1 

UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF MICHIGAN 

SOUTHERN DIVISION 

JAMES ABBOTT, 

Case No. 14-cv-11778 

Plaintiff, Hon. Matthew F. Leitman 

v. 

FORD MOTOR COMPANY 

SALARIED DISABILITY PLAN, 

Defendant. 

_________________________________________________________________/ 

OPINION AND ORDER GRANTING DEFENDANT’S MOTION TO 

AFFIRM ADMINISTRATIVE DECISION (ECF #23) AND 

DENYING PLAINTIFF’S MOTION TO DENY 

ADMINISTRATIVE DECISION (ECF #25) 

 Plaintiff James Abbott (“Abbott”) worked as an automobile analyst for Ford 

Motor Company (“Ford”). While employed at Ford, Abbott participated in the 

Ford Motor Company Salaried Disability Plan (the “Plan”). After experiencing 

symptoms of depression, Abbott applied for and was granted disability benefits 

under the Plan. For the reasons described below, the Plan later reduced the amount 

of Abbott’s disability benefits. Abbott subsequently filed an administrative appeal 

challenging the reduction of his disability benefits. The entity designated by the 

Plan to review such appeals – the Salaried Disability Appeals Committee (the 

“Appeals Committee”) – affirmed the reduction. 

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 Abbott then filed this action in which he challenges the reduction of his 

disability benefits. (See ECF #1.) The parties have now filed cross-motions for 

judgment on the administrative record. Abbott asks the Court to “deny” the 

administrative decision that affirmed the reduction of his benefits (“Abbott’s 

Motion”) (see ECF #25); the Plan asks the Court to “affirm” that decision (“the 

Plan’s Motion”) (see ECF #23). The Court GRANTS the Plan’s Motion and 

DENIES Abbott’s Motion. 

FACTUAL BACKGROUND AND PROCEDURAL HISTORY 

A. Ford Makes Disability Benefits Available to Eligible Employees 

 Ford is an automobile manufacturer. It offers disability benefits to eligible 

employees through the Plan. (See the Plan, ECF #22-2 at 3-26, Pg. ID 68-91.) 

 Certain factors affect the amount of disability benefits a Plan participant is 

eligible to receive. For example, if a participant is eligible to receive income or 

benefits from other specified “income sources,” the amount of the participant’s 

disability benefits may be reduced. (The Plan at § 5.05, ECF #22-2 at 16, Pg. ID 

81.) These “income sources” include Social Security benefits and retirement 

benefits that a participant is eligible to receive. (Id. at § 5.05(iii), ECF #22-2 at 16, 

Pg. ID 81.) Thus, if a Plan participant is entitled to receive retirement benefits or 

Social Security benefits, his disability benefits may be reduced by the amount of 

those other benefits that he is eligible to receive. (See id.) 

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 The Plan further explains how a participant’s possible eligibility for 

retirement benefits affects the calculation of the amount of disability benefits he 

receives. (See id. at § 3(viii), ECF #22-2 at 10, Pg. ID 75.) Specifically, 

participants are told that starting on the “first day of the thirteenth month of 

Disability,” the Plan will “presume” that a participant is entitled to receive 

retirement benefits. (Id.) At that time, the Plan may reduce a participant’s 

disability benefits by the amount of retirement benefits the participant is presumed 

eligible to receive. A participant can overcome this presumption – and thus avoid 

a reduction of his disability benefits – only if the participant “provides proof that 

an application for [retirement] benefits was made and denied.” (Id.) Thus, unless a 

participant applies for, and is denied, retirement benefits, the Plan will reduce the 

participant’s disability benefits payments by the amount of retirement benefits that 

the participant is presumptively entitled to receive. 

B. Abbott Applies For and Receives Disability Benefits, and the Plan 

Instructs Abbott to Apply for Social Security and Retirement Benefits 

 Abbott began working for Ford in 1977. (See ECF #22-5 at 82, Pg. ID 374.) 

While employed by Ford, Abbott was a participant in the Plan. 

 On November 8, 2004, Abbott applied for disability benefits under the Plan. 

(See ECF #22-5 at 82, Pg. ID 374.) UniCare, the Plan’s claims processor, denied 

Abbott’s application on January 5, 2005. (See ECF #22-7 at 56, Pg. ID 478.) 

Abbott appealed the denial to the Appeals Committee. 

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On February 7, 2006, Suzanne De Haan (“De Haan”), on behalf of the 

Appeals Committee, sent a letter to Abbott’s then counsel (with a copy to Abbott) 

concerning the results of Abbott’s appeal. (See ECF #22-5 at 73-74, Pg. ID 365-

66.) De Haan first informed Abbott’s counsel that the Appeals Committee had 

overturned UniCare’s previous decision denying Abbott disability benefits. (See id.

at 73, Pg. ID 365.) De Haan then told Abbott’s counsel that in order to avoid a 

reduction in Abbott’s benefits, Abbott needed to provide UniCare with proof that 

he applied for and was denied (1) Social Security benefits and (2) retirement 

benefits. (See id. at 73-74, Pg. ID 365-66.) De Haan explained that if Abbott did 

not supply such proof to UniCare, then as of March 1, 2006, the Plan would 

presume that Abbott was eligible to receive both Social Security and retirement 

benefits, and it would reduce his disability benefits by the presumed amounts of 

those other benefits. (See id.) 

D. Abbott Applies for Social Security Benefits and Retirement Benefits, 

 But He Withdraws His Application for Retirement Benefits 

In response to De Haan’s letter, Abbott applied for retirement benefits from 

Ford on February 28, 2006. (See id. at 58, Pg. ID 350.) At or around this same 

time, Abbott also applied for Social Security benefits. (See id. at 29-34, Pg. ID 

321-26.) While Abbott successfully completed the process for obtaining Social 

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Security benefits1

 (see id.), he withdrew his application for retirement benefits 

before Ford could make a decision with respect to what amount of retirement 

benefits, if any, Abbott was entitled to receive. (See id. at 57, Pg. ID 349; see also 

ECF #22-4 at 62, Pg. ID 287.) 

E. The Plan Reduces Abbott’s Disability Benefits Based on His Presumed 

Retirement Benefits, and Abbott Files an Administrative Appeal 

Challenging That Reduction 

 

 Abbott never provided UniCare with proof that he applied for and was 

denied retirement benefits. (Abbott could not provide such proof because, as noted 

above, he had withdrawn his application for retirement benefits.) As a result, 

starting on March 1, 2006, UniCare presumed that Abbott was eligible to receive 

$1,379.54 per month in retirement benefits, and it reduced Abbott’s monthly 

disability payment by that amount. (See ECF #22-7 at 56, Pg. ID 478; see also 

ECF #22-6 at 2-11, Pg. ID 376-85.) 

 On January 4, 2011, Abbott filed a “first-level appeal” under the Plan 

challenging the reduction of his disability benefits. (See ECF #22-2 at 28, Pg. ID 

93.) UniCare denied that appeal on January 6, 2011. (See id. at 29, Pg. ID 94.) 

                                                            

1

 After Abbott applied for Social Security benefits, he requested a hearing on his 

application before an Administrative Law Judge. (See ECF #22-5 at 32, Pg. ID 

324.) On November 19, 2008, the assigned Administrative Law Judge concluded 

that Abbott was disabled and was entitled to Social Security benefits. (See id.) The 

Plan then offset the amount of Social Security benefits Abbott began receiving 

($1,939.00) against the amount of his disability benefits. (See ECF #22-7 at 56, Pg. 

ID 478.) Abbott has not challenged that reduction of his disability benefits. 

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UniCare explained that Abbott’s disability benefits were properly reduced because, 

pursuant to Section 3(viii) of the Plan, (1) it was presumed that Abbott was eligible 

for retirement benefits and (2) Abbott’s disability benefits were decreased by the 

amount of retirement benefits Abbott was entitled to receive. (See id.) Unicare 

further told Abbott that he could file a “second level appeal” with the Appeals 

Committee. (See id.) Abbott declined to do so.2

 On May 2, 2014, Abbott filed this action against the Plan and UniCare 

challenging the reduction of his disability benefits.3

 (See Compl., ECF #1.) In June 

2015, the parties jointly moved to stay this action so that Abbott could pursue a 

“second-level appeal” with the Appeals Committee. (See ECF #18.) The Court 

entered a stay on June 12, 2015. (See ECF #19.) 

 Abbott filed his “second-level appeal” on July 16, 2015. (See ECF #22-5 at 

3-7, Pg. ID 295-99.) In that appeal, Abbott argued that UniCare should not have 

reduced his disability benefits based upon his failure to apply for retirement 

benefits. (Id. at 7, Pg. ID 299.). Abbott told the Committee that he “did not apply 

for his [retirement benefits]...because he lacked decision making skills.” (Id. at 6, 

Pg. ID 298.) Abbott said that due to his depression, he had “been in a mental fog,” 

                                                            

2

 While Abbott did not file a “second-level appeal” at that time, he did file a 

second “first-level appeal” on July 18, 2013, raising the same issues he did in his 

January 4, 2011, appeal. (See ECF #22-3 at 56, Pg. ID 201.) UniCare responded 

that it had previously “addressed” the basis for his appeal (i.e., by rejecting the 

same claim in 2011.) (See id. at 58, Pg. ID 203.) 

3

 The Court has since dismissed Abbott’s claims against UniCare. (See ECF #14.) 

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was “incapable of understanding the terms of the Plan,” and thus was “incapable of 

applying for his [retirement benefits] in a timely fashion.” (Id.) He asked the 

Appeals Committee to excuse his failure to apply for retirement benefits and to 

reinstate the full amount of his disability benefits. (Id. at 7, Pg. ID 299.) 

 The Appeals Committee denied Abbott’s “second-level appeal” on 

September 1, 2015. (See ECF #22-7 at 56-58, Pg. ID 478-80.) The Appeals 

Committee noted that Abbott did, in fact, “submit[] a retirement application” but 

that he later “withdrew his application” before a decision could be reached on the 

application. (Id. at 60-62, Pg. ID 482-84.) Thus, the Appeals Committee 

concluded that Abbott was not entitled to a restoration of the full amount of his 

disability benefits based on his argument that he was unable to apply for retirement 

benefits. (Id.) 

 Following the denial of Abbott’s “second-level appeal,” the parties returned 

to this Court. Abbott asks the Court to reverse the reduction of his benefits. (See 

Abbot’s Motion, ECF #25.) The Plan requests that the Court affirm the reduction. 

(See the Plan’s Motion, ECF #23.) Pursuant to Local Rule 7.1(f)(2), the Court 

concludes that oral argument is not necessary and would not aid its decision on the 

motions. 

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GOVERNING LEGAL STANDARD 

 Section 502(a)(1)(B) of the Employee Retirement Income Security Act of 

1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), authorizes an individual to bring a 

civil action “to recover benefits due to him under the terms of [his] plan, to enforce 

[his] rights under the terms of the plan, or to clarify [his] rights to future benefits 

under the terms of the plan.” Where, as here, a plan administrator has discretionary 

authority to determine eligibility for benefits or to construe the terms of a plan (see 

the Plan at §§ 7-8, ECF #22-2 at 20-21, Pg. ID 85-86), the Court reviews the 

administrator’s action under the “arbitrary and capricious” standard of review.4

 

Shelby Cty. Health Care Corp. v. S. Council of Indus. Workers Health & Welfare 

Trust Fund, 203 F.3d 926, 933 (6th Cir. 2000) (quoting Firestone Tire & Rubber 

Co. v. Bruch, 489 U.S. 101, 115 (1989)). 

 “The arbitrary or capricious standard 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). At the same time, 

a district court reviewing a plan administrator’s determination under the arbitrary-

                                                            

4

 Both parties concur that the “arbitrary and capricious” standard governs the 

Court’s review in this case. (See the Plan’s Mot. at 10-12, Pg. ID 500-02; Abbott’s 

Mot. at 5, Pg. ID 514.) 

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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). Abbott 

has the burden of demonstrating that the administrator acted arbitrarily or with 

caprice. See Senzarin v. Abbott Severance Pay Plan for Emp. of KOS Pharm., 361 

Fed. App’x 636 (6th Cir. 2010) (citing Rochow v. Life Ins. Co. of North Am., 482 

F.3d 860, 865 (6th Cir. 2007)). 

ANALYSIS 

The decision by the Appeals Committee was neither arbitrary nor capricious. 

It was a straightforward and reasonable application of the plain language of the 

Plan. See Kennedy v. Plan Adm’r for DuPont Sav. & Inv. Plan, 555 U.S. 285, 300 

(2009) (Under applicable provisions of ERISA, “the terms of the Plan” control 

whether participant is entitled to benefits (quoting 29 U.S.C. § 1132(a)(1)(B))). 

The Plan provides that (1) disability benefits may be reduced by the amount 

of retirement benefits a participant is eligible to receive, and (2) it is presumed that 

a participant is eligible to receive retirement benefits unless he proves otherwise by 

applying for, and being denied, such benefits. It is undisputed that Abbott did not 

present to the Appeals Committee proof that he had applied for, and been denied, 

retirement benefits. Thus, the Appeals Committee had every right under the Plan 

to uphold (1) the presumption that Abbott was eligible for retirement benefits, and 

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(2) the reduction to Abbott’s disability benefits by the amount of retirement 

benefits to which he was presumptively entitled. 

 Abbott resists this conclusion. He argues that the Appeals Committee 

should have excused his withdrawal of his application for retirement benefits 

because he was suffering from a serious mental illness at the time of the 

withdrawal. (See Abbott’s Mot. at 6, Pg. ID 515.) In support of this argument, 

Abbott relies upon cases in which courts have excused late disability filings or 

tolled statutes of limitations on the basis that the claimant suffered from a mental 

illness. (See id.) Abbott’s argument fails for two reasons. 

 First, Abbott never asked the Appeals Committee to excuse the withdrawal

of his application for retirement benefits on the basis that he suffered from a 

mental illness. Instead, Abbott asked the Appeals Committee excuse his failure to 

apply for retirement benefits in the first place. (See ECF #22-5 at 6-7, Pg. ID 298-

99.) Since Abbott never asked the Appeals Committee to excuse his withdrawal 

of his application for retirement benefits, he cannot now claim that the Appeals 

Committee erred when it failed to grant him relief on that basis. 

 Moreover, the Appeals Committee properly rejected the argument that 

Abbott did present in his appeal – i.e., that his failure to apply for retirement 

benefits in the first instance should be excused. As the Appeals Committee 

properly noted, Abbott unquestionably did apply for retirement benefits, and then 

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withdrew his application less than two weeks later. (See ECF #22-5 at 57-58, Pg. 

ID 349-50.) Thus, the Appeals Committee correctly concluded that Abbott’s claim 

for relief rested on a faulty premise. 

 Second, the case law that Abbott relies upon is inapposite. Each of the cases 

Abbott has cited – Chapman v. ChoiceCare Long Island Term Disability Plan, 288 

F.3d 506 (2d Cir. 2002), Smith-Haynie v. Dist. of Columbia, 155 F.3d 575 (D.C. 

Cir. 1998), and Stoll v. Runyon, 165 F.3d 1238 (9th Cir. 1999) – addressed whether 

a plaintiff’s failure to take an affirmative action by a specified deadline should be 

excused due to a mental illness. Here, in sharp contrast, Abbott, while represented 

by counsel, did timely file his application for retirement benefits. But he later 

withdrew his application. Moreover, during the same timeframe that Abbott 

withdrew his application for retirement benefits, he was able to apply for Social 

Security benefits, request a hearing on that application before an Administrative 

Law Judge, and appear at that hearing. The cases Abbott cites simply do not 

address the circumstances that exist here. 

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CONCLUSION 

 For the reasons stated above, the Appeals Committee did not act arbitrarily 

or capriciously when it affirmed the reduction of Abbott’s disability benefits. 

Accordingly, IT IS HEREBY ORDERED that the Plan’s Motion (ECF #23) is 

GRANTED, and Abbott’s Motion (ECF #25) is DENIED. 

       s/Matthew F. Leitman 

 MATTHEW F. LEITMAN 

 UNITED STATES DISTRICT JUDGE 

Dated: March 22, 2016 

I hereby certify that a copy of the foregoing document was served upon the parties 

and/or counsel of record on March 22, 2016, by electronic means and/or ordinary 

mail. 

 s/Holly A. Monda 

 Case Manager 

 (313) 234-5113

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