United States District Court, W.D. Michigan, Southern Division
OPINION AND ORDER REVERSING THE DENIAL OF DISABILITY
L. Maloney United States District Judge
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.
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.
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.
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.).
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.)
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.)
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.
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.
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.
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
then filed her complaint here seeking judicial review of
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).
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. 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.)
argues Hartford's description of her job duties provide a
basis for reversing the decision. Tobin insists her job
duties included substantially more ...