347 F.3d 161 | 6th Cir. | 2003
Before: MOORE and GILMAN, Circuit Judges; MILLS,
District Judge. [*] UNITED STATES COURT OF APPEALS _________________ FOR THE SIXTH CIRCUIT _________________ COUNSEL ARGUED: Aaron P. Rosenfeld, VORYS, SATER, J AMES M C D ONALD , (cid:88) SEYMOUR & PEASE, Columbus, Ohio, for Appellants. (cid:45) Plaintiff-Appellee, Tony C. Merry, PALMER VOLKEMA THOMAS, (cid:45) Columbus, Ohio, for Appellee. ON BRIEF: Aaron P. (cid:45) No. 02-3053 v. Rosenfeld, David A. Campbell, VORYS, SATER, (cid:45) >
SEYMOUR & PEASE, Columbus, Ohio, for Appellants. (cid:44) Tony C. Merry, PALMER VOLKEMA THOMAS, W ESTERN -S OUTHERN L IFE (cid:45) Columbus, Ohio, for Appellee. I NSURANCE C OMPANY ; (cid:45) W ESTERN -S OUTHERN L IFE (cid:45) _________________ (cid:45) D ISABILITY P LAN ; S ECURITY (cid:45) OPINION P LAN C OMMITTEE OF THE (cid:45) _________________ W ESTERN -S OUTHERN L IFE (cid:45) D ISABILITY P LAN , (cid:45) RICHARD MILLS, District Judge. James McDonald Defendants-Appellants. (cid:45) worked for Western-Southern Life Insurance Company for (cid:45) nearly twenty-one years before he began receiving long-term (cid:78) disability (“LTD”) benefits from Western-Southern Life Insurance Company’s Flexible Benefits Plan due to his severe
Appeal from the United States District Court depression and his aggressive personality disorder. [1] for the Southern District of Ohio at Columbus. No. 98-00414—John D. Holschuh, District Judge. After paying LTD benefits for over seven years, Western- Southern terminated McDonald’s LTD benefits after it Argued: September 9, 2003 concluded that he was no longer disabled from performing any and every occupation, business, or employment for
Decided and Filed: October 20, 2003 After the covered Employee has completed 5 After the Appeals Committee affirmed Western-Southern’s uninterrupted Years of Employment, Long-Term decision to terminate McDonald’s LTD benefits, McDonald Disabled shall mean the complete and continuous filed suit in federal district court seeking the reinstatement of incapacity of the Covered Employee to engage in any his LTD benefits, which he claimed were denied in violation and every occupation, business or employment for of his rights under the Employee Retirement Income Security wages, compensation or profit. Act (“ERISA”). 29 U.S.C. § 1001 et seq . ERISA. After reviewing the administrative record, the district judge Pursuant to the terms of the plan, a covered employee has a concluded that Western-Southern’s decision to terminate continuing obligation to furnish proof of his long-term McDonald’s LTD benefits was arbitrary and capricious, and disability, to be examined in order to verify his long-term therefore, he ordered the reinstatement of McDonald’s LTD disability, and to provide any release required by the plan. benefits.
In the fall of 1988, McDonald began to experience severe For the following reasons, we AFFIRM the judgment of depression. On October 26, 1988, Western-Southern awarded the district court. McDonald short-term disability benefits due to his depression. On August 23, 1989, the Social Security I. BACKGROUND Administration determined that McDonald was totally and permanently disabled. On January 12, 1990, Western- James McDonald began working for Western-Southern on Southern notified McDonald that it had approved his October 11, 1976. His last position with the company was as application for LTD benefits, to be effective January 26, a district sales manager in charge of the Columbus, Ohio, 1990, based upon his severe depression and his aggressive office. As an employee of Western-Southern, McDonald was personality disorder. a participant in the Western and Southern Life Insurance Company Flexible Benefits Plan. The Plan provided LTD
On October 30, 1996, pursuant to a periodic evaluation of benefits for covered employees who were determined to his continued eligibility for LTD benefits, Western-Southern suffer from a long-term disability or who were determined to asked McDonald to provide information to it relating to his be long-term disabled. “Long-Term Disability or Long-Term disability and to sign an authorization for the release of his
medical records. [2] Upon receipt of this material, Western- Disabled” is defined by the terms of the plan as: Long-Term Disability or Long-Term Disabled shall mean until the Covered Employee has completed 5 [2] Througho ut his disab ility, McD onald has been under the care of Dr.
uninterrupted Years of Employment a disablement Hubert T. Goodman, a psychiatrist, and D r. Kent G. H amd orf, Ph.D., a resulting from sickness or accidental bodily injury of psychologist. In addition, McDonald has appeared for an independent such a nature that the disabled Covered Employee is medical examination, pursuant to Western-Southern’s requests, on receiving disability benefits under the Social Security July 10, 1989 , with Dr. Michael Murphy, a psychiatrist, who gave McDonald a Minnesota Multiphasic Personality Inventory (“MMP I”), and No. 02-3053 McDonald v. Western-Southern 5 6 McDonald v. Western-Southern No. 02-3053 Life Ins. Co., et al. Life Ins. Co., et al. Southern’s medical consultants believed that some of loss. Based upon his examination and interview of McDonald’s activities, which were noted in his medical McDonald, Dr. Clary rendered the following conclusion: records, were inconsistent with a diagnosis of major depression. [3] Mr. McDonald would be able to relate satisfactorily with
Accordingly, Western-Southern asked supervisors and co-workers. He would be able to McDonald to submit to an independent medical examination understand and follow instructions in a competitive in order to determine whether he remained eligible to receive setting. He would be able to maintain attention and LTD benefits.
attendance for a reasonable period of time and would On May 2, 1997, Dr. Richard M. Clary, a psychiatrist, perform routine repetitive tasks without undue examined McDonald. [4] Dr. Clary’s examination consisted of supervision. He would be able to exercise acceptable a standard psychiatric evaluation, the MMPI-2 psychological judgment concerning work functions and would have test, and a clinical interview of McDonald. Thereafter, Dr. some difficulty understanding the stress and pressure Clary submitted a report to Western-Southern which associated with day to day work activities. He might be contained his evaluation of McDonald’s condition and the able to return to work in a very low stress environment results of McDonald’s MMPI-2. on a limited trial basis.
Specifically, Dr. Clary’s report indicated that the results of On May 19, 1997, Western-Southern sent McDonald a McDonald’s MMPI-2: (1) were consistent with symptoms of letter informing him that his LTD benefits would be depression and showed an over-sensitivity to criticism; terminated effective June 30, 1997. In this letter, Western- (2) displayed an underlying hostility as well as evidence of Southern advised McDonald that, based upon Dr. Goodman’s anger and resentment; and (3) indicated paranoid tendencies medical records and Dr. Clary’s conclusions, it was but did not show any paranoid delusions or psychotic terminating his LTD benefits because it now appeared that he thinking. Dr. Clary diagnosed McDonald as having could engage in an occupation for wages, and thus, he no dysthymic disorder, a dependent personality, possible longer met the definition of “Long-Term Disability or Long-
Term Disabled” as defined by the terms of the plan. [5] paranoid personality, macular degeneration of the left eye, decreased vision in his right eye, and high frequency hearing he could have returned given his limitations. [7] McDonald offered Mr. Eichenbaum’s affidavit because Dr. Clary’s [8] findings were based, in part, on the fact that McDonald regularly played The audio tape of this telephone conversation was later transcribed, bridge for points, and Dr. Clary opined that this activity was inconsistent was disclosed to McDonald during discovery, and was provided to the with McDonald’s disability claim. district court as part of the parties’ cross-motions for summ ary jud gment. No. 02-3053 McDonald v. Western-Southern 9 10 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. U.S.C. § 1140 and 1132(a)(3). At the conclusion of the and, therefore, not disabled. On January 4, 2002, Western- discovery period established by the district court, McDonald Southern filed a timely notice of appeal from the district
court’s order. [9] and Western-Southern filed cross-motions for summary judgment.
II. DISCUSSION
On December 14, 2001, the district court entered an order The sole issue which the Court must decide in this appeal granting in part and denying in part both parties’ motions for is whether or not the district court erred in holding that summary judgment. Specifically, the district court held that Western-Southern’s decision to terminate McDonald’s LTD Western-Southern’s decision to terminate McDonald’s LTD benefits was arbitrary and capricious. We find that the district benefits was arbitrary and capricious because Western- court did not err in so holding. Southern could not offer a reasoned explanation, based upon the evidence in the administrative record, for finding that
A.
ARGUMENTS McDonald was able to engage in gainful employment and, thereby, rendering him ineligible for LTD benefits under the
1. Western-Southern plan. In reaching this conclusion, the district court noted the unanimity of the opinions of Dr. Goodman and Dr. Hamdorf
Western-Southern claims that there are two issues which regarding McDonald’s disability, found that Dr. Clary’s this Court must address in order to resolve this appeal. The initial report was an insufficient basis upon which to first issue is whether Western-Southern substantially terminate McDonald’s LTD benefits because Dr. Clary complied with ERISA’s procedural requirements, and if not, merely stated that McDonald might be able to return to work whether the substantive remedy imposed by the district court in a very low stress environment on a limited trial basis, and was proper. Western-Southern argues that the district court’s held that Dr. Clary’s supplemental report should be given order should be reversed because the district court “very little weight” because it was radically different from his erroneously concluded that it had failed to comply with initial report and because it was rendered only after an ERISA’s procedural requirements in terminating McDonald’s ex parte telephone conference with Western-Southern’s LTD benefits, and thus, the district court improperly granted representatives. Accordingly, the district court entered a substantive remedy to McDonald as a result of this alleged judgment in McDonald’s favor and against Western-Southern procedural defect. Specifically, Western-Southern asserts that on his claim to recover benefits and ordered the reinstatement the district court erred in holding that the telephone call of McDonald’s LTD benefits. between members of its Appeals Committee and Dr. Clary was improper and constituted a “procedural defect” because
As for McDonald’s two other claims, the district court found against McDonald and in Western-Southern’s favor. Specifically, the district court held that McDonald’s breach of No. 02-3053 McDonald v. Western-Southern 11 12 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. neither McDonald nor his counsel were included in the claims that the district court had no basis to disregard Dr. telephone call. Based upon this finding of an alleged Clary’s supplemental report. procedural defect, Western-Southern contends that the district
Finally, Western-Southern argues that, even assuming court improperly disregarded a highly relevant portion of the arguendo that a procedural defect exists, the remedy of administrative record, i.e. , Dr. Clary’s supplemental report.
wholly discounting Dr. Clary’s supplemental report is Western-Southern argues that it provided McDonald with contrary to Sixth Circuit precedent. See Id . at 807 (holding a full and fair review of the record on his administrative that “[g]enerally, the courts have recognized in ERISA cases appeal and that the procedures which occurred in this case that procedural violations entail substantive remedies only substantially complied with the requirements of 29 U.S.C. when some useful purpose would be served.”). § 1133. Western-Southern asserts that, contrary to the district The second issue that Western-Southern claims must be court’s characterization, there was nothing improper about its
resolved in this appeal is whether the district court erred in employees contacting Dr. Clary for a clarification of his holding that its decision to terminate McDonald’s LTD initial report. Western-Southern contends that ERISA’s benefits was arbitrary and capricious. Given the plan’s claims procedures are not adversarial or “trial-like” as definition of long-term disability or long-term disabled as the described by the district court; on the contrary, ERISA’s incapacity to engage in any and every occupation for wages, claims procedures are designed to be an inexpensive, given Dr. Clary’s opinion that McDonald is not suffering expeditious, and non-adversarial method of claims settlement. from a condition which prevents his return to work, and given Thus, Western-Southern asserts that the district court erred in Dr. Goodman’s medical reports which indicate that failing to fully consider Dr. Clary’s supplemental report McDonald is playing bridge for points, golfing, boating, and because this Court has adopted a rule of substantial
going on vacations, Western-Southern contends that it would compliance under § 1133. See Kent v. United of Omaha Life defy logic to affirm the district court’s decision because it is Ins. Co. , 96 F.3d 803, 808 (6th Cir. 1996)(holding “that when possible to offer a reasoned explanation, based upon the claim communications as a whole are sufficient to fulfill the administrative record, for the termination of McDonald’s purposes of Section 1133 the claim decision will be upheld LTD benefits. Accordingly, Western-Southern asks the Court even if a particular communication does not meet those to reverse the district court’s order and to remand this case requirements.”).
with directions to the district court to enter judgment in its Furthermore, Western-Southern argues that its ERISA favor. fiduciary obligations and the terms of the plan itself required 2. McDonald it to investigate McDonald’s claims on appeal. Contrary to the district court’s conclusions, Western-Southern contends
McDonald concedes that the district court correctly found that Dr. Clary’s initial report is not in conflict with his “arbitrary and capricious” to be the appropriate standard of supplemental report. In both reports, Dr. Clary concludes that review because the terms of the plan give the plan McDonald is not disabled, as that term is defined by the plan, administrator the discretionary authority to determine and his supplemental report merely explains whatever eligibility for benefits and to construe the terms of the plan. ambiguity exists in his initial report. Thus, Western-Southern However, McDonald argues that the district court’s order No. 02-3053 McDonald v. Western-Southern 13 14 McDonald v. Western-Southern No. 02-3053 Life Ins. Co., et al. Life Ins. Co., et al. should be affirmed because the district court also correctly supplement contradicted Dr. Clary’s initial opinion and found that Western-Southern’s decision to terminate his LTD because the only event which triggered the change in Dr. benefits was arbitrary and capricious given the administrative Clary’s opinion was a telephone call from members of record. McDonald claims that the evidence overwhelmingly Western-Southern’s appeals committee. Under these establishes that he is totally disabled (as defined by the terms circumstances, McDonald argues that the district court of the plan) and that Western-Southern had no reasonable correctly found Western-Southern’s decision to terminate his basis for determining otherwise. LTD benefits to be arbitrary and capricious, and thus, this
Court should affirm the district court’s decision. McDonald asserts that the medical evidence indicates that he has had a mental illness since 1989, that his condition has B. ANALYSIS not improved over time, that his condition is not likely to We have explained: improve, and that his treating physicians believe him to be disabled. In fact, McDonald notes that even Dr. Clary
As a general principle of ERISA law, federal courts believed that more treatment with his psychologist would be review a plan administrator’s denial of benefits de novo , unlikely to result in any improvement or change in his “unless the benefit plan gives the plan administrator condition. discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Wilkins v. Moreover, McDonald asserts that, other than Dr. Clary’s Baptist Healthcare Sys., Inc. , 150 F.3d 609, 613 (6th Cir. supplemental report, there is no evidence in the administrative 1998)( citing Firestone Tire & Rubber Co. v. Bruch , 489 record to indicate that there has been a change in his U.S. 101, 115, 109 S. Ct. 948, 103 L. Ed.2d 80 (1989)). condition, nor has any new medical evidence been presented When a plan administrator has discretionary authority to since Western-Southern initially determined him to be
determine benefits, we will review a decision to deny disabled which would support a conclusion that he is now no benefits under “the highly deferential arbitrary and longer disabled. The Social Security Administration has capricious standard of review.” Yeager v. Reliance concluded that he is disabled, his treating physicians and the Standard Life Ins. Co. , 88 F.3d 376, 380 (6th Cir. 1996). independent medical examiners (save Dr. Clary) have found him to be disabled, and his MMPI and MMPI-2 tests support
Sanford v. Harvard Indus., Inc. , 262 F.3d 590, 595 (6th Cir. a finding of disability. 2001). “[T]he arbitrary and capricious standard is the least demanding form of judicial review of administrative action. Finally, McDonald argues that the district court correctly When applying the arbitrary and capricious standard, the discounted Dr. Clary’s supplemental report. Contrary to Court must decide whether the plan administrator’s decision Western-Southern’s characterization of the facts, McDonald was rational in light of the plan’s provisions. Stated claims that the district court did not refuse to consider Dr.
differently, when it is possible to offer a reasoned Clary’s supplemental report due to any “procedural explanation, based on the evidence, for a particular outcome, irregularity” in the manner in which it was obtained, nor did that outcome is not arbitrary or capricious.” Williams v. it impose any “substantive remedy” as a result of this International Paper Co. , 227 F.3d 706, 712 (6th Cir. irregularity. Rather, the district court simply found that the 2000)(internal citations and quotations omitted). report should be given “ very little weight” because the No. 02-3053 McDonald v. Western-Southern 15 16 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. Generally, when a plan administrator chooses to rely upon The medical evidence establishes that McDonald’s the medical opinion of one doctor over that of another in diagnosis and condition have remain unchanged since he was determining whether a claimant is entitled to ERISA benefits, first diagnosed with severe depression and aggressive the plan administrator’s decision cannot be said to have been personality disorder in the late 1980's and was awarded LTD arbitrary and capricious because it would be possible to offer benefits by Western-Southern. As noted supra , the results of a reasoned explanation, based upon the evidence, for the plan his MMPI-2 in 1997 are substantially similar to the results of administrator’s decision. [10] See Abnathya v. Hoffmann-
his 1989 MMPI, and even Dr. Clary admitted that more LaRoche, Inc ., 2 F.3d 40, 47 (3d Cir. 1993)(holding that a treatment with his psychologist would be unlikely to result in plan administrator may rely upon a single medical opinion any improvement or change in McDonald’s condition. Both finding that an employee is not disabled); see also Donato v. Dr. Goodman and Dr. Hamdorf have unequivocally and Metropolitan Life Ins. Co. , 19 F.3d 375, 380 (7th Cir. repeatedly opined that, based upon the medical evidence and 1994)(upholding a plan administrator’s denial of benefits their treatment of him, McDonald is totally incapable of where a psychiatrist found the employee to be “severely returning to work due to his mental condition. See Hoover v. depressed,” there being insufficient evidence to “support the Provident Life and Accident Ins. Co. , 290 F.3d 801, 809 (6th conclusion that [the plaintiff’s] depression, regardless of Cir. 2002)(applying a de novo standard of review in finding treatment, would constitute a total disability” and upholding that “Provident relied on the IME performed by Dr. Roseman plan administrator’s denial of claim where independent and the review of Hoover’s medical records by Provident’s medical consultant’s opinion was contrary to plaintiff’s in-house physicians . . . . As pointed out by the district court, doctor’s opinion); see also Birdsell v. United Parcel Serv. of although Dr. Roseman’s assessment did not totally endorse Am. , 94 F.3d 1130, 1133 (8th Cir. 1996)(holding that a plan the assessment of Hoover’s treating physician, Dr. Vinson, he administrator’s decision to deny benefits was not arbitrary or did not refute it. The evidence presented in the administrative capricious simply because the plan administrator adopted one record did not support the denial of benefits when only of two competing views). Provident’s physicians, who had not examined Hoover,
disagreed with the treating physicians. Under these Under these circumstances, however, the district court did circumstances, the district court’s decision to reverse not err in refusing to defer to Western-Southern’s reliance Provident’s denial of residual benefits to Hoover was correct upon Dr. Clary’s opinion in terminating McDonald’s LTD
. . . .”). benefits or in finding Western-Southern’s decision to be arbitrary and capricious. In addition, two independent medical examiners questioned
McDonald’s ability to return to work. In 1989, Dr. Murphy opined that McDonald may be able to return to work but only under careful supervision of his therapist. In 1994, Dr. Altman opined that McDonald could not return to his usual [10] occupation. Dr. Altman also noted that McDonald’s severe In Black & Decke r Disability Plan v. Nord , ___ U.S. ___, 123 S. Ct. 1965 (2003), the United States Supreme Court held “that plan personality disorder prevented him from progressing and that, administrators are not obliged to accord special deference to the opinions of treating physicians” and “that courts have no warrant to order application of a treating physician rule to employee benefit claims made under ERISA . . . .” Id . at 1966, 1969. No. 02-3053 McDonald v. Western-Southern 17 18 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. because he has long since made any progress which he is Second , in his initial report, Dr. Clary merely opined that going to make, therapy would only be supportive for him. [11]
McDonald might be able to return to work under certain limited circumstances. The mere possibility that a participant
What remains are the initial and supplemental reports of Dr. in an ERISA plan might be able to return to some type of Clary. As noted supra , in his initial report, Dr. Clary opined: gainful employment, in light of overwhelming evidence to the contrary, is an insufficient basis upon which to support a plan Mr. McDonald would be able to relate satisfactorily with administrator’s decision to deny that participant’s claim for supervisors and co-workers. He would be able to LTD benefits. See Mein v. Pool Co. Disabled Int’l Employee understand and follow instructions in a competitive Long Term Disability Benefit Plan , 989 F. Supp. 1337, 1350 setting. He would be able to maintain attention and (D. Colo. 1998)(holding that a plan administrator’s decision attendance for a reasonable period of time and perform to deny ERISA benefits was arbitrary and capricious where it routine repetitive tasks without undue supervision. He was based upon a physician’s opinion that the claimant may would be able to exercise acceptable judgment be capable of some sedentary work); see also Norris v. concerning work functions and would have some Citibank, N.A. Disability Plan , 308 F.3d 880, 883-84 (8th Cir. difficulty withstanding stress and pressures associated 2002)(quoting Fletcher- Merrit v. NorAm Energy Corp. , 250 with day to day work. He might be able to return to F.3d 1174, 1179 (8th Cir. 2001)(holding that “‘[s]ubstantial work in a very low stress environment on a limited trial evidence is more than a mere scintilla. It means such relevant basis. evidence as a reasonable mind might accept as adequate to support a conclusion. Both the quantity and quality of
We believe that Dr. Clary’s initial report was an insufficient evidence may be considered.’”); but see Miller v. basis upon which to determine that McDonald could engage Metropolitan Life Ins. Co. , 925 F.2d 979, 985 (6th Cir. in an occupation for wages. First , Dr. Clary’s opinion (which 1991)(holding that “Plaintiff makes much of the fact that in was contained within his initial report) regarding whether the narrative portion of his report, Dr. Murthi stated that he McDonald was disabled was ambiguous at best. The best recommended a return to work on a trial basis . . . . Even evidence of this ambiguity lies in the fact that Western- though Dr. Murthi recommended work only on a trial basis, Southern had to contact Dr. Clary in order to have him clarify we do not believe Metropolitan’s action in terminating his report. [12] function pretty we ll in a working environment. Ma ybe no t interact with wondering if we were reading it right, interpreting it right or what?” No. 02-3053 McDonald v. Western-Southern 19 20 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. benefits was inconsistent with the scheme as set forth in the telephone contact from Western-Southern. See EEOC v. UPS , Plan.”)(emphasis in original). 149 F. Supp. 2d 1115, 1139 (N.D. Cal. 2000)(finding that the
defendant’s principal expert witness was not credible because Likewise, we believe that Dr. Clary’s supplemental report the changes made to his draft expert report were all made at was an insufficient basis upon which to determine that the suggestion of defense counsel, and thus, “[i]n context, it McDonald could engage in an occupation for wages. In his seems clear that [the expert] lost his independence and supplemental report, Dr. Clary was much more forceful in his objectivity. He simply became part of the UPS advocacy conclusion that McDonald was able to engage in gainful team.”). Although Dr. Clary opined that McDonald could employment. In fact, Dr. Clary went so far as to accuse return to work, he did not say what kind of work he could McDonald of malingering in his ability to return to work: perform. See Quinn v. Blue Cross and Blue Shield Ass’n , 161
F.3d 472, 476 (7th Cir. 1998)(“At her deposition, however, In my medical opinion, Mr. McDonald is not suffering Calhoon admitted that she did not know what Quinn’s job from any psychiatric or psychological impairment that is duties entailed, what her exertional requirements were, any severe enough to prevent him from returning to work but training and experience she possessed, or any transferable he, in fact, does not want to return to work. skills she may have obtained. Calhoon simply based her opinion on her own notion of what a payroll accounts
Although the district court found that there was no evidence assistant does. This, without more, is not enough. We agree of bias by Dr. Clary and although there was nothing untoward that Calhoon was under no obligation to undergo a full-blown about Western-Southern contacting Dr. Clary in order to have vocational evaluation of Quinn’s job, but she was under a him clarify his initial report, it is noteworthy that Dr. Clary duty to make a reasonable inquiry into the types of skills became more definite in his opinion only after he was Quinn possesses and whether those skills may be used at contacted by Western-Southern. In his supplemental report, another job that can pay her the same salary range as her job Dr. Clary did not change his diagnosis of McDonald, did not with HCSC.”); see also VanderKlok v. Provident Life and modify the results of McDonald’s MMPI-2, or alter his belief Accident Ins. Co. , 956 F.2d 610, 614-15 (6th Cir. 1992) that therapy would be of little use to McDonald. Moreover, (quoting Torix v. Ball Corp. , 862 F.2d 1428, 1431 (10th Cir. he did not re-examine McDonald, nor did he receive any new 1988)(“the phrase ‘prevented from engaging in every business medical evidence or reports upon which to base his clarified or occupation’ [in an ERISA plan] cannot be construed so conclusion. In fact, the only new medical evidence submitted narrowly that an individual must be utterly helpless to be after Dr. Clary’s initial report was reports from Dr. Goodman considered disabled and that nominal employment, such as and Dr. Hamdorf in which they reiterated their opinions that selling peanuts or pencils which would only yield a pittance, McDonald was disabled and which attempted to rebut Dr. does not constitute a ‘business or occupation.’ Instead, a Clary’s conclusions contained within Dr. Clary’s initial claimant's entitlement to payments based on a claim of ‘total report. Therefore, we agree with the district court that Dr. Clary’s supplemental report should be discounted. Dr. Clary’s supplemental report was significantly different than his initial report without any justification for the change, other than the No. 02-3053 McDonald v. Western-Southern 21 22 McDonald v. Western-Southern No. 02-3053
Life Ins. Co., et al. Life Ins. Co., et al. disability’ must be based on the claimant’s ability to pursue under the deferential arbitrary and capricious standard is not ‘gainful employment in light of all the circumstances.’”). [13]
a rubber stamp and deference need not be abject. Even under the deferential review we will not uphold a termination when
Finally, contrary to Western-Southern’s argument, the there is an absence of reasoning in the record to support it. highly deferential standard of review applicable in this case The termination decision here is just such a does not automatically mandate adherence to Western- decision.”)(internal citation omitted); see also Swaback v. Southern’s decision. “Review under [the arbitrary and American Info. Techs. Corp. , 103 F.3d 535, 540 (7th Cir. capricious] standard is extremely deferential and has been 1996)(holding that “[a]lthough we review the committees’ described as the least demanding form of judicial review. It actions in a deferential light, we shall not rubber stamp their is not, however, without some teeth.” Cozzie v. Metropolitan decisions.”). Life Ins. Co. , 140 F.3d 1104, 1107-08 (7th Cir. 1998) (internal citation omitted). “‘Deferential review is not no III. CONCLUSION review,’ and ‘deference need not be abject.’” Hess v.
Accordingly, for the reasons set forth above, we AFFIRM Hartford Life & Accident Ins. Co. , 274 F.3d 456, 461 (7th the judgment of the district court. Cir. 2001)(quoting Gallo v. Amoco Corp. , 102 F.3d 918, 922 (7th Cir. 1996)). In the instant case, the district court had an obligation under ERISA to review the administrative record in order to determine whether the plan administrator acted arbitrarily and capriciously in making ERISA benefits determinations. This obligation inherently includes some review of the quality and quantity of the medical evidence and the opinions on both sides of the issues. Otherwise, courts would be rendered to nothing more than rubber stamps for any plan administrator’s decision as long as the plan was able to find a single piece of evidence–no matter how obscure or untrustworthy–to support a denial of a claim for ERISA benefits. See Hackett v. Xerox Corp. Long-Term Disability Income Plan , 315 F.3d 771, 774-75 (7th Cir. 2003)(“Review
NOTES
[*] The Honorable Richard M ills, United States District Judge for the Central District of Illinois, sitting by designation.
[1] W e will refer to Defendants-Appellants collectively as “Western- Southern” for ease of reference. 1 No. 02-3053 McDonald v. Western-Southern 3 4 McDonald v. Western-Southern No. 02-3053 Life Ins. Co., et al. Life Ins. Co., et al. wages, compensation, or profit as was required by the terms Act. Once a Covered Employee is receiving such of the plan in order to be considered disabled and in order to benefits his period of Long-Term Disability shall be receive LTD benefits. deemed to include the waiting period for such benefits.
[5] Spe cifically, W estern-S outhern wro te: To be considered totally disabled, you must be unable to perform any gainful emp loyme nt. This requirement is set forth in the enclosed on Ju ly 25, 1994 , with Dr. Jero ld Altm an, a psychiatrist. cop y of Sec tion 2.2 7 of the official plan document.
[3] Specifically, Western-Southern noted that McD onald had been In reviewing your file, particular attentio n was p aid to the most playing bridge for points, golfing, boating, and going on cru ises. recent medical reports covering your condition. This included, a copy of Dr. Goodman’s medical records and the results of the
[4] Western-Southern hired International Claims Specialist, a third party medical examination completed at our request by Dr. Clary on administrator, to select an independent medical examiner for McDonald. May 2, 199 7. Based upon Dr. Goodm an’s medical records and International Claims Specialist selected Dr. Clary without any input from the findings of Dr. Clary, it appears that you are not disabled W estern-Southern. from performing any occupation. It is our decision that you d id No. 02-3053 McDonald v. Western-Southern 7 8 McDonald v. Western-Southern No. 02-3053 Life Ins. Co., et al. Life Ins. Co., et al. Thereafter, Western-Southern offered McDonald a position, chief legal counsel and a member of the Appeals Committee), but he refused it.
[6] Dean Vonderheide (who was Western-Southern’s director of benefits), and Megan Ratchford (who was Western- On June 4, 1997, McDonald, through counsel, filed an Southern’s nurse coordinator). This telephone conversation was audio taped.
[8] At the end of this telephone conversation, administrative appeal of Western-Southern’s decision to terminate his LTD benefits. As part of his appeal, McDonald Wuebbling asked Dr. Clary to submit a second letter presented new evidence which included affidavits from Dr. discussing the issues raised during their telephone Goodman, Dr. Hamdorf, and Mr. Eichenbaum, McDonald’s conversation. bridge coach. Therein, both Dr. Goodman and Dr. Hamdorf opined that McDonald is totally disabled from engaging in On December 17, 1997, Dr. Clary submitted an addendum any work for profit. In his affidavit, Mr. Eichenbaum testified to his initial report. In this addendum, Dr. Clary found that, that McDonald is a poor bridge player and that, based upon contrary to Dr. Goodman’s and Dr. Hamdorf’s opinions and his observations of McDonald’s bridge playing skills, he despite McDonald’s poor bridge playing skills, McDonald believes that McDonald is totally disabled from working.
[7] was capable of returning to work. Specifically, Dr. Clary found: Upon receipt and review of the evidence which McDonald submitted as part of his administrative appeal, Western- In my opinion, Mr. McDonald is not suffering from any Southern telephonically contacted Dr. Clary in order to psychiatric or psychological impairment that is severe discuss the issues raised by McDonald’s new evidence and in enough to prevent him from returning to work but he, in order to have Dr. Clary clarify his previous findings and fact, does not want to return to work. conclusions. Participating in this telephone call with Dr. On January 2, 1998, Western-Southern informed McDonald Clary were Don Wuebbling (who was Western-Southern’s that his administrative appeal was denied. On April 17, 1998, McDonald filed a Complaint (which he later amended) in federal district court against Western- not qualify at this time for long-term disability benefits because Southern, alleging that it had wrongfully terminated his LTD it appears you could eng age in an occupation for w ages. benefits in violation of his rights under ERISA. Specifically, (emphasis in original). McDonald alleged three causes of action against Western- Southern: (1) a claim to recover benefits under ERISA, 29
[6] McD onald disputes Western-Southern’s assertion that it made him U.S.C. § 1132(a)(1)(B); (2) a claim for breach of fiduciary an offer of employment after it terminated his LTD benefits; rather, duty under ERISA, 29 U.S.C. § 1109 and § 1132(a)(3); and McDonald claims that W estern-S outhern simp ly made a gratuitous offer (3) a claim for intentional denial of benefits under ERISA, 29 to interview him knowing that there were no positio ns available to which
[9] fiduciary duty claim was barred because it was redundant to On February 20, 2002, the district court denied McDonald’s motion his claim for denial of benefits, and the district court found for attorney’s fees and nontaxable costs but granted his motion to amend that McDonald’s claim for intentional denial of benefits failed the judgment to include an award for prejudgm ent interest. Mc Do nald does not challenge this order by the district court on appeal, nor has he because McDonald presented no evidence that Dr. Clary was appealed the district court’s ruling against him with regard to his claim for biased or predisposed to concluding that he was able to work breach o f fiduciary duty or his claim for intentional denial of benefits.
[11] Apparently, W estern-Southern took no action with re gard to peo ple a whole lot, but – but do a lot of things. And we were a little McDonald’s LT D b enefits after it received Dr. Murp hy’s and Dr. uncertain in that towards the end of your letter (unintelligible) indicates Altman’s repo rts. that – or he indicates some hesitancy about his being able to work, or at least that’s the wa y we’re re ading it and maybe that’s not the way you
[12] During W estern-S outhern’s telephone conference with Dr. Clary, intended it – to read. But towards the end (unintelligible) saying that he Wuebbling said: “And we went through your evaluation of his condition might be able to return to work in a very low-stress environment on a (unintelligible) make a decision about the status of disability benefits, and limited trial basis, which suggests that maybe he could n’t return to work it kind o f looks, going through the – the evaluation, is though he was or couldn’t work and that (unintelligible) seems sort of (unintelligible) doing an awful lot of things that are consisten t with som eone who could what you were saying in the earlier part of the letter, and we were
[13] Another reason why his supplemental report should be discounted is because Dr. Clary concluded that McDo nald’s challenge to W estern- Southern’s termination of his LTD benefits was indicative o f his ability to return to work: “In my medical opinion, the vigorous pursuit of disab ility claim would argue against disability for severe depression .” This “medical” conclusion, of course, is absurd and would render meaningless the statutory right to file suit in district court in o rder to challenge denials of ERISA benefits and denials of disability insurance benefits and supplemental security income under the Social Security Act.
