The opinion of the court was delivered by: Thomas A. Varlan United States District Judge
Plaintiff Richard Lawhorn filed this action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C.§ 1001, et seq., to recover long-term disability benefits from defendants Nortel Network, Inc. ("Nortel") and The Prudential Life Insurance Company of America ("Prudential"). The case is before the Court on the plaintiff's Motion for Judgment on the Record [Doc. 20] and the defendants' Motion for Judgment Affirming the Decision of the Employee Benefits Committee [Doc. 21]. The Court previously ordered [Doc. 17] that plaintiff's state law claims of breach of contract, bad faith, and breach of fiduciary duty be dismissed as a result of stipulation by the parties to that effect. Accordingly, plaintiff's remaining claims are for breach of fiduciary duty pursuant to ERISA and denial of ERISA benefits. [Id. at 1.] Plaintiff argues that defendants acted arbitrarily and capriciously in the refusal to continue payment of his long term disability benefits and urges the Court to reverse defendants' administrative decision to that effect. Defendants argue that the decision to deny plaintiff long term disability benefits is supported by the administrative record and should be affirmed. The Court has carefully considered the parties' briefs [Docs. 20, 22, 23, 24, 25], as well as the entire administrative record.
For the reasons set forth herein, the Court will deny plaintiff's motion for judgment on the record and grant defendants' motion for entry of judgment.
Nortel employed plaintiff as Project Manager from August 10, 1987, until approximately August 2001. [Doc. 6 at ¶ 3; Administrative Record ("AR") at 423]. As a Project Manager, plaintiff did the majority of his work, including writing and responding to e-mails, taking and making phone calls, and writing and presenting reports, while sitting at a desk in his office. [AR at 450.] The position did not require that plaintiff undertake any lifting or heavy physical activities, [id.], and required "only occasional reaching, handling, and fingering." [AR at 444.] The position has been described as being "sedentary." [E.g., AR at 431, 444.]
As an employee of Nortel, plaintiff was covered under Nortel's FLEX Benefits Plan (the "Plan"), a plan providing short- and long-term disability benefits and subject to ERISA. [AR at 1-23.] Under the terms of the Plan, Nortel is the plan administrator [id. at 66], Prudential is the claims administrator [AR at 69], and Nortel's Employee Benefits Committee ("EBC"), a specific department within Nortel, "is the final authority to review denied Claims." [Id.] The Plan also states that a covered individual is considered totally disabled and therefore qualified to receive long-term disability benefits "if a Physician certifies that you cannot work because of an Illness or accidental Injury, and the clinical evidence supports this opinion." [AR at 16.] The Plan provides that a covered individual "must provide written proof of your Total Disability to the Claims Administrator, who will make the final determination of disability." [Id.] Lastly, the Plan sets forth two definitions of what it means to be "unable to work," with these varying based upon how long the covered individual has been receiving disability benefits:
During the first 18 months of covered Total Disability (from the first date of STD), you will be considered unable to work if you cannot perform the work you were normally performing at the time of your disability with or without reasonable accommodations for the limitations resulting from your Illness or Injury.
After the first 18 months of covered Total Disability (from the first date of STD), you will be considered unable to work if you are unable to perform any reasonable occupation. A "reasonable occupation" is any job you are or could become qualified to do with your education, training or experience." [AR at 16.] Accordingly, the Plan provides that long-term disability benefits end when "[y]ou stop being Totally Disabled" or "[y]ou are able to return to work at any reasonable occupation...." [AR at 17.]
On August 9, 2001, plaintiff went out of work on short-term disability as a result of a diagnosis of bilateral carpal tunnel syndrome. [AR at 111, 424, 437.] On October 5, 2001, upon being referred to him for evaluation, plaintiff saw Dr. Thomas M. Koenig, an orthopedic surgeon, who confirmed that plaintiff had moderate carpal tunnel syndrome in his right hand and mild to moderate carpal tunnel syndrome in his left hand. [AR at 340.] Dr. Koenig opined that plaintiff's carpal tunnel syndrome was "likely to require surgery in the future" and recommended that, "[f]rom an orthopedic standpoint, should the surgical option be chosen, it would be better to do this sooner rather than later...." [Id.] Dr. Koenig also noted that plaintiff could return to "modified duty" at work and stipulated that it entail "no repetative [sic] frequent gripping or grabbing, or typing, no lifting > 25 lbs, no shifts > 8 hours...." [AR at 341.]
Plaintiff did in fact have surgery on his left wrist on November 6, 2001 and subsequently saw Dr. Koenig for a post-operative examination on November 14, 2001. [AR at 342.] In his report of this visit, Dr. Koenig noted that plaintiff was presently "unable to work," [AR at 343], but that he had "responded well" to the surgery on his left wrist and that "[h]e noted 65% improvement in his right wrist" as a result of a cortisone injection administered to plaintiff on the October 5, 2001 visit. [AR at 342.] A second post-operative visit with Dr. Koenig on November 19, 2001 confirmed again that plaintiff had "[r]esponded well" to surgery, [AR at 345], and noted that plaintiff would be able to "return to modified duty" at work. [AR at 347.]
On a January 15, 2002 visit, Dr. Koenig referred plaintiff to Dr. Berta Bergia, a neurologist, "to rule out residual left [carpal tunnel syndrome] following his surgery." [AR at 352.] Dr. Bergia examined plaintiff on February 20, 2002, and noted that "[n]o residual carpal tunnel was seen." [AR at 391.] Also during this time period, plaintiff's short-term disability benefits were exhausted on February 7, 2002, at which point plaintiff applied for and was granted long-term disability benefits. [Doc. 20 at 3; AR at 111.]
Plaintiff went on to see Dr. Koenig five more times in 2002.*fn1 With each visit, Dr. Koenig's records noted that plaintiff was permitted to work "modified duty," which consisted of the following: "(1) no overhead work (2) lifting restrictions of 30 lbs. (3) frequent changes in position to standing or sitting." [E.g., AR at 370.] On October 15, 2002, Dr. Koenig referred plaintiff to Dr. C. Sanford Carlson, also an orthopedic surgeon, for a second opinion as to the prognosis for his carpal tunnel syndrome. [AR at 330.] Dr. Carlson opined that plaintiff "needs to continue active use of his left hand" and "should at this point return to modified duty using his computer to the best of his ability, even if he has to go very slowly." [AR at 332.] Dr. Carlson went on to note that "[t]he dexterity required by the computer would be very good exercise for the patient, even if he is slow when doing it." [Id.]
On January 7, 2003, Prudential sent plaintiff a letter informing him that his long-term disability benefits would be terminated effective as of February 7, 2003. [AR at 322.] In that letter, Prudential stated that because plaintiff's initial 18-month long-term disability benefit coverage would end on February 7, 2003, plaintiff was then subject to the higher standard of needing to be "unable to perform any reasonable occupation" to continue to receive benefits, as opposed to only needing to prove that his disability preventing him from "performing work you were normally performing," and determined that plaintiff did not meet this standard. [AR at 323.] The letter went on to detail the various medical conclusions of Dr. Koenig and Dr. Carlson that support Prudential's termination of plaintiff's benefits. These include the following:
* The April 2002 evaluation by Dr. Koenig indicating that plaintiff could return to work with restrictions on lifting and typing.
* The October 2002 evaluation from Dr. Carlson noting that plaintiff's carpal tunnel syndrome was not a severe case and that it may resolve completely. As a result, Dr. Carlson recommended that plaintiff not have surgery on his right hand "at this time" and that plaintiff should "continue active use of [his] left hand." [AR at 332.]
[AR at 323.] This letter acknowledged that plaintiff was "not able to return to your previous job as a Market Project Manager," but concluded that plaintiff was "physically capable of performing another job that requires less repetitive hand motion/typing." [AR at 324.] The letter also noted that "Dr. Carlson actually recommends use of the computer to the best of your ability, even if you have to go very slowly." [Id.] On April 7, 2003, plaintiff filed an appeal of the EBC's decision to terminate his long-term disability benefits. [AR at 314.] In this letter, plaintiff indicated he was basing his appeal upon an attached Functional Capacity Evaluation ("FCE") performed by Knoxville Physical Therapy, Inc. on March 18, 2003, which plaintiff claimed indicated that he was then "unable to perform the tasks of sedentary work or any other job due to my on going problems." [Id.] Examination of the FCE itself reveals that while it noted that plaintiff "does not tolerate prolonged sitting required for most sedentary jobs," it stated that plaintiff qualifies for the U.S. Department of Labor Job Classification of "sedentary" and remarked that plaintiff "tolerates sitting doing keyboard or computer work intermittently for 4 hours/day with stretch breaks." [AR at 315.]
As a result of this appeal, Prudential sent plaintiff a letter on May 6, 2003 requesting that he undergo an Independent Medical Examination ("IME") to be performed by Dr. Bergia.*fn2 [AR at 296-297.] Dr. Bergia examined plaintiff on August 20, 2003 and after recounting his lengthy medical history, concluded the following:
Based on the examination and review of the job description, this gentleman should be able to perform his job with job modification. He would not be able to do continuous repetitive typing with his hands given his carpal tunnel syndrome and complex regional pain syndrome. However, returning him to work initially four to six hours a day as recommended by Dr. Carlson with typing for no more than one hour at a time with breaks and ...