may, in 18 its discretion, consider evidence outside the administrative record. The decision on the merits, however, 19 must rest on the administrative record once the conflict has been established by extrinsic evidence or 20 otherwise. Id. at 970. Finally, the Abatie Court reaffirmed the principle that when an administrator 21 engages in wholesale and flagrant violations of the procedural requirements of ERISA, the decision made 22 by the administrator to deny benefits is reviewed de novo. Id. at 971. 23 24 In a later refinement of the Abatie standard, the Ninth Circuit stated that when considering 25 evidence outside the administrative record in ERISA denial of benefits cases in which the plan 26 administrator had a structural conflict of interest, the trial court must view the evidence of bias in the light 27 28 most favorable to the claimant, as the nonmoving party, and to “temper the abuse of discretion standard with appropriate skepticism.” Nolan v. Heald College, 551 F.3d 1148, 1155 (9th Cir. 2009). ORDER Page - 4 1 2 Applying the guidance provided by the Circuit Court and looking at the structural conflict of interest with as much skepticism as the Court can muster, the decision of MetLife to deny benefits is still 3 affirmed. The Court always views evidence of the type common in ERISA cases with skepticism. The 4 5 Court knows from personal experience that “independent medical examinations” are not independent. 6 Physicians retained by insurance companies to evaluate and at times contradict treating physicians can 7 make vast amounts of money in the enterprise. Knowing the precise dollar figure does not enhance the 8 Court’s skepticism. 9 Sometimes conflicts of interest can cause decision-makers to alter the decision-making process in 10 11 ways that make a decision to decline benefits more likely. The Court looked for such irregularities here. 12 This Court did not find the kind of procedural irregularities that would indicate the kind of flagrant abuse 13 the Abatie court discussed. Neither did the Appellate Panel that reviewed the Court’s earlier decision. 14 See Welsh, id. at 3-4. 15 Finally, the Court is aware that insurance company profits increase as benefit pay-outs decrease. 16 17 18 19 20 21 Again, knowing the specifics in dollars and cents would not alter the approach taken by this Court in evaluating the evidence for and against disability in this case. This Court is firmly convinced that at the time he left the employ of Deloitte & Touche, David Welsh was not “disabled” as that term was defined in the Plan. If the Court applied a de novo standard, the result would be the same. This was not a close case and no amount of skepticism as a method of 22 tipping the scales will alter that conclusion. 23 24 25 26 27 28 ORDER Page - 5 1 2 3 For the foregoing reasons, Defendants’ Motion for Summary Judgment [Dkt. #103] is GRANTED and the Amended Complaint is DISMISSED. Dated this 29th day of November, 2010. 4 5 7 A 8 RONALD B. LEIGHTON UNITED STATES DISTRICT JUDGE 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ORDER Page - 6
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