Opinion
Case No. 2:13-cv-00017
04-03-2014
ROGER A. HUNT, Plaintiff, v. HARTFORD LIFE AND ACCIDENT INSURANCE CO., Defendant.
JUDGE GREGORY L. FROST
Magistrate Judge Norah McCann King
OPINION & ORDER
This matter is before the Court for consideration of the parties' cross-motions for judgment on the administrative record. The Court now considers: (1) Defendant's motion for judgment on the administrative record (ECF No. 17), Plaintiff's memorandum in opposition (ECF No. 20), and Defendant's reply (ECF No. 23); and (2) Plaintiff's motion for judgment on the administrative record (ECF No. 18), and Defendant's memorandum in opposition (ECF No. 19). For the reasons that follow, the Court GRANTS Defendant's motion and DENIES Plaintiff's motion.
Plaintiff did not file a reply in support of his motion.
I. BACKGROUND
Plaintiff brings his Complaint under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq., commonly referred to as "ERISA." Plaintiff alleges that Defendant, who administers a Group Benefit Plan under which Plaintiff was covered, wrongly denied his claim for long-term disability benefits. A brief summary of the facts underlying this case is set forth below.
From roughly 2006 through 2009, Plaintiff worked as a welder for Liebert Corporation ("Liebert"). As an employee of Liebert, Plaintiff was covered under a Group Benefit Plan, which Defendant insured. (ECF No. 15-9, the "Plan.") The Plan provides that participants such as Plaintiff will be paid a monthly benefit if he or she becomes disabled while insured thereunder. (Id. at 11.)
In 2009, Plaintiff sought disability benefits for back pain and lumbar strain pursuant to the Plan. Plaintiff's physicians diagnosed him with degenerative disc disease, lumbar disc protrusions, and lumbar stenosis with neurogenic claudication, among other things. Plaintiff ceased working at Liebert in September 2009 and did not return.
Defendant approved and paid short-term disability payments to Plaintiff. Subsequently, in March 2010, Plaintiff applied for long-term disability benefits pursuant to the Plan. Defendant found that Plaintiff was disabled from performing his occupation as a welder, which requires the ability to "turn repetitively and lift up to 50 pounds." (ECF No. 15-8, at 67). Defendant approved Plaintiff's claim for long-term disability benefits in a letter dated April 1, 2010.
Defendant's April 1, 2010 letter informed Plaintiff that benefit payments would continue as long as he met the policy definition of "Disabled." (ECF No. 15-3, at 85-86.) The letter also states: "We encourage you to return to work as soon as possible . . . If you need assistance in dealing with medical issues or preparing for work, please call our office. Our Clinical Case Management staff can help with job placement, workplace modifications and other services." (Id.)
Long-term disability benefit determinations under the Plan are made in two phases, consistent with the Plan's definition of "disabled." Specifically, the Plan defines "Disability" or "Disabled" as follows, in relevant part:
• For the 24 months following the [initial period of short-term payments], you are prevented from performing one or more of the Essential Duties of Your Occupation . . . ;(ECF No. 15-9, at 21-22 (emphasis added).) The Plan also states that benefit payments will be terminated once the participant is no longer "disabled" as defined above.
• After that, you are prevented from performing one or more of the Essential Duties of Any Occupation[, which is defined as an occupation for which the participant is qualified by education, training or experience, and that has an earnings potential above a specified threshold.]
In October 2011, Defendant informed Plaintiff that his disability benefit payments would cease on March 31, 2012 unless he was disabled from "any occupation." (ECF No. 15-3, at 37-38.) Defendant indicated that it was in the process of reviewing Plaintiff's file to determine whether he was entitled to continuing benefits.
From reviewing Plaintiff's file, Defendant determined that Plaintiff could perform an occupation requiring sedentary to light strength. That determination was based, inter alia, on a physician's report stating that Plaintiff was capable of sitting for eight hours with no restrictions lifting up to twenty pounds. (ECF No. 15-7, at 69.) Another physician's report (dated January 12, 2012) states: "I do not feel it would be reasonable for him to return to a job that has significant lifting requirements however a sit down occupation would be reasonable as long as he had the capability of free rests or stretching and changing of his position." (ECF No. 15-5, at 136.)
Relying on that belief, on February 14, 2012, Defendant conducted an Employability Analysis to identify occupations that matched Plaintiff's functional capabilities, education, training and work history ("Analysis"). (ECF No. 15-7, at 6-8.) The Analysis identified ten occupations that were a match. (Id. at 8.) Of those ten occupations, nine are classified as requiring "light strength," and one (the position of "lock assembler") is classified as requiring "sedentary" strength. Defendant concluded that Plaintiff was not disabled from "any occupation" and was not entitled to long-term disability benefit payments after 24 months.
The classifications are available through the United States Department of Labor's website, available at https://www.oalj.dol.gov/LIBDOT.HTM. The "strength classification" can be determined by searching each occupation by number. Specifically, the classification for the position of "lock assembler" (706.684-074), can be found at https://www.oalj.dol.gov/PUBLIC/DOT/REFERENCES/DOT07A.HTM. The "S" under "strength" means "sedentary." See http://www.oalj.dol.gov/PUBLIC/DOT/REFERENCES/DOTAPPC.HTM.
Defendant expressed its conclusion to Plaintiff in a letter dated February 21, 2012. (ECF No. 15-3, at 18-22.) That letter states: "We have completed our review of your claim for benefits and have determined that you do not meet the policy definition of Disability beyond 4/1/12. Because of this, Long Term Disability (LTD) benefits are not payable beyond 3/31/12." (Id. at 18.) The letter goes on to quote the relevant provisions of the Plan, summarize Plaintiff's file and the materials reviewed, and explain Defendant's conclusion that Plaintiff was not disabled from "any occupation." The letter also notes that an employability analysis "showed that there are a number of occupations for which you are qualified that are within your physical capabilities." (Id. at 21.) The letter then lists three "sample" occupations from the Analysis, all of which require light strength. (Id.) Finally, the letter summarizes Plaintiff's appeal rights under the Plan.
On March 29, 2012, Plaintiff (through his attorney) wrote a letter to Defendant exercising his appeal rights. (ECF No. 15-6, at 124-25.) In that letter, Plaintiff's attorney stated that Plaintiff was "interested in" pursuing vocational services under the Plan. (Id. at 125.) The term "vocational services" refers to the following "rehabilitation" provision in the Plan:
What is Rehabilitation?(ECF No. 15-9, at 13.)
Rehabilitation is a process of working together to plan, adapt, and put into use options and services to meet Your return to work needs.
A Rehabilitation program may include, when we consider it to be appropriate, any necessary and feasible:
1. vocational testing;
2. vocational training;
3. alternative treatment plans such as:
a) support groups;4. work-place modification to the extent not otherwise provided;
b) physical therapy;
c) occupational therapy; and
d) speech therapy;
5. job placement; and
6. transitional work; and
7. similar services.
Plaintiff's March 29, 2012 letter asked Defendant to explain why it had not offered vocational assistance. Plaintiff also requested that Defendant produce a copy of its internal policy regarding same. Initially, Defendant did not produce the internal policy to Plaintiff on the ground that it was confidential and proprietary. Defendant produced the policy in this litigation under seal and pursuant to a Stipulated Confidentiality Agreement and Protective Order. (ECF No. 16.)
Defendant responded to Plaintiff's letter on April 5, 2012. (ECF No. 15-3, at 15.) At that time, Defendant informed Plaintiff that it could not evaluate his request for vocational assistance because an adverse decision had already been issued. (Id.) Defendant noted:
[W]e never found the claimant to be a viable candidate [for vocational assistance] for a variety of reasons, including:(Id. at 16.) Defendant also noted that "the case file contains an Attending Physician statement dated 7/15/2011 indicating he could not participate." (Id.) Indeed, Plaintiff's treating physician indicated on July 15, 2011 that Plaintiff was unable to participate in vocational rehabilitation services. (ECF No. 15-7, at 69.)
The claimant was released to work several times; we would anticipate a return to work, which never came to fruition. Then we would need to do what we could, to determine why he was not a candidate to return to work and why he should remain on disability.
As the parties debated the vocational services issue, the administrative appeal process continued. Plaintiff underwent a Functional Capacity Evaluation, the results of which list his "physical demand level" as "sedentary." (ECF No. 15-6, at 53.) Defendant referred Plaintiff's file to three physician reviewers, all of whom concluded that Plaintiff was capable of performing a sedentary occupation. (ECF No. 15-5, at 99-121.)
In a letter dated October 4, 2012, Defendant informed Plaintiff that his appeal had been referred to an appeal unit, which reviewed Plaintiff's file independently from the individual who made the original decision to terminate benefits and without deference to that decision. (ECF No. 15-3, at 1.) The appeal unit determined that Plaintiff was capable of working at the sedentary level. As such, and because "[a]n employability analysis identified an occupation that was prevalent in the national economy and exceeded Mr. Hunt's wage replacement requirement," Defendant affirmed its decision that Plaintiff did not meet the Plan's definition of "Disabled" beyond April 1, 2012. (Id. at 5.)
As stated above, the Analysis identified the position of "lock assembler," which requires only sedentary strength, as a match.
Plaintiff does not dispute that he can perform a sedentary occupation. Nor does Plaintiff explain why he is unable to perform the position of "lock assembler." Instead, Plaintiff argues that he cannot perform the three sample occupations Defendant listed in its February 21, 2012 letter (all of which require "light strength"), such that Defendant's decision that he is not disabled from any occupation is arbitrary and capricious. Plaintiff also claims that Defendant's refusal to consider his March 29, 2012 request for rehabilitation assistance was unreasonable. And finally, Plaintiff argues that Defendant should be required to produce a copy of its internal rehabilitation policy unencumbered by the requirements of the Stipulated Confidentiality Agreement and Protective Order.
II. ANALYSIS
The parties agree that the "arbitrary and capricious" standard governs the Court's analysis. That is, because the Plan gives Defendant discretionary authority to determine eligibility for benefits, "the highly deferential arbitrary and capricious standard of review is appropriate." Judge v. Metro. Life. Ins. Co., 710 F.3d 651, 657 (6th Cir. 2013) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989) and Borda v. Hardy, Lewis, Pollard & Page, P.C., 138 F.3d 1062, 1066 (6th Cir. 1998)).
The Plan states that Defendant has "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy." (ECF No. 15-9, at 21.)
This standard "does not require [the Court] merely to rubber stamp the administrator's decision." Jones v. Metro. Life Ins. Co., 385 F.3d 654, 661 (6th Cir.2004) (citing McDonald v. Western-Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003)). Rather, under the arbitrary and capricious standard, a plan administrator's decision will be upheld so long as "it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome." Davis v. Ky. Fin. Cos. Ret. Plan, 887 F.2d 689, 693 (6th Cir. 1989) (noting that "the arbitrary and capricious standard is the least demanding form of judicial review"). A court must therefore "review the quantity and quality of the medical evidence and the opinions on both sides of the issues." Jones, 385 F.3d at 661. In other words, the Court will uphold a benefit determination if it is "rational in light of the plan's provisions." Yeager v. Reliance Standard Life Ins. Co., 88 F.3d 376, 381 (6th Cir. 1996).
The Court acknowledges that Defendant, as both the payor of any benefits and the decision-maker with respect to benefits, faces an inherent conflict of interest. See Judge, 710 F.3d at 663-64 (quoting Schwalm v. Guardian Life Ins. Co. of Am., 626 F.3d 299, 311 (6th Cir. 2010)). Such a conflict, however, should not be given "significant weight" when, as here, the claimant "has pointed to nothing more than the general observation that [the administrator] had a financial incentive to deny the claim." Id. at 644.
With those standards in mind, the Court turns to the merits of Plaintiff's claims for relief.
1. Count One - For Benefits
Plaintiff brings his first claim for relief under 29 U.S.C. §1132(a)(1)(B), which allows a participant or beneficiary of a qualifying plan "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." Plaintiff alleges that he is entitled to long-term disability benefits under the Plan and that Defendant wrongly deprived him of the same. The question, therefore, is whether Defendant's decision to deny Plaintiff long-term disability benefits after 24 months was arbitrary and capricious.
Having reviewed the parties' briefs and the administrative record, the Court finds that Defendant's decision was neither arbitrary nor capricious. Pursuant to the plain language of the Plan, Plaintiff was only entitled to disability benefits after 24 months if he was incapable of performing "any occupation." There is no dispute that Plaintiff was, as of March 31, 2012, capable of performing at least sedentary work. Defendant elected to conduct an Employment Analysis, which revealed a sedentary occupation that matched Plaintiff's skills, education, and salary requirements. Given these facts, as well as the detailed explanation Defendant provided in its February 24, 2012 and October 4, 2012 letters documenting its initial and appellate review, the Court cannot conclude that Defendant acted arbitrarily or capriciously when it determined that Plaintiff was not disabled from "any occupation."
Plaintiff does not dispute that he was capable of performing sedentary work. Nor does Plaintiff argue that there exist no sedentary jobs matching his education, skills, training, and salary threshold. Plaintiff therefore does not argue that he is incapable of performing "any occupation" or that Defendant's determination on this point was incorrect. Stated differently, Plaintiff does not make any meaningful argument as to why he is entitled to long-term disability benefits after 24 months under the Plan.
Instead, Plaintiff mischaracterizes the issue and attempts to make a technical argument as to why the Court should overturn Defendant's decision. First, Plaintiff argues that "[Defendant] terminated [Plaintiff's] disability benefits because it said he could work as an Inspector and Tester, or a Solderer, or an Assembler." (ECF No. 18, at 7.) Because Plaintiff cannot perform those light-strength jobs, he concludes that Defendant's decision to terminate his benefits was incorrect. Plaintiff then concludes that Defendant acted arbitrarily and capriciously by later affirming its incorrect decision.
That argument fails. Defendant terminated Plaintiff's disability benefits because it determined that Plaintiff was not disabled from performing "any occupation," not because it believed Plaintiff could perform three jobs in particular. See ECF No. 15-3, at 18-22. Defendant later affirmed its decision that Plaintiff was not disabled from performing "any occupation." Because that finding was rational and supported by the evidence, it was neither arbitrary nor capricious. Plaintiff's reliance on the three jobs cited in Defendant's February 21, 2012 letter is simply a red herring.
Plaintiff next argues that Defendant was required to disclose the occupation of "lock assembler" in its February 12, 2012 letter and allow Plaintiff to present rebuttal evidence proving he cannot perform that occupation. In support, Plaintiff notes that 29 C.F.R. §2560.503-1(g)(1) requires a plan administrator to explain with specificity why a claim was denied. Plaintiff argues that, since he did not have a chance to explain why he was unqualified to perform the occupation of lock assembler, he did not receive the required "full and fair review" of his claim on appeal.
That argument also fails. Plaintiff cites no authority in support of his contention that Defendant was required to identify matching occupations and disclose those occupations to Plaintiff in order to satisfy ERISA. In fact, the Sixth Circuit recently held the opposite: "[A] plan administrator is not required to obtain vocational evidence where the medical evidence contained in the record provides substantial support for a finding that the claimant is not totally and permanently disabled." Judge v. Metro. Life Insur. Co., 710 F.3d 651 (6th Cir. 2013). See also Douglas v. Gen. Dynamics Long Term Disability Plan, 43 F. App'x 864, 870 (6th Cir. 2002) (holding that a plan administrator is not required to consult with a vocational expert to determine whether a plaintiff is disabled from performing any job and noting that a participant is free to consult with a vocational expert if he or she wishes to do so). Absent an obligation to obtain and disclose vocational evidence, Plaintiff cannot show that Defendant was required to disclose the position of "lock assembler" and/or consider rebuttal evidence in order to meet its statutory obligations.
Moreover, Plaintiff was free to consult its own vocational expert to identify matching occupations and then present evidence that he could not perform those occupations. Cf. Douglas, 43 F. App'x at 870. Plaintiff elected not to do so, instead choosing to rebut the three sample occupations listed in Defendant's February 12, 2012 letter.
One additional point is worth noting. Plaintiff does not argue that Defendant's conclusion in February 2012 that Plaintiff could perform at a "sedentary to light" strength level was arbitrary or capricious. Indeed, Plaintiff's medical records at that time supported that conclusion. See, e.g., ECF No. 15-7, at 69 (stating that Plaintiff could sit for eight hours and lift up to twenty pounds). Plaintiff argues only that subsequent tests revealed that he is limited to a sedentary occupation. See ECF No. 18, at 9. Defendant correctly reevaluated Plaintiff's file in light of that new information. See ECF No. 15-3, at 5; cf. Boone v. Liberty Life Assur. Co. of Boston, 161 F. App'x 469, 474 (6th Cir. 2005) (a plan administrator can consider new evidence on appeal and amend its reasoning for denying benefits as long as there is no "arbitrary inconsistency" between the initial and appellate decision). To now argue that Defendant acted arbitrarily by citing three sample occupations in its February 21, 2012 letter, based on evidence created after that letter, defies logic and would lead to an absurd result in this case.
In short, Defendant's decision to deny Plaintiff long-term disability benefits after 24 months was neither arbitrary nor capricious. The Court therefore GRANTS Defendant's motion for judgment on the administrative record (ECF No. 17) on Count One and DENIES Plaintiff's motion for judgment on the administrative record (ECF No. 18) on Count One.
2. Count Two - For Vocational Assistance
In Count Two of his Complaint, Plaintiff alleges that he was entitled to, and was unreasonably denied, rehabilitation assistance under the Plan. Plaintiff purports to bring this claim under § 1132(a)(1)(B) and, alternatively, § 1132(a)(3). In his brief, however, Plaintiff acknowledges that the Court cannot conclude that he is entitled to rehabilitation pursuant to § 1132(a)(1)(B). Instead, he asks the Court to remand his claim "to permit [the parties] to address the issue in the first instance." (ECF No. 18, at 11.) Plaintiff also abandons his alternative claim under § 1132(a)(3). (ECF No. 20, at 8 n.3.)
The Court begins its analysis by noting that the Plan, on its face, does not entitle Plaintiff or any other participant to rehabilitation assistance. Stated differently, rehabilitation is not a "benefit" to which any participant is due. The Plan is clear that "BENEFITS" include monthly payments to which a participant is entitled if he or she meets the definition of "Disabled." Once it is determined that a participant meets that definition, monthly payments "will be paid." (ECF No. 15-9, at 11.)
Rehabilitation, in contrast, is discussed in the Plan's "BENEFITS" section only as a potential ground for termination of monthly benefit payments. Pursuant to the Plan, Defendant can terminate monthly benefit payments if a disabled participant refuses to participate in a rehabilitation program. Rehabilitation is later defined as a program that "may include" certain services, "if [Defendant] consider[s] it to be appropriate." (Id. at 13). There are no criteria that a participant must meet in order to receive or be considered for a rehabilitation program. Tellingly, in arguing that, "[u]nder the terms of the Plan, [Defendant] expressly promises to provide rehabilitation assistance to claimants," (ECF No. 18, at 9), Plaintiff cites nothing but the definition of "Rehabilitation" quoted above.
Without demonstrating that rehabilitation is a Plan benefit to which participants are entitled in certain circumstances, Plaintiff cannot show that he is "due" rehabilitation services for purposes of his § 1132(a)(1)(B) claim. His claim therefore fails. See 29 U.S.C. § 1132(a)(1)(B); see also Lowborn v. Nortel Networks, Inc., No. 3:04 CV 481, 2006 WL 270285, at *2 (E.D. Tenn. Feb. 2, 2006) (finding that a claimant could not bring a § 1132(a)(1)(B) claim for rehabilitation assistance because, inter alia, "the administrator's rehabilitation service responsibilities are phrased in discretionary, rather than mandatory, terms"). Nevertheless, the Court will address each of Plaintiff's arguments.
Plaintiff makes what can be interpreted as three arguments in support of his position. First, Plaintiff challenges Defendant's decision not to offer him vocational services. Plaintiff argues that, "when a claimant seeks rehabilitation assistance, [Defendant] has a fiduciary duty, at a minimum, to consider whether vocational assistance might be in the claimant's interest." (ECF No. 20, at 6.) Plaintiff also argues that 29 C.F.R. § 2560.503-1(b)(5) mandates that plan provisions be applied consistently with respect to similarly-situated claimants, and that, since vocational assistance was offered to other claimants, they should have been offered to Plaintiff.
This argument fails for several reasons. Because ERISA preempts common law claims, Plaintiff cannot use the fiduciary relationship to create duties that are not set forth in the Plan. See, e.g., Gibson v. Prudential Ins. Co. of Am., 513 F. Supp. 2d 950, 958 (E.D. Tenn. 2007) (when a claimant pursues a § 1132(a)(1)(B) claim, he or she may not also recover for a claim administrator's alleged breach of fiduciary duty regarding discretionary rehabilitative assistance); cf. Cochran v. Prudential Ins. Co. of Am., No. 09-cv-11752, at *7 (E.D. Mich. Jan. 20, 2010) (noting that, although a plan administrator may be required to determine whether a claimant is disabled from "any occupation," he or she is under no duty "to actually find a claimant a job or guarantee a claimant's actual marketability"). Plaintiff similarly cannot rely on ERISA's breach of fiduciary duty provision. Lawhorn, 2006 WL 270285, at *2 ("To the extent that plaintiff seeks recovery under ERISA's breach of fiduciary duty provision, 29 U.S.C. § 1109, plaintiff is reminded that § 1109 'allows relief only for an entire plan and not for individual participants or beneficiaries.' " (citing Bagsby v. Cent. States, Se. & Sw. Areas Pension Fund, 162 F.3d 424, 430 (6th Cir. 1998)). And finally, even if Defendant had a fiduciary duty to "consider whether vocational assistance might be in the claimant's interest," the record reflects that Defendant did consider rehabilitation in this case but determined it was not appropriate. See, e.g., ECF No. 15-2, at 45, 57-58. Plaintiff's fiduciary argument therefore fails.
Plaintiff's argument regarding 29 C.F.R. § 2560.503-1(b)(5) similarly fails. That regulation sets forth "minimum requirements for employee benefit plan procedures pertaining to claims for benefits." 29 C.F.R. § 2560.503-1(a) (emphasis added). As stated above, however, rehabilitation is not a "benefit" that the Plan provides. Plaintiff's request for rehabilitation therefore was not a "claim for benefits" within the meaning of the regulation. In fact, the Plan is clear that "claims" for benefits must be made "within 30 days after Disability starts" or "as soon as possible" and pursuant to standard claim forms. (ECF No. 15-9, at 11, 18, 32.) Plaintiff's request for rehabilitation did not meet those criteria, perhaps suggesting that he understands his request was not a "claim" for "benefits." Because a request for rehabilitation is not a claim for benefits within the meaning of § 2560.503-1(b)(5), that section does not aid Plaintiff's argument.
Moreover, even if § 2560.503-1(b)(5) did apply, it would not alter the Court's conclusion. The regulation states that, "where appropriate," "plan provisions" must be applied consistently with respect to similarly-situated claimants. 29 C.F.R. § 2560.503-1(b)(5). That regulation would require Defendant to apply the Plan's definition of "Rehabilitation" consistently; it does impose any obligation on Defendant with regard to the circumstances under which it must offer or provide rehabilitation assistance. Tellingly, Plaintiff omits reference to the term "where appropriate" in his discussion of § 2560.503-1(b)(5). The Court agrees with Defendant that it is not appropriate to mandate a consistent application of a plan provision that expressly gives the administrator discretion to determine if, when, and the extent to which rehabilitation assistance is appropriate in a particular case. Plaintiff's argument that Defendant was obligated to offer rehabilitation assistance to Plaintiff therefore fails.
Plaintiff's second argument in support of his position relates to Defendant's internal policy documents. Plaintiff posits that Plan administrators exercise their discretion regarding rehabilitation assistance in accordance with Defendant's internal rehabilitation policies, such that a claimant is entitled to rehabilitation assistance whenever Defendant's internal policies so dictate. Plaintiff concludes that, because Defendant failed to provide him with its internal rehabilitation policies during the administrative review process, Plaintiff was denied a "full and fair review" of his request.
This argument fails as well. A plan beneficiary is entitled to a "full and fair review" of the decision to deny his or her "claim for benefits," also known as an "adverse benefit determination." 29 U.S.C. § 1133; 29 C.F.R. § 2560.503-1(h). Because Plaintiff's request for rehabilitation was not a claim for benefits, and because Defendant's decision not to offer or request the same was not an adverse benefit determination, Plaintiff cannot demonstrate that he was entitled to a "full and fair review" of his request for rehabilitation.
Even if Plaintiff was entitled to a "full and fair review" of his request, Plaintiff's argument fails for the alternative reason that, although internal policies may establish guidelines with respect to the determination whether a claimant is put on a rehabilitation plan, they do not necessarily dictate that determination. Here, for example, Defendant's internal policies identify certain circumstances in which a claim administrator should refer a file to a rehabilitation case manager. (ECF No. 16, at 6.) But Defendant relied on reasons unrelated to those criteria in determining that rehabilitation was not appropriate in this case. (ECF No. 15-3, at 15.) Most notably, Defendant relied on the fact that Plaintiff's treating physician indicated on July 15, 2011 that Plaintiff was unable to participate in vocational rehabilitation services. See id.; ECF No. 157, at 69. Defendant also relied on the fact that Plaintiff did not express an interest in rehabilitation services until after the February 12, 2012 adverse benefit determination had been issued, despite being notified in April 2010 that such services may be available. (ECF No. 15-3, at 15, 85.) Because neither of these reasons is covered in Defendant's internal policy, Defendant's failure to produce its policy during the appeal process did not deprive Plaintiff of a full and fair review of his claim.
For his third argument, Plaintiff asserts that Defendant's decision to deny his request for rehabilitation was contrary to the administrative record and Defendant's internal policy such that it necessarily was arbitrary and capricious. Plaintiff adds that Defendant's decision not to evaluate his request again on appeal was equally arbitrary and capricious.
Like Plaintiff's earlier arguments, this argument fails. Under the arbitrary and capricious standard of review, Defendant need only demonstrate a reasoned explanation, based on the evidence, for its decision to deny Plaintiff's request. Given that rehabilitation assistance was not mandatory under the Plan, that one of Plaintiff's treating physicians stated he was not eligible for vocational assistance (a fact which Defendant's claims administrator noted in Plaintiff's file), and that Plaintiff did not express an interest in such assistance for nearly two years after being approved for long-term benefits, a reasoned explanation for Defendant's decision clearly exists. Based on these facts, the Court cannot conclude that Defendant's decision not to provide rehabilitation assistance was arbitrary or capricious.
For all of these reasons, the Court finds that Plaintiff is not entitled to rehabilitation under the Plan. Plaintiff similarly is not entitled to a remand and/or additional review of his request. The Court therefore GRANTS Defendant's motion for judgment on the administrative record (ECF No. 17) on Count Two and DENIES Plaintiff's motion for judgment on the administrative record (ECF No. 18) on Count Two.
3. Count Three - For Injunctive and Other Appropriate Equitable Relief
In Count Three of his Complaint, Plaintiff asks the Court for "an order compelling [Defendant] to produce to Plaintiff a copy of its internal rehabilitation policy, unencumbered by the requirements that accompany the protective order." (ECF No. 18, at 15.) Plaintiff's argument relies on 29 U.S.C. § 1024(b)(4), which provides: "The administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary, plan description, and the latest annual report, any terminal report, the bargaining agreement, trust agreement, contract, or other instruments under which the plan is established or operated."
The Court finds that Defendant's internal rehabilitation policies are not "instruments under which the plan is established or operated" pursuant to § 1024(b)(4). Because the Plan does not obligate Defendant to provide rehabilitation assistance in any circumstance, its rehabilitation policies are, at most, internal interpretive tools that do not formally govern the operation of the Plan. See Gabrenya v. Managed Disability Plan, No. 2:12-cv-1217, 2013 WL 6154573, at *3-4 (S.D. Ohio Nov. 20, 2013) (holding that a plan administrator's internal list regarding a list of presumptive disabilities was outside the scope of § 1024(b)(4)); accord Mondry v. Am. Fam. Mut. Ins. Co., 557 F.3d 781, 799-80 (7th Cir. 2009) (stating that "a number of courts have concluded that internal guidelines or memoranda that a claims administrator uses in deciding whether or not a claim for benefits falls within the coverage of a plan do not constitute 'other instruments under which the plan is established or operated' " and collecting cases).Furthermore, because rehabilitation is not a right to which any Plan participant is entitled, the Sixth Circuit's statement that "courts should favor disclosure where it would help participants understand their rights," Bartling v. Fruebauf Corp., 29 F.3d 1062, 1070 (6th Cir. 1994), is not applicable to the facts of this case.
The Mondry court reached a "narrow holding" that, "when a claims administrator expressly cites an internal document and treats that document as the equivalent of plan language in ruling on a participant's entitlement to benefits, the administrator renders that document one that in effect governs the operation of the plan for purposes of section 1024(b)(4)." 7 F.3d at 801. That holding is not applicable in this case, where there is no evidence that Defendant relied on its internal rehabilitation policy to reject Plaintiff's request for rehabilitation assistance.
--------
Plaintiff's remaining arguments in support of Count III rely on 29 C.F.R. § 2560.503-1(h)(2)(iii), which requires a claims administrator to provide a claimant with "reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits." Because Plaintiff's request for rehabilitation was not a claim for benefits, however, Plaintiff's arguments fail for the same reasons as those set forth above. Moreover, even if 29 C.F.R. § 2560.503-1 did govern the facts of this case, the Court agrees with Defendant that, because it rejected Plaintiff's rehabilitation request for reasons other than those covered by its internal policy, Defendant's internal rehabilitation policies are not "relevant" as defined in 29 C.F.R. § 2560.503-1(m)(8).
Plaintiff's request for a copy of Defendant's internal rehabilitation policies unencumbered by Stipulated Confidentiality Agreement and Protective Order is without merit. Accordingly, the Court GRANTS Defendant's motion for judgment on the administrative record (ECF No. 17) on Count Three and DENIES Plaintiff's motion for judgment on the administrative record (ECF No. 18) on Count Three.
III. CONCLUSION
For the foregoing reasons, the Court hereby GRANTS Defendant's motion for judgment on the administrative record (ECF No. 17) in its entirety and DENIES Plaintiff's motion for judgment on the administrative record (ECF No. 18) in its entirety. The Clerk is DIRECTED to enter judgment accordingly and terminate this case from the docket records of the United States District Court for the Southern District of Ohio, Eastern Division.
IT IS SO ORDERED.
__________
GREGORY L. FROST
UNITED STATES DISTRICT JUDGE