MARIANNE O. BATTANI, District Judge.
This matter is before the Court on Defendant Chrysler Group LLC-UAW Pension Plan's Motion for Judgment on the Administrative Record (Doc. 11) and Plaintiff Jearel Brooks' Cross-Motion for Judgment on the Administrative Record (Doc. 12). Plaintiff brought this action under the Employee Retirement Income Security Act challenging Defendant's denial of permanent total disability retirement benefits. (Doc. 1). The Court has reviewed the record and finds oral argument will not aid in the resolution of this dispute.
Plaintiff Jearel Brooks' former employer, Chrysler Group LLC ("Chrysler"), provides eligible employees permanent total disability retirement benefits ("PTD benefits") under the Chrysler Group LLC-UAW Pension Plan ("the Plan" or "Defendant"). (AR 3-4).
To obtain PTD benefits under the Plan, an employee must: (1) be permanently and totally disabled for the remainder of his or her life; (2) have been disabled for at least five months prior to the effective date of retirement indicated on the retirement application; and (3) retire before age 65 with ten or more years of credited service. (AR 14-15).
Regarding the first condition, the Plan explains:
An employee who applies for PTD benefits must submit to an examination by a sponsor appointed physician who will issue a medical opinion on whether the employee is permanently and totally disabled. (AR 14-16). If the sponsor's physician disagrees with the employee's physician on the disability question, then the employee is required to submit to an independent medical exam ("IME") by a physician selected by the PTD Review Committee, a body charged with reviewing PTD benefits claims.
In March 2009, Plaintiff applied for PTD benefits arising out physical injuries he sustained in a car accident which occurred sometime in 2007. The PTD Review Committee denied that application on June 22, 2009. (AR 164). Plaintiff appealed to the Board of Administration; the Board denied his appeal on October 26, 2009. (AR 150). Plaintiff did not seek judicial review of the October 26, 2009 denial.
On December 9, 2009, Plaintiff again applied for PTD benefits. This time, he claimed he was disabled because of certain psychiatric conditions. Dr. Sandaire, Plaintiff's physician, stated that Plaintiff has "bi-polar disorder-most recent episode manic with psychotic features, outpatient treatment and hospitalizations in distant past, 1 suicide attempt." (AR 167). When asked to explain Plaintiff's physical work restriction, Dr. Sandaire responded: "until [Plaintiff] learned positive coping skills his temper will prevent him from working with others." (AR 168). Dr. Sandaire concluded that Plaintiff is permanently and totally disabled for the rest of his life because his "social skills are impaired due to his psychological state of mind."
In January 2010, Dr. Zimmer, a Chrysler-appointed physician, examined Plaintiff. (AR 169-170). Dr. Zimmer concluded that Plaintiff's bi-polar disorder and psychotic features were controllable and that he is capable of working.
On February 15, 2010, Dr. Wolf examined Plaintiff for a determination of permanent and total disability "as it pertained to the diagnosis of Bipolar Disorder with most recent episode manic with psychotic features." (AR 220). After reviewing Plaintiff's medical files and conducting an in-person interview, Dr. Wolf found no evidence of cognitive impairment of an organic type, no evidence of thought disorder of a psychotic type, no evidence of hallucinations, and no evidence of apparent suicidal, aggressive, or homicidal ideation, intent, or plan. (AR 223). Dr. Wolfe ultimately concluded that Plaintiff is not permanently disabled for the rest of his life.
By letter dated February 25, 2010, the PTD Review Committee notified Plaintiff that it had denied his December 2009 application for PTD benefits. (AR 163). Plaintiff appealed to the Board of Administration. (AR 234-236). Although Plaintiff expressly focused this appeal on the February 25, 2010 denial, he referenced the spine, leg, and ankle problems that were the subject of his failed March 2009 application.
The Board of Administration ordered an independent review of Plaintiff's medical documentation as part of the appeal process. (AR 138). On September 9, 2010, Dr. Polsky examined the entirety of the medical records that Plaintiff had submitted in support of his PTD benefits application. (AR 287-289). Dr. Polsky found no evidence of delusions, hallucinations, paranoia, or of a formal thought disorder.
On January 31, 2011, Plaintiff filed suit against Defendant seeking judicial review of the September 24, 2010 denial. (Doc. 1 Ex. 1, p. 4, ¶ 8). The parties' cross-motions for judgment on the administrative record are fully briefed and now before the Court. (Doc. 11; Doc. 12).
A district court reviews an ERISA plan administrator's denial of benefits de novo, unless the plan gives the administrator discretionary authority to determine eligibility for benefits.
As a threshold matter, Plaintiff concedes the Plan contains language sufficient to grant Defendant discretionary authority to determine benefits eligibility. (Doc. 12, p. 5). Therefore, the Court reviews this case under the deferential arbitrary and capricious standard.
The parties present three issues for decision: (1) whether Defendant properly denied Plaintiff's December 2009 application for PTD benefits; (2) whether the denial was the result of a structural conflict of interest; and (3) whether the Court should award Plaintiff attorney fees. The Court begins with the first issue.
Plaintiff argues Defendant ignored certain medical evidence in denying his December 2009 application. Specifically, Plaintiff maintains Defendant failed to consider his spine, leg, and ankle injuries he sustained in the 2007 car accident. (Doc. 12, p. 10). This argument ignores the medical basis that was the subject of Plaintiff's December 2009 application. In that application, Plaintiff alleged he was disabled solely because of his bi-polar disorder and related psychotic features. (AR 167-168). There is absolutely no claim, reference, or implication in that application that his physical injuries rendered him disabled. Although Plaintiff included medical documentation related to these injuries in his appeal of the February 25, 2010 denial, the proper scope of review was limited to the claim arising out of the alleged psychiatric condition only. Consequently, Defendant was not under an obligation to evaluate the medical evidence surrounding his spine, leg, and ankle in connection with this appeal. These medical records were simply immaterial for the purposes of determining whether Plaintiff was entitled to PTD benefits based on his bipolar disorder and related psychotic features.
Plaintiff's argument also ignores the reality that the physical injuries he offers in support of his December 2009 application were the basis of his failed March 2009 application. Plaintiff's Complaint in this case does not challenge Defendant's denial of his March 2009 application. He unequivocally focuses this civil action on the denial of his December 2009 application. (Doc. 1 Ex. 1, p. 4, ¶8 ). Therefore, the medical evidence related to Plaintiff's spine, leg, and ankle problems does not support his argument that Defendant arbitrarily and capriciously denied his December 2009 application for PTD benefits based on his psychiatric condition.
Even if Defendant should have considered the medical evidence related to Plaintiff's physical injuries, the Court must affirm the denial because a reasonable basis for the decision clearly exists on the evidence presented.
Plaintiff argues a structural conflict of interest motivated Defendant's decision to deny his application for PTD benefits. Plaintiff claims a conflict exists because "Chrysler is the company not only making the decisions in the claim process but is also the entity paying the claims." (Doc. 12, p. 9). The Court agrees with Defendant that Plaintiff's conflict of interest analysis is fundamentally flawed because he misunderstands the structure of the Chrysler Group LLC-UAW Pension Plan. The defendant in this case is the Plan, not Chrysler. Chrysler merely sponsors of the Plan. The Board of Administration administers the terms of the Plan and determines benefits eligibility, not Chrysler. The Board is an impartial fiduciary body separate and distinct from Chrysler. It consists of three Chrysler-appointed members and three UAW-appointed members. Plan benefits are paid from the Pension Fund, not Chrysler. Accordingly, there is no conflict of interest as Chrysler is not charged with administering claims or paying them.
Plaintiff argues he is entitled to attorney fees under 29 U.S.C. § 1132(g)(1) because Defendant did not consider his physical injuries in connection with his December 2009 application. (Doc. 12, p. 12-13). The Court has rejected this proposition for the reasons set forth above. Therefore, Plaintiff is not entitled to an award of attorney fees.
For the reasons stated above, Defendant's Motion for Judgment on the Administrative Record (Doc. 11) is