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Evans v. Metro. Life Ins. Co.

Evans v. Metro. Life Ins. Co.

United States Court of Appeals for the Fourth Circuit

December 4, 2003, Argued ; February 10, 2004, Decided

No. 03-1065

Opinion

 [*308]  SHEDD, Circuit Judge:

In this ERISA appeal, we consider whether Metropolitan Life Insurance Company (MetLife) abused its discretion in denying the claim for long-term disability (LTD) benefits filed by Robert S. Evans. The district court granted summary judgment in favor of MetLife, finding that MetLife did not abuse its discretion. For the following reasons, we vacate the judgment of the district court and remand for further [**2]  proceedings.

Evans, a nuclear fuels engineer employed at BWX Technologies, Inc. (B&W), began experiencing abdominal pain and fatigue in February 1999. Evans first received treatment from his family physician, Dr. Kim Wright, but his abdominal pain persisted. Dr. Wright referred Evans to a gastroenterologist. Both Dr. Wright and the gastroenterologist diagnosed Evans as suffering from chronic abdominal pain and irritable bowel syndrome (IBS).

Despite his condition, Evans continued to work from February 1999 through December 1, 1999. Commencing December 2, 1999, Evans was given a week off from work. Dr. Wright thereafter continued Evans off work for more than six months. Evans's childhood stuttering returned, so Dr. Wright referred him to a psychologist, Dr. Daniel Owens, for assessment in January 2000. Dr. Owens continued treating Evans through at least September 2000. While Evans was away from work, Dr. Wright also referred him to another gastroenterologist at the University of Virginia for a second opinion. That doctor  [*309]  changed Evans's medications, which provided some short-term relief.

Because Evans was feeling somewhat better, Dr. Wright thought it would be appropriate to [**3]  return Evans to work at B&W on June 19, 2000. Dr. Wright hoped that once Evans returned to the routine of his job that his condition might continue to improve. Over the next six weeks, Evans worked sporadically; he worked some part-time days and some full-time days, but he also took off several sick days. His last day at work was July 27, 2000. Evans took several more leave days thereafter until August 9, 2000, when it appears B&W placed him on approved medical leave of absence.

B&W offers its employees LTD benefits through a group disability insurance policy (the Plan) issued by MetLife. MetLife is also the administrator of the Plan. B&W filed the initial LTD application form with MetLife on behalf of Evans on August 9, 2000. On the form, B&W indicated that Evans's "Date Last Worked" was December 1, 1999, but that his "Date Returned to Work" was June 19, 2000.

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358 F.3d 307 *; 2004 U.S. App. LEXIS 2086 **

ROBERT S. EVANS, Plaintiff-Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant-Appellee.

Subsequent History: Subsequent appeal at Evans v. Metro. Life Ins. Co., 2006 U.S. Dist. LEXIS 18360 (W.D. Va., Apr. 11, 2006)

Prior History:  [**1]  Appeal from the United States District Court for the Western District of Virginia, at Lynchburg. (CA-02-23-6). Norman K. Moon, District Judge.

Disposition: Vacated and remanded.

CORE TERMS

disabled, benefits, total disability, district court, abused, summary judgment, quit work, eligible, return to work, receives

Civil Procedure, Appeals, Standards of Review, De Novo Review, Pensions & Benefits Law, Judicial Review, De Novo Standard of Review, Summary Judgment Review, General Overview, Standards of Review, Labor & Employment Law, Conditions & Terms, Duration of Employment, Administrative Law, Substantial Evidence, Abuse of Discretion, ERISA, Civil Litigation