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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF PENNSYLVANIA

ELLEN WATSON : CIVIL ACTION

: No. 05-3481

v. :

:

METROPOLITAN LIFE INS. CO. :

:

O’NEILL, J. : JULY 11, 2007

MEMORANDUM

Plaintiff Ellen Watson filed a complaint on July 7, 2005 under the Employee Retirement

Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., claiming that defendant

Metropolitan Life Insurance Co. (“MetLife”) wrongfully denied her long term disability benefits. 

Before me now are the parties’ cross motions for summary judgment and defendant’s response to

plaintiff’s motion.

BACKGROUND

Watson was hired by Verizon on November 4, 1991 as a Maintenance Administrator in

Verizon’s Customer Service Department. In 2001, she began experiencing pain in her back and

right leg that she associated with the need to care for her son who has cerebral palsy. An MRI of

her spine in May 2002 showed right sided disc herniation compressing the right S/1 nerve root

and also a shallow disc herniation at L/4, L/5 not compromising the central canal or neural

foramen. She also was diagnosed with major depressive disorder by Dr. Misook Soh, Board

Certified in psychiatry. Dr. Soh based his diagnosis on Watson’s monthly therapy sessions, a

GAF score of 55, and her family life. Since her diagnosis, Watson has been medicated with

Zoloft, Webultrin and Trazodone. 

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 1 of 10
1At one point in her motion, Watson argues that her claim for benefits was approved and

then denied. I disagree. MetLife decided to pay plaintiff long-term disability benefits to avoid

inconveniencing her while its disability determination was being made. 

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On May 8, 2002, Watson stopped working, claiming that she was disabled due to thoracic

lumbar disc displacement, major depressive disorder, thyroiditis, plantar fascitis, and heel spur. 

After fifty-two weeks, Watson became eligible to apply for long-term disability under the

Verizon Long-Term Disability Benefit Plan for Mid-Atlantic Associates. Verizon established the

Plan to provide its eligible employees with disability benefit. MetLife administers the benefits

and claims under the Plan. The Plan vests MetLife with complete discretionary authority to

interpret the terms of the Plan and to determine eligibility for Plan benefits. 

The Plan defines “Total Disability” as “unable, due to sickness or injury documented by

objective medical evidence, to perform any job for which you are or may become qualified by

reason of education, training, or experience, or any job that pays, on a full-time basis, 50 percent

or more of your base pay.” The Plan also requires that a disabled individual “must be under the

care of a qualified physician who must provide appropriate documentation of your disability.” 

Further, to be considered disabled, “[y]ou must take proper care of yourself and receive medical

treatment.”

On March 30, 2003, MetLife acknowledged its receipt of plaintiff’s claim for long-term

disability benefits and requested forms and medical documentation by April 25, 2003. When it

did not receive the required information by May 7, 2003. MetLife denied Watson’s claim.

Watson then submitted some information. MetLife initiated plaintiff’s long-term

disability benefits pending the conclusion of its investigation.1 As part of its initial review,

MetLife considered various records, including Watson’s job description, an MRI of the lumbar

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 2 of 10
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spine (5/20/02), an IME exam from (3/27/03), Watson’s employee statement (4/03), her personal

profile evaluation form (4/03), the attending physician statement by Dr. John Walsh (5/7/03),

Behavioral Health Initial Functional Assessment Form by Dr. M. Soh (6/30/03 and 12/15/03),

Lab work (6/30/03, 10/8/03, 10/20/03, and 12/8/03), Functional Capacity Evaluation Report

(7/31/03), Letters to MetLife from Dr. John Walsh (8/14/03 and 12/15/03), Thyroid Image update

(9/3/03), Thyroid B Scan (10/23/03), Letter to Dr. Walsh from Dr. Anne France Walczak,

Endocrinology (10/25/03), Letter from Dr. Walsh from Dr. Urbas, Podiatry (12/14/03). 

Watson’s claim was initially reviewed by a MetLife Case Manager, a Nurse Consultant, a

Psychiatric Clinical Specialist and a Verizon Medical Doctor. 

After completing its initial review of Watson’s claim for benefits, MetLife notified her

that her claim was denied because her medical information did not support and provide sufficient

proof of total disability as defined by the Plan. Specifically regarding Watson’s mental health,

MetLife advised her that the “information provided fails to support the presence of a psychiatric

condition that would preclude [her] from performing her own job.” MetLife further found that

the medical information provided to them did not support total disability, that there were no

neurological findings or underlying lesions, that Watson had a sedentary work capacity and could

perform her job with accommodations. MetLife also noted that her thyroiditis was under control

and her plantar facitis and heel spur were 90% improved.

On May 25, 2004, Watson advised MetLife that she was appealing the denial of her

benefits. MetLife’s Appeal Unit referred plaintiff’s file for review by two Independent Physician

Consultants. The Psychiatric Independent Physician Consultant reviewed Watson’s file and

found that the forms submitted by her psychiatrist “did not present a detailed mental status

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examination.” Further, he found that the forms did not specify why Watson’s symptoms “would

prevent [her] from working at her own occupation.” The other Independent Physician Consultant

also found that the file lacked objective medical evidence to support a physical functional

impairment. Reviewing the Functional Capacity Evaluation (“FCE”), he found that it

“substantiates that [Watson] should be able to return to a sedentary activity with a gradual return

to full time work. Remaining out of work has hindered her return to productivity and would

seem to be inhibiting her psychological well-being.” 

On July 8, 2004, MetLife advised Watson that it was not changing its decision to deny

benefits. It advised Watson that the “medical documentation on file does not provide physical or

psychological evidence that [she] was precluded from performing the duties of her own job.” 

Plaintiff requested a second level appeal but did not submit any additional information or

medical documentation for review. MetLife referred plaintiff’s request for a second level appeal

to the Verizon Claims Review Committee. 

The Committee referred plaintiff’s file for review to Ruksana Sadiqali, M.D., of Verizon

Occupational Health Services. Dr. Sadiqali recommended an additional FCE based on his belief

that MetLife had approved, then denied long-term benefits to Watson. Following Watson’s

second FCE, performed on January 27, 2005, the Verizon Claims Review Committee advised

Watson’s counsel that her request for long-term disability benefits was being denied. The

Committee advised plaintiff’s counsel that the information provided did not substantiate

Watson’s request for reinstatement of her long-term disability benefits. It also advised plaintiff’s

counsel that its decision was final and advised plaintiff of her rights under ERISA.

Watson was awarded Social Security Disability benefits in November 2002. Dr. Alan

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 4 of 10
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Groth of the Pennsylvania Bureau of Disability Determination, after a physical examination and

in-person consultation, declared that Watson was suffering from severe depression, chronic low

back pain, trigeminal neuraglia and mitral valve prolapse. The State Social Security

Administration found Watson to be totally disabled from any occupation for which she was

qualified. These records do not appear in MetLife’s Administrative Record.

STANDARD OF REVIEW

Rule 56(c) of the Federal Rules of Civil Procedure provides, in relevant part, that

summary judgment is proper “if the pleadings, depositions, answers to interrogatories, and

admissions on file, together with the affidavits, if any, show that there is no genuine issue as to

any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed. R.

Civ. P. 56(c). The moving party “bears the initial responsibility of informing the district court of

the basis for its motion, and identifying those portions . . . which it believes demonstrate the

absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). 

After the moving party has filed a properly supported motion, the burden shifts to the nonmoving

party to “set forth specific facts showing that there is a genuine issue for trial.” Fed. R. Civ. P.

56(e).

I must determine whether any genuine issue of material fact exists. An issue is genuine if

the fact finder could reasonably return a verdict in favor of the non-moving party with respect to

that issue. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). An issue is material only

if the dispute over the facts “might affect the outcome of the suit under the governing law.” Id.

In making this determination, I must view the facts in the light most favorable to the non-moving

party, and the non-moving party is entitled to all reasonable inferences drawn from those facts. 

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 5 of 10
2When reviewing an administrator’s determination, courts may only review the evidence

that was before the administrator at the time of its determination. Mitchell v. Eastman Kodak

Co., 113 F.3d 433, 440 (3d Cir. 1997). Watson attempts to supplement the record with her

Social Security documents, including her examination by Dr. Groth, but admits that MetLife did

not have copies of those documents when it denied her long-term disability benefits. Therefore, I

cannot consider them. 

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Id. However, the nonmoving party may not rest upon the mere allegations or denials of the

party's pleading. See Celotex, 477 U.S. at 324. The non-moving party must raise “more than a

mere scintilla of evidence in its favor” in order to overcome a summary judgment motion and

cannot survive by relying on unsupported assertions, conclusory allegations, mere suspicions. 

Williams v. Borough of W. Chester, 891 F.2d 458, 460 (3d Cir. 1989). If the evidence for the

nonmoving party is merely colorable, or is not significantly probative, summary judgment may

be granted. Anderson, 477 U.S. at 249-50 (citations omitted).

Cross-motions are merely claims by each side that it alone is entitled to summary

judgment; they do not constitute an agreement that if one is denied the other is necessarily

granted or that the losing party waives judicial consideration and determination of whether

genuine issues of material fact exist. Rains v. Cascade Indus., Inc., 402 F.2d 241, 245 (3d Cir.

1968). If any such issue exists it must be disposed of at trial and not on summary judgment. Id.

In the present case, there are no genuine issues of material fact. Both parties agree on the

relevant facts and refer to the same standardized record.2 The only issue before me is whether as

a matter of law MetLife’s decision to deny Watson long term disability benefits was arbitrary and

capricious. I hold that it was not.

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DISCUSSION

A. ERISA Standard of Review 

Where the administrator of a long term disability plan has discretion to interpret the plan

and determine whether benefits are available to an injured employee, the administrator’s exercise

of discretion is judged by an arbitrary and capricious standard. See Firestone Tire & Rubber Co.

v. Bruch, 489 U.S. 101, 115 (1989); Abnathya v. Hoffman-LaRoche, Inc., 2 F.3d 40, 45 (3d Cir.

1993). “Under the arbitrary and capricious standard, an administrator’s decision will only be

overturned if it is without reason, unsupported by substantial evidence or erroneous as a matter of

law.” Pinto v. Reliance Standard Life Ins. Co., 214 F.3d 377, 387 (3d Cir. 2000). I am not free

to substitute my own judgment for that of an administrator absent such a showing. Id

B. Diagnoses of Treating Physicians

Watson argues that MetLife’s decision to deny her long-term benefits was arbitrary and

capricious because it gave little to no consideration to the diagnoses of her treating physicians. 

Although in some cases “opinions of a claimant’s treating physician[s] are entitled to substantial

and at times even controlling weight,” Skretvedt v. E.I. DuPont de Nemours & Co., 268 F.3d

167, 187 (3d Cir. 2001), quoting Fargnoli v. Massanari, 247 F.3d 34, 43 (3d Cir. 2001), “plan

administrators are not obliged to accord special deference to the opinions of treating physicians”

because there is also bias and conflict of interest on the part of “a treating physician who, in a

close case, may favor a finding for the patient.” Stratton v. E.I. Dupont De Nemours & Co., 363

F.3d 250, 258 (3d Cir. 2004), citing Black & Decker Disability Plan v. Nord, 538 U.S. 822

(2003). As the Supreme Court stated in Black & Decker:

Plan administrators, of course, may not arbitrarily refuse to credit a claimant's reliable

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 7 of 10
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evidence, including the opinions of a treating physician. But, we hold, courts have no

warrant to require administrators automatically to accord special weight to the opinions of

a claimant’s physician; nor may courts impose on plan administrators a discrete burden of

explanation when they credit reliable evidence that conflicts with a treating physician's

evaluation.

538 U.S. at 823-24. MetLife’s administrators throughly reviewed the opinions of Watson’s

treating physicians and addressed both their subjective findings and the accompanying objective

evidence. Thus, the fact that MetLife accorded greater weight to its reviewing physicians than to

Watson’s treating physicians does not make its decision to deny plaintiff’s long-term disability

benefits arbitrary and capricious. 

C. Social Security Evidence

Watson also argues that MetLife ignored her Social Security evidence. A plan

administrator need not defer to a SSA decision when determining whether a claimant qualifies

for disability benefits. Dorsey v. Provident Life & Accident Ins. Co., 167 F. Supp. 2d 846, 856

n.11 (E.D. Pa. 2001). An SSA decision is merely one factor that may be considered; it is not

dispostive in determining whether an ERISA administrator’s decision is arbitrary and capricious. 

Id. As I discussed above, the plan administrator reviewed and assessed the medical evidence

provided by Watson. Watson admits that she did not provide the Social Security documents to

MetLife at the time of its decision to deny Watson long-term disability benefits. Therefore,

because the Social Security documents were not part of the record provided by Watson and

reviewed by MetLife, the administrator’s decision not to review them cannot be arbitrary and

capricious. 

D. Interpretation of FCEs

Watson also argues that MetLife’s interpretation of her first FCE was questionable and

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 8 of 10
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that MetLife entirely ignored her second favorable FCE. According to Watson, MetLife failed to

give any consideration of the FCE performed on January 27, 2005. MetLife, however, did

consider the second FCE. In their letter dated March 14, 2005, the Verizon Claims Review

Committee notified Watson that Ms. Laina Curran, MSPT, reviewed the FCE and found that

“based on individual tolerances for Sitting (Frequently), Standing (Occasionally) and Walking

(Frequently), it appears clinically reasonable that [plaintiff] can tolerate sedentary work for the 8

hour day.” Contrary to Watson’s arguments, the second FCE was not favorable to her–it only

supported MetLife’s decision that she was able to perform her job with accommodations. 

Further, the second FCE was ordered only because the Verizon Claims Review Committee

erroneously believed that MetLife had approved and then later denied Watson’s disability

benefits. Therefore, I cannot say that MetLife’s decision to deny Watson’s long term disability

benefits was arbitrary and capricious based on MetLife’s interpretation of the first FCE or their

failure to consider Watson’s second FCE. 

E. Review of MetLife’s Determination

There is ample evidence to support MetLife’s decision not to award long-term disability

benefits to Watson. MetLife carefully reviewed Watson’s medical records at each stage of her

appeals process. It also thoroughly addressed the subjective opinions of her treating doctors and

the objective medical evidence in her file. When the administrator has reviewed all the evidence

and there is no indication of a conflict of interest I cannot substitute my judgment for the

judgment of the plan administrator. Therefore, I find that MetLife’s decision to deny Watson

long-term disability benefits was not arbitrary and capricious. 

An appropriate Order follows. 

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 9 of 10
IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF PENNSYLVANIA

ELLEN WATSON : CIVIL ACTION

: No. 05-3481

v. :

:

METROPOLITAN LIFE INSURANCE CO. :

ORDER

And now, this 11th day of July, 2007, upon consideration of defendant MetLife’s motion

for summary judgment, plaintiff Watson’s motion for summary judgment and defendant’s

response thereto, and for the reasons set forth in the accompanying memorandum, defendant’s

motion for summary judgment is GRANTED. Plaintiff’s motion for summary judgment is

DENIED. Judgment is entered in favor of defendant Metropolitan Life Insurance Co. and against

plaintiff Ellen Watson.

Defendant’s motion to Strike Plaintiff’s Supplemental Administrative Record is DENIED

as moot. 

The clerk is ordered to close this case statistically.

s/Thomas N. O’Neill, Jr. 

THOMAS N. O’NEILL, JR., J.

Case 2:05-cv-03481-TON Document 22 Filed 07/11/07 Page 10 of 10