Cannon v. PNC Financial Services Group, Inc.

123 F. Supp. 3d 945, 2015 U.S. Dist. LEXIS 110768, 2015 WL 5005802
CourtDistrict Court, W.D. Kentucky
DecidedAugust 21, 2015
DocketCIVIL ACTION NO. 3:13-CV-954-CRS
StatusPublished

This text of 123 F. Supp. 3d 945 (Cannon v. PNC Financial Services Group, Inc.) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cannon v. PNC Financial Services Group, Inc., 123 F. Supp. 3d 945, 2015 U.S. Dist. LEXIS 110768, 2015 WL 5005802 (W.D. Ky. 2015).

Opinion

MEMORANDUM OPINIÓN

Charles R. Simpson III, Senior Judge United States District Court

Michael A. Cannon, executor for and on behalf of the Estate-of Christine Cannon, seeks to recover long-term disability benefits pursuant to Section 502(a)(1)(B)-of the Employee Retirement Income Security Act of 1974 after Liberty Life Assurance Company of Boston (“Liberty”) denied Christine Cannon’s (“Cannon”) claim and appeal under The PNC Financial Services Group, Inc. Long-Term Disability Plan (the “Plan”). Both sides moved, for judgment on the administrative record. These motions require the Court to determine whether Liberty’s decisions were arbitrary and capricious. For the reasons that follow, the Court finds that they were not. It will grant Liberty’s motion, deny Cannon’s, and dismiss this case with prejudice.

I. Procedural History

The Plan provides qualified and eligible employees with long-term disability (“LTD”) benefits of sixty percent of their pre-disability compensation. See AR 203. To qualify for LTD benefits for the first two years, a participant must prove that she is “Disabled,” which is defined as “unable to perform the material or essential duties of [her] own occupation as it is normally performed in that national economy.” Id. The Plan places a continuing responsibility oh the participant to submit proof that she is Disabled and receiving appropriate treatment under the continued regular care of a licensed physician. AR 211. It provides that LTD benefits will stop if the participant fails to provide proof that she is receiving appropriate treatment or complying with a treatment plan. Id. Because Liberty and PNC entered into the Administrative Services Only Agreement, Liberty had discretionary authority to interpret the terms of the Plan and evaluate all questions of entitlement to LTD benefits under the Plan. AR 215-17, 219-41.

The PNC Financial Services Group, Inc. (“PNC”) employed Cannon as an Investigations Senior Analyst (or a. check fraud investigator, as Gannon described it), a sedentary position-that required her to sit at a computer terminal for most of the day. On October 25, 2012, she stopped [947]*947work to undergo a hysterectomy scheduled for the following day. On December 31, after her procedure and a few months of recovery, she returned to work. But just a few days later — January 3, 2013 — Cannon again stopped wt?rk because of abdominal pain. After this second stoppage, she made a claim for LTD benefits under the Plan. Liberty initially awarded her benefits but later determined that Cannon was no longer Disabled. Cannon appealed that decision, but Liberty affirmed. Then, Cannon brought this action.

II. Standard

It is well-settled that “a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Kalish v. Liberty Mut./Liberty Life Assurance Co. of Boston, 419 F.3d 501, 505-06 (6th Cir.2005) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). “When such authority is granted” — as here — “the highly deferential arbitrary and capricious review is appropriate.” Borda v. Hardy, Lewis, Pollard & Page, P.C., 138 F.3d 1062, 1065-66 (6th Cir.1998) (quotations omitted).

Under the arbitrary and capricious standard, “[decisions of the administrator or fiduciary must be upheld ... if ‘rational in light of the plan’s provisions.’ ” Id. at 1066 (quoting Miller v. Metro. Life Ins. Co., 925 F.2d 979, 983 (6th Cir.1991)). In other words, the administrator’s “decision will not be deemed arbitrary and capricious so long as ‘it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome.’ ” Kalish, 419 F.3d at 506 (quoting Davis v. Ky. Fin. Cos. Ret. Plan, 887 F.2d 689, 693 (6th Cir.1989)). Notwithstanding this highly deferential standard of review, a reviewing court should not merely “rubber stamp a plan administrator’s decision.” Schwalm v. Guardian Life Ins. Co. of Am., 626 F.3d 299, 308 (6th Cir.2010).

‘‘Lastly, the Court notes that its review is limited to the administrative record.” Lewis v. Liberty Life Assurance Co. of Boston, No. 3:12-cV-215-H, 2013 WL 2319349, at *4 (W.D.Ky. May 28, 2013) (citing Schwalm, 626 F.3d at 303 (“A court may consider only that evidence presented to the plan administrator at the time he of she determined the employee’s eligibility in accordance with'the plan’s terms.”)).

III. Administrative record review

To determine whether' Liberty’s decisions to deny LTD benefits and to deny Cannon’s appeal were arbitrary and capricious, the Court will conduct a thorough review of the' administrative record. The administrative record in this ease includes notes-from communications between Cannon and Liberty, records from several physicians and a physical therapist, records from independent reviewers, and Liberty’s conclusions.

1. Liberty begins its investigation

Liberty began its investigation shortly after Cannon made her claim. It conducted its initial interview on January 29, 2013. AR 9. In that interview, Cannon reported her hysterectomy and said that it may have caused or worsened nerve damage that was causing abdominal pain. Id. She said the pain was so bad that she went to the hospital, and she also reported that sitting caused the worst pain. Id.. She reported that she could stand for a while but needed to lie down for.relief from the pain; she could type “and do. everything except sit.” Id. She reported taking daily pain medication. Id. And she told Liberty that her estimated return to work date was as soon as possible, but she had not set a firm date. Id. She also noted that she was see[948]*948ing Dr. Horlander (OB/GYN), Dr. Jonathon Reinstine (OB/GYN), Dr. Ricky Collis (pain management), and Dunn Physical Therapy. Id.

The same day, Liberty sent Cannon a letter and several requests for information that it needed to process her claim. AR 18-27. The letter said that, under the terms of the Plan, Cannon had 45 days to provide proof of a disability. Id. at 18. Liberty also contacted Cannon’s medical providers to request medical records from October 1, 2012, to the present. AR 28-47.

Meanwhile, the administrator of Cannon’s claim for short-term disability benefits sent Liberty copies of Cannon’s medical records from her recent visits with Dr. Horlander. AR 48-50. Cannon visited Dr. Horlander on January 2 and 7, 2013.

Dr. Horlander’s notes from the January 2 visit report that Cannon suffered “sharp, constant pain” in her abdomen and pelvis; she also said that it “hurts to sit.” AR 49.

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123 F. Supp. 3d 945, 2015 U.S. Dist. LEXIS 110768, 2015 WL 5005802, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cannon-v-pnc-financial-services-group-inc-kywd-2015.