The opinion of the court was delivered by: MARILYN PATEL, Chief Judge, District
Re: Defendant's Motion for Partial Summary Judgment
This action arises from defendant Acuson Corporation Long Term
Disability Plan's ("Acuson") decision to terminate its payment of
disability benefits to plaintiff Daniel Firestone ("Firestone")
after the 24-month period set forth for mental illness-related
disabilities. Plaintiff has brought suit in this court seeking to
overturn defendant's decision according to the standards set
forth in the Employee Retirement Income Security Act ("ERISA").
Now before the court is defendant's motion for partial summary
judgment on the issue of what standard of review this court
should apply when evaluating defendant's decision to terminate
benefits. Having considered the arguments presented and for the
reasons stated below, the court enters the following memorandum
I. Firestone's Disability Plan
On April 20, 2000, plaintiff Daniel Firestone ceased working as
a purchasing manager for Acuson Corporation due to his disability
or disabilities at issue in this case. As an employee of Acuson,
Firestone was covered under the company's Long Term Disability
Plan, issued by Liberty Life Assurance Corporation to Acuson. Gallegos Dec., Exh. A, at
GBP-24. As its name may indicate, this plan provided long-term
disability benefits to qualified employees. See generally
id. In relevant part, the plan explained that:
When we [Liberty] receive proof that you [a covered
employee] are Disabled due to Injury or Sickness and
require the regular attendance of a Physician, we
will pay you a Monthly Benefit after the end of your
Elimination Period. The benefit will be paid for the
period of your Disability if you give to us proof of
1. Disability; and
2. regular attendance of a Physician.
Id. at GBP-013 (capitalization in original). While the plan
promised (in theory) to pay a limitless number of monthly
benefits for most typical physical disabilities, it placed a
specific restriction on the number of benefits that would be paid
to former employees who were disabled by "Mental Illness" or
"Drug and Alcohol Abuse":
The benefit for Disability due to Mental Illness and
Alcohol or Drug Abuse will not exceed 24 months of
Monthly Benefit payments unless you meet one of these
1. You are in a Hospital or Institution for Mental
Illness and Alcohol or Drug Abuse at the end of the
24 month period. The Monthly Benefit will be paid
during the confinement.
. . . .
Id. at GBP-016. In addition, and crucially, the plan stated
that "Liberty shall possess the authority, in its sole
discretion, to construe the terms of this policy and to determine
benefit eligibility hereunder." McGee Dec., Exh. A, at 24.
II. Liberty's Evaluation of Firestone's Disability Claim
Defendant received plaintiff's notice of disability claim on
June 21, 2000. On the submitted form, plaintiff identified his
psychiatrist, Dr. Frank Annis, as his treating physician, and
described his disability as "Depression, sluggishness, lack of
focus/concentration, anxiety. Onset over a prolonged period of
time becoming increasingly worse." McGee Dec., Exh. B, at CF 363.
Plaintiff noted also that he had "high blood pressure,
complicated by one kidney removed for cancer in 1997." Id.
Plaintiff explained that his illness had begun as early as April
1999. Dr. Annis, in turn, concluded that plaintiff suffered from a
"Class 4" mental/nervous impairment, viz., that "patient is
unable to engage in stressful situations or engage in
interpersonal relations," and a "Class 3" physical impairment,
viz., "slight limitation of functional capacity; capable of light
work" which he believed derived from plaintiff's high blood
pressure. Dr. Annis stated that plaintiff was taking various
psychiatric medications "for dealing with symptoms and major life
restructuring." Id. at CF 358-59. According to a record from a
previous office visit, those psychiatric medications were Xanax
and Zoloft, which plaintiff was ingesting in order to treat his
anxiety and depression. Id. at CF 372.
On July 2, 2000, Liberty Life's case manager reviewed
plaintiff's claim and recommended that Liberty Life approve the
claim based upon plaintiff's mental condition. Liberty, however,
decided that further investigation was warranted and spoke with
plaintiff's wife on July 6, 2000; she confirmed that "Mr.
Firestone is currently limited in his activities of daily living"
and his "depression is only slightly improving." Id. at CF 013.
Still not satisfied with the degree of information in their
position regarding plaintiff's condition, on July 17, 2000,
Liberty asked Stephanie Nelson, a Registered Nurse in Liberty's
Managed Disability Services (MDS) unit to review Firestone's
file. Nurse Firestone indicated that in her opinion "the
[doctor's] treatment for [plaintiff] does not appear consistent
with [plaintiff's] reported symptoms." Id. at CF 011.
Pursuant to this opinion, Liberty then requested further notes
and information from Dr. Annis on July 19, 2000. Id. at CF
350-53. In response to this request, Dr. Annis reported that his
Axis I diagnosis was that plaintiff suffered from a "major
depressive disorder," his Axis III diagnosis was of "s/p renal
cancer nephrectomy," that plaintiff's Axis IV psychosocial and
environment problems are "related to social environment" and
"include occupational problems," and that his Axis V GAF score
was 40. Dr. Annis described plaintiff's symptoms as "insomnia,
constriction of interest, difficulty concentrating, alteration in
affect, psycho motor agitation, psycho motor retardation,
depleted energy, suicidal ideation, decreased appetite and
feelings of guilt/unworthiness." Id. at CF 346. Dr. Annis
explained that he had prescribed Zoloft, Atenelil, Trazodone, and
Ativan, and stated that he believed that plaintiff would recover
fully by October 15, 2000. Id. at CF 344-46. Following the receipt of this information from Dr. Annis, Liberty notified
plaintiff that it had approved his claim for disability benefits.
Id. at CF 337-340. The letter of notification stated, inter
alia, that plaintiff's claim for benefits was being approved on
the grounds that he suffered from a mental disability, and
noted that twenty-four month limit on mental illness disability
On October 5, 2000, Firestone submitted a second Disability
Claim Form to Liberty, this time describing his disability as
"[c]ontinuous hypertension, rapid irregular heartbeat, acid
reflux discomfort, inability to swallow food, food impaction.
Symptoms growing worse thru [sic] late '99 into 2000." Id. at
CF 323. Plaintiff listed a new doctor, Seth Weissman, M.D., as
his treating physician.*fn2 Id. Several weeks later, Dr.
Weissman filed an "Attending Physician's Statement" ("APS") that
described plaintiff as suffering from "severe GERD"
(Gastrointestinal Reflux Disease) with "concurrent conditions" of
"high blood pressure, history of renal cell carcinoma, and
depression. Id. at CF 321. Dr. Weissman concluded that
plaintiff suffered from a Class 5 physical impairment, as well as
a Class 4 mental impairment. Id. at CF 322.
Presented with this new claim, Liberty requested additional
records and information from Drs. Weissman and Annis. Dr.
Weissman submitted paperwork indicating that plaintiff's Axis I
diagnosis was "major depressive disorder . . . panic disorder,"
his Axis III diagnosis was "stp [status post] kidney cancer," and
his Axis IV diagnosis was "severe work burn out." Id. at CF
307. Dr. Annis's further notes confirmed this, referencing
plaintiff's "Arethemia, GERD, and high blood pressure." Id. at
302-304. Liberty continued to request additional updated
information from Drs. Weissman and Annis, and on December 29,
2000, Dr. Weissman filed another APS stating that plaintiff still
suffered from a "Class 5" impairment, but one that was "due to
psychiatric > [sic] physical limitations." Id. at CF 296. Dr.
Weissman's subsequent office notes provide greater detail as to
plaintiff's physical state. Dr. Weissman's notes from February 5,
2001, describe symptoms including "occasional reflux" and
"episodes of arrhythmia," and conclude that "[t]he patient's
blood pressure control is fair on current regimen" but that the
patient will undergo further tests regarding his GERD. Id. at
CF 183. Dr. Weissman's notes from April 9, 2001, state that
plaintiff's GERD was "under pretty good control" but explain also
that "[t]he patient's blood pressure is not optimal" and describe periods of dizziness. Id. at CF 185-86. Finally,
Dr. Weissman's June 1, 2001, office notes, following a subsequent
examination of plaintiff, state that plaintiff's heartbeat has a
"[r]egular rate and rhythm without murmur" and describe his blood
pressure as "much better controlled on his current regimen," but
explain also that "the patient's [GERD] symptoms have returned."
Id. at CF 187.*fn3
Over the following months, Liberty continued to request more
information regarding plaintiff's condition, and plaintiff's
doctors continued to submit additional notes and reports that
described his changing status and shed more light on his evolving
health. On August 20, 2001, Liberty received a "Physical
Capabilities Form" from Dr. Weissman that opined that plaintiff
would not be able to work a full eight-hour workday.*fn4
Id. at CF 166-67. When asked for the reason for his opinion,
however, Dr. Weissman explained that "severe depression limits
Mr. Firestone at the current time." Id. at CF 167 (emphasis
added). On February 20, 2002, Dr. Annis sent to Liberty a new
"Functional Mental Status Evaluation" in which he stated, in
response to the Liberty's query regarding the manner in which
plaintiff's symptoms interfere with his ability to work, that
plaintiff "is mostly disabled by his physical
condition."*fn5 Id. at CF 149 (emphasis added).
In contradictory fashion, Dr. Weissman sent a note to Liberty
on March, 7, 2002, stating that Firestone was "primarily disabled
due to psychiatric condition." Id. at CF 142. Dr. Weissman
supplemented these notes with a "Physical Capacities Form" on
which he wrote that restrictions on plaintiff's physical
abilities and capacities were "based mostly on patient's
subjective complaints, overall fatigue and weakness." Id. at CF
144. The form also described Dr. Weissman's diagnosis of
plaintiff as including depression, high blood pressure, and GERD.
Id. However, in May of that year, on another Functional
Capabilities Form, Dr. Weissman submitted to Liberty a somewhat
different formulation of his diagnosis of plaintiff's condition,
explaining that Firestone's restrictions on activity were due to
his "severe depression which greatly limits his overall physical
activity." Id. at CF 69. Dr. Weissman also listed hypertension,
GERD, and renal cell carcinoma among plaintiff's "concurrent
conditions." Id. Regardless of the cause of plaintiff's
condition, Dr. Weissman's description of it painted a ...