Opinion
Civil Action No. 01-10560-RWZ
July 2, 2002
MEMORANDUM OF DECISION
Plaintiff, Ellen McCarthy worked for Raytheon Company ("Raytheon") from April, 1965, until August 30, 1999, several days before the first of two total knee replacement surgeries on her left knee. At that time she was employed as an accountant. According to her disability claims file, plaintiff received Short Term Disability ("STD") benefits from September, 1999, through November, 1999, at which point she was approved for Long Term Disability ("LTD") benefits through November 28, 2000.
Metropolitan Life Insurance Company ("MetLife") was the claims administrator responsible for determining a participant's eligibility benefits under Raytheon's disability plans. The LTD plan states that benefits are payable during the first 18 months of disability to an employee who is fully disabled. The plan defines a fully disabled employee as one who, "because of sickness or injury . . . (i) cannot perform the essential elements and substantially all of the duties of his or her job . . . even with reasonable accommodation; and (ii) is under the care of a Doctor." Benefits are payable thereafter only to an employee who is totally disabled. According to the plan, a totally disabled employee is one who "cannot do any other job for which he or she is fit by education, training or experience." After several appeals and subsequent extensions of plaintiff's benefits, MetLife upheld its decision to terminate them on November 28, 2000. Plaintiff then filed this claim, based on defendant's alleged wrongful termination of her LTD benefits. Both parties have filed motions for summary judgment.
According to the claims file, the administrator's determination was based on (1) a "report of physical capacity" prepared by one of plaintiff's treating physicians, Dr. Joseph McCarthy, (2) an independent medical examination by Dr. Fred Kohanna, and (3) an independent records review by Dr. Jeffrey Kahn. Dr. McCarthy reported, on September 15, 2000, that plaintiff could sit for three hours, stand for one hour, and walk for one hour each work day. Given the sedentary nature of the job, defendant concluded that plaintiff could work five hours a day at the time of this report.
Dr. Kohanna reported, on November 14, 2000, that plaintiff would be able to return to work in two weeks if she received the necessary accommodations, namely reduced hours, the use of a cane, limited standing and walking, the ability to elevate her legs as needed, and a medical parking space. Dr. Kahn concurred with this opinion.
Plaintiff argues that defendant's decision is unreasonable, in light of the primary care physician's report, dated January 16, 2001, which concluded that plaintiff was temporarily disabled from any gainful employment. Although this evidence may support plaintiff's claim, it does not render defendant's determination arbitrary and capricious. See Vlass v. Raytheon Employees Disability Trust, 244 F.3d 27, 29-30 (1st Cir. 2001) (arbitrary and capricious standard used to review discretionary determinations of administrator); Terry v. Bayer Corp., 145 F.3d 28, 40 (1st Cir. 1998) (same); Doyle v. Paul Rever Life Ins. Co., 144 F.3d 181, 183-85 (1st Cir. 1998) (same); Diaz v. Seafarers Int'l Union, 13 F.3d 454, 456 (1st Cir. 1994) (same).
Pursuant to this standard, the Court must review the decision and determine whether the factual findings are supported by substantial evidence and whether such decision was reasonable. Diaz v. Seafarers Int'l Union, 13 F.2d at 456. Substantial evidence is "evidence reasonably sufficient to support a conclusion." Doyle, 144 F.3d at 184. Based on the record, the administrator's conclusion that plaintiff's impairment did not meet the definition of "fully disabled," under the LTD plan, was both reasonable and supported by substantial evidence. An employee is considered "fully disabled" if he or she is unable to perform "essential elements and substantially all of the duties of his or her job [at Raytheon] even with reasonable accommodation." Raytheon Company Long Term Disability Plan 2.11 (emphasis added). Plaintiff's job as an accountant did not require any demanding physical activity. Rather, the claims file states that she was required to sit 61-100 percent of the time, stand 1-19 percent of the time and walk 1-19 percent of the time. Plaintiff's treating physician and two independent consultants presented medical evidence supporting the administrator's conclusion that she could perform these tasks for five hours a day. In addition, Raytheon was willing to make the necessary changes in plaintiff's schedule to accommodate her medical needs. All of these factors are more than enough to meet the substantial evidence threshold.
Because the administrator's determination was not arbitrary or capricious, summary judgment for the defendant is allowed. Judgment may enter for the defendant.