STANLEY R. CHESLER, District Judge.
This matter comes before the Court upon the filing by Defendant Bayer Corporation ("Bayer"), Defendant Matrix Absence Management ("Matrix"), and Defendant Bayer Corporation Disability Plan (collectively "Defendants") of a motion for summary judgment (Docket No. 71), pursuant to Federal Rule of Civil Procedure 56. Plaintiff Alexander N. Prezioso ("Plaintiff) has submitted a brief in opposition (Docket No. 74), and Defendants have submitted a reply brief (Docket No. 91). The Court has reviewed the parties' submissions and proceeds to rule without oral argument.
From August 1, 2008 to June 6, 2012, Plaintiff worked for Bayer as a U.S. Deputy Director of Medical Affairs. Def. SUMF ¶ 51. Bayer is a Plan Administrator of a medical disability plan (the "Plan") offered to its employees, including Plaintiff.
The Plan includes STD benefits for disabilities lasting less than 26 weeks, as well as LTD benefits for disabilities lasting longer than 26 weeks. Plan Doc. 121, 126. The Plan defines disability as being "under the care of a physician whose specialty or experience is appropriate for your condition" and that, "based on objective medical evidence," results in the covered employee being "unable to do your job." Def. SUMF ¶ 3.
To receive long-term disability under the Plan, the claimant 1) "must be unable to perform the essential duties of [the claimant's] regular occupation; 2) must provide "objective medical evidence satisfactory to the company or its delegate in its sole discretion, to support [the claimant's] initial claim for, and continuing eligibility to receive, disability benefits"; and 3) must apply for disability benefits under the Social Security Act ("SSDI"). Plan Doc. 128, 130. After 18 months of receiving LTD benefits, the claimant may only continue to receive such benefits if she is "totally disabled," which the Plan defines as being "unable to work at any job for which you are or could become qualified by education, training, or experience." Plan Doc. 126.
The Plan authorizes Bayer to terminate LTD benefits for various reasons, including if the claimant does not "provide satisfactory objective medical evidence of [the] continuing disability," is no longer disabled, or is "no longer under the regular care of a physician whose specialty or experience is appropriate for [the claimaint's] condition." Plan Doc. 127.
On June 6, 2012, Plaintiff stopped working and applied for STD benefits. Plaintiff's primary care physician, Dr. Orlandoni, diagnosed Plaintiff with fatigue, arthralgias (i.e. joint pain
Subsequent to these medical visits, Matrix determined that it was "unlikely the EE [employee] will be able to RTW [return to work] to perform sedentary duties as of LTD effective date of 12/5/12." CF 2084. Matrix subsequently approved Plaintiff for LTD benefits, effective December 5, 2012. Def. SUMF ¶ 34. By letter dated February 8, 2013, Matrix denied Plaintiff's LTD benefits, stating that "there is no objective medical evidence that supports ongoing disability." CF 131-132. During this time period, the following medical professionals opined on Plaintiff's condition and his estimated return to work:
In July 2013, Plaintiff appealed his denial of LTD benefits, arguing that reexamination was warranted based on the following medical restrictions: 1) "permanent residual damage, pain and loss of function and range of motion to both hands," constant numbing and paresthesia, and chronic fatigue resulting from the 1997 motorcycle accident; 2) cervical disk herniations; 3) elevated levels of uric acid; 4) toxic heavy metals from the right hip prothesis; and 5) exacerbation of these conditions from the mono infection. CF 5-6.
In October 2013, orthopedic specialist Dr. Vega conducted an independent medical exam ("IME"). According to the report, Plaintiff indicated that his job was mainly sedentary. Def. SUMF ¶ 43. In the IME, Dr. Vega determined that Plaintiff's multiple medical conditions did not preclude sedentary work (CF 275-276), as Plaintiff's multiple subjective symptoms were not corroborated by objective diagnostic exams that indicated an inability to perform sedentary work. As such, Dr. Vega reported that Plaintiff was not disabled from February 1, 2013 onward. Def. SUMF ¶ 43. Plaintiff was awarded SSDI benefits in October 2013. During the examination for those benefits, disability examiner Dr. Park determined that "based on the medical evidence the claimant retains a RFC [residual functional capacity] for [] sedentary work." Def. ¶ 44; SUMF CF 2117.
In November 2013, the Committee notified Plaintiff that it was upholding the denial of LTD benefits, on the basis that Plaintiff had failed to provide objective medical evidence of his ongoing disability as required by the Plan. CF. 1
Plaintiff filed suit in May 2014, and in May 2015 he notified Defendants of certain items "missing from the administrative record." CF 3629. In a motion dated December 2015, Defendants conceded that the final benefit determination on appeal was based on an incomplete administrative record (Docket No. 28-1, 2), and accordingly Defendants sought voluntary remand. Def. SUMF ¶ 48. By Order dated January 21, 2016, this Court granted Defendants' voluntary request for remand and stayed the lawsuit pending the Committee's "completion of the evidentiary record and review of the full record." Docket No. 35, 1-2.
Following remand, Plaintiff did not submit additional medical evidence regarding the ongoing nature of his medical condition, but he did take issue with the Committee's characterization of his job requirements. Def. SUMF ¶ 50; CF 574-575 ("The Administrative Records reflects that Defendants over the course of time, downgraded my job description from light to medium with travel to sedentary, travel not mentioned, without providing any documentation. . ."). The Committee solicited three medical reviews to address Plaintiff's job requirements:
Citing the above factors as well as the material added to the administrative record after the voluntary remand, the Committee upheld the denial of Plaintiff's LTD benefits in March 2016 (Def. SUMF ¶ 54), at which point Plaintiff filed a motion to compel production of additional material. By Order dated December 8, 2016, Magistrate Judge Cathy Waldor remanded the case once again, in order for Defendants to produce "travel and expense reports"— such as time logs, expense accounts, airline records, etc—that Plaintiff could present on remand as evidence of his position's vocational requirements. Docket No. 50, 4-5.
Following the second remand, Plaintiff argued that the job duties were light to moderate with travel. Def. SUMF ¶ 58. In support of this contention, Plaintiff submitted two reports:
To address these two medical evaluations, the Committee solicited two further medical reviews:
After Drs. Agnew and Thomas submitted their reports, Plaintiff submitted responses from Dr. Arena and Ms. Mocarski. Def. SUMF ¶ 65. By letter dated November 3, 2017, the Committee notified Plaintiff that, having considered the additional letters and evidence, it determined that Plaintiff was not disabled from performing his job and it therefore upheld the denial of the LTD benefits. Def. SUMF ¶ 66.
Summary judgment is appropriate under Federal Rule of Civil Procedure 56 where "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a);
Once the moving party satisfies its burden under Rule 56, the non-moving party "must do more than simply show that there is some metaphysical doubt as to the material facts."
Under ERISA § 502(a)(1)(B), codified at 29 U.S.C. § 1132(a)(1)(B), a participant in a benefits plan covered by ERISA may bring civil suits to "to recover benefits due to him under the terms of his plan." Federal courts examine such challenges under de novo review unless, as here, "the benefit plan expressly gives the plan administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the plan's terms."
A court may generally only conduct its review by reference to the record as it existed before the plan administrator when it made the challenged decision.
Under the arbitrary and capricious standard, courts should uphold the plan administrator's determination to deny benefits unless it was "without reason, unsupported by substantial evidence, or erroneous as a matter of law."
In their moving papers, Defendants argue that the administrative record and review process, including the evidence supplemented by the two remand reviews, does not demonstrate that the denial of Plaintiff's LTD benefits was arbitrary and capricious. In particular, Defendants argue that the record—including Plaintiff's treatment record, the orthopedic IME, the occupational ODA, the physical therapy PCA, and the various independent vocational and physician reviews—confirm that "Plaintiff was not precluded from performing his regular occupation as of February 1, 2013 or any job for which he is or could become qualified, as of June 5, 2014." Docket No. 71-2, 6-7.
Plaintiff counters that the determination was arbitrary and capricious due to "structural and procedural irregularities," and because a "conflict of interest impacted Defendants [sic] decision." Docket No. 74, 4-5. Although not organized as such in his moving papers, Plaintiff's various arguments appear to group within four broad claims: 1) the denial of LTD benefits was based on a previously undisclosed version of the Plan; 2) Defendants improperly reclassified Plaintiff's job requirements from "light to medium" to "sedentary" during the LTD review; 3) Defendants and various reviewing physicians were improperly motivated by conflicts of interest; and 4) miscellaneous arguments indicate the presence of genuine issues of material fact.
In reviewing the motion at bar, this Court has meticulously examined the parties' 56.1 statements, the disability Plan, as well as the numerous medical reports, plan documents, and inter-party correspondence contained in the nearly 7,000 page claim file. Based on this review, this Court is satisfied that Defendants' decision to deny LTD benefits was not arbitrary and capricious or an abuse of discretion, but rather was reasonable and supported by substantial evidence. Because Plaintiff fails to raise a genuine issue of material fact, this Court will grant Defendants' motion for summary judgment on both the claim for denial of benefits under ERISA 502(a)(1)(B) and for breach of fiduciary duty under ERISA § 502(a).
Based on the administrative record following the two remand reviews, this Court is satisfied that Defendants have reasonably relied on substantial evidence to support their determination that Plaintiff was not disabled from performing the essential duties of his position. Following Defendants' voluntary remand, Plaintiff did not submit additional medical documentation to demonstrate the ongoing nature of his disability, but he did take issue with the Committee's characterization of the job requirements. To address this concern, the Committee:
1) obtained the ODA based on Plaintiff's former colleague Edio Zampaglione; 2) received a medical review from orthopedic surgeon Dr. Agnew; and 3) obtained an independent vocational review from Horizon, which determined that Plaintiff was not "totally disabled" from performing
Following Plaintiff's submission of medical reports from Dr. Arena and Ms. Mocarski subsequent to the second remand, the Committee solicited two further medical reports, in order to determine whether Plaintiff could meet the essential travel requirements of his former position. In the first report, Dr. Agnew reviewed the 2016 ODA, in which Mr. Zampaglione noted that the position required up to 20% of "very flexible" "domestic" travel, as well as the vocational rehabilitation assessment from Ms. Mocarski. Dr. Agnew concluded that even if
Subsequent to the second remand, Defendants also solicited an independent physician review from orthopedic surgeon Dr. Thomas, who thoroughly reviewed Plaintiff's treatment history, including an examination of Dr. Vega's IME hip exam, the notes from rheumatologist Dr. Golombek, the metal ion testing and prosthesis evaluation from orthopedist Dr. Colizza, orthopedic surgeon Dr. Bouillon's notes, and Dr. Park's SSA review. In evaluating all of this medical evidence—and proceeding from the same assumption that Ms. Mocarski and Mr. Zampglione accurately characterized the exertional requirements of the position—Dr. Thomas similarly concluded that Plaintiff was not disabled from performing his job. In view of the substantial medical evidence examined by the Committee and its reviewing physicians, this Court is satisfied that Defendants did not abuse their discretion or act in an arbitrary and capricious manner when they denied Plaintiff LTD benefits.
Not only have Defendants adequately demonstrated that the denial of LTD benefits was reasonable and supported by substantial evidence, Plaintiff has failed to indicate that there are genuine issues of material fact that preclude summary judgment. In short, Plaintiff's arguments are either unsupported by the record or fail to rebut or discredit the substantial evidence that underlies Defendants' decision.
In his moving papers, Plaintiff argues, for the first time in this litigation, that the "Plan (`2014 Plan') presented here is not the Plan that was in effect during the Plaintiff's disability case" (Pl. SUMF ¶ 2) and that this `2014 Plan' "did
In light of the serious nature of this allegation, this Court has scrupulously reviewed the administrative record, including the Plan as appended to Plaintiff's May 16, 2014 complaint (Docket No. 1-1, "Compl.," Ex. A); the plan as produced to Plaintiff on January 6, 2015 pursuant to Defendants' discovery disclosures under Rule 26(a)(1) (Docket No. 91-3, Reply Ex. 1); the Plan as produced to Plaintiff on April 1, 2015 in response to Plaintiff's discovery request for a copy of the "Summary of my LTD benefits" (Docket No. 91-4, Reply Ex. 2); and the plan as presented in Defendants' motion at bar (Docket No. 71-5, Ex. A).
Having conducted this review, this Court is satisfied that Defendants have not, as Plaintiff argues, "covertly and surreptiously added" a previously undisclosed Plan. Instead, Plaintiff's May 2014 complaint appears to append an incomplete version of the Plan, in which the document ends mid-sentence on page 29 ("The Savings & Retirement Plan — a plan intended to qualify under Section 401(a) and 401(k) of the Internal. . ."). Plaintiff's incomplete version attached to the complaint omits the subsequent pages that complete the sentence and detail the terms and conditions for LTD benefits eligibility. As Defendants produced to Plaintiff a full and complete copy of the Plan on numerous occasions during the administrative review process, Plaintiff's argument is unsupported by the record and accordingly fails to raise any genuine issues of material fact.
Plaintiff argues that "An egregious action by the Defendants was to reclassify the Plaintiff's job duties from light to medium with travel to an entirely new description of sedentary activity level of exertion for his job duties." Docket No. 74, 8. As evidence that Defendants initially classified the job duties as "light to medium," Plaintiff cites two Bayer human resource documents in the claim file, which both indicate "light to medium with travel" under the subsection header "Job Description/Occupation/DOT." CF 252; 230. The job description to which Plaintiff cites, however, further notes that there was "no job description yet on file; requested." Such documents provide an insufficient basis to substantiate Plaintiff's argument that Defendants reclassified his job duties from "light to medium" to sedentary, as the quoted documents themselves indicate that there was "no job description on file."
Even if this Court accepted Plaintiff's argument, such reclassification would not be dispositive because the entire issue is ancillary to this Court's primary review. Namely, this Court's task is not to assess whether Defendants accurately labeled the job requirements, but rather whether Defendants determined—reasonably and supported by substantial evidence—that Plaintiff was "unable to perform the essential duties of [his] regular occupation." Plan Doc. 125. To make that determination, both Dr. Agnew and Dr. Thomas based their review on the job description from Plaintiff's own expert's as well as the 20% travel requirement from Mr. Zampaglione's ODA. Based on such an assumption, both doctors found that Plaintiff was not precluded from performing his job duties. Further, Plaintiff has provided no objective medical evidence to contradict the medical determination that he is capable of meeting such travel demands. Accordingly, this Court is satisfied that Defendants did not abuse their discretion by determining that Plaintiff could satisfy the travel requirements of his position.
In his opposition papers, Plaintiff argues that Defendants' review process was compromised by structural conflicts of interest, because the Plan is "primarily funded by Bayer Corporation's general assets and Bayer Corporation has sole discretion to award or deny LTD benefits." Docket No. 74, 34. Plaintiff further argues that the independent medical reviews Defendants obtained before denying the LTD benefits were similarly compromised by bias or conflicts of interest.
As previously noted, subsequent to the Supreme Court's ruling in
Plaintiff advances other arguments for why summary judgment is not appropriate. Having reviewed the moving papers and the administrative record, this Court is satisfied that such arguments do not give rise to genuine issues of material fact.
Plaintiff argues that "Defendants never define, describe, qualify or quantify anywhere in the Disability Plan plain language what they consider as `Objective Medical Evidence.'" Pl. SUMF ¶ 6. However, the Plan specifically provides that the provision of such OME is determined by "the company or its delegate in its sole discretion" (Plan Doc. 130), so the failure to define OME does not render the decision arbitrary and capricious under
Plaintiff argues that the Committee acted arbitrarily and capriciously because they failed to rebut the medical opinions advanced by Plaintiff's medical experts.
At numerous points in his motion, Plaintiff contends that Defendants are conspiring to withhold relevant information.
In addition to a claim for denial of benefits under ERISA § 502(a)(1)(B), Plaintiff also asserts a claim for breach of fiduciary duty under ERISA § 502(a). Compl., 2. Section 502(a)(3) creates an equitable remedy for ERISA plan beneficiaries "A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan." 29 U.S.C. § 1132(a)(3). Such equitable relief is not appropriate, however, where the Plaintiff otherwise has an adequate remedy under other provisions of Section 502.
In his complaint, Plaintiff alleges that Defendants breached their fiduciary duty by, among other things, "fail[ing] to perform their administrative duties," failing "to provide [Plaintiff's] plan benefits in accordance with the plan," "through purported conflicts of interest," and by "ignoring" the medical opinions of certain physicians. Compl. ¶¶ 4, 10-12, 14-15, 17, 21. The complaint indicates that the alleged breach of fiduciary duty consisted of the denial of LTD benefits. Compl. ¶ 24 ("I suffered cognizable losses as a result of Bayer Corporation's breach of their fiduciary duty. As a result of Bayer Corporation's actions, I was denied my LTD benefits."). Plaintiff has an adequate remedy to address such injury, namely the first cause of action for denial of benefits under ERISA Section 502(a)(1)(B). Because the equitable catchall provision in Section 502(a)(3) is not appropriate for injuries otherwise recoverable under other provisions of Section 502, this Court will grant Defendants motion for summary judgment on this claim.
For the forgoing reasons, this Court will grant Defendants' motion for summary judgment and this Court will dismiss with prejudice both Plaintiff's claim for denial of benefits under § 502(a)(1)(B) as well as Plaintiff's claim for breach of fiduciary duty under ERISA § 502(a). An appropriate Order accompanies this Opinion.
Under Local Rule 56.1(a), the non-movant opponent to a motion for summary judgment is required to furnish a responsive statement that "address[es] each paragraph of the movant's statement, indicating agreement or disagreement and, if not agreed, stating each material fact in dispute and citing to the affidavits and other documents submitted in connection with the motion." Instead of indicating such agreement or disagreement with each of Defendants' proffered undisputed facts, Plaintiff's responsive statement largely consists of various arguments for why this Court should accord little weight to Defendants' facts.
Plaintiff's failure to comply with Local Rule 56.1 provides this Court the discretion to assume that Plaintiff accepts the facts in Defendants' statement that it does not specifically dispute.
