A federal district court in Illinois has ruled that a partner at an international law firm in Chicago who suffered from eye disease was entitled to receive long term disability benefits, reversing the insurance company's decision.
The case
Mary C. Fontaine was a partner at the law firm of Mayer Brown in Chicago, where she practiced in the firm's structured finance group for 30 years. In 1997, Ms. Fontaine began having problems with her vision, complaining of seeing floaters and flashes in her eyes and having trouble focusing. Her doctors diagnosed her with myopic macular degeneration, a condition that results in a loss of vision in the center of the visual field. Over the next several years, Ms. Fontaine's condition deteriorated and, in 2011, she decided that her vision had become so impaired that she could no longer perform her material job duties. She then filed a claim for disability benefits with MetLife under two policies she had with MetLife: a long term disability policy and an individual disability policy.
In support of her claim, Ms. Fontaine provided her medical records, a list of her treating physicians, and a nine page employee statement explaining why she believed that her eye disease prevented her from performing the material duties of her job.
In the employee statement, Ms. Fontaine described the nature of her work as a structured finance partner. She stated that she "designed, documented, negotiated and closed complex financial transactions (including securitizations, CLOs and derivatives) that were funded in global capital markets." She stated that the structured finance partner's role in these transactions was to "break portfolios of financial assets and related risks into different categories and to allocate each category of risk, as well as cash flow from the financial assets, among a number of different parties." She described her practice as "requir[ing] the ability to master and manipulate large concepts and simultaneously insure the accuracy of minute detail spread across thousands of pages of interlocking contracts." She noted that a typical contract went through several rounds of revision, and, as the lead partner on a transaction, she ultimately was responsible for making sure that the final draft incorporated all of the comments from the various parties. She noted that "[h]undreds of millions, or even billions, of dollars change hands in these transactions" and that "[t]here is no margin for error."
Ms. Fontaine described her typical day, which she said began at 6:15 when she woke up to catch the 7:16 train downtown. She stated that, while she was on the train, she would read and respond to Blackberry messages that came in overnight. She arrived at the office around 8:00 a.m. She stated that, throughout the day, she would draft and edit documents, read laws and regulations relevant to her transactions, field written and telephone questions from clients and associates, work through term sheets and diagrams for potential new transactions, and participate in business development activities. She stated that she would read and respond to between 150 and 300 emails per day. She would leave the office between 8:00 p.m. and 1:00 a.m, and she regularly worked during the weekend. In addition to her typical working days, she traveled to other cities several times per year to make client pitches and attend conferences.
Ms. Fontaine listed several reasons her eye disease prevented her from doing her job. She stated that she had difficulty "reading and digesting complex cash flow formulas that go on for pages and often involve footnotes in tiny type," "reading numbers and accurately noting where the decimal point is placed," and "discerning the subtle differences between similar contract provisions during contract negotiations conducted in concentrated time frames." She stated that she could not "generate timely issue summaries for clients, or lead them through a line-by-line review of lengthy contracts." She could not correct the work of attorneys whom she supervised and "misplaced words in documents in a way that change[d] the[ir] legal meaning." She stated that she could not "read fast enough to get through the volume of work on [her] desk each day." She also stated that she could "no longer effectively generate new business" because she could not read materials to prepare for meetings with a potential client and had difficulty reading name tags and business cards.
Ms. Fontaine concluded by noting that, although she had not yet made a mistake that was catastrophic to one of her clients, she did not believe she could "justify subjecting my clients or my firm to the risk that I will make such a mistake."
MetLife denied Ms. Fontaine's claim for disability benefits. MetLife concluded that the medical information she provided did "not support any restrictions or limitations that would prevent her from performing her occupation."
Ms. Fontaine appealed MetLife's denial of her claim, but MetLife upheld its decision.
Ms. Fontaine brought suit to challenge MetLife's denial of her claim under Section 502(a)(1)(B) of the Employee Retirement Income Security Act, 29 U.S.C. § 1132 ("ERISA"). She sought $33,500 per month (plus accrued cost-of-living adjustments), less $2,444 per month, representing the amount of Social Security disability benefits she had been awarded.
The parties filed cross-motions for entry of judgment.
The policies
The long term disability policy defined disabled as:
