Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-5_10-cv-05399/USCOURTS-cand-5_10-cv-05399-5/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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Case No.: 5:10-cv-05399-EJD

ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

SAN JOSE DIVISION

ROBERT GORDON,

Plaintiff,

v.

METROPOLITAN LIFE INSURANCE 

COMPANY,

Defendant.

Case No. 5:10-cv-05399-EJD 

ORDER DENYING PLAINTIFF'S 

MOTION FOR SUMMARY 

JUDGMENT; GRANTING 

DEFENDANT'S MOTION FOR 

SUMMARY JUDGMENT

Re: Dkt. Nos. 62, 64

I. INTRODUCTION

In this action under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 

§1001, et seq. (“ERISA”), Plaintiff Robert Gordon (“Plaintiff”) seeks long term disability benefits 

from Defendant Metropolitan Life Insurance Company (“Defendant”). Presently before the Court 

are the parties’ competing motions for summary judgment. The Court finds it appropriate to take 

the motions under submission for decision without oral argument pursuant to Civil Local Rule 7-

1(b). For the reasons set forth below, the Court DENIES Plaintiff’s motion for summary judgment 

and GRANTS Defendant’s motion for summary judgment.

II. BACKGROUND

Plaintiff worked as a Senior Staff Systems Programmer with Ashton-Tate starting in 1989. 

In 1991, Ashton-Tate was purchased by Borland Software (“Borland”) and Plaintiff worked for 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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Borland until May 1, 2002. As a Borland employee, Plaintiff was eligible for LTD benefits 

through the Borland Software Corporation LTD Plan (“the Plan”), which is governed by ERISA. 

Defendant MetLife funded LTD benefits under the Plan and was also the claim administrator for 

the LTD claims. The Plan includes the following definition of “Disability,” subject to all other 

Plan terms and conditions:

“Disabled” or “Disability” means that, due to sickness, pregnancy or 

accidental injury, you are receiving Appropriate Care and Treatment 

from a Doctor on a continuing basis; and 

1. during your Elimination Period and the next 60 month 

period, you are unable to earn more than 80% of your Predisability 

Earnings or Indexed Predisability Earnings at your Own Occupation 

for any employer in your Local Economy; or 

2. after the 60 month period, you are unable to earn more than 

80% of your Indexed Predisability Earnings from any employer in 

your Local Economy at any gainful occupation for which you are 

reasonably qualified taking into account your training, education, 

experience and Predisability Earnings.

Your loss of earnings must be a direct result of your sickness, 

pregnancy or accidental injury. Economic factors such as, but not 

limited to, recession, job obsolescence, paycuts and job-sharing will 

not be considered in determining whether you meet the loss of 

earnings test.

Administrative Record (“AR”) at 001470. The Plan contains the following limitation for 

disabilities due to a mental or nervous disorder or disease:

Limitation For Disabilities Due to Particular Conditions

Monthly Benefits are limited to 24 months during your lifetime if 

you are Disabled due to a Mental or Nervous Disorder or Disease, 

unless the Disability results from:

1. schizophrenia; 

2. bipolar disorder;

3. dementia; or

4. organic brain disease.

“Mental or Nervous Disorder or Disease” means a medical condition 

of sufficient severity to meet the diagnostic criteria established in 

the current Diagnostic And Statistical Manual of Mental Disorders. 

You must be receiving Appropriate Care and Treatment for your 

condition by a mental health Doctor.

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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AR at 001485.

On or about April 19, 2002, Plaintiff commenced a period of short term disability. He 

returned to work on May 1, 2002, but was terminated that same day due to performance issues and 

his behavior at a meeting with Human Resources about his performance issues. MetLife AR at 

001412-13. 

On October 22, 2009, seven years after Plaintiff allegedly became disabled, Plaintiff 

submitted a claim for LTD benefits for a disability beginning April 19, 2002. AR at 001440. He 

indicated on the claim form that he suffered from the following conditions that prevented him 

from performing his job: arthritis in the spine and joints; severe insomnia; collapsed thoracic 

vertebra; very large spinal osteophytes; herniated vertebral discs; severe cervical foraminal 

stenosis; depression; chronically active viruses; anxiety; ADD; heart palpitations; impaired shortterm memory; migraine headaches; chronic system inflammation; left knee surgery; cervical spine 

surgery; left shoulder surgery; Apico/jaw surgery; sinus surgery; thoracic and lumbar disc disease; 

chronic esophagitis; and chronic sinusitis. AR at 001440-41. Accompanying Plaintiff’s claim 

form was a note from his treating physician, Dr. Resneck-Sannes, dated October 15, 2009, which 

indicated that the most recent date of treatment was October 15, 2009, and stated that Plaintiff had 

“disabling back & neck pain for degenerative disc disease,” “chronic migraine headaches,” and 

“failed knee and shoulder surgery” since February of 2002. Id. 

In May of 2010, Defendant notified Plaintiff that it lacked “required Employer information 

to complete the initial review” of Plaintiff’s claim. AR at 001079. More specifically, Defendant 

stated that it lacked verification from Borland that Plaintiff was eligible for LTD coverage. 

Defendant further indicated that Plaintiff’s claim would be closed until it received the employer 

verification, but also stated Plaintiff could appeal the decision because the claim “was denied in 

whole or in part.” AR at 001080. Plaintiff appealed Defendant’s decision (AR at 001053), and 

initiated this action on November 29, 2010. See Compl., Docket Item No. 1.

Pursuant to stipulation, the instant action was stayed while Defendant resolved Plaintiff’s 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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appeal. On March 30, 2012, Defendant determined that Plaintiff had coverage under the Borland 

Plan through May 1, 2002. AR at 000947. A few days later, Plaintiff faxed to Defendant certain 

forms Defendant required to determine his eligibility for benefits. AR at 000961.

On December 7, 2012, Defendant notified Plaintiff his LTD claim was denied because the 

information in the claim file did not support a finding of disability within the meaning of the Plan. 

AR at 000776. On May 7, 2013, Plaintiff appealed Defendant’s decision. Defendant has not 

issued a formal decision on Plaintiff’s appeal.

The court lifted the stay and restored this case to active litigation on January 2, 2015. See

Docket Item No. 48. By Order dated April 29, 2015, this Court determined that Defendant’s 

benefit decision is subject to review under an abuse of discretion standard. See Order Denying 

Plaintiff’s Motion for Summary Adjudication. This Court noted, however, that procedural 

violations of ERISA’s requirements are evidence of arbitrary and capricious decision making. Id. 

at 7:26-8:3 (citing Gatti v. Reliance Standard Life Ins. Co., 415 F.3d 978, 985 (9th Cir. 2005) and 

Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 972 (9th Cir. 2006) (“A procedural 

irregularity, like a conflict of interest, is a matter to be weighed in deciding whether an 

administrator’s decision was an abuse of discretion.”)). The Court also advised the parties that it 

would conduct a review of Defendant’s benefit decision “with a heightened degree of skepticism 

and will consider additional evidence submitted with Plaintiff’s notice of appeal.” Id. at 8:4-6. 

(citing Hinz v. Hewlett Packard Co. Disability Plan, No. 10-CV-03633-LHK, 2011 U.S. Dist. 

LEXIS 386454, at *24 (N.D. Cal. March 30, 2011). 

Plaintiff now moves for summary judgment, contending that he has been disabled within 

the meaning of the Plan since he stopped working on April 19, 2002. Defendant opposes 

Plaintiff’s motion for summary judgment and also moves for summary judgment in its favor, 

contending that its determination was reasonable, supported by the evidence, and not an abuse of 

discretion. 

III. STANDARDS

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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Ordinarily, a motion for summary judgment should be granted if “there is no genuine 

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” 

Fed.R.Civ.P. 56(a); Addisu v. Fred Meyer, Inc., 198 F.3d 1130, 1134 (9th Cir. 2000). The moving 

party bears the initial burden of informing the court of the basis for the motion and identifying the 

portions of the pleadings, depositions, answers to interrogatories, admissions, or affidavits that 

demonstrate the absence of a triable issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 

323 (1986). If the moving party meets this initial burden, the burden then shifts to the non-moving 

party to go beyond the pleadings and designate specific materials in the record to show that there 

is a genuinely disputed fact. Fed.R.Civ.P. 56(c); Celotex, 477 U.S. at 324. The court must draw 

all reasonable inferences in favor of the party against whom summary judgment is sought. 

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). 

IV. DISCUSSION

A. Standard of Review

Under the abuse of discretion standard of review, “the plan administrator's interpretation of 

the plan ‘will not be disturbed if reasonable.’” Day v. AT&T Disability Income Plan, 698 F.3d 

1091, 1096 (9th Cir. 2012) (citing Conkright v. Frommert, 559 U.S. 506 (2010)). The test for 

abuse of discretion in a factual determination is whether “we are left with a definite and firm 

conviction that a mistake has been committed,” and the court “may not merely substitute [its] view 

for that of the fact finder.” Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676 (9th 

Cir. 2011), citing United States v. Hinkson, 585 F.3d 1247, 1262 (9th Cir. 2009). “To do so, we 

consider whether application of a correct legal standard was (1) illogical, (2) implausible, or (3) 

without support in inferences that may be drawn from the facts in the record.” Id. at 676.

B. Defendant’s Benefit Determination Was Not Unreasonable

The Administrative record shows that Plaintiff suffered mentally and emotionally as of 

April 19, 2002, and there is evidence that Plaintiff’s condition was directly related to issues at his 

workplace and with his supervisor. There is also evidence that Plaintiff suffered from chronic 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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pain. The issue before the court, however, is not whether Plaintiff suffered from these medical 

challenges. Instead, the proper inquiry is whether Defendant’s disability determination was 

reasonable. Day, supra.

The Administrative Record contains conflicting medical opinions regarding whether 

Plaintiff’s mental condition and chronic pain rendered Plaintiff disabled within the meaning of the 

Plan as of April 19, 2002. Nevertheless, Defendant’s determination that Plaintiff was not 

“disabled” within the meaning of the Plan cannot be characterized as illogical, implausible or 

without support in inferences that may be drawn from the record.

1. Defendant’s Medical Reviewers Conducted a Thorough Review of Plaintiff’s Record 

Defendant’s medical reviewers conducted a lengthy and thorough review of Plaintiff’s 

records. These records confirm that Plaintiff suffered from multiple medical conditions as of 

April 19, 2002. A diagnosis alone, however, does not necessarily establish a disability. Jordan v. 

Northrop Grumman Corp. Welfare Benefit Plan, 63 F.Supp.2d 1145, 1157 (C.D. Cal. 1999), aff’d

370 F.3d 8699 (9th Cir. 2004), disapproved on other grounds, Montour v. Hartford Life and Acc. 

Ins. Co., 588 F.3d 623 (9th Cir. 2009). 

Dr. Koopman’s Assessment in April of 2002

Included in the Administrative Record is an April 19, 2002 workers’ compensation report 

by Dr. Jane Koopman with the Santa Cruz Medical Clinic. AR at 001111-12. Dr. Koopman 

described Plaintiff as “a 49-year old staff systems programmer at Borland who presents 

complaining of emotional distress” arising out of Plaintiff’s working conditions and a hostile 

supervisor. AR at 001111. Specifically, Dr. Koopman’s notes included the following description 

of Plaintiff’s work conditions:

History here is that there have been some changes of personnel over 

the last nine months at his work. This has placed a great deal of 

stress on his boss who has been passing some of this on to the 

patient. He has been threatening to fire him and berating him in 

public. He has been given contradictory orders. The patient has 

complained to Human Resources three times in the past couple of 

months. Yesterday, there was an episode where his boss accused 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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him of mismanaging a project that was not even his. The patient 

turned around and walked away. His boss approached him in such a 

manner, that he actually felt physically threatened. There was no 

altercation, but shortly afterward the patient felt quite nauseated 

with his heart racing, sweating and went and informed his employer 

that he was leaving work for the day.

AR at 001111. Dr. Koopman noted that Plaintiff was taking blood pressure medication, Ativan 

and Topamax; that he was having difficulty falling asleep and waking up; that he has been having 

trouble concentrating and difficulty with his memory; that he reported feeling depressed; and that 

“heart racing episodes” have been occurring for several days, but these episodes do not involve 

shortness of breath, chest pain or nausea. AR at 001111-12. Dr. Koopman observed that Plaintiff 

initially had difficulty even starting to speak and appeared very stressed. Dr. Koopman’s 

assessment was that Plaintiff had “1. Stress reaction with both anxiety and depressive features. 2. 

hypertension. 3. Complaints of palpitations-probably part of his anxiety but would like to rule out 

arrhythmia.” AR at 001112. Testing later confirmed that Plaintiff had no heart condition. AR at 

001118.

According to a Doctor’s First Report of “Occupational Injury or Illness” dated April 22, 

2002, Plaintiff reported to Dr. Koopman that constant threats and harassment from his boss caused 

him to feel faint and nauseated, and to suffer elevated blood pressure, rapid heartbeat and 

sweating. AR at 001132. On April 26, 2002, Plaintiff had a follow up visit with Dr. Koopman. 

The notes of the visit indicate that a Worker’s Compensation attorney recommended that Plaintiff 

return to work if he could be transferred to another department, and that Plaintiff planned to return 

to work the following Monday. Dr. Koopman’s assessment was that Plaintiff had: “1. Stress 

reaction with both anxiety and depressive features. 2. Hypertension in good control today. 3. 

History of palpitations; pending Holter results.” AR at 001113. 

Dr. Zweng’s 2002 Assessment

On April 29, 2002, Plaintiff was seen by Dr. Dean G. Zweng at the Santa Cruz Medical 

Clinic, who noted the following:

A 49-year old who has been off work due to anxiety and job stress. 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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He feels like he needs to get back to work, although it does not feel 

too much better. He did meet with his employers and some initial 

changes were made to decrease his level of stress at work. On 

further questioning, he has had some chronic feelings of irritability 

and inability to make decisions, sleep disturbance, anxiety and 

agitation. In low mood and tearfulness. He has a bedridden 

daughter for four years at home and a history of depression. He has 

been on different anti-depressant medications in the past mainly to 

control his chronic pain issues of his neck and back. He was able to 

tolerate Paxil in the past; however, it did not help his chronic pain. 

He has also been on Celexa recently which caused him too much 

agitation, and he could not tolerate Zoloft or try a cycle of 

antidepressants. He also has a history of hypertension. 

AR at 001116. Dr. Zweng’s assessment was that Plaintiff had “[a]djustment reaction with anxiety 

and depression with probably underlying major depression.” Id. Dr. Zweng released Plaintiff to 

return to work. Id.

Dr. Mears’ 2002 Assessment

On May 1, 2002, Plaintiff was seen by Dr. William C. Mears at the Santa Cruz Medical 

Clinic. Dr. Mears noted that Plaintiff “continues with anxiety, rapid heartbeat, unable to sleep. . . . 

Also increased anxiety at work. He said that he was suspended today.” AR at 001119. Dr. 

Mears’ assessment was that Plaintiff had: “1. Palpitations; work-up in progress. 1. Adjustment 

disorder with anxiety and depression related to job stressors. 3. Insomnia, possibly related to his 

Paxil.” Id.

Dr. Koopman’s May 4, 2002 Assessment

Plaintiff was seen for the third time by Dr. Koopman on May 4, 2002. The notes from this 

visit describe the following:

[Plaintiff] returns today complaining of diarrhea. He is uncertain 

whether this is a side effect of some of the medications he has been 

placed on or of another etiology. Since I last saw him on 4/26, 

patient returned to work the following Monday which would have 

been 4/29. I had given a note saying he was okay to return to work 

as long as he was in a different department than his usual one. He 

reports that he was told by his Human Resources person there that 

that was not acceptable and that he had to go back and see the doctor 

and get a note saying that he was okay to go back to his usual work. 

Apparently, he saw Dr. Zweng here who put him on Paxil and did 

send him off with a note saying he was okay to return to his usual 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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duties. He went to work the following day on 4/30 and was told he 

was suspended. He was having a great deal of difficulty sleeping at 

night and was seen the following day on Wednesday, 5/1, by Dr. 

Mears who suggested he take the Paxil in the a.m. and also gave him 

Clonazepan to take a bedtime. He was wearing the Holter monitor 

that had been arranged for the palpitations he has been having the 

whole of Tuesday and reports that his heart did seem like it was 

racing at times during then so presumably we would have caught 

anything that was there. He then received a letter from his employer 

Thursday, 5/2, saying that he had been fired. . . . 

AR at 001122. Dr. Koopman’s assessment was that Plaintiff suffered from anxiety/depression 

and diarrhea. 

Dr. Mears’ May 2002 Assessment

Plaintiff returned to Dr. Mears on May 11, 2002, at which time Dr. Mears noted that 

Plaintiff’s palpitations seem to be better; that Plaintiff was suffering from diarrhea; and that 

Plaintiff’s “stress has increased” and that he “is still feeling as anxious and depressed as he was 

before.” AR at 001126. Dr. Mears made the following assessment: “1. Palpitations; improved on 

Tenormin. 2. Diarrhea, possibly secondary to the Tenormin (Atenolol) versus secondary to 

Blastocystis. 3. Adjustment disorder, anxiety and depression due to job stress.” Id.

Dr. Meade’s March 2003 Assessment

In a March 21, 2003 Workers’ Compensation Report, Dr. Michael G. Meade summarized 

Plaintiff’s history (as told by Plaintiff) as follows. Plaintiff was hired at Ashton-Tate through a 

vocational rehabilitation program after a back injury. AR at 001146. Plaintiff was happy working 

as a systems software worker until 2000, when a new CEO was hired. Id. Plaintiff felt 

overwhelmed, and his supervisor began harassing him on a daily basis, demanding that Plaintiff 

work faster. Id. When asked about non-industrial stressors, Plaintiff told Dr. Meade that he was 

taking care of his ill 18 year-old daughter, who had been bedridden for the past ten years. Id. 

Plaintiff told Dr. Meade that caring for his daughter was stressful, but that “the stress has been 

present for five years with no sign of disability proceeding from it.” Id. Dr. Meade also noted 

that Plaintiff “denies other medical, relationship, family, legal and financial problems.” Id. 

Dr. Meade opined that Plaintiff was “suffering from an episode of major depression, which 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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is of severe nature, and is characterized by serious generalized anxiety and discrete panic attacks.” 

AR at 001155. Further, Dr. Meade opined that Plaintiff’s depression “is superimposed on an 

underlying dysthymia, and chronic, probable lifelong Attention Deficit Hyperactivity Disorder.” 

Id. Dr. Meade also stated: that “[t]here is ample medical evidence on today’s examination to 

establish that the patient is currently temporarily totally disabled on a psychiatric basis”; that 

Plaintiff “is not permanent and stationary with respect to his mental illness”; and that “it is quite 

clear from the history and the medical records that this depression developed in response to 

industrially related stress, namely the harassment and threatening of the patient by his immediate 

supervisor, leading ultimately to the disciplinary action of May 2002, the proximate cause of his 

abrupt termination May 1, 2002.” AR at 001155-56. 

Assessments re Neck and Back Pain from 2003

In August of 2003, Plaintiff was evaluated by Dr. Michael D. Butcher for multiple 

musculoskeletal complaints including in the following order of severity: neck pain, upper back 

pain, shoulder pain, left knee pain and hip pain. Dr. Butcher determined that Plaintiff appeared to 

have stiffness and limited range of motion in the neck and back, and swelling in the left knee. AR 

at 001159. Plaintiff had MRIs taken of his spine, left and right shoulders, and left knee. On 

August 29, 2003, Dr. Samir Sharma reported that the MRI of the cervical spine showed cervical 

spondylosis markedly at C5-6 with disc involvement and root involvement at the C5-6 level. On 

the lumbosacral MRI, Dr. Sharma saw evidence of lumbar stenosis, particularly at L4-5 and L3-4 

levels. AR at 001180.

Included in the Administrative Record is a “To Whom It May Concern” letter written by 

Dr. Butcher dated September 17, 2003, in which Dr. Butcher opined that Plaintiff is unable to 

work due to multiple musculoskeletal problems, including degenerative disc disease of the neck 

and lower back, arthritis in the right shoulder and torn cartilage in the left knee. AR at 001193. 

On October 28, 2003, Dr. Butcher prepared another report in which he opined again that Plaintiff 

was disabled from gainful employment. AR at 001198. There is also a letter dated November 14, 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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2003 from Dr. Rosemaria Gennuso to Dr. Butcher, stating that Plaintiff had “neck pain notable in 

all directions, worse with extension.” AR at 001201. Dr. Gennuso noted, however, that although 

Plaintiff has had longstanding trouble with his neck, Plaintiff had no treatment for his neck for the 

past eighteen months. AR at 001200.

Dr. Summa’s Evaluations from 2010 and 2012

Included in the Administrative Record are two evaluations by Dr. Chris Summa, a spinal 

and orthopedic surgeon. The New Patient Evaluation dated September 2, 2010 stated that Plaintiff 

suffered a severe cycling accident approximately 20 years ago in which he fell off a cliff, and that 

Plaintiff had back pain for many years. AR at 000807. Plaintiff reported that his back pain 

worsened over the last five years, and that he could not stand or sit for very long, and that his daily 

activities, such as washing dishes and doing laundry, had become difficult. Id. Plaintiff had not 

had any back surgeries, although he did undergo a foraminotomy of the cervical spine in 2004. Id. 

Plaintiff also reported that he had numerous nerve blocks, medications, physical therapy, traction, 

chiropractic and acupuncture treatment. Id. Dr. Summa’s medical impression was that Plaintiff 

had a T7-T8 disc herniation with thoracic degenerative disc disease. Id. 

Plaintiff returned to Dr. Summa on May 31, 2012. Dr. Summa reported that Plaintiff was 

experiencing worsening difficulties with sitting and standing despite eighteen sessions of 

“Rolfing.” AR at 000810. Dr. Summa’s medical impression was that Plaintiff had L3-L4 and L4-

L5 advanced degenerative disc disease. Id. Dr. Summa recommended fusion surgery, but 

Plaintiff was opposed to surgery.

2. Independent Physician Consultants Concluded Plaintiff Was Not Disabled

Defendant retained three Independent Physician Consultants (“IPC”), Dr. Lee Becker, Dr. 

Sugerman and Dr. Jane St. Clair, to review Plaintiff’s medical records. Each of the consultants 

concluded that Plaintiff was not disabled within the meaning of the Plan.

Assessments of IPC Dr. Lee Becker

On July 3, 2012, Defendant obtained a review from Dr. Lee Becker, a Board-certified 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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psychiatrist. AR at 00935-945. Dr. Becker summarized Plaintiff’s medical records, and opined 

that “[o]verall, the information available to review did not support significant, global psychiatric 

functional limitations, along with objective findings, to preclude full-time occupational 

functioning from the date in question forward on an ongoing basis.” AR at 000942. 

Dr. Becker’s IPC report was sent to Dr. Andrew Abarbanel, one of Plaintiff’s treating 

psychiatrists. Dr. Abarbanel described Dr. Becker’s report as accurate, and acknowledged that 

Plaintiff’s difficulties were largely the result of workplace mistreatment. Dr. Abarbanel, however, 

opined that “the nature of the psychiatric injuries resulting from the abusive treatment make it very 

likely, in my estimation, that [Plaintiff] sustained an ongoing disability.” AR at 00874. Dr. 

Abarbanel reasoned as follows: 

Specifically, his mood disorder (by my thinking best diagnosed as 

Major Depressive Disorder, Recurrent, 296.32) and his anxiety 

disorder (by my thinking best diagnosed as an anxiety disorder with 

post-traumatic features, 300.00). The former disorder is an ongoing 

disorder that, once exacerbated as it was, makes it much more likely 

for it to persist. The latter, almost by definition of the posttraumatic features tend to persist . . .

My point, then, is that the reports establish the effects, industrially 

caused, the company’s actions precipitated are by their nature very 

likely to persist. That fact, plus the fact that Mr. Gordon is now ten 

years older and about to turn 60, make it very likely that a 

significant degree of disability would be identified if he is examined 

currently. I would very much recommend that examination now if 

you intend to establish ongoing disability.

AR at 000874-75.

On October 9, 2012, Dr. Becker prepared an addendum to his initial report to discuss Dr. 

Abarbanel’s letter. Dr. Becker determined that the additional information from Dr. Abarbanel did 

not impact the initial report, stating:

The psychiatric response letter indicates no major issues with the 

psychiatric consultant report findings. The letter clarifies the 

clinician’s working diagnoses, as well as describing causative 

factors contributing, which have been previously noted. The 

clinician speculates on disability status. However, no additional 

psychiatric clinical information was provided for review, such as 

additional detailed objective mental health findings, progress notes, 

or psychological testing and ongoing treatment by the psychiatrist 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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was not described.

AR at 000797.

Assessments of IPC Dr. Sugerman

After Plaintiff filed an appeal, Defendant retained Dr. Peter Sugerman, a Board-certified 

psychiatrist, to prepare an IPC report dated July 16, 2013. Dr. Sugerman determined that there 

was insufficient evidence of a psychiatric functional impairment. AR at 671. In an addendum 

dated January 28, 2014, Dr. Sugerman reiterated his original opinion that from the outset, 

Plaintiff’s condition was viewed as chronic and reflective of situational factors, but not of such a 

severity that required intensive treatment. AR at 000581-82. In another addendum dated March 

14, 2014, Dr. Sugerman considered additional information submitted by Dr. Abarbanel, but 

concluded that the new information amounted to opinion only, without detailed, objective, global 

mental health data. AR at 000552 . Dr. Sugerman prepared another addendum dated August 18, 

2014, in which he confirmed his prior assessment. AR at 000359-364.

Assessments of IPC Dr. Jane St. Clair

On August 2, 2013, Dr. Jane St. Clair prepared an IPC report. Dr. St. Clair, who is Boardcertified in Occupational Medicine, focused her review on Plaintiff’s alleged shoulder, knee and 

spinal impairments. Dr. St. Clair concluded that there was no documentation to show that 

Plaintiff’s musculoskeletal complaints existed with such severity as to cause restrictions and 

limitations on April 19, 2002. AR at 675-683.

After speaking to Plaintiff’s physician, Dr. Resneck-Sannes, Dr. St. Clair prepared an 

addendum dated August 25, 2013. AR at 655-656. According to the addendum, Dr. ResneckSannes told Dr. Clair that Plaintiff had had various musculoskeletal complaints for as long as he 

had known Plaintiff, and confirmed that he did not have any records for April through December 

of 2002. Plaintiff was seen by Dr. Resneck-Sannes on February 5, 2002, and again on June 23, 

2003: there are no records of Plaintiff having been seen by Dr. Resneck-Sannes between February 

2002 and June 2003. AR at 00656. Dr. St. Clair prepared additional addendums dated January 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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28, 2014 (AR at 000592-93), March 22, 2014 (AR at 000564-567), and June 29, 2014 (AR at 

000390-92). 

In light of the assessments prepared by Dr. Becker, Dr. Sugerman and Dr. St. Clair, 

Defendant could reasonably conclude that despite Plaintiff’s medical ailments, he could perform 

his Own Occupation for a different employer. 

3. Plaintiff Has Not Shown that Defendant’s Disability Determination is Unreasonable 

To substantiate his claim of disability, Plaintiff relies on, among other things, the opinion 

of Dr. Steven Padgitt dated December 9, 2002, approximately six months after Plaintiff’s 

termination, which stated: 

This is to verify that I have begun a course of treatment with Robert 

Gordon. The patient reports a long-standing history of 

attention/concentration (Attention Deficit Disorder) problems. It is 

also clear from his historical report that he suffers from Post 

Traumatic Stress Disorder, an anxiety disorder resulting from 

environmental stress/trauma. The PTSD symptoms are exacerbating 

his attention and concentration difficulties. This disorder appears 

related to his work conditions under the employ of Borland Software 

Corporation.

He was assessed using Quantitative EEG technology and showed 

abnormalities when compared to his asymptomatic peers. We are 

treating predominantly with a course of EEG Biofeedback.

AR at 000713. Plaintiff also relies on a psychiatric evaluation of Dr. Michael Meade stating that 

Plaintiff was temporarily totally disabled on a psychiatric basis. AR at 001155. These diagnoses 

alone, however, do not necessarily establish eligibility for benefits. See e.g. Jordan, supra; Martin

v. Continental Cas. Co., 96 F.Supp.2d 983, 994 (N.D. Cal. 2000); Hoskins v. Bayer Corp. and 

Business Serv. Long Term Disability Plan, 564 F.Supp.2d 1097, 1107 (N.D. Cal. 2008). 

Furthermore, Dr. Becker considered both Dr. Padgitt’s and Dr. Meade’s opinions and set 

forth several reasonable bases to support his conclusion that Plaintiff was not disabled under the 

Plan. Among other things, Dr. Becker noted that Plaintiff was able to attend to his chronically 

bedridden child and spent time writing software, playing on his computer, reading, and attending 

to various household chores. AR at 000943. Dr. Becker also noted that the “[m]ental status 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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examination findings showed no significant lability or agitation, speech within normal limits, and 

no significant abnormalities in thought processing, or reality testing, immediate or remote recall, 

abstraction, intellect, or insight and judgment.” AR at 000943-44. Dr. Becker’ report stated that

“[m]ild decrease in recent recall was noted and difficulties with calculations noted.” AR at 

000944. Dr. Becker, however, determined that “there was no indication that additional 

psychological or neuropsychological testing was pursued to further assess cognitive and executive 

functioning. Furthermore, the GAF score was noted to be 61 with the highest in the past year of 

81, which did not appear to be supportive of continuous, severe regression in daily functioning.” 

Id. Dr. Becker also noted that Plaintiff was “able to attend to his own needs, household needs, the 

needs of a chronically ill family member, and there was no indication that the [Plaintiff] required 

significant personal assistance from others, which would be typically seen in individuals with 

severely impairing psychiatric conditions.” AR at 000944. Further, from 2003 forward, there was 

no indication of ongoing, intensive mental health treatment. Id. 

Dr. Becker’s addendum also sets forth an additional reasonable basis for rejecting 

Plaintiff’s claim of disability based on a psychiatric condition. Specifically, Dr. Becker stated that 

the documentation Plaintiff submitted after Dr. Becker’s initial review did not contain any 

additional psychiatric clinical information, such as additional detailed objective mental health 

findings, progress notes or psychological testing and ongoing treatment by the psychiatrist. AR at 

000796.

Plaintiff next takes issue with Dr. Sugerman’s report dated July 16, 2013, and contends 

that the report should be disregarded because Dr. Sugerman “exclude[d] the concept of 

psychological injury due to a work situation.” AR at 00604. Dr. Sugerman, however, explained 

his analysis and reasoning on this point as follows:

Comments by this reviewer about these data exclude the concept of 

psychological injury due to a work situation. This topic was 

probably addressed by those who helped the claimant pursue 

worker’s compensation and is not germane to this report, which 

addresses whether evidence of impairment due to a psychiatric 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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illness. For the purposes of this report, stress it not an illness. It is a 

condition of life. Responses to stress are therefore not considered 

symptoms of illness unless it can be demonstrated that the 

claimant’s psychological condition developed into a psychiatric 

illness. Stress is mentioned repeatedly in this file, referring to the 

claimant’s work situation, illness in his daughter, and financial 

difficulties.

It is my opinion, after reviewing available data, that symptoms do 

not support a severe psychiatric condition that would require 

psychiatric limitations or restrictions. From the outset, the 

claimant’s condition was viewed as somewhat chronic in nature, 

reflective of situational factors, and not of such severity that 

intensive care was required. Objective abnormalities are not 

reflective of impairment by documenting severe abnormalities. 

Complaints of cognitive difficulties are complicated by an ongoing 

diagnosis of attention deficit disorder, a chronic disorder that may 

alter a mental status exam on an ongoing basis, and often individuals 

compensate for such abnormalities. Thus, a singular abnormality by 

Dr. Meade, who tested serial sevens and spelling world [sic] 

backwards (considered a crude mental status test), is difficult to 

generalize to the level of imapriment [sic]. Furthermore, linking 

cognitive states to a psychiatric condition is not a simple equation, 

since many factors can impact cognition.

The file does not argue for a severe psychiatric condition that would 

support psychiatric limitations by linking symptoms to a decline in 

global functional difficulties. For exam, Dr. Meade noted on 

3/21/03 that the claimant was able to care for his daughter, perform 

household chores, or work on computer programs, which tends to 

argue against the presence of significant psychiatric impairment 

rather than for disability as he concluded. Other mental health notes 

do not comment on the claimant’s functional abilities and therefore 

do not support impairment through this method.

The file does not include explicit evidence of psychiatric symptoms 

that are more reliably associated with impairment, such as suicidal 

or homicidal ideation that requires risk management, extreme 

psychomotor retardation or agitation, extreme mood lability, morbid 

preoccupation with worthlessness or guilt, difficulties with reality 

testing, severe disorganization, severely disturbed speech, 

impulsivity or poor judgments that require intervention, multiple 

panic attacks with agoraphobia, dissociative states, or substance 

abuse that requires medical treatment.

AR at 000604-05. Thus, Dr. Sugerman was distinguishing between a psychological injury and a 

severe psychiatric condition that would require psychiatric limitations or restrictions. Defendant’s 

reliance on Dr. Sugerman’s opinion was not unreasonable. 

Next, Plaintiff contends that the opinion of Plaintiff’s treating physician, Dr. Abarbanel, 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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establishes Plaintiff’s disability. In a letter dated January 16, 2014, Dr. Abarbanel stated:

I have treated Mr. Gordon previously from May 2002 through June 

2003. I treated him for the psychiatric condition of Major 

Depressive Disorder with anxiety; I cannot render an opinion 

regarding his physical condition at that time except to note that he 

was in pain and on pain medication. Those medications, I should 

add, exacerbated the functional limitations caused by his 

psychological condition.

At the time I treated him he was disabled from doing his work at 

Borland Software Company due to his psychological conditions. He 

was suffering from severe depression and anxiety due in large part 

to the way the management at Borland treated him. At that time, he 

exhibited many of the symptoms of Post-traumatic disorder from 

their treatment of him; those symptoms did not disappear when he 

found himself unemployed and unemployable. His psychological 

condition affected his ability to concentrate, remember important 

facts, and to deal with others. He would not have been able to 

concentrate enough to perform any occupation and could not take 

instruction or criticism from employers. The anxiety generated by 

performing any job would have been unbearable for him. 

I have recently seen him on 1-9-14 and 1-16-14. I found at those 

time that his psychological condition continues to preclude him from 

work. He has trouble dealing with the stresses of daily life even 

without the burden of job responsibilities. If he tried to cope with 

the stresses of a full time job, I believe he would respond with 

serious depressive and anxiety symptoms.

AR at 000576. On April 18, 2014, Dr. Abarbanel opined that Plaintiff was “totally disabled from 

his job.” AR at 000330. 

 Dr. Sugerman considered Dr. Abarbanel’s letters, and acknowledged that Plaintiff suffered 

from a psychiatric condition. Dr. Sugerman, however, disagreed with Dr. Abarbanel’s conclusion 

that the psychiatric condition rendered Plaintiff totally disabled within the meaning of the Plan. A 

disagreement among two physicians does not render Defendant’s disability determination 

unreasonable.

Plaintiff next takes issue with Defendant’s determination that Plaintiff did not suffer from a 

disabling degree of pain. Among other things, Plaintiff points to the opinion of Plaintiff’s 

physician, Dr. David Resneck-Sannes, prepared in 2009, as evidence of disabling pain. In that 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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opinion, Dr. Resneck-Sannes opined that in February of 2002, Plaintiff suffered from disabling 

back pain for degenerative disc disease, chronic migraine headaches and failed knee and shoulder 

surgery. Plaintiff also relies on a letter dated January 22, 2014 in which Dr. Resneck-Sannes 

stated:

During the time of 2002-2004 he was seen 13 times in my office. 

During that time he had treatment such as shoulder injections and 

medication renewals. The pain medications prescribed were for his 

neck, back and joint pains requiring various combinations of antiinflammatory and narcotic preparations. Several of these 

medications are known to affect cognition and impeded focus.

These conditions, and the pain medications he took because of them, 

made it hard for Mr. Gordon to work. In 2002 Mr. Gordon’s ability 

to sit still and work at a desk would be limited because of his back 

problems. Furthermore, his ability to concentrate would have been 

impeded due to his constant chronic pain and the pain medications 

he was taking, which are known to affect cognition and focus. In 

2002, Mr. Gordon was unable to work a full time sedentary job, 

especially one that required a lot of focus and concentration. Any 

other problems Mr. Gordon suffered from would have only 

exacerbated his disabling condition.

AR at 000574. Dr. Resneck-Sannes prepared another letter dated May 15, 2014 in which he stated 

that he had treated Plaintiff for back pain for over twelve years and that Plaintiff’s back pain was 

severe enough to prevent him from working. AR at 000399.

Dr. Jane St. Clair, however, reviewed Dr. Resneck- Sannes’ records, as well as the records 

of Plaintiff’s other treating physicians, and reasonably concluded that the medical records did not 

support functional physical limitations for the continuous time period from April 19, 2002 to the 

date of her report. While acknowledging that Plaintiff had dealt with many chronic medical 

conditions throughout the years and had taken various medications, Dr. St. Clair determined that 

“[t]here is no documentation that severity of his musculoskeletal complaints existed at the time of 

disability (4/19/02).” AR at 000680. Dr. St. Clair reviewed Plaintiff’s medical records at least 

twice in search of evidence of treatment for pain management, and noted that Dr. Resnick-Sannes 

saw Plaintiff on February 5, 2002, and then not again until June 23, 2003. AR at 000656. In an 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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addendum, Dr. Jane St. Clair concluded:

There is no question that Mr. Gordon had musculoskeletal issues 

that cause chronic pain in multiple areas, starting back many years 

prior to the workplaces changes in 2002. He had managed them 

well with minimal medications for years; other than one reference to 

MS Contin and OxyContin (Resneck Sannes, 1/8/05), most of the 

medications lists include only propoxyphene. This use of minimal 

medication is perhaps how he was able to perform well as a senior 

programmer at Borland for so many years. The changes in the 

workplace were a source of new stress for him. Decreased coping 

abilities for increasing stressors can cause the perception increased 

pain at levels that were previously manageable. 

This reviewer believes that his attention to his workplace issues and 

their psychological effects . . . made it more difficult to seek medical 

attention for the chronic pain issues. While he sought psychological 

help and medications to deal with his increasing anxiety, depression, 

low mood, he failed to focus on the physiological symptoms: neck 

pain, shoulder pain, and low back pain.

AR at 000389. Thus, Dr. St. Clair repeatedly acknowledged that Plaintiff suffered from chronic 

pain. What is missing from Plaintiff’s medical records, however, is documentation of pain 

management treatment to show that the severity of Plaintiff’s pain rendered him disabled within 

the meaning of the Plan. In the absence of such documentation, it was not unreasonable for 

Defendant to conclude that Plaintiff was not disabled within the meaning of the Plan.

Plaintiff’s multiple criticisms of Dr. St. Clair’s evaluation, which border on unprofessional, 

are unfounded. Dr. St. Clair clarified her analysis in an addendum dated June 29, 2014:

Mr. Gordon had residual physical abilities in spite of the chronic 

daily pain he experienced. My interpretation of the situation (from 

review of the documentation) was that he desired to continue to 

work, was released to work in another department, and when this 

was not allowed, he was terminated. Mr. Gordon had the capacity to 

work in a similar position in a less stressful setting, most likely at 

another company. Without a new job and with no opportunity to 

work at Borland, his work opportunities were limited, but his ability 

to work remained physically intact. 

AR at 000353. There is evidence in the record to show that Plaintiff desired to work and was 

released to work by both Dr. Koopman and Dr. Zweng; it was not unreasonable for Dr. St. Clair to 

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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infer from these facts that Plaintiff had the capacity to work in a different setting. 

Plaintiff attempts to discredit each of Defendant’s medical reviewers by highlighting how 

much money Defendant has paid them. The fact that the medical reviewers are compensated for 

their services, however, is unremarkable in and of itself. See e.g. Polnicky v. Liberty Life 

Assurance Company of Boston, 2014 WL 969973 (N.D. Cal. 2014) (denying request for discovery 

re consulting physician’s compensation); Lavino v. Metro. Life Ins. Co., 779 F.Supp.2d 1095, 

1104 (C.D. Cal. 2011) (finding evidence that “MLS performed 77 examinations for MetLife 

between 2009 and September 2010, for which MetLife had paid $118,816.25” not probative of 

bias); Nolan v. Heald College, 745 F.Supp.2d 916, 923 (N.D. Cal. 2010) (concluding that statistics 

showing that MetLife paid NMS $236,490 in 2002, $569,795 in 2003, $838,265 in 2004, and

$1,671,605 in 2005 for independent medical opinions “are not probative of bias”). Absent from 

the record in this case is any evidence that the reviewing physicians’ compensation was improper, 

i.e. that they were paid only if they found in Defendant’s favor, were paid for incomplete reviews,

or their compensation was excessive by industry standards.

Lastly, Plaintiff faults Defendant for relying upon the opinions of medical reviewers who 

never examined Plaintiff. In-person medical examinations, however, are not mandated under 

ERISA. Rather, a failure to obtain an in-person medical examination “is merely a factor to be 

considered when determining whether a plan administrator abused its discretion.” Nolan v. Heald 

College, 745 F.Supp.2d, 916, 923 (N.D. Cal. 2010), citing Metropolitan Life Ins. Co. v. Glenn, 

554 U.S. 105, 128 S.Ct. 2343, 2352 (2008). A “pure paper review” does not constitute an abuse of 

discretion. Corby v. Unum Life Ins. Co. of America, 2010 WL 3768040, *5 (N.D. Cal. 2010); see

also Bender v. Hartford Life Ins. Co., 2011 WL 3566483, *13 (N.D. Cal. 2011). Moreover, it is 

questionable whether an in-person exam of Plaintiff would have been helpful because there was 

more than a seven year lapse between the claimed date of disability and the date the claim was 

filed.

//

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ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; GRANTING 

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

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V. CONCLUSION

The reports by Defendant’s examiners demonstrate a thorough consideration of Plaintiff’s 

medical records and a rational basis for concluding that Plaintiff was not disabled within the 

meaning of the Plan. Plaintiff has not carried his burden to show that Defendant’s denial of 

benefits was illogical, implausible or unsupported by inferences from the record. Accordingly, 

Defendant’s motion for summary judgment is GRANTED, and Plaintiff’s motion for summary 

judgment is DENIED. 

IT IS SO ORDERED.

Dated: September 7, 2017

______________________________________

EDWARD J. DAVILA

United States District Judge

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