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Tobin v. Hartford Life and Accident Insurance Co.

United States District Court, W.D. Michigan, Southern Division

February 8, 2017

Mary Beth Tobin, Plaintiff,
v.
Hartford Life and Accident Insurance Company, Defendant.

          OPINION AND ORDER REVERSING THE DENIAL OF DISABILITY BENEFITS

          Paul L. Maloney United States District Judge

         Plaintiff Mary Beth Tobin challenges, under the Employee Retirement Income Security Act (ERISA), the denial of her application for long-term disability benefits. As provided by the Case Management Order (ECF No. 7; ECF No. 10), Tobin first filed her brief (ECF No. 13), Defendant Hartford Life then filed its response (ECF No. 15), and Tobin filed a reply (ECF No. 19).[1] Oral argument is scheduled for March 27, 2017. The Court has reviewed the briefs, the administrative record (ECF No. 8), and relevant law and concludes that the matter will be decided without a hearing.

         I.

         Mary Beth Tobin worked in Florida for Disney Worldwide Services as manager of costuming operations. (ECF No. 8-4 PageID.586 and PageID.589.) Tobin's last day of work was October 2, 2012. While in Florida, Tobin was under the care of Dr. Dacelin St. Martin.

         Soon after she stopped working, Tobin moved to Michigan, where she was under the care of Dr. Troy Thompson, who is board certified in family medicine. (ECF No. 8-2 Thompson Dep. at 6 PageID.210.) On her disability claim form, Tobin stated she had been under a doctor's care since February 2012 for fibromyalgia and hypertension. (ECF No. 8-4 PageID.580.) Along with her claim form, Tobin submitted an Attending Physician's Statement of Functionality, which was completed by Dr. Thompson. (ECF No. 8-4 PageID.576-77.) Hartford later summarized Dr. Thompson's functional assessment as limiting Tobin to the following:

capable of sitting for 30-60 minutes at a time for up to 3-4 hrs per day; stand for 5-15 minutes at a time for a total of 45 minutes per day; walk only a few feet at a time for a total of 30 minutes per day and carry 1 lb occasionally; reach at desk/waist level frequently, never reach above shoulders and never finger/handle.

(ECF No. 8-1 “Initial Denial” PageID.104-05.).

         Tobin's file was sent to two doctors for independent reviews. (ECF No. 8-4 PageID.571-72.) Dr. Scott Benson, a board certified psychiatrist, reviewed the file for the purpose of offering an opinion about Tobin's psychiatric health. (ECF No. 8-4 PageID.560-63.) Dr. Michael Farber, board certified in internal medicine, reviewed the file for the purpose of offering an opinion about Tobin's physical abilities. (ECF No. 8-4 PageID.564-70.) As part of the claim review, Tobin's supervisor completed a Physical Demands Analysis (PDA), which summarized the physical requirements of Tobin's position. (ECF No. 8-4 PageID.586-87.) Hartford later described the requirements as follows:

you must be able to sit for 6 hrs per day, stand for 2 hrs per day, walk for 1 hr per day, frequently reach at waist/desk level, occasionally stoop, reach above shoulders, drive, reach below waist and finger/handle/feel.

(Initial Denial PageID.104.)

         Hartford denied Tobin's claim in a letter dated April 12, 2013. (Initial Denial PageID.102-07.) Hartford noted that Tobin sought disability benefits for hypertension, fibromyalgia, and depression. (Id. PageID.104.) Hartford noted that Dr. Benson found no psychiatric conditions that would warrant limitations or restriction on Tobin. Hartford also noted that Dr. Farber found insufficient medical data to support limitations on Tobin's physical abilities. Hartford concluded that Tobin should be able to perform the essential functions of her job as manager of costume operations. (Id. PageID.106.)

         Tobin appealed the initial denial of her claim. As part of her appeal, Tobin submitted her medical records from Dr. St. Martin and Dr. Thompson. Dr. Thompson was deposed in September 2013. (ECF NO. 8-2 PageID.205-57.) Dr. Thompson completed a form used for diagnosing fibromyalgia. (ECF No. 8-2 PageID.270-72.) Tobin submitted a Vocational Opinion authored by Mark Pinti, a vocational and rehabilitation consultant. (ECF No. 8-1 PagerID.182-86.) Tobin also submitted an information sheet on fibromyalgia which was published by the American College of Rheumatolgy. (ECF No. 8-1 PageID.172-76.)

         Tobin's file was sent to three doctors for independent reviews. Her file was reviewed by Dr. Lawrence Farago, who is board certified in psychiatry (ECF No. 8-1 PageID.132-35); Dr. Charles Brock, who is board certified in neurology (ECF No. 8-1 PageID.136-43); and Dr. Dayton Payne, who is board certified in internal medicine and rheumatology (ECF No. 8-1 PageID.144-147). Tobin's filed was also reviewed by Roger McNeeley, a vocational rehabilitation consultant. (ECF No. 8-1 PageID.124-30.)

         Hartford denied Tobin's appeal in a letter dated November 18, 2013. (ECF No. 8-1 “Final Denial” PageID.91-97.) Hartford concluded that the medical record did not support the conclusion that Tobin had a significant psychological condition, nor did the record support the conclusion that Tobin had functional deficits resulting from a psychological condition. Hartford also concluded that Tobin's self-reported complaints were not supported by measureable evidence from a neurological or rheumatological perspective. Hartford noted that the reviewers did not find any substantial functional deficits.

         Hartford addressed Pinti's vocational assessment. Hartford reasoned that Pinti largely relied on Dr. Thompson's conclusions. Hartford acknowledged that if Dr. Thompson's conclusions were medically supported, then it would agree with Pinti's conclusions. Hartford, however, disagreed with Dr. Thompson's conclusions, again asserting that the medical record did not support a finding that Tobin had a psychiatric condition or psychological functional deficit. Similarly, the medical record did not support a finding that Tobin had functional limitations that would prevent her from working in a sedentary capacity. Hartford also disputed Pinti's assessment of the physical demands of Tobin's job.

         Tobin then filed her complaint here seeking judicial review of Hartford's decision.

         II.

         Federal courts review ERISA benefits decisions under either the de novo standard or the arbitrary and capricious standard. If an ERISA benefits plan give the administrator discretion to interpret the terms of the plan or to make benefit determinations, this Court reviews the administrator's decisions under the arbitrary and capricious standard. Price v. Bd. of Trustees of the Indiana Laborer's Pension Fund, 632 F.3d 288, 295 (6th Cir. 2011) (citations omitted). The arbitrary and capricious standard is 'the least demanding form of judicial review of administrative action.'" Farhner v. United Transp. Union Discipline Income Prot. Program, 645 F.3d 338, 342 (6th Cir. 2011) (citation omitted). The arbitrary and capricious standard extends to this Court's review of the plan administrator's interpretations of the plan itself, Kovach v. Zurich American Ins. Co., 587 F.3d 323, 328 (6th Cir. 2009), as well as the plan administrator's factual determinations, see Gatlin v. Nat'l Healthcare Corp., 16 F.App'x 283, 288 (6th Cir. 2001). Under this standard of review, a court must uphold the plan administrator's decision "if it is the result of a deliberate, principled reasoning process and is supported by substantial evidence." Glenn v. Metlife, 461 F.3d 660, 666 (6th Cir. 2006) (citation omitted). "Put another way, 'when it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome, that outcome is not arbitrary and capricious.'" Pflaum v. UNUM Provident Corp., 175 F.App'x 7, 9 (6th Cir. 2006) (quoting Williams v. Int'l Paper Co., 227 F.3d 706, 712 (6th Cir. 2000)). Under the arbitrary and capricious standard, courts may consider whether the plan administrator had a conflict of interest, which arises when the plan administrator makes the benefits decision and is responsible for paying for the benefits. See Calvert v. Firstar Fin., Inc., 409 F.3d 286, 292 (6th Cir. 2005).

         The Court reviews Hartford's decision under the arbitrary and capricious standard. The Plan grants Hartford “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” (ECF No. 8-4 PageID.695.) This language confers discretionary authority with Hartford.[2] The parties also agree that the Hartford's decision must be reviewed under the arbitrary and capricious standard. (Def. Br. at 16 PageID.781; Pl. Reply at 1 PageID.855.)

         III.

          A. Your Occupation

         Tobin argues Hartford's description of her job duties provide a basis for reversing the decision. Tobin insists her job duties included substantially more ...


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