Opinion
No. C-02-2835 SC
October 17, 2003
JUDGMENT
In accordance with this Court's ORDER GRANTING PLAINTIFF'S CROSS-MOTION for JUDGMENT ON THE RECORD and DENYING DEFENDANTS' MOTION FOR JUDGEMENT ON THE RECORD, it is HEREBY ORDERED, ADJUDGED, and DECREED that:
Judgement shall be entered in favor of PLAINTIFF and against DEFENDANTS.
IT IS SO ORDERED.
ORDER GRANTING PLAINTIFF'S CROSS-MOTION FOR JUDGMENT ON THE RECORD AND DENYING DEFENDANTS' MOTION FOR JUDGMENT ON THE RECORD
I. INTRODUCTION
This action arises out of the ChevronTexaco Long-Term Disability Plan Organization's and its Plan Committee's ("Defendants" or "Plan Organization") termination of Antonio Di Giovanni's ("Plaintiff") long term disability ("LTD") benefits. Plaintiff brought this action seeking reimbursement and reinstatement of his LTD benefits pursuant to Employee Retirement Income Security Act (ERISA) § 502(a)(1)(B). Both parties have filed motions for judgment on the administrative record. Having reviewed the record and all the papers submitted by the parties, and for the reasons articulated below, the Court grants Plaintiff's cross-motion for judgment on the record and denies Defendants' request for judgment on the record.
II. BACKGROUND
The events leading up to this case are too lengthy and detailed to be given a complete rendition. The Court will do its best here to summarize the relevant facts. Like many companies, ChevronTexaco offers LTD benefits for its employees. For purposes of this litigation, the LTD benefits available under the ChevronTexaco Plan ("Plan") is self-funded — ChevronTexaco Corporation pays the LTD benefits from a trust set up for that purpose. Motion for J. on the Admin. Record at 26. During the time period relevant to this litigation, Connecticut General Life Insurance Company ("CGLIC" or "Claims Administrator") acted as the third party claims administrator for LTD benefit claims made under the Plan. After a claim was submitted, CGLIC made the initial claim determination. When a claim was denied, the participant was required to appeal the claim denial to the Long Term Disability Plan of the Chevron Corporation Long Term Disability Plan Organization ("Plan Organization"). The Plan Organization, as Plan Administrator, reserved to itself the discretionary authority to make the final determination as to a participant's eligibility for benefits.
Plaintiff was hired as an administrative assistant by Chevron in February of 1988. Two years later, in February of 1990, Plaintiff left work, complaining of stress and depression. Plaintiff was diagnosed as HIV positive sometime in 1990. By letter dated May 6, 1991, the Claims Administrator approved Plaintiff's LTD benefit claim based on a diagnosis of major depression, a condition falling under the Plan's 18 month mental illness limitation. Admin. Record at 2073-75. In 1992, as Plaintiff's benefits were about to expire, CGLIC investigated whether Plaintiff qualified for continued LTD benefits under the Plan's "hard test". On the basis of a letter and medical documentation provided by Lowell Young, M.D., CGLIC approved Plaintiff for LTD benefits. Dr. Young's letter stated that Plaintiff's diagnosis is "HIV seropositivity with AIDS-related complex" with "severe progressive peripheral neuropathy". Admin. Record at 1878. Dr. Young opined that Plaintiff's symptoms were "truly incapacitating" and that his "prognosis for return to any occupation is zero." Id. In a letter telling Plaintiff that his claim had been approved, CGLIC notified Plaintiff that they would regularly be sending him Attending Physician's Statements of Disability ("APS") to have his doctor complete, and that it was Plaintiff's responsibility to have the forms completed and returned to Defendants. Admin. Record at 1876. The APS forms utilize a classification system to describe a claimant's physical or mental limitations and abilities. See e.g., Admin. Record at 1857.
ChevronTexaco Corporation is the successor corporation to Chevron Corporation.
Section 4 of the Plan, entitled "Definition of Total Disability", sets forth the Plan definition of total disability at issue in this litigation. It states in relevant part that "`Total Disability' and `Totally Disabled' mean that because of injury or sickness the Member is unable to perform any occupation for which the Member is qualified or may reasonably become qualified by reason of education, training, or experience, whether or not a job involving such occupation is available within the Corporation." Admin. Record at 1236-37.
Dr. Young is the chief of the Division of Infectious Diseases at California Pacific Medical Center.
On August 9, 1993 Plaintiff provided an updated APS form completed by Kent Sack, M.D. Dr. Sack, an HIV/AIDS specialist, certified that Plaintiff was "totally disabled" and that his condition was "permanent," meaning Plaintiff would "never" return to work. Admin. Record at 1861. Contradicting himself somewhat, Dr. Sack identified Plaintiff as having a Class 4 physical limitation, meaning he was capable of clerical/administrative (sedentary) activity.
On March 8, 1994, Thomas Greely, M.D., a family practitioner, completed an updated APS form, certifying that Plaintiff was totally disabled from performing any occupation. Dr. Greely listed Plaintiff as having a Class 5 physical impairment and. opined that Plaintiff would "never" be able to resume any kind of work. Admin. Record at 1866-67. Dr. Greely completed another APS form on December 20, 1994, where he again certified Plaintiff as totally disabled and stated his belief that Plaintiff would never be able to return to any kind of work. On this form, Dr. Greely listed Plaintiff as having a Class 4 physical limitation. Admin. Recor at 1864-65.
A class 5 physical impairment indicates a "severe limitation of functional capacity; incapable of minimal (sedentary) activity."
On November 17, 1995, the Dominion Life Foundation ("Foundation"), on behalf of Plaintiff, sent a letter to CGLIC stating-that:
On May 15, 1992, Plaintiff executed articles of incorporation for the Dominion Life Foundation, which were filed with the Secretary of State of California. According to the articles of incorporation, the purpose of the Foundation is to provide advocacy to terminally ill AIDS patients, primarily in disputes with the Social Security Administration, insurance companies, etc. Admin. Record at 1816-1817.
"Considering the degenerative nature of [Plaintiff's] disease, we find it unproductive to continue filling these [APS] forms out at a cost to the patient. . . . Therefore, unless you can provide this office with some compelling reason that necessitates the need for our client to continue to present these forms to his doctor for completion at a cost to him given the nature of his illness and that every other insurance company waives this process in consideration of an HIV (AIDS) diagnosis, we will be unable to accommodate your request at this time."
Admin. Record at 1851. CGLIC responded by citing to the Plan guidelines, which require that a claimant for benefits must be under the care of a licensed physician and state that proof of continued eligibility for benefits is the responsibility of the claimant. Admin. Record at 1849-50. CGLIC stated that Plaintiff's failure to submit evidence of continued treatment and disability would result in a suspension of Plaintiff's benefits until such time as the information was provided.Id. On February 2, 1996, the Foundation forwarded a new APS form, dated January 15, 1996, wherein Dr. Greely certified Plaintiff as totally disabled with a. Class 5 physical impairment. The part of the form asking Dr. Greely for his assessment of when Plaintiff might be able to return to work was left blank.
On January 27, 1997 Dr. Greely sent Defendants another APS form certifying Plaintiff as totally disabled. Inexplicably, Dr. Greely listed Plaintiff as having both a Class 3 and Class 5 physical impairment by checking both boxes. Again, the part of the form asking Dr. Greely for his assessment of when Plaintiff might be able to return to work was left blank. Admin. Record at 1830. Dr. Greely noted that Plaintiff had improvement in his T4 cell count and white blood cell count.
Class 3 indicates that a patient has a "slight limitation of functional capacity" and is "capable of light work".
In what would turn out to be his final APS form, on December 19, 1997, Dr. Greely again certified Plaintiff as totally disabled and again checked the boxes for both a Class 3 and a Class 5 physical impairment, but this time Dr. Greely opined that Plaintiff would "never" be able to return to work. Admin. Record at 1825.
On February 11, 1998, CGLIC sent Plaintiff a letter asking him to complete the enclosed Disability Questionnaire in order to update his file. In response, Plaintiff completed the questionnaire, listing his current medications, symptoms, and limitations. When asked for the names of his treating physicians, Plaintiff responded "you already have." Admin. Record at 1807-10. By letter dated July 31, 1998, the Claims Administrator requested that Dr. Greely supply information regarding Plaintiff's current medical status. Admin. Record at 1802. Dr. Greely did not respond to the Claim Administrator's request for information. On November 16, 1998, CGLIC again asked Dr. Greely for this information. On December 12, 1998, Dr. Greely responded by returning the letter with a handwritten note, stating that he was waiting for Plaintiff to come for an office visit so that he could complete the assessment. The same letter was resent to Dr. Greely on December 14, 1998 and February 11, 1999, with no response. Admin. Record at 1781. On April 6, 1999, Dr. Greely returned the Claims Administrator's letter with another handwritten note indicating that he had requested that Plaintiff appear for an office visit to assess his condition and that Plaintiff "[w]as aware that this [was] required to process his claim." Id. On April 29, 1999, Dr. Greely's office informed the Claims Administrator that Plaintiff's last visit was November 30, 1998, that Dr. Greely had advised Plaintiff of the need to be evaluated, but that Plaintiff had not cooperated. Admin. Record at 1773. On June 3, 1999, the Claims Administrator again contacted Dr. Greely's office. Admin. Record at 1771-72. On June 7, 1999, Dr. Greely's office again notified the Claims Administrator that Plaintiff had cancelled his last appointment without rescheduling. Id.
After reviewing the above information, the Claims Administrator determined that there was no evidence of HIV symptomology that would prevent Plaintiff from returning to work. Admin. Record at 1771. The Claims Administrator requested that its medical director, Wei Kuo, M.D., contact Dr. Greely for a peer review of Plaintiff's disability status.Id. Dr. Kuo and Dr. Greely spoke by telephone on June 11, 1999. Dr. Greely stated that he could not comment on Plaintiff's disability because he had not seen Plaintiff since November 30, 1998. Admin. Record at 1770. By letter dated June 24, 1999, the Claims Administrator informed Plaintiff that he was no longer entitled to LTD benefits because he was no longer suffering disabling symptoms from HIV/AIDS.
On July 1, 1999, the Foundation appealed the denial of LTD benefits on Plaintiff's behalf. Admin. Record at 1759-62. Plaintiff stated that he was not aware that Dr. Greely had refused to certify him, and also notified CGLIC that he had been receiving treatment at the Veterans Administration (VA) in Martinez, California. Admin. Record at 1759-1762. Plaintiff stated his belief that Dr. Greely was aware of this, as Dr. Greely had been in contract with Plaintiff's doctor at the VA. Id. Plaintiff's appeal went on to list his impression of his medical condition, and concluded with a request that his benefits be reinstated, immediately. CGLIC acknowledged receipt of Plaintiff's request for review and advised Plaintiff that he should submit all medical evidence necessary for a review of his claim. Admin. Record at 1750.
What followed was a series of unfruitful communications between the parties, with Defendants requesting Plaintiff's current medical records, and Plaintiff responding with long letters expressing his subjective view of his symptoms, his religious beliefs, his daily routine, and many other unhelpful topics. Finally, on October 12, 1999, Defendants obtained Plaintiff's VA medical records by fax. Defendants asked Plaintiff's doctor at the VA, a Dr. Green, to provide them with a narrative on Plaintiff's condition. Dr. Green declined, stating, "I think the office notes should be self-explanatory." Admin. Record at 1574. Plaintiff's records from the VA did not contain an APS form or any other documentation commenting on Plaintiff's disability status. After reviewing this information, the Claims Administrator recommended denial of Plaintiff's appeal, and the Plan Organization agreed. Plaintiff was notified in November of 1999 that his appeal had been denied. Admin. Record at 1533-1536.
Plaintiff responded with a long letter on November 22, 1999, wherein he requested that Chevron of Texaco engage a "qualified medical examiner" in order to evaluate his disability. Admin. Record at 1509. Defendants' Benefits Administrator, Robert Howisey, forwarded Defendants' request for an Independent Medical Evaluation ("IME") to Beth Spicer, a CGLIC claims reviewer. Id. at 1512. CGLIC never obtained an IME for Plaintiff.
Again, what followed was a series of unproductive communications between the parties, with Plaintiff claiming that he was disabled and that his case had been evaluated improperly, and Defendants claiming that the objective medical evidence did not support a claim for continuing disability. Defendants told Plaintiff that he had exhausted all administrative remedies and that his case was closed, but they also told him that in order to I have his benefits reinstated he should submit medical information dated prior to June 24, 1999 which would support a claim of continuing disability. Admin. Record at 1497, 1465-67. On December 6, 2001, Plaintiff wrote to Defendants asking that his claim be reevaluated. Plaintiff attached a November 15, 2001 letter from Dr. Green wherein Dr. Green stated that Plaintiff had been under his care for 4 years, that Plaintiff has "profound neuropathy" that precludes him from working, and that Plaintiff has been seeing a neurologist who concurs with these findings. Admin. Record at 1463. Plaintiff wrote to Defendants again on February 5, 2002, identifying his neurologist and suggesting that CGLIC contact him directly if they had any questions. Id. at 1446-48. Defendants informed Plaintiff two weeks later that his claim was still denied. Id. at 1445. By letter dated March 28, 2002, the Claims Administrator informed Plaintiff that his file had been reviewed on February 25, 2002, and in their view the medical documentation did not establish a continuing disability from June 1999 to the present. Id. at 2622. The Claims Adminstrator again advised Plaintiff that he had exhausted all of his administrative remedies, but that he could provide medical documentation for further review and consideration. Id. On April 4, 2002, Plaintiff submitted a letter from his neurologist, Dr. Brad Volpi, which stated that Plaintiff was totally disabled from, inter alia, progressive neuropathy. At Defendants' request, Plaintiff provided the Claims Administrator medical information and reports from Dr. Volpi's office, including two unsigned letters apparently from Dr. Volpi to Dr. Green dated December 13, 2000 and July 6, 2001, which both stated that Plaintiff suffered from peripheral neuropathy which adversely affected his ability to be employed. Admin. Record at 1358-60, 1364-66. The Claims Adminstrator's medical director, John Mendez, M.D., reviewed Dr. Volpi's records and spoke with Dr. Volpi regarding his assessment that Plaintiff had disabling pain and fatigue from HIV and neuropathy. In a very brief statement, Dr. Mendez concluded that Plaintiff's medical records did not objectively substantiate Plaintiff's claim of total disability. Admin. Record at 2619. Plaintiff was informed that, although Dr. Volpi considered Plaintiff to currently be disabled, Dr. Volpi could not address his functionality as to July 1, 1999. Id. The Claims Administrator concluded that because there was no evidence that Plaintiff had been continuously disabled from July 1, 1999 through May 2002, Plaintiff's claim would not be reopened. Id. Plaintiff then filed this action on June 13, 2002 pursuant to ERISA 502(a)(1)(B), seeking reinstatement of his LTD benefit claim, unspecified damages for breach of fiduciary duty, statutory penalties based on Defendants' alleged failure to provide "claims information and materials," and attorney's fees and costs of suit. Defendants filed a motion for judgment on the administrative record. Plaintiff cross-motioned for judgment on the record., Having considered these two motions together and in light of the record and all the papers submitted by the parties and for the reasons explained below, we grant Plaintiff's cross-motion for judgment on the record and deny Defendants' request for judgment on the record. III. LEGAL STANDARD A. Standard of Review
Section 502 states, in pertinent part:
(a) A civil action may be brought —
(1) By a participant or beneficiary —
(b) To recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;
A challenge to an ERISA plan's termination of benefits is reviewed by a district court de novo "unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the plan does grant such discretion, a reviewing court applies an "abuse of discretion" — also known as an "arbitrary and capricious" — standard of review. See Jebian v. Hewlett Packard Co., 310 F.3d 1173, 1177 (9th Cir. 2002); Taft v. Equitable Life Assurance Soc'y, 9 F.3d 1469, 1471 (9th Cir. 1994). The Ninth Circuit has held that it is an abuse of discretion for ERISA plan administrators to render decisions without any explanation, or to construe provisions of the plan in a way that conflicts with the plain language of the plan. Eley v. Boeing Co., 945 F.2d 276, 279 (9th Cir. 1991). A decision that is not supported by substantial evidence in the record constitutes an j abuse of discretion.Mhadbhi v. Jefferson Pilot Fin., 255 F. Supp.2d 1109, 1114 (N.D.Cal. 2003) (citing McKenzie v. Gen. Tel. Co., 41 F.3d 1310, 1316 (9th Cir. 1994). "[A]n administrator also abuses its discretion if it relies on clearly erroneous findings of fact in making benefit determinations."Taft, 9 F.3d at 1473.
B. The Record to be Reviewed
When a court reviews the administrator's decision, whether de nova or for abuse of discretion, the record that was before the administrator furnishes the primary basis for review. Kearney v. Standard Ins. Co., 175 f.3d 1084, 1090 (9th Cir. 1999). A district court has discretion to allow evidence that was not before the plan administrator "only when circumstances clearly establish that additional evidence is necessary to conduct an adequate de novo review." Monaeluzo v. Baxter Travenol Disability Benefit Plan, 46 F.3d 938, 942 (9th Cir. 1995); Taft, 9 f.3d at 1472 ("Permitting a district court to examine evidence outside the administrative record would open the door to the anomalous conclusion that a plan administrator abused its discretion by failing to consider evidence not before it.")
IV. ANALYSIS
In this case the Defendants clearly reserved for themselves discretionary authority to determine eligibility for benefits., or to construe the terms of the plan. Section 4(b) of the Plan, entitled "Definition of Total Disability," states that the "Organization shall have the sole discretion to determine whether a Member is Totally Disabled under this Section 4(b)." Admin. Record at 1236-1237. Therefore, we review the Defendants' decision to terminate Plaintiff's benefits for an abuse of discretion. Based on the evidence before the Claims Administrator and the Plan Organization at the time the decisions at issue were under consideration, we find it was an abuse of discretion to terminate Plaintiff's LTD benefits. We emphasize that we are not deciding Plaintiff's disability status or his entitlement to benefits under the Plan. Rather, we are saying that based on the evidence before us, we cannot find substantial evidence to support the Defendants' decision. Furthermore, as explained more fully below, we find certain aspects of Defendants' conduct problematic under the circumstances of this case. Therefore, the most equitable solution at this point is to remand this case back to the plan administrator for a determination consistent with the principles set forth in this decision.
A. Defendants Failed to Follow Plan Guidelines
Appendix B to the Defendants' Administrative Services Agreement with CGLIC sets forth the "detailed steps that [CGLIC] is to take" in denying claims or discontinuing benefit payments. Admin. Record at 1318-1322. That review process required, among other things, that:
1. The review schedule take into consideration the following elements: diagnosis, claimant's age, degree of impairment, prognosis, anticipated return to work date, rehabilitation potential, etc. Par. III(e).
2. The claimant be advised that an investigation was being conducted.
3. Where a termination of benefits was indicated, the Claims Administrator should obtain a vocational evaluation that specifies particular jobs the claimant can perform or could reasonably become qualified to perform. Par. (v)(D).
4. Confirm that claimant's file contains written documentation from appropriate sources to support termination of benefits. Par. VI(B)(1).
5. Confirm that every lead has been followed to its conclusion and that all discrepancies have been resolved. Par. VI(B)(3).
6. When a difference of opinion exists between Medical Department staff and claimant's attending physician, an Independent Medical Examination must be obtained. Par.(VI)(B)(5).
In deciding to terminate Plaintiff's benefits, Defendants departed greatly from the process delineated above. It does not appear that any of the above-mentioned steps were followed. In the context of this case, such a departure amounted to an abuse of discretion.
First, neither CGLIC nor the Defendants notified Plaintiff that they were investigating whether to terminate his benefits. In an effort to disprove this, Defendants cite to several communications made on their behalf in 1998 and early 1999. Def's. Opp. to PI. Cross-Motion at 4. However, with the exception of the Disability Questionnaire on February 11, 1998, it does not appear that one of these letters was sent to Plaintiff. Rather, they were all sent to Plaintiff's doctors, with whom he was not receiving treatment at the time. Furthermore, we cannot find any other evidence in the record indicating an attempt by the Defendants to let Plaintiff know that a decision to terminate his benefits was underway.
Second, Defendants failed to obtain a vocational evaluation, or its equivalent, that specified particular jobs the claimant could perform or could reasonably become qualified to perform. There is no indication that Defendants ever sought such information, or why they chose not to.
Third there were several discrepancies in Plaintiff's medical documentation that Defendants left unresolved. Defendants rely heavily in their moving papers on the fact that Dr. Greely twice in 1997 checked the box indicating that Plaintiff had a Class 3 physical impairment. See e.g., Def's. Motion for Judgment on the Record at 8. However, Defendants failed to address both in their investigation and before this Court why Dr. Greely continued to certify Plaintiff as totally disabled, on multiple occasions stated that Plaintiff would "never" return to work, and checked the Class 5 box as well on these occasions. Additionally, even after Defendants learned that Plaintiff was being treated at the VA they never sent Dr. Green an APS form or asked him directly whether or not Plaintiff was disabled from working. Defendants make much of the fact that Dr. Green refused their request to provide a narrative report and that he did not refer to Plaintiff as totally disabled in the file. Def's. Opp. to Pl. Cross-Motion at 8. However, neither of these facts answer the underlying question which Defendants never got around to asking Dr. Green: was Plaintiff disabled from working? Finally, there seemed to be much debate about the relationship between Plaintiff's increased T4 and white blood cell count and his ability to resume employment. Defendants consistently point to Plaintiff's increased T4 and white blood cell numbers in order to justify their inference that he was capable of working. However, Plaintiff disputes this inference, and this Court cannot find in the record how Defendants resolved this issue. In sum, after reviewing all of the papers and the administrative record, this Court is left with the impression that Defendants engaged in a rather selective review of the evidence and failed to explore certain discrepancies or inconsistencies in Plaintiff's medical history.
In addition to emphasizing only certain portions of Dr. Greely's and Dr. Green's files, Defendants also seem to ignore the surveillance of Plaintiff which CGLIC arranged in October of 1999. During 4 full days of surveillance, investigators reported Plaintiff coming out of his residence only once, for fifteen minutes.
Fourth, Plaintiff's review schedule did not appear to be tailored in any respect to the particulars of his case. While we are not saying that this is required in every case, given the severity of Plaintiff's condition and the many peculiarities of this case, it is somewhat odd that Defendants made no effort to tailor their review process to Plaintiff's situation. In hindsight, both parties certainly would have benefitted from greater cooperation.
We are referring to, inter alia, Plaintiff's deeply-held religious beliefs and his often recalcitrant conduct in dealing with Defendants.
Finally, for reasons that are not clear to this Court, Defendants never sought to obtain an IME in this case. There clearly seemed to be some question about a difference of opinion between Defendants' Medical Department staff and Plaintiff's treating physicians. Further, Plaintiff offered to undergo an IME. Despite this, no examination of any kind was sought by the Defendants.
While each of these omissions in isolation would most likely be insufficient to overturn Defendants' decision, their amalgamation warrants a different result. What is most confusing is that despite all of the correspondence between the parties in this case, Defendants never sought — nor took Plaintiff up on his offer — to obtain an IME, a functional capacity assessment-("FCE"), a vocational assessment, or any other unambiguous, reliable information regarding Plaintiff's condition. Furthermore, Defendants never informed Plaintiff that they were considering whether to terminate his benefits. Under the circumstances of this case, particularly, where a claimant has on multiple occasions and by different doctors been certified as "totally disabled" and given a "zero" chance of returning to work, where the existing medical information is ambiguous at best, and, as discussed below, there is no substantial evidence indicating that Plaintiff was no longer disabled, Defendants' decision to terminate benefits was an abuse of discretion.
B. Defendants' Decision Not Supported by Substantial Evidence
In addition to departing markedly from their delineated review process, Defendants reached a decision that finds little support in the record. In concluding that Plaintiff was no longer disabled, Defendants rely almost entirely on Plaintiff's increased T4 count and white blood cell count and the absence of any mention of neuropathy in Plaintiff's medical records and his correspondence for a number of years. Def's. Motion for J. at" Il. We have already mentioned the conflicting interpretations regarding the relationship between Plaintiff's blood work and his ability to work. With respect to the Plaintiff's failure to mention neuropathy in any of his correspondence with CGLIC and Defendants and the absence of neuropathy in Plaintiff's medical files for a number of years, we agree that this is highly questionable and properly the cause for concern. However, this fact alone, when viewed in the context of the entire record, does not justify the conclusion that Plaintiff had ceased to be disabled. At best, this represented a discrepancy that Defendants should have investigated and allowed Plaintiff an opportunity to explain. By terminating Plaintiff's benefits on the basis of this evidence and without following their own guidelines in conducting a proper review, Defendants abused their discretion.
It should be noted that we are not holding that it is Defendants' burden to prove that Plaintiff's disability had ceased. Rather, we are saying that Defendants' decision and the manner in which it was arrived constitute such a significant departure from the purpose and guidelines of the Plan as to amount to an abuse of discretion. Further, we note that Plaintiff often was less than helpful in resolving this dispute. Plaintiff certainly could have helped his cause had he submitted more appropriate information in a timely manner. Nevertheless, we find that under all of the facts of this case, Defendants' decision to terminate Plaintiff's benefits was arbitrary and capricious.
C. Remand is the Appropriate Disposition of this Case
This matter must be remanded to the plan administrator for a reevaluation of Plaintiff's claim in a manner consistent with this order. The primary task on remand will be a determination of whether Plaintiff's medical condition renders him totally disabled as defined under the Plan.
V. CONCLUSION
Having reviewed the record and all the papers submitted by the parties and for the reasons discussed above, this Court HEREBY GRANTS Plaintiff's cross-motion for judgment on the record and HEREBY DENIES Defendants' request for judgment on the record. Plaintiff's LTD benefit claim is HEREBY REMANDED to the Plan Organization for a redetermination consistent with this order. Both parties will pay their own costs in connection with bringing these motions. Additionally, Plaintiff has stated that he does not intend to pursue his claims for breach of fiduciary duty, and statutory penalties for failure to provide documents, nor does he object to dismissal of these claims. Pl. Opp. to Def's. Motion for J. on Admin. Record at 15. Accordingly, these claims are HEREBY DISMISSED.
IT IS SO ORDERED.