The opinion of the court was delivered by: Dolly M. Gee United States District Judge
FINDINGS OF FACT AND CONCLUSIONS OF LAW
This matter is before the Court following a bench trial on the administrative record on October 14, 2010. Peter S. Sessions of Kantor & Kantor LLP appeared on behalf of Plaintiff, Terrance Burnett. Robert K. Renner of Barger & Wolen LLP appeared on behalf of Defendants, Raytheon Company Short-Term Disability Plan and Raytheon Company Long-Term Disability Plan. After the parties filed supplemental briefs, the Court took the matter under submission on October 28, 2010.
Having carefully reviewed the administrative record and the arguments of counsel, as presented at the hearing and in their written submissions, the Court makes the following findings of fact and conclusions of law pursuant to Rule 52 of the Federal Rules of Civil Procedure.
1. The Raytheon Company ("Raytheon") provides a short-term disability benefits plan ("STD Plan") and long-term disability benefits plan ("LTD Plan") for the benefit of its employees. (Administrative Record ("A.R.") 1--87 [Doc. # 16].)
2. The STD Plan designates Metropolitan Life Insurance Company ("MetLife") as a Claims Administrator for the Plan:
2.5 Claims Administrator means the Metropolitan Life Insurance Company or other entity or individual designated by the Plan Administrator to administer claims filed under the Plan. (A.R. 6.)
3. The STD Plan vests MetLife, as the Claims Administrator, with discretionary authority to determine eligibility for benefits:
6.1 Designation of Plan Administrator. The general administration of the Plan shall be the responsibility of the Company. The Company shall be the Plan Administrator and named fiduciary for purposes of ERISA. Benefits under this Plan will be paid only if the Claims Administrator decides it is in its discretion that the Participant is entitled to them. All determinations of the Plan Administrator and Claims Administrator with respect to any matter within their discretion assigned responsibilities hereunder shall be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious.
6.2 Discretion to Interpret Plan. The Plan Administrator and Claims Administrator, within their respective areas of authority, shall have absolute discretion to construe and interpret any and all provisions of the Plan . . . . The decisions of the Plan Administrator upon all matters within the scope of its authority shall be binding and conclusive upon all persons. With respect to all issues arising under claims for benefits and appeals with respect thereto, the Claims Administrator shall have full discretion and final authority to interpret the Plan, and its decisions as to claims shall be binding and conclusive upon all persons.
* * * 6.4 Duties of Claims Administrator. Determination of all claims for Benefits and questions which may arise under the Plan with respect to the payment of Benefits shall be made by the Claims Administrator in accordance with the provisions of the Plan and consistent with the Claims Administrator's fiduciary obligations. The Claims Administrator shall provide a full and fair review of any claim that is denied, in whole or in part. All decisions regarding claims for Benefits under the Plan shall be based on objective evidence satisfactory to the Claims Administrator. Benefits under this Plan will be paid only if the Claims Administrator decides in its sole discretion that the claimant is entitled to them.
4. The Raytheon STD Plan defines "Full Disability" as follows:
2.11 Full Disability or Fully Disabled means that, due to an Injury or Sickness which is not covered by an applicable workers' compensation statute a Participant: (i) is under the regular care and attendance of a Doctor; and (ii) is unable to perform all of the essential elements of such Participant's regular job with reasonable accommodations. (A.R. 7.) Further, the STD Plan specifies the maximum duration of STD benefits:
2.13 Maximum Benefit Duration means . . . a ten (10) week period beginning on the date of the commencement of Benefits payable to a Participant. (A.R. 7.)
5. The Raytheon LTD Plan defines "Full Disability" as follows: 2.11 Full Disability or Fully Disabled means that, because of a sickness or injury which is not covered by an applicable workers' compensation statute, a Participant: (i) cannot perform the essential elements and substantially all of the duties of his or her job with the Employer even with a reasonable accommodation; and (ii) is under the care of a Doctor. (A.R. 39.)
6. The Raytheon LTD Plan provides for coordination of benefits with the STD Plan: 2.26 Waiting Period means with respect to each Period of Disability, the period for which a Participant is eligible for benefits under the Employer's short-term disability program. Participants must exhaust their short term disability benefits before Benefits become payable hereunder. (A.R. 40.)
7. The LTD Plan specifies the procedural requirements with which a Raytheon employee must comply to be eligible for LTD Benefits:
(A) All claims for Benefits under the Plan, regardless of the nature of the claim, shall be submitted to the Claims Administrator in writing on a form provided by the Claims Administrator, or in any other manner designated by the Claims Administrator.
(F) Failure by a Participant or beneficiary to follow the requirements of this ARTICLE shall result in the denial of the claim submitted. The Participant or beneficiary submitting such deficient claim shall be deemed to have not exhausted his or her administrative remedies under the Plan. (A.R. 52)
8. The STD Plan and LTD Plan are both self-funded employee welfare benefit plans, meaning that Raytheon did not purchase an insurance policy from any insurer in order to satisfy the Plans' obligations to provide the respective types of disability benefits to eligible/entitled participants.*fn1
Burnett's Initial Claim For STD Benefits
9. In February 2008, Plaintiff Terrance Burnett ("Burnett") was 52 years old and employed as a Senior Program Cost-Schedule & Control Analyst ("Program Cost Analyst") for Raytheon's Government and Defense Group. At that time, Burnett had been employed by Raytheon for approximately 30 years. (A.R. 204, 216.)
10. As an employee of Raytheon, Burnett was covered under the STD Plan and LTD Plan benefits. (A.R. 89.)
11. In the position of Program Cost Analyst, Burnett maintained a "high" level of independence. (A.R. 241.) His job required continuous computer use, shifting from one idea/process/task to another quickly, and complex and multiple mental tasks. (A.R. 232.) Burnett referred to his assigned programs as "dynamic" and enjoyed keeping them on schedule and on budget. (A.R. 240--41.)
12. Burnett suffers from a psychiatric condition apparently caused by the painful breakup of his 23-year marriage in 2007. (A.R. 240, 285.)
13. Burnett's psychiatric condition worsened, which caused him to stop working after February 14, 2008. (A.R. 216, 240--41.)
14. Burnett subsequently submitted a STD benefits claim to MetLife. On February 20, 2008, MetLife acknowledged Burnett's claim by a letter and sent him an authorization form to obtain the medical information and records it needed to make a claim determination. (A.R. 243.)
15. On February 20, 2008, Burnett visited his psychiatrist, Dr. Daniel Anderson. During the visit, Burnett stated that he was not feeling well and was engaging in minimal activity. Dr. Anderson noted Mr. Burnett's marital difficulties, diagnosed him with major depressive episode, and increased his prescription for Lexapro, an antidepressant, from 15 milligrams to 20 milligrams. (A.R. 251.)
16. On February 21, 2008, MetLife spoke with Mr. Richard Santos, Burnett's supervisor at Raytheon. Mr. Santos confirmed Burnett's job description and noted the following: three weeks prior, Burnett had taken on additional job duties, which required him to travel once a week; Burnett's performance had increasingly worsened in the previous six to eight months; he had more absences from work than usual in the previous three to four months; and he had been dealing with personal issues in the previous six to eight months, which had "taken hold of him and affected his job performance." (A.R. 240--41.)
17. On February 23, 2008, MetLife spoke with Burnett's psychologist, Dr. Steven Friedman, who stated that Burnett was "a poster boy for major depression severe" and informed MetLife that Burnett was very suicidal, tearful, unable to focus or concentrate; had lost 25 pounds; and suffered from insomnia. (A.R. 240.)
18. On February 26, 2008, MetLife conducted an initial telephonic interview with Burnett, during which Burnett discussed his current symptoms. Burnett told MetLife that, while he didn't want to come across as suicidal, if he "didn't wake up, it would be okay." Burnett informed MetLife of his daily crying spells, trouble sleeping, significant weight loss in the previous year, impaired focus and concentration, difficulty being around people, and overwhelming depression and anxiety. Burnett informed MetLife that his wife had left him a year prior and that he had previously sought treatment from Dr. Anderson and Dr. Freidman for depression. Burnett explained that he had attended a divorce settlement meeting on February 1, which confirmed for him that his wife was not coming back and caused him to fall into a depressed state. Burnett described feeling as though he was ...