Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-akd-3_14-cv-00107/USCOURTS-akd-3_14-cv-00107-0/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 29:1132 E.R.I.S.A.-Employee Benefits

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

UNITED STATES DISTRICT COURT

DISTRICT OF ALASKA

Maurice K. Mason, )

)

Plaintiff, ) 3:14-cv-0107 JWS

)

vs. ) ORDER AND OPINION

)

Federal Express Corporation, et al., ) [Re: Motions at dockets 55 and 57]

)

)

Defendants. )

)

I. MOTIONS PRESENTED

At docket 55 plaintiff Maurice K. Mason (“Mason”) moves for judgment after a

trial on the record pursuant to Federal Rule of Civil Procedure (“Rule”) 52 or,

alternatively, summary judgment pursuant to Rule 56. Defendants Federal Express

Corporation, FedEx Trade Networks Transport & Brokerage, Inc., Aetna Life Insurance

Company, Federal Express Corporation Short Term Disability Plan, and Federal

Express Corporation Long Term Disability Plan (collectively, “Defendants”) oppose

Mason’s motion at docket 58 and cross-move for summary judgment at docket 57. 

These two filings are supported by a memorandum at docket 59. Mason replies in

support of his motion at docket 66 and opposes Defendants’ cross-motion at docket 67. 

Mason’s memorandum in support of these two filings is at docket 64, and his

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 1 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

declaration is at docket 65. At docket 73 Defendants reply in support of their crossmotion.

Oral argument was not requested and would not assist the court.

II. BACKGROUND

While he was employed by defendant FedEx Trade Networks Transport &

Brokerage, Inc. (“FedEx Trade”) Mason was diagnosed with a rare autoimmune disease

known as Stiff Person Syndrome (“SPS”). SPS is “manifested clinically by the

continuous isometric contraction of many of the somatic muscles; contractions are

usually forceful and painful and most frequently involve the trunk musculature, although

limb muscles may be involved.”1

 After defendant Aetna Life Insurance Company

(“Aetna”) denied his claim for short-term disability benefits, he filed suit under the

Employee Retirement Income Security Act of 1974, as amended (“ERISA”).2 His

complaint alleges: (1) wrongful denial of his claim for short-term disability benefits;

(2) wrongful refusal to consider his claim for long-term disability benefits; (3) breach of

fiduciary duty; and (4) failure to provide requested plan documents. Although the

parties style their cross-motions as summary judgment motions, they would be more

accurately described as partial summary judgment motions because they only address

the merits of the first of Mason’s four causes of action: whether Aetna abused its

discretion in denying Mason’s short-term disability claim.

Mason argues that Aetna abused its discretion by ignoring objective medical

evidence in the record that shows that his SPS and the side effects of his medications

prevent him from performing the duties of his former job. The following is a summary of

the evidence in the record.

1STEDMAN’S MEDICAL DICTIONARY (2014). See also doc. 32-2 at 9.

229 U.S.C. §§ 1001-1461.

-2-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 2 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

A. Initial Treatment from Medical Park Family Care

Beginning in early 2008 Mason repeatedly complained about muscle spasms to

his primary care physicians at Medical Park Family Care,3

 but the physicians were

unable to determine their cause.4 For example, Mason saw Dr. James R. Lord on

May 8, 2009, complaining of “continuing very unusual symptoms,” including “various

types of body spasms in the hands, legs, feet”; “some cramping”; swollen joints; and

blurred vision.5

 Dr. Lord stated that Mason’s symptoms were “very difficult to explain.”6

B. SPS Diagnosis from the VA

In February 2010 Mason saw neurologist Gregg Meekins, M.D. with the VA

Medical Center. Dr. Meekins noted Mason’s lengthy history “of severe spasms

affecting hands, feet, torso, etc.,” and the multiple medications that Mason was taking

“without benefit or intolerable side effects of excessive sedation.”7 Dr. Meekins ordered

laboratory testing, which “came back positive for very high anti-glutamic acid

3Doc. 32-2 at 122. See also Mason’s November 26, 2008 chart note, id. at 126 (“This

44-year-old male is having unusual symptoms that continue, which include this type of cramping

sensation of his extremities associated with some tremors. . . . . He is noting increased

intensity and frequency recently.”); his April 21, 2009 chart note, id. at 127 (“[H]as had an

increase in his muscle spasm. . . . . Primarily they are in the hands, forearms, lower legs and

feet.”); his October 15, 2009 notes, id. at 130 (“This 45-year-old male presents with a long

history of cramping in the extremities and neck as well. It has been going on for greater than a

year.”); his November 11, 2009 notes, id. at 132 (“45-year-old male presents for a constant

cramping pain in his neck for the past 3-4 days. . . . . Pain intermittently down both arms,

tingling or burning and somewhat painful, associated w/ hand and finger spasms or locking

up.”); his February 4, 2010 notes, id. at 136 (“Chief Complaint: Cramping in stomach, arms, and

legs that will not stop, and along with headaches (since Monday).”); his February 12, 2010

notes, id. at 138; and his February 15, 2010 notes, id. at 140 (“This patient returns with

continued spasms of the extremities and cramping with headaches of concern it may have been

related to anxiety a full work up has been done with no etiology determined at this time.”).

4See, e.g., Masons’s November 26, 2008 chart note, id. at 126 (“Extremity cramping.

tremors, and weakness. The etiology Is not clear.”); and his February 4, 2010 note, id. at 137

(“Unclear etiology of patent’s symptoms . . . .”).

5

Id. at 129.

6

Id.

7

Id. at 57.

-3-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 3 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

decarboxylase [“GAD”] 65 antibody level consistent with the diagnosis of stiff-person’s

syndrome.”8 After diagnosing Mason with SPS, he prescribed baclofen to treat Mason’s

condition.9

 Although a subsequent laboratory test in July 2010 came back normal,10

Mason’s blood was retested in December 2010 and the results were positive for SPS

(“although not as high a level” as the February result).11

 Defendants do not contest the

validity of Mason’s SPS diagnosis.

C. Consult with Neurologist Wayne Downs, M.D. 

Mason met with neurologist Wayne Downs, M.D. in April 2010. Mason described

his history of cramping, which he said had gotten gradually worse.12 He also explained

that he was being treated with several “potentially sedating drugs” which caused a “lack

of focus and short-term memory loss.”13 Mason told Dr. Downs that he was not able to

perform his job and in “the last few days he [had] been found asleep at his desk on two

occasions.”14

Dr. Downs assessed Mason as having “anti-GAD65 stiff person syndrome.” As

to Mason’s lack of focus and memory loss, Dr. Downs stated that Mason’s

encephalopathy15 was “worse on his current medications” and suspected that this was

because of the baclofen he was taking. At the time Mason was taking 60 mg of

8

Id.

9

Id.

10

Id. at 101.

11

Id. at 108.

12

Id. at 146.

13

Id.

14

Id.

15Encephalopathy is a disorder of the brain. STEDMAN’S MEDICAL DICTIONARY (2014).

-4-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 4 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

baclofen daily.

16

 Dr. Downs wrote that “[w]ere l treating him I would taper the baclofen

off relatively rapidly and then start pushing the Valium.”17 “If we can get him off his

sedating medications and he is still having an encephalopathic problem,” Dr. Downs

wrote, “then I think a neuropsych[ological] test would be indicated to quantitate [sic] this

as this may be a source of employment difficulties.”18

D. Follow-Up Treatment

Following his consult with Dr. Downs, Mason returned to Medical Park Family

Care complaining about the side effects of his medications. On May 7, 2010 Dr. Lord

ordered Mason to taper off baclofen but stated that he would still “likely need high

doses of muscle relaxants for the muscle cramps and stiffness.”19

 

On July 8, 2010 Mason saw Dr. Lord again, complaining that his SPS was

worsening and that the tapering of the dosage of his muscle relaxants was not

helping.

20

 The notes from Dr. Lord’s physical examination state that Mason was in

“moderate pain/distress” and “[v]isibly uncomfortable, some palpable spasms on chest

wall, discomfort with walking and changing positions.”21

On July 15, 2010, Mason was admitted to the emergency department of

Providence Alaska Medical Center, complaining of cramps and muscle spasms with

pain that he described as a 10 on a scale of 0 to 10.22 The emergency department

physician noted that Mason did not appear to be in distress or discomfort despite his

16Doc. 32-2 at 146.

17

Id. at 148.

18

Id. at 149.

19

Id. at 153.

20

Id. at 163.

21

Id.

22

Id. at 52.

-5-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 5 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

stated pain level, and that he was alert and oriented. Mason was given morphine and

Ativan for his pain and instructed to follow up with his primary care physician.23 

The next morning Mason met with Dr. Lord, who noted in his physical exam that

Mason was suffering from “moderate pain/distress.”24 Later that day Mason was again

admitted to the emergency room complaining of pain.25 The emergency department

physician noted that Mason’s inability to control his SPS-related pain was “unfortunately

par for this unfortunate malady,” which he described as “ultimately . . . very difficult to

treat.”26

In the following months Mason sought medical treatment repeatedly for his SPS,

including the following visits:

∙ Dr. Lord’s July 27, 2010 physical exam notes state that Mason was

suffering from “mild pain/distress” and had a “depressed affect.”27

Dr. Lord concluded that Mason’s SPS had deteriorated. 28 

∙ The next day Mason met with Dr. Meekins, complaining of painful spasms

and stiffness in his trunk and extremities. Dr. Meekins described Mason’s

SPS as “progressive.”29

23

Id. at 53.

24

Id. at 164.

25

Id. at 55.

26

Id.

27

Id. at 168.

28

Id.

29

Id. at 61.

-6-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 6 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

∙ On August 16, 2010, Dr. Lord again examined Mason, assessed Mason’s

SPS had deteriorated, and noted that he was suffering from “mild

pain/distress” and “[c]ontinued diffuse muscle spasms.”30

 

∙ Dr. Lord examined Mason again on August 25, 2010, and again noted that

Mason was suffering from “mild pain/distress” and had a “depressed

affect.”31

 ∙ On September 22, 2010, Mason was referred to VA internist Madeleine M.

Grant, M.D., who addressed Mason’s reports that his medicine was

causing him to be too sedated to drive or work.32 Dr. Grant listed Mason’s

treatment goal as “find[ing] medication that worked and did not affect him

cognitively.”33 She recommended tapering Mason’s baclofen usage and

gradually increasing diazepam.

∙ In Dr. Lord’s notes to Mason’s September 29, 2010 visit, Dr. Lord states

that he discussed Mason’s SPS with the VA and they agreed to “maximize

the dosing of Valium to try and treat his spasms” and “[s]lowly titrate down

the baclofen.”34

∙ On October 6, 2010, Mason complained to Dr. Lord that his body cramps

had “worsened especially the feet and arms since tapering off of the

baclofen” but he noticed less sedation.35

30

Id. at 173.

31

Id. at 175.

32

Id. at 68.

33

Id. at 69.

34

Id. at 181.

35

Id. at 183.

-7-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 7 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

∙ On October 28, 2010, Dr. Lord again noted that Mason’s SPS had

deteriorated, he was suffering “moderate pain/distress,” and had a

“depressed affect.”36

∙ On November 15, 2010, Mason complained to Dr. Lord about “pain and

discomfort and depression” from SPS. Dr. Lord’s physical exam noted

that Mason was suffering from “moderate pain/distress” and had a

“depressed affect.”37

∙ On December 23, 2010, Mason told another Family Park Medical Care

physician, Jeffrey Kim, M.D., that he was doing “okay” on Valium but it

made him “very sleepy and very poor functioning.”38

∙ On January 9, 2011, Mason was admitted to the emergency department

at the hospital complaining of severe abdominal pain, which he graded as

a 9 on a scale of 0 to 10.39 The emergency department physician noted

that Mason alleviated his pain by taking his medication at home, but within

about 20 minutes of presenting himself at the hospital Mason had already

fallen asleep.40

E. Neuropsychological Exam

Because Mason was complaining of memory decline, Dr. Meekins referred

Mason to neuropsychologist Paul D. Dukarm, Ph.D. for testing in September 2010. In

his summary of his findings Dr. Dukarm states that Mason was “exhibiting variable

neurocognitive performance deficits in the areas of executive functioning. Specifically,

he [was] demonstrating impaired performance in the area of visuospatial organization

36

Id. at 188.

37

Id. at 190.

38

Id. at 192.

39

Id. at 48.

40

Id. at 49.

-8-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 8 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

and planning during problem solving and impaired response flexibility under changing

conditions.”41 In addition, Dr. Dukarm found that Mason was “borderline deficient” with

regard to “[d]eductive logic as it relates to attribute identification and concept formation,”

and he showed “deficiencies for learning and retaining uncontexualized verbal

information, such as a word list.”42

 Dr. Dukarm noted, however, that Mason’s

“recognition [was] intact as well as his learning efficiency and retention of other forms of

verbal information (prose) and non-verbal information.”43

 And although Mason’s “[b]asic

auditory attention and working memory” were “low average,” he was in the average

range with regard to “visual working memory,” “verbal fluency under time pressure,

sequencing and alternating attention under time pressure, and inhibiting automatic

responses under time pressure.”44

Dr. Dukarm concluded that the findings of his exam were “compatible with a

diagnosis of Cognitive Disorder, NOS.”45 “Etiology of neurocognitive deficits is unclear

and likely multifactorial. . . . . The most likely contributing factors to this patient’s

performance deficits include medication effects, pain, and sleep disturbance. Other

contributing factors include the autoimmune disease of which he is diagnosed, but the

cognitive effects are unclear as to the nature and source of the impact from this

condition.”46

41

Id. at 77.

42

Id.

43

Id.

44

Id.

45

Id.

46

Id. at 77-78.

-9-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 9 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

F. Psychotherapy

On September 1, 2010, Mason was seen by Camilla A. Madden, Ph.D., a

psychologist at the VA, who diagnosed Mason with severe depression related to his

struggles at work and with his family because of the side effects of his medications and

the limitations of his disorder.47 Mason continued to see Dr. Madden regularly for

treatment of his depression.48

 

G. Mason Applies For Short-Term Disability Benefits

Mason applied for short-term disability benefits in December 2010, stating that

he was no longer able to work due to his SPS and described his symptoms as follows:

“Muscle spasms all over, cramps all over, dystonia49 in the hands and feet, chronic

fatigue, unable to concentrate and chronic headache.” 50 In order for employees to

qualify for short-term disability benefits under the Short Term Disability Plan (“the Plan”)

administered by defendant Federal Express Corporation (“FedEx”), they must show that

they suffer from an “occupational disability,” which the Plan defines as “the inability of a

Covered Employee, because of a medically-determinable physical impairment or

Mental Impairment, to perform the duties of his regular occupation.”51

47

Id. at 64-65.

48See, e.g., id. at 66-67; 71-72; 79-82; 83-84; 88-89, 90-91; 94-85; 97-98.

49Dystonia is defined as “[a] syndrome of abnormal muscle contraction that produces

repetitive involuntary twisting movements and abnormal posturing of the neck, trunk, face, and

extremities.” STEDMAN’S MEDICAL DICTIONARY (2014).

50Doc. 32-3 at 32-33.

51See the Plan § 1.1(s), doc. 32-6 at 50. See also Doc. 59 at 4.

-10-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 10 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

H. Mason’s Supervisor States that Mason is Unable to Work

Mason worked as a manger for FedEx Trade who oversaw a group of 26

employees.52

 His former supervisor, Linda Combs (“Combs”), wrote an email stating

that Mason “would suffer from severe muscle cramping” at work “and his limbs would

‘lock up.’”53

 For example, Combs reported that she had observed Mason not being able

to get up from a meeting table “because his legs locked up” and “his hands cramp up

and lock where he could not open his hand.” 54

 Combs also stated that she saw Mason

“fall to the ground with leg spasms at an employee picnic.”55

Combs stated that Mason started “really declining in the fall of 2009,” when he

had “spasms much more frequently and more severely.”56

 Mason started taking

medication but it was “very sedating,” causing him to take most of March and some of

April 2010 off from work so that he could “try[] to cope on these medications.”57 When

he returned to work, he “struggled with staying awake and alert through an 8 hour work

day,” had a bad limp, and experienced difficulty walking around the two-floor office.58

Combs reported that Mason had “trouble focusing and remembering things,” and “many

times” on the job “was falling asleep, slurring his words and making very little sense.”59

Combs stated that she “would send him things that he didn’t ever remember seeing”

52Doc. 32-2 at 235.

53

Id. at 236.

54

Id.

55

Id.

56

Id.

57

Id. at 237.

58

Id.

59

Id.

-11-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 11 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

and that he “could not keep up with his deadlines.”60 “I finally told him that this was

getting way out of control,” Combs wrote. “We wouldn’t allow any other employee to

come in and pass out at their desk. I felt like I was dealing with a situation that

presented the company with a grave liability.”61

Combs’ report is consistent with a December 13, 2010 entry in Aetna’s claim

records which states that Mason’s “HR Advisor” called Aetna because she wanted to

help Mason with his claim. The advisor stated that she would “make [Mason]

understand” what Aetna needed and would “ask [Mason’s] girlfriend to help him,

because he is in a lot of pain and many times he is [on] pain medicine and cannot

understand what he is being asked.”62

I. Mason’s Treating Physicians Opine That He Is Unable to Work

In June 2010 Dr. Lord filled out a FedEx form indicating that Mason was unable

to perform any of his job functions due to his SPS, and his condition was permanent.63

Dr. Lord elaborated on his opinion in a July 29, 2010 letter, in which he stated that 

Mason’s medical concerns—including “uncontrollable muscle spasms throughout the

body, irritable bowel-like symptoms, generalized anxiety and depression, restless legs,

circulatory conditions, hypertension, spontaneous tendon ruptures and sleep

disorder”—can be attributed to his “definitive diagnosis” of SPS.64 Dr. Lord wrote that

Mason’s “symptoms have progressively worsened and his symptoms are currently

60

Id.

61

Id.

62Doc. 32-3 at 45.

63Doc. 32-2 at 159-62.

64

Id. at 172.

-12-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 12 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

poorly controlled. He is medically disabled at this time and would benefit from

evaluation by a leading expert on stiff person syndrome.”65

The physician responsible for Mason’s primary care shifted from Dr. Lord to

Dr. Kim.

66

 Dr. Kim wrote a letter on December 23, 2010, stating that Mason’s SPS

diagnosis had been confirmed by two separate neurologists and rendered him

permanently disabled.67 Dr. Kim also completed an “Attending Physician Statement” on

January 21, 2011, that states Mason is unable to work in any capacity due to his

disease and the effects of his medications and lists the objective data upon which this

opinion relies, including physical exams that reveal spasms in Mason’s chest and

abdomen and cramps in his extremities, and various diagnostic tests that were

performed on Mason that confirm his SPS diagnosis.68 Dr. Kim expanded on this

opinion in the following two notes in Mason’s file: (1) on January 21, 2011, Dr. Kim

wrote that “[f]or reasons related to medication side effects as well as symptoms

associated with his condition, [Mason] is unable to function adequately at work and

should certainly be considered disabled;”69 and (2) on January 26, 2011, Dr. Kim wrote

that Mason was “currently, and for the foreseeable future, significantly disabled and

unable to function at any effective level in a work capacity.”70

J. Aetna Denies Mason’s Claim

Aetna denied Mason’s claim on March 28, 2011. In the denial notice Aetna

Nurse Consultant Patricia Karns (“Karns”) writes that she reviewed Mason’s file and

65

Id.

66Doc. 55 at 11.

67Doc. 32-2 at 194.

68

Id. at 198.

69

Id. at 196.

70

Id. at 199.

-13-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 13 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

presented his claim to “an independent peer physicians [sic] specializing in internal

medicine, neurology, and neuropsychology.” She informs Mason that Aetna

determined that “the clinical data received and reviewed fails to support a functional

impairment from [Mason’s] sedentary occupation.”71

Aetna did find that some unspecified “data indicates that [Mason was] unable to

work related to side effects of [his] medications.”72 “However,” Aetna continued, “the

office visit notes from Dr. Kim and Dr. Grant do not document any objective findings to

indicate a functional impairment such as significant sleepiness or disorientation during

office visits. The documentation also noted that you are alert and oriented.”73 Aetna

also concluded that there was “no documentation of any cognitive impairment”74

 despite

the apparent contrary conclusion of Dr. Dukarm, because Dr. Dukarm “did not record

any significant sedation during the interview or testing.”

75

 Aetna also discounted the

results of Dr. Dukarm’s test that supported a disability finding, stating that “there was no

consistency or validity testing results.”76

Aetna’s notice states that Mason needed to submit, among other things,

“medical documentation that clearly states the significant objective findings that

substantiate a disability.”77 Aetna defined “significant objective findings” as “signs,

which are noted on a test or medical exam and are considered significant anatomical,

physiological, or psychological abnormalities that can be observed by a practitioner

71

Id. at 4.

72

Id.

73

Id. (emphasis added).

74

Id.

75

Id. (emphasis added).

76

Id.

77

Id. at 5.

-14-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 14 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

apart from your description of your symptoms.” Aetna provided examples of such data:

(1) “[p]hysician exam reports, office notices, progress notes;” (2) “[o]ther Healthcare

provider reports;” and (3) “[d]iagnositic test results, i.e. lab tests, radiographic tests.”78

Aetna informed Mason in bold print that “[p]ain, without significant objective findings, is

not proof of disability.”79

 

Mason appealed on June 24, 2011. 80 

K. Mason Submitted Additional Information

Between the date of Aetna’s denial and the date Mason filed his appeal, Mason

was admitted to the emergency department three times related to SPS spasms: on

April 27,81

 May 11,82 and May 28, 2011.83 Mason submitted to Aetna the medical

records related to these admissions.84

On May 23, 2011, the Social Security Administration determined that Mason was

disabled under the rules of its disability insurance program (“SSDI”).85 The SSDI

program “provides benefits to a person with a disability so severe that she is ‘unable to

do [her] previous work’ and ‘cannot . . . engage in any other kind of substantial gainful

78

Id.

79

Id. at 4.

80Doc. 32-3 at 19.

81Doc. 32-2 at 32-39 (Mason was suffering from “still present,” severe, “whole body

spasms” and listed his pain level at 10 on a scale of 0 to 10).

82

Id. at 22-31 (Mason was taken to the emergency room in an ambulance complaining of

whole body muscle spasms and listed his pain level at 10).

83

Id. at 15-21 (Mason had fallen after suffering a spasm in his right leg, and was

diagnosed with a left ankle sprain and right quadriceps strain).

84

Id. at 11.

85

Id. at 12.

-15-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 15 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

work which exists in the national economy.”86 Mason submitted to Aetna his Notice of

Award of SSDI benefits.87

Mason also submitted to Aetna letters from three of his treating doctors:

Dr. Grant, Dr. Downs, and Dr. Madden. Dr. Grant wrote a letter dated March 3, 2011,

stating that it was her opinion that Mason was unable to work on account of his

disability “both due to severe discomfort from his stiff man syndrome, and also from

side effects of the medication, which affects him cognitively.”88

Dr. Downs wrote a letter dated June 10, 2011, stating that Mason’s “symptoms

are consistent with [SPS] and blood work has been positive for the relevant antibodies. 

The diagnosis is not in question.”89

 Dr. Downs provided Aetna with the following

information about SPS:

The disease is extremely rare and poorly understood. There seem to be

several etiologies, but the final result is significant loss of inhibition of

spinal motor neurons which results in extreme excessive firing of these

motor neurons and contraction of the innervated muscles. This is similar

to but very much more severe than what is seen in spasticity after a

stroke, and the spasms can in fact be severe enough to break bones. 

Symptoms can sometimes be controlled by medications, but the

medications are extremely sedating, and we have as of yet been unable

to give [Mason] any significant relief.

90

 

In addition, Dr. Downs provided Aetna with a copy of the section from Goetz Textbook

of Clinical Neurolgy that discusses SPS and directed its attention to the final section,

“Prognosis and Future Perspectives.” That section reads as follows: “Without

treatment, SPS progresses to total disability related to generalized rigidity and

86Cleveland v. Policy Mgmt. Sys. Corp., 526 U.S. 795, 797 (1999) (citing § 223(a) of the

Social Security Act, as set forth in 42 U.S.C. § 423(d)(2)(A)).

87Doc. 32-2 at 11.

88

Id. at 121.

89

Id. at 8.

90

Id.

-16-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 16 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

secondary musculoskeletal deformities. The pathogenetic autoimmune mechanisms

remain to be elucidated.”91

Finally, Dr. Madden wrote a letter dated July 13, 2011, in which she describes

how the side effects of Mason’s medications impair his ability to function. She notes

that Mason’s medications make him “very tired to the point of not being able to stay

awake while engaged in an appointment. There have been therapy sessions with me

when Mr. Mason has fallen asleep despite a valiant effort to stay awake and to benefit

from the therapeutic encounter.”92 Dr. Madden states that she “repeatedly noted that

[Mason’s] insight and judgment is good when not impaired due to the effects of

medication which alters his cognitive faculties,” but “neuropsychological testing has

indicated that he has a severe degree of intellectual loss from one and a half years ago

when he was still able to function as a manger at Federal Express.”93 Further, Dr.

Madden states that the side effects of Mason’s medications “are so serious that Mr.

Mason and his wife have frequently told me that he does not take his medication so that

he will be able to stay awake and alert enough so that he can communicate,

understand and remember what has taken place in a health care appointment or in

appointments with other agencies and physicians.”94

L. Aetna’s Appeals Committee Upholds the Denial of Mason’s Claim

The Plan provides that if an “adverse benefit determination is appealed on the

basis of medical judgment, the appeal committee shall consult with an independent

health care professional who is qualified in the areas of dispute who shall not have

91

Id. at 9.

92

Id. at 13.

93

Id.

94

Id.

-17-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 17 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

been involved in the initial claim denial.”95 In October 2011 Aetna’s Appeals Committee

upheld the denial of Mason’s claim. The denial letter states that the Committee

reviewed “all appeal information submitted, all medical documentation and the Peer

Physician Reviews dated 02/10/11, 02/24/11, 03/07/11, 03/08/11, 03/24/11, 08/06/11,

08/09/11, and 09/14/11.”96

 These Peer Physician Reviews included reviews from the

original three specialists in internal medicine, neurology, and neuropsychology, as well

as second opinions from three different physicians in those fields. Based on their

review, the Committee concluded that there were “no significant objective findings to

substantiate that a functional impairment exists that would render [Mason] unable to

perform [his] sedentary job duties as a Tax Analyst from 12/01/10 through current.”97

 

1. Aetna’s Internal Medicine Peer Reviews

a.) Wendy Weinstein, M.D.

Dr. Weinstein, who is board-certified in internal medicine, submitted a

February 11, 2011 Peer Physician Review that states she reviewed various medical

reports and concludes that “none of the examination findings by multiple providers have

documented abnormalities that would preclude the claimant from performing a

sedentary occupation.”98 Dr. Weinstein submitted a second Peer Physician Review on

March 9, 2011, after receiving additional medical reports to review. In neither of these

reviews did Dr. Weinstein engage in a “peer-to-peer consultation” with any of Mason’s

treating physicians.99

With regard to the effects of Mason’s SPS, Dr. Weinstein’s February 11 report

states that Mason was noted to “walk stiffly” at “one point,” “but there has been no

95Doc. 32-6 at 72.

96Doc. 32-1 at 1.

97

Id. at 2.

98Doc. 32-2 at 260.

99

Id. at 255, 260.

-18-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 18 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

documentation of abnormal muscle tone on specific muscle testing or other

musculoskeletal or neurologic examination abnormalities.” She acknowledges that

Dr. Meekins diagnosed Mason with SPS in February 2010, but adds that “there was no

documentation of any change in the claimant’s physical examination and no

documentation of specific functional impairments that would preclude the claimant from

performing his sedentary occupation as of 12/1/10.”100 Dr. Weinstein’s March 9 report

reaches the same conclusion, but adds the fact that on November 15, 2010, Dr. Lord

observed Mason in “moderate pain and distress.” Dr. Weinstein discounted this

observation, however, because “no details of specific observations were presented.”101 

With regard to the side effects of Mason’s medications, Dr. Weinstein discounts

Dr. Dukarm’s neuropsychological test’s conclusion that Mason was likely suffering from

a cognitive defect caused in part by the effects of his medications. Dr. Weinstein writes

that the test’s “findings were non-specific and it was noted they could be attributed to

medication affects, pain, and sleep disturbance as well as depression.”102 Although

Mason “complained of somnolence from his medications,” Dr. Weinstein writes, “there

has been no documentation of pathologic hypersomnolence, difficulty with

communication in the office visits, or significant cognitive impairments. Progress notes

have described that claimant as alert and intelligent.”103 Dr. Weinstein was not provided

with any of Dr. Madden’s records.

Dr. Weinstein’s second review indicates that she was provided with a copy of

Dr. Dukram’s neuropsychological test and Combs’ email.104 Despite Dr. Dukram’s

finding that Mason had a cognitive impairment on September 27, 2010, Dr. Weinstein

100

Id. at 255.

101

Id. at 260.

102

Id. at 256.

103

Id.

104

Id. at 258.

-19-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 19 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

writes that “it appears the claimant was still able to perform his own occupation with the

first date of absence being listed as 11/10/10.”105 (Dr. Weinstein claims that she

reviewed all of Mason’s records, including Combs’ email, before reaching this

conclusion).106

b.) Second Opinion From Dennis Mazal, M.D.

Dr. Mazal, who is board certified in pulmonology and internal medicine,

submitted an August 8, 2011 Peer Physician Review that states that he cannot “discuss

functionality” based on Mason’s SPS diagnosis because neurological diagnoses are

“not within the scope of [his] specialty.”107 

With regard to the side effects of Mason’s medications, Dr. Mazal wrote without

further explanation that “[t]here is no documentation that any of those medications

caused any clinically significant side effects or adverse reactions that impact the

claimant’s ability to perform the duties of a sedentary demand occupation during the

time period under consideration.”108 Dr. Mazal did not engage in a peer-to-peer

consultation with any of Mason’s treating physicians.

2. Aetna’s Neuropsychology Peer Reviews

a.) Elana Mendelssohn, Phy.D.

Dr. Mendelssohn, who is board certified in clinical psychology and

neuropsychology, submitted a February 24, 2011 Peer Physician Review. 

Dr. Mendelssohn prefaced her report by noting that most of the records she reviewed

pertain to Mason’s “physical complaints” related to SPS, and therefore she deferred “to

the appropriate medical specialists to determine the impact of [Mason’s] medical

105

Id. at 260.

106

Id. at 259.

107Doc. 32-3 at 1.

108

Id.

-20-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 20 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

complaints on his functionality.”109 Dr. Mendelssohn proceeded to evaluate Mason’s

neurological complaints in the records she reviewed. She ultimately concluded that

“clinical documentation does not support a functional impairment that would preclude

[Mason] from performing the essential duties of his own occupation from 12/1/10 to

forward.”110

 Dr. Mendelssohn submitted a second Peer Physician Review on March 7,

2011, after receiving Combs’ email to review. In neither of these reviews did

Dr. Mendelssohn engage in a “peer-to-peer consultation” with any of Mason’s treating

physicians.111

With regard to the side effects of Mason’s medications, Dr. Mendelssohn noted

that “various treating providers included sporadic reports of [Mason’s] emotional and

cognitive difficulties,” but discounted this by concluding that none of those providers

“included specific measurements of [Mason’s] cognition or a description of direct and

observed behaviors to corroborate the presence of impairment in neuropsychological

functioning.”112 

Dr. Mendelssohn noted that Dr. Dukarm’s neuropsychological exam diagnosed

Mason with a cognitive disorder secondary, in part, to the side effects of his

medications. But she then offered four reasons for why she discounted the results of

this test: (1) Mason continued to work afterward; (2) “there was no indication that

[Dr. Dukarm] utilized symptom validity measures to ensure adequate effort and

motivation and valid test findings; (3) “office visits just prior to and after the

neuropsychological examination noted that the claimant presented as alert and oriented

with normal attention and concentration;” and (4) “none of [Mason’s] providers indicated

109Doc. 32-2 at 242.

110

Id. at 245.

111

Id. at 245, 249.

112

Id. at 245.

-21-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 21 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

that the claimant was unable to work in relation to his neuropsychological status.”113

Dr. Mendelssohn made these four findings without the benefit of Dr. Madden’s records

or Combs’ email.

After reviewing Combs’ email that outlined Mason’s problems at work,

Dr. Mendelssohn maintained that Mason had not shown that he is disabled because:

(1) Combs’ report of Mason slurring words was not reflected in the documents that she

reviewed previously; (2) although Combs reported that Mason was falling asleep at

work, “there was no indication that [Mason] fell asleep during [Dr. Dukarm’s]

evaluation;” (3) “[a]lthough [Dr. Dukarm] noted that [Mason] appeared lethargic, more

specific description was not included;” and (4) there was no indication from Mason’s

various office visit notes that he was “falling asleep during his office visits nor did the

provided information include . . . description of overt cognitive difficulties.”114 Again,

Dr. Mendelssohn lacked Dr. Madden’s records when she made these findings. 

Dr. Mendelssohn concluded that, although Combs’ report indicates “both physical and

cognitive difficulties,” “there continues to be a lack of clear and consistent description of

direct and observable behaviors to substantiate the presence of a functional

impairment.”115

b.) Second Opinion From Leonard Schnur, Phy.D.

Dr. Schnur, who is board certified in psychology, submitted an August 9, 2011

Peer Physician Review. He was provided with Dr. Madden’s July 13, 2011 letter. With

regard to the side effects of Mason’s medications, Dr. Schnur’s report states that the

documentation he reviewed “referenced possible side effects from [Mason’s]

medication regimen for treatment of stiff-man syndrome, which apparently results in

drowsiness, sedation, and reduced concentration and attention.” Dr. Schnur declined

113

Id.

114

Id. at 249-50.

115

Id. at 250.

-22-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 22 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

to comment on how these side effects impact Mason’s ability to work, however, stating

that Mason’s “medication regimen and any adverse medication side effects . . . would

go beyond the scope of [his] expertise and should be addressed by the appropriate

peer specialty.”116

3. Aetna’s Neurology Peer Reviews

a.) Vaughn Cohan, M.D.

Dr. Cohan, who is board certified in neurology, submitted a March 26, 2011 Peer

Physician Review. After describing the records he reviewed, Dr. Cohan states that

“[t]he neuropsychological and neurocognitive aspects of this case would fall outside the

scope of general medical neurology” and therefore he deferred to Dr. Mendelssohn

regarding those issues.117 

Dr. Cohan describes a “peer-to-peer consultation” he had with Dr. Kim, who is a

family practitioner and not a neurologist, despite noting that Mason’s treating

neurologists are Dr. Downs and Dr. Meekins.118 According to Dr. Cohan, Dr. Kim stated

that Mason reported “that his cramping diminishes while on medications, but his

medications cause him to experience undesirable adverse sedative effect.”119 When

Dr. Cohan asked Dr. Kim “about his notes indicating that [Mason] appears in office to

be alert and oriented with no evidenced signs of over-sedation[,] Dr. Kim stated that the

claimant has reported to him that he does not take his medications prior to office visits

so that be may interact with medical provider optimally.”120 According to Dr. Cohan,

Dr. Kim stated that he had never observed Mason overly sedated or cognitively

116Doc. 32-3 at 6.

117Doc. 32-2 at 265.

118

Id. at 245, 249.

119

Id. at 265.

120

Id.

-23-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 23 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

impaired and indicated “that there is no apparent physical impairment that would

preclude performance of desk work.”121

Dr. Cohan relied heavily on Dr. Kim’s statements in his report. He states that

“[a]lthough there are references to over-sedation in the medical record and as

submitted by one of the claimant’s coworkers/managers, nevertheless, there is no

independent medical verification or substantiation to that effect. When the claimant has

been seen medically by medical providers, there has been no report of objective excess

sedative or medication effect.”122 (Dr. Cohen was provided with Dr. Madden’s records

and he claims that he reviewed them.)123 Dr. Cohen concluded that “the documentation

provided fails to demonstrate objective evidence of a functional impairment for the

claimant’s own sedentary occupation from 12/1/10 to the present.”124

b.) Second Opinion From Andrew J. Gordon, M.D.

Dr. Gordon, who is board certified in neurology, submitted an August 11, 2011

Peer Physician Review. Mason asserts that “Dr. Gordon was the only reviewer hired by

Aetna that did not appear to be ‘in house.’ He apparently works for MES.”125 After

reviewing Mason’s records, including those from Dr. Madden, Dr. Gordon concluded

that “there is significant objective clinical documentation that reveals a functional

impairment that would preclude [Mason] from performing the essential duties of [his]

own occupation which is a sedentary demand level from 12/01/10 through current.”126

He supported this conclusion with the following evidence:

121

Id.

122

Id. at 266.

123

Id. at 264.

124

Id. at 266.

125Doc. 55 at 23.

126Doc. 32-3 at 11.

-24-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 24 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

The claimant is described by numerous doctors including two neurologists

as having Stiff Man Syndrome. He tests positive twice (blood work). 

There are numerous notes indicating refractory spasms, cramping and

poor work performance resulting from these symptoms. Evaluation and

testing has excluded other diagnoses. The claimant is described as

responding poorly to usual treatment and he is described as suffering

from side effects with treatment which include lethargy and sleepiness. A

supervisor at work documents his inability to properly perform his duties

and gives numerous examples of his impairments that have occurred as a

result of Stiff Man Syndrome. Finally, the treating neurologist notes that

the claimant cannot work due to refractory symptoms and resultant

functional impairment.127

In response to this report, Aetna sent Dr. Gordon the following message:

“Dr. Gordon please clarify: You found the claimant to be impaired from 12/01/10

through current however; [sic] your report and findings were based on the medical data

dated prior to the disability date under consideration of 12/01/10. Please review and

comment on the medical data, physical exam findings that demonstrate a functional

impairment for the time period under review (12/01/10 through current).”128

About one month later, Dr. Gordon submitted a second review in which he states

that Aetna’s request for “clarification” changed his prior recommendation, and he now

concludes that Mason has not shown that he is disabled. Dr. Gordon asserts that

“records from earlier periods (early 2010 and before) document more significant

difficulties with spasticity, gait impairment and altered mental status,” but “the more

recent records from 12/1/10 onward do not demonstrate functional impairment from a

neurologic perspective.”129 Dr. Gordon did not engage in a peer-to-peer consultation

with any of Mason’s treating physicians.

127

Id.

128

Id. at 14-15.

129

Id. at 15.

-25-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 25 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

III. STANDARD OF REVIEW

A. The Abuse of Discretion Standard Applies

To determine which standard of review applies in an ERISA benefits case, the

court must determine whether the ERISA plan unambiguously grants discretion to the

administrator.130

 “[B]y default, review of denial of ERISA benefits is de novo” and for

the administrator “to obtain the more lenient abuse of discretion standard of review, a

plan must unambiguously so provide.”131

 Here, the parties agree that the benefit plan at

issue gives the administrator, Aetna, discretionary authority to determine benefits

eligibility.

132

 The court will therefore review Aetna’s determination for abuse of

discretion.133 Under the abuse of discretion standard, courts consider all of the relevant

circumstances and defer to the administrator’s decision so long as it is reasonable.134

That is, courts defer “to the administrator’s benefits decision unless it is ‘(1) illogical,

(2) implausible, or (3) without support in inferences that may be drawn from the facts in

the record.’”135 

Determining that the abuse of discretion standard applies “is only the first step” in

determining the standard by which courts review an administrator’s denial of benefits.136

Even where the court must “nominally review for abuse of discretion, the degree of

deference” that the court will accord to an administrator’s decision can vary significantly

130Pac. Shores Hosp. v. United Behavioral Health, 764 F.3d 1030, 1039 (9th Cir. 2014).

131Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 673 (9th Cir. 2011).

132Doc. 55 at 28; Doc. 59 at 16.

133Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (citing

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)).

134Pac. Shores Hosp., 764 F.3d at 1042.

135Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 929 (9th Cir. 2012) (quoting

Salomaa, 642 F.3d at 676).

136Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 867 (9th Cir.

2008).

-26-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 26 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

depending on the presence of a conflict of interest137 or procedural irregularities138 in the

record. Here, on account of the significant conflict of interest and procedural

irregularities presented, the court concludes that Aetna’s decision is entitled to little

deference.

1. Conflict of Interest

“[T]he degree of skepticism with which [courts] regard a plan administrator’s

decision when determining whether the administrator abused its discretion varies based

upon the extent to which the decision appears to have been affected by a conflict of

interest.”139 Where an administrator operates under a conflict of interest, that conflict

does not alter the standard or review itself, but it “‘must be weighed as a factor in

determining whether there is an abuse of discretion.’”140 In evaluating a conflict of

interest, the court must consider not only the terms of the underlying plan and the

medical evidence in the record,141 but also the “nature, extent, and effect on the

decision-making process of any conflict of interest” and decide on the record as a whole

“how much or how little to credit the plan administrator’s reason for denying insurance

coverage.”142 Thus, if all of the other factors are “closely balanced,” a conflict of interest

“will act as a tiebreaker.”143

137

Id. at 868.

138Abatie, 458 F.3d at 972.

139Stephan, 697 F.3d at 929.

140Abatie, 458 F.3d at 965 (quoting Firestone, 489 U.S. at 115).

141Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 630 (9th Cir. 2009).

142Abatie, 458 F.3d at 967-68. See also Salomaa, 642 F.3d at 681 (Hall, J., dissenting)

(“Although this standard’s dualism between skepticism and deference may seem strange, it is

the proper standard and must be applied carefully.”).

143Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 117 (2008).

-27-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 27 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Mason argues that Aetna operates under a conflict of interest because its

behavior is similar to the behavior of the administrators in Abatie,

144 Saffon,145

Montour,

146

 and Salomaa.

147

 Those cases are not on all fours, however, because they

each involved a disability determination made by the same entity that funded the ERISA

plan. In Firestone, the Supreme Court “did not catalogue the full range of types of

conflicts of interest, but it suggested that a conflict exists when a plan administrator

(which acts as a fiduciary toward the plan participants, who are beneficiaries) is also the

sole source of funding for an unfunded plan.”148 Administrators who operate under this

structural conflict of interest have an incentive “to pay as little in benefits as possible to

plan participants because the less money the insurer pays out, the more money it

retains in its own coffers.”149 This specific conflict is not present here because the Plan

is self-funded and maintained by FedEx.

150

 Aetna is the Plan’s “Claims Paying

Administrator”151 and, in that role, determines eligibility for Plan benefits.152

But that is not the end of the story. Mason also argues that a conflict of interest

exists here because “Aetna’s contract with FedEx depends on providing favorable

144Abatie, 458 F.3d at 959.

145Saffon, 522 F.3d at 866.

146Montour, 588 F.3d at 626-27.

147Salomaa, 642 F.3d at 674.

148Abatie, 458 F.3d at 965 n.5 (citing Firestone, 489 U.S. at 105).

149Abatie, 458 F.3d at 966.

150Doc. 59 at 3 ¶¶ 3-4.

151Doc. 32-6 at 1.

152

Id. at 3.

-28-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 28 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

financial results for FedEx.”153 Aetna responds by calling this a “scandalous allegation”

that is “completely unfounded and not supported by any evidence in the record.”154 

Defendants do not dispute that FedEx pays benefits claims out of its own

undedicated funds. FedEx therefore has an obvious incentive to hire a Claims Paying

Administrator that minimizes benefits awards. According to the Supreme Court in

Glenn, an employer’s own conflict may “extend to its selection of an insurance company

to administer its plan.”155 In fact, it has been noted that “[a] so-called independent

administrator may have much more of an incentive to decide against claimants” than

either an employer or “an insurance company spending ‘its own money.’”156 These

“independent” administrators may have an incentive to “show how tough they are on

claims to better market their services to self-insured employers,” whereas insurance

companies “may have an incentive to be more liberal than is appropriate because its

experience-based premiums amount to a cost-plus contract, such that the more it

spends, the more it makes.”157 Similarly, an employer might “wish to slant its decisions

in favor of coverage in close cases” in order to “make working there attractive by means

of a reputation for good medical coverage,” among other reasons.158

It is apparent from the record that FedEx’s (and by extension, Aetna’s) conflict of

interest significantly colored the decision-making process. Nowhere is this conflict more

evident than with Aetna’s response to Dr. Gordon’s initial finding that Mason is disabled. 

Aetna’s treatment of Dr. Gordon’s disability finding suggests bias for at least five

153Doc. 55 at 37.

154Doc. 59 at 23.

155Glenn, 554 U.S. at 114.

156Abatie, 458 F.3d at 977 (Kleinfeld, J., concurring).

157

Id.

158

Id.

-29-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 29 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

reasons. First, Aetna’s request for “clarification” misleadingly implies that Dr. Gordon’s

initial report only considered medical data dated before December 1, 2010.159 This is

not so: Dr. Gordon’s report also relies on Mason’s second blood test that cam e back

positive for SPS (dated December 7, 2010)160 and Dr. Downs’ June 10, 2011 letter.161 

Second, Mason asserts and Aetna does not deny that the Plan does not forbid

consideration of medical records that predate the date of the claim.

162

 It would be

illogical for it to do so.

Third, Aetna asked Dr. Gordon to submit a new report, ostensibly because he

relied on pre-December 2010 data, but it did not ask the same of its doctors who found

that Mason was not disabled, even though they, too, relied on such data.163

 It is unclear

why Aetna needed “clarification” from Dr. Gordon, but not Drs. Weinstein or

Mendelssohn.

Fourth, the date restriction that Aetna imposed on Dr. Gordon is inconsistent with

the scope of records upon which Aetna itself relied. For example, Aetna’s initial denial

letter references Mason’s September 2010 neuropsychological exam, and its final

denial letter relies on exam reports from July 16, 2010 and November 24, 2010.

Finally, Dr. Gordon’s supplemental report indicates that he was influenced by

Aetna’s suggestive request for “clarification.” Dr. Gordon’s second report concludes

that “[w]hile records from earlier periods (early 2010 and before) document more

significant difficulties with spasticity, gait impairment and altered mental status; the

159Doc. 32-3 at 15.

160See id. at 11 (noting that Mason tested “positive twice (blood work)” for SPS); id. at 10

(“Anti-GAD antibodies (diagnostic test for Stiff Man Syndrome) are positive (slightly elevated)

on 12/7/10 and significantly elevated on 2/24/10 and negative from 7/28/10.”).

161

Id. at 11 ([T]he treating neurologist notes that the claimant cannot work due to

refractory symptoms and resultant functional impairment.”).

162Doc. 64 at 31.

163See Doc. 32-2 at 243-45, 252-256, 259-60.

-30-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 30 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

more recent records from 12/1/10 onward do not demonstrate functional impairment

from a neurologic perspective.”164 Dr. Gordon does not state what might have changed,

from a neurologic perspective or otherwise, that could explain this significant

improvement in Mason’s condition. Nor does he attempt to reconcile his conclusion

with the conclusion of Mason’s treating doctors that Mason’s disability was permanent

and progressive in nature.165

2. Procedural Irregularities

“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.”166 If the

administrator “can show that it has engaged in an ‘ongoing, good faith exchange of

information between [itself] and the claimant’” and the evidence shows only a minor

procedural irregularity, the court should continue to give the administrator’s decision

broad deference.167 If the administrator’s “procedural defalcations are flagrant, de novo

review applies” and “the court is not limited to the administrative record and may take

additional evidence.”168 Most of the time, the procedural errors “are not sufficiently

severe to transform the abuse-of-discretion standard into a de novo standard” and in

164Doc. 32-3 at 15.

165Doc. 32-2 at 160 (“Probable duration of condition: life long”); id. at 161 (“[E]stimate the

beginning and ending dates for the period of incapacity: permanent”); id. at 194 (stating that

Mason’s SPS “has rendered him permanently disabled.”); id. at 198 (“I anticipate significant

clinical improvement by (date): never.”). See also id. at 8-9. These prognoses are consistent

with Dr. Meekins’ assessment of Mason’s SPS as progressive on July 28, 2010. Id. at 61. See

also id. at 172 (Dr. Lord noted on July 29, 2010, that Mason’s symptoms have “progressively

worsened and his symptoms are currently poorly controlled.”); id. at 173 (Dr. Lord noted on

August 16, 2010, that Mason’s SPS had “deteriorated”); id. at 188 (Dr. Lord noted on

October 28, 2010, that Mason’s SPS had “deteriorated”).

166Abatie, 458 F.3d at 972.

167

Id. (quoting Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income Prot.

Plan, 349 F.3d 1098, 1107 (9th Cir. 2003)).

168

Id. at 973.

-31-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 31 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

such instances the court must “weigh any procedural errors as a factor in determining

whether [the administrator] abused its discretion.”169 

Saffon is instructive. In Saffon the claimant was receiving disability benefits on

account of degeneration of her cervical spine.170 When MetLife, her plan administrator,

commissioned a doctor to review her medical records, the doctor determined that the

claimant’s file lacked “detailed, objective, functional findings or testing which would

completely preclude” the claimant’s return to work.171

 MetLife forwarded its doctor’s

report to the claimant’s treating neurologist, who then submitted to MetLife a note

explaining why the claimant’s previous MRI was objective evidence of her cervical

pathology. MetLife’s doctor was unpersuaded by this submission, and MetLife

terminated the claimant’s benefits. The termination letter stated that the claimant could

appeal this determination by providing, among other things, “objective medical

information to support [her] inability to perform the duties of [her] occupation.”172

Although the claimant submitted additional evidence on appeal, Metlife’s second

reviewing doctor reached the same conclusion as its first: there was “‘not enough

objective medical findings and office notes’” showing that the claimant’s “‘self-reported

headache and chronic pain syndrome has been enough to preclude her from’

working.”173 MetLife affirmed the termination.

The Ninth Circuit held that MetLife’s termination was riddled with procedural

errors. It held that MetLife’s termination letter was insufficient for at least three reasons. 

First, although the letter notes that “‘[t]he medical information provided no longer

provides evidence of disability that would prevent [the claimant] from performing [her]

169Pac. Shores Hosp., 764 F.3d at 1040. See also Abatie, 458 F.3d at 972.

170Saffon, 522 F.3d at 866.

171

Id. at 869.

172

Id.

173

Id. at 869-70.

-32-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 32 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

job or occupation,’” it does not “explain why that is the case, and certainly does not

engage [the claimant’s treating neurologist’s] contrary assertion.” Second, although the

letter suggests that the claimant can “appeal by providing ‘objective medical information

to support [her] inability to perform the duties of [her] occupation,’” it “does not explain

why the information [she] has already provided is insufficient for that purpose.”174

 And

third, if MetLife believed that it was necessary for the claimant to present some means

for objectively testing the claimant’s ability to perform her job, such as a “Functional

Capacity Evaluation,” MetLife “was required to say so at a time when [the claimant] had

a fair chance to present evidence on this point.”175 In addition to these errors related to

the notice, the court also faulted MetLife for communicating directly with the claimant’s

doctors without advising her of the communication and taking “various of her doctors’

statements out of context or otherwise distorted them in an apparent effort to support a

denial of benefits.”176 

The procedures that Aetna followed in this case are even more flawed that those

at issue in Saffon. 

a. Aetna’s Notices Are Deficient

ERISA plan administrators “must follow certain practices when processing and

deciding plan participants’ claims.”177 For example, 29 C.F.R. § 2560.503-1 provides

that an ERISA plan administrator investigating a claim must engage in “a meaningful

dialogue” with the beneficiary.

178

 “If benefits are denied in whole or in part, the reason

174

Id. at 870.

175

Id. at 871.

176

Id. at 873.

177Abatie, 458 F.3d at 971.

178Booton v. Lockheed Med. Ben. Plan, 110 F.3d 1461, 1463 (9th Cir. 1997) (citing

former 29 C.F.R. § 2560.503-1(f)). The pertinent language is now codified at 29 C.F.R.

§ 2560.503-1(g).

-33-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 33 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

for the denial must be stated in reasonably clear language, with specific reference to

the plan provisions that form the basis for the denial; if the plan administrators believe

that more information is needed to make a reasoned decision, they must ask for it.”179

 

Aetna’s March 28, 2011 denial notice analyzes hundreds of pages of Mason’s

medical records in one paragraph containing a series of disjointed sentences.180

 Like

the notice in Saffon, it does not clearly explain to the claimant what was necessary to

perfect the claim. Although Aetna informs Mason that he was required to submit

“medical documentation that clearly states the significant objective findings that

substantiate [his] disability,” such as physician exam reports, office notes, or diagnostic

test results such as lab tests,181

 it does not clearly inform him of the specific reasons

why its reviewers found that the evidence he already submitted was insufficient. For

example, it does not clearly state that Aetna would disregard his diagnostic test results

if they do not contain “consistency or validity testing results.”182 If Aetna believed that

validity testing results were necessary, it was required to say so “in a manner calculated

179Booton, 110 F.3d at 1463. See also 29 C.F.R. § 2560.503-1(g)(1) (requiring, among

other things, that notices of adverse benefit determinations must set forth “in a manner

calculated to be understood by the claimant:” (i) “[t]he specific reason or reasons for the

adverse determination;” (ii) “[r]eference to the specific plan provisions on which the

determination is based;” and (iii) “[a] description of any additional material or information

necessary for the claimant to perfect the claim and an explanation of why such material or

information is necessary.”).

180Doc. 32-2 at 4.

181

Id. at 5.

182See Dr. Mendelssohn’s first report, id. at 243-44 (“Dr. Dukarm noted that the claimant

appeared lethargic, and the claimant reported having a headache and experiencing pain.

There was no indication that formal measures of validity were utilized to ensure valid test

results.”); id. at 245 (rejecting Dr. Dukarm’s cognitive disorder diagnosis in part because “there

was no indication that the examiner utilized symptom validity measures to ensure adequate

effort and motivation and valid test findings.”); Dr. Mendelssohn’s second report, id. at 249 (“[I]n

my previous review I questioned the presence of whether the claimant’s test performance was

reflective of valid test findings. However, validity could not be determined given that there was

no indication that the examiner administered symptom validity measures to ensure optimal

effort and motivation and validity of the neuropsychological evaluation.”).

-34-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 34 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

to be understood by”

183

 Mason at a time when he had a meaningful opportunity to

present evidence on this point. 

The record is replete with similar examples. Aetna’s denial notice does not

disclose to Mason that Dr. Mendelssohn discounted his doctors’ observations of his

emotional and cognitive difficulties because those doctors did not include “specific

measurements of [Mason’s] cognition or a description of direct and observed behaviors

to corroborate the presence of impairment in neuropsychological functioning.”184

 Nor

does it disclose to him that Dr. Weinstein discounted an exam finding that he had an

irregular gait because there was “no documentation of abnormal muscle tone on

specific muscle testing or other musculoskeletal or neurologic examination

abnormalities.”185 Or that Dr. Weinstein discounted his somnolence complaints

because there was “no documentation of pathologic hypersomnolence, difficulty with

communication in the office visits, or significant cognitive impairments.”186 Or that

Dr. Weinstein found that Mason’s file was lacking “documentation of consistently

abnormal musculoskeletal or neurologic examination findings.”187 Aetna’s failure to

disclose these alleged deficiencies to Mason, “a maneuver that has the effect of

insulating [its] rationale from review, contravenes the purpose of ERISA.”188

Further, when Dr. Kim filled out Aetna’s “Attending Physician Statement” form,

he listed numerous diagnostic test results that, in his opinion, were “objective data” that

document Mason’s disability, including the lab tests that confirmed Mason’s

18329 C.F.R. § 2560.503-1(g)(1).

184Doc. 32-2 at 245.

185

Id. at 255.

186

Id. at 256.

187

Id. 32-2 at 260.

188Cf. Abatie, 458 F.3d at 974.

-35-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 35 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

diagnosis.189 If Aetna believed that these test results did not contain “significant

objective findings that substantiate” his disability, it was required to say so and explain

why not. Aetna’s denial letter makes no mention of Mason’s lab tests; it vaguely

concludes that Dr. Kim “was unable to provide any objective findings or clinical

observations to correlate with your subjective complaints due to diagnosis of stiff person

syndrome.”190

b. Aetna Failed to Engage in a Good Faith Exchange of

Information

In determining the degree of deference to which an administrator is entitled,

courts must also consider its course of dealing with the claimant and her doctors.191 In

Saffon the Ninth Circuit chided the plan administrator for only communicating the

results of its reviewing physician’s findings with the claimant’s doctor and not also the

claimant herself. Aetna did substantially worse here by providing none of its reviewing

doctors’ reports to either Mason or his physicians at any point during the administrative

process.192

 Aetna’s initial denial letter fails to provide Mason with even its reviewers’

names, identifying them only as “independent peer physicians specializing in internal

medicine, neurology, and neuropsychology.”193

 Without any way for his treating doctors

to confer with Aetna’s doctors, or to submit reports that respond to Aetna’s reports,

Aetna significantly hindered Mason’s ability to develop the administrative record. 

189Doc. 32-2 at 198.

190

Id. at 4.

191Saffon, 522 F.3d at 873.

192Doc. 55 at 36.

193Doc. 32-2 at 4.

-36-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 36 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Defendants argue that Mason had no right to review and rebut its peer review

reports “generated during the appeal process.”194 Even assuming this is true,

Defendants confuse the issue. The problem is not that Aetna failed to disclose to

Mason the reports that Drs. Mazal, Schnur, and Gordon generated during the appeal

process, but rather the reports from Drs. Weinstein, Mendelssohn, and Cohan upon

which Aetna relied when it initially denied Mason’s claim.

195

 The Ninth Circuit has held

that where an administrator does not give the claimant, her attorney, or her physicians

access to the medical reports of its own physicians upon which it relied, this violates the

claimant’s statutorily right to a “full and fair” review of the denial.196

What is more, Aetna even failed to provide its own reviewers with pertinent

records. As Mason observes, Aetna failed to provide Dr. Weinstein or Dr. Mendelssohn

with any records from his treating psychologist, Dr. Madden.197 Defendants dispute this,

and assert that “Dr. Mendelssohn’s report specifically states that Dr. Mendelssohn

reviewed at least fourteen medical notes from [Dr. Madden]. Dr. Mendelssohn also

commented on these records directly in her report.”198 This is false. Defendants

support their factual assertions with a citation to Aetna’s March 28, 2011 denial letter,

194Doc. 73 at 8 (citing Midgett v. Washington Grp. Int’l Long Term Disability Plan, 561

F.3d 887, 896 (8th Cir. 2009); Metzger v. UNUM Life Ins. Co. of Am., 476 F.3d 1161, 1166

(10th Cir. 2007); Warming v. Hartford Life & Acc. Ins. Co., 663 F. Supp. 2d 10, 20 (D. Me.

2009); Winz-Byone v. Metro. Life Ins. Co., No. EDCV 07-238-VAP, 2008 WL 962867, at *8

(C.D. Cal. Mar. 26, 2008)).

195See Metzger, 476 F.3d at 1166 (holding that although plan administrators must

release documents relied upon during the initial benefit determination, they need not release

“documents generated during the appeal process itself.”); Midgett, 561 F.3d at 896 (“[T]he full

and fair review to which a claimant is entitled under 29 U.S.C. § 1133(2) does not include

reviewing and rebutting, prior to a determination on appeal, the opinions of peer reviewers

solicited on that same level of appeal.”) (emphasis added).

196Salomaa, 642 F.3d at 679 (citing 29 U.S.C. § 1133).

197Doc. 32-2 at 247-48.

198Doc. 73 at 7.

-37-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 37 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

not Dr. Mendelssohn’s reports.199 Neither of Dr. Mendelssohn’s reports state that she

reviewed any records from Dr. Madden200, and Dr. Mendelssohn does not comment on

any of Dr. Madden’s records in either of her two reports.201

This particular deficiency was likely significant to Dr. Weinstein’s and

Dr. Mendelssohn’s findings. Dr. Mendelssohn concludes that none of the records that

Aetna provided her show that Mason “was falling asleep during his office visits nor did

the provided information include . . . description [sic] of overt cognitive difficulties.”202

Similarly, Dr. Weinstein states that “there has been no documentation of pathologic

hypersomnolence, difficulty with communication in the office visits, or significant

cognitive impairments.”203

 If Drs. Weinstein and Mendelssohn had been provided with

Dr. Madden’s records, they would have learned that for each of Mason’s 14 visits with

Dr. Madden, spanning approximately six months, Dr. Madden’s mental status exams

noted that Mason was “lethargic.”204 Had they followed up with Dr. Madden about what

she meant, Dr. Madden would have likely informed them that Mason was “very tired”

during his therapy sessions and had fallen asleep “despite a valiant effort to stay

awake.”205

199Doc. 32-2 at 4.

200

Id. at 241-42, 247-48.

201

Id. at 241-46, 247-50.

202

Id. at 249-50.

203

Id. at 256.

204

Id. at 63, 66, 72, 81, 83, 88, 91, 94, 97, 103, 106, 110, 113, and 117.

205

Id. at 13. Although Defendants correctly note that Dr. Schnur was provided with

Dr. Madden’s records, he made no findings regarding the side effects of Mason’s medications,

stating that he lacked necessary expertise to do so. Doc. 32-3 at 6.

-38-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 38 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Finally, Aetna’s physicians erred by not engaging in peer-to-peer consultations

with Mason’s physicians to resolve perceived ambiguities in Mason’s records.206 For

example, Dr. Weinstein noted that Dr. Lord observed Mason in “moderate pain and

distress,” but discounted this finding because Dr. Lord provided “no details of specific

observations.”207

 Yet Dr. Weinstein’s report does not indicate that she contacted

Dr. Lord to obtain more details about what he observed, despite the fact that Dr. Lord

invited Aetna to contact him with “any further concerns or questions.”208

 Similarly,

Dr. Mendelssohn noted that Dr. Dukarm observed that Mason “appeared lethargic”

during his neuropsychological test, yet she discounted this observation because “more

specific description [sic] was not included.”209

 Dr. Mendelssohn’s report does not

indicate that she contacted Dr. Dukarm to obtain clarification of what he specifically

meant by “lethargic.” The Ninth Circuit’s description of Aetna’s efforts in Booton is

equally apt here: “Lacking necessary- and easily-obtainable information, Aetna made its

decision blindfolded.”210

B. A Bench Trial on the Record Would be Improper 

The parties dispute whether the proper vehicle for determining Mason’s benefit

claim is a “bench trial on the record” followed by a judgment that complies with Rule 52

or summary judgment under Rule 56. Relying on Kearney v. Standard Insurance

Company,

211

 Mason argues that “the proper procedure in ERISA cases involving the

206The only Aetna physician that reached out to one of Mason’s treating physicians was

Dr. Cohan, but this was not a true “peer-to-peer” consultation because Dr. Cohan, a

neurologist, inexplicably did not consult with Mason’s neurologists but instead Dr. Kim, a

general practitioner. Doc. 32-2 at 265.

207

Id. at 260.

208

Id. at 172.

209

Id. at 249.

210Booton, 110 F.3d at 1463.

211175 F.3d 1084 (9th Cir. 1998) (en banc).

-39-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 39 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

review of the denial of benefits is a ‘trial on the record.’”212 Mason asserts that, “[s]ince

Kearney, the Ninth Circuit has reaffirmed [that] a ‘trial on the record’ is the correct

approach” in Thomas v. Oregon Fruit Products Co.

213

 Under this approach, Mason

argues, the court can “decide what the facts are.”214

Mason is essentially seeking to transform this abuse-of-discretion case into one

involving de novo review. But, because the cases upon which his argument relies

involve de novo review, his argument misses the mark.215

 It is true that in ERISA cases

decided under the de novo standard courts may conduct trials on the record. This is

because those courts are tasked with evaluating evidence and making credibility

determinations anew.

216

 Such trials are not appropriate in abuse-of-discretion cases,

however. As the Ninth Circuit explained in Bendixen v. Standard Ins. Co., “it is

important to keep in mind that the remand and reversal of the summary judgment in

[Kearney] depended upon the application of de novo review by the district court.”217 In

212Doc. 55 at 2.

213228 F.3d 991, 996 (9th Cir. 2000) (“Kearney clarifies that participants and

beneficiaries claiming benefits under ERISA are not entitled to ‘full trial[s] de novo’ because

such trials would undermine the policies behind ERISA. Rather, Kearney created a ‘novel form

of trial,’ in which the district court, subject to its discretion to consider additional evidence under

limited circumstances, is to conduct ‘a bench trial on the record.’”) (citing Kearney, 175 F.3d at

1094, 1095 & n.4).

214Doc. 64 at 2.

215See Kearney, 175 F.3d at 1095-96; Thomas, 228 F.3d at 994 (“As in Kearney, the

district court should have reviewed Thomas’ claim de novo.”); O’Neal v. Life Ins. Co. of N. Am.,

10 F. Supp. 3d 1132, 1135 (D. Mont. 2014). But see Tapley v. Locals 302 & 612 of Int’l Union

of Operating Engineers-Employers Const. Indus. Ret. Plan, 728 F.3d 1134, 1139 (9th Cir. 2013)

(the district court conducted a trial on the record despite the fact that the abuse of discretion

standard of review applied). Because the Ninth Circuit did not address the propriety of the

district court’s procedural choice on appeal and, in any event, reversed the court’s judgment,

Tapley is not binding authority on this issue. Id. at 1139-43.

216Kearney, 175 F.3d at 1095.

217185 F.3d 939, 942-43 (9th Cir. 1999) (overruled on other grounds by Abatie, 458 F.3d

at 965).

-40-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 40 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

cases where the abuse of discretion standard applies, whether the administrator

abused its discretion is a question of law, not fact, based on a review of the

administrative record, as opposed to a trial.218 Because a motion for summary

judgment is “the conduit to bring [that] legal question before the district court,”219

Mason’s motion for a post-trial judgment under Rule 52 will be denied.

C. Summary Judgment Principles Have Limited Application

Because of the limited nature of review, “[t]raditional summary judgment

principles have limited application in ERISA cases governed by the abuse of discretion

standard.”220 Thus, “the usual tests of summary judgment, such as whether a genuine

dispute of material fact exists,” generally do not apply.

221

IV. DISCUSSION

A. FedEx Trade Is Not a Proper Party

Defendants argue that Mason’s employer, FedEx Trade, is not a proper party to

this action because it is only a “Controlled Group Member” and “Sponsoring Employer,”

and it does not exercise any control over the plan as an administrator or otherwise.222

In Cyr v. Reliance Standard Life Ins. Co., the Ninth Circuit held that “liability under 29

U.S.C. § 1132(a)(1)(B) is not limited to a benefits plan or the plan administrator,”223 but

did not define the precise limitations of ERISA liability. In Spindex Physical Therapy v.

United Healthcare of Arizona, the court provided some guidance: “proper defendants

under § 1132(a)(1)(B) for improper denial of benefits at least include ERISA plans,

218Nolan v. Heald Coll., 551 F.3d 1148, 1154 (9th Cir. 2009).

219Bendixen v. Standard Ins. Co., 185 F.3d 939, 942 (9th Cir. 1999)

220Stephan, 697 F.3d at 929.

221Nolan, 551 F.3d at 1154.

222Doc. 59 at 16-17.

223642 F.3d 1202, 1207 (9th Cir. 2011).

-41-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 41 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

formally designated plan administrators, insurers or other entities responsible for

payment of benefits, and de facto plan administrators that improperly deny or cause

improper denial of benefits.”224

Mason responds by stating that he is not pursuing a § 1132(a) claim against

FedEx Trade, but rather a claim that arises under § 1132(c) for FedEx Trade’s violation

of 29 U.S.C. § 1024(b)(4) and 29 C.F.R. § 2560.503-1(h)(2)(iii). 225 This argument fails

because, as Defendants point out, § 1132(c) actions may only be brought against plan

administrators.226 Mason does not dispute that FedEx Trade is not the Plan’s

administrator. Summary judgment will be granted in FedEx Trade’s favor. 

B. Aetna Abused Its Discretion

The court finds that, based on the record that Aetna had bef ore it, Aetna abused

its discretion in denying Mason’s claim. The evidence in the record shows that Mason

suffers from a permanent disability that prevents him from working. Aetna’s conclusion

to the contrary is illogical, implausible, and not supported by the facts.

1. Evidence of Mason’s Medical Conditions

As noted above, the fundamental basis of Mason’s claim is his contention that he

can no longer work because he suffers from a combination of (1) painful spasms and

(2) the negative side effects from the medication he takes for those spasms. 

a.) SPS Symptoms

There is ample objective evidence in the record showing that Mason suffers from

painful spasms, including Mason’s blood tests that came back positive for SPS and

exam notes that show Mason has been repeatedly observed suffering from symptoms

224770 F.3d 1282, 1297 (9th Cir. 2014).

225Doc. 64 at 27.

22629 U.S.C. § 1132(c) (“Any administrator . . . who fails or refuses to comply with a

request for any information which such administrator is required by this subchapter to furnish to

a participant or beneficiary . . . may in the court’s discretion be personally liable to such

participant or beneficiary . . . .”) (emphasis added).

-42-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 42 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

typical of this disease: spasms, pain, and stiffness.227 Mason’s April 27, 2011

emergency department physical exam notes, for example, state that Mason’s

extremities were stiff and he was suffering from painful spasms.228

 And his May 11,

2011 emergency room notes state that Mason was observed suffering from “severe”

“whole body spasms.”229

 Contrary to Aetna’s conclusion, these are “objective findings”

that substantiate Mason’s self-reported symptoms.

Inexplicably, both of Aetna’s denial notices fail to mention Mason’s positive lab

results. Aetna’s final denial notice also does not connect his spasms with his SPS

diagnosis, stating only that the data show that Mason “had stiffness and muscle

pain.”230

 Although that notice does summarize the two emergency room records

mentioned above, Aetna distorts their significance and omits reference to relevant facts

in an apparent effort to support a denial. The only aspect of Mason’s April 27

emergency department notes that Aetna mentions is that they do not “reveal any

neurological defects.”231 And with regard to Mason’s May 11 emergency department

notes, Aetna states only that they show Mason “had stiffness and muscle pain,” but his

“motor power and sensation were normal.”232 Aetna selectively ignores the objective

evidence that shows Mason was suffering from painful spasms. Selective consideration

of evidence is a hallmark of arbitrary and capricious decision-making.

233

227See, e.g., Doc. 32-2 at 23, 49, 56, 163, 173.

228

Id. at 36.

229

Id. at 23.

230Doc. 32-1 at 1.

231Doc. 32-1 at 2.

232

Id.

233See Glenn, 554 U.S. at 118 (holding that selective consideration of evidence is a

proper grounds for setting aside an administrator’s decision); Holmstrom v. Metro. Life Ins. Co.,

615 F.3d 758, 777 (7th Cir. 2010).

-43-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 43 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

b.) Medication Side Effects

Aetna does not dispute that Mason’s medications can potentially cause side

effects of sedation and cognitive impairment; it does dispute that Mason was in fact

suffering from them.

234

 But, again, Aetna selectively ignores evidence in the record.

Ample evidence in the record shows that Mason’s medication had a sedative

effect, including all 14 visit notes from Dr. Madden, various visit notes from other

doctors,235

 notes from Dr. Kim,

236

 Dr. Madden,237

 and Dr. Grant,238

 and Combs’ email. 

Aetna’s final denial letter mostly fails to mention this evidence. It does mention

Dr. Madden’s November 24, 2010 office visit note, but selectively omits Dr. Madden’s

description of Mason’s consciousness as lethargic,239

 and instead focuses solely on

Dr. Madden’s other observations that do not support a disability finding.

240

 Aetna’s

initial denial letter concludes that there is no objective proof that Mason suffers from

234See Dr. Cohan’s report, doc. 32-2 at 266 (“Although the claimant does take

medications which have potential adverse side effects, including sedation, nevertheless there is

no objective data in the medical records provided to substantiate that the claimant has

experienced those adverse medical side effects.”).

235See Dr. Dukarm’s report, doc. 32-2 at 75 (“His affect appeared obtunded . . . . The

patient appeared lethargic . . . .”); Dr. Downs’ April 29, 2010 note, id. at 148 (“His attention span

and concentration are slightly reduced, and he appears somewhat somnolent.”); Dr. Lord’s May

5, 2010 office note, id. at 150 (physical exam describes Mason as “fatigued”); Dr. Lord’s May 7,

2010 office note, id. at 152 (same); Providence Alaska Medical Center’s January 11, 2011

emergency report, id. at 48 (“He did take diazapam and Zanaflex that has improved his

symptoms. When he initially checked in, his pain [was] 9/10. Currently, he has minimal pain

and is sleeping.”); id. at 49 (“He is sleeping upon my arrival into the room, which was about 20

minutes after presentation.”).

236Doc. 32-2 at 196, 198.

237

Id. at 13.

238

Id. at 121.

239

Id. at 94.

240Doc. 32-1 at 1 (noting only that Dr. Madden described Mason’s mood as depressed,

his thought process as normal and coherent, his language as intact, and his speech as

spontaneous).

-44-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 44 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

somnolence because it focuses only on the notes from Dr. Kim and Dr. Grant, which,

according to Aetna, did not “document any objective findings to indicate a functional

impairment such as significant sleepiness or disorientation during office visits.”241

 Not

only does this conclusion ignore the contrary evidence in the record noted above, but 

also ignores an explanation for why Dr. Kim and Dr. Grant did not observe Mason’s

sleepiness. Both Dr. Madden and Dr. Kim stated that Mason did not take his

medication before his doctors’ visits so that he could be awake and alert enough to

communicate, understand, and remember what was going on.242

Dr. Dukram’s neuropsychological test is also objective evidence that Mason

suffers from a cognitive disorder. Over the course of this four-hour exam, Dr. Dukram

subjected Mason to a litany of tests,243 the results of which led him to conclude that

Mason was exhibiting “variable neurocognitive performance deficits in the areas of

executive functioning” and diagnosed him with “Cognitive Disorder, NOS.”244 Aetna’s

final denial letter does not even mention these tests. Aetna’s initial denial letter does

mention them, but only to discount their medical significance based on dubious factual

grounds245 and naked speculation that Mason might not have been putting forth his best

effort during the exam.

241Doc. 32-2 at 4.

242

Id. at 13, 265.

243

Id. at 75.

244

Id. at 77.

245Although Aetna concludes that Dr. Dukarm did not note “significant sedation” during

testing, Dr. Dukarm described Mason as “lethargic” and his affect “obtunded.” Aetna’s

interpretation of Dr. Dukarm’s remarks is questionable.

-45-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 45 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2. Evidence of Mason’s Disability

As Defendants point out, just because someone has a medical condition does

not by itself establish disability.

246

 Sometimes the person’s medical conditions are so

severe that the person cannot work, but other times “people are able to work despite

their conditions; and sometimes people work to distract themselves from their

conditions.”247 There is ample evidence here, however, that shows that the combined

effects of Mason’s conditions are severe enough to prevent him from working as a

manager for FedEx Trade.

Dr. Lord, Dr. Kim, and Dr. Grant each concluded that Mason is unable to work on

account of his medical conditions. Aetna’s denial notices do not consider these

significant opinions, let alone explain why these three treating physicians got it wrong. 

Aetna also failed to consider Mason’s SSDI award as evidence of his disability. “Social

Security disability awards do not bind plan administrators, but they are evidence of

disability. Evidence of a Social Security award of disability benefits is of sufficient

significance that failure to address it offers support that the plan administrator's denial

was arbitrary, an abuse of discretion. Weighty evidence may ultimately be

unpersuasive, but it cannot be ignored.”248

Finally, Aetna failed to consider the only evidence in the record regarding

Mason’s actual performance at work: Combs’ email. In her email Combs states that

Mason fell asleep on the job “many times,” had difficulties focusing and remembering

things, and had become a “grave liability” for the company. Aetna’s two denial notices

completely ignore this probative evidence. 

246

Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 880 (9th Cir.

2004).

247

Id. 

248Salomaa, 642 F.3d at 679. See also Bennett v. Kemper Nat. Servs., Inc., 514 F.3d

547, 555 (6th Cir. 2008).

-46-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 46 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Before receiving Combs’ email, Drs. Mendelssohn and Weinstein each

concluded that the side effects of Mason’s medications must not have been so bad

because he was still able to work.249

 But, when Aetna presented Combs’ email to

Drs. Mendelssohn and Weinstein, showing otherwise, each doctor’s opinion remained

the same. Dr. Mendelssohn dismisses Combs’ description of Mason’s troubles at work

as not credible for dubious reasons, including her incorrect findings that the record

contained “no indication that [Mason] was falling asleep during his office visits”250

 and

that there were no medical findings that Mason suffers from “overt cognitive

difficulties.”251 Dr. Weinstein’s second report is even less defensible. After providing

Dr. Weinstein with Combs’ email, Aetna asked her whether “the clinical data correlate[s]

with the symptoms exhibited at work to support an inability to perform his job

functions.”252 It appears that Dr. Weinstein did not even read Combs’ email because

her response begins: “It is not clear what symptoms were exhibited at work . . . .”253

Instead of asking Dr. Weinstein to clarify her answer, as it did with Dr. Gordon, Aetna

simply accepted her response.

249Doc. 32-2 at 245 (Dr. Mendelssohn’s first report states, “It was opined [on

Dr. Dukarm’s report] that the claimant’s cognitive difficulties were multifactorial in nature

secondary to medications, pain, sleep disturbance, and depression. However, it is important to

note that the claimant continued to work despite findings from this evaluation.”); id. at 255-56

(Dr. Weinstein’s first report discounts Mason’s SPS symptoms because he had been suffering

from them “for over 15 years and this has not precluded him from working.” It also discounts

Dr. Dukarm’s findings because, “[d]espite the fact that this study was done on 9/27/10, it

appears the claimant was still able to perform his own occupation with the first date of absence

being listed as 11/10/10.”).

250

Id. at 250.

251

Id.

252

Id. at 260.

253

Id. 

-47-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 47 of 48
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

V. CONCLUSION

For the reasons set forth above, Plaintiff’s motion at docket 55 for judgment

pursuant to Rule 52 is DENIED. Summary judgment is GRANTED in favor of FedEx

Trade Networks Transport & Brokerage, Inc. In all other respects, Plaintiff’s motion for

partial summary judgment at docket 55 is GRANTED, and Defendants’ cross-motion for

partial summary judgment at docket 57 is DENIED. Defendants are hereby ORDERED

to grant Plaintiff’s claim for short-term disability benefits.

DATED this 22nd day of February 2016.

/s/ JOHN W. SEDWICK

SENIOR UNITED STATES DISTRICT JUDGE

-48-

Case 3:14-cv-00107-JWS Document 74 Filed 02/22/16 Page 48 of 48