United States District Court, D. Connecticut
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)
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