JOSEPH F. BIANCO, District Judge.
Plaintiff Carol Valentine ("plaintiff') brings this action under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"), challenging the termination of her long-term disability ("LTD") benefits by defendant Aetna Life Insurance Company ("Aetna," or "defendant"). Plaintiff was employed by Hubbard Broadcasting ("Hubbard"), where she was a participant in an LTD policy administered by Aetna (the "Plan"), until she allegedly became disabled under the provisions of the Plan due to a trigeminal nerve disorder. Plaintiff now challenges Aetna's partial rejection of her claim for LTD benefits. Specifically, plaintiff alleges that Aetna's finding that plaintiff's disability ended on June 30, 2012, and its resultant decision to terminate her benefits subsequent to that date was arbitrary and capricious.
Plaintiff and defendant now both move for summary judgment pursuant to Federal Rule of Civil Procedure 56. Defendant moves for summary judgment on the grounds that sufficient evidence in the record supports defendant's decision to deny plaintiff benefits in addition to those benefits already provided. Plaintiff cross-moves for summary judgment, asserting that the evidence in the record establishes that plaintiff had an ongoing disability, or in the alternative for a remand to the plan administrator for reconsideration of her claim. For the reasons set forth below,
The Plan is an employee welfare benefit plan governed by ERISA. ("ERISA Rights," VAL 38-39.) Hubbard established and maintains the Plan to provide LTD benefits to eligible employees, and Aetna acts as the Plan's claims administrator. (Id.)
The Plan provides that:
("Policyholder and Insurance Company Matters" at "ERISA Matters," VAL 105.)
The Plan provides that
("Long Term Disability Coverage" at "Test of Disability," VAL 4 (emphasis in original).) The Plan further states that:
("Long Term Disability Coverage" at "A Period of Disability," VAL 5 (emphasis in original).)
The Plan further provides that benefits are "payable after the elimination period ends for as long as the period of disability continues." ("Long Term Disability Coverage" at "When Benefits Are Payable," VAL 5.) The elimination period under the Plan is 180 days. ("Disability Coverage" at "Long Term Disability Benefits," VAL 33.)
Valentine was employed by Reelz TV, an affiliate of Hubbard, as a Director of Ad Sales Planning starting on or about December 1, 2008, until her last day of work on November 15, 2011. (VAL 729.) Plaintiff's salary at the end of her employment was approximately $225,000 plus commissions, amounting to gross pay of $316,868.56 in 2011. (Id. at 490, 722.) Plaintiff's job description reflects that some of her duties were to conduct negotiations on advertising time, create marketing platforms, maintain current business while "aggressively" seeking new business, interact with clients/agencies and account executives including entertaining them at industry events, present competitive research, and travel out of town. (Id. at 652-53.) It also notes that her position required "average sitting, standing, and office-type movement," the "ability to stand and present to a group for many hours," the "ability to travel via taxi, bus, personal car, commercial airline & train," and "average lifting, moving and pulling abilities." (Id. at 653.)
On or about April 4, 2012, Valentine filed a claim for LTD benefits claiming to be disabled and unable to work as of December 14, 2011 due to symptoms related to her diagnosis of a "trigeminal nerve disorder, unspecified" originally caused by an injury to her trigeminal nerve during a root canal in February 2010. (Id. at 107-108, 120, 122.) Plaintiff alleged that her symptoms (which increased in November 2011 after another dental procedure) in combination with side effects from prescribed medication included "daily persistent headache" and "fatigue, diminished memory, poor concentration, clouded thought combined with constant pain," causing her neurocognitive effects which limited her work performance. (Id. at 120-22.)
Plaintiff's treating physician for her allegedly disabling condition during this period was Dr. David Sirois, DMD, PhD, a specialist in cranial nerve injuries.
Dr. Sirois noted that, although he had noted mild improvement with treatment, "overall the prognosis is poor in that her condition is permanent and symptoms will remain to some degree indefinitely." (Id.) Dr. Sirois stated, "There is no objective test to prove or otherwise quantify her pain condition and I must rely on her self-report of limitations." (Id.) He also noted that he had prescribed plaintiff a number of medications, and that the side effects of those medications were part of plaintiff's disability, though as plaintiff's treatment evolved he planned to adjust her medications to ameliorate those effects. (Id.) Dr. Sirois concluded that plaintiff's prognosis would be clearer after six months of further treatment, i.e. through September 2012, and that he "reasonably expect[ed] she would remain disabled" during that period. (Id.) Dr. Sirois concurrently noted on the Aetna APS form that plaintiff's disability began on December 14, 2011 and would be continue "indefinite[ly] pending outcome to ongoing treatment." (Id. at 732.)
Aetna claim analyst Elizabeth Wing conducted a phone interview with plaintiff on April 16, 2012, after which she referred the claim to a nurse consultant, Jeanette Stehly, for a review. (Id. at 121-26.) Stehly reviewed plaintiff's records and concluded that her claim should be denied, finding that Dr. Sirois' APS indicated plaintiff "can work sedentary and he has not imposed restrictions yet it seems he is saying she is impaired."
After requesting and receiving further information from Valentine, including the older evaluations from Dr. Loria and Dr. Snyder, Wing conducted a phone interview with Dr. Sirois on May 14, 2012. (Id. at 152-53, 157.) During the interview, Dr. Sirois averred that his original APS was intended to state that plaintiff was disabled due to illness and pain, and that he would fill out a new APS if it would be helpful; though some of her symptoms (the diminished memory and poor concentration) were based on "self reports" and not on formal or structured testing, Dr. Sirois said he believed plaintiff's complaints, and that both the distraction caused by her illness/pain and the medications would cause her "fogged memory and difficulties in thought process." (Id. at 157.) The file was then referred back to Stehly, who again found that the records submitted were insufficient to support a finding of a functional impairment, pointing to the "highly subjective" nature of the claim and the lack of examination results to support a finding that plaintiff was unable
Defendant then referred plaintiff's claim file to an outside vendor for the retention of an independent medical record peer review physician consultant ("IPC"). (Id. at 34348.) The IPC for the initial review of plaintiff's claim was Dr. Choon Rim, a neurologist. (Id.) Following a review of the records and a conversation with Dr. Sirois,
Defendant subsequently notified plaintiff by letter dated May 29, 2012, that her claim for LTD benefits had been denied.
Plaintiff, via her counsel, filed an appeal letter on November 5, 2012, arguing that Aetna failed to "fully address the vocational limitations caused by [plaintiff's] medical condition which manifests in chronic pain and causes [plaintiff] significant diminution of her ability to concentrate, requires her to take unscheduled breaks and whole or partial days off, and negatively affects her ability to deal with stress and interact with others. It is our contention that [plaintiff's] medically determinable condition causes severe pain which precludes her ability to return to the highly skilled and highly stressful executive position she had for Hubbard and has required her to attempt a less stressful and skilled position."
Dr. Sirois' narrative summarized his treatment of plaintiff from March 28, 2012 (the date of the visit prior to the completion of his previous APS form) onward, including synopses of his visit notes. He stated, since beginning treatment, plaintiff had experienced:
(Id. at 500.) Dr. Sirois' narrative and office notes reflect that, although plaintiff showed signs of improvement, during each of her full medical examinations (on March 28, May 23, July 11, August 28, September 19, and November 21) plaintiff consistently exhibited the objective symptom of mechanical allodynia, as well as the other subjective symptoms and side effects. (Id. at 497-501.) For example, on September 19, plaintiff informed Dr. Sirois that she continued to experience "global improvement," but also that she suffered from "flaring symptoms," including an episode of the worst occipital pressure she had ever suffered, as well as a new "right foot numbness every other day [associated] with night time dysesthesia lasting ~2 hours." (Id. at 499.) Plaintiff's medications continued to cause the same side effects of dizziness, fogginess, and diminished concentration. (Id. at 497-500.)
Dr. Sirois also listed plaintiff's restrictions, which he stated were in large part "self-reported by Ms. Valentine and have not been formally assessed/tested. However, her limitations are entirely consistent with her pain and medications, and in my years of experience as a recognized expert in persistent neuropathic pain are accurate and credible. Additionally, some of her most impactful symptoms (pain, impaired cognitive performance, hypersensitivity to environmental stimuli) have no objective, validated method of assessment." (Id. at 501.) Dr. Sirois stated plaintiff should be restricted in, among other things, her exertion (limits on her ability to lift things above ten pounds or over her shoulders including a computer bag, or walk/stand due to dizziness or disorientation), manual dexterity (limits on her right arm to conduct tasks such as grasping, holding, and writing), and her participation in "high-pressure situations which require quick decision making, complex decision making, and multi-tasking ... due to medication side effects or as the direct result of her pain/sensory symptom intensity." (Id.) Overall, Dr. Sirois stated that:
(Id. at 500.)
The report from vocational expert Pasternak, dated November 4, 2012, largely aligned with Dr. Sirois' assessment. Pasternak interviewed plaintiff by phone and in person, reviewed her medical reports, and conducted research in recognized vocational resources. (Id. at 461-62.) Pasternak also reviewed plaintiff's new employment, which he described as having fewer responsibilities, including being under the supervision of someone occupying a position comparable to plaintiff's old job at Hubbard. (Id. at 465.) In sum, Pasternak found that plaintiff was "incapable of performing the duties of her former position as a Vice President of Sales/Marketing," given her moderate to severe restrictions in a number of areas, including the ability to maintain attention and concentration and to perform simple or complex tasks repetitively over a period of time. (Id. at 466.) Pasternak attributed this to plaintiff's chronic pain and its cognitive effects, her "Type A" personality, and the "extremely stressful and stress-producing" nature of her position at Hubbard. (Id. at 466-67.)
Plaintiff's affidavit further elaborated on the symptoms she allegedly was experiencing day-to-day. In particular, plaintiff described that the "neuralgia and permanent nerve damage" she had suffered and the side effects of the multiple medications she was taking caused her to have sensitivity to atmospheric noise or voices on the phone; sensitivity to touch, causing difficulty in traveling; inability to focus, and headaches when she attempts to work on one task for an extended period; effects on memory; drowsiness; and extreme pain. (Id. at 457-58.) Plaintiff noted that she had returned to work in a lesser capacity than her previous position, but that she was unsure if she would be able to continue due to her condition. (Id. at 458-59.)
After receiving plaintiff's submitted records and examination reports, defendant again referred plaintiff's file to another IPC, Dr. Stuart Rubin, who is certified in Physical Medicine and Rehabilitation. (Id. at 280, 283.) Dr. Rubin reviewed the claim record and called Dr. Sirois on three occasions to conduct a peer-to-peer consultation, but was unable to reach him, and Dr. Sirois did not return the calls.
Notably, the "brief claim synopsis" section of the report describes the full contents of plaintiff's claim file as reviewed by Dr. Rubin, including Dr. Sirois' letter of November 29, 2012 and his office visit notes through September 29, 2012 (id. at 280-81), but Pasternak's report and plaintiff's affidavit are not listed. Further, in Dr. Rubin's description of his "clinical file review," he outlines plaintiff's medical history
Dr. Rubin issued his report on January 30, 2013, and concluded that the records and examinations supported a finding of plaintiff's functional impairment from the initial date of the claim through June 30, 2012. (Id.) Specifically, Dr. Rubin found that the records showed that plaintiff was suffering from impairments including "chronic neuropathic pain affecting the face, allodynia, diminished neurocognition, diminished memory, and poor concentration" from December 14, 2011 through March 30, 2012; Dr. Rubin, however, opined that "[i]t is reasonable that these impairments will continue for another three months through 6/30/12." (Id.)
Dr. Rubin stated that "[f]unctional impairment is not supported from 7/1/12 through 8/19/12.
Aetna allegedly mailed Dr. Rubin's IPC report to Dr. Sirois on February 6, 2013, and demanded that he review and respond to the report (including whether or not he agreed with the conclusions) within five calendar days. (Id. at 234.) Dr. Sirois did not respond. On March 1, 2013, defendant notified Valentine that it had decided to adopt the opinion of Dr. Rubin, partially overturn its previous denial of her claim and grant her benefits through June 30, 2012, noting that the IPC found that plaintiff's functional impairment was supported by the medical records through March 30, 2012, and it would have been reasonable to expect those impairments to continue only for another three months. (Id. at 237.) Defendant's letter, which for the most part mirrors Dr. Rubin's report, did not reference any of the medical examinations or reports from Dr. Sirois or Pasternak subsequent to March 30, 2012. The letter stated, "There is a lack of medical findings (i.e. examination findings as of July 1, 2012, cognitive evaluations, or functional examination or correlations, etc.) to support Ms. Valentine's inability to perform
Plaintiff filed the complaint on March 18, 2014. On April 25, 2014, defendant filed its answer. On October 22, 2014, defendant filed its motion for summary judgment. On November 21, 2014, plaintiff filed her cross-motion for summary judgment. Defendant filed its reply in support of its motion and opposition to plaintiff's motion on December 22, 2014. Plaintiff filed her reply in support of her cross-motion on January 9, 2015. Defendant filed an additional reply in support of its motion to strike plaintiff's extra-record submissions on January 16, 2015. The Court heard oral argument on February 6, 2015. Defendant submitted a supplemental letter regarding ERISA's requirements regarding the inclusion of certain language in the Plan on February 11, 2015. Plaintiff submitted a response on February 13, 2015. The matter is fully submitted.
The standards for summary judgment are well settled. Pursuant to Federal Rule of Civil Procedure 56(c), a court may not grant a motion for summary judgment unless "the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c); Globecon Group, LLC v. Hartford Fire Ins. Co., 434 F.3d 165, 170 (2d Cir.2006). The moving party bears the burden of showing that he or she is entitled to summary judgment. See Huminski v. Corsones, 396 F.3d 53, 69 (2d Cir.2005). The court "is not to weigh the evidence but is instead required to view the evidence in the light most favorable to the party opposing summary judgment, to draw all reasonable inferences in favor of that party, and to eschew credibility assessments." Amnesty Am. v. Town of W. Hartford, 361 F.3d 113, 122 (2d Cir.2004); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) (holding that summary judgment is unwarranted if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party").
Once the moving party has met its burden, the opposing party "must do more than simply show that there is some metaphysical doubt as to the material facts ... [T]he nonmoving party must come forward with specific facts showing that there is a genuine issue for trial." Caldarola v. Calabrese, 298 F.3d 156, 160 (2d Cir.2002) (quoting Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986)). As the Supreme Court stated in Anderson, "[i]f the evidence is merely colorable, or is not significantly probative, summary judgment may be granted." Anderson, 477 U.S. at 249-50, 106 S.Ct. 2505 (citations omitted). Indeed, "the mere existence of some alleged factual dispute between the parties" alone will not defeat a properly supported motion for summary judgment. Id. at 247-48, 106 S.Ct. 2505. Thus, the nonmoving party may not rest upon mere conclusory allegations or denials, but must set forth "concrete particulars" showing that a trial is needed. R.G. Group, Inc. v. Horn & Hardart Co., 751 F.2d 69, 77 (2d Cir.1984) (internal quotations omitted). Accordingly, it is insufficient for a party opposing summary judgment "merely to assert a conclusion without supplying supporting arguments or facts." BellSouth Telecomms., Inc. v. W.R. Grace & Co., 77 F.3d 603, 615 (2d Cir.1996) (internal quotations omitted).
A denial of benefits under ERISA "`is to be reviewed under a de
Here, the Plan explicitly affords defendant such discretionary authority.
In particular, according to the Second Circuit, an administrator's decision is arbitrary and capricious "if it was `without reason, unsupported by substantial evidence or erroneous as a matter of law.'" Krauss, 517 F.3d at 623-24 (quoting Fay v. Oxford Health Plan, 287 F.3d 96, 104 (2d Cir.2002)). In particular, "[s]ubstantial evidence is `such evidence that a reasonable
Thus, "[u]nder the arbitrary and capricious standard, the scope of judicial review is narrow." Celardo, 318 F.3d at 146; see also Miller, 72 F.3d at 1070 ("When an employee benefit plan grants a plan fiduciary discretionary authority to construe the terms of the plan, a district court must review deferentially a denial of benefits...."); Lee v. Aetna Life and Cas. Ins. Co., No. 05 Civ. 2960, 2007 WL 1541009, at *4 (S.D.N.Y. May 24, 2007) ("Under the arbitrary and capricious standard of review, Aetna's decision to terminate benefits is entitled to deference...."); Butler v. New York Times Co., No. 03 Civ. 5978, 2007 WL 703928, at *3 (S.D.N.Y. Mar. 7, 2007) ("Under the `arbitrary and capricious' standard the scope of review is a narrow one. A reviewing court must consider whether the decision was based on a consideration of the relevant factors and whether there has been a clear error of judgment.'" (quoting Bowman Transp. Inc. v. Ark.-Best Freight Sys., 419 U.S. 281, 285, 95 S.Ct. 438, 42 L.Ed.2d 447 (1974))); Greenberg v. Unum Life Ins. Co. of America, No. 03-CV-1396, 2006 WL 842395, at *8 (E.D.N.Y. Mar. 27, 2006) ("Decisions of the plan administrator are accorded great deference: the court may not upset a reasonable interpretation by the administrator.... Accordingly, it is inappropriate in this setting for the trial judge to substitute his judgment for that of the plan administrator.") (citations and quotation marks omitted).
"The legal standard for considering evidence outside the administrative record depends on the standard of review to be applied to the claim. For a de novo review of the administrator's decision, `the district court ought not to accept additional evidence absent good cause.' [Zervos, 277 F.3d at 646.] For a review under the `arbitrary and capricious' standard, however, `a district court's review ... is limited to the administrative record. Miller, 72 F.3d at 1071." Parisi v. UnumProvident Corp., No. 03-CV-1425, 2007 WL 4554198, at *8 (D.Conn. Dec. 21, 2007); see Miller, 72 F.3d at 1071 ("We follow the majority of our sister circuits in concluding that a district court's review under the arbitrary and capricious standard is limited to the administrative record."); Fitzpatrick v. Bayer Corp., No. 04 Civ. 5134, 2008 WL 169318, at *9 (S.D.N.Y. Jan. 17, 2008) ("In assessing whether the decision of the administrator was reasonable, the court may not consider extrinsic matters but must remain within the bounds of the administrative record considered by the plan's decision-maker.") (citation and quotation marks omitted); Leccese v. Metro. Life Ins. Co., No. 05-CV-6345, 2007 WL 1101096, at *5 (W.D.N.Y. Apr. 12, 2007) ("The Second Circuit has considered whether a district court should consider evidence that was not before the plan administrator and held that additional evidence may be considered upon de novo review of an issue of plan interpretation. However, since the parties agree that the standard of review in this case is arbitrary and capricious, the Court is limited to a review of the record as it existed before the plan administrator.") (citations and quotation marks omitted); Nelson v. Unum Life Ins. Co. of Am., 421 F.Supp.2d 558, 572 (E.D.N.Y.2006) ("Thus, in determining whether Unum's denial of benefits was arbitrary and capricious, it is proper to consider nothing more and nothing less than the administrative record."), aff'd, 232
Defendant argues that its decision to deny plaintiff any benefits beyond June 30, 2012, was not arbitrary and capricious because plaintiff did not submit sufficient evidence, such as clinical findings or objective test results, to support a functional impairment after that date.
"It has long been the law of this Circuit that `the subjective element of pain is an important factor to be considered in determining disability.'" Connors v. Connecticut Gen. Life Ins. Co., 272 F.3d 127, 136 (2d Cir.2001) (quoting Mimms v. Heckler, 750 F.2d 180, 185 (2d Cir.1984)).
The Second Circuit vacated the decision of the district court for several reasons. First, the Second Circuit found that Principal erred by failing to "give adequate attention to Miles's subjective complaints, as it failed to either assign any weight to them or to provide specific reasons for its decision to discount them." Id. at 486-88. The court of appeals found that Principal's disregard for Miles' subjective complaints solely because of their subjectivity, without any other valid reason to discount the evidence in the record, was arbitrary and capricious. Id. Second, the Second Circuit held that Principal's request for objective evidence that Miles was suffering from tinnitus was unreasonable, given that Principal did not itself identify to the claimant any test which would provide conclusive, objective evidence of his impairment. Id. at 488-89. Third, the Second Circuit
Here, after a careful review of the administrative record with respect to Valentine's claim, the Court finds that this case bears a strong resemblance to Miles. Dr. Rubin's IPC report-which defendant cites as the basis for its partial reversal of the initial denial of plaintiff's claim, wherein it accepted plaintiff's claim through June 30, 2012, and denied her benefits subsequent to that date (see VAL 237; Def.'s Mem. of Law, ECF No. 22, at 22-23)-is utterly perplexing when compared to the administrative record. Dr. Rubin first determined that plaintiff's functional impairment was supported through March 30, 2012, based on her subjective complaints and the supporting medical records regarding her "chronic neuropathic pain affecting the face, allodynia, diminished neurocognition, diminished memory, and poor concentration." (VAL 282.) Dr. Rubin then opined, without further explanation, that it "is reasonable that these impairments will continue for another three months through 6/30/12."
The Court finds these statements to be entirely inconsistent with the overall administrative record. Dr. Rubin clearly credited plaintiff's objective and subjective symptoms-based on the supporting medical records provided by Dr. Sirois — in finding that her functional impairment was proven through March 30, 2012, and provided an extensive summary of Dr. Sirois' visit notes through that date in his report. Then, without explanation or, indeed, any discussion whatsoever, Dr. Rubin seemingly ignored the entire administrative record
Dr. Rubin instead concluded, without explanation, that there was a "paucity of records" to describe plaintiff's medical, cognitive, and functional examinations and evaluations after March 30, 2012. Although the Court does not conclude that the medical records contained in Valentine's claim file irrefutably support a disability finding, the administrative record in this case certainly could not be described as having a "paucity" of records regarding all of those topics subsequent to March 30, 2012. As discussed above, Dr. Sirois' APS report and office visit notes alone describe multiple medical examinations of plaintiff, in which she showed some measure of improvement over time, but nonetheless consistently displayed the same objective and subjective symptoms and medication side effects (including mechanical allodynia, chronic pain, tiredness, fogginess, and diminished concentration) that Dr. Rubin described as being present in the records prior to March 30, 2012. (VAL 497-526.) Dr. Sirois concluded that these symptoms caused her to be functionally impaired such that she could perform her old job at Hubbard throughout this time. (VAL 500-01.) Pasternak's vocational expert report and plaintiff's affidavit provide additional support for these findings. Aetna, therefore, clearly failed to "assign any weight" or "provide specific reasons for its decision to discount" plaintiff's subjective (or objective) complaints, supported by the findings of her treating physician and vocational expert. Miles, 720 F.3d at 486-88. While defendant is not required to accept plaintiff's evidence, including her subjective complaints, at face value, it must "properly consider[] and reject[]" that evidence "for specific reasons supported by the record."
As discussed above, Aetna failed to fully and fairly review aspects of plaintiff's evidence during its claim administration process. The Court does not conclude that Valentine's claim, upon full consideration of the record, must necessarily be granted. In other words, the Court does not conclude that there is no possible evidence that would support a denial of benefits. The appropriate remedy in this situation, therefore, as the Second Circuit noted in Miles, is to return this case to the administrator for reconsideration based on the entire administrative record. See id. at 490 ("Our precedents make clear that even where we conclude a plan administrator's finding was arbitrary and capricious, we will typically not substitute our own judgment, but rather will return the claim for reconsideration unless we `conclude that there is no possible evidence that could support a denial of benefits.' ... Among other things, remand will afford Principal the opportunity to consider the evidence under the appropriate legal standards and, if it wishes, to evaluate Miles. We do not suggest that those are the only appropriate considerations on remand, and we intend no limitation by mentioning them. Principal is expected to provide a full and fair reconsideration of Miles's claim." (quoting Miller v. United Welfare Fund, 72 F.3d at 1074)); see also Shore v. Painewebber Long Term Disability Plan, No. 04-CV-4152 (KMK), 2007 WL 3047113, at *14 (S.D.N.Y. Oct. 15, 2007) ("At this time, the Court is not prepared to find that Reliance is unwilling or unable to fairly evaluate Plaintiff's claim for benefits, and Plaintiff points to nothing in the record, other than Reliance's denial of her claim, that proves otherwise."); Robinson v. Metro. Life Ins. Co., No. 05 Civ. 1534(LLS), 2006 WL 1317019, at *2 (S.D.N.Y. May 12, 2006) (granting summary judgment and remanding claim for reconsideration because "there is no basis for granting Ms. Robinson's claim and directing MetLife to provide her with long-term disability benefits. The record evidence is insufficient to compel the finding that a reasonable fiduciary must grant her claim.").
For the foregoing reasons, after careful review of the entire administrative record, and according Aetna a deferential standard of review, the Court concludes that defendant's decision to terminate plaintiff's long term disability benefits beyond June 30, 2012 failed to address substantial evidence in the record, and was thus arbitrary and capricious as a matter of law. Plaintiff's claim is, therefore, remanded to Aetna for reconsideration, including the updated November 29, 2012 APS report from Dr. Sirois, his supporting office visit notes, the Pasternak vocational expert report, and plaintiff's affidavit.
SO ORDERED.
