Case Story: Our Client v. Bridgestone/Firestone Long Term Disability Benefits Plan

The plaintiff, our client, worked as a Curing Technician for Bridgestone until their ulcerative colitis and frequent diarrhea made it impossible for them to work.   Our client suffered from Crohn’s disease, a chronic illness that created inflammation of their digestive tract and resulted in abdominal pain, diarrhea, and fatigue.  Our client filed for LTD (long term disability) benefits under their company’s LTD plan, which was self-funded and self-administered by Bridgestone.

In February of 2000, the plaintiff began leave under the Family Medical Leave Act and was approved for short term disability (“STD”) benefits due to their ulcerative colitis and frequent diarrhea.   In July 2000, our client made a claim for benefits under the LTD plan and was approved effective September 2000.

In 2001, the defendant requested updated proof of their disability.  Our client submitted another Certificate of Disability from Dr. Daniel again opining that they could not do any work.  Dr. Bulen again agreed.  Our client also underwent a total proctocolectomy and ileostomy in 2001 and pathology reports confirmed a severely diseased bowel. (This procedure removed the large intestine and rectum and connected the ileum to a small opening in the skin of the abdomen, where a small pouch was attached to collect stool.) The defendant concluded that our client was still eligible for LTD.

Under the plan, after two years an employee must prove he or she is unable to perform any occupation and they must also be approved for Social Security benefits.  The plan provides that the Bridgestone Disability Committee initially determines whether an employee was eligible for LTD.  The claimant submits evidence, then this evidence is sent to a medical advisor, who reviews it and makes an oral presentation at the Disability Committee meeting. Based on the record and the opinion of the medical advisor, the Disability Committee determines whether or not to grant LTD benefits. If the Disability Committee denies LTD, the claimant may appeal to the Bridgestone Pension Board, which makes the final determination.  The Pension Board and its medical advisor review the record and determine eligibility.

In this case, after two years the plaintiff’s case was reviewed.  Our client submitted more records, including their Doctor’s Certificate of Disability from 2000 that stated our they were incapable of sedentary work, their surgery records, and more notes from their treating physicians concluding that our client was incapable of performing even sedentary activities. Drs. Daniel and Shull both submitted evidence that our client was still disabled.  The court found the record was replete with evidence that the plaintiff could not work beginning with the time our client stopped working.  For example, when the plaintiff developed ulcerative colitis and frequent diarrhea in 1999, their treating physician, Dr. Daniel, indicated our client was unable to work and could only return to work if their disease went into remission.  In 2000, he provided a Certificate of Disability concluding that our client was disabled from gainful employment.  A company medical doctor, Dr. Chastain, examined their and agreed with Daniel’s conclusion that our client was disabled.  Dr. Bulen, a non-examining file reviewer, reviewed the file and also concluded our client could not do their job.

However, Dr. Moten (the Disability Committee’s medical advisor) reviewed these records and made a presentation at the Disability Committee meeting. The Disability Committee reviewed their record and listened to Dr. Moten’s opinion.  No transcript or memo of Dr. Moten’s statements or presentation was made.   A handwritten note on an internal memorandum stated that he did not “feel our client meets the requirements for continued benefits.  NO physical dis [sic].  Mental?” Based on Dr. Moten’s opinion, Bridgestone decided that the plaintiff was not disabled and would no longer receive LTD benefits.  The plaintiff appealed this decision to the Pension Board.  The Pension Board reviewed the file and after this review, agreed with the Disability Committee’s determination that our client was not disabled.

Because the Bridgestone LTD plan granted the Bridgestone decision makers discretion, as most LTD policies and plans do, the case in court was decided under an arbitrary and capricious standard of review.  The court, in this case, explained that, under the arbitrary and capricious standard, as long as the administrator’s decision is rational, it will not be found arbitrary and capricious.  Elliott v. Lockheed Martin Energy Systems, 61 F.Supp. 745, 751 (E.D.Tenn. 1999).  However, the plan administrator “may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.”  Black & Decker v. Nord, 538 U.S. 822, 834, 123 S.Ct. 1965, 155 L.Ed2d 1034 (2003).  At a minimum, the plan administrator must perform “some review of the quality and quantity of the medical evidence and the opinions on both sides of the issues.”  McDonald v. Western-Southern Life Insurance Company, 347 F.3d 161, 172 (6th Cir. 2003).

In this case, the plaintiff submitted extensive records of their Crohn’s disease and their treating physicians all agreed that our client was disabled from all employment.  There was no written evidence in the record that our client could perform any job.  Despite this, Dr. Moter concluded that our client was not disabled and the Disability Committee relied on his opinion.  He never treated or examined the plaintiff; moreover, he was not a gastroenterologist.  Most importantly, there was no written evidence of his report to the Disability Committee and this report was apparently what the Committee relied upon to reach its decision. Because Bridgestone found the plaintiff disabled without any written evidence in the record to support this finding, the court found the decision to deny their benefits arbitrary and capricious.

The court granted reasonable attorney’s fees and costs to the plaintiff.  The court pointed to the complete lack of any medical opinion to support the defendant’s decision to deny their benefits and decided that granting their attorney’s fees and costs were reasonable in this instance.  The award did not include amounts expended in pursuing claims upon which the plaintiff was unsuccessful, but were not part of their claim for benefits.

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