Opinion
Civil No. 03-4389 (RHK/AJB).
July 29, 2004
ORDER
This matter comes before the Court on Plaintiff's motion for attorneys' fees and costs. Based on the files, records, and proceedings herein, the Court FINDS:
1. There is no presumption of attorneys' fees and costs under ERISA;
2. In determining whether to award fees and costs, the Court considers the five factors set out by the Eighth Circuit in Lawrence v. Westerhaus:
(1) the degree of the opposing parties' culpability or bad faith; (2) the ability of the opposing parties to satisfy an award of attorneys' fees; (3) whether an award of attorneys' fees against the opposing parties could deter other persons acting under similar circumstances; (4) whether the parties requesting attorneys' fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA itself; and (5) the relative merits of the parties' positions.749 F.2d 494, 496 (8th Cir. 1984).
3. The factors are weighed as follows:
a. MetLife breached its fiduciary duty, abused its discretion, and demonstrated bad faith in at least two ways:
i. First and most importantly, MetLife required Pralutsky to submit objective medical evidence of a disease whose symptoms are "entirely subjective." Sarchet v. Chater, 78 F.3d 305, 306-07 (7th Cir. 1996). Because "the amount of pain and fatigue that a particular case of [fibromyalgia] produces cannot be objectively measured," MetLife's interpretation, if allowed to stand, "would mean that fibromyalgia could never be shown to be totally disabling." Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003) (Posner, J.). By requiring objective medical evidence of a disease and symptoms that are not susceptible to such evidence, MetLife, in essence, created an ex post facto exclusion of this very disabling condition. That represents an egregious breach of trust between the insurer and insured.
ii. Second, by launching a broadside on Pralutsky's documentation (as it has throughout this litigation), MetLife has "sandbagged [Pralutsky with] after-the-fact plan interpretations devised for purposes of litigation." Marolt v. Alliant Techsystems, Inc., 146 F.3d 617, 620 (8th Cir. 1998). Under ERISA, a denial of claim must be written "in a manner calculated to be understood by the claimant" and contain "[t]he specific reasons for the denial." 29 C.F.R. § 2560.503-1(g)(1)(i). That's why, in the Eighth Circuit, courts "are free to ignore ERISA plan interpretations that did not actually furnish the basis for a plan administrator's benefit decision." Marolt v. Alliant Techsystems, Inc., 146 F.3d 617, 620 (8th Cir. 1998) (emphasis added). Judging by MetLife's papers in the present motion, MetLife's misbehavior in this regard continues to this day.
MetLife made only two relevant remarks about Pralutsky's documentation in its denial letters. In its initial denial, MetLife stated that "[m]edical documentation does not support severity of diagnosis for fibromyalgia. . . ." (Mohs Aff. Ex. A at AR 76 (emphasis added).) But as the Seventh Circuit has noted, "[t]here are no laboratory tests for the presence or severity of fibromyalgia." Sarchet, 78 F.3d at 306-07. Second, MetLife stated on appeal that Pralutsky's inability to work due to pain and fatigue was "without subs[t]antiation from the medical records. B[e]sides self reported complaints, the[r]e [are] essentially no objective medical findings to support the pathology in the musculoske[le]tal or neurological systems." (Mohs Aff. Ex. A at AR 103.) Read in context, these sentences merely disqualify "self reported complaints" from the substantiation MetLife will consider. They do not suggest, and a reasonable plan participant would not read them to suggest, a larger problem with Pralutsky's medical records. MetLife may not therefore use this language as a Trojan Horse to smuggle into the case its countless " post hoc rationales." Conley v. Pitney Bowes, 176 F.3d 1044, 1049 (8th Cir. 1999).
b. MetLife is able to pay fees and costs;
c. The award of fees and costs will help to deter others from similar conduct;
d. This action has benefitted all plan participants by clarifying the type of evidence MetLife may require from fibromyalgia claimants; and
e. The relative merits of the parties' positions heavily favored Pralutsky.
4. Having weighed these factors, the Court finds that Pralutsky is entitled to attorneys' fees and costs.
5. The fees and costs requested by Pralutsky (and calculated through the lodestar method) are reasonable and appropriate.
Therefore, IT IS ORDERED that Plaintiff's Motion for Attorneys' Fees and Costs (Doc. No. 18) is GRANTED. Plaintiff is AWARDED attorneys' fees and costs in the amount of $14,179.11 ($13,286.36 in fees + $892.75 in costs).