Christmas v. Sun Life Assurance Company of Canada

          MEMORANDUM OF DECISION RE: PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT [ECF NO. 12] AND DEFENDANT'S MOTION FOR JUDGMENT ON THE PLEADINGS [ECF NO. 11]

          KARI A. DOOLEY, U.S.D.J

         Statement of the Case

         The Plaintiff, Meghan Christmas, (“Plaintiff” or “Christmas”) pursuant to the Employee Retirement and Income Security Act (“ERISA”), 29 U.S.C. §1001 et seq., challenges the denial of her claim for Long Term Disability (“LTD”) benefits by the Defendant, Sun Life Assurance Company of Canada (“Defendant” or “Sun Life”). Before the Court are Christmas's motion for summary judgment and Sun Life's motion for judgment on the record, both of which the Parties have agreed should be treated as motions for a trial “on the papers.” The Court has reviewed the parties' submissions, the administrative record, the applicable statutory scheme and controlling appellate authority on the issues presented. For the reasons that follow, Christmas's motion for summary judgment is DENIED, and Sun Life's motion for judgment on the pleadings is GRANTED.

         Factual and Procedural Background

         Christmas worked for ISGN Corporation (“ISGN”) as a “Manager - Global Solutions Integration” until April 9, 2014. ISGN had a LTD benefits plan for its employees that is covered by the provisions of ERISA and insured by Sun Life (the “Plan”). ISGN is the Plan administrator, but it delegated to Sun Life “its entire discretionary authority” to review and to decide claims for LTD benefits as follows:

The Plan Administrator has delegated to Sun Life its entire discretionary authority to make all final determinations regarding claims for benefits under the benefit plan insured by this Policy. This discretionary authority includes, but is not limited to, the determination of eligibility for benefit, based upon enrollment information provided by the Policyholder, and the amount of a benefits due, and to construe the terms of this Policy.

Any decision made by Sun Life in the exercise of this authority, including review of denials of benefit, is conclusive and binding on all parties. Any court reviewing Sun Life's determinations shall uphold such determination unless the claimant proves that Sun Life's determinations are arbitrary and capricious.

         In this case:

Total Disability or Totally Disabled means during the Elimination Period and the next 24 months, the Employee, because of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation. . . . To qualify for benefits, the Employee must satisfy the Elimination Period with the required number of days of Total Disability, Partial Disability or combination of Days of Total and Partial Disability.

         Christmas stopped working on April 9, 2014. She filed a claim for LTD benefits on June 3, 2014. Thereafter, Christmas submitted multiple medical records from multiple treatment providers in support of her claim, including the records of Dr. Christopher Skola, her rheumatologist, and Dr. Michael Karasik, her gastroenterologist. Ultimately, Sun Life denied Christmas's claim for LTD benefits on July 28, 2014. Christmas appealed the denial on December 31, 2014. During the appeal process, Sun Life engaged National Medical Review, Co. Ltd. (“NMR”) to provide a records review by three physicians - D. Dennis Payne, M.D, Board Certified in Internal Medicine and Rheumatology; David Hoenig, M.D., Board Certified in Neurology and Pain Medicine; and Steven Channick, M.D., Board Certified in Internal Medicine. After reviewing the medical records provided by Christmas, each reviewing physician provided an assessment of Christmas's medical conditions particular to his specialty. Based largely on these assessments, Sun Life determined that the denial of benefits was the appropriate decision and denied Christmas's appeal on March 3, 2015. This action was filed thereafter on September 20, 2017.

         As noted above, Sun Life's motion is captioned a motion for “judgment on the record” while Christmas's motion is styled as a motion for summary judgment. “Sometimes in ERISA cases parties make a ‘motion for judgment on the administrative record,' which we have observed is a motion that does not appear to be authorized in the Federal Rules of Civil Procedure. . . . If such a motion is treated as a summary judgment motion, the district court must limit its inquiry to determining whether questions of fact exist for trial. . . . In some circumstances, it may be appropriate for the district court to treat such a motion as requesting essentially a bench trial ‘on the papers' with the District Court acting as the finder of fact. . . . In that scenario, the district court may make factual findings, but it must be clear that the parties consent to a bench trial on the parties' submissions, . . . and the district court must make explicit findings of fact and conclusions of law pursuant to Federal Rule of Civil Procedure 52(a).” O'Hara v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA, 642 F.3d 110, 116 (2d Cir. 2011) (citations omitted; internal quotation marks omitted). Here, the Parties have explicitly advised the Court, citing O'Hara, that they seek a trial “on the papers.” Joint Report of Rule 26(f) Planning Meeting, ECF No. 9; Joint Status Report, ECF No. 22; Pls.' Mem. Supp. Summ. J., ECF No. 12-1.

         Standard of Review

         The Court must first determine the appropriate standard of review to be applied to Sun Life's determination to deny Christmas's claim for LTD benefits. Christmas contends that de novo review applies here, while Sun Life contends that an arbitrary and capricious standard applies.

         “[ERISA] permits a person denied benefits under an employee benefit plan to challenge that denial in federal court.” Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108 (2008). “In ‘determining the appropriate standard of review,' a court should be ‘guided by principles of trust law'; in doing so, it should analogize a plan administrator to a trustee of a common-law trust; and it should consider a benefit determination to be a fiduciary act (i.e., an act in which the administrator owes a special duty of loyalty to the plan beneficiaries).” Id. 111 (quoting Firestone Tire & Rubber Co. v. Bruch, 489, U.S. 101, 111-13 (1989)). Under principles of trust law, a plan administrator's denial of benefits will generally be reviewed de novo, unless the plan itself provides otherwise. Id. See also, Hobson v. Metro. Life Ins. Co., 574 F.3d 75, 82 (2d Cir. 2009) (“a administrator's decision to deny benefits is reviewed de novo” except “where, . . . written plan documents confer upon a plan administrator the discretionary authority to determine eligibility.”)

         However, where the plan documents give the plan administrator discretion to review and to decide benefit claims, a reviewing court will not disturb the plan administrator's decision denying benefits “unless it is arbitrary and capricious.” Hobson, 574 F.3d at 82 (internal quotations omitted). Under this deferential level of review, a court will overturn an administrator's decision to deny benefits only where the decision “was without reason, unsupported by substantial evidence or erroneous as a matter of law.” Id. at 83. Substantial evidence “is such evidence that a reasonable mind might accept as adequate to support the conclusion reached by [the decisionmaker] . . . and requires more than a scintilla but less than a preponderance.” Miller v. United Welfare Fund,72 F.3d 1066, 1072 (2d Cir. 1995) ...