In this case, Gary Carty (“Carty”) worked as a manager of Eastman Chemical Company’s (“Eastman”) information technology department. Gary held a policy under the Eastman Chemical Company Welfare Benefit Program which Metropolitan Life Insurance Company (“MetLife”) administered. Under the policy provisions, a claimant is considered disabled if he cannot make 80% of his pre-disability salary when he executes the same job duties that he had prior to the disability. In order to be considered disabled after eighteen months, “you may not earn more than 50% of your pre-disability earnings from any employer in your local economy at any gainful occupation for which you are reasonably qualified, taking into account your training, education, and experience.”
In March 2013, Carty filed for long-term disability benefits because of depression, anxiety, and bipolar disorder. These benefits were approved starting on June 8, 2013. For the next few years, MetLife kept track of Carty’s treatment. In March 2015, a review of Carty’s file was recommended because he allegedly had infrequent treatment visits. On April 17, 2015, MetLife informed Carty that it was terminating his benefits because his issues did not satisfy the disability definition. Carty appealed and MetLife again denied his long-term disability benefits. MetLife stated that Carty had been violating a specific provision of the plan which required “appropriate care and treatment.” Carty then filed this suit.
The court held that MetLife had been ignoring documentation of symptoms by Carty’s psychiatrist, Dr. Ronald Smith, and psychologist, Dr. Edward Latham. Further, the court believed that MetLife did not give Carty sufficient notice regarding his infrequent treatment as a reason for terminating his benefits. As such, the court held that “[i]n light of the cumulative deficiencies in MetLife’s process and reasoning. . . . MetLife acted arbitrarily and capriciously in concluding that Carty was no longer impaired and that he was not receiving appropriate care and treatment.” This led to an order to remand the instant case to MetLife to reconsider.
Carty cited four main reasons for his belief that MetLife acted in an arbitrary and capricious manner. First, he believed that MetLife’s decision that he was not disabled was arbitrary and capricious because of the evidence that he presented. Secondly, he believed that MetLife’s decision was arbitrary and capricious because it failed to carry out a vocational review related to Carty’s earning capacity. Thirdly, he believed that MetLife failed to rely on his own doctors’ conclusions and heavily relied on its own. Fourthly, he believed that MetLife only relied on his impairments through 2015 and not through the present.
Overall the court condensed the above four reasons into two main questions. Was it arbitrary and capricious for MetLife to determine that Carty was capable of earning $63,100 at some point during the applicable time period? And, was MetLife arbitrary and capricious when it examined Carty’s issues over time?
Regarding the first question, the court believed that MetLife must have had a reason for believing that Carty could obtain an earning of $63,100. Otherwise, it would have been acting in an arbitrary and capricious matter. The court first examined Carty’s symptoms; it cited information from the first part of the lawsuit, stating that he had problems with interpersonal interaction, regular attendance, and conflict with routine stressors. Additionally, the court found that there was new evidence that Carty had additional cognitive deficits which would limit his ability to complete certain work or learn new skills. With those issues, MetLife simply had to show that Carty could not earn 50% of his pre-disability salary of $126,200. Overall, the court held that MetLife essentially did not provide a basis for determining that Carty was or is able to earn $63,100. Further, the court did not believe that with his impairments, Carty would have been able to earn that amount.
In addressing the second question, the court believed that it was completely reasonable for MetLife to question Carty’s conditions at certain points in time. However, the court had issues with the process that MetLife appeared to use for its analysis. For example, the court had a problem with the Independent Medical Examination that Dr. Ihrig performed. The question that was focused on for the IME was whether “the medical information support[ed] functional limitations due to a cognitive condition, as of 5/1/15.” There was additional evidence, however, of Carty’s condition that may have been progressive post-2015. Further, Carty’s issues were not limited strictly to the state of his impaired cognitive condition.
MetLife had the ability to determine the range of questions that it asked Dr. Ihrig for the IME. However, the court believed that MetLife should have recognized its own analytical limitations in order to prove that its decision-making process was rational. Alternatively, MetLife drew the conclusion that Carty’s records “did not support cognitive or psychiatric functional limitations, as of May 1, 2015.” However, Dr. Ihrig was never asked about Carty’s psychiatric limitations. He warned that his report’s “focus on cognitive functioning may have been confining in [the] scope and specificity of [his] responses.” Also, “Carty does appear to suffer from a major mental illness that has affected him broadly” and “likely cognitively.” The court held that Dr. Ihrig’s analysis did not support MetLife’s conclusions related to cognitive and psychiatric limitations. More specifically, the court believed that MetLife failed to take into consideration the limitations of Dr. Ihrig’s report.
For the reasons above, the court found in favor of Carty. In this type of case, the court usually remands to the administrator in order to reconsider the claim. However, because this was the second time this suit came before the court, it believed that it would be pointless for a remand to MetLife for a second time. More particularly, the court understood that MetLife already feels that there is a single conclusion to be drawn from the record. Therefore, in this case, the court decided to order MetLife to pay Carty’s past benefits and restore his current ones, as well.
[Note: this claim was not handled by the Ortiz Law Firm. It is merely summarized here for a better understanding of how Federal Courts are handling long term disability insurance claims.]Here is a PDF copy of the decision. As an extra added bonus, below this 2019 decision is a link to the prior 2016 court decision on the same matter.
Prior 2016 Court Decision in Carty v. MetLife:
