Langlois v. Metropolitan Life Insurance Company, No. 5:2011cv03472 - Document 50 (N.D. Cal. 2012)

Court Description: ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 re 40 , 42 (rmwlc2, COURT STAFF) (Filed on 5/24/2012)
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Langlois v. Metropolitan Life Insurance Company Doc. 50 1 2 3 4 E-FILED on 5/24/12 5 6 7 IN THE UNITED STATES DISTRICT COURT 9 FOR THE NORTHERN DISTRICT OF CALIFORNIA 10 United States District Court For the Northern District of California 8 SAN JOSE DIVISION 11 12 JOSEPH H. LANGLOIS, JR., 13 14 15 No. 11-cv-03472 RMW Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, 16 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 [Re Docket Nos. 40, 42] Defendant. 17 18 19 Plaintiff Joseph Langlois ("Langlois") filed this ERISA lawsuit against his former employer, 20 defendant Metropolitan Life Insurance Company ("MetLife"), seeking long-term disability benefits 21 allegedly owed to him for the period between January 15, 2010 and March 3, 2011. The parties now 22 move separately for judgment under Fed. R. Civ. P. 52. After careful consideration of the 23 administrative record and supplemental reports submitted by MetLife, the court concludes that 24 Langlois has failed to prove by a preponderance of the evidence that he was disabled under the terms 25 of MetLife's employee insurance policy during the claim period. Accordingly, the court grants 26 MetLife's motion for judgment. 27 28 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 1 I. LEGAL STANDARD 2 Fed. R. Civ. P. 52 provides that "[i]n an action tried on the facts without a jury … the court 3 must find the facts specially and state its conclusions of law separately." Unlike a Rule 56 motion 4 for summary judgment, a Rule 52 motion seeking disability benefits requires the court to actually 5 decide whether the plaintiff is disabled under the terms of the policy at issue. See Kearney v. 6 Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999). The court must therefore evaluate the 7 persuasiveness of conflicting testimony and make findings of fact. Id. This is considered a "bench 8 trial on the record," which may "consist[ ] of no more than the trial judge rereading [the 9 administrative record]." Id. United States District Court For the Northern District of California 10 II. FINDINGS OF FACT 11 A. Employment Background 12 1. Langlois began working for MetLife as a financial services representative in 1987. AR 60.1 13 In 1998, Langlois switched his focus to "financial planning" and formed his own independent 14 practice within MetLife. Id. Langlois' role as a financial planner required him to advise clients on a 15 wide range of issues such as tax and investment strategies, retirement planning and insurance 16 coverage. AR 80. 17 2. 18 "interpersonal skills," including dependability, perceptiveness, and the ability to listen and 19 communicate effectively. AR 82. Such skills are also important in acquiring new clients through 20 sales presentations or networking. AR 80. In addition, financial planners need analytical skills in 21 order to process complex financial information and provide competent advice. AR 82. 22 3. 23 an overall "book of business" of about 2,700 clients. AR 69. By many measures, Langlois was one 24 of MetLife's top-performing financial planners in the country. AR 61. 25 B. Financial planners develop close relationships with their clients. They must have strong By the late 2000s, Langlois had a client base of about 1,000 actively managed clients, with Employment Conflicts and the Onset of Langlois' Alleged Disability 26 27 28 1 Citations to "AR" refer to the administrative record as provided by Langlois. The court has eliminated any superfluous zeroes in its citations. For example, the page that is Bates-stamped "LANGLOIS000060" is cited as "AR 60." ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 2 1 4. 2 management as early as 2002. AR 62. He had an adversarial relationship with a particular manager 3 in the firm's San Diego office between 2002 and 2005, and was frustrated by MetLife's decision to 4 settle certain "customer disputes" in the customers' favor despite his assertions of innocence. See 5 id.; AR 167. During this time, Langlois often felt stressed and anxious, but did not seek medical 6 help because he "thought those feelings would pass." AR 62. 7 5. 8 The increased supervision subjected Langlois to greater oversight, monitoring and control by 9 MetLife and restricted the autonomy of his practice. Id. The added scrutiny also caused Langlois In spite of Langlois' strong job performance, he experienced "difficulties" with MetLife In August 2009, MetLife began to increase its supervision of Langlois' practice. AR 167. United States District Court For the Northern District of California 10 stress and anxiety. AR 62. 11 6. 12 several MetLife employees. AR 63. The same day, Langlois sought urgent care treatment from Dr. 13 Gordon Booth. AR 98. Langlois reported shortness of breath, chest tightness, insomnia and 14 "extreme stress over situations at his company at this time." Id. Dr. Booth conducted a chest x-ray, 15 which did not reveal any abnormalities. Id. Dr. Booth diagnosed Langlois with "panic disorder, 16 anxiety reaction and transient situational disorder," and prescribed Ativan for anxiety control. AR 17 99. 18 7. 19 certified psychiatrist and Clinical Professor of Psychiatry at the University of California at San 20 Diego. AR 106-07. Dr. Munoz diagnosed Langlois with depression and anxiety, which the doctor 21 noted were "triggered" by work-related conflicts. Id. Dr. Munoz continued Langlois' prescription 22 for Ativan, and recommended that Langlois take antidepressants. Id. Langlois refused because he 23 feared the medication would cause adverse effects related to his recent gastric bypass surgery. Id. 24 8. 25 the Year award, which he had expected to receive because he had the most "points." AR 63. 26 Langlois worried that not receiving the award would reflect poorly on him in the eyes of his co- 27 workers, which added to his feelings of stress and anxiety. Id. 28 9. On October 20, 2009, Langlois had a "meltdown" at work during which he cried in front of On December 4, 2009, Langlois began weekly treatment with Dr. Rodrigo Munoz, a board- Later that month, Langlois found out that he did not receive the MetLife Financial Planner of On January 8, 2010, Langlois visited the Metro Comprehensive Medical center after ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 3 1 experiencing heart palpitations. AR 146. The treating physician noted that Langlois reported 2 "moderate duress with work" and manifested "features of anxiety and acute stress response," but that 3 he denied "regularly feeling down" or having suicidal thoughts. AR 146-47. 4 10. 5 "enhanced supervision monitoring plan." AR 63-64; AR 167. As part of the plan, Langlois would 6 be required to move from his independent practice into a more traditional practice within MetLife. 7 Id. Langlois stated that "having been on enhanced supervision in 2004 and 2005, I knew about the 8 stress and anxiety that it would put on me and my entire firm." AR 64. According to Langlois, this 9 was the "tipping point" in the development of his stress and anxiety-related symptoms. AR 64. On January 14, 2010, MetLife informed Langlois that his practice was to be placed under an United States District Court For the Northern District of California 10 11. 11 Langlois immediately left his office and sought treatment for chest pain from his primary care 12 physician, Dr. Gilbert Dominguez. AR 150-52. Dr. Dominguez noted that "most of [Langlois'] 13 symptoms are related to the current stress from his job situation. Rather than place patient on daily 14 antidepressant, will try very low dose beta blocker to try and normalize blood pressure … when he 15 gets angry at work." AR 15. 16 C. Initial Disability Benefits Claims 17 12. Following his January 14, 2010 departure, Langlois did not return to work at MetLife for 18 more than a year. Instead, he initiated claims for Individual Disability Insurance, short-term 19 disability ("STD") benefits and Family and Medical Leave Act ("FMLA") benefits. 20 13. 21 indicating that Langlois was "severely anxious-depressed – unable to think or concentrate - unable to 22 make decisions." AR 104. Dr. Munoz further stated that the probable duration of Langlois' 23 condition was "indefinite at this time." AR 103. 24 14. 25 MAR 16.2 After being notified of MetLife's intent to implement the enhanced supervision plan, On January 20, 2010, Dr. Munoz submitted a form in connection with Langlois' claims On January 28, 2010, MetLife granted Langlois STD benefits until the end of March 2010. 26 Citations to "MAR" refer to the MetLife Administrative Record, which appears to contain the many of the same materials as the Administrative Record provided by Langlois but in a different order. Where Langlois did not provide materials relevant to the court's resolution of this case, the court refers to the pages as they are listed in the MAR. 2 27 28 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 4 1 15. 2 updated information on Langlois' condition, including office visit notes, objective exam findings, a 3 treatment plan, diagnostic test results, and rehabilitation and progress notes. See MAR 29; 36. 4 16. 5 him permission to respond to questions associated with the date on which Langlois could return to 6 work. MAR 604. He very briefly summarized his treatment, stating that "Mr. Langlois has seen me 7 because of a major depression, a single episode, related to distress caused by conditions at work." 8 AR 153. Dr. Munoz concluded that Langlois continued to have problems with concentration and 9 decision-making that would prevent him from working until the end of September 2010. Id. In late March and early April 2010, MetLife sent several requests to Dr. Munoz seeking On April 6, 2010, Dr. Munoz sent a letter to MetLife, noting that Langlois had only given United States District Court For the Northern District of California 10 17. 11 spring of 2010. Dr. Dominguez' notes indicate that during both visits, Langlois was alert, displayed 12 an "appropriate affect and demeanor" and that he was "under stress at work and taking his 13 medications as directed for anxiety without any problems." AR 541-45. 14 D. Long-Term Disability Benefits Claim and the MetLife Plan 15 18. On May 27, 2010, Langlois opened a long-term disability ("LTD") benefits claim. 16 19. Under the relevant terms of the MetLife employee insurance plan (the "Plan"), an employee 17 suffers from a long-term disability if "during the first 18 months of disability ... , including the 18 period of short term disability," he is unable to earn more than 80% of his pre-disability income at 19 his "own occupation" for any employer in the "local economy." AR 34. The employee's loss of 20 earnings must be a result of his "sickness." Id. 21 20. 22 which he responded "N.A." to most questions. MAR 564-68. In response to inquiries about his 23 medical condition, Langlois simply stated: "See Dr. Munoz letter at STD dept." MAR 564. When 24 asked if he could return to work if his employer made reasonable accommodations, Langlois 25 responded "No!" MAR 567. For his expected return to work date, Langlois listed "unknown at this 26 time." Id. Langlois also submitted an Employee Statement, in which he classified his condition as a 27 "work-related" illness and referred MetLife to Dr. Munoz and Dr. Dominguez for medical 28 information requests. MAR 558-60. Langlois also received treatment from Dr. Dominguez for swollen lymph nodes twice in the In connection with his LTD claim, Langlois submitted a largely blank Personal Profile in ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 5 1 21. 2 ongoing treatment. Dr. Munoz began the conversation by stating that it was a "complicated case" 3 with a "high potential for litigation." MAR 526. Dr. Munoz also indicated that he had received a 4 letter from Langlois' attorney stating that he did not have permission to release Langlois' medical 5 records. Id. He told Dr. Kaplan that Langlois' psychiatric problems began after his employer took 6 "some type of corrective action … against him," and that he was "obsessed with the situation with 7 his employer." AR 159. Dr. Munoz had not conducted any psychological or psychiatric testing on 8 Langlois, but observed that the patient was "having variable moods, depressed at times, optimistic 9 other times." AR 159-60. Langlois also experienced "social isolation" and was "embarrassed to be On June 1, 2010, Dr. Eric Kaplan, a MetLife consultant, spoke to Dr. Munoz about Langlois' United States District Court For the Northern District of California 10 around people that he worked with as he was not invited to some type of work-related celebration 11 which he felt entitled to have been invited." Id. Langlois was still having difficulty focusing and 12 making decisions but had not experienced a change in appetite, psychosis or suicidal ideation. Id. 13 22. 14 diagnostic test results and treatment notes. See MAR 533-36. In response, Dr. Munoz provided a 15 short declaration reiterating his opinion that Langlois suffered from "severe depression and anxiety 16 disorder" which rendered him unable to perform the duties of his occupation. MAR 515. On July 9, 17 2010, MetLife informed Langlois that it could not complete its evaluation of his claim without Dr. 18 Munoz' medical records. MAR 528. 19 23. At some point in July 2010, MetLife discontinued Langlois' STD benefits. 20 24. On August 5, 2010, MetLife sent a letter to Langlois requesting that he submit to an 21 Independent Medical Evaluation ("IME"), and indicating that if an IME was not completed by 22 August 26, 2010, it would assess his claim for LTD benefits "with the information currently 23 contained in your file." MAR 511. 24 On June 2 and July 2, 2010, MetLife again wrote to Dr. Munoz seeking medical records, 1. 25 MetLife's Independent Medical Evaluation i. Assessment of Dr. Travis Fogel 26 25. 27 Linda University Health Care, conducted an IME of Langlois at MetLife's request. AR 127. 28 26. On August 9 and 10, 2010, Dr. Travis Fogel, a board-certified neuropsychologist with Loma The IME consisted of a five-hour clinical interview and eight hours of neuropsychological ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 6 1 tests on two consecutive days. AR 133. Dr. Fogel also reviewed letters from Drs. Kaplan and 2 Munoz. AR 127. 3 27. 4 generally "alert" and "attentive," but that he became agitated when discussing his disability claim 5 and work at MetLife. AR 133-34. For example, during his interview, Langlois "expressed 6 continued astonishment and disbelief over the recent and proposed changes in his work environment 7 and over the reported increased scrutiny over his business." AR 132. 8 28. 9 a decline in his memory, ability to concentrate and processing speed, "on comprehensive In a 38-page report describing the results of the IME, Dr. Fogel noted that Langlois was Dr. Fogel also stated that while Langlois reported a number of cognitive problems, including United States District Court For the Northern District of California 10 neurological testing, ... Langlois' performance was within normal limits across all cognitive 11 domains." AR 171-72; AR 187. In addition, Langlois acknowledged that his cognitive complaints 12 resulted "chiefly" from work-related problems. AR 172. 13 29. 14 recent two-week trip to Mexico and two separate social engagements—a birthday party and poker 15 night—during the evenings following the IME sessions. AR 182. 16 30. 17 Depression Inventory ("HDI") and Minnesota Multiphasic Personality Inventory ("MMPI"). AR 18 183. After reviewing the results of these tests, Dr. Fogel indicated: "Mr. Langlois does not meet the 19 DSM-IV criteria for Major Depression. More specifically, Mr. Langlois meets just 1 of the 9 criteria 20 or symptoms … well below the required cutoff of 5 or more symptoms. Furthermore, the one 21 criterion that he met (i.e. diminished ability to think or concentrate or indecisiveness, nearly every 22 day) was not one of the two required symptoms (namely, depressed mood or loss of pleasure)." AR 23 186. 24 31. 25 services representative, Dr. Fogel concluded: 26 27 28 Dr. Fogel further observed that Langlois described having an "active social life," including a The IME included administration of two "self-report" tests for depression, the Hamilton In response to a prompt regarding Langlois' motivation to return to work as a financial Mr. Langlois would appear very motivated to return to work as a financial services representative were he able to return to his business operations from prior to the increased scrutiny, supervision, monitoring and oversight he began to experience. Put another way, Mr. Langlois appears very motivated to work as a financial services representative, but not motivated to return to his current position with his current employer … Mr. Langlois stated this fairly forcefully when he said, "If I walk into ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 7 1 that office, I die." … Mr. Langlois noted that previously had plans to retire in 2014 when he could have "maxed" his benefits and for his son (who works in his office) to take over his practice, adding, "I thought I would do it on my terms." Mr. Langlois made it clear … that he was unwilling and refused to work in his current work environment with its current and proposed restrictions and limitations and its associated financial repercussions … However, Mr. Langlois' decision not to work is by choice and not due to a disabling neuropsychological condition. AR 191. 2 3 4 5 ii. Assessment of Dr. Eric Kaplan 6 32. On September 13, 2010, Dr. Kaplan reviewed Dr. Fogel's IME findings on behalf of MetLife. 7 33. Dr. Kaplan noted that Langlois had expressed a number of subjective complaints, including: 8 "Gets tired and depressed easily, increased forgetfulness, struggles finding words, feeling less 9 sharp." AR 204. However, Dr. Kaplan indicated that the HDI and MMPI assessments did not United States District Court For the Northern District of California 10 support a diagnosis of depression or generalized anxiety disorder. Id. Dr. Kaplan concluded that the 11 "findings do not support significant psychiatric symptoms" and that Langlois "did not exhibit any 12 behaviors during the evaluation that would offer support for his self-described cognitive 13 complaints." AR 204-05. 14 34. 15 or emotional benefits derived from malingering or symptom exaggeration] have a significant impact 16 on the claimant's disability claim." AR 205; AR 216. Dr. Kaplan also noted that "there is substantial evidence that secondary gains [i.e., financial 17 18 19 20 21 22 23 24 25 26 27 28 2. Denial of Langlois' LTD Claim 35. MetLife denied Langlois' LTD claim on September 29, 2010. AR 79. 36. In its denial letter, MetLife explained that the results of its independent evaluation did not support a finding that Langlois' condition prevented him from working. The letter stated: "On the comprehensive neuropsychological testing, your overall performance was within normal limits across all cognitive domains, including general intelligence, memory, language and executive functioning. During the examination, you were not observed demonstrating any behaviors that would support your self-described cognitive complaints. Additionally, the examination findings do not support any psychiatric symptoms, cognitive dysfunction or impairment to your daily activities." AR 22. E. Langlois' Administrative Appeal 37. Langlois appealed Metlife's denial of LTD benefits on March 4, 2011. AR 1. Around the ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 8 1 same time, he returned briefly to work at MetLife, but did not stay. MAR 132. His appeal therefore 2 sought LTD benefits only for the period between January 14, 2010 and March 3, 2011.3 3 38. 4 challenging the results of MetLife's IME, a report from a vocational consultant, and declarations 5 from several of his co-workers. 6 In support of his appeal, Langlois submitted a letter from Dr. Munoz, a medical evaluation 1. Letter from Dr. Munoz 39. 8 Langlois on a weekly basis between December 4, 2009 and March 1, 2011. He opined that Langlois 9 suffered from "severe anxiety and depression." AR 106. He noted that Langlois' condition impaired 10 United States District Court For the Northern District of California 7 his relationships with his son, his fiancée and his parents, and that his "social isolation" also made it 11 difficult for him to function successfully in business relationships. Id. Dr. Munoz further observed 12 that Langlois "constantly has trouble focusing, remembering and making decisions." Id. He 13 indicated that Langlois' depression "worsened significantly" in the fall of 2010 and that he had 14 expressed thoughts of suicide in October 2010. AR 107. At that point, Dr. Munoz prescribed the 15 antidepressant Lexapro, which the doctor insisted Langlois take regardless of his concerns about 16 gastrointestinal problems. Id. Dr. Munoz concluded that between January 2010 and March 2011, 17 Langlois' "depressed affect, lethargy, lack of concentration, difficulties with interpersonal 18 relationships and other symptoms of depression and anxiety rendered him totally unsuitable" for 19 work as a financial planner between January 2010 and March 2011. AR 107. Dr. Munoz' letter did 20 not include additional treatment notes, diagnostic test results or other medical records. 21 In a two-page letter summarizing Langlois' treatment, Dr. Munoz indicated that he had seen 2. Assessment of Dr. McDonough Challenging MetLife's IME Findings 22 40. 23 prepared a report summarizing a session he had held with Langlois on October 14, 2010. See AR 24 206-219. 25 41. 26 Kaplan. Specifically, Dr. McDonough noted that Dr. Fogel's report included forty factual errors in On February 16, 2011, Dr. Mark McDonough, a neuropsychologist at Scripps Hospital, Dr. McDonough's report was highly critical of the reports prepared by Drs. Fogel and 27 3 28 It is not entirely clear why Langlois seeks LTD benefits for the period from January 2010 through July 2010, when it is undisputed that he received STD benefits. As the court's resolution of the present motions does not turn on this issue, it will not address it here. ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 9 1 its background history section. Of particular significance were mistakes regarding the large amount 2 of the monthly disability payments allegedly owed to Langlois and Langlois' plans to retire, which 3 Dr. McDonough opined "may have skewed [Dr. Fogel's] thinking as he interpreted the test data" 4 towards false conclusions regarding secondary gains or Langlois' motivation to return to work. AR 5 207. 6 42. 7 "innocuous" references to planned social activities. AR 208. As Dr. McDonough explained, the fact 8 that Langlois engaged in social activities did not mean that he approached such activities without a 9 loss of energy, and thus did not necessarily support a conclusion that Langlois was not depressed. Dr. McDonough also felt that Drs. Fogel and Kaplan placed undue weight on Langlois' United States District Court For the Northern District of California 10 AR 208-10. 11 43. 12 and his interpretation of their results. First, Dr. McDonough observed that Dr. Fogel atypically 13 administered the MMPI by recording Langlois' responses himself rather than allowing Langlois to 14 record his own responses. AR 214. Dr. McDonough indicated that this approach could have 15 "unknown effects." Id. Second, Dr. McDonough opined that Dr. Fogel focused disproportionately 16 on the HPI test over the MMPI. AR 213. Third, Dr. McDonough observed that Dr. Fogel's report 17 highlighted scores that fell below the cutoff for clinical depression, but discounted or ignored scores 18 that were above the cutoff. AR 211. 19 44. 20 "answer in the way he had during the first assessment," the results of this evaluation showed a 21 significantly higher incidence of depressive symptoms than the test administered by Dr. Fogel two 22 months earlier. See AR 217-19. 23 45. 24 Fogel's cognitive testing in his report. 25 46. 26 "pervasive flaws" and ignored "significant evidence of [Langlois'] depression and anxiety." AR 219. 27 He further indicated that MetLife's experts' opinions that Langlois was motivated by secondary gains 28 were "reckless" and unsubstantiated by corroborating data. AR 217. In addition, Dr. McDonough critiqued Dr. Fogel's administration of the HDI and MMPI tests Dr. McDonough also administered his own MMPI test. Although Langlois was asked to Dr. McDonough did not conduct any additional cognitive testing or address the results of Dr. Dr. McDonough concluded that the reports prepared by Drs. Fogel and Kaplan suffered from ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 10 1 3. Report from Vocational Consultant Douglas Gorman 2 47. 3 he assessed Langlois' ability to work as a financial planner. 4 48. 5 that "depression and anxiety adversely impacted [Langlois'] cognitive capacities essential to the 6 quality and detail-rich necessities of the financial planning and plan-maintenance process." AR 86. 7 Mr. Gorman also found that Langlois' social isolation resulted in an "incapacity for building and 8 maintaining complex and close business relationships indispensable to a successful financial 9 planning/advising practice." Id. On March 3, 2011, Douglas Gorman, a "vocational consultant," prepared a report in which Relying primarily on the evaluations of Drs. Munoz and McDonough, Mr. Gorman opined United States District Court For the Northern District of California 10 49. 11 earn more than 80% of his pre-disability earnings as a financial planner in his local economy. AR 12 86-87. 13 Mr. Gorman concluded that as a result of Langlois' psychological condition, he was unable to 4. Co-Worker Declarations 14 50. 15 submitted declarations indicating that they had seen a significant deterioration in Langlois' 16 mood, energy-level and cognitive abilities leading up to his departure from MetLife in January 2010. 17 See AR 91-97. 18 51. 19 departure. Laura Szymanski said that she spoke regularly with Langlois after he left MetLife, and 20 that there is "no fire in him anymore." AR 97. Kyle Farmer indicated that he had seen Langlois a 21 "number of times" since January 2010, and that he is "definitely not the same guy right now that he 22 used to be." AR 95. Farmer further noted that "the difficulties [Langlois] has been having with 23 MetLife have been devastating for him. I have seen him cry when he starts to talk about it." Id. 24 52. 25 Three of Langlois' MetLife co-workers, Laura Szymanski, Kyle Farmer and Caroyln Keltner, Two of the co-workers also briefly described contact they had with Langlois following his MetLife failed to render a decision on Langlois' appeal within the 90-day window required by 26 the Plan, claiming that it needed more time to submit Langlois' file to an independent physician 27 consultant ("IPC") for review. See MAR 134; 119. 28 53. This action was filed on July 15, 2011. Dkt. No. 1. ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 11 1 F. 2 IPC Evaluations of Langlois' Claim 1. Assessment of Dr. Catherine Leveroni 3 54. 4 claim. The first such assessment was conducted by Dr. Catherine Leveroni, a clinical 5 neuropsychologist at Harvard Medical School, who reviewed Langlois' file in its entirety and 6 prepared a report dated July 21, 2011. MAR 991. 7 55. 8 HDI rather than the MMPI. According to Dr. Leveroni, while the MMPI test is a more 9 comprehensive test, the HDI is more focused on depressive symptoms and is thus "widely Despite the initiation of litigation, MetLife continued to pursue IPC evaluations of Langlois' Dr. Leveroni disagreed with Dr. McDonough's critique of Dr. Fogel's decision to rely on the United States District Court For the Northern District of California 10 considered the gold standard for measuring depression in psychiatry." MAR 998. 11 56. 12 administered by Dr. Fogel and Dr. McDonough "suggested exaggeration of symptoms for the 13 purposes of secondary gain." Id. 14 57. 15 work situation and do not transfer to other settings." Id. She also observed that while Dr. Munoz' 16 letters inidcated that Langlois has "severe depression … [his] treatment plan is more consistent with 17 mild than severe depression and anxiety." Id. Specifically, Dr. Leveroni noted that Langlois' low 18 dose antidepressant prescription and lack of additional medications, inpatient hospitalization or 19 supplemental psychotherapy called into question Dr. Munoz' diagnosis. Id. 20 58. 21 were sufficient during the claim period to enable him to perform his job. However, she noted that 22 his depressive symptoms could affect his capacity to function and that "reasonable 23 accommodations," including a reduction to part time work, might be appropriate. MAR 999. 24 Dr. Leveroni also stated that the differences between Langlois' responses on the MMPI tests In addition, Dr. Leveroni noted that Langlois' anxiety and panic are "circumscribed to his In conclusion, Dr. Leveroni opined that Langlois' intellectual, cognitive, and social abilities 2. Assessment of Dr. Martin Kelley 25 59. 26 Harvard Medical School, who also reviewed the administrative record in its entirety and prepared a 27 report dated September 7, 2011. MAR 973. The second IPC evaluation was conducted by Dr. Martin Kelley, a Professor of Psychiatry at 28 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 12 1 60. 2 complete evaluation of Langlois' case difficult. MAR 975-76. Dr. Kelley indicated that Dr. Munoz 3 had told him over the phone that Langlois had "fears about information from his medical records 4 being released to [MetLife]." MAR 973-74. 5 61. 6 identify forty specific errors in Dr. Fogel's report was evidence of Langlois' mental competence, and 7 thus "perhaps inadvertently" undermined Dr. McDonough's conclusions. MAR 975. Further, after 8 reviewing Dr. McDonough's raw data, Dr. Kelley questioned whether the substantial differences 9 between the results of Dr. McDonoguh's MMPI test and the test administered by Dr. Fogel were a Dr. Kelley noted that Dr. Munoz' refusal to release detailed treatment records made a Dr. Kelley criticized Dr. McDonough's report, opining that the fact that Langlois was able to United States District Court For the Northern District of California 10 consequence of the latter doctor's errors or the former's. Id. 11 62. 12 Dr. Kelley next stated: Though there is some issue because Mr. Langlois refuses to make his records available for review, it is clear from what is available that he operates very successfully in his self-interest. That is manifested even in his limiting Dr. Munoz' accessibility and release of his psychiatric records. [Further, in testing with both Drs. Fogel and McDonough] it is very clear that Mr. Langlois fully understands his situation, operates in a sophisticated manner to protect himself, and displays no cognitive symptoms or symptoms of a psychiatric disorder that would render him unable to function in his previous position if he were motivated to do so. MAR 976. 13 14 15 16 63. Dr. Kelley concluded that while Langlois may not have been able to work full time for a 17 period of days or weeks in January 2010, there was no evidence of long-term disability. Id. 18 64. On September 14, 2011, MetLife informed Langlois' counsel that it had obtained IPC 19 evaluations of Langlois' file. MAR 964. MetLife included copies of the supplemental reports and 20 invited Langlois to respond. Id. Langlois' counsel replied that as such materials were not part of the 21 administrative record, they could not be considered with Langlois' appeal. MAR 962. Langlois 22 therefore did not forward the supplemental reports to Dr. Munoz for review or otherwise respond to 23 their contents. 24 65. MetLife never issued a decision on Langlois' administrative appeal. See Dkt. No. 35. 25 Consequently, on December 16, 2011, the court determined that it would review MetLife's initial 26 decision to deny Langlois' LTD benefits claim de novo. Id. 27 III. ANALYSIS 28 A. Consideration of the IPC Reports ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 13 1 As a threshold matter, the parties dispute whether the court may consider the IPC reports 2 because they were prepared after the initiation of litigation and are thus not part of the administrative 3 record. In reviewing a denial of benefits de novo, the court is not limited to the record before 4 the plan administrator. Jebian v. Hewlett-Packard Co. Emple. Benefits Org. Income Prot. Plan, 349 5 F.3d 1098, 1110 (9th Cir. 2003). However, "the district court should exercise its discretion to 6 consider evidence outside of the administrative record only when circumstances clearly establish 7 that additional evidence is necessary to conduct an adequate de novo review of the benefit decision." 8 Opeta v. Northwest Airlines Pension Plan, 484 F.3d 1211, 1217 (9th Cir. 2007) (emphasis in 9 original) (internal citations and quotation marks omitted). Such circumstances may include claims United States District Court For the Northern District of California 10 11 that raise issues regarding the credibility of medical experts. Id. While it is a close question, the court concludes that consideration of the IPC reports is 12 necessary to conduct an adequate de novo review of the benefit decision because Langlois' claim 13 involves substantial issues regarding expert credibility. First, by relying heavily on Dr. 14 McDonough's report, Langlois has raised a serious question as to the reliability of MetLife's medical 15 experts. See Dkt. No. 42 at 16-18; Dkt. No. 48 at 8-11. Indeed, Dr. McDonough's report is devoted 16 entirely to critiquing the methodology, precision and conclusions of Drs. Fogel and Kaplan. Even 17 Dr. McDonough's administration of the MMPI, which Langlois calls "significant evidence of [his] 18 depression and anxiety," Dkt. No. 48 at 7, was targeted towards undermining Dr. Fogel's credibility, 19 since Dr. McDonough asked Langlois to "answer in the way he had during the first assessment" 20 rather than simply conducting his own evaluation. AR 215. This case thus falls "squarely within the 21 first example cited in Opeta." Reynolds v. UNUM Life Ins. Co. of Am., No. 10-2383, 2011 U.S. Dist. 22 LEXIS 90314, at *3 (D. Ariz. Aug. 12, 2011) (granting request for discovery of supplemental 23 evidence of bias on the part of insurer's expert where plaintiff had raised an issue regarding his 24 credibility); Knopp v. Life Ins. Co. of N. Am., No. 09-0452 CRB (EMC), 2009 U.S. Dist. LEXIS 25 120267, at *8 (N.D. Cal. Dec. 28, 2009) ("The Court concludes that Ms. Knopp has made an 26 adequate showing that she is entitled to some discovery which could bear directly and substantially 27 on the credibility of the medical reviewers engaged by the insurer."). 28 In addition, because the only medical professionals to have contact with Langlois during the ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 14 claim period–Drs. Munoz, Fogel and McDonough–reached directly conflicting conclusions, 2 resolution of this case turns largely on an assessment of the credibility of each expert. The parties 3 have elected to have this case decided on the record, and thus there has been no opportunity to 4 observe the experts in person. Consequently, the court is ill-equipped to evaluate their credibility 5 without looking to supplemental evidence. See Duncanson v. Royal & SunAlliance Group Life Ins. 6 Policy, No. 10-02898 JSW, 2011 U.S. Dist. LEXIS 136792, at *10-11 (N.D. Cal. Nov. 29, 2011) 7 (concluding on a Rule 52 motion that "because there is conflicting medical evidence in the record ... 8 [extrinsic] evidence relating to the credibility of Dr. Dell is necessary to conduct an adequate de 9 novo review of the benefits decision"); compare Callow v. Prudential Ins. Co. of America, No. 07- 10 United States District Court For the Northern District of California 1 1247, 2009 U.S. Dist. LEXIS 47737, at *8 (W.D. Wash. May 21, 2009) (denying motion to allow 11 claimant to supplement the record with live testimony and noting that "should the Court find any 12 actual conflicts between their opinions, it shall consider the thoroughness of the evaluation and 13 report in determining how much weight to accord any expert's opinion") (emphasis added). 14 Further, it is clear that the IPC reports "bear[] directly and substantially" on the credibility of 15 the parties' experts. Knopp, 2009 U.S. Dist. LEXIS 120267, at *8. For example, Dr. McDonough 16 attacked Dr. Fogel's "non-empirical conclusions" and reliance on the HDI over the MMPI, 17 suggesting bias in favor of the insurer, while the IPC explained why the HDI was the more 18 appropriate measure of Langlois' symptoms under the circumstances. Similarly, Dr. McDonough 19 called MetLife's experts' opinion that Langlois was motivated by secondary gains "reckless" and 20 "unsubstantiated," AR 217, but both IPCs reached the same conclusion after reviewing the raw data. 21 Dr. Leveroni's IPC report also explicitly questioned Dr. Munoz' reliability, noting that his treatment 22 regime was inconsistent with his diagnosis of severe depression. Supplemental materials are 23 particularly helpful in evaluating Dr. Munoz' credibility because his evaluation is both cursory and 24 lacking in supporting records or explanation. See Muniz v. Amec Constr. Mgmt., 623 F.3d 1290, 25 1298 (9th Cir. 2010) (district court did not abuse its discretion in ordering and considering the 26 results of an independent medical examination where the claimant's treating physician's records were 27 "inconsistent and incomplete"). 28 Finally, although it is true, as Langlois' counsel noted at oral argument, that the supplemental ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 15 1 materials give MetLife the "last word" on this claim, the court is not concerned that Langlois has 2 been "sandbagged by a rationale the plan administrator adduces only after the suit has commenced." 3 Jebian, 349 F.3d at 1104. In fact, MetLife explicitly invited Langlois to review and respond to the 4 IPC reports more than six months before submitting this motion, but Langlois refused to do so. See 5 Muniz, 623 F.3d at 1298 (no abuse of discretion where claimant was given an adequate opportunity 6 to challenge the supplemental report). Moreover, the supplemental reports do not offer any 7 additional basis for denying Langlois' claim; they merely evaluate the materials already in the 8 record. MetLife's position remains largely unchanged from the explanation laid out in its denial 9 letter: that Langlois's "self-described" symptoms of disability are contradicted by the more United States District Court For the Northern District of California 10 "objective" evaluation conducted by Dr. Fogel. Compare Saffon v. Wells Fargo & Co. Long Term 11 Disability Plan, 522 F.3d 863, 872 (9th Cir. 2008) ("The district court must give Saffon an 12 opportunity to present evidence on the one issue that was newly raised by MetLife in its denial 13 letter–the results of a Functional Capacity Evaluation or other objective evidence of whether she is 14 totally disabled under the terms of the Plan.") (emphasis added). Given that Langlois has had notice 15 of MetLife's position since September 29, 2010, it is reasonable to infer that if he had any additional 16 evidence supporting his claim–such as Dr. Munoz' treatment notes or the results of other diagnostic 17 testing–he would have produced it. The court thus concludes that the supplemental reports may be 18 considered in determining whether MetLife properly denied Langlois' claim.4 19 B. Denial of Benefits In an ERISA action, the plaintiff carries the burden of showing, by a preponderance of the 20 21 evidence, that he was disabled under the terms of the Plan during the claim period. Oster v. Std. Ins. 22 Co., 759 F. Supp. 2d 1172, 1185 (N.D. Cal. 2011). Langlois must therefore establish that as a result 23 of his depression and anxiety, he was unable to earn more than 80 percent of his previous income by 24 working as a financial planner for any employer in his local economy throughout the entire period 25 from January 15, 2010 to March 3, 2011. AR 24. 26 4 27 28 Contrary to Langlois' argument, MetLife's previous assertion that the materials produced before litigation constituted the "entire Administrative Record," see Dkt. No. 31-1, does not estop it from submitting supplemental materials which it plainly acknowledges are not part of the administrative record. See Humetrix, Inc. v. Gemplus S.C.A., 268 F.3d 910, 917 (9th Cir. 2001) ("[Judicial estoppel] bar[s] a party from making a factual assertion in a legal proceeding which directly contradicts an earlier assertion made in the same proceeding.") (emphasis added). ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 16 1 In support of his position, Langlois relies primarily on the letter submitted by Dr. Munoz 2 indicating that Langlois suffered from "severe" depression and anxiety, rendering him incapable of 3 functioning as a financial planner throughout the claim period. AR 106. Langlois emphasizes that 4 financial planning requires substantial interpersonal and analytical skills, and thus that the cognitive 5 and social issues associated with depression and anxiety were especially disabling for an individual 6 in his position. The court gives Dr. Munoz' opinion some credence because he is Langlois' treating 7 physician and the only medical professional who maintained a relationship with Langlois for the 8 entire period at issue. However, courts are not required to "accord special weight to the opinions of 9 a claimant's physician" and may "credit reliable evidence that conflicts with a treating physician's United States District Court For the Northern District of California 10 evaluation." Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003). As discussed 11 below, in light of the substantial evidence contradicting the Dr. Munoz' conclusion, the court finds 12 that Langlois has failed to meet his burden to show he suffered from a long-term disability. 13 First, the court finds extremely persuasive Dr. Fogel's opinion that at least by the summer of 14 2010, Langlois was capable of working as a financial planner, but either unwilling or unable to 15 return to MetLife. First, there is no question that Langlois' condition was "triggered" by MetLife's 16 decision to increase supervision of his practice. AR 106. In addition, there is significant evidence 17 that Langlois' symptoms remained closely intertwined with his "situation" at MetLife throughout the 18 claim period. Dr. Munoz acknowledged in April 2010 that Langlois' condition was "a single episode 19 related to distress caused by conditions at work" and that Langlois was still "obsessed with the 20 situation with his employer" two months later. AR 159; 153. Dr. Leveroni also opined that 21 Langlois' symptoms were "circumscribed to his work situation and do not transfer to other settings." 22 MAR 998. Langlois' co-worker Kyle Farmer similarly highlighted Langlois' "difficulties" with 23 MetLife as the root of his condition. AR 95. Even Langlois himself conceded that his complaints 24 resulted "chiefly" from work-related problems. AR 172. Of course, as Langlois argues, it is the 25 extent of his illness that matters, not its cause. Nevertheless, the undisputed fact that Langlois' 26 symptoms were so intimately related with his circumstances at MetLife strongly suggests that they 27 did not preclude him from working elsewhere. 28 This conclusion is bolstered by evidence that Langlois' condition improved shortly after he ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 17 left MetLife in January 2010. For instance, while Langlois went to the hospital for anxiety-related 2 symptoms three times in the months leading up to his departure, he reported no similar visits after 3 January 2010. In fact, when Langlois was treated in March and May 2010 for lymph node problems, 4 Dr. Dominguez specifically noted that he was alert, attentive and taking anxiety medication "without 5 any problems." MAR 541-45.5 Dr. Kelley agreed that Langlois improved after leaving MetLife, 6 opining that Langlois may have been disabled for "days or weeks" in January 2010, but did not 7 suffer from a long-term disability. MAR 976. The co-worker declarations also focus 8 overwhelmingly on Langlois' symptoms before leaving MetLife; to the extent that they refer to any 9 later period, they are too vague to prove that Langlois suffered from a genuine disability. Further, 10 United States District Court For the Northern District of California 1 while Dr. Munoz called Langlois "severely anxious-depressed" in January 2010, he observed that 11 Langlois had "variable moods" by June 2010. AR 104; AR 159-60. Although a claimant who has 12 "good days and bad days" may be sufficiently disabled to merit an award of benefits, Dr. Munoz did 13 not explain how long Langlois' sporadic periods of depression lasted, making it impossible to 14 determine whether his condition would have prevented him from working at that time. Compare 15 Thivierge v. Hartford Life & Accident Ins. Co., No. 05-0163 CW, 2006 U.S. Dist. LEXIS 25216, at 16 *35-36 (N.D. Cal. Mar. 28, 2006) (finding plaintiff disabled by chronic fatigue syndrome where her 17 "bad days" were unpredictable and could last for up to two weeks). Ultimately, evidence of 18 Langlois' revival in the spring and summer of 2010 implies both that his condition was directly 19 connected to the environment at MetLife and that he could have returned to work for a different 20 employer if he had wanted to. Langlois argues that evidence that his depression "worsened significantly" in the fall of 2010 21 22 belies the contention that he improved after leaving MetLife. AR 107. However, the court finds 23 such evidence questionable given the reasons to believe that Langlois was motivated by secondary 24 gains. First of all, the timing is suspect: Langlois' first "suicidal ideations" and substantially 25 increased MMPI score came just after MetLife denied his claim for benefits. While it is possible 26 27 28 5 The court affords Dr. Dominguez' notes additional credibility as they appear to be the only documentation in the record that was not prepared to support either party's position regarding Langlois' disability. ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 18 1 that his decline was unrelated to or a genuine consequence of MetLife's action, the court finds it at 2 least as likely that Langlois embellished his illness after realizing that his benefits were in jeopardy. 3 This conclusion was also supported by each of MetLife's experts, as well as by Langlois' refusal to 4 release his medical records and Dr. Munoz' cryptic statement that the case had a "high potential for 5 litigation" before MetLife had even denied his claim. Viewed as a whole, this evidence lines up 6 with Dr. Kelley's description of Langlois as an individual who "operates very successfully in his 7 self-interest ... [but] displays no ... symptoms ... that would render him unable to function in his 8 previous position if he were motivated to do so." MAR 976. Dr. Munoz' and Dr. McDonough's conclusions are also somewhat suspect in that they are 9 United States District Court For the Northern District of California 10 based entirely on self-reported symptoms. See Leipzig v. AIG Life Ins. Co., 362 F.3d 406, 409 (7th 11 Cir. 2004) ("Physicians accept at face value what patients tell them about their symptoms; but 12 insurers … must consider the possibility that applicants are exaggerating in an effort to win benefits 13 (or are sincere hypochondriacs not at serious medical risk.)"). Although the Plan does not require a 14 claimant to provide objective evidence of disability, subjective evidence of a disabling condition is 15 inherently less reliable than objective evidence. Of course, the court is conscious that psychological 16 disorders may not always be objectively verifiable. However, where, as here, self-reported 17 symptoms are contradicted by testing showing Langlois to be "within normal limits across all 18 cognitive domains," the court finds the more objective evidence to be more convincing. AR 187.6 19 Finally, as noted above, Dr. Munoz' opinion is less persuasive given its lack of supporting 20 evidence. The only time Dr. Munoz described Langlois' symptoms in any detail—including his 21 suicidal ideations and trouble with personal relationships—was in a two-page letter summarizing an 22 entire year's worth of treatment. Although Dr. Munoz is not required to disclose confidential 23 information about his patients, such a cursory assessment, largely devoid of dates or description of 24 Langlois' week-to-week progress, makes it extremely difficult to find that Langlois was disabled for 25 the entire period in question. Furthermore, the court is particularly troubled by the assertion, which 26 6 27 It is worth repeating here that while Dr. McDonough challenged Dr. Fogel's evaluation of Langlois' depressive symptoms, he did not critique the results of Dr. Fogel's cognitive tests or conduct any of his own. 28 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 19 1 Langlois does not refute, that Dr. Munoz withheld records because of Langlois' "fears" that they 2 would get back to MetLife. MAR 973-74. This at least raises an inference that such materials 3 would be favorable to the insurer, and warrants further discounting of Dr. Munoz' opinion. 4 5 Accordingly, the court finds that Langlois has failed to meet his burden to show he was 6 disabled as defined by the Plan. That is not to say that Langlois was not depressed or anxious. 7 Psychological illness is complex, often misunderstood and inherently difficult to verify, which 8 makes it a particularly inapt subject for litigation. However, based on the evidence in the record, the 9 court cannot conclude that it is more likely than not that Langlois' symptoms prevented him from United States District Court For the Northern District of California 10 earning at least 80 percent of his previous income for any employer during the claim period. 11 Therefore, Langlois has not established that he is entitled to long-term disability benefits. 12 IV. ORDER 13 14 For the foregoing reasons, the court grants MetLife's motion for judgment under Fed. R. Civ. P. 52. 15 16 17 DATED: May 24, 2012 RONALD M. WHYTE United States District Judge 18 19 20 21 22 23 24 25 26 27 28 ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT UNDER RULE 52 No. 11-cv-03472 RMW EDM 20