“Boxell V. Plan For Group Ins. Of Verizon Communications”

“Boxell v. Plan for Group Ins. of Verizon Communications”

51 F. Supp. 3d 759 (N. D. Ind., 2014)

Ms. Boxell was employed by Verizon Communications, Inc., as a network engineer. When she first began experiencing pain in her lower back and legs, testing suggested that she may have Paget’s Disease, a disorder characterized by abnormal bone growth that can cause bones to become fragile or misshapen. Over time, her condition continued to worsen and interfered with her ability to work, so ultimately, Ms. Boxell sought disability benefits. MetLife, the administrator for the plan, approved short-term disability benefits and then long-term disability benefits for Ms. Boxell, but then terminated the LTD benefits after 12 months, claiming that her diagnoses of low back pain and fibromyalgia were subject to a 12-month limitation of benefits for neuromusculoskeletal/soft tissue disorders. Around that time, in a phone call to Ms. Boxell, a claims representative told her, “we are not questioning disability. The plan has a limited benefit condition clause.”

Ms. Boxell hired us. We submitted a detailed and comprehensive appeal, which was denied. We then filed suit. The district court held that MetLife’s decision was arbitrary and capricious and ordered a remand to MetLife, explaining:

1. The Plan’s decision was arbitrary and capricious, reasoning that the Plan relied on flawed reasoning in finding that Ms. Boxell’s fibromyalgia was not disabling and in discounting the Social Security Administration’s conclusion that Ms. Boxell was disabled and that it upheld its denial of her benefits based on different reasons than it initially denied them. It also failed to adequately acknowledge and justify its departure from its previous findings.

2. The reasons the Plan offered for concluding that Ms. Boxell’s fibromyalgia was not disabling did not support its conclusion.

3. To the extent the Plan argued that there was no objective evidence of Ms. Boxell’s physical limitations was factually unsupported.

4. To the extent the Plan seeks to discredit or distinguish objective evidence of Ms. Boxell’s physical limitations, this argument falls short because the Plan failed to articulate those bases at the administrative level.

5. To the extent the Plan sought to justify its conclusion that fibromyalgia was not disabling by arguing that Ms. Boxell’s own doctor excluded it as a disabling diagnoses, “This statement is false, and misstates the record.”

6. The Plan did not offer any satisfactory explanation for discounting the Social Security Administration’s findings that Ms. Boxell was disabled, reasoning that the Plan’s stated reasons in litigation were either factually incorrect or distinguishable and therefore “its failure to offer any plausible reason for discounting the SSA findings is an indication that the Plan’s decision was arbitrary and capricious.”

7. There are also a number of ways in which the Plan’s reasoning was not only inconsistent over time but also self-contradictory. These contradictions not only suggest arbitrary and capricious decision making, but they also denied Ms. Boxell a full and fair review of her claim by misrepresenting the issues on which she would need to provide additional evidence. These included:

A. Denying Ms. Boxell’s appeal for different reasons than it initially terminated her benefits which “not only exemplifies the definition of capricious, it implicates Ms. Boxell’s right to a full and fair review of her claim. . .” Since the Plan told Ms. Boxell in its’ September 16, 2011, letter that it already found she was disabled due to fibromyalgia, she had no reason to submit additional evidence on that issue. “In this regard, the Plan did not just ‘move the target’ it hid the target, giving Ms. Boxell no way to know she needed to contest the Plan’s finding on this issue.”

B. The Plan’s attempt to downplay this discrepancy by claiming that its initial statement that Ms. Boxell was disabled due to the fibromyalgia “was only a scrivener’s error and should be disregarded, but the drafting history of the letter belies these assertions.”

C. “Furthermore, the Plan’s ultimate finding that Ms. Boxell was not disabled not only contradicted its initial denial letter, it was inconsistent with its entire course of handling Ms. Boxell’s claim.”

D. “The Plan also appears to have changed its mind as to whether fibromyalgia was subject to the 12-month limitation of benefits.” The Court explained that an entry in the claims log on May 1, 2012, indicated that the limited disability benefit provision did not apply “But despite the apparent change in its interpretation of this provision, the Plan never expressly acknowledged to Ms. Boxell that it had changed its mind, nor did it ever provide reasons for having done so.”

The Court, therefore, remanded the case to MetLife to reconsider its decision.