Opinion
NO. 01 C 3407
June 10, 2002
MEMORANDUM AND ORDER
I. BACKGROUND
Ronald Reipsa ("Plaintiff") worked for Allstate Insurance Company as an agent selling insurance and processing insurance applications from February 1971 until April 19, 1997. Plaintiff was a participant in an employee welfare benefit plan ("Plan") with a policy of long term disability insurance. Allstate administered the Plan and MetLife ("Defendant") insured it.
The Plan has two phases and provides benefits for employees it deems totally disabled. Phase one consists of a waiting period and the twenty-four months immediately thereafter. Under phase one, an employee is totally disabled if he or she is unable to perform the duties of his or her particular occupation. The Plan provides:
Totally Disabled or Total Disability means that due to Sickness or Injury:
you are unable to perform the material duties of your own occupation with your Employer during the Waiting Period and during the next 24 months
In their pleadings, the parties cite to Defendant's administrative record from its internal review as "MET ###". See Pl. SOF Ex.; see also Vartanian v. Metro. Life Ins. Co., No. 01 C 2674, 2002 WL 484852 (N.D.Ill. March 29, 2002) (same attorneys and same Defendant used same internal citation format). To maintain continuity and avoid confusion, the Court will continue to use this citation format.
Following phase one, an employee remains eligible only if he or she meets the total disability standard of phase two. Phase two provides:
Thereafter, you must be totally incapable due to Sickness or Injury of performing the material duties of any gainful occupation for which you are reasonably fit based on training, education or experience.
(MET 044.)
Further, the Plan gives the plan administrator discretion. The Plan provides:
The Plan Administrator and MetLife, as the claims review fiduciary, have the authority to determine all questions arising under the provisions of the Plan, including the power to determine the rights and eligibility of participants or any other persons, and to remedy ambiguities, inconsistencies or omissions.
***
In carrying out their respective responsibilities under the Plan, the Plan Administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan services in accordance with the terms of the Plan. Any interpretation and determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.
(MET 042.)
In April 1997, Plaintiff went on "illness allowance" after he had trouble performing his job and sought benefits under the Plan. In support of his claim, Plaintiff provided a report from his physician, Dr. Krates. Dr. Krates determined Plaintiff suffered from dry macular degeneration, a progressive eye condition with no available treatment. (MET 249,) Dr. Krates also declared Plaintiff totally disabled from his occupation but not totally disabled from any occupation. (MET 250, 252.) To further investigate Plaintiff's claim, Defendant sent Plaintiff to another physician, Dr. Saxe, for an independent medical examination. Dr. Saxe diagnosed "minimal macular degeneration" and determined Plaintiff was "not totally disabled from his own occupation." (MET 208.) Dr. Krates responded to Dr. Saxe's report and agreed with Dr. Saxe's conclusions, but added that Plaintiff suffered from depression as well. Based on the information available, Defendant granted Plaintiff benefits under the first phase of the Plan.
In July 1999, Defendant investigated Plaintiff's claim under phase two of the Plan. Defendant received a report from Network Medical Review ("NMR"), a review board Defendant uses extensively to determine benefit eligibility. NMR's physician, Dr. Yanik, reviewed Plaintiff's records but did not examine Plaintiff. Dr. Yanik determined there was "insufficient evidence" to "support the determination of inability to work based on visual dysfunction." (MET 132.) However, Dr. Yanik recognized Plaintiff's disease was progressive and stated "should further clinical information of visual deterioration or advancement of Mr. Reipsa's macular degeneration come to light," he would reevaluate. (MET 132.) Dr. Krates did not respond to Dr. Yanik's report. Along with the NMR report, Defendant hired a private investigator to observe Plaintiff's daily activities. The investigator observed Plaintiff driving and washing his car. On November 11, 1999, Defendant terminated Plaintiff's benefits.
Plaintiff appealed initially and Defendant affirmed its denial of benefits. Plaintiff appealed a second time and included a report by a new physician, Dr. Pavletic. Dr. Pavletic agreed with the dry macular degeneration diagnosis and felt it "would inhibit Plaintiff's ability to work for long stretches of time on a computer." (MET 087.) Defendant again affirmed its denial of benefits. Plaintiff then hired a new attorney and requested a further review. Plaintiff's new counsel sent to Defendant a letter and a vocational evaluation conducted by Ms. Cheryl Hoiseth, a vocational expert regularly consulted in Social Security proceedings. The analysis revealed Plaintiff was "not a candidate for competitive employment" and "because of Mr. Reipsa's educational level and his work experience, it is likely that any other related work he might try to pursue would require the same or similar visual demands." (MET 070.) Defendant refused to consider the vocational evaluation and denied Plaintiff another review.
On May 9, 2001, Plaintiff filed this lawsuit. Both parties have moved for summary judgment and the Court granted Plaintiff's Motion For Leave to File Additional Evidence, i.e. a copy of the Social Security Administration's March 22, 2002 notice of award and decision entitling Plaintiff to a period of disability benefits beginning April 24, 1997. (Soc. Sec. Admin. Order and Decision, March 22, 2002.)
II. SUMMARY JUDGMENT STANDARD
Summary judgment is appropriate if, after drawing all reasonable inferences in favor of the non-moving party, the court concludes there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Juarez v. Ameritech Mobile Communications, Inc., 957 F.2d 317, 320 (7th Cir. 1992). The question is "whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law." Anderson v. Liberty Lobby, 477 U.S. 242, 251-52. On cross-motions for summary judgment, the court "considers the merits of each cross-motion separately and draws all reasonable inferences and resolves all factual uncertainties against the party whose motion is under consideration." Rowell v. Life Ins. Co. of North America, No. 96 C 8076, 1998 WL 708805, at *3 (N.D. Ill. Sept. 30, 1998) (citations omitted); see also Vartanian, 2002 WL 484852, at *4.
III. ERISA STANDARD OF REVIEW
Judicial review of benefit eligibility requires "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." Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the plan confers this discretionary power on the plan administrator, then the court must "review the administrator's benefit entitlement decision under the arbitrary and capricious standard." Rowell, 1998 WL 708805 at *4 "The courts have consistently held that there are no `magic words' determining the scope of judicial review of decisions to deny benefits." Herzberger v. Standard Ins. Co., 205 F.3d 327, 331 (7th Cir. 2000). Moreover, the plan's language need not "contain an `explicit' grant of discretionary authority in order for a discretionary standard of review to apply." Donato v. Metro. Life Ins. Co., 19 F.3d 375, 379 (7th Cir. 1994). Rather, "the court must look to the plain language of the plan and determine whether the terms in question are clear; if the language is unambiguous, the inquiry need go no further." Trombetta v. Cragin Fed. Bank for Sav. Employee Stock Ownership Plan, 102 F.3d 1435, 1438 (7th Cir. 1996) (citing Ryan v. Chromalloy Am. Corp., 877 F.2d 598, 602 (7th Cir. 1989)).
The arbitrary and capricious standard "is narrow and a court is not to substitute its judgment" for that of the decisionmaker. Motor Vehicle Mfr. Assoc. of the U.S. v. State Farm Mutual Auto. Ins. Co., 463 U.S. 29, 43 (1983). Rather, when the court gives deference under the arbitrary and capricious standard, it should "uphold the plan administrator's `denial of a claim if the denial is based on a reasonable interpretation of the relevant plan documents.'" Cuddington v. Northern Indiana Pub. Serv. Co., 33 F.3d 813, 816 (7th Cir. 1994) (quoting Shull v. State Mach. Co. Employees Profit Sharing Plan, 836 F.2d 306, 308 (7th Cir. 1987)). In other words, the court "can overturn [the trustees] determination only by finding that they abused their discretion, which is to say, that they were not just clearly incorrect but downright unreasonable." Fuller v. CBT Corp., 905 F.2d 1055, 1058 (7th Cir. 1990) (citing Disher v. Info. Res., Inc., 873 F.2d 136, 140 (7th Cir. 1989)). "[B]efore condemning a decision as arbitrary or capricious a court must be very confident that the decisionmaker overlooked something important or seriously erred in appreciating the significance of the evidence." Pokratz v. Jones Dairy Farm, 771 F.2d 206, 209 (7th Cir. 1985).
Some courts may apply a stricter version of the arbitrary and capricious standard if a conflict of interest exists. Mers v. Marriott Int'l Group Accidental Death and Dismemberment Plan, 144 F.3d 1014, 1020 (7th Cir. 1998). "If a benefit plan gives discretion to an administrator or fiduciary who is operating under a conflict of interest, that conflict must be weighed as a `factor determining whether there is an abuse of discretion.'" Firestone, 489 U.S. at 115 (quoting Restatement (Second) of Trusts § 187, Comment D (1959)). Nevertheless, the Seventh Circuit presumes a fiduciary acted neutrally, unless the claimant provides specific evidence of actual bias to show a significant conflict. Mers, 144 F.3d at 1020. "[T]he existence of a potential conflict is not enough." Id. The burden lies with the plaintiff to prove entitlement to benefits. Fuja v. Benefit Trust Life Ins., 18 F.3d 1405, 1408 (7th Cir. 1994). Further, a proven conflict of interest or actual bias will not change the standard of review a court applies to the administrator's decision, but will cause the Court "to give the arbitrary and capricious standard more bite." Chojnacki v. Georgia-Pacific Corp., 108 F.3d 810, 815 (7th Cir. 1997). "The more serious the conflict, the less deferential our review becomes." Id.
In this case, Plaintiff claims the policy document and plan description do not provide a sufficient grant of discretionary authority to Defendant to make factual benefit determinations. To the contrary, the Plan specifically gives fiduciaries "discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan services in accordance with the terms of the Plan." (MET 042.) Further, the Plan grants "authority to determine all questions arising under the provisions of the plan." (MET 042.) Although "magic words" are unnecessary, the Plan's explicit language is unambiguous. The Plan clearly states both factual determinations regarding eligibility for the Plan's services and interpretations of the Plan's terms are subject to the administrative discretion of the Plan's fiduciaries.
Alternatively, Plaintiff argues for a relaxed standard based on an alleged conflict of interest by Defendant. Plaintiff claims NMR utilized a non-examining physician, Dr. Yanik, to generate an unfavorable report designed to deny benefits and maintains the close relationship between Defendant and NMR reveals an actual prejudicial bias. While persuasive, Plaintiff fails to present specific evidence to establish an actual conflict. See Mers, 144 F.3d at 1020-21.
First, Plaintiff argues Defendant's dual role as both a payor and adjudicator of claims establishes evidence of a conflict. However, courts have repeatedly rejected Plaintiff's argument that a significant conflict exists merely because there is an inherent conflict of interest. Mers, 144 F.3d at 1020-21 (the Seventh Circuit applied a law and economic rationale in such an inherent relational conflict and declared "it is a poor business decision to resist paying meritorious claims for benefits"); Chalmers v. Quaker Oats, 61 F.3d 1340, 1344 (7th Cir. 1995); Van Boxel v. Journal Co. Employees' Pension Trust, 836 F.2d 1048, 1051 (7th Cir. 1991); Vartanian, 2002 WL 484852, at *7, Again, Plaintiff must prove a "significant conflict" and there is a presumption against a conflict without specific evidence. Mers, 144 F.3d at 1020.
However, the Court finds Defendant's relationship with NMR troubling. To suggest Defendant's reliance on NMR for favorable results illustrates bias, Plaintiff raises a recent Ninth Circuit case which cautioned benefit plans against consistently hiring physicians for their expert opinions while also building in a financial motive for predetermined opinions. Regula v. Delta Family-Care Disability Survivorship Plan, 266 F.3d 1130 (9th Cir. 2001). In Regula, the court found "inconsistency in the administrator's dealings with the beneficiary" to be evidence of self-interest, and the court expressed concern over an insurer repeatedly hiring the same physicians as experts. Id. at 1143. In the Seventh Circuit, judges have cited Defendant's repeated use of NMR in ERISA disability benefits appeals. Ladd v. ITT Corp., 148 F.3d 753, 755 (7th Cir. 1998) (NMR is "a consulting firm that MetLife uses extensively"); Vartanian, 2002 WL 484852, at *10 ("MetLife continually uses doctors from Network Medical Review."). Further, in the present matter, Defendant awarded benefits to Plaintiff based in part on the personal exams of Plaintiff by Drs. Krates and Saxe; however, Defendant then sent Plaintiff's case files to NMR for a review by Dr. Yanik, with a rejection to follow. While the Court may give the report of an examining physician more authority than the report of a non-examining physician, see DeFranceco v. Bowen, 867 F.2d 1040 (7th Cir. 1989) (Court cited cases that "greatly discount the report of a non-examining physician in favor of the report of the claimant's own physician" in a Social Security disability claim) and Poulos v. Motorola Long Term Disability Plan, 93 F. Supp.2d 926, 929-30 (N.D.Ill. 2000) (the court did "not wholly discount the nonexamining physician's conclusions, but they are less weighty than the reports of the examining physicians"), NMR's nonexamining physician reached the same conclusion as Plaintiff's doctor and other physicians, i.e. Plaintiff has a progressive illness but was not totally disabled for any job. Dr. Yanik recognized Plaintiff has macular degeneration and even identifies the disease as progressive. Regardless, Dr. Yanik still concluded "there is insufficient evidence at this time to support the determination of inability to work based on visual dysfunction." (MET 132.) Dr. Yanik based his conclusion on Plaintiff's own doctors' determinations. First, Dr. Krates evaluation showed Plaintiff is totally disabled for his occupation, but not totally disabled for any occupation. (MET 132.) Second, Dr. Saxe's examination revealed Plaintiff has "minimal macular degeneration" and "is not totally disabled from his own occupation." (MET 208.) Later, Dr. Pavletic's report merely stated Plaintiff's diagnosis "would inhibit his ability to work for long stretches of time on a computer." (MET 087.) While there are no magic words to indicate a claimant is totally disabled, the examining physicians here failed to state Plaintiff is totally disabled from any job. Thus, Dr. Yanik's conclusion does not reveal a blatant bias toward Defendant; rather, Dr. Yanik's decision reflects similar assessments of Plaintiff's own treating physicians.
In both the present case and Vartanian, Defendant placed Plaintiff under surveillance prior to terminating benefits and Plaintiff's counsel asserted such conduct illustrates clear bias. The Court agrees with the court's finding in Vartanian:
"Without a showing that surveillance is not appropriate and as such demonstrates bias, this is not sufficient to infer bias. It is the responsibility of MetLife to ensure that they are not being defrauded and any measures they may take to verify a claim are probably reasonable unless it can be shown otherwise."Vartanian, 2002 WL 484852, at *2; see also Clausen v. Standard Ins. Co., 961 F. Supp. 1446, 1457 (D.Colo. 1997) (video surveillance where plan participant walked her dog for two miles does not suggest participant was capable of that activity on a sustained basis).
Moreover, even if Dr. Yanik's determination was contrary to the treating physicians, he could still enjoy the deferential standard if he "had given reasons for disagreeing" with the other doctors. Ladd, 148 F.3d at 756. Here, the issue in Ladd is irrelevant, because Dr. Yanik does not present contradicting views.
IV. DENIAL OF BENEFITS
"In evaluating a plan administrator's decision under an arbitrary and capricious standard of review, the court should consider only the evidence that was before the administrator when it made its decision." Hess v. Hartford Life Accident Ins. Co., 274 F.3d 456, 462 (7th Cir. 2001). "If the claimant submits additional evidence to the administrator, however, and requests the administrator to reconsider his decision, that additional information should be treated as part of the administrative record." Vega v. Nat'l Life Ins. Services, Inc., 188 F.3d 287, 300 (5th Cir. 1999). In the Seventh Circuit, if the administrator knew of the evidence and easily could have obtained it, the evidence is "properly part of the administrative record." Hess, 274 F.3d at 462-463. "The fact that the examiner did not bother to read pertinent evidence actually before him cannot shield [defendant's] decision from review." Id. Rather, remand often is appropriate in order for the evaluator to consider the evidence. Id. at 463. However, remand is unnecessary when "the case is so clear cut that it would be unreasonable for the plan administrator to deny the application for benefits on any ground." Id. at 464 (quoting Gallo v. Amoco Corp., 102 F.3d 918, 923 (7th Cir. 1996)). Here, Hoiseth's vocational evaluation is properly part of the record because Plaintiff asked Defendant to reconsider his claim and Defendant had access it. Plaintiff claims Defendant's refusal to consider Hoiseth's report illustrates Defendant's bias and arbitrary and capricious misconduct. See Poulos, 93 F. Supp. at 932 (finding Defendant's explanation that plaintiff was able to work inadequate without citing specific jobs).If Defendant had acted in good faith in terminating Plaintiff's disability benefits, then it seems it should have reviewed the vocational evaluation conducted by Hoiseth and/or conducted its own comprehensive evaluation, and should review the Social Security Administration ("SSA") decision approving Plaintiff's application for disability benefits. See 29 U.S.C. § 1001(b) (the implicit purpose of ERISA is to "protect . . . the interests of participants in their employee benefit plans and their beneficiaries"); Brown v. Blue Cross Blue Shield of Alabama, Inc., 898 F.2d 1556, 1566 n. 11 (11th Cir. 1990) (a plan fiduciary must make "an honest effort to ascertain the facts upon which its exercise must rest and an honest determination from such ascertained facts"; a fiduciary's failure to investigate may infer "an improper motive sufficient to set aside a fiduciary's decision"). The Court believes "a reasonable decision maker, one not operating under a predisposition or inclination to terminate benefits," would welcome the opportunity to review all relevant data and personal examinations before taking the serious step of terminating disability benefits. Vartanian, 2002 WL 484852, at *10. A review of the Hoiseth vocational evaluation and the SSA's decision and underlying findings would evidence "a reasonable and objective approach and decision making process", as opposed to "a hurried determination to terminate benefits based upon the thinnest of evidence." Id. Therefore, since "our procedural rules encourage the parties to resolve their dispute at the administrator's level", the Court remands this matter to the plan administrator to fully and fairly review all materials, including the vocational evaluation and the SSA decision. Vega, 188 F.3d at 300 ("If a claimant believes that the district court is a better forum to present his evidence and we permit the claimant to do so, the administrator's review of claims will be circumvented); see also Hess, 274 F.3d at 464 (a remand to address factual disputes "is sometimes the appropriate step to order."); Gallo, 102 F.3d at 923.
This conclusion and decision to remand is similar to and supported by recent cases in this District. In Quinn, the Seventh Circuit addressed the remedy for an ERISA violation by the plan administrator. Quinn v. Blue Cross Blue Shield Ass'n, 161 F.3d 472, 477. The court noted "in some cases, retroactive reinstatement of benefits is the proper remedy." The Seventh Circuit recognized reinstatement of benefits was proper where the claimant was receiving disability benefits and "but for their employer's arbitrary and capricious conduct, would have continued to receive the benefits". Id. at 477. However, the court stated where additional findings of fact are required or where the plan fails to provide an adequate reasoning, the appropriate remedy was a remand to the plan administrator "unless it `is so clear cut that it would be unreasonable for the plan administrator to deny the application for benefits on any ground.'" Id. (citing Hess, 274 F.3d at 464). In Quinn, the Seventh Circuit stated the plan administrator "should have identified the skills necessary to obtain another job and whether [the claimant] possessed those skills", reversed the district court's grant of retroactive benefits and remanded the case to the plan administrator for a proper finding on the plaintiff's ability to obtain a comparable occupation. Id. at 476-78. The court noted the district court's award of retroactive benefits constituted a decision that the plaintiff was disabled. Id.; see also Hess, 274 F.3d at 464; contra O'Reilly v. Hartford Life Accident Ins. Co., 272 F.3d 955, 959+ (7th Cir. 2001). Here, Defendant chose not to review the vocational evaluation or to conduct its own inquiry into Plaintiff's occupational opportunities in light of his disability. Such a restrictive review may predetermine the outcome and leads the Court to conclude Defendant's termination of Plaintiff's benefits here was arbitrary and capricious. Since the termination of Plaintiff's benefits is found to be arbitrary and capricious, the appropriate remedy here is a remand for additional findings.
In Poulos, the court concluded a plan administrator's termination of benefits was arbitrary and capricious where the plan failed to consider the participant's age, work experience, and skills in determining whether the participant was disabled. Poulos, 93 F. Supp.2d at 926. The plan's restriction of its analysis to physical limitations without a "holistic inquiry demanded by its own Plan language, which would have required taking into consideration her age, skills, job history, and other relevant factors," was unreasonable. Id. at 933. Particularly relevant to the present case, the plan defined disability as the inability "to perform all of the normal duties of any occupation or employment for wage or profit for which [she] is reasonable qualified by education, training, or experience." Id. at 929; see Glenn v. Secretary of Health and Human Serv., 814 F.2d 387, 389 (7th Cir. 1987) ("disability is a function in part of employment opportunities, and employability in turn is a function not only of one's physical capacity but of education, age, and other factors.") Here, Defendant's definition of disability is similar to the definition in Poulous. Further, Defendant failed to analyze constructively whether Plaintiff's physical limitations could prevent employment and neglected to consider Plaintiff's age, work history, and skills. "By not even performing the slightest inquiry into this matter, [the plan] made [its] decision arbitrarily and capriciously." Quinn, 161 F.3d at 476.
In Carugati, the court held the plan failed to make the rational connection between the evidence in the case and its conclusion to terminate benefits; thus, as a matter of law, the plan's termination of benefits was arbitrary and capricious. Carugati v. Long Term Disability Plan for Salaried Employees, No. 01 C 5863, 2002 WL 441479, at *6 (N.D.Ill. Mar. 21, 2002). The court concluded the termination was unjust and determined the appropriate remedy was a remand to the plan administrator for additional findings. The court emphasized that in finding the plan's termination of benefits was arbitrary and capricious, the court did not conclude the claimant was totally disabled under the plan's definition of total disability. Id. at *9 Rather, the plan administrator's failure to assess the claimant's vocational capabilities combined with its failure to adequately assess claimant's condition and the record evidence constituted an arbitrary and capricious decision to terminate benefits. If the court awarded retroactive disability benefits to claimant, then the court would be finding claimant was disabled during the period following termination of benefits. In addition, as in the present case, the claimant's "evidence is not so `clear cut' that it would be unreasonable on any grounds to deny benefits." Id. (citing Quinn, 161 F.3d at 478). The Court must remand this matter to the claims review fiduciary because the plan's decision was "arbitrary and capricious, but not necessarily wrong." Quinn, 161 F.3d at 478.
Further, the SSA decision relied upon additional medical findings unavailable to Defendant at the time of its decision to terminate; in addition to Dr. Krates' exam, Dr. Kisla and Dr. Jam of the SSA hearing office staff examined and evaluated Plaintiff. While the standards in SSA cases are not binding in ERISA matters, courts have consistently relied upon the instructive nature of SSA decisions in disability benefit cases. See Ladd, 148 F.3d at 754 (Seventh Circuit used SSA standards to analyze ERISA plan language and reverse an arbitrary and capricious denial of benefits); Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 695 and n. 11 (7th Cir. 1992) (Seventh Circuit found the SSA's review of a claim and subsequent decision to continue benefits to be a significant factor in determining ERISA disability benefits); Carugati, 2002 WL 441479, at *6+; LaBarge v. Life Ins. Co. of North America, No. 00 C 512, 2001 WL 109527, at **8 (N.D.Ill. Feb. 6, 2001) ("The findings of the Social Security Administration is [sic] compelling evidence of (plaintiff's) disability."); Pierce v. American Waterworks Co., Inc., 693 F. Supp. 996 (W.D. Pa. 1988). Since the SSA decision is not derived from evidence already available to Defendant, the Court must remand this matter for further review. See Perkins v. Chater, 107 F.3d 1290, 1295 (7th Cir. 1997) (in the context of an appeal for Social Security disability benefits, a remand to the Commissioner is appropriate when material new evidence is presented; an evaluation based entirely on evidence considered by the ALJ is not new); Sample v. Shalala, 999 F.2d 1138, 1144 (7th Cir. 1993) (a medical conclusion offered after the ALJ's decision in a SSA appeal but based on evidence in the administrative record considered by the ALJ cannot be fairly characterized as new); Govindarajan v. FMC Corp., 932 F.2d 634 (7th Cir. 1991) (selective review of medical evidence to justify denial of benefits is arbitrary and capricious); see also Vega, 188 F.3d at 300 (courts are not permitted "to consider evidence introduced to resolve factual disputes with respect to the merits of the claim when that evidence was not in the administrative record"). Will the Court's decision to remand this matter result in this matter again appearing before the Court if Defendant affirms its decision to terminate Plaintiff's disability benefits ? Possibly. If the Court chose to bypass the administrative review and instead inserted itself as a better forum for Plaintiff to directly present his evidence, would the Court then challenge and breach Congress' clear mandate that ERISA matters be resolved at the administrative level ? Definitely.
III. CONCLUSION
Plaintiff's motion for summary judgment is GRANTED. Defendant's motion for summary judgment is DENIED. This matter is REMANDED to MetLife to make findings consistent with this order and opinion.
IT IS SO ORDERED.