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holding that a plan administrator "reasonably exercised its discretion" in reviewing the opinions of claimant's treating physicians, but choosing to rely on the diagnoses of doctors consulted by the administrator
Summary of this case from Winkler v. Metropolitan Life Insurance CompanyOpinion
No. 01 Civ. 5495 (HB).
October 18, 2004
OPINION ORDER
Following remand by the Second Circuit for lack of sufficient notice that a grant of summary judgment for the Defendants was under consideration, Plaintiff, Andrea Tholke ("Tholke"), and Defendants, Unisys Long Term Disability Plan (the "LTD Plan"), the Unisys Employee Benefits Administrative Committee (the "Committee") and Unisys Corporation ("Unisys") (collectively "Defendants"), cross-moved, pursuant to Fed.R.Civ.P. 56, for summary judgment. For the following reasons, Defendants' motion for summary judgment is GRANTED and Plaintiff's motion for summary judgment is DENIED.
I. BACKGROUND
The court assumes familiarity with the discussion of the background facts as set forth in Tholke v. Unisys Corp, No. 01 Civ. 5495, 2004 WL 960029 (2d Cir. May 5, 2004) (Unisys IV) (reversing district court's granting of Defendants summary judgment motion for failure to provide plaintiff with adequate notice); Tholke v. Unisys Corp, No. 01 Civ. 5495, 2003 WL 22077429 (S.D.N.Y. Sept. 5, 2003) (Unisys III) (denying plaintiff's attorney's fees request); Tholke v. Unisys Corp, No. 01 Civ. 5495, 2003 WL 21203349 (S.D.N.Y. May 21, 2003) (Unisys II) (granting Defendants motion for summary judgment); Tholke v. Unisys Corp, No. 01 Civ. 5495, 2002 WL 575650 (S.D.N.Y. Apr. 16, 2002) (Unisys I) (remand to Committee for full and fair review).
The predecessor of Unisys, Sperry Corporation, hired Tholke as a mailroom clerk in 1980. Complaint, at ¶ 7. Beginning in 1983, Tholke left the mailroom and began a career working as a reproducer or copy machine operator. (Lucas Ex. 3). As a Unisys employee, Tholke participated in the Long Term Disability Plan. (Lucas Ex. 3). Tholke suffers from cerebral palsy, a condition known to Unisys when Tholke was hired. ( Id., at Tab D, Drs' Op.).
On December 5, 1992, Tholke was involved in an automobile accident in which she sustained injuries to her left knee, neck and back. Subsequently, Tholke went on medical leave from the date of the accident until February 16, 1993. ( Id., at Tab E, Jul. 11, 1994 Hartford Ltr. to Tholke). On February 19, 1993, Tholke returned to work at Unisys and continued to work there until July 9, 1993. ( Id., at Tab D, Drs' Op.). Between December 5, 1992 and February 1993, and again from July 8, 1993 to January 8, 1994, Tholke received Short-Term Disability benefits ("STD") from the Unisys STD Plan based upon her doctor's, Dr. Isaac Cohen ("Cohen"), determination that Tholke was disabled and unable to return to work as a consequence of internal derangement of the left knee. ( Id.).
On February 1, 1994, Tholke filed for Long Term Disability ("LTD") benefits with the Hartford Life Insurance Co. ("Hartford"). (Lucas Ex. 3). The plan, in pertinent part, defines a disabled employee as "unable, due to . . . disability, to perform the essential functions of . . . regular occupation at any job site within Unisys." ( Id. at Tab H, Rel. Prov. LTD Plan). Hartford was responsible for processing the application. ( Id.). As part of Hartford's application review, Hartford requested Tholke submit to "independent medical examinations" by Drs. Charles Pitman ("Pitman") and Armand Prisco ("Prisco"). ( Id., at Tab D, Drs' Op.). In addition, Hartford sought information regarding the physical demands of Tholke's employment from both Tholke and Unisys. ( Id., at Tab B, Tholke Descrip. of Job Resp.; Id., at Tab C, Co.'s Descrip. of Job Resp.). On July 11, 1994, Hartford denied Tholke's LTD claim because she was not "disabled" for the purposes of the plan. ( Id., at Tab E, Hartford Appeal Determ.).
Hartford's review of Tholke's medical condition included: (1) Cohen's diagnosis of "injuries to her cervical spine, lumbar spine, as well as left knee" and, therefore, she was "unable to perform her job"; (2) Prisco's Sept. 28, 1993 report and diagnosis that Tholke had "a contusion [sic] left knee as well as sprains of both the cervical and lumbar portions of the spine;" "[T]he claimant [Tholke] does not need any treatment;" and, "[T]he claimant is not disabled from her job as a Xerox reproducer"; (3) Pitman's reports, dated May 2, 1994 and June 29, 1994, and diagnosis that Tholke had "a contusion of the left knee as well as a sprain of the cervical and lumbar spine which required no active treatment" and the "physical capacities evaluation form," which indicated, among other things, that Tholke could return to work to perform "sedentary work," that she could stand for five hours intermittently during an eight hour day, walk intermittently one to two hours a day and she "is capable of bending at the waist during the work day, but should refrain from lifting or bending at the waist while weight bearing"; (4) Dr. Wortman's report, dated Dec. 21, 1992, and diagnosis that there was "no evidence of an internal derangement of Ms. Tholke's left knee"; and, (5) Sal Scalise's ("Scalise"), Tholke's supervisor, indications that Tholke's job "rarely required her to lift more than 20 lbs.," "her job was flexible in that she could sit or stand at will and may sit as much as 8 hours in any day" and "there were no requirements for bending." ( Id., at Tab B-D).
On May 30, 1995, following two unsuccessful appeals to Hartford, Tholke filed an appeal to the Committee, the designated plan administrator. ( Id., at Tab H, Rel. Prov. LTD Plan). A non-voting member of the Committee, Mary Massman ("Massman"), reviewed Tholke's file and wrote a summary and report, which affirmed the administrative determination. (Lucas Ex. 8, Jul. 8, 2002 Comm. Mtg. Mins.). On August 3, 1995, Committee endorsed Massman's memorandum and denied benefits without comment or review of the documentation. Unisys I, 2002 WL 575650, at *4.
On June 18, 2001, following the prior denials of Tholke's LTD benefits claim, Tholke's attorney, Robert J. Bach ("Bach"), commenced this action against Defendants. Tholke sought a court order finding the Committee's denial of her claim for LTD benefits as arbitrary and capricious pursuant to the Unisys LTD Plan under the Employee Retirement Income Security Act (ERISA) 29 U.S.C. § 1001 et seq. Unisys I, 2002 WL 575650, at *4. Tholke's motion was granted to the extent that the matter was remanded to Unisys for further review. The review was to be "full and fair," as required by 29 U.S.C. § 1133(2), to take place within 90 days, and to provide the Court with prompt notification of any such decision in writing. Unisys I, 2002 WL 575650 at *3. The Committee was ordered ("Order") to "examine fully (1) the discrepancy between the statements by [Plaintiff] and her supervisors as to the nature of her job, and (2) the discrepancy between the diagnoses of Cohen, Dr. Prisco and Dr. Pitman." Id., 2002 WL 575650, at *4.
Pursuant to the Order, the Committee retained the service of Network Medical Review ("NMR"), an independent medical review firm, to advise the Committee as to a orthopedic specialist. (Lucas Ex. 4, Jun. 20, 2002 Ltr. Lucas to Kehoe). NMR recommended Dr. Richard Silver ("Silver"), a board certified orthopedic surgeon, as a consultant. (Lucas Ex. 5, Silver CV). In addition, the Committee encouraged Tholke to provide any additional information or documentation that Tholke wanted the Committee to consider. On June 10, 2002, Tholke's attorney submitted a letter providing additional materials to the Committee. (Lucas Ex. 2, Jun. 10, 2002 Ltr. Bach to Comm.). Silver reviewed, as part of the record, Cohen, Prisco and Pitman's opinions of Tholke's condition, documents that described Tholke's job requirements, including affidavits from Tholke, Scalise and Val Rizzi ("Rizzi"), the Unisys I decision, the relevant provisions of the LTD Plan, and a description of the issues the Committee sought to resolve. (Lucas Ex. 4, Jun. 20, 2002, Ltr. Lucas to Kehoe; Lucas Aff. ¶ 11).
On July 3, 2002, after reviewing the materials provided by the Committee, Silver faxed a report to the Committee. (Lucas Ex. 6, Jul. 3, 2002 Ltr. Silver to Comm.). In addition, the Committee was provided with an administrative record to consider Tholke's claim, including: (1) a letter from Tholke's counsel explaining why Tholke should be provided with LTD benefits; (2) a December 13, 1993 occupational analysis form; (3) a January 20, 1994 occupational analysis form; (4) June 7, 1994 phone records prepared by Hartford of conversations with Rizzi and Scalise; and, (5) report and physical capabilities form prepared by Pitman. (Lucas Ex. 8, Jul. 8, 2002 Comm. Mtg. Mins.).
On July 8, 2002, the Committee convened to review Tholke's appeal. Silver participated by telephone and discussed the discrepancies in the various doctors' records with regard to Tholke's condition. ( Id.). According to the minutes taken at the meeting, Silver concluded, "none of the subjective complaints made by Ms. Tholke were supported by objective medical findings" and Tholke's "subjective complaints are out of proportion to the objective findings." ( Id.). The Committee also examined Tholke's Social Security award, but "regardless of the reasons for the social security disability determination, the Committee noted that a social security disability determination is based on a different standard than that used by the Plan, and thus, would have little effect on the Committee's determination." ( Id.). Based upon the information provided by Silver, and a review of the underlying facts and documentation, the Committee concluded, "any controversy over the job duties was moot and there was no objective medical information to support the claim that Ms. Tholke met the requirements of the LTD Plan for benefits." ( Id.).
Following the July 8, 2002 Committee meeting, the Committee discovered that Silver's "Estimation of Physical Capacities" ("EPC") form, (Lucas Ex. 9, Jul. 9, 2002 Ltr. Silver to Lucas), had been inadvertently omitted from the materials provided to the Committee. (Lucas Ex. 10, Jul. 12, 2002 Comm. Mtg. Mins.). Concerned by the potential inconsistencies between the conversation with Silver and the EPC, the Committee reconvened on July 12, 2002. Again, Silver participated in the Committee's meeting by telephone. When asked about the EPC form, Silver stated "the limitations reflected on the Physical Capacities form [EPC] applied only for the period before Tholke reached maximum medical improvement" and that Tholke should have healed within six months of the accident or July 1993. (Lucas Ex. 9, Jul. 9, 2002 Ltr. Silver to Lucas; Lucas Ex. 10, Jul. 12, 2002 Comm. Mtg. Mins.). Silver stressed to the Committee, "[T]here were no objective findings to substantiate her inability to work in my considered medical/orthopedic/surgical opinion." (Lucas Ex. 9, Jul. 9, 2002 Ltr. Silver to Lucas). Accordingly, on July 15, 2002, Tholke was informed of the Committee's decision to deny Tholke's claims for benefits. (Lucas Ex. 7, Jul. 15, 2002 Ltr. Lucas to Bach).
On August 12, 2002, Tholke's attorney provided the Court with a letter informing the Court of the Committee's decision, arguing the Committee had failed to follow the Court's Order, "the reports of Drs. Cohen and Pitman provided objective medical evidence to sustain a finding of disability" and, therefore, request a trial date. (Courtian Ex. 2, Aug. 12, 2002 Ltr. Bach to Ct.). In response, on August 16, 2002, Defendants requested the Court grant summary judgment and dismiss the Complaint with prejudice based upon the Committee's decision and Unisys I. (Courtian Ex. 3, Aug. 16, 2002 Ltr. Bach to Ct.). In response, the Court requested copies of the documents referenced by the Committee. On March 13, 2003, Defendants provided the Court, and Tholke's counsel, with copies of the referenced documents and, on April 1, 2003, with the Committee minutes. (Courtian Ex. 4, Mar. 13, 2003 Ltr. Courtian to Ct.). Subsequently, on May 21, 2003, the Court granted Defendant's motion for summary judgment. Unisys II, 2003 WL 21203349, at *4.
Following the Court's decision, on June 4, 2003, counsel for Tholke requested the withdrawal of the Court's May 21, 2003 decision for lack of fair notice that the court was considering Defendants' summary judgment motion and rejection of Tholke's request for a trial date. On June 24, 2003, Tholke filed a motion to recover attorney's fees from Defendants. Both the withdrawal of the Court's decision and the attorneys' fees motion were denied. Unisys III, 2003 WL 22077429, at * 1. Subsequently, on June 25, 2003, Tholke filed a Notice of Appeal from, among other things, the Court's decision granting Defendants' motion for summary judgment. Unisys IV, 2004 WL 960029, at *1.
Relying on First Financial Ins. Co. v. Allstate Interior Demolition Corp., 193 F.3d 109, 115 (2d Cir. 1999), the Second Circuit held that Tholke was provided with insufficient notice that the Court was considering a grant of summary judgment for Defendants. Unisys IV, 2004 WL 960029, at *5. Accordingly, the Second Circuit vacated the judgment and remanded the matter back to the Court for further proceedings in order to "to give Plaintiff a full opportunity to present her arguments and evidence." Id., 2004 WL 960029, at *5.
Pursuant to the Second Circuit's remand, on May 20, 2004, I memo endorsed a May 18, 2004 letter from defense counsel which established a briefing schedule that would provide parties with sufficient notice. Pursuant to the briefing schedule, motions for summary judgment would be due on June 7, 2004, responses due on June 21, 2004 and replies due on June 30, 2004. Dckt. No. 57. These motions for summary judgment were filed in accordance with that memo endorsement.
II. DISCUSSION
This is the second such occasion for the Court to review cross-motions for summary judgment and the parties raise many of the same issues. First, the Court must determine the proper standard which to review the cross-motions for summary judgment and the Committee's determination of Tholke's LTD Benefit's appeal. Celardo v. GNY Automobile Dealers Health Welfare Trust, 318 F.3d 142, 146 (2d Cir. 2003). Second, the Court must apply the requisite standard to Tholke and Defendants' cross motion for summary judgment. Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995).
A. Standard of Review
A court will not grant a motion for summary judgment unless it determines that there is no genuine issue of material fact and the undisputed facts are sufficient to warrant judgment as a matter of law. Fed.R.Civ.P. 56; Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986); Anderson v. Liberty Lobby Inc., 477 U.S. 242, 250 (1986). The party opposing summary judgment "may not rest upon the mere allegations or denials of the adverse party's pleading, but . . . must set forth specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e). In determining whether there is a genuine issue of material fact, the Court must resolve all ambiguities, and draw all inferences, against the moving party. United States v. Diebold, Inc., 369 U.S. 654, 655 (1962) ( per curiam); Donahue v. Windsor Locks Bd. of Fire Comm'rs, 834 F.2d 54, 57 (2d Cir. 1987). It is not the court's role to resolve issues of fact; rather, the court may only determine whether there are issues of fact to be tried. Donohue, 834 F.2d at 58 (citations omitted).
When considering cross-motions for summary judgment, the same legal standards apply and a court "must evaluate each party's motion on its own merits, taking care in each instance to draw all reasonable inferences against the party whose motion is under consideration." Make The Road by Walking, Inc. v. Turner, 378 F.3d 133, 142 (2d Cir. 2004) (citations omitted). The court may deny both parties motion for summary judgment if the court finds the existence of disputed material facts. Morales v. Quintel Entm't, Inc., 249 F.3d 115, 121 (2d Cir. 2001). Therefore, "each party's motion must be examined on its own merits, and in each case all reasonable inferences must be drawn against the party whose motion is under consideration." Id., at 121.
In addition to the summary judgment standard set forth above, the Court must determine what standard of review to apply to Unisys's denial of benefits. As the Second Circuit noted, "[a] denial of benefits under ERISA is reviewed by the District Court 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." Muller v. First Unum Life Ins. Co., 341 F.3d 119, 123-124 (2d Cir. 2003) (emphasis added). Where a benefit plan's administrator or fiduciary has discretionary authority to determine eligibility, such as the Committee indisputably had here, a court "narrowly reviews" the denial of benefits, Burke v. Kodak Ret. Income Plan, 336 F.3d 103, 110 (2d Cir. 2003), under an arbitrary and capricious standard. Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). Under this standard, the Court will overturn a denial of benefits only if the plan administrator's decision is "without reason, unsupported by substantial evidence or erroneous as a matter of law." Pulvers v. First UNUM Life Ins. Co., 210 F.3d 89, 92 (2d Cir. 2000). Substantial evidence "is more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Christian v. Apfel, 01 Civ. 6045, 2002 WL 257295 at *2 (2d Cir. Feb. 21, 2002).
B. Arbitrary and Capricious
Under an arbitrary and capricious standard, "we may overturn a decision to deny benefits only if it was without reason, unsupported by substantial evidence or erroneous as a matter of law." Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995). The district court is required to consider whether the plan administrator's "decision was based on a consideration of the relevant factors and whether there has been a clear error of judgment," because the district court may not "upset a reasonable interpretation by the administrator," Zuckerbrod v. Phoenix Mut. Life Ins. Co., 78 F.3d 46, 49 (2d Cir. 1996), or "substitute [the district court's] own judgment for that of the . . . Committee as if [the district court were] considering the issue of eligibility anew." Pagan, 52 F.3d at 442.
With summary judgment motions, "the arbitrary and capricious standard requires that we ask whether the aggregate evidence, viewed in the light most favorable to the non-moving party, could support a rational determination that the plan administrator acted arbitrarily in denying the claim for benefits." Davis v. Commercial Bank of New York, 275 F. Supp. 2d 418, 425 (S.D.N.Y. 2003). The reviewing court need only "assure that the administrator's decision falls somewhere on a continuum of reasonableness — even if on the low end." Id., at 425.
As the "plan administrator," Defendants and Tholke agree, the Committee has been delegated responsibility for the administration and interpretation of the LTD Plan for disabilities arising on or before December 31, 1993. (Pl.'s Mtn. Summ. J. at 3; Def.'s Mtn. Summ. J. at 4-5). The Committee's denial of Tholke's LTD benefit claim, therefore, "will not be overturned unless it is found to be without reason; unsupported by substantial evidence; or erroneous as a matter of law." Couture v. Unum Provident Corp., 315 F. Supp. 2d 418, 428 (S.D.N.Y. 2004); Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995).
Accordingly, the Court must determine if the Committee afforded Tholke (1) a full and fair review of her claim, and whether the Committee's decision was (2) reasonable, based upon consideration of (a) the doctors' opinions and diagnosis, (b) Tholke's employment responsibilities, and (c) the Committee's determination of "disabled" under the LTD Plan.
1. Did Tholke Receive "Full and Fair Review"?
Full and fair review requires the plan administrator to:
[C]onsider any and all pertinent information reasonably available to him. The decision must be supported by substantial evidence. . . . Must notify the participant promptly, in writing and in language likely to be understood by laymen, that the claim has been denied with the specific reasons therefore . . . [and] must also inform the participant of what evidence he relied upon and provide him with an opportunity to examine that evidence and to submit written comments or rebuttal documentary evidence.Hammer v. First Unum Life Ins. Co., 01 Civ. 9307, 2004 WL 1900334 at *5 (S.D.N.Y. Aug. 25, 2004) (citations omitted). Failure to provide a full and fair review may render the plan administrator's decision arbitrary and capricious. Crocco v. Xerox Corp., 137 F.3d 105, 108 (2d Cir. 1998).
Tholke's LTD benefit claim was provided extensive review. First, the LTD benefit claim was reviewed by Hartford on February 1, 1994, appealed to Hartford on August 19, 1994, and, again, appealed to Hartford on February 7, 1995. (Lucas Ex. 3, Tab E). After exhausting the remedies within Hartford, Tholke appealed Hartford's denial of benefits to the Committee. The Committee reviewed Tholke's LTD claim once on May 30, 1995 and, again, following the Court's decision in Unisys I, on July 8, 2002 and July 12, 2002. The Committee reviewed an extensive record from various physicians, fellow employees, and Tholke herself.
Second, following the Court's remand in Unisys I, the Committee relied upon an extensive and wide-ranging administrative record in denying Tholke's LTD benefits claim. The administrative record included descriptions of Tholke's job responsibilities from supervisors, co-workers, doctors, and Tholke herself. (Lucas Ex. 3, Tab B-D). The record included Drs. Cohen, Prisco, Pitman, and Wortman's reports and notes. (Lucas Ex. 3, Tab D). Silver participated in the actual Committee meeting. (Lucas Ex. 8, Jul. 8, 2002 Comm. Mtg. Mins.). The administrative record also included Hartford's determination of Tholke's appeals and the Social Security Administration's disability determination. (Lucas Ex. 3, Tab E-F).
Third, Tholke was provided with no less than four opportunities to supplement the administrative record and sufficient opportunity to participate in the Committee's review of her appeal. The administrative record considered by the Committee provided all documents submitted by Tholke in support of her LTD benefit claim and included a letter to the Committee letter explaining why Tholke's claim should be granted, along with accompanying attachments. (Lucas Ex. 3, Tab A, Jun. 10, 2002, Ltr. from Bach to Comm.). With regard to Tholke's ability to continue as a reproducer or copy machine operator, the administrative record included affidavits from Tholke, dated January 28, 2002 and June 6, 2002, describing her employment responsibilities. (Lucas Ex. 3, Tab B). The administrative record also included the Social Security Administration's determination of disability and award correspondence. (Lucas Ex. 3, Tab F).
Fourth, following the Court's decision in Unisys I, the Committee contacted NMR "to review the opinions provided by the three doctors who had previously examined Ms. Tholke" and "to be available by phone to discuss this matter" at the Committee meeting. (Lucas Ex. 4, Jun. 20, 2002, Ltr. Lucas to Kehoe). NMR recommended Silver, who provided the Committee with a faxed report regarding Tholke's condition specifically noting Tholke's medical history and job responsibilities. (Lucas Ex. 6, Jul. 3, 2002 Ltr. Silver to Lucas). Silver determined that Tholke:
Would need to avoid being around moving machinery and working at unrestricted heights that are unprotected. She would need to avoid climbing ladders. She would need to avoid going up and down stairs. Ms. Tholke could certainly perform duties consistent with a sedentary position. She could sit predominantly and walk periodically for five or ten minutes. She would need to avoid carrying anything greater than 10 to 15 pounds.
(Lucas Ex.6, Jul. 3, 2002 Ltr. Silver to Lucas).
The Committee's decision reviewed the relevant factors for determining Tholke's LTD benefit claim and the Committee's decision fails to demonstrate "a case of clear error of judgment." Jordan, 46 F.3d 1264, 1271 (2d Cir. 1995).
2. Was the Denial of LTD Benefit's Reasonable?
To determine whether a plan administrator's decision was "reasonable," the Court must ensure that the decision was supported by the "evidence that a reasonable mind might accept as adequate to support the conclusion reached by the administrator" and a reasonable mind "requires more than a scintilla but less than a preponderance." Celardo v. GNY Auto. Dealers Health Welfare Trust, 318 F.3d 142, 146 (2d Cir. 2003). The Court is "not free to substitute their own judgment for that of the plan administrator as if they were considering the issue of eligibility anew." Id., at 146 (citations omitted). Instead, the Court must review the evidence and determine whether, in the aggregate, "the evidence, viewed in the light most favorable to the non-moving party, could support a rational determination that the plan administrator acted arbitrarily in denying the claim for benefits." Davis v. Commercial Bank of New York, 275 F. Supp. 2d 418, 425 (S.D.N.Y. 2003).
a. Doctors Discrepancies
In Black Decker v. Nord, the Supreme Court held that ERISA claims administrators are not required to accord treating physicians' special deference in ERISA actions for denial of benefits, but "may not arbitrarily refuse to credit a claimant's reliable evidence, including the opinions of a treating physician." 538 U.S. 822, 831-834 (2003). The Supreme Court granted substantial deference to the plan administrator's review of conflicting medical opinions and instructed district courts to not "require administrators automatically to accord special weight to the opinions of a claimant's physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation." Id., at 834. The LTD benefit plan affords the Committee discretion to weigh different medical opinions and to determine, based upon the evidence submitted, whether an applicant is physically able to work. The Court, therefore, must determine, if the Committee's decision was unreasonable without requiring the Committee to afford one doctor greater weight than another.
The administrative record indicates that the Committee reviewed the opinions of Tholke's treating physicians, but after consulting with Pitman, Prisco and Wortman's MRI reports and, later, Silver's independent opinion, reached a different conclusion that Tholke had no disability that would prevent her from working as a reproducer or copy machine operator. The Committee reasonably exercised its discretion by relying on Silver and Prisco's conclusions, instead of Cohen's diagnosis, that Tholke was not totally disabled as defined in the LTD benefit plan. See Black Decker, at 834.
b. Employment Responsibilities
In order to determine Tholke's eligibility under the LTD Plan, the Committee was required to determine if Tholke could perform the essential functions of her employment and ensure she was "unable, due to [her] disability, to perform the essential functions of [her] regular occupation at any job site within Unisys." (Lucas Ex. 3, Tab H, Rel. Prov. LTD Plan).
I conclude once again that the Committee adequately reviewed the capability of Tholke to perform the essential functions of her regular occupation as a reproducer or copy machine operator. The Committee sufficiently investigated both Tholke's job requirements and whether she could satisfy those requirements. The denial of LTD benefits by the Committee was well reasoned, reviewing Silver's opinion and those of the other doctors and employees. The Committee articulated a reasonable decision regarding both Tholke's job description and ability to perform. The denial of LTD benefits, supported by the administrative record, was not "clearly erroneous." Celardo, 318 F.3d at 146.
c. "Disabled" Defined under the LTD Plan
Lastly, during both the July 8, 2002 and July 12, 2002 Committee meeting, the Committee considered, among other things previously discussed, Tholke's overall ability to perform her job in her capacity as a reproducer or copy machine operator. (Lucas Ex. 8, Jul. 8, 2002 Comm. Mtg. Mins.; Ex. 10, Mins. of Jul. 12, 2002 Comm. Mtg.). The minutes of the Committee's conversation with their medical consultant, Silver, indicate that the Committee inquired as to Tholke's "essential job functions . . . and attempted to determine whether or not accommodations were made." (Lucas Ex. 8, Jul. 8, 2002 Comm. Mtg. Mins.). Given the demands of a reproducer or copy machine operator, the Committee determined, after consultation with Silver and a review of the administrative record, "it is likely that the actual duties performed fell somewhere between what Andrea [Tholke] described and what the supervisor [Scalise] described and that is likely that Andrea's fellow employees pitched in and assisted her to perform her functions." ( Id.). The Committee decided, therefore, that "[B]ased on the information provided by Dr. Silver, and its review of the underlying facts and documentation, the Committee concluded that any controversy over the job duties was moot and there was no objective medical information to support the claim that Ms. Tholke met the requirements of the LTD Plan for benefits." ( Id.).
Once again, I find that Tholke's disagreement with the Committee's conclusions was unfounded, the Committee's determination was adequately supported by substantial evidence from Tholke's supervisor, Prisco, Pitman, Wortman's MRI report, and the outside medical consultation of Silver. While Tholke dispute's the Committee's determination of Tholke's injury and her ability to return to full employment as a reproducer or copy machine operator, the Committee's denial of LTD benefits was supported by the administrative record and sufficiently reasonable as to satisfy Celardo standard. 318 F.3d at 146. The Committee's decision under the LTD Plan was not unreasonable and, therefore, the Court is "not free to substitute [their] own judgment for that of the [plan administrator] as if [they] were considering the issue of eligibility anew." Id. at 146.
III. CONCLUSION
For all of the foregoing reasons, defendant's motion for summary judgment is GRANTED and the complaint is DISMISSED. Plaintiff's motion for Summary Judgment is DENIED. The Clerk is instructed to close this motion and all other open motions and remove this case from my docket.
IT IS SO ORDERED.