Myers v. Bridgestone/Firestone Long-Term Disability Benefits Plan
No. 4:03-CV-60, 2005 WL 1240603 (E.D.Tenn. March 1, 2005) (Unpublished).
The plaintiff, our client, worked as a Curing Technician for Bridgestone until her ulcerative colitis and frequent diarrhea made it impossible for her to work. She suffered from Crohn’s disease, a chronic illness that created inflammation of her digestive tract and resulted in abdominal pain, diarrhea, and fatigue. She filed for LTD (long term disability) benefits under her 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 her ulcerative colitis and frequent diarrhea. In July 2000 she made a claim for benefits under the LTD plan and was approved effective September 2000.
In 2001 the defendant requested updated proof of her disability. She submitted another Certificate of Disability from Dr. Daniel again opining that she could not do any work. Dr. Bulen again agreed. She 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 she 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 she 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. She submitted more records, including her Doctor’s Certificate of Disability from 2000 that stated she was incapable of sedentary work, her surgery records, and more notes from her treating physicians concluding that she was incapable of performing even sedentary activities. Drs. Daniel and Shull both submitted evidence that she was still disabled. The court found the record was replete with evidence that the plaintiff could not work beginning with the time she stopped working. For example, when the plaintiff developed ulcerative colitis and frequent diarrhea in 1999, her treating physician, Dr. Daniel, indicated she was unable to work and could only return to work if her disease went into remission. In 2000 he provided a Certificate of Disability concluding that she was disabled from gainful employment. A company medical doctor, Dr. Chastain, examined her and agreed with Daniel’s conclusion that Myers was disabled. Dr. Bulen, a non-examining file reviewer, reviewed the file and also concluded she could not do her 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 her 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 Ms. Myers 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 she 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 her Crohn’s disease and her treating physicians all agreed that she was disabled from all employment. There was no written evidence in the record that she could perform any job. Despite this, Dr. Moter concluded that she 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 her 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 her benefits and decided that granting her 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 her claim for benefits.