UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF MICHIGAN 

SOUTHERN DIVISION 

Plaintiff Elizabeth Stephens brings this suit pursuant to the Employee Retirement Income 

Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. From late 2012 to at least mid-2013, Stephens, 

a Benefits Coordinator for Kelly Services, Inc., suffered from heart problems and high blood 

pressure and could not work. Although Defendants Prudential Insurance Company of America 

and Kelly Services, Inc. Disability Income Plan provided short term disability benefits for a time, 

Stephens says that Defendants terminated those benefits too early and wrongly denied her long 

term disability benefits. 

Before the Court are Plaintiff’s Motion for Judgment on the Administrative Record (Dkt. 

26) and Defendants’ Motion for Judgment Affirming the Denial of Plaintiff’s Request for 

Benefits (Dkt. 29). Upon careful review of the briefs and the Administrative Record, for the 

following reasons, the Court REMANDS to the plan administrator for further administrative 

proceedings. 

ELIZABETH KATHRYN STEPHENS, 

 Plaintiff, 

 

v. 

 

THE PRUDENTIAL INSURANCE 

COMPANY OF AMERICA AND KELLY 

SERVICES, INC. DISABILITY INCOME 

PLAN, 

 Defendants. 

Case No. No. 14-11809 

Honorable Laurie J. Michelson 

OPINION AND ORDER GRANTING IN PART PLAINTIFF’S MOTION 

REQUESTING JUDGMENT ON THE ADMINISTRATIVE RECORD AND 

DENYING DEFENDANTS’ MOTION FOR JUDGMENT AFFIRMING THE DENIAL 

OF PLAINTIFF’S REQUEST FOR BENEFITS 

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I. 

A. 

Kelly Services, Inc. employed Stephens as a Benefits Coordinator starting on November 

8, 2010. (Dkts. 13–15, Administrative Record (“AR”) at 184.) Kelly Services covered Stephens 

under its Disability Income Plan (“the Plan”). (Dkt. 24, at 1–36.) Coverage included short term 

disability (“STD”) and long term disability (“LTD”). (AR at 183.) Defendant Prudential 

administers claims under the Plan. (Dkt. 24, at 33.) Kelly Services, Inc.’s Benefit Plans 

Committee was the Plan administrator. (Id.) 

The Plan provides benefits to employees with a “certified disability,” which the Plan 

defines as follows: 

“Certified disability” means you are under the care of a Physician. You will not 

be deemed to be under the care of a Physician on any day more than 31 days 

before the date he or she has seen and treated you in person for the disease or 

injury that caused the disability, and the Claims Administrator has determined 

there is a significant change in your physical or mental condition while you are 

covered under the Disability Plan that will effect the following: 

During your first 36 months of disability, you are not able, solely because of 

sickness or injury, to perform the substantial and material duties of your own 

occupation, and you have a 20% or more loss in earnings due to the same sickness 

or injury. 

After 36 months of disability, you are not able, solely because of sickness or 

injury, to perform the substantial and material duties of any occupation for which 

you are reasonably suited through education, experience, or training. 

(Dkt. 24, at 12.) 

B. 

After about two years at Kelly Services, Stephens underwent cardiac surgery—an aortic 

Type A dissection repair—at the University of Michigan Hospital. (AR at 325.) She was 

hospitalized from November 19, 2012 until December 7, 2012. (AR at 325.) After her release, 

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she was briefly re-hospitalized at Saint Joseph Mercy Hospital in Oakland County on December 

8, 2012 because of “severe palpitations.” (AR at 674.) 

Stephens submitted a claim to Prudential for STD benefits on December 11, 2012. (AR at 

795–800.) Prudential approved Stephens for STD coverage from November 19, 2012 through 

June 30, 2013. (AR at 729, 823.) 

Records from Stephens’ hospitalization noted that her “post-operative course has been 

complicated by an acute chronic kidney injury.” (AR at 328.) Dr. Fahd Al-Saghir, Stephens’ 

long-time nephrologist, evaluated Stephens on January 9, 2013 and reported that her chronic 

kidney disease was at stage three. (AR at 224, 282.) According to Dr. Al-Saghir, her kidney 

disease had been “stable for years.” (AR at 282.) 

On January 16, 2013, Dr. Bo Yang, the cardiac surgeon who treated Stephens at the 

University of Michigan Hospital, wrote that Stephens had “recovered well” from her November 

2012 operation. (AR at 336.) Still, Dr. Yang noted various complications, including edema, 

chronic renal insufficiency, and high blood pressure. (AR at 336.) He recommended a follow-up 

with Dr. Kirit Patel, a cardiologist. (AR at 336–37.) Prior records reflect that high blood pressure 

was an issue for Stephens leading up to her November 2012 surgery. (See, e.g., AR 211.) 

Dr. Patel examined Stephens on January 31, 2013. He concluded, “Overall from the 

cardiac standpoint, patient is stable.” (AR at 675.) But he prescribed Xanax because Stephens 

had “a lot of anxiety.” (AR at 675.) Stephens also visited Dr. Al-Saghir that day. (See AR at 

225.) Dr. Al-Saghir noted, “Acute kidney injury with recent hospitalization with dissecting 

thoracic aneurysm, resolved.” (AR at 225.) He again noted that Stephens’ chronic kidney disease 

was at stage three. (Id.) 

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From February 20, 2013 through April 22, 2013, Stephens attended 24 cardiac 

rehabilitation sessions at St. Joseph Mercy Hospital in Oakland County. (AR at 310–313.) 

According to her discharge report, Stephens experienced “[o]ccasional episodes of minor 

shortness of breath with initial exercise session with symptoms lessening as [she] progressed in 

[the] program.” (AR at 310.) Her “average exercise/MET level” improved throughout the 

program. (AR at 310.) The report also stated that Stephens would “continue with a home based 

exercise program” involving walking. (AR at 310.) 

In connection with her receipt of STD benefits, Stephens filled out a detailed daily 

activities questionnaire for Prudential on March 17, 2013. (AR at 314–21.) She listed various 

conditions that would prevent her from returning to work: aortic dissection surgery, depression, 

hypertension, glomerulonephritis, arthritis, asthma, a voice box injury, and numbness in her 

fingers and left hand. (AR at 314.) She reported that her voice “goes out,” making it difficult to 

speak over the phone at length. (Id.) Similarly, she stated that it would be difficult to sit in front 

of a computer at length because of chest pain. She also wrote that she needed to “keep stress 

levels low” and that she could not do household activities involving pushing, lifting, or stretching 

because of pain from her incisions. (AR at 314, 318.) She reported that she walked for four hours 

and read for two each week. (AR at 319.) 

Several days later, on March 20, 2013, Stephens again visited Dr. Al-Saghir. He noted 

that Stephens’ chronic kidney disease and edema had become “unstable.” (AR at 230.) His notes 

also indicated “Lethargy/Dry mouth.” (AR at 230.) 

On April 16, 2013, Stephens followed up with Dr. Yang at the University of Michigan 

Hospital. According to a report from the examination, Stephens stated that “her recovery is 

steadily progressing.” (AR at 651.) The report concluded, “In summary, Mrs. Stephens remains 

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stable. . . . She was advised to not excessively strain, lift, push, or pull more than 30 – maximum 

50 pounds.” (AR at 652.) In a letter to Drs. Patel and Al-Saghir about the examination, Dr. Yang 

wrote, “Mr. Stephens did not like Mrs. Stephens going back to work. We will extend her time off 

work for another three months since the stress at her work was very high and her blood pressure 

was consistently high during the work.” (AR at 654.) 

Two days later, on April 18, 2013, Dr. Al-Saghir reported that Stephens had high blood 

pressure and that her chronic kidney disease was still at stage three. (AR 105–07.) 

By May 9, 2013, Dr. Patel, Stephens’ cardiologist, wrote, “I think clinically she seems to 

be doing fine” following her surgery at the University of Michigan. (AR at 666.) And he thought 

that her hypertension was “well controlled” and that her glomerulonephritis and renal 

insufficiency were “stable now.” But he also wrote that Stephens “is very, very confused after 

the surgery. Since it is not getting better and is getting worse, which is very contrary to her 

previous nature, we will at least get a CT or an MRI of the brain.” 

On May 22, 2013, Dr. Al-Saghir signed a form for Prudential, which, consistent with the 

April 16, 2013 report from Dr. Yang, marked July 16, 2013 as a target date for Stephens’ return 

to work. (AR at 669.) He also wrote, “Can do desk work . . . Can’t do lifting or physical work.” 

(AR at 670.) He also appears to have written (his handwriting is difficult to decipher), “Monitor 

BP and kidney function.” (AR at 670.) Dr. Al-Saghir’s notes from a visit with Stephens that day 

reflect that she walked for a half-hour daily. But he noted that Stephens did not “feel good,” 

suffered from “memory loss/loss of focus,” and that her incision was “hurting.” (AR at 241.) 

Some evidence in the record suggests that in June 2013, Stephens’ recovery became more 

complicated. During that time, she made several visits to the emergency room at Saint Joseph 

Mercy Hospital Oakland. First, on June 5, 2013, Stephens went to the hospital, reporting heart 

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palpitations. Records from the visit reflect that on that same day “her palpitations have now 

improved and she has no more symptoms now.” (AR at 562.) Another physician noted the next 

day that Stephens “stated that she walks on a daily basis, approximately 1.25 miles per day 

without difficulty” and that prior to the heart palpitations, she had “walked earlier that day 

without experiencing any of the aforementioned symptoms.” (AR at 568.) The hospital 

discharged Stephens on June 6, 2013. 

Stephens was again hospitalized because of reported heart palpitations from June 8–12, 

2013. (AR at 530, 535.) Tests revealed high blood pressure, which was ultimately controlled, and 

a focal dissection of the anterior abdominal aorta. (AR 535.) She was instructed to follow-up 

with Dr. Al-Saghir in five to seven days and Dr. Patel in two weeks. (AR at 531.) 

Stephens again went to the hospital two days after her prior discharge, because of 

elevated blood pressure and palpitations. (AR at 543.) 

After her release from her third hospitalization in about two weeks, Stephens followed up 

with Dr. Al-Saghir on June 19, 2013. According to his notes, Stephens’ kidney disease had 

elevated from stage three to four. (AR at 244, 246.) He also noted in a letter to Dr. Patel, 

“Episodes of hypertensive urgencies, questionable panic attacks.” (AR at 244.) 

Stephens followed up with Dr. Patel on June 20, 2013. He described her condition as 

“stable” but noted her “significant anxiety” and stress. (AR at 649.) He also wrote, “I think she is 

probably not ready to go to work basically because of her anxiety, the uncontrolled hypertension, 

the residual dissection of the descending thoracic aorta, and the repair of the ascending aorta in 

November 2012. In my opinion, the lady should probably just stay off work and be disabled.” 

On June 23, 2013, Stephens went to the emergency room again and reported that her 

heart was racing. (AR at 556-57.) On arrival, her blood pressure and heart rate were “normal.” 

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Three days later, Stephens returned to Dr. Al-Saghir. That day Dr. Al-Saghir wrote to Dr. 

Patel: “She reports an erratic pulse associated with blood pressure spikes,” but “[h]er heart is 

regular rate and rhythm.” (AR at 254.) Dr. Al-Saghir also wrote, “Worsening renal function” and 

“Recent spikes in heart rate and blood pressure. Etiology is not clear.” (AR at 254.) A holter test 

from that day yielded these results: “Rare atrial or ventricular actopic beats were present. A 

single 6-beat nonsustained atrial run occurred.” (AR at 146.) 

On July 26, 2013, Stephens sent another daily activities questionnaire to Prudential. She 

reported that she walked 30 minutes daily and read two hours weekly. (AR at 390.) She also 

reported memory loss and difficulty pushing, pulling, and lifting. (AR at 388–89.) 

On July 31, 2013, Dr. Al-Saghir wrote a letter describing Stephens’ various conditions, 

including stage four chronic kidney disease “secondary to chronic membranous 

glomerulonephritis,” labile hypertension that is “difficult to control,” and type two diabetes. He 

concluded, “I feel that Elizabeth Stephens needs to stay off of work and is not able to go back to 

work because of labile hypertension that is difficult to control and fluctuation in her kidney 

function.” (AR at 152.) 

With the foregoing medical evidence in hand, in early August 2013 Prudential decided 

that Stephens had not been disabled under the Plan as of July 1, 2013 and therefore terminated 

her STD benefits. On August 12, before receiving formal notice of this decision, Stephens called 

Prudential to file an application for LTD benefits. (AR at 789.) On August 13, 2013, Prudential 

informed Stephens by letter that it had terminated her STD benefits as of June 30, 2013. (AR at 

820–23.) Later, on January 22, 2014, Kelly Services communicated to Stephens that she was not 

eligible for LTD benefits because her certified disability from November 19, 2012 through June 

30, 2013 did not meet the Plan’s twelve-month elimination period. (AR at 183.) 

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C. 

Stephens would eventually appeal these decisions but continued with medical treatment 

in the meantime. 

On September 5, 2013, Dr. Patel noted that Stephens “had significant problems with 

anxiety disorder . . . with multiple admissions, but now she has settled down.” (AR at 147.) He 

concluded that “[f]rom an aortic aneurysm dissection standpoint, she is fine.” (AR at 147.) 

Three weeks later, Dr. Al-Saghir wrote that Stephens had “[a]cute kidney injury on top of 

[stage four] chronic kidney disease.” (AR at 132.) Still, he stated that her blood pressure was 

“well-controlled now.” (Id.) He also wrote, “[c]ongestive heart failure, compensated.” (Id.) 

On December 10, 2013, Dr. Yang wrote a letter noting that he had last seen Stephens on 

April 16, 2013. (AR at 308.) Even so, he opined on Stephens’ ability to work: “I feel that she is 

stable from a cardiac stand point and would not disable her. I feel that any decision on her 

disability should be made by the physicians currently treating her on a regular basis. The 

important issue is to control her systolic blood pressure and our cardiologist will help her with 

the blood pressure control.” (AR at 308.) 

On January 20, 2014, Dr. Al-Saghir wrote another letter describing Stephens’ medical 

history and current status. (AR at 282.) Dr. Al-Saghir noted that her chronic kidney disease 

“deteriorated” after her November 2012 surgery. (AR at 282.) He also wrote, “She continues to 

report surges of her blood pressure in the evening. Blood pressure control is important to protect 

her kidneys from further deterioration in her renal function. Also, the fact that she has chronic 

kidney disease makes her blood pressure more resistant to treatment.” (AR at 282.) He wrote that 

the stresses of daily life “lead to surges in her hypertension, to the best we can see it, and that 

would make her even sedentary job stressful to the way she describes it.” (AR at 283.) Thus, Dr. 

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Al-Saghir concluded, “It is my feeling, because of the difficulty in controlling Mrs. Stephens’ 

hypertension and the anxiety that she had developed after her thoracic surgery, Mrs. Stephens is 

disabled from performing the material and substantial duties of her regular occupation as a 

Benefits Coordinator for Kelly Services.” (AR at 283.) 

On February 4, 2014, Dr. Robert Brook from the University of Michigan’s Hypertension 

and Vascular Medicine Clinic examined Stephens and found that her hypertension was under 

control. In a letter to Dr. Al-Saghir, Dr. Brook wrote, “In sum, I believe her blood pressure is 

extremely well controlled at this point in time. In the past, I believe that she was paying too 

much attention to inaccurate home blood pressure readings as well as some spurious and 

intermittent and episodic blood pressure elevations.” (AR at 48.) He also noted that based on his 

review of her home blood pressure log, “[h]er average blood pressure now is likely over 

controlled still.” (AR at 50.) He noted that her Type A dissection “is stable” and that “prior poor 

control hypertension reported by patient was spurious.” (AR at 50.) As for physical restrictions, 

he advised Stephens that she could walk for 30 minutes per day at three to three and a half miles 

per hour and should “follow the limitations of the weightlifting as prescribed by the thoracic 

surgeons.” (AR at 52.) Finally, he noted that her kidney disease appeared stable. (AR at 52.) 

D. 

On January 24, 2014, Stephens appealed Prudential’s August 2013 termination of her 

STD benefits. (AR at 164–267.) 

In connection with Stephens’ appeal, Prudential retained an occupational health 

specialist, Dr. Joseph Rea, to review Stephens’ entire medical record. In an April 4, 2014 report, 

Dr. Rea found “insufficient support for any significant physical limitations from July 1, 2013, 

forward.” (AR at 157–163.) He acknowledged that her “central medical issue” was hypertension, 

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which “probably both contributed to and resulted from advance[d] kidney disease” and “likely 

had a role in aortic dissection.” (AR at 160.) But he cited Dr. Brooks’ February 2014 finding that 

Stephens’ hypertension was controlled, if not over controlled. (AR at 160.) Dr. Rea also 

concluded that Stephens’ physicians’ comments that Stephens was “disabled” were “probably 

overconservative in view of the evidence.” (AR at 162.) Dr. Rea also pointed to Dr. Yang’s 

December 2013 letter and the results of a February 4, 2014 echocardiogram as evidence that 

Stephens’ general cardiac health was stable. (AR at 43–44, 160.) 

On April 30, 2014, Prudential denied Stephens’ appeal for STD benefits in a letter that 

borrowed heavily from Dr. Rea’s report, finding “Based on the information available, there 

appeared to be insufficient support for any significant physical limitations from July 1, 2013 

forward.” (AR at 802–05.) In a separate letter, Prudential denied Stephens’ appeal for LTD 

benefits. (AR at 806–809.) 

E. 

Stephens filed suit against Defendants on May 6, 2014. She asserts that Defendants 

terminated her STD benefits and denied her LTD benefits in violation of the Employee 

Retirement Income Security Act of 1974. (Compl. at ¶¶ 6, 34.) Defendants disagree, asserting 

that Prudential’s decision was neither arbitrary nor capricious. (Dkt. 29, Def.’s Mot. for J. at 24.) 

On January 20, 2015, the parties filed summary-judgment motions in support of their positions. 

(Dkt. 29, Def.’s Mot. for J.; Dkt. 26, Pl.’s Mot. for J.) 

II. 

Section 502(a)(1)(B) of ERISA authorizes an individual to bring an action “to recover 

benefits due to [her] under the terms of [her] plan, to enforce [her] rights under the terms of the 

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plan, or to clarify [her] rights to future benefits under the terms of the plan.” 29 U.S.C. 

§ 1132(a)(1)(B). 

A. 

A plan administrator’s decision to deny benefits “is to be reviewed under a de novo

standard unless the benefit plan gives the [plan’s] administrator or fiduciary discretionary 

authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone 

Tire& Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). “When the plan grants the plan 

administrator such discretion, then a court must review the administrator’s denial of benefits 

under the arbitrary-and-capricious standard.” Shaw v. AT & T Umbrella Ben. Plan No. 1, —

 F.3d —, No. 14-2224, 2015 WL 4548232, at *7 (6th Cir. July 29, 2015) (citing Marks v. 

Newcourt Credit Grp., Inc., 342 F.3d 444, 456 (6th Cir.2003)). 

Here, the Plan provided Prudential “full discretion” over the administration and 

interpretation of the Plan, determinations of benefits eligibility, and determinations of the 

statuses and rights of Plan participants. (Dkt. 26, at 31.) Accordingly, the parties agree that the 

arbitrary and capricious standard of review applies. (Dkt. 29, Def.’s Mot. for J. at 13–14; 

Dkt. 26, Pl.’s Mot. for J. at 1–2.) 

B. 

“The arbitrary or capricious standard [of review] is the least demanding form of judicial 

review of administrative action. When it is possible to offer a reasoned explanation, based on the 

evidence, for a particular outcome, that outcome is not arbitrary or capricious.” Davis v. 

Kentucky Fin. Cos. Ret. Plan, 887 F.2d 689, 693 (6th Cir.1989) (internal quotation marks and 

citations omitted). Yet, arbitrary and capricious review “is not . . . without some teeth.” Evans v. 

UnumProvident Corp., 434 F.3d 866, 876 (6th Cir. 2006) (internal quotation marks and citations 

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omitted). Indeed, a district court reviewing a plan administrator’s determination under the 

arbitrary-and-capricious standard does not sit merely to “rubber stamp the administrator’s 

decision.” Jones v. Metro. Life Ins. Co., 385 F.3d 654, 661 (6th Cir. 2004). “The obligation under 

ERISA to review the administrative record in order to determine whether the plan administrator 

acted arbitrarily and capriciously ‘inherently includes some review of the quality and quantity of 

the medical evidence and the opinions on both sides of the issues.’” Evans, 434 F.3d at 876 

(quoting McDonald v. Western–Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003)). 

On review, this Court considers only the evidence before the plan administrator at the 

time the employee’s disability eligibility was determined. Yeager v. Reliance Standard Life Ins. 

Co., 88 F.3d 376, 381 (6th Cir. 1996). 

III. 

 Defendants argue that Prudential’s April 30, 2014 letter, which is the decision under 

review, see McClain v. Eaton Corp. Disability Plan, 740 F.3d 1059, 1066 (6th Cir. 2014), 

“presents a principled reasoning process based on the available information and is supported by 

that information.” (Dkt. 29, Def.’s Mot. for J. at 19.) The Court disagrees. Timing proves fatal to 

any conclusion that Prudential’s April 30, 2014 denial letter was the product of a “deliberate, 

principled reasoning process supported by substantial evidence.” See Helfman v. GE Group Life 

Assur. Co., 573 F.3d 383, 394 (6th Cir. 2009). 

A. 

Though Prudential determined that Stephens was no longer disabled as of the first of July, 

2013, the record—including the views of Stephens’ three treating physicians—demonstrates that 

Stephens was not able to return to work at the very least through the fifteenth of that month. 

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Consider first Dr. Yang’s April 16, 2013 assessment of Stephens. Dr. Yang, Stephens’ 

cardiac surgeon at the University of Michigan Hospital, noted that Stephens was “making very 

good progress on recovering,” but he determined that it was necessary for her to remain off work 

for three more months. (AR at 654.) His reason was that “the stress at her work was very high 

and her blood pressure was consistently high during the work.” (AR at 654.) By December 10, 

2013, months after Prudential denied Stephens’ STD benefits, Dr. Yang changed course, writing, 

“I feel that she is stable from a cardiac stand point and would not disable her.” (AR at 308.) 

Nevertheless, Dr. Yang noted that he had not personally seen Stephens in close to eight months, 

and he expressly deferred any ultimate disability determination to her other physicians: “I feel 

that any decision on her disability should be made by the physicians currently treating her on a 

regular basis.” And at the time of Dr. Yang’s December 10, 2013 letter, the two physicians to 

whom he deferred—Dr. Patel and Dr. Al-Saghir—both held the view that Stephens was disabled. 

Stephens’ cardiologist, Dr. Patel, asserted on June 20, 2013 that Stephens was “probably 

not ready to go to work” and that she “should probably just stay off work and be disabled.” (AR 

at 649.) He cited a host of reasons for Stephens’ disability: “anxiety, the uncontrolled 

hypertension, the residual dissection of the descending thoracic aorta, the repair of the ascending 

aorta in Nov. 2012.” (AR at 649.) True, in his September 2013 letter, Dr. Patel did not opine on 

Stephens’ disability status, and he described her condition as “stable.” (AR at 147.) But there is 

little room to interpret his “stable” remark as indicating that he thought Stephens was able to 

work—he made the very same comment in his June 2013 letter in which he suggested she should 

remain off work indefinitely. (AR at 649.) In other words, Dr. Patel never expressly backpedaled 

from his conclusion that Stephens was disabled. 

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Dr. Al-Saghir also believed that Stephens was disabled at all times relevant to her claim 

for benefits. According to a May 22, 2013 questionnaire that he submitted to Prudential, he 

recommended for her to remain off work at least through mid-July 2013. (AR at 669.) By the end 

of July 2013, Dr. Al-Saghir, opined, “I feel that Elizabeth Stephens needs to stay off of work and 

is not able to go back to work.” (AR at 152.) He cited Stephens’ hypertension “that is difficult to 

control” and “fluctuation in her kidney function.” (AR at 152.) Into early 2014 he still thought 

that Stephens could not return to work, emphasizing Stephens’ hypertension, kidney disease, and 

anxiety. (AR at 282.) 

In sum, all three of Stephens’ treating physicians thought that she should remain off work 

at least through July 15, 2013—two weeks after Prudential terminated Stephens’ benefits. 

B. 

To be sure, Prudential was not required to defer without question to Stephens’ three 

treating physicians. See Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003) 

(“[C]ourts have no warrant to require administrators automatically to accord special weight to 

the opinions of a claimant’s physician.”). However, Prudential was not allowed to “arbitrarily 

disregard” them either. See Evans v. UnumProvident Corp., 434 F.3d 866, 877 (6th Cir. 2006); 

see also Black & Decker, 538 U.S. at 834 (“Plan administrators, of course, may not arbitrarily 

refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.”). 

As evidenced by Prudential’s April 30, 2014 denial letter, Prudential did just that in concluding 

that Stephens was not disabled as of July 1, 2013. 

In its denial letter, Prudential informed Stephens that her “own cardiologist, Dr. Yang, 

opined they did not find [her] to be disabled from a cardiac perspective.” (AR at 804.) But Dr. 

Yang in fact recommended for Stephens to remain disabled “for another three months” starting 

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on April 16, 2013. (AR at 654.) His December 2013 letter eliminates any ambiguity concerning 

when that three month period ended, as he noted that he had previously “extended her disability 

to mid July 2013.” (AR at 308.) 

Prudential’s denial letter also minimized Stephens’ physicians’ disability determinations 

because “later commentary showed Ms. Stephens’s cardiac status was overall stable.” (AR at 

804.) Prudential’s statement reveals its own flaw: the “later commentary” about Stephens’ health 

status was from September 2013, December 2013, January 2014, and February 2014, and did not 

speak to her health status in July 2013. 

Indeed, the denial letter highlights Prudential’s erroneous reliance on post-July 2013 

medical evidence. Prudential claimed that Stephens’ hypertension “of late, seemed to have been 

placed under better control, if not even excessive control” and cited Dr. Brook’s February 4, 

2014 letter in support. (AR at 803.) But Dr. Brook indicated only that Stephens’ hypertension 

was under control “at this point in time,” i.e., as of the writing of his February 4, 2014 letter. (AR 

at 48.) Dr. Brook did not comment on the status of Stephens’ blood pressure as far back as July 

1, 2013. (See id.) Nor did his letter opine on Stephens’ overall disability status. (See id.) 

Similarly, Prudential’s letter asserts that Stephens’ kidney disease was “managed 

supportively through medication and nutritional supplementation.” (AR at 804.) Yet, Prudential 

failed to acknowledge that Stephens’ kidney disease—though stable by the time of the April 

2014 letter—had become unstable immediately prior to the termination of her benefits. Indeed, 

Dr. Al-Saghir diagnosed Stephens with stage four kidney disease in late June 2013 and 

concluded in July 2013 that she was disabled as a result of that and other issues. (AR at 152, 244, 

246.) 

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Prudential’s letter also placed undue reliance on Dr. Rea’s April 4, 2014 file review of 

Stephens’ records. 

First, though nothing is “inherently improper with relying on a file review,” the Sixth 

Circuit has held that “the failure to conduct a physical examination—especially where the right 

to do so is specifically reserved in the plan—may, in some cases, raise questions about the 

thoroughness and accuracy of the benefits determination.” Calvert v. Firstar Fin., Inc., 409 F.3d 

286, 295, 297 n. 6 (6th Cir. 2005). Here, the Plan gave Prudential the right to “schedule an 

independent medical exam” at any time during its review of Stephens’ claim. (Dkt. 26, at 16.) 

The Plan also provided that if Prudential and a treating physician “cannot agree on a length of 

disability, there may be an independent medical examination arranged.” (Dkt. 26, at 16.) 

Prudential scheduled no such examination. 

Second, Dr. Rea’s findings themselves are questionable. He reached the conclusion that 

“there appeared to be insufficient support for any significant physical limitations from July 1, 

2013 forward” by erroneously calling into question the credibility of Stephens’ treating 

physicians. In particular, Dr. Rea claimed, “There has been comment that Ms. Stephens is 

‘disabled’ from working. However, this stance is probably overconservative in view of the 

medical evidence.” (AR at 162.) As discussed, this opinion, insofar as it applies to Stephens’ 

condition in July 2013, is simply not supported by the record. Dr. Rea also implicitly challenged 

Stephens’ credibility, citing Dr. Brook’s statement that “[t]he report of poor control of 

hypertension as seen by Ms. Stephens was judged to be ‘spurious,’ given measurements at the 

clinic screening visit were actually low.” (AR at 160.) Dr. Rea’s “credibility determinations 

made without the benefit of a physical examination support a conclusion that the decision was 

arbitrary.” See Helfman, 573 F.3d at 395–96. 

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Third, because much of Prudential’s April 30, 2014 denial letter appears to have been 

copied directly from Dr. Rea’s report, it is no surprise that the letter and report share the same 

overarching flaw: Dr. Rea arbitrarily used medical evidence from well after July 1, 2013 in an 

attempt to establish that Stephens was no longer disabled as of July 1, 2013. In text that 

ultimately appeared verbatim in Prudential’s denial letter, Dr. Rea cited Dr. Yang’s December 

2013 letter to conclude that Stephens’ overall cardiac health was stable; Dr. Rea cited Dr. 

Brook’s February 2014 letter to conclude that her hypertension was under control; and Dr. Rea 

cited a February 2014 Echocardiogram, noting that Stephens’ “[h]eart function was overall 

normal.” (AR at 160, 803.) None of this evidence from late 2013 and early 2014 supported the 

overall findings of Prudential and Dr. Rea that “there appears to be insufficient support for any 

significant physical limitations from July 1, 2013 forward.” (AR at 160, 803.) 

Thus, the reasons Prudential provided in its April 30, 2014 letter terminating Stephens’ 

benefits as of July 1, 2013 simply do not support rejecting the consistent opinions of three 

treating sources that Stephens was disabled past that date. 

C. 

Defendants now attempt to shore up Prudential’s decision by criticizing Stephens’ 

treating physicians’ references to anxiety and stress, asserting, “The lack of the required 

diagnosis by a treating physician who specializes in psychological disorders precludes any 

reliance on Stephens’ claimed anxiety to support her claim of disability.” (Dkt. 31, Def.’s Resp. 

to Pl.’s Mot. for J. at 4.) The Court is not persuaded by Defendants’ post-hoc rationale. 

The Sixth Circuit has acknowledged that “stress may be a factor in individuals with heart 

conditions that may prevent them from working.” Helfman, 573 F.3d at 395. In Helfman, the 

Court held that a plan administrator’s failure to consider plaintiff’s stress weighed in favor of an 

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arbitrary and capricious finding because nothing in the plan “precluded ‘prophylactic’ 

restrictions and limitations on [plaintiff’s] ability to work from consideration.” Id.; see also 

Glenn v. Metro. Life Ins. Co., 461 F.3d 660, 673 (6th Cir. 2006) (holding that it was 

“unreasonable for Metlife to have dismissed stress as an improperly documented, subjective, and 

irrelevant factor in its disability determination”). 

As the Defendants point out, the Plan here provides, “If you are on disability due to a 

mental/nervous diagnosis, the Disability Plan requires you to have a treating physician who 

specializes in psychological disorders.” (Dkt. 26, at 16.) However, this does not render Stephens’ 

reported anxiety and stress totally irrelevant to her claim. Similar to the plan in Helfman, nothing 

in the Plan here appears to prohibit consideration of prophylactic restrictions and limitations in 

determining whether a Plan participant is disabled. Additionally, the record makes clear that each 

of Stephens’ three treating physicians cited anxiety as only one of several factors preventing her 

from working. For instance, Dr. Al-Saghir’s January 20, 2014 letter references Stephens’ anxiety 

as a contributor to her hypertension, which in turn influences (and is influenced by) her kidney 

disease. (AR at 283.) 

Defendants rely on Hogan v. Life Ins. Co. of North America, 521 F. App’x. 410 (6th Cir. 

2013), to discount Stephens’ treating physicians’ references to her anxiety and stress. In Hogan, 

the Court held that the plan administrator did not arbitrarily or capriciously deny Hogan’s 

benefits claim that was based heavily on mental health issues undiagnosed by a specialist. Id. at 

412. But Hogan’s claim was primarily based on her mental health issues, unlike Stephens’, 

which is primarily based on physical symptoms. See id. at 412. And, in contrast to the substantial 

record here, the evidence that Hogan submitted to the plan administrator consisted of “three brief 

visit notes from Hogan’s treating physician—an internist lacking any sort of mental-health 

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specialization.” See id. at 416. The Court thus does not find Hogan persuasive on the facts of this 

case. 

Accordingly, references to Stephens’ anxiety and stress do not undermine the other 

findings and conclusions of her treating physicians. 

* * * 

In sum, the Court finds that Prudential’s final decision was not the result of a “deliberate, 

principled reasoning process supported by substantial evidence.” See Helfman, 573 F.3d at 394. 

It was arbitrary and capricious for Prudential to find that Stephens was no longer disabled as of 

July 1, 2013 on the basis of evidence that had little, if any, relevance to that time. 

IV. 

Remaining is the issue of the proper remedy: remand for further fact finding or award 

benefits. On this question the Court agrees with Defendants: Stephens is not necessarily entitled 

to a benefits award. 

A court has “two options” after finding that a plan denied benefits arbitrarily and 

capriciously: “award benefits to the claimant or remand to the plan administrator.” Shaw v. AT & 

T Umbrella Ben. Plan No. 1, — F.3d —, No. 14-2224, 2015 WL 4548232, at *11 (6th Cir. July 

29, 2015). “[W]here the problem is with the integrity of the plan’s decision-making process, 

rather than that a claimant was denied benefits to which he was clearly entitled, the appropriate 

remedy generally is remand to the plan administrator.” Id. (quoting Elliott v. Metro. Life Ins. Co., 

473 F.3d 613, 622 (6th Cir. 2006)). Compare Elliott, 473 F.3d at 622 (holding remand was 

appropriate where it was not “clear[]” that plaintiff was entitled to benefits), with Shelby Cnty. 

Health Care Corp. v. Majestic Star Casino, 581 F.3d 355, 373 (6th Cir. 2009) (“[W]here ‘there 

[was] no evidence in the record to support a termination or denial of benefits,’ an award of 

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benefits is appropriate without remand to the plan administrator.”). Still, “plan administrators 

should not be given two bites at the proverbial apple where the claimant is clearly entitled to 

disability benefits. They need to properly and fairly evaluate the claim the first time around; 

otherwise they take the risk of not getting a second chance, except in cases where the adequacy 

of claimant's proof is reasonably debatable.” Hayden v. Martin Marietta Materials, Inc. Flexible 

Benefits Program, 763 F.3d 598, 609 (6th Cir. 2014). 

On balance, the record is insufficient to establish that Stephens was “clearly entitled” to 

benefits for the entire period from July 1, 2013—when Prudential initially terminated her 

benefits—through Prudential’s April 30, 2014 denial of her appeal. As discussed, Stephens’ 

three treating physicians agreed that she was disabled at least through July 15, 2013. But after 

July 15, 2013, the record includes fewer examinations, and Stephens’ disability status is murkier. 

For instance, Dr. Yang did not treat Stephens after April 16, 2013, when he extended her 

disability for three additional months. Dr. Patel last expressly opined on Stephens’ disability 

status in June 2013. Granted, Dr. Al-Saghir made clear that throughout the entire relevant time 

he believed Stephens was disabled, but he hinged much of his final January 2014 determination 

on Stephens’ hypertension. (AR at 282–83.) And just two weeks later, Dr. Brook found that 

Stephens’ hypertension was well controlled and perhaps over-controlled. (AR at 48, 50.) 

Thus, the record contains evidence that at some point prior to Prudential’s April 30, 2014 

denial letter, but after July 15, 2013, she may have been able to return to work. Where, as here, 

no dividing line is apparent from the record, it is for the plan administrator to draw it in the first 

instance. See, e.g., Elliott, 473 at 622–23 (remanding because “[w]e are not medical specialists 

and that judgment is not ours to make”). 

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Accordingly, the Court will remand the matter to Prudential to provide a “full and fair 

review.” See Helfman v. GE Group Life Assur. Co., 573 F.3d at 396.1

 

V. 

For the reasons stated, the Court finds that Prudential’s April 30, 2014 denial of 

Stephens’ benefits as of July 1, 2013 was arbitrary and capricious. Accordingly, the Court 

GRANTS IN PART Plaintiff’s Motion for Judgment on the Administrative Record and DENIES 

Defendants’ Motion for Judgment Affirming the Denial of Plaintiff’s Request for Benefits. 

The Court also REMANDS the case to the plan administrator for a full and fair review to 

determine Plaintiff’s claim for benefits. 

IT IS SO ORDERED. 

s/Laurie J. Michelson 

LAURIE J. MICHELSON 

UNITED STATES DISTRICT JUDGE 

 Dated: August 18, 2015 

CERTIFICATE OF SERVICE 

The undersigned certifies that a copy of the foregoing document was served on the attorneys 

and/or parties of record by electronic means or U.S. Mail on August 18, 2015. 

 s/Jane Johnson 

Case Manager to 

 Honorable Laurie J. Michelson 

 

1

 This ruling applies equally to Prudential’s denial of STD and LTD benefits. The record 

does not appear to contain any specifics on the LTD policy, other than Prudential’s statement in 

its April 30, 2014 LTD denial letter that the elimination period is 365 days, which Kelly Services 

also noted in its January 22, 2014 letter. (AR at 183, 806.) Assuming that is correct, because 

Stephens was originally disabled as of her November 19, 2012 surgery, it is conceivable that 

based on the medical evidence and opinions contained in the records of Drs. Yang, Patel, and AlSaghir, that Stephens was still disabled as of November 19, 2013, after the elimination period 

ended, making Stephens possibly eligible for LTD benefits for at least some period of time. 

Again, the exact timing is for Prudential to determine in a full and fair review on remand. 

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