Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_04-cv-04394/USCOURTS-cand-4_04-cv-04394-4/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.: Employee Benefits

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United States District Court

For the Northern District of California

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1

 On January 5, 2005, the Court approved a stipulation

substituting Defendant Liberty Life Assurance Company for Defendant

McKesson Corporation Employees’ Long Term Disability Benefit Plan

(McKesson Plan), and dismissing the claims against McKesson Plan.

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

MICHAEL CREMIN,

Plaintiff,

v.

McKESSON CORPORATION EMPLOYEES’ LONG

TERM DISABILITY BENEFIT PLAN and

LIBERTY LIFE ASSURANCE COMPANY OF

BOSTON,

Defendants.

 /

No. C 04-4394 CW

ORDER DENYING

PLAINTIFF’S

MOTION FOR

JUDGMENT, DENYING

DEFENDANT’S

CROSS-MOTION, AND

REMANDING CASE TO

PLAN

ADMINISTRATOR

Plaintiff Michael Cremin moves the Court, pursuant to Federal

Rule of Civil Procedure 52, for review of Defendant Liberty Life

Assurance Company’s1 termination of his long-term disability

benefits. Defendant opposes the motion, and cross-moves for

judgment in its favor. The matter was heard on December 2, 2005. 

Having considered the parties’ papers, the evidence cited therein

and oral argument on the motions, the Court DENIES the parties’

motions for judgment, but GRANTS Defendant’s motion in the

alternative to remand the case to the Plan Administrator for

further consideration.

BACKGROUND

The following facts are taken from the administrative record,

McGee Decl., Ex. C, unless otherwise noted. Plaintiff began

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2

Research conducted by Defendant shows that the Medical Board

of California put Dr. Karalis on probation, which was completed on

June 9, 1998. He also resigned, with charges pending, from the

State Bar of Californa, after serving five years’ probation for

Medicaid fraud. 

2

working for McKesson Corporation in 1980. At all times relevant to

this action, Plaintiff was covered by the McKesson Plan, which is a

benefits plan organized under the Employee Retirement Income

Security Act (ERISA). 

Plaintiff suffered a heart attack in 1988. Ten years later,

on January 23, 1998, Plaintiff was placed on short-term disability

by his cardiologist, Dr. Gershengorn, due to an unspecified cardiac

condition. Dr. Gershengorn initially recommended that Plaintiff

take a two week break, return to work part-time for two or three

weeks, and then be reassessed. CF-0490. 

Plaintiff returned to work on February 10, 1998, but worked

only part-time until September 21, 1998, when he filed a claim for

long-term disability benefits. On the long-term disability claim

form, Plaintiff listed his disabling conditions as coronary artery

disease and anxiety; the claim form identified both Dr. Gershengorn

and Plaintiff’s psychiatrist, Dr. Karalis.2

 According to the

physician’s statement completed by Dr. Karalis, Plaintiff suffered

from severe anxiety disorder. Dr. Karalis defined his physical

impairment as Class 5: “severe limitation of functional capacity:

incapable of minimum (sedentary) activity.” At the time Plaintiff

applied for long-term disability benefits, the McKesson Plan was

self-funded by the McKesson Corporation and administered by

Preferred Works. 

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Preferred Works awarded Plaintiff long-term disability

benefits on April 20, 1999. The approval letter stated that

Plaintiff would receive long-term benefits for twenty-four months,

and would thereafter continue to receive benefits if Plaintiff

(1) could prove by “objective medical evidence” that he was unable

to perform any occupation for which he was reasonably qualified,

and (2) was receiving Social Security disability benefits. On

August 16, 1999, the Social Security Administration granted

Plaintiff disability benefits, effective retroactively from

January, 1999. 

The McKesson Plan defines “disability” as follows:

“Disability” shall mean any physical or mental condition

arising from an illness, pregnancy or injury which renders a

Participant incapable of performing work. During the first

thirty (30) months of Disability, a Participant must be unable

to perform the work of his or her regular occupation or any

reasonably related occupation, and must not, except as

provided in Section 3.4, be performing work or services of any

kind for remuneration. After thirty (30) months of

Disability, a Participant must be unable to perform the work

of any occupation for which he or she is or becomes reasonably

qualified by training, education or experience, and, in

addition, be receiving Social Security benefits on account of

his or her disability.

Effective January 1, 2000, McKesson Corporation became wholly

insured by Defendant, and Defendant became responsible for both the

funding and administration of the McKesson Plan. 

Dr. Gershengorn’s office notes and tests results date back to

January, 1997. In early 1997, Dr. Gershengorn noted that Plaintiff

was “feeling pretty well,” with back and hip pain but no chest

pain. On June 27, 1997, Dr. Gershengorn noted that Plaintiff “uses

Xanax for sleep.” CF-484. 

On December 4, 2001, Dr. Gershengorn submitted to Defendant a

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physical capacities form which stated that Plaintiff was physically

capable of sitting up to eight hours, with breaks. CF-269. He

also checked a box indicating that Plaintiff could “work 8 hours

per workday.” Id. In May, 2002, in response to a request from

Defendant for updated medical information, Dr. Gershengorn

submitted office notes which indicated that, among other things,

Plaintiff was still taking Xanax as recently as May 8, 2001. 

According to an August 12, 2002, update from Dr. Gershengorn,

Plaintiff suffered from coronary heart disease, he was permanently

restricted in all functional activities other than sitting, and his

estimated return to work date was “unknown.” CF-169. 

According to forms regularly submitted by Dr. Karalis between

September, 1998 and May, 2000, Plaintiff suffered from anxiety

disorder and was “totally disabled.” Dr. Karalis’ initial notes of

September 10, 1998, near the end of Plaintiff’s part-time work

experience, indicate that Plaintiff said that he had

psychologically deteriorated over the year, that he couldn’t “work

those long hours at McKesson,” and that he felt he was “pushing

himself into another heart attack.” CF-499. The documentation

indicates that Dr. Karalis provided Plaintiff with supportive

psychotherapy, on an as-needed basis, but that Plaintiff took

cardiac medications only. CF-0301, 0303. According to a March 20,

2001 form, Dr. Karalis indicated that Plaintiff’s psychiatric

condition had “not worsened” during his treatment, but that

Plaintiff could do “no work at all.” CF-0281. At that point, Dr.

Karalis described Plaintiff’s Axis V Global Assessment of

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3Plaintiff asks the Court to take judicial notice of an

excerpt from the American Psychiatric Association’s Diagnostic and

Statistical Manual of Mental Disorder, Fourth Edition DSM-IV-TR,

which describes the GAF scale between 41 and 50 as “Serious

symptoms (e.g., suicial ideation, severe obsessional rituals,

frequent shoplifting) OR any serious impairment in social,

occupational, or school functioning (e.g., no friends, unable to

keep a job).” The Court grants the unopposed request for judicial

notice.

4Defendant attempts to dismiss the recent GAF rating as

“inadmissible hearsay, unsupported, speculative, and improper

expert opinion.” Defendant fails to show that Dr. Karalis’ opinion

as Plaintiff’s treating psychiatrist is inadmissible. 

5

Functioning (GAF) as 45.3 Dr. Karalis revised Plaintiff’s

estimated date to return to work to “never.” CF-0279. On February

13, 2002, Dr. Karalis told Defendant that he had last seen

Plaintiff on February 2, 2002; that Plaintiff remained totally

disabled due to anxiety disorder; that Plaintiff’s prognosis

remained poor; and that Plaintiff could not return to work. Dr.

Karalis’ office notes further indicate that he had contact with

Plaintiff on February 5, 2002, April 11, 2002, May 22, 2002, and

August 6, 2002. On each occasion, Dr. Karalis noted that he

provided supportive therapy to Plaintiff. In his February 5, 2002

note, Dr. Karalis stated “GAF remains 45.”4 

In a May 5, 2000 questionnaire, Plaintiff stated that he

could, among other activities, drive his car, occasionally go

grocery shopping, and visit friends’ houses. He stated that he was

not able to participate in an exercise program such as aerobics,

that he had difficulty sleeping at night, and that he sometimes

took a nap during the day for one to four hours. On February 4,

2002, Plaintiff filled out a similar, updated activities

questionnaire. At that point, he stated he could drive for short

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periods of time, and left his house several times per week. 

However, he reported that he could not participate in an exercise

program, was able to sit only one hour per day, and that his daily

routine involved fourteen hours in bed or watching television, in

addition to a two hour nap. According to Defendant’s notes from a

February 7, 2002 phone call, Plaintiff reported that he had “hurt

his ankle and torn some ligaments due to exercise he needs to do.” 

CF-0015. 

Defendant began a review of Plaintiff’s claim file on March 9,

2002. Susan Leonardos, a registered nurse, conducted the initial

review. According to her notes, Dr. Karalis told her on August 7,

2002 that he had not seen Plaintiff since February, 2002 (contrary

to his records of visits in April and May), that he was “not saying

that [Plaintiff] cannot RTW [return to work],” and that he agreed

that Plaintiff “may well have a sedentary capacity.” CF-0175. 

When Nurse Leonardos asked why Plaintiff was not prescribed antidepressant or anti-anxiety medication, Dr. Karalis reportedly told

her that he did not do so because of Plaintiff’s cardiac condition,

but that Plaintiff had “improved overall,” that he was seen “only”

“every few” months, and that he had “never been in therapy.” CF180. After Nurse Leonardos concluded that there was no objective

evidence from Dr. Karalis to support a finding that Plaintiff was

incapable of sedentary functional activity, Defendant ordered

surveillance of Plaintiff. On Thursday, March 28, Friday, March

29, and Saturday, March 30, Plaintiff was twice seen leaving his

house, once to go to the store and once to drive to an

acquaintance’s house, and was once seen retrieving an object from

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his car.

On August 30, 2002, Defendant sent Plaintiff a letter stating

that his long-term disability benefits had been terminated. The

letter indicated that Defendant had determined that Plaintiff was

capable of sedentary work, relying in part upon the functional

limitations form completed on August 12, 2002 by Dr. Gershengorn. 

Defendant also stated that its determination was based in part upon

Nurse Leonardos’ opinion that “there is not enough information to

support lack of function from a psychiatric perspective. The

claimant sees the psychiatrist sporadically and is on no

psychiatric medication.” The termination letter stated that

Plaintiff could perform the following sedentary jobs: financial

analyst, budget analyst, economist, and credit analyst.

In a letter dated October 10, 2002, Plaintiff appealed the

termination of his benefits. The October 10 letter also requested,

among other things, copies of the surveillance tapes that Defendant

had made of Plaintiff. Plaintiff also sent Defendant a October 18,

2002 letter from Dr. Karalis in which the psychiatrist expressed

his disagreement with the termination of benefits. Specifically,

Dr. Karalis stated that it appeared that Defendant had terminated

Plaintiff’s disability benefits based solely upon the August 12,

2002 physician’s statement from Dr. Gershengorn which indicated

that Plaintiff was not restricted from sitting for eight hours,

although he was restricted in all other physical activities. Dr.

Karalis reported the October 15, 2002 administration of Zung

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5Dr. Mirkin, hired by Defendant to review Plaintiff’s file,

states that the Zung test is a self-rating scale that can be used

to assess progress over time, but which “is not a diagnostic tool

and certainly not one that should be used to resolve a dispute as

to the valid presence of symptoms because there is no objective

validity scale built into the inventory questions.” CF-0114. 

Plaintiff does not dispute this statement. 

8

Depression and Anxiety Psychological Tests5; the results showed, in

part, that Plaintiff felt more nervous and anxious than usual, that

he felt weak or tired easily, that he got tired for no reason, that

he had some loss of mental clarity, and that he did not find it

easy to make decisions. Dr. Karalis opined that, given the

exertional restrictions imposed by Dr. Gershengorn, Plaintiff could

not work; he elaborated, 

In my experience, patients who attempt job reentry in jobs

allowing only “sitting” do not do well, since sitting becomes

uncomfortable and there is often (as with you) an ongoing

psychological impairment (concentrating, remembering,

analyzing, etc.--commonly called cognitive functions). 

CF-0141. Dr. Karalis further stated that Plaintiff could not

perform the sedentary jobs recommended by Defendant because

Plaintiff did “not possess the stabilization of moods and control

of psychiatric symptomatology required to have predictably stable

cognitive functioning to perform these jobs, which assume full

cognitive functioning.” CF-0143. 

Defendant conducted further daily surveillance of Plaintiff

from November 6 through November 10, 2002. Over the course of

those five days, Plaintiff was observed leaving his residence only

three times: once to retrieve a newspaper on the curbside, once to

drive to the store, and once to drive to an unknown location. At

one point, Plaintiff left his car parked partially in a lane of

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traffic. 

Plaintiff called Defendant on November 21, 2002 and informed a

representative that his cardiologist, Dr. Gershengorn, also

disagreed with Defendant’s decision to terminate his benefits and

would be submitting a letter to that effect. Also in November,

Defendant initiated a review by psychiatrist Dr. Mirkin of the

information in Plaintiff’s file. On November 30, 2002, Dr. Mirkin

submitted a report that, under the heading “Recommendations and

Conclusions,” criticized Dr. Karalis’ treatment and opinions, on

the grounds that: (1) the psychatric information supporting

Plaintiff’s disability was subjective only, and his condition

should have been treated more aggressively, e.g. with medication,

if it was as debilitating as Dr. Karalis claimed; (2) there was no

indication of imminent threat from Plaintiff’s cardiac disease, and

if Plaintiff displayed abnormally cautious behavior, Dr. Karalis

should have treated it more aggressively; (3) Dr. Karalis’ office

notes are very brief, and fail to support his medical conclusion of

total disability for Plaintiff and his specific opinion that

Plaintiff lacked the cognitive functioning to work; and (4) there

was no indication from the record why Plaintiff suddenly became so

concerned about another heart attack. 

In a December 4, 2002 letter to Defendant, Dr. Gershengorn

stated that, while he did report the functional limitations cited

in Defendant’s original termination decision letter, Plaintiff also

had limitations on non-exertional activities such as “structured

schedules, deadlines, adversarial relationships, and commuting to

work.” CF-85. Dr. Gershengorn further stated as follows: “He

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remains on cardiac medications . . . and Xanax, and he remains in

therapy for his anxiety disorder. I am unaware of any dramatic

improvement in Mr. Cremin’s medical condition that warrants

reversal of the previous decision, which found him to be disabled.” 

Id. 

On October 18, 2004, Plaintiff filed a complaint for

declaratory judgment that he is entitled to long-term disability

benefits under the McKesson Plan. 

In its October 3, 2005 order addressing the issue of the

standard of review, the Court found that Plaintiff had submitted

material, probative evidence that Defendant had an actual conflict

of interest when it terminated Plaintiff’s benefits. Among other

factors, the Court found that Dr. Mirkin’s report was “little more

than an incomplete critique of Dr. Karalis’ treatment plan,” which

Plaintiff did not have the opportunity to view and address. Oct.

3, 2005 Order at 15. 

LEGAL STANDARD

 ERISA provides Plaintiff with a federal cause of action to

recover the benefits he claims are due under the Plan. 29 U.S.C. 

§ 1132(a)(1)(B). The standard of review of a plan administrator's

denial of ERISA benefits depends upon the terms of the benefit

plan. In its October 3, 2005 order, the Court determined that

Defendant’s termination of Plaintiff’s benefits would be reviewed

de novo. Therefore, as explained by the Court at the February 18,

2005 case management conference, the Court conducts a bench trial

based on the administrative record in order to evaluate Plaintiff's

claim. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1094-95 (9th

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Cir. 1999) (en banc), cert. denied, 528 U.S. 964 (1999). 

In its de novo review of Defendant’s decision to deny

benefits, the Court must decide whether Plaintiff is disabled under

the terms of the plan. In Juliano v. Health Maintenance

Organization of New Jersey, Inc., 221 F.3d 279, 287-8 (2nd Cir.

2000), the Second Circuit held that it was the plaintiffs’ burden

“to establish that they were entitled to [the] benefit [sought]

pursuant to the terms of the Contract or applicable federal law.” 

Following Juliano, the Court concludes that Plaintiff must carry

the burden to prove that he was disabled under the meaning of the

plan. Sabatino v. Liberty Life Assur. Co., 286 F. Supp. 2d 1222,

1232 (N.D. Cal. 2003). On de novo review, the Court may weigh

contradictory evidence. Newcomb v. Standard Ins. Co., 187 F.3d

1004, 1007 (9th Cir. 1999). 

"While under an abuse of discretion standard [the Court's]

review is limited to the record before the plan administrator, this

limitation does not apply to de novo review." Jebian v. HewlettPackard Co. Employee Benefits Organization Income Protection Plan,

349 F.3d 1098, 1110 (9th Cir. 2003). The 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.'" Kearney, 175

F.3d at 1090 (citations omitted); see also Mongeluzo v. Baxter

Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 943 (9th

Cir. 1995) (On de novo review, "new evidence may be considered . .

. to enable the full exercise of informed and independent

judgment."). 

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6Plaintiff also points to Defendant’s failure to conduct an

independent psychiatric examination of him, alleged gaps and errors

in Dr. Mirkin’s review of Plaintiff’s file, and Defendant’s failure

to solicit review of Dr. Mirkin’s report from Drs. Karalis or

Gershengorn. Although these factors were relevant to the Court’s

decision to apply a de novo standard of review, and may go to the

weight of Dr. Mirkin’s evidence, these alleged errors are not, in

themselves, affirmative evidence that Plaintiff is disabled. 

12

DISCUSSION

I. Plaintiff’s Evidence of Disability

As evidence that he is disabled, Plaintiff points to the

following: (1) the opinions of his treating physicians, including

Dr. Karalis’ determination that Plaintiff had a GAF score of 45;

(2) the Social Security Administration’s determination that he was

disabled; and (3) the results of Defendant’s surveillance of

Plaintiff.6 Defendant does not dispute that Plaintiff may have

been disabled at some point in the past, but argues that this

evidence is insufficient to prove that his disability continued

until September 1, 2002, when Defendant discontinued benefits. 

A. Dr. Gershengorn

Dr. Gershengorn’s records show that Plaintiff is physically

capable for sitting for eight hours, but is not capable of any

other regular work activity. None of the evidence from the

cardiologists’ records suggests that sedentary work would, in

itself, put Plaintiff at cardiac risk. However, Dr. Gershengorn’s

December 4, 2002 letter does state that Plaintiff “also has nonexertional limitations due to his medical conditions.” Dr.

Gershengorn opined that non-exertional activities “that could be

harmful to him include structured schedules, deadlines, adversarial

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7

Defendant objects to the Court’s consideration of Dr.

Gershengorn’s letter, which was not before the plan administrator

when Plaintiff’s benefits were terminated. However, the Court

finds that consideration of this opinion of Plaintiff’s treating

physician is necessary in order to “enable the full exercise of

informed and independent judgment." Mongeluzo, 46 F.3d at 943. 

The Court notes that Defendant was aware at the time it denied

Plaintiff’s appeal that Dr. Gershengorn disagreed with Defendant’s

denial of benefits. Furthermore, as the Court noted in its October

3, 2005 order, Plaintiff did not have the opportunity to view and

address Dr. Mirkin’s report prior to Defendant’s final decision

regarding his benefits; under these circumstances, Defendant’s

objection to the letter are inconsistent and unfounded. 

13

relationships, and commuting to work.”7 He also notes that “major

depression/anxiety has been shown to be the strongest predictor of

adverse outcome (MI, CABG, angioplasty) on patients with coronary

artery disease,” although he renders no opinion on whether

Plaintiff in fact suffers from major depression or anxiety. 

In the absence of any specific findings, direct observations

or diagnoses to the contrary, it appears that Dr. Gershengorn’s

opinion regarding Plaintiff’s non-exertional limitations is not

based directly on objective evidence. He may have been relying on

Dr. Karalis’ diagnosis, or Plaintiff’s self-reporting of anxiety. 

Notably, Dr. Gershengorn does not actually say that Plaintiff

cannot work; instead, the cardiologist merely states that he is

“unaware of any dramatic improvement in Mr. Cremin’s medical

condition that warrants reversal of the previous decision, which

found him to be disabled.” Moreover, Plaintiff concedes that his

cardiac condition, standing alone, is not disabling. Pl.’s Reply

Br. 3. Therefore, even taking into consideration the December 4

letter, Dr. Gershengorn’s records and opinions do not provide

sufficient, objective medical evidence to establish that Plaintiff

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is disabled under the plan. 

B. Dr. Karalis

The parties sharply dispute the significance of Dr. Karalis’

evidence. Nurse Leonardos’ notes of her August, 2002 phone

conversation, in which Dr. Karalis allegedly told her that

Plaintiff had improved and might have functional capability,

contrast sharply with his previous, regular descriptions of

Plaintiff as totally disabled, as well as his October 18, 2002

letter opining that Plaintiff’s cognitive impairments prevented him

from performing even a completely sedentary job. Defendant uses

this discrepancy to dismiss Dr. Karalis’ February, 2002 GAF rating,

an objective test, as “irrelevant” because Dr. Karalis later told

Defendant that Plaintiff’s condition had improved. The Court

cannot resolve the discrepancies between Nurse Leonardos’ notes and

Dr. Karalis’ later statements. 

Nevertheless, Dr. Karalis’ documentation contains little in

the way of objective assessment of Plaintiff’s cognitive

impairments. The GAF result of 45 does provide some objective

evidence of Plaintiff’s level of functioning, yet the rating, in

itself, shows that Plaintiff may not be able to work but not that

Plaintiff cannot work, because such an assessment may relate to

social rather than occupational functioning. Plaintiff does not

dispute Dr. Mirkin’s opinion that the Zung tests, based on selfreporting of anxiety and depression, are not an acceptable means to

reach an objective disability determination. Dr. Karalis did not

prescribe any medication for Plaintiff. Although apparently

Plaintiff was taking Xanax prescribed by Dr. Gershengorn, there is

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8Plaintiff’s statement that Dr. Karalis initially provided

Plaintiff with “intensive” therapy is unsupported by the record. 

At best, the evidence shows that the two spoke or met somewhat more

frequently earlier in their relationship. 

15

no evidence in the record that Dr. Karalis was aware of this. Dr.

Karalis’ notes and letter state that he gave Plaintiff “supportive

therapy,” but nowhere does he describe the intensity, goals or

outcomes of that therapy in any detail.8 Dr. Karalis’ credibility

is undermined by his suspension from the California State Bar for

Medicaid fraud. For these reasons, although Dr. Karalis’ opinion

and GAF assessment provide some evidence in support of Plaintiff’s

disability claim, the Court finds that Dr. Karalis’ opinions are

not sufficiently persuasive to allow Plaintiff to meet his burden

of proof. 

C. Surveillance Tapes

Plaintiff asserts that the surveillance tapes, which show a

generally low level of activity as well as poor driving skills,

support his claim of disability. The Court finds that the tapes,

while consistent with the claimed disability, are not, in

themselves, probative, objective medical evidence of disability. 

D. Social Security Determination

The Social Security Administration's (SSA’s) determination

that Plaintiff was disabled is a factor that weighs in Plaintiff’s

favor. However, there are no substantive findings by the SSA

contained within the administrative record. And, although SSA

regulations generally require administrative law judges to give

deference to the opinions of a claimant’s treating physician, such

special deference is not required in the ERISA context. Black &

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Decker Disability Plan v. Nord, 538 U.S. 822, 829-30 (2003). Here,

much of Plaintiff’s case rests on the credibility of his treating

physicians. Nevertheless, the Court finds that the SSA’s

determination, at minimum, provides objective support for the

opinions of Plaintiff’s treating physicians as of SSA’s August,

1999 award of benefits. See Calvert v. Firestar Finance, Inc., 409

F.3d 286, 294 (6th Cir. 2005) (holding that SSA disability

determination supports conclusion that objective support existed

for treating physician’s opinion). 

Plaintiff further urges the Court to find that, having

required him to apply for Social Security benefits, Defendant is

now judicially estopped from arguing that he is not disabled under

the plan. Judicial estoppel is a doctrine which “precludes a party

from gaining an advantage by taking one position, and then seeking

a second advantage by taking an incompatible position.” Rissetto

v. Plumbers & Steam Fitters Local 343, 94 F.3d 597, 600 (9th Cir.

1996). However, Defendant did not argue to the SSA that Plaintiff

was disabled, and Plaintiff has not shown that Defendant has taken

inconsistent positions. Furthermore, as the Court ruled in its

previous order in response to a similar argument by Plaintiff, the

SSA disability determination does not create an irrebuttable

presumption of disability under the plan because the SSA’s

mandatory treating physician rule does not apply in the ERISA

context. October 3, 2005 Order at 14 (citing Black & Decker). 

II. Defendant’s Evidence of No Disability

Although Plaintiff’s evidence of continued disability is weak,

Defendant does not persuasively rebut it. The purported

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inconsistencies identified by Defendant are overblown, or decrease

the weight of Plaintiff’s evidence rather than demonstrate that

Plaintiff was not disabled as of September, 2002. For instance,

without additional information about the exercise that Plaintiff

told Defendant he needed to do but that resulted in a broken ankle,

there is no reason to think that it is necessarily inconsistent

with Plaintiff’s earlier May 5, 2000 statement that he could not

participate in an exercise program such as aerobics. Nor is

Plaintiff’s part-time employment status in 1998 persuasive evidence

that Plaintiff is not disabled. Nothing in the record reflects

Plaintiff’s actual work performance during that time, and Plaintiff

subsequently ceased work altogether, with the support of his

doctors. 

Dr. Mirkin’s report is more thoroughly reasoned and supported

than the opinions of Dr. Karalis. As the Court found in its prior

order, however, Dr. Mirkin’s report is at best an incomplete

critique of Dr. Karalis’ opinions and treatment. Dr. Mirkin did

not examine Plaintiff or communicate directly with Plaintiff’s

treating physicians; instead, he reviewed the scanty records. Dr.

Mirkin’s opinion that Plaintiff should have been treated more

aggressively is persuasive, but it is equally susceptible to two

different interpretations: that Dr. Karalis erred in concluding

that Plaintiff could not work, because his depression and anxiety

is not that severe; or in the alternative, that Plaintiff does

suffer severe depression and anxiety, but that Dr. Karalis’

treatment was inadequate. 

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III. Remedy

In light of the gaps in the record, the Court finds it cannot

reach an adequately supported final adjudication of Plaintiff’s

disability claim. Plaintiff has introduced some evidence of

disability, but it is not sufficient to meet his burden of proof. 

Nevertheless, the Court has serious questions regarding Plaintiff’s

level of impairment that render final judgment in Defendant’s favor

inappropriate. Relatively minimal additional development of the

record could significantly assist a fact-finder. For instance, if

Dr. Karalis knew that Plaintiff took Xanax prescribed by Dr.

Gershengorn and relied on this in devising Plaintiff’s psychiatric

treatment, this would alter the import of Dr. Mirkin’s opinion. 

Therefore, the Court concludes that the most appropriate course is

to remand Plaintiff’s claim to the Plan Administrator for

additional investigation. 

Plaintiff argues that Defendant’s authority supporting remand

is inapposite. Both Gallo v. Amoco Corp., 102 F.3d 918 (7th Cir.

1996) and Miller v. United Welfare Fund, 72 F.3d 1066 (2nd Cir.

1995) involved a lower court’s review under an “arbitrary and

capricious,” standard, and thus are not directly applicable to this

de novo review. Yet even Plaintiff’s authority, also involving

review under the arbitrary and capricious standard, suggests that

the Court has the authority to remand a case where, as here, the

facts are unclear. Cf. Grosz-Salomon v. Paul Revere Life Ins. Co.,

237 F.3d 1154, 1163 (9th Cir. 2001) (holding retroactive

reinstatement of benefits to be appropriate remedy where Plan

Administrator’s decision “was simply contrary to the facts”). 

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Therefore, the Court grants Defendant’s motion for remand. 

CONCLUSION

For the foregoing reasons, the Court DENIES Plaintiff’s motion

for judgment (Docket No. 60) and GRANTS Defendant’s cross-motion,

in the alternative, to remand Plaintiff’s claim to the Plan

Administrator for further investigation (Docket No. 62). The case

will be closed, and the Clerk shall enter judgment in Defendant’s

favor. Each party shall bear its own costs of the action. 

IT IS SO ORDERED.

Dated: 12/21/05

 

CLAUDIA WILKEN

United States District Judge

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