Mowery, Lisa v. Metropolitan Life Insurance Company
3:16-cv-00516
W.D. Wis.Jun 2, 2017Background
- Lisa Mowery, a lead ICU/CCU registered nurse, stopped working after multiple severe allergic reactions beginning March–April 2013 and sought ongoing treatment from allergists and her PCP.
- Medical record evidence included multiple ER visits (some treated with epinephrine), patch testing positive for PTBP‑FR and MDBGN, clinicians’ diagnoses or impressions of idiopathic anaphylaxis or possible mast cell disorder, and treating physicians’ opinions that she could not safely return to ICU work.
- Mowery applied for long‑term disability under Dignity Health’s ERISA plan (MetLife administrator); MetLife denied benefits, relying primarily on reports from its independent reviewer, Dr. Robert Lin.
- Dr. Lin concluded the record did not support systemic contact allergy, mast cell activation syndrome, or functional limitations preventing work, emphasizing negative nitrile patch testing and absence of documented workplace allergen causing anaphylaxis.
- MetLife’s final denial (June 1, 2015) adopted Dr. Lin’s view and concluded Mowery did not meet the plan’s definition of disability (unable to perform substantial and material acts of her usual occupation).
- The district court reviewed MetLife’s discretionary decision under the arbitrary‑and‑capricious standard and found MetLife’s reliance on Dr. Lin unreasonable because his reports contain material errors and ignored treating‑provider opinions and relevant record evidence; the claim was remanded for further administrative proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether MetLife’s denial was arbitrary and capricious | Mowery: MetLife relied solely on a flawed IPC report that mischaracterized records, ignored treating‑physicians’ conclusions that she suffered anaphylaxis/was unable to return to ICU, and failed to analyze how her condition/medications affect job functions | MetLife: its discretionary denial was reasonable based on independent reviewer Dr. Lin’s opinion that tests and records did not establish systemic sensitivity, mast cell disorder, or work‑disabling limitations | Court: Denial was arbitrary and capricious; MetLife unreasonably adopted Dr. Lin’s report which contained factual errors and failed to address material evidence; remand ordered |
| Proper scope of review under ERISA | Mowery: court should ensure administrator considered whether medical evidence supports inability to perform substantial/material job acts | MetLife: review limited to MetLife’s record and reasonable reliance on its expert supports denial | Court: review limited to administrator’s record and standard, but MetLife must analyze evidence bearing on plan’s defined ultimate issue (ability to perform job); it failed to do so |
| Whether lack of identified workplace allergen defeats disability claim | Mowery: Identifying a specific trigger is not required; focus is whether reactions and treatment/medications preclude job performance | MetLife: absence of identified workplace cause and negative nitrile patch argues against disability | Court: Even absent a single identified workplace allergen, MetLife still had to assess functional limitations; it did not adequately do so |
| Reliance on independent medical consultant vs. treating physicians | Mowery: treating physicians’ consistent conclusions and specific observations cannot be ignored or mischaracterized | MetLife: reasonable to rely on independent IPC reports when supported by record review | Court: Administrator cannot simply adopt an IPC report that ignores or misstates treating‑provider evidence; such reliance is arbitrary |
Key Cases Cited
- Majeski v. Metropolitan Life Insurance Co., 590 F.3d 478 (7th Cir.) (administrator’s ignoring treating‑physician conclusions can render denial arbitrary)
- Love v. National City Corp. Welfare Benefits Plan, 574 F.3d 392 (7th Cir.) (same principle regarding failure to acknowledge claimant’s evidence)
- Anderson v. Liberty Lobby, 477 U.S. 242 (1986) (standard for summary judgment; genuine issue of material fact inquiry)
- Donato v. Metropolitan Life Insurance Co., 19 F.3d 375 (7th Cir.) (scope of judicial review limited to record before administrator)