Opinion
Case No. 3:05 CV 7039.
September 6, 2006
MEMORANDUM OPINION
I. Introduction
This case is before the Court on cross-motions for summary judgement regarding a dispute over a claim for long-term disability ("LTD") benefits by Plaintiff Mikolajczyk from Defendant Broadspire, an ERISA Plan Administrator. Defendant terminated Plaintiff's LTD benefits. Plaintiff administratively appealed as provided in the Plan, and Defendant affirmed the denial. Both Plaintiff and Defendant seek relief in the form of summary judgment in this Court, pursuant to Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609 (6th Cir. 1998). This Court has jurisdiction pursuant to 28 U.S.C. § 1331. For the reasons discussed below, Plaintiff's motion is granted and Defendant's motion is denied.
II. The ERISA Plan
The Lumbermens Mutual Casualty Company issued a group policy for disability insurance to ABN AMRO North America, Inc. ("ABN AMRO"), the ABN AMRO long-term disability plan, beginning August 1, 2000 and continuing from year to year thereafter. Administrative Record of Mikolajczyk Claim 001 (hereinafter "MIKO"). The Plan Administrator is Broadspire ("Defendant"). Ms. Mikolajczyk was an employee of ABN AMRO and was thus a participant in the plan. The purpose of the policy is to "provide disability management, rehabilitation services, and protection against loss of income if [a participant] becomes Disabled as a result of a significant change in physical or mental condition that begins on or after [the participant's] coverage effective date under the Plan." MIKO 009.
The Court will refer to pages in the administrative record as MIKO because the parties have identified each page of the administrative record with a MIKO number. In the docket, the administrative record is located at Document Numbers 28-2 to 28-12, Exhibits A-K, with each page's MIKO number in the lower right corner.
The Plan Document, under the heading "Allocation of Authority," states: We reserve full discretion and authority to manage the Group Policy, administer claims, and interpret all policy terms and conditions[.] This includes, but is not limited to, the right to:
1. Resolve all matters when a review has been requested;
2. Establish and enforce rules and procedures for the administration of the Group Policy and any claim under it;
3. Determine your eligibility coverage;
4. Determine whether proof of your loss is satisfactory for receipt of benefit payments according to the terms and conditions of the Plan.
MIKO 024.
In an amendment to the agreement dated June 10, 2002, the Plan also incorporated the following provisions:
[The administrator] shall have discretionary authority to interpret the terms of the Policy and to otherwise determine a claimant's eligibility for benefits throughout the entire claim process, including, during the claim's initial submission and throughout any and all levels of appeal in accordance with the aforementioned Policy. Client shall reserve unto itself discretionary authority to overturn any denial following exhaustion of the administrative appeal process. Amendment to the Plan, Doc. No. 28-13, Ex. L. at LMB04 (hereinafter referred to as "LMB").
Under the Plan, "Disabled" means the administrator's determination that a significant change in [the claimant's] physical or mental condition due to:
1. Accidental injury;
2. Sickness;
3. Mental Illness;
4. Substance Abuse; or
5. Pregnancy, [which] began on or after [the claimant's] Coverage Effective Date and prevents [the claimant] from performing, During the Benefit Qualification Period and the following 24 months, the Essential Functions of [the claimant's] Regular Occupation or a Reasonable Employment Option offered . . . by the Employer, and as a result [claimant] is unable to earn more than 60% of [claimant's] Pre-disability Weekly Income. . . .
After that [24 month time period, claimant] must be so prevented from performing the Essential Functions of any Gainful Occupation that [claimant's] training, education and experience would allow [claimant] to perform.
MIKO 012.
The Plan defines "Essential Functions" as "functions which are normally required for the performance of an occupation, and which cannot be reasonably omitted or modified." MIKO 026. Further, the Plan specifies that "[t]he weekly benefit payable under This Plan will be reduced by the weekly amount of any Other Income Benefits provided to you for loss of income as a result of the same period of Disability." MIKO 010. "Other Income Benefits" include Social Security Disability benefits, MIKO 027, for which claimants are required to apply, MIKO 028.
III. The Administrative Record
A. Defendant Initially Awards Plaintiff Benefits
Sandra Mikolajczyk ("Plaintiff") is a 51 year old female with a history of anxiety, depression, fatigue, Xanax addiction, chronic C6 radiculopathy, carpel tunnel syndrome, cholloid brain cyst — craniotomy, hydrocephalus, left hemiparesis secondary to craniotomy, multi-valve prolapse, cervical disc surgery, anterior cervical neural decompression, arthrodesis, cervical plating and bone graft, and seizure disorder. MIKO 288. While working for ABN AMRO as a Branch Manager, she was admitted to The Toledo Hospital on August 31, 2001, with a cholate brain cyst and hydrocephalus. MIKO 189.
On September 4, 2001, Dr. Joseph S. Yazdi performed a "bifrontal craniotomy transcortial resection of cholloid cyst, (and) placement of a ventriculostmy." MIKO 150.
On September 11, 2001, Plaintiff was transported for rehabilitation to Flower Hospital with a diagnosis of "left hemiparesis, left hemi-sensory deficits, secondary to cholatebrain cyst with hydrocephalus and craniotomy." MIKO 190. She was discharged from Flower Hospital on September 25, 2001 and readmitted to The Toledo Hospital with "severe hydrocephalus, cause of protein buildup in vein at back of ventricle." MIKO 081. In a second surgery the following day, Dr. Yazdi installed an internal shunt in Plaintiff's head. Id. She was discharged to rehabilitation on September 28, 2001 and discharged from rehabilitation to her home on October 24, 2001. Id.
On November 1, 2001, Peggy Kleinert ("Kleinert"), a Broadspire f/k/a Kemper ("Defendant") employee, spoke to Dr. Yazdi and noted that Plaintiff had severe weakness on her left side, difficulty raising her right arm and no coordination with her left arm. Plaintiff was depressed, disoriented, and losing muscle in her left shoulder. MIKO 104. On November 24, 2001, in a "letter of medical necessity," Dr. Yazdi stated:
Ms. Sandra Mikolajczyk has been under my care since late August when she underwent surgery for her brain tumor. She subsequently had to undergo another surgery for the hydrocephalus. As a result of the first surgery, she was left with the left side of her body being paralyzed. She has since then recovered to some degree where she has some weakness and also some paralysis on the left side. She ambulates with a walker, however, requires assist for it. Otherwise, she is wheelchair-bound.
MIKO149. Dr. Yazdi prescribed physical therapy and occupational therapy including electrical stimulation of Plaintiff's muscles. Id.
On November 29, 2001, Kleinert spoke with Dr. Thomas who reported that Plaintiff's condition was getting worse, she was depressed, had no concept of time, poor recent memory, tremors on her left side, atrophy of her left shoulder and was unable to handle any type of stress or interaction with people. On December 14, 2001, Kleinert spoke with Plaintiff's physical therapist and noted that Plaintiff had decreased range of motion in her left shoulder, fingers, thumb, left hip and left knee, along with left ankle dorsiflexion of zero left heel cord tightness with ankle clonus and a circumductive gait. She also noted "increased spasticity while standing" and that Plaintiff was having emotional problems and depression — "afraid of losing her husband of five years if she does not get better fast enough." MIKO 085.
In a note dated December 20, 2001, Kleinert wrote that long-term disability (LTD) was expected and that Plaintiff had "left hemiplegia." MIKO 094.
On January 8, 2002, Kleinert e-mailed Maria Gomez, the Disability Specialist at ABN AMRO (Plaintiff's employer) requesting a "physical and psychological job description of Plaintiff's position (Branch Manager)." She asked whether the job was a sedentary position and how much physical activity, including lifting, was involved. MIKO 071. Gomez's response read:
As far as the physical aspects of the job, our managers are being asked to spend much more time out of the office, calling on existing and potential customers. . . . [E]ventually, the majority of the time will be spent outside the office. Thus, much more time on the road making presentations. Most presentations would include materials which shouldn't exceed 25-50 lbs. When in the office, most of the time would be spent working at her desk, on the telephone or at the computer.
MIKO 070.
On January 11, 2002, Dr. Yazdi noted that Plaintiff was about three months after resection of a colloid cyst and placement of a shunt, and that motor and sensation on the right side was intact. However, on the left side, "the deltoids are about 1/5 but biceps and triceps are about 4/5," and there was some degree of foot-drop on Plaintiff's left side. MIKO 142.
On January 30, 2002, Plaintiff submitted to Defendant an Application for Long-Term Disability Benefits. MIKO 061-62. Plaintiff's application was supported by an Attending Physician's Statement ("APS") signed by Joseph Hacker, M.D. Under "Objective Findings" and "Physical Impairments," Dr. Hacker stated "total left side hemiparesis." Under "Prognosis" he stated "poor." He described her level of impairment as Class V, "severe limitation of functional capacity/incapable of sedentary work." MIKO 063-64. Dr. Hacker classified Plaintiff's mental/nervous impairment as Class IV, "marked limitation/unable to engage in stress of interpersonal relationships." MIKO 064.
Several of Broadspire's medical review forms list five classes of physical impairment:
Class I No limitation of functional capacity/capable of heavy work.
Class II Slight limitation of function capacity/capable of medium manual work.
Class III Moderate limitation of functional capacity/capable of light work.
Class IV Marked limitation of functional capacity/capable of sedentary work.
Class V Severe limitation of functional capacity/incapable of sedentary work.
Dr. Joseph Yazdi also submitted an APS supporting Plaintiff's Application for LTD Benefits. He described Plaintiff's condition as "paralysis on left side — foot drop." He indicated that she was not a suitable candidate for vocational rehabilitation and initially classified both her level of physical impairment and her level of mental impairment as Class IV. MIKO 145-46. He incorporated a copy of his November 14, 2001 letter of medical necessity. MIKO 149.)
As a condition for continuing receipt of long-term disability benefits, Defendant required Plaintiff to apply for social security disability benefits, MIKO 065, and, under the plan, the amount of LTD benefits is reduced by the amount of SSDI benefits received. MIKO 067. Plaintiff received notice of an award of monthly disability benefits from the Social Security Administration beginning February 2002. MIKO 208-10.
On February 14, 2002, at the request of Defendant, Plaintiff's employer completed a Job Analysis Work Sheet for the position of Branch Manager. MIKO 199. On the Job Analysis Work Sheet, John M. Costas stated that the Branch Manager frequently had to lift and carry from 1-10 lbs. from the ground to her knees and waist and occasionally had to lift 11-25 lbs. in the same fashion. He stated that she had to frequently reach and occasionally pull and that the job involved sitting six hours per day, standing two hours per day, walking one hour per day, working under deadlines three hours per day, and supervising others three hours per day. MIKO 199.
On February 18, 2002, Jason E. Blasbalg ("Blasbalg"), Disability Claims Examiner, wrote to Drs. Hacker and Yazdi requesting updated medical information and asking each of them for a "projected return to work date" for Plaintiff. In response to that question, Dr. Yazdi responded "unknown at this time," MIKO 211, and Dr. Hacker responded "never," MIKO 224.
On February 28, 2002, Blasbalg requested a Peer Review from Dr. Gerald Goldberg, a neurologist. The information attached to the Request for Peer Review consisted of the APS forms from Drs. Yazdi and Hacker, MIKO 145-46, 063-64, medical letters from Drs. Yazdi and Hacker, physical therapy notes, and a job description for Branch Manager. MIKO 215.
Dr. Goldberg submitted his Peer Review Report on March 12, 2002. In response to the question "Does the attached medical documentation support that Mrs. Mikolajczyk remains disabled from her own occupation as a Bank Branch Manager?" he determined that the documentation "supports disability." MIKO 216. Describing Plaintiff's first surgery for cholloid cyst in the ventricular system on the right side of her brain and her second surgery to correct a subsequent hydrocephalus with the installation of a ventricular peritoneal shunt, Dr. Goldberg stated, "After the surgery, [Plaintiff] was left with a left hemiparesis which was fairly significant." MIKO 217. Indicating that the medical record "document(s) significant leftsided hemiparesis," Dr. Goldberg stated:
Yes, the claimant is totally disabled based upon the enclosed documentation. Although the claimant's job description indicates most of her work is sedentary and requires the ability to prepare plans, she is very limited in her ability to move and walk very far based on her left hemiparesis. Due to her ongoing problems with the hemiparesis, this neuralgic condition would prevent her from carrying out the essential duties of her job.
MIKO 217.
On March 14, 2002, Kemper approved Plaintiff for LTD benefits in the monthly amount of $2,103.36. The offset of SSDI benefits in the amount of $962.00 per month reduced the net monthly LTD benefit to $1,141.36. MIKO 220-21.
B. Defendant Denies Plaintiff Benefits After Periodic Review
On August 8, 2002, Kemper notified Plaintiff that it was commencing a periodic review. MIKO 226. Kemper requested that she complete a new Long-Term Disability Questionnaire and have her doctors submit updated medical information. Id. Plaintiff completed the questionnaire stating that she was "unable to walk unassisted" and that she had "no use of arm, partial paralysis of left side" and "short-term memory loss." She reported taking Xanax, Dilantin, Paxil, Zanaflex, Vaciofen, and Botox shots. When asked to put a check next to the Activities of Daily Living ("ADL's") that she could perform, she indicated that she could only cook in a microwave, read, watch TV, and dress without assistance in simple clothing. By not marking the following items, she indicated that she could not make beds, climb stairs, launder, dust/mop, sweep/vacuum, walk, garden, drive, or perform routine hygiene without assistance. MIKO 227. Plaintiff also stated that she needed assistance with other ADL's.
On October 14, 2002, Dr. Timothy Sigman completed an APS. He noted findings of spasticity, weakness on the left side, and imbalance. With respect to vocational rehabilitation, he stated "unable to tolerate full day." MIKO 242. Dr. Sigman classified Plaintiff's level of physical impairment as Class V, "severe limitation of functional capacity/incapable of sedentary work." MIKO 243. He also stated that Plaintiff could never lift or carry more than 10 lbs. and could never squat, crawl, climb, reach above shoulder level, crouch, kneel, balance, push/pull, or drive an auto. MIKO 244-45. He stated that she could not use her left hand for repetitive actions such as simple grasping, pushing and pulling, or fine manipulating. Likewise, she could not use her left foot for repetitive movements. In response to the question "Can patient work now?" Dr. Sigman responded "no." Id.
On March 28, 2003 Dr. Sigman completed an Estimated Physical Abilities worksheet ("EPA"), stating that he felt Plaintiff could sit for four hours per day, stand for one hour, and walk for one hour. He projected a return-to-work period of one year. MIKO 468-69.
On June 11, 2003 Dr. Yazdi again examined Plaintiff. He noted that she had driven an automobile. MIKO 294.
On June 19, 2003, Dr. Timothy Hacker physically examined Plaintiff. He completed both an APS, MIKO 284, and an EPA, MIKO285-286. Dr. Hacker stated that in an eight-hour work day, Plaintiff could not sit, stand, or walk for more than one hour. MIKO 285. With regard to specific abilities, he stated that she could not lift or carry up to 10 lbs., bend, stoop, squat, crawl, climb, reach above shoulder level, crouch, or kneel. He stated that she could not use her left hand for simple grasping, pushing and pulling, or fine manipulating, and could not use her left foot for repetitive movements. In response to the question "Can patient work now?" he responded "no." MIKO 285-86.
Dr. Yazdi also examined Plaintiff on September 5, 2003 and indicated that her physical condition had not changed and that she was able to ambulate only for a few steps without the aid of her cane. He stated that she continues to have difficulty with spasm on her left side, as well as tightness, swelling and cold sensation in her extremity. He concluded by saying "given the permanence of disability . . . and the fact that she really needs to maintain a strong muscle tone, because otherwise she would develop significant atrophy," he recommended workout equipment that would provide resistance training. MIKO 327.
On October 6, 2003, Kemper again wrote to Plaintiff requesting that she complete another Long-Term Disability Questionnaire and submit updated medical documentation from her providers. MIKO 307-08. On October 18, 2003, Plaintiff submitted the completed questionnaire, describing her disability as "partial paralysis of left side." MIKO 310. She stated that her left side was very weak and of limited use and that she suffered numbness and chronic fatigue. She stated that she struggled to walk and that, at times, she could not move. She added that she had little control over her kidneys and bowels. Id. In response to the question "Do you use any assistive devices?" she answered "yes" and listed a foot and leg brace, a cane, a splint brace on her right hand, and a shoulder brace. She also indicated that she was unable "to take care of all [her] personal needs" independently. Id.
On November 5, 2003, Dr. Yazdi completed an Attending Physicians Statement Update. MIKO 331-32. He repeated his diagnosis of hydrocephalus and stated "patient's left side paralyzed, patient ambulates with walker and cane." Dr. Yazdi stated that "patient is permanently disabled and unable to return to workforce." He again classified Plaintiff's physical impairment as Class V, "severe limitation of functional capacity/incapable of sedentary work," and added the note "patient will not return to workforce." He listed her status as unchanged and her prognosis "fair." Id.
On March 10, 2004, Kemper requested that Dr. Vaughn Cohan evaluate Plaintiff's functional impairment related to "any occupation." At this point, the 24 month period for disability from Plaintiff's own occupation had expired, and, under the terms of the plan, in order to qualify for continued benefits, she would have to be "prevented from performing the essential functions of any gainful occupation that her training, education, and experience would allow her to perform." MIKO 012.
Defendant selected the following documents for Dr. Cohan to review and consider: The Long-Term Disability Questionnaire from Plaintiff dated 10/18/03 (MIKO 310-13); office notes dated 09/05/03 (MIKO 340) and 06/11/03 (MIKO 344); NCS data dated 01/24/02 (MIKO 342-43), 05/22/03 (unidentifiable in record), 08/15/03 (unidentifiable in record), and 09/04/03 (unidentifiable in record); APS/EFCE dated 11/05/03 from Dr. Yazdi (MIKO 331-32); Employer Job Analysis Work Sheet (MIKO 341); and the DOT Job Description (MIKO 347-48). Dr. Cohan determined that those records "fail to support functional impairment(s) that preclude work through the entire time period." Id. Dr. Cohan also stated "we have no information regarding the claimant's initial therapy or surgery," and that "there are no physical exam findings reported." MIKO 349. Dr. Cohan concluded that "the documentation provided" did not demonstrate objective evidence of a functional impairment, which would preclude the claimant from performing "any occupation," although "the claimant should not be required to perform work that requires extensive standing and/or ambulating." MIKO 349. He further opined that Plaintiff was mentally functioning, had driven an automobile, and had physical restrictions that would be compatible with a sedentary job. MIKO 348-49.
There did exist, as previously mentioned, reports related to initial diagnosis and treatment as well as findings of physical examinations, but Dr. Cohan's statements correctly indicate that these documents were not a part of the file he was given to review.
On May 14, 2004 Defendant obtained an Employment Assessment Report regarding Plaintiff from Julie S. McKeown, M.S., Field Care Manager. Ms. McKeown noted that the targeted wage for Plaintiff's purposes was $25,240.20, or $12.13 hourly, to satisfy the 60% requirement of the Plan. Reviewing Dr. Cohan's peer review form, Ms. McKeown performed a transferable skills assessment (TSA) and determined that Plaintiff could return to her work as a Branch Manager. Ms. McKeown also identified other job openings within Plaintiff's geographical area that would satisfy the 60% salary requirement. These included customer service positions with Farmers Financial Services, The Art Institute, Management Recruiters, Respironics, City of Toledo, Smith Boughman, and Game Stop. The customer service positions require the employee "to interview applications and record information into a computer[, t]alk to customers by phone and receive orders[, f]ill out forms, determine changes for service and make sure orders are shipped from the warehouse." MIKO 357-61.
On May 20, 2004 Defendant informed Plaintiff that she was not "Disabled" from "any occupation" and that benefits were terminated effective June 1, 2004. The letter referenced Dr. as findings of physical examinations, but Dr. Cohan's statements correctly indicate that these documents were not a part of the file he was given to review. Yazdi's indication that Plaintiff was spastic and lacked tone. The letter also noted that Plaintiff was ambulatory and could drive, and that she was able to work as a Branch Manager or in other positions with a sedentary job description (such as the customer service positions assessed by Ms. McKeown). MIKO 364-67.
C. Defendant Denies Plaintiff's Administrative Appeal
On October 1, 2004, Plaintiff filed an administrative appeal including Attending Physician Statement Updates from Drs. Yazdi and Hacker, and medical statements from Drs. Sigman and Jane Broering-Ammons, a board certified psychiatrist.
Dr. Yazdi stated in his September 29, 2004 APS that Plaintiff's status had "retrogressed" and that her prognosis was "permanently disabled." He further stated that Plaintiff had "achieved maximum medical improvement" and that her current level of physical impairment continued to be Class V, "severe limitation of functional capacity/incapable of sedentary work." Under "Objective Clinical Findings" Dr. Yazdi stated: "She is very weak on the left arm and leg as well as right leg. She has a very difficult time walking even with a cane. She cannot stand up without support." MIKO 378-80. Dr. Yazdi also included a copy of his May 26, 2004 letter in which he stated that Plaintiff "[w]ill remain permanently disabled because of her inability to control the functions on the left side of her body, as well as both her legs. She has a very difficult time with gait or manual dexterity." MIKO 382.
Dr. Hacker also submitted an APS Update in support of Plaintiff's appeal. He again stated that Plaintiff's level of disability was Class V, that she could not lift 1-10 lbs. from the ground to her waist, and was not physically capable of performing work that required her to stand for two hours per day and walk for one hour per day. Under "Objective Clinical Findings" Dr. Hacker listed gait abnormality, falling frequently, uses brace, cane, or walker, spasticity, uncoordination, fatigue, and "restless — needs to frequently change positions." MIKO 384-85. In a cover letter dated July 6, 2004, Dr. Hacker added: "Sandra Mikolajczyk should be considered totally disabled. She has a left side hemiparesis secondary to a craniotomy. She's also followed for seizure disorder, anxiety, depression, hydrocephalus, and mitrovalve prolapse." In his APS, Dr. Hacker also noted Plaintiff's loss of manual dexterity. MIKO 385.
Dr. Sigman also submitted a statement in support of Plaintiff's administrative appeal. He stated that she had been his patient since her rehabilitation began in 2001. He stated that her surgery "resulted in left hemiparesis, left hemi-sensory deficits, spasticity, and significant anxiety and depression." He added that she has impaired endurance and energy level and has highly abnormal gait mechanics. MIKO 386. Dr. Sigman listed "Objective Clinical Findings," stating that a physical examination shows clear evidence of spastic changes in the left upper and lower extremity, severely abnormal gait with very short step length, and left-sided weakness. Id.
In a letter dated August 19, 2004, Dr. Broering-Ammons stated that Plaintiff had been her patient since February 5, 2003 and "maintains a diagnosis of major depression, moderate to severe, and mood disorder secondary to brain trauma." MIKO 387. She added: Due to the above conditions, she is unable to maintain employment of any capacity. Despite treatment with anti-depressant medications, her mood is labile and she is easily agitated. She has poor internal controls, which interferes with interactions with the public. I do not expect to see marked improvements in the near future to warrant a return to work.Id.
On October 19, 2004 Defendant obtained a medical review of the documents in the administrative file from Dr. Jamie Wancier. Dr. Wancier noted that Plaintiff underwent a bifrontal craniotomy on August 31, 2001. The tumor removal did not eliminate the hydrocephalus and on September 26, 2001 a second surgical procedure consisted of the placement of a low-pressure shunt. Dr. Wancier noted that post-operation, Plaintiff was left with significant left-side weakness and left hemisensory syndrome. He noted that, according to Dr. Sigman, claimant was able to function at a modified independent level using a walker. There was continued left-side weakness and spasticity more in the leg than in the foot, arm, or hand, as well as some degree of left foot equinovarus deformity. Dr. Wancier also noted that there are no tests or notes demonstrating any cognitive difficulties, and that Dr. Yazdi indicated weakness in the right leg, but the medical records reflect no notation to that effect. He noted that Dr. Sigman stated that Plaintiff was permanently disabled, but that this opinion was not based on any comprehensive neurologic examination by Dr. Yazdi. Dr. Wancier opined that restrictions and limitations on work would be permanent and would consist of sedentary work that does not require the use of both feet or both hands. MIKO 511-13.
Dr. Wancier also reported that the following documentation would be helpful in further evaluating Plaintiff's claim: comprehensive psychological testing, a repeat MRI of the brain with and without contrast, and a PET Scan to assess permanence of brain damage. Id. On November 17, 2004 Broadspire affirmed its denial of benefits. MIKO 389-90.
IV. Discussion
A. Standard of Review
As a general principle of ERISA law, federal courts review a plan administrator's denial of benefits de novo, "unless the benefit plan gives the plan administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 613 (6th Cir. 1998) (citing Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). When a plan administrator has discretionary authority to determine benefits, the Court will review a decision to deny benefits under "the highly deferential arbitrary and capricious standard of review." Yeager v. Reliance Standard Life Ins. Co., 88 F.3d 376, 380 (6th Cir. 1996), Sanford v. Harvard Indus., Inc., 262 F.3d 590, 595 (6th Cir. 2001).
The arbitrary and capricious standard "is the least demanding form of judicial review of administrative action." When applying the arbitrary and capricious standard, "the Court must decide whether the plan administrator's decision was rational in light of the plan's provisions. Stated differently, when it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome, that outcome is not arbitrary or capricious." Williams v. International Paper Co., 227 F.3d 706, 712 (6th Cir. 2000) (internal citations and quotations omitted). Consequently, a decision will be upheld "`if it is the result of a deliberate principled reasoning process, and if it is supported by substantial evidence.'" Id. (quoting Baker v. United Mine Workers of America Health Retirement Funds, 929 F.2d 1140, 1144 (6th Cir. 1991)). "The ultimate issue in an ERISA denial of benefits case is not whether discrete acts by the plan administrator are arbitrary and capricious but whether its ultimate decision denying benefits was arbitrary and capricious." Spangler v. Lockheed Martin Energy Sys., Inc., 313 F.3d 356, 362 (6th Cir. 2002).
The arbitrary and capricious standard of review "is not, however, without some teeth." McDonald v. Western-Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003) (quoting Cozzie v. Metro. Life Ins. Co., 140 F.3d 1104, 1107-08 (7th Cir. 1998)). "Merely because our review must be deferential does not mean our review must also be inconsequential. While a benefits plan may vest discretion in the plan administrator, the federal courts do not sit in review of the administrator's decisions only for the purpose of rubber stamping those decisions." Moon v. Unum Provident Corp., 405 F.3d 373, 379 (6th Cir. 2005). The obligation under ERISA to review the administrative record in order to determine whether the plan administrator acted arbitrarily and capriciously "inherently includes some review of the quality and quantity of the medical evidence and the opinions on both sides of the issues." McDonald, 347 F.3d at 172.
B. Additional Guidelines for "Arbitrary and Capricious" Review
In reviewing the administrative record in an ERISA denial of benefits case under the arbitrary and capricious standard, the Sixth Circuit has established certain other rules that guide this Court's interpretation of the record.
Generally, when a plan administrator chooses to rely upon the medical opinion of one doctor over that of another in determining whether a claimant is entitled to ERISA benefits, the plan administrator's decision cannot be said to have been arbitrary and capricious because it would be possible to offer a reasoned explanation, based upon the evidence, for the plan administrator's decision.347 F.3d at 169. In ERISA cases, "courts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant's physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation." Black Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003). However, the Supreme Court has also noted that "plan administrators . . . may not arbitrarily refuse to credit a claimant's reliable evidence, including the opinions of a treating physician." Id. See Evans v. Unumprovident Corp., 434 F.3d 866, 877 (6th Cir. 2006).
Additionally, although the Sixth Circuit has found "nothing inherently objectionable about a file review by a qualified physician in the context of a benefits determination," Calvert v. Firstar Fin., Inc., 409 F.3d 286, 296 (6th Cir. 2005), it is a factor to be considered in reviewing the propriety of an administrator's decision regarding benefits.
We regard [the plan administrator's] decision to conduct a file review rather than a physical exam as just one more factor to consider in our overall assessment of whether Liberty acted in an arbitrary and capricious fashion. Thus, while we find that [the administrator's] reliance on a file review does not, standing alone, require the conclusion that [the administrator] acted improperly, we find that the failure to conduct a physical examination — especially where the right to do so is specifically reserved in the plan — may, in some cases, raise questions about the thoroughness and accuracy of the benefits determination.Id. at 295; Evans, 434 F.3d at 877. Additionally, "a plan administrator may not arbitrarily disregard reliable medical evidence proffered by a claimant, including the opinions of a treating physician." Id. "[A]n independent medical examination under particular circumstances [also constitutes an] element in the equation of the reasonableness of an administrator's benefits determination." Id.
Several decisions of the Sixth Circuit are instructive in interpreting these rules and applying them to the facts contained in an administrative record. In McDonald v. Western-Southern Life Ins. Co., supra, the court
held that the ERISA plan administrator acted arbitrarily and capriciously in terminating the LTD benefits of the plaintiff, where the evidence of record indicated that his severe depression and aggressive personality disorder remained unchanged; his treating physicians unequivocally and repeatedly opined that he was totally incapable of returning to work due to his mental condition; two independent medical examiners also questioned the plaintiff's ability to return to work; a psychiatrist's initial report ambiguously stated that the plaintiff might be able to return to work in a very low stress environment on a limited trial basis; and, the psychiatrist's supplemental report, which accused the plaintiff of malingering, was significantly different from his initial report without any justification for the change, other than telephone contact from the defendant. 347 F.3d at 163-66. In these circumstances, [the court] held that "the mere possibility that a participant in an ERISA plan might be able to return to some type of gainful employment, in light of overwhelming evidence to the contrary, is an insufficient basis upon which to support a plan administrator's decision to deny that participant's claim for LTD benefits." Id. at 170-71.Evans at 877-78.
In [ Moon v. Unum Provident Corp., supra, the] Court held that the termination of the plaintiff's disability benefits pursuant to an ERISA plan was arbitrary and capricious where the plaintiff's primary treating physician carefully documented that the plaintiff's uncontrollable labile hypertension rendered her unable to work, and the only contrary opinion came from one of the defendant's in-house staff physicians, who arrived at his opinion not upon an examination of the plaintiff, but rather upon a selective review of the administrative record. 405 F.3d at 374-78. In so holding, [the court] noted that, "Dr. Feagin's role was not as a neutral independent reviewer, but as an employee of Unum. It is not enough for Unum to offer an explanation for the termination of benefits; the explanation must be consistent with the `quantity and quality of the medical evidence' that is available on the record." Id. at 381 (quoting McDonald, 347 F.3d at 172). Factoring in the plan administrator's conflict of interest, [the court] also observed that "when a plan administrator's explanation is based on the work of a doctor in its employ, we must view the explanation with some skepticism." Id. at 381-82.Evans at 878.
In [ Calvert v. Firstar Fin., Inc., supra, the] Court held that, in the context of the record as a whole and considering the defendant ERISA plan administrator's conflict of interest, the administrator acted arbitrarily and capriciously in denying the participant with a back injury further LTD benefits. 409 F.3d at 295-97. A neurosurgeon engaged by the administrator conducted a file review and opined that the participant's claimed limitations were subjective exaggerations, and there was no objective data in the record to support any restriction on the participant's activities. Id. at 296-97. [The court] reiterated that there is nothing inherently improper with relying on a file review, even one that disagrees with the conclusions of a treating physician. Where, as here, however, the conclusions from that review include critical credibility determinations regarding a claimant's medical history and symptomology, reliance on such a review may be inadequate. Id. at 297. Under the circumstances, the Court found the neurosurgeon's file review to be "clearly inadequate" and his conclusions "incredible on their face" when compared to the objective data from the participant's x-rays and CT scans and the "thorough objectively verifiable [disability] determinations" of the Social Security Administration and the participant's treating physician. Id. at 296-97.Evans at 878 (internal quotations omitted).
[I]n Kalish, [the court] held that the ERISA plan administrator acted arbitrarily and capriciously in denying benefits to the participant on the basis of his cardiac condition where the administrator relied exclusively on an independent expert's file review that was "inadequate in several crucial respects." 419 F.3d at 510. Specifically, the expert opined that the participant could return to a position requiring "light activity," but did not state that the participant could return to his former "high-stress" position as director of transportation, which entailed the supervision of fifty employees and extensive travel: "The fact that Kalish might be capable of sedentary work cannot be a rational basis for finding that he was not disabled, given that his former occupation required him to walk, stand, and reach for several hours a day." Id. at 507. Moreover, the independent expert's conclusory assertions in this regard failed to rebut the contrary medical conclusions of the physician who conducted regular physical examinations of the participant. Id. at 509. Finally, the expert's report neglected to mention the observations of the plan administrator's own field investigator that undermined the expert's diagnosis. Id. at 509-10. Under these circumstances, [the Sixth Circuit] concluded that the plan administrator improperly denied the participant's claim for benefits.Evans at 878-89.
In Spangler v. Lockheed Martin Energy Sys., 313 F.3d 356 (6th Cir. 2002), the court found an administrator's decision to be arbitrary and capricious when the administrator selectively chose medical reports to send to its evaluator. The court noted that the administrator Met-Life "`cherry-picked' [the Plaintiff's] file in hopes of obtaining a favorable report from the vocational consultant as to [Plaintiff's] ability to work. Met Life's action in sending only Dr. MacKay's September 14, 1999, report to Crawford was arbitrary and capricious. Met Life should have provided Crawford with all of the medical records relevant to [Plaintiff's] capacity to work. As a result, the report by Crawford's vocational consultant was an incomplete and inaccurate representation of [Plaintiff's] ability to work." Id. at 362.
In Evans, supra, the court found an administrator's actions to be arbitrary and capricious when the administrator was selective in its review of the plaintiff's medical evidence. The administrator's "reliance solely on file reviews by its in-house physicians is questionable in light of the critical credibility determinations made in those file reviews, the factual inaccuracies contained therein regarding plaintiff's treatment history, and the fact that the file reviews categorically dismissed the reliable opinion of plaintiff's treating physician that the stress factor militated against plaintiff's resumption of her administrative position." Evans, 434 F.3d at 880. Additionally, the court noted that Plaintiff's driving a car against her treating physician's recommendation does not "adversely impact a doctor's diagnosis or disqualify a person for benefits." Id. at 879.
Most recently, in Glenn v. MetLife et al, ___ F.3d ___, 2006 U.S. App. LEXIS 22432 (6th Cir. Sept. 1, 2006) (Case No. 05-3918), the Sixth Circuit held that another factor in the determination of arbitrary and capricious denials arises when a plan requires the claimant to seek Social Security Disability compensation in order to offset the payment that the plan would award her, yet the administrator does not give adequate weight to the SSDI's disability determination. The administrator should have considered the SSDI determination in making its own determination regarding the Plaintiff's disability status. This is particularly true when the plan requires the claimant to seek SSDI payments, and the plan reduces its own payment to the claimant by the amount of the SSDI benefits award. Id. C. Bruch Discretion Exists and the Standard of Review is Arbitrary and Capricious
Plaintiff argues that this Court should review de novo the Defendant's decision to deny Plaintiff's benefits under the ERISA plan. Defendant maintains that it is entitled to deference under the "arbitrary and capricious" standard of review. The issue is whether the Plan "gives the plan administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Bruch, 489 U.S. at 115. If the Plan gives the administrator Bruch discretion, the "arbitrary and capricious" standard applies. If the Plan does not give the administrator Bruch discretion, the Court will review the administrator's denial of benefits de novo. Id.
Plaintiff argues that the Defendant does not have plenary discretion under the plan, based specifically on the provision of an amendment to the plan that provides that, "Client shall reserve unto itself discretionary authority to overturn any denial following exhaustion of the administrative appeal process." LMB 04. Plaintiff argues that this provision gives the ultimate determination of claims to the employer (by and through its agent/insurer Lumbermens), and thereby limits the discretion that the administrator (Defendant Broadspire) realistically possesses under the Plan.
The Court finds that discretionary authority has been vested in the Defendant as administrator. The same section of the amendment to the plan also provides, "[The administrator] shall have discretionary authority to interpret the terms of the Policy and to otherwise determine a claimant's eligibility for benefits throughout the entire claim process, including, during the claim's initial submission and throughout any and all levels of appeal in accordance with the aforementioned Policy." LMB 04. Literally, this provision grants the discretionary authority to Broadspire that the Supreme Court specifically required in Bruch. That authority must be "discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Bruch, supra. The language of the Plan here, on its face, gives Broadspire the discretionary authority to determine claimants' eligibility. It is in this phrase, as well as in the "Allocation of Authority" clause discussed above, that the discretion is granted, not in the phrase that Plaintiff cites.
In addition to the textual fidelity of the Plan's "discretionary authority" clause, the Court is also of the opinion that the plan administrator has Bruch discretion because the "overturn" clause applies only to administrative denials of benefits, and not grants of benefits by the administrator. This distinction is important because it leads to the interpretation of the "overturn" clause as a common-sense provision that the employer may choose to use its own money to assist one of its former employees with benefit payments, even if the employee's appeals are denied by the administrator. The Court is in no rush to create a disincentive for such potential cooperation between the employer and a disabled employee by holding that the inclusion of such clauses in ERISA plans entitles claimants to de novo review in federal courts. For these reasons, the Court will review Broadspire's denial of benefits to Plaintiff under the "arbitrary and capricious" standard.
B. Defendant's Denial of Plaintiff's Claim was Arbitrary and Capricious
Defendant Broadspire's denial of Mikolajczyk's LTD benefits was arbitrary and capricious. Plaintiff has met the burden of showing that Defendant's decision does not offer a reasoned explanation based on the evidence, and Plaintiff has shown that Defendant is unable to demonstrate that its decision resulted from a deliberate, principled reasoning process supported by substantial evidence. See Williams, 227 F.3d at 712. As plan administrator, Broadspire refused to credit Plaintiff's reliable evidence, including the opinions of her treating physicians, did not conduct any physical examination, and instead relied on document reviews that were incomplete and went against the weight of the administrative evidence in reaching its decision to deny benefits.
While an administrator may generally give weight to one doctor's opinion over another without acting arbitrarily or capriciously, "a plan administrator may not arbitrarily disregard reliable medical evidence" offered by a claimant's treating physicians. See Black Decker, 538 U.S. at 834; Evans, 434 F.3d at 877. Nor may an administrator selectively choose only cumulatively favorable documents with which to conduct a medical document review. See Moon, 405 F.3d at 374-78; Evans, 434 F.3d at 878.; Kalish, 419 F.3d at 510; Spangler, 313 F.3d at 362. Additionally, when the conclusions of a medical review "include critical credibility determinations regarding a claimant's medical history and symptomology, reliance on such a review may be inadequate." Calvert, 409 F.3d at 297; Evans, 434 F.3d at 878. Also, "the mere possibility that a participant in an ERISA plan might be able to return to some type of gainful employment, in light of overwhelming evidence to the contrary, is an insufficient basis upon which to support a plan administrator's decision to deny that participant's claim for LTD benefits." McDonald, 347 F.3d at 170-71; Evans, 434 F.3d at 877-78. Finally, where a plan administrator requires the claimant to seek SSDI payments to offset the plan's payments, the administrator should give due consideration to the SSDI determination in making its own decision. Glenn, supra.
Initially, it is telling that Defendant granted benefits to Plaintiff at first, but then found her no longer "Disabled" in spite of overwhelming medical evidence that her condition had actually become worse over time. On March 14, 2002, Broadspire initially approved Plaintiff for benefits (as had Social Security Disability Insurance the prior month). This approval was on the basis of the medical opinions of three physicians and a physical therapist who had examined Plaintiff, and one physician who had reviewed Plaintiff's file at Defendant's request. Drs. Yazdi, Thomas, and Hacker all indicated that Plaintiff was experiencing debilitating physical and mental symptoms that would prevent her from returning to work. They classified her, respectively, as "not a suitable candidate for vocational rehabilitation," MIKO 145, physically weak and "unable to handle any type of stress or interaction with people," MIKO 085, and at a Class V level of "severe limitation of functional capacity/incapable of sedentary work," MIKO 063-64. The physical therapist noted spasticity, decreased range of motion, and emotional problems. MIKO 085. Dr. Goldberg's peer review involved a review of the opinions of Drs. Yazdi and Hacker, physical therapy notes, and a job description for Branch Manager. MIKO 215. On this basis, Dr. Goldberg recommended disability benefits, and Broadspire granted them.
On May 20, 2004, Defendant terminated Plaintiff's LTD benefits, and on November 17, 2004 Defendant affirmed that decision. In making the May 20 termination decision, the Defendant had by that point acquired several more statements and examination results from Drs. Yazdi and Hacker, as well as ones submitted by Plaintiff from Dr. Timothy Sigman, that cumulatively show no improvement in Plaintiff's condition. Dr. Yazdi noted that Plaintiff's condition had not improved and classified her condition as Class V. MIKO 331-32. Dr. Hacker, who also physically examined Plaintiff, stated his opinion that she remained unable to work, nor could she sit, stand, or walk for more than one hour. MIKO 284-86. Dr. Sigman also opined that Plaintiff was unable to work, nor could she use her left hand for simple activities. MIKO 244-45. He estimated a return-to-work period of one year. Id.
Prior to the November 17 decision, Defendant possessed all the above-mentioned reports from Drs. Yazdi, Thomas, Hacker, and Sigman; the already-recorded physical therapy notes; and a psychological report by Dr. Jane Broering-Ammons. Dr. Broering-Ammons diagnosed Plaintiff with major depression and mood disorder secondary to brain trauma, noting that Plaintiff "has poor internal controls, which interferes with interactions with the public." She also did "not expect to see marked improvements in the near future to warrant a return to work." MIKO 387. Dr. Yazdi submitted an additional report stating that Plaintiff's condition had actually "retrogressed" and that she was "permanently disabled." MIKO 378-80. Dr. Hacker submitted an update stating: "Sandra Mikolajczyk should be considered totally disabled." MIKO 385. Dr. Sigman noted evidence of "spastic changes in the left upper and lower extremity," impaired energy levels, and highly abnormal gait mechanics. MIKO 386. In other words, Plaintiff was in the same or worse condition than she was in previously.
When Broadspire sought a peer review of Plaintiff's condition during the appeals process from Dr. Cohan, it provided him with documents regarding administrative notes and only a few of the treating physicians' medical reports, in addition to a questionnaire filled out by the Plaintiff. Dr. Cohan made his conclusion on the basis of those documents alone, without a physical examination. While Dr. Cohan's review may have been entirely accurate on the basis of those documents, Defendant had selectively chosen a sparse number of documents for Dr. Cohan to review. This selectivity on the part of Broadspire was unreasonable. Broadspire "should have provided [Dr. Cohan] with all of the medical records relevant to [Plaintiff's] capacity to work." Spangler, 313 F.3d at 362.
When Broadspire sought a medical review of the documents in the administrative record from Dr. Wancier on October 19, 2004, Dr. Wancier acknowledged the treating physicians' medical reports but found them inadequate to support a finding of disability from "any occupation." MIKO 511-13. Dr. Wancier's major concern was the lack of "objective" evidence of Plaintiff's psychological capacities, as well as evidence of the true source of Plaintiff's physical disability (whether it was actually widespread or limited to Plaintiff's foot). Id. In light of the evaluations of Drs. Yazdi, Thomas, Hacker, Goldberg, Sigman, and Broering-Ammons, as well as the physical therapist, many of which contained "Objective Clinical Findings," Dr. Wancier's evaluation fails to give due credit to these recorded medical evaluations that were based in large part on physical examinations. Such refusals of credit are arbitrary and capricious, and for Broadspire to go against the tremendous weight of medical evidence in denying LTD benefits is unreasonable, arbitrary, and capricious.
Defendant makes much of the fact that Plaintiff was observed driving an automobile, arguing that should tend to support the reasonableness of its decision. The Sixth Circuit, however, has held that a plaintiff's driving a car against her treating physician's recommendation does not "adversely impact a doctor's diagnosis or disqualify a person for benefits." Evans, 434 F.3d at 879. In other words, while it may be imprudent of a patient to drive against her doctor's recommendations, it does not support a decision that Plaintiff is not disabled in light of the supporting medical evidence. Id.
Defendant Broadspire had all of the aforementioned documentation in its possession when it made its denial decisions. The documents demonstrate a clear decline over time in Plaintiff's condition, or at least a stagnation, from the point at which Broadspire and SSDI did find her disabled. Even after the point at which Plaintiff's condition was to be assessed with regards to her ability to work at "any gainful occupation that her training, education, and experience would allow her to perform," Defendant concluded, in a May 14, 2004 report, MIKO 357-61, and in its termination letter of May 20, 2004, MIKO 364-67, that Plaintiff could return to work in her previous position of Branch Manager. According to Plaintiff's employer, the Branch Manager's responsibilities included visiting existing and potential customers outside the office, making presentations on the road, lifting up to 25 or even 50 pounds, supervising others, sitting six hours a day, walking and standing two hours a day, working under deadlines, and using the telephone and computer. MIKO 071, 199. Even the customer service positions that Defendant also considered satisfactory involved interviewing applicants, using a computer, communicating with customers, filling out paperwork, and other duties, aside from traveling to and from work and being in a workplace for full work days. MIKO 357-61.
That Defendant determined Plaintiff to be physically and mentally capable of such tasks was an abuse of its discretion. The administrative record is replete with references to Plaintiff's incapacity to perform these tasks, based on medical evaluations by several physicians and therapists. Drs. Hacker, Sigman, and Yazdi each at some point had classified Plaintiff as Class V disabled, meaning that she was severely limited in her functional capacity and incapable of even sedentary work. MIKO 063-64, 242, 331-32. Dr. Goldberg, a physician engaged by Defendant itself, noted that "[a]lthough the claimant's job description indicates most of her work is sedentary . . . [her] condition would prevent her from carrying out the essential duties of her job." MIKO 217. Dr. Sigman opined that Plaintiff would be "unable to tolerate a full day" of work. MIKO 242. Dr. Hacker noted Plaintiff's fatigue, restlessness, and lack of coordination and manual dexterity. MIKO 384-85. Additionally, according to the questionnaire Plaintiff completed in late 2003, she lacked control over her kidney and bowels, and was unable to take care of her most personal needs without assistance. MIKO 310. Dr. Sigman noted Plaintiff's anxiety and depression. MIKO 386. Dr. Hacker classified Plaintiff's mental condition as Class IV, "marked limitation/unable to engage in stress of interpersonal relationships." MIKO 064. A board-certified psychologist, Dr. Broering-Ammons, opined that Plaintiff's "mood is labile and she is easily agitated[, and s]he has poor internal controls, which interferes with her interactions with the public." MIKO 387. Given these conditions, it was unreasonable for Defendant to decide that Plaintiff was capable of working as a Branch Manager or a customer service representative, as described by Defendant in the record.
Another factor in the Court's consideration is that Defendant never conducted a physical exam upon which to base its denial. An Administrator's "failure to conduct a physical examination — especially where the right to do so is specifically reserved in the plan — may, in some cases, raise questions about the thoroughness and accuracy of the benefits determination." Calvert, 409 F.3d at 295; Evans, 434 F.3d at 877. Here, Defendant relied exclusively on reviews of medical reports, which, at least in part, were inadequate as described above. Even when Dr. Wancier, in his final review, recommended further tests that would clarify the level of Plaintiff's disability, Defendant gave no opportunity to Plaintiff to have such tests performed before informing Plaintiff that the denial of her appeal would be upheld. Defendant's refusal to conduct a physical examination, even when tests were recommended by its own reviewing physician, is another factor that weighs against the reasonableness of Defendant's denial of benefits.
Yet another "significant factor" weighing against Defendant is the issue of SSDI payments. Glenn, supra at 8. The Plan requires claimants to seek SSDI payments, and if such payments are awarded, the Plan deducts its own payments by the amount of the SSDI payments. See MIKO 010, 027-8. In such situations, if the administrator does not then give appropriate consideration to the SSDI determination, that will tend to suggest that an administrator's denial of benefits was arbitrary and capricious. Glenn, supra. Here, Plaintiff applied for and received SSDI benefits, per the plan provisions. Defendant reduced the benefits that it would have to pay by the amount of the SSDI benefits. While denying Plaintiff's benefits, Defendant did not consider the SSDI determination of disability. "Having benefitted financially from the government's determination that [Mikolajczyk] was totally disabled, [Broadspire] obviously should have given appropriate weight to that determination." Id. Because Broadspire did not give the SSDI determination appropriate consideration, this factor weighs in favor of finding Defendant's denial to have been arbitrary and capricious.
As a result of this determination, the Court awards Plaintiff her long-term disability benefits, retroactive to the date on which they were terminated. See Glenn v. MetLife, supra at n. 5 (remanding to award retroactive benefits where administrator's denial was arbitrary and capricious); Kalish, supra (remanding to award retroactive benefits where administrator's refusal to consider medical evidence was arbitrary and capricious); and Williams v. Int'l Paper Co., 227 F.3d 706 (6th Cir. 2000) (remanding to award retroactive benefits where administrator arbitrarily and capriciously ignored evidence in making its benefits determination).
V. Conclusion
For the reasons stated above, Plaintiff's motion for summary judgment (Doc. No. 34) is granted and Defendant's motion for summary judgment (Doc. No. 29) is denied. Accordingly, the Plaintiff is awarded her long-term disability benefits, retroactive to the date on which they were terminated.
IT IS SO ORDERED.