LUKMAN v. METROPOLITAN LIFE INSURANCE COMPANY (2025)

Rule 52 Order Granting Motion for Judgment in Favor of Plaintiff

Re: Dkt. No. 20

Presently before the Court is plaintiff Vera Lukman's appeal of defendant Metropolitan Life Insurance Company (“MetLife”)’s denial of her application for disability benefits under a long-term disability (“LTD”) benefits plan covered by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. The parties filed cross-motions for summary judgment under Federal Rule of Civil Procedure 52 that are fully briefed.¹ The Court heard the parties’ arguments on September 9, 2025.

Having considered the parties’ briefing, the administrative record, and the arguments of the parties, the Court Issues the following determination which constitutes Findings of Fact and Conclusions of Law pursuant to Rule 52(a), and based thereon, Finds in favor of plaintiff Vera Lukman.

I. Applicable Legal Standard

Plaintiff appeals MetLife's denial of benefits under ERISA, 29 U.S.C. Section 1132(a)(1)(B), otherwise known as Section 502. A beneficiary or plan participant may sue in federal court “to recover benefits due to [her] under the terms of [her] plan, to enforce [her] rights under the terms of the plan, or to clarify [her] rights to future benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). A claim of denial of benefits in an ERISA case “is to be reviewed under a de novo standard unless the benefit plan gives the [plan's] administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989).

The parties agree that the standard of review here is de novo. (Dkt. No. 17, 2:22-23.) On such a review, the court conducts a bench trial on the record and makes findings of fact and conclusions of law based upon that record. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999) (bench trial may “consist[ ] of no more than the trial judge reading [the administrative record]”). Plaintiff bears the burden of establishing that she was disabled under the terms of the plan during the claim period by a preponderance of the evidence. See Eisner v. The Prudential Ins. Co. of Am., 10 F.Supp.3d 1104, 1114 (N.D. Cal. 2014). “In conducting a de novo review, the Court gives no deference to the insurer's interpretation of the plan documents, its analysis of the medical record, or its conclusion regarding the merits of the plaintiff's benefits claim.” McDonnell v. First Unum Life Ins. Co., Case No. 10-cv-8140, 2013 WL 3975941, at *12 (S.D.N.Y. Aug. 5, 2013); Tedesco v. I.B.E.W. Local 1249 Ins. Fund, No. 14-CV-3367 (KBF), 2017 WL 3608246, at *6 (S.D.N.Y. Aug. 21, 2017), aff'd, 729 F.App'x 136 (2d Cir. 2018) (citing Firestone, 489 U.S. at 112, 109 S.Ct. 948) (same). The Court finds that the administrative record here suffices and a trial with live witness testimony is not necessary.

A. Consideration of Plaintiff's Extra-Record Evidence

The Court's review of an ERISA claim is generally limited to the record that was before the administrator at the time it made its decision. Kearney, 175 F.3d at 1090. However, the Ninth Circuit has held that the Court may allow additional exhibits when appropriate. Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 943-44 (9th Cir. 1995) (quoting Quesinberry v. Life Ins. Co. of North Am., 987 F.2d 1017, 1025 (4th Cir. 1993) (en banc)).

In Opeta v. Northwest Airlines Pension Plan for Contract Employees, the Ninth Circuit, again quoting Quesinberry, provided a “non-exhaustive list” of circumstances in which extra-record evidence can be considered necessary:

[C]laims that require consideration of complex medical questions or issues regarding the credibility of medical experts; the availability of very limited administrative review procedures with little or no evidentiary record; the necessity of evidence regarding interpretation of the terms of the plan rather than specific historical facts; instances where the payor and the administrator are the same entity and the court is concerned about impartiality; claims which would have been insurance contract claims prior to ERISA; and circumstances in which there is additional evidence that the claimant could not have presented in the administrative process.

484 F.3d 1211, 1217 (9th Cir. 2007). Here, plaintiff did present the additional evidence to MetLife. However, she did so after MetLife had concluded the appeals process. In response, MetLife informed her that the only available path left to plaintiff was to file this lawsuit, which she did.

Plaintiff argues that procedural irregularities in the administration of her claim justify the Court considering the new evidence to “recreate what the administrative record would have been had the procedure been correct.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 973 (9th Cir. 2006) (quoting VanderKlok v. Provident Life & Accident Ins. Co., 956 F.2d 610, 617 (6th Cir. 1992)). Specifically, plaintiff claims that MetLife violated ERISA regulations governing notice and disclosure requirements. See 29 C.F.R. § 2560.503-1(g)(1). ERISA regulations require a plan administrator to include various pieces of information in any notification of an adverse benefit determination, including the following: (i) the specific reason or reasons for the adverse determination; (ii) reference to the specific plan provisions on which the determination is based; and (iii) a description of any additional information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary. Review of the extra-record evidence is appropriate “only when circumstances clearly establish that additional evidence is necessary to conduct an adequate de novo review of the benefit decision.” Abatie at 970.

Plaintiff argues that MetLife's May 2, 2022, denial letter fails to identify what kind of evidence was necessary for Lukman to perfect the claim, such as the neuropsychological testing that MetLife later pointed to as missing from her appeal to support a cognitive deficit. (See Dkt. No. 19, Administrative Record, METLIF0422-METLIF0426.)²

As discussed below, the Court finds that the record evidence provides sufficient information to make its finding that plaintiff established by a preponderance of the evidence that she was partially disabled. Therefore, consideration of the extra-record evidence is not necessary.

II. Findings of Fact

Many of the basic facts are undisputed. The Court notes material disputes.

A. Lukman's Employment

Plaintiff has been employed by Google as a software engineer since January 2017. Her job includes “designing, developing, testing, deploying, and improving software, as well as managing individual project priorities, deadlines and deliverables.” (AR 858.) Plaintiff stopped working on October 30, 2020. In the following year, her providers collaboratively proposed a plan to help her return to work. Plaintiff returned to work part-time on the recommendation of her providers for 50% FTE (full-time employment) status May 3, 2021. (Id. 436-438.) She continued to work part-time at varying levels of FTE until July 11, 2023, when plaintiff stopped working again. On February 1, 2024, plaintiff returned to work remotely at 50% FTE. (P Mtn. at 15.)

B. Long Term Disability Plan

As a benefit of her employment, plaintiff is a participant in the Google Long-Term Disability Plan (“the LTD Plan”). (AR 1371.) The LTD Plan is an employee welfare benefit plan regulated by ERISA. Defendant MetLife is the claims administrator and fiduciary for the LTD Plan. It makes decisions regarding eligibility under the terms of the plan.

To qualify for disability benefits, a claimant must submit written evidence that she is either “totally” or “partially” disabled to establish entitlement to long term disability benefits. (AR 1396, 1405.) For total disability, the claimant must submit evidence that she was unable to perform with “reasonable continuity” the “important tasks, functions and operations” generally required of her role during the relevant period.³ (AR 1396.) For partial disability, the claimant must submit evidence that while actually working, the claimant was unable to earn 80% or more of her pre-disability earnings. (Id.) Pre-disability earnings are defined by the Plan as the salary the claimant earned on her last day of active work before disability. (AR 1393.) The evidence submitted must include: the nature and extent of the loss or condition; MetLife's obligation to pay the claim; and the claimant's right to receive payment. (AR 1394.)

Plaintiff ceased working on October 30, 2020. The claims administrator for Google's Voluntary Disability Plan, Sedgwick, approved short-term disability benefits for the maximum 52-week duration of her claim. Plaintiff submitted her LTD claim to MetLife on January 11, 2022 with a disability date of November 2, 2020. (AR 989.) In a May 2, 2022 letter, MetLife denied plaintiff's claim based on a lack of “medically-supported physical or psychiatric/psychological restrictions/limitations” that would cause her to be unable to perform her usual occupation. (AR 423.) Thereafter, on or before October 28, 2022, plaintiff submitted a written appeal to MetLife. After MetLife completed its review of plaintiff's appeal, it issued a final denial of plaintiff's claim on February 10, 2023 in part because the evidence did not suggest plaintiff was “impaired by a mental health condition of such severity to warrant the placement of restrictions and limitations.” (AR 78.)

C. Treatment History

Plaintiff's claims regarding her level of impairment rely largely on submissions from Drs. Katie Young, David Leong, Myrto Ashe, Mark Tsuchiyose, Kin Yuen, and Katherine Wu.

A. Pre-Disability History of Treatment

Plaintiff began seeing a psychologist, Dr. Katie Young, in October 2016. She was initially treated for PTSD due to childhood abuse, including nightmares, insomnia, and debilitating anxiety. (AR 517.)

Plaintiff's primary care provider was Dr. Myrto Ashe who documented plaintiff's various gastroenterological (“GI”) symptoms as early as February 2018. Dr. Ashe also noted plaintiff began to experience brain fog and fatigue in 2017. In 2019, plaintiff developed “Easy bruising.” (Id.) As of June 29, 2021, Dr. Ashe documented that plaintiff could not eat more than 300 to 400 calories per meal, well below her maintenance calories. (Id.) He recommended various treatments, including medication to help with eating and a stress treatment program to help with her chronic fatigue.

Plaintiff first started seeing Dr. Mark Tsuchiyose, a GI specialist, in January 2019. Dr. Tsuchiyose's records indicate that plaintiff complained of multiple symptoms, including fatigue, abdominal pain, gas, heartburn, stomach cramps, dysphagia, cough, easy bruising, itching, rashes, strong allergic reactions, back pain, joint pain, numbness or tingling, and difficulty sleeping. (AR 524.)

Plaintiff was later treated by rheumatologist Dr. Katherine Wu after plaintiff was referred for pain in her hand. Plaintiff had an appendectomy in March 2017. (AR 523.) Dr. Wu's notes indicate that plaintiff had been experiencing pain all over her body ever since the appendectomy, several years prior. (AR 358-361.)

B. Post-Disability History of Treatment

In November 2020, plaintiff left work due to “worsened somatic and psychiatric symptoms,” including cognitive decline, and various physical impairments including pain and GI symptoms. (AR 517.) Dr. Young wrote in her letter to support plaintiff's appeal that “partial hospitalization and inpatient admission were not indicated, not because she was not severely impaired, but because partial programs” focus on “imminent suicidal or homicidal threat,” which plaintiff did not need. (AR 1768.)

To address her psychological issues, plaintiff began attending sessions with a psychotherapist, David Leong, three times per week. (AR 517-519.) Leong initiated various medical trials to treat patient's issues, including PTSD and dissociative disorder. He also ran her therapy program focused on anxiety and trauma. (Id.) Leong worked in consultation with plaintiff's other providers to form a plan for her to return to work full-time, which included a ramp-up period during which she would work part-time. (AR 623-625.) Leong noted in a March 2, 2022 session that plaintiff was tolerating part-time work and was successfully reducing the amount of dissociation and PTSD symptoms. (AR 1652.) He recommended that she return to work at 60% with a gradual increase in workload, however he warned that monitoring was needed to ensure the return to work was successful. (AR 624.)

Drs. Young, Ashe, Tsuchiyose, and Wu all submitted documentation of plaintiff's continuing symptoms following her disability date of November 2, 2020.

In November 2020, Dr. Young recorded that plaintiff's stress was exacerbating her leaky gut syndrome resulting in alternating constipation and diarrhea. (AR 911.) Dr. Young recorded that plaintiff was exhibiting depressed mood, constricted affect, distracted attention, withdrawn behavior, and limited memory. (AR 882-885.) Dr. Young found plaintiff could focus and concentrate for only 30 to 50 minutes at a time. (Id.) In subsequent sessions, Dr. Young found that plaintiff's ability to focus continued to decline. On March 10, 2021, Dr. Young found her ability to focus and concentrate had decreased to just 15 to 30 minutes. Dr. Young also noted that plaintiff was distracted and exhibiting distant engagement, needing redirection and reminders from her spouse. She also found plaintiff was fractured between separate personality states. On July 12, 2021, plaintiff told Dr. Young that she was experiencing anxiety, pain, fatigue, attention issues, sleep issues, and gastrological issues.

On January 21, 2022, plaintiff visited sleep specialist Dr. Yuen for an overnight sleep study. Dr. Yuen found that plaintiff had various symptoms, including daytime sleepiness and sleep paralysis. She recommended plaintiff return to the sleep clinic to address obstructive sleep apnea (“OSA”). (AR 839-850.)

Plaintiff visited Dr. Ashe monthly between June 2021 and January 2022. Following an August 9, 2021 visit, Dr. Ashe noted that lab work demonstrated plaintiff had excessive oxidative stress and mitochondrial damage, low iron saturation, excessive clostridioides difficile (a bacterium that causes inflammation of the colon - colitis), and a very high glycolic acid marker. (AR 742.) He coordinated a treatment plan with Dr. Tsuchiyose that included an elimination diet, nutritional supplements and food tolerance testing to address her GI issues. (AR 740-741.) On November 2, 2021, in consultation with plaintiff's other providers, Dr. Ashe recommended plaintiff return to work at no more than 50% until February 2022. (AR 753.)

On November 18, 2022, Dr. Tsuchiyose completed a disability substantiation form. The form had eight “check the boxes” questions. (AR 341-342.) Notably here, the “no” box was checked on Question “5. Does the impairment substantially limit a major life activity?” but then the following Question read: “6. If yes, which major life activities are affected?” and two options were “checked” in response: “Concentrating” and “Interacting with Others.” (Id.) Further, Dr. Tsuchiyose also checked boxes in Question 2 confirming diagnoses of GERD, abdominal bloating, small intestinal bacterial overgrowth (“SIBO”), IBS, leaky gut, and stress. (AR 341-342). He checked “Yes” (Question 3) indicating that Lukman's conditions do “rise to the level of impairment” and which are “Long-term, more than a year,” not “Short-term, up to a year” (Question 4). (Id.)

With respect to this form, defendant stresses the “No” box on Question 5 to argue that the doctor confirmed that plaintiff's impairments do not ‘substantially limit a major life activity’ and Question 7 do not ‘substantially limit the operation of a major bodily function.’ As noted above, with respect to Question 5, plaintiff counters that the checked “no” box must have been a clear typo given that the companion Question 6 was answered in the affirmative. By contrast, the companion question to Question 7 (Question 8) was not answered in the affirmative.

As noted above, plaintiff visited Dr. Wu following a referral for hand pain on May 28, 2021. (AR 358-361.) Although Dr. Wu's exam did not find evidence of swollen joints and her rheumatology labs were negative, she noted that plaintiff complained of brain fog, nausea, GERD, and general pain. Dr. Wu also noted upon examination that plaintiff had tender points including in her extremities, upper chest, back, and trochanter regions. (AR 360.)

C. Post-May 2, 2022 Denial History of Treatment

Following MetLife's initial denial of plaintiff's claim for LTD benefits, plaintiff continued to see her providers for her constellation of psychological and physical issues.

On August 24, 2022, Dr. Ashe submitted a substantiation form recommending that plaintiff not work during a flareup of her GI symptoms, noting “It's better to take the day off and make up work on a different day. It would prevent a flare up from turning into a longer period of disability.” (AR 374.)

On November 5, 2022, Dr. Yuen administered an updated Polysomnogram & Multiple Sleep Latency Test, wherein she confirmed that Lukman experienced mild OSA, Periodic Limb Movements of Sleep, short sleep latency possibly due to Narcolepsy, Idiopathic Central Nervous System Hypersomnia, Depression or Chronic Sleep Deprivation, and the absence and/or delay of REM sleep onset. (AR 349-351.) On November 17, 2022, Dr. Yuen concluded that plaintiff “has pathologic daytime hypersomnia” and recommended “special accommodations at work to take 1 or 2 scheduled naps of 30 minutes.” (AR 352 (cleaned up).)

Further, several of plaintiff's providers submitted letters in support of her appeal, emphasizing plaintiff's restrictions that limited her ability to return to full-time work. Thus:

On January 19, 2023, Dr. Yuen wrote “We are exploring a regimen that will allow her to be functional with less sleepiness during the day, but it will be difficult for her to maintain constant level of alertness and cognitive function throughout the day ․ Her results were not normal. I hope you understand that since her sleep-wake cycle cannot be normally regulated, her daytime function will continue to be impaired. There is no cure at the current time.” (AR 133-4 (emphasis in original).)

On January 20, 2023, Dr. Tsuchiyose wrote, “Vera has expressed a combination of these symptoms, some of which I have observed and examined in person, especially during the worst of her symptoms. The cognitive aspects of her gastrointestinal disorders have impacted Vera's ability to perform her day-to-day work responsibilities, and supports her claim of being unable to work at 80% or greater capacity.” (AR 106.)

D. Claim History

Plaintiff's claimed disability date is November 2, 2020. The Claims Administrator for Google's Voluntary Disability Plan, Sedgwick, approved short-term disability benefits for the maximum 52-week duration of that claim. MetLife received plaintiff's LTD claim in January 2022. In consideration of the claim, MetLife obtained various documents from plaintiff, including medical records and materials from the short-term disability and voluntary disability files. MetLife referred the claim file to a Nurse Consultant (NC), a Psychiatric Clinical Specialist (PCS), and an Independent Physician Consultant (IPC). (AR 422-423.)

MetLife sent plaintiff a letter denying her claim dated May 2, 2022. (AR 422-428.) The letter stated that the claim was denied because MetLife found plaintiff was not totally disabled as defined by the Plan and was not partially disabled because plaintiff was not working during the Elimination Period. The letter included instructions for how to submit an appeal of the decision. Plaintiff argues the letter did not identify what MetLife needed “to perfect the claim.”

Plaintiff submitted her appeal of the initial denial in November 2022. MetLife ordered reviews by two peer reviewers, IPC Belcourt and IPC Richardson. (AR 301, 313.) Plaintiff's doctors submitted responses supporting her disability and plaintiff submitted a letter outlining her objections to the initial denial. MetLife denied the appeal in a February 10, 2023 letter. (AR 77-83.) Plaintiff claims that this letter is the first time MetLife informed her that her claim was defective because there was no neuropsychological testing to support a cognitive deficit.

MetLife did not have plaintiff examined at any point during this review process. (See, generally AR.) This appeal followed.

III. Conclusions of Law

MetLife proffered four reasons for denying plaintiff LTD benefits. One, the medical evidence did not demonstrate that plaintiff suffered from psychiatric or physical functional limitations, based upon normal physical examinations and labs. Two, plaintiff's self-reported symptoms are refuted by a lack of clinical evidence. Three, plaintiff's symptoms improved significantly over time, as demonstrated by plaintiff's self-reporting, her physicians’ records, gaps in treatment, and the nature of the treatments themselves. Four, plaintiff's physician's statements and non-work activities show that she could work full-time. The Court considers each.

1. Evidence of Plaintiff's Physical and Psychological Symptoms

MetLife relies heavily on the conclusions of IPC Dr. Jason Estok that “[t]here is no sustained clinical documentation of ongoing and impairing psychiatric symptoms in the medical record for the time period in question” and NCs that plaintiff's physical conditions “are not supported by the medical evidence” and “do not rise to the level of impairment.” (AR at 496, 1214-1224.)

Each of the doctors who examined plaintiff determined that she was unable to perform the duties of her job as a software engineer at 80% FTE. They based their opinions on formal diagnoses, testing, lab work, physician objective assessments, their own physical and psychological examinations of plaintiff, as well as consistent and corroborated subjective symptom reports. Her condition did not show sufficient improvement to return to work full-time prior to February 2023, when MetLife upheld its denial of plaintiff's appeal for LTD benefits. These facts support a finding that plaintiff was partially disabled under the Plan's definition of disability. See supra, p. ––––.

2. Evidence of Plaintiff's Self-Reported Symptoms

“[A] disability insurer cannot condition coverage on proof by objective indicators where the condition is recognized yet no such proof is possible.” Cruz-Baca v. Edison International Long Term Disability Plan, 708 Fed.Appx. 313, 315 (9th Cir. 2017) (internal citations omitted). The Ninth Circuit has found that chronic pain, like that of which plaintiff complains, “is an inherently subjective condition.” Id., at 315; see also Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 872 (9th Cir. 2008) (criticizing plan's denial of benefits for lack of objective evidence of pain since it is inherently subjective).

MetLife fails to provide any authority, medical or otherwise, to show that plaintiff's self-reported symptoms are not debilitating. Each specialist who examined plaintiff, and whose chart notes can be found in the administrative record, determined that she suffers from a whole host of physical and psychological symptoms, which impact her ability to concentrate. See supra II. C. Although many of these determinations are based largely on plaintiff's self-reported symptoms, a disability determination may be based on a patient's self-reported symptoms if said reporting is credible. See Demer v. IBM Corp. LTD Plan, 835 F.3d 893, 905-06 (9th Cir. 2016) (finding that an administrator abused its discretion in denying LTD benefits based on claimant's failure to provide objective evidence of disability where claimant provided subjective complaints corroborated by his treating physicians).

Plaintiff sought treatment for her symptoms as early as 2017 and continued to seek a firm diagnosis and treatment throughout her disability application and appeal, including three-times weekly intensive therapy treatments, sleep tests, and a variety of other examinations. Plaintiff's treating physicians noted at various times that her physical and psychological symptoms were likely to impact her ability to focus. Moreover, Dr. Young documented plaintiff's inability to concentrate, including that her concentration deteriorated during the relevant time period. This inability to concentrate was not simply self-reported; Dr. Young observed it in her sessions with plaintiff in 2021 and 2022. (AR 882-885.)

None of plaintiff's treating physicians questioned the legitimacy of her complaints. Indeed, IPC Estok, upon whose opinion MetLife relies heavily, did not call into question the legitimacy of plaintiff's self-reported complaints.

Accordingly, the Court finds that plaintiff's subjective self-reported symptoms support a finding of partial disability.⁴

3. Evidence of Plaintiff's Symptoms Improving

MetLife's decision relied on the opinions of in-house NCs, PCS, and IPCs rather than the physicians who examined and treated plaintiff. MetLife's reviewers only reviewed the records and medical testing of other doctors. While ERISA does not accord special deference to the opinions of a treating physician, Black & Decker Disability Plan v. Nord, 538 U.S. 822, 831, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003) (ERISA does not import treating physician rule from Social Security regulations), courts generally give greater weight to doctors who have actually examined the claimant versus those who only review the file. See Eisner, 10 F.Supp.3d at 1115; Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676 (9th Cir. 2011); Heinrich v. Prudential Ins. Co. of Am., No. C 04-02943 JF, 2005 WL 1868179, at *8 (N.D. Cal. July 29, 2005) (failure of administrator's physicians to examine claimant entitles their opinions to less weight than treating physicians since the nature of the condition at issue produces symptoms that must be evaluated through in-person examination); see also Cooper v. Life Ins. Co. of N. Am., 486 F.3d 157, 167 (6th Cir. 2007) (reliance of file reviewers rather than actual physical examination may “raise questions about the thoroughness and accuracy of the benefits determination”).

On de novo review, the Court must “evaluate the persuasiveness of conflicting testimony and decide which is more likely true.” Kearney, 175 F.3d at 1095. “The credibility of physicians’ opinions turns not only on whether they report subjective complaints or objective medical evidence of disability, but on (1) the extent of the patient's treatment history, (2) the doctor's specialization or lack thereof, and (3) how much detail the doctor provides supporting his or her conclusions.” Hart v. Unum Life Ins. Co. of Am., 253 F. Supp. 3d 1053, 1070 (N.D. Cal. 2017).

Though plaintiff's treatment record shows that some of her symptoms improved at times, every specialist who examined plaintiff, and whose chart notes can be found in the administrative record, determined that she consistently suffered from symptoms that inhibited her ability to concentrate.⁵ In November 2020, shortly after plaintiff left work the first time, Dr. Young determined that plaintiff could focus and concentrate for only 30 to 50 minutes at a time. (Id.) In subsequent sessions, Dr. Young found that plaintiff's ability to focus continued to decline. Later, on March 10, 2021, Dr. Young found her ability to focus and concentrate had decreased to just 15 to 30 minutes. This is further corroborated by plaintiff's other doctors who found that her various symptoms were impacting her ability to concentrate.

For example, in February 2022, Dr. Yuen wrote that plaintiff “feels almost always tired on a daily basis” and that as a result she has “decreased concentration and memory.” (AR 630-631.) In November 2022, Dr. Tsuchiyose noted that her GI conditions affected plaintiff's ability to concentrate and interact with others. (AR 341-342). In her 2023 letter in support of plaintiff's appeal, Dr. Yuen wrote “it will be difficult for her to maintain constant level of alertness and cognitive function throughout the day. She is to have scheduled sleep periods during the day when she can. This may be an evolving disorder that leads eventually to narcolepsy.” (AR 104.) She also wrote, “since her sleep-wake cycle cannot be normally regulated, her daytime function will continue to be impaired.” (AR 104-105.)

The Court gives greater weight to plaintiff's treating physicians and concludes that their findings support a finding of partial disability.

4. Evidence that Plaintiff Could Work Full Time

MetLife argues that plaintiff's return to part-time work, statement that she was considering pursuing a PhD, and engaging in a house remodel demonstrate that she was capable of returning to work full-time.

MetLife does not provide any authority for the proposition that an attempt to return to work part-time should rebut a claim of partial disability. Such a position is untenable. It was the unsuccessful partial return that confirmed the disability. Drs. Ashe, Young, and Leong all recommended that plaintiff return to work at part-time FTE. In November 2021, Dr. Ashe recommended plaintiff return to work at no more than 50% until February 2022. (AR 753.) On March 2, 2022, Dr. Leong recommended she return to work at 60% with a gradual increase in workload, however he warned that monitoring was needed to ensure the return to work was successful. (AR 624.) Their recommendations are consistent with an employee who is attempting yet struggling to return to full-time work due to her significant physical symptoms and difficulty concentrating.

MetLife exaggerates the relevance of plaintiff's own statements that she would like to pursue a PhD at some point. Because someone expresses a desire to engage in an activity does not evidence that she is capable of doing so now. The Court finds similarly unpersuasive MetLife's argument that because plaintiff's house was being remodeled, she was not experiencing limitations on her capacity to work. There is nothing in the record or the parties’ briefs to suggest that plaintiff was engaged in the remodeling work herself. Instead, plaintiff described to her doctors how her stress caused by the home remodel project was exacerbating her symptoms.

These arguments do not support MetLife's denial of plaintiff's claim.

Accordingly, based upon an exhaustive review of the administrative record here, the Court finds that plaintiff has established that she was partially disabled under the Plan's definition of disability. Plaintiff was, while actually working, unable to earn 80% or more of her pre-disability earnings.⁶ (AR 1396.)

* * *

The Court also addresses one additional defense argument. It does not compel a different result.

Defendant argues that plaintiff cannot meet the Plan's definition of Partial Disability because she was not working during the claim's Elimination Period and must be working in some capacity to be considered Partially Disabled under the terms of the Plan. (D Motion at 8.) The argument is specious. Defendant not only conceded that if a claimant did not work for one day, that would not disqualify her from partial disability, but defendant could not extend the logic here. Said differently, defendant could not provide any basis for why a period of six months not working followed by a partial return to work (either working full-time for a short period followed by a relapse or working part-time for a long period) should serve as a basis to disqualify a claimant from a partial disability claim. Nor could the Court find any such basis in the LTD Plan. (AR 1371-1423.)

No genuine dispute exists that plaintiff did not work from November 2, 2020 to May 3, 2021, and then worked at varying FTE levels between May 3, 2021 to July 11, 2023, at which point plaintiff stopped working again. Plaintiff claims that she returned to work remotely at 50% FTE on February 1, 2024. A review of the available paystubs in the Administrative Record, confirms that argument and the fact that plaintiff did not work more than 80% FTE during the relevant time period. (AR 633-705, 1516-1588.)

IV. Disposition

Upon de novo review of the record, the Court finds that plaintiff has established by a preponderance of the evidence that she was partially disabled under the terms of the Plan during the relevant period.

The parties shall, within twenty-one days of the date of this Order: (1) meet and confer to resolve the amount of disability benefits due plaintiff, and (2) submit a proposed form judgment consistent with the terms of this Order and approved as to form.

This Order terminates Docket No. 20.

It Is So Ordered.

FOOTNOTES

1.   Dkt. Nos. 20, Motion for Declaratory Judgment (“P Mtn.”), 21, Opposition and Cross-Motion for Judgment on the Administrative Record (“D Mtn.”), 22, Combined Opposition to Defendants’ Cross-Motion for Judgment & Reply in Support of Plaintiff's Motion for Judgment (“P. Oppo.”), and 23, Reply (“D. Oppo.”).

2.   Hereinafter, all references to the administrative record will take the form of “AR [Terminal Digits].”

3.   The relevant period is the Elimination Period (determined in plaintiff's schedule of benefits to be six months) and the subsequent 24 months, which is 30 months total. (AR 1390.)

4.   The Court is unpersuaded by MetLife's implicit argument that plaintiff was “planning” to go on leave out of any malicious or fraudulent intent. (D Mtn. at 16.) That plaintiff discussed her symptoms and the possibility that she may require a leave from work to deal with them before her date of disability only serves to underscore that the issues she experienced were part of an ongoing timeline of developing issues.

5.   Plaintiff accuses defendant of misleading the Court by providing a “selective recitation of portions of the medical records, and at times misquotes.” The Court has not seen evidence of inaccurate quotes from the record. By contrast, there are several instances where defendant's quotes or summaries of the record do not accurately reflect the full context. For example, defendant writes that plaintiff's GI symptoms “all improve” in May 2021. (D Mtn. at 4:3-4.) Plaintiffs note that the full quote demonstrates that while Dr. Tsuchiyose worked on a plan with plaintiff to return to work in May 2021, “She still has gas and bloating as well as fatigue and occasional brain fog.”The Court takes notice of the discrepancies noted by plaintiff in its side-by-side comparison and has determined that, overall, the evidence shows while plaintiff's symptoms improved at various times during the relevant period, her doctors consistently recorded that she was unable to return to work full-time.

6.   Pre-disability earnings are defined by the Plan as the salary claimant earned on her last day of active work before disability. (AR 1393.)

Yvonne Gonzalez Rogers, United States District Court Judge