1 RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit I.O.P. 32.1(b) File Name: 14a0191p.06 

### UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

_________________

G AYLON H AYDEN , Plaintiff-Appellant ,

v

.

M ARTIN M ARIETTA M ATERIALS , I NC

. F LEXIBLE B ENEFITS P ROGRAM , Defendant-Appellee

. ┐ │ │ │ │ │ │ │ │ ┘ No. 13-6319

Appeal from the United St ates District Court for the Western District of Kentucky at Paducah. No. 5:11-cv-00116—Thomas B. Ru ssell, District Judge. Decided and Filed: August 18, 2014
Before: GILMAN, GIBBONS, an d STRANCH, Circuit Judges.

_________________ COUNSEL

ON BRIEF: Geordi Garatt, Paducah, Kentucky, for A ppellant. Robert L. Steinmetz, Rebecca A. Wood, GWIN STEINMETZ & BAIRD, PLLC, Louisville, Kentucky, for Appellee.
GIBBONS, J., delivered the opi nion of the court, in wh ich GILMAN, J., joined, and STRANCH, J., joined in part. STRANCH, J. (pp. 15–17), delivered a separate opinion concurring in part a nd dissenting in part.

_________________ OPINION

_________________
JULIA SMITH GIBBONS, Circui t Judge. Gaylon Hayden, a participant in Martin Marietta Materials, Inc.’s long-term disability plan (“the Plan”), appeals from two adverse judgments in her suit for long-term disability benefits under the Employee Retirement Income 

### >No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 2

Security Act (“ERISA”), 29 U.S.C. § 1001 et seq

. In the district court’s first order, it affirmed the plan administrator’s denial of benefits on Hayden’s physical-disabi lity claim but remanded her mental-disability claim because the plan admi nistrator failed to consider medical evidence from three doctors. On remand, the plan admini strator again rejected Hayden’s claim, and the
district court affirmed. For the reasons set fo rth below, we affirm with respect to Hayden’s physical-disability claim but reverse with respect to her mental-disability claim. We further
instruct the district court to aw ard Hayden mental-health benefits consistent with the terms of the
Plan.

I.
Hayden was employed as an office manager at Martin Marietta beginning in 1997. She was covered by Martin Marietta’s long-term disabi lity plan, which was insured and administered by Liberty Life Assurance Company of Boston (“Li berty”). She stopped working as an office manager on January 4, 2010, and applied for benefits under the Plan the next day.

A.
Martin Marietta employees who provide proof that they are disabled due to injury or sickness are entitled to monthly disability payments under the Plan. The Plan defines “disability” and “disabled”:
1. For persons other than pilots, co-p ilots, and crewmembers of an aircraft: i. if the Covered Person is eligible for the 24 Month Own Occupation benefit, “Disability” or “Disabled” means that during the Elimination Period and the next 24 months of Di sability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and ii. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Subs tantial Duties of Any Occupation.
In turn, the Plan defines “Any Occupation,” “Own Occupation,” and “Elimination Period”:
“Any Occupation” means any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 3

“Own Occupation” means the Covered Person’s occupation that he was performing when his Disability or Partial Disability began. For the purposes of determining Disability unde r this policy, Liberty wi ll consider the Covered Person’s occupation as it is normally performed in the national economy. “Elimination Period” means a period of consecutive da ys of Disability or Partial Disability for which no benefit is payabl e. The Elimination Period is shown in the Schedule of Benefits and begins on the first day of Disability.
Employees disabled by mental illness are en titled to recover “a combined period of 24 months of Monthly Benefit payments while the Covered person is insured.”

“Mental Illness” means a psychiatric or psychol ogical condition classified as such in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) regardless of the underlying cause of the Mental Illness. If the DSM is discontinued, Liberty will use the replacement chosen or published by the American Psychiatric Association.
An employee is thus entitled to benefits for a period of 24 m onths if she cannot perform the duties of her own occupation from the first day of claimed disability through the next 180 days (the Elimination Period) and subseq uent 24 months, and, thereafter is entitled to benefits if the employee cannot perform the material an d substantial duties of any occupation. Hayden claims
that she was disabled within th e meaning of the Plan by virt ue of both physical and mental
ailments.

B.
Hayden suffers from a litany of physical ailments, including, among others: chronic hepatitis C; pancreatitis; fibroc ystic breast disease with breast implants; degenerative arthritis; breast carcinoma; hypothyroidism; hypoten sion; hypertension; and crepitation 1 and decreased range of motion around her shoulders, cervical spine, hips, and knees.
Dr. Joseph Bassi is Hayden’s primary trea ting physician. As early as 2003, Dr. Bassi suggested that Hayden consider applying for disabil ity benefits. In his notes from April of that year, he wrote: “I spoke with the patient regardin g her overall situation. Sh e is slowly declining, has lost weight . . . . I think it is time Gaylon consider total perman ent disability.” On January 6,

1 Crepitation in one’s joints is characterized by gratin g or popping sounds and sensations that occur when the joint is moved.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 4

2010, two days after Hayden left Martin Marietta , Dr. Bassi noted: “Her symptoms have been going on for an extended period of time[], months; mild to modera te severity, now more severe in the context of advancing generalized medical illness.” Hayden continued to visit Dr. Bassi during the Elimination Period. By Septembe r 2010, Dr. Bassi had become concerned that Hayden suffered from syncope 2 or presyncope, and in November 2010, Hayden was hospitalized for presyncope. She was eventually sent to Vanderbilt Universi ty Medical Center, where a QSWEAT showed abnormal results as to whether Hayden suffered from syncope.
In January 2011, Dr. Bassi gave a sworn stat ement in connection w ith Hayden’s claim for Social Security disability benefits. Dr. Bassi explained that by the time of his consultation in January 2010, “the multiple symptoms from her comorbities 3 had gotten to a point where . . . she just couldn’t continue any further.” Dr. Bassi also explained that Hayden suffered from serious dysfunction of her autonomic nervous system a nd that while she was on a medication called Midodrine, the FDA had discontinued the drug and there was no replacement. Without the Midodrine, Dr. Bassi opined that Hayden would be prevented from performing even basic functions such as standing for m oderate periods of time. Hayden was eventually awarded Social Security disability benefits.
Dr. Kest also saw Hayden from June 2008 through 2010. In December 2009, he noted
that her left vocal cord showed signs of paralysis but believed that her right vocal cord was compensating for the problem. In Septembe r 2010, he found an edema of the laryngeal structures which affected her ability to speak.

C.
Hayden submitted evidence from four doctors detailing her serious psychiatric conditions. She saw Dr. Ronald Kelley from December 2006 to February 2007. Dr. Kelley diagnosed her with general a nxiety disorder, major depressi on, and insomnia. Thereafter, Hayden’s oncologist referred her to Dr. Roger Lyons for treatme nt of extreme anxiety with consequential depression. She saw Dr. Lyons throughout 2008. Dr. Lyons observed that her

2 Syncope, generally speaking, is fainting.

3 Comorbidity refers to the simultaneous presence of multiple, independent conditions.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 5

“thought content was dysphoric and fear-based (a ppears to be a manic defense),” that her psychomotor skills “appeared leaden su ggesting malaise,” that she had “annoying preoccupations with fears that produce ritualistic/prophylactic beha viors,” and that her emotional tone was dulled and numb. Hayden did not con tinue treatment with Dr. Lyons because her insurance company erroneously advised her that she would not be covered.
In his January 6, 2010, consultation with Hayde n, Dr. Bassi noted that Hayden suffered from anxiety with depression that had become wors e with her deteriorating health. He stated that she suffered from “disability, weakness, and inability to care about he r day to day life” and that she had significant weight lo ss because she was “just not eati ng.” Dr. Bassi explained that she had previously “forced herself to work, but now she just can’t continue on.” In February, he
observed in connection with hi s diagnosis of anxiety and de pression that “[h]er life is overwhelmed by symptoms at this time” and that “[ i]t is obvious this patien t is no longer able to function effectively with ongoing sy mptoms.” Dr. Bassi’s notes fr om July 2010 recount that she was “totally disabled, if nothing else, from her nerv es, dealing with multiple issues at this time.” In his sworn statement in connection with Hayden’ s claim for Social Security disability benefits, Dr. Bassi explained that by January 6, 2010, “she was basically overwhelmed with her day-today life chores, activity of daily living, stresses and just pl ain physical work she was doing” and that she was at “a point where she just coul dn’t function from her psychiatric issues.”
Dr. Thomas Muehleman examined Hayden on March 25, 2010 in connection with her claim for Social Security disability benefits. Dr. Muehleman concluded that she was moderately impaired in her “ability to unders tand, retain, or follow instructi ons; probably markedly impaired in ability to sustain attention to perform simple, repetitive tasks, or relate to others and [co]- worker[s] and supervisors at this time; and marked ly impaired in ability to tolerate stress and pressures associated with day-to-day work activ ities.” Hayden was treated by Dr. David Meyer in September and November 2010. Although af ter the Elimination Period, Dr. Meyer also diagnosed her with recurrent major depression a nd severe anxiety. Dr. Meyer, like Dr. Bassi, concluded that, given Hayden’s mental state, she was barely able to perform the basic activities of daily living and could not do “m uch beyond her basic self-care.”No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 6

D.
Hayden’s Elimination Period ran from January 4 to July 4, 2010. On July 22, 2010, Liberty conducted an initial fi le review of the records that Hayden’s treating physicians provided. Liberty’s initial conclusion was that while Hayden had “multiple medical problems . . . [,] none of them seem[s] to be significantly imp airing at this time.” Liberty assigned the file to Dr. David Peterson for peer-to-peer cont act with Dr. Bassi and overall clarification. 4 In his conversation with Dr. Peterson, Dr . Bassi stated that Hayden was totally disabled from anxiety and depression. Dr. Peterson concluded that “[ t]he medical records do not support impairment from working at her usual occupation based on any medical diagnosis.” Dr. Peterson, observing that her chronic anxiety disorder was not well c ontrolled, stated that hi s report did not address her diagnosis of chronic anxiet y disorder and recommended an evaluation by a board-certified psychiatrist.
Liberty referred Hayden’s file to Dr. Raymond Chagnon, an internist, and Dr. Gil Lichtshein, a psychiatrist, for an independent panel review. Dr. Chagnon contacted Dr. Bassi, who explained that “[a]s to restrictions and limitations she has difficulty handling daily life, decrease in interpersonal relationships, difficulty engaging in everyday life activities. Her depression and anxiety is her impairment, which are contributed by her medical problems.” Dr. Chagnon concluded “that she has multiple medical problems and the list is very long, but there are no medical problems that are causing her any im pairments, restrictions and limitations at this time. There is no specific impairment except for some generalized fatigue and weakness.” Dr. Lichtshein also spoke with Dr. Bassi, who again explained that he believed Hayden was disabled as a result of her anxiety and depression. “He stated that she cannot function in interpersonal relationship and group settings and stated that she cries and bawls in his office.” Dr. Lichtshein concluded: “There was no objective data, reported testing, behavior al description or collateral information to substantiate the presence of any level or degree of cognitive impairment, inability to perform activities of daily li ving, or any other type of func tional impairment.” Finally, he
stated that “review of the enclosed records do not support any psychiatric di agnosis at this time.”

4 While Dr. Peterson’s review was pending, the Plan received an April 27, 2010 assessment from the University of Kentucky’s Chandler Medical Center explai ning that Hayden was doing well and remained in clinical remission from her breast cancer.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 7

Liberty denied Hayden’s claim for benef its by letter dated August 26, 2010. Hayden appealed and submitted additional evidence, incl uding Dr. Bassi’s sworn statement in connection with her claim for Social Security disability benefits and records of her hospitalization in November 2010. Dr. Gregg Marella, an internist, reviewed Hayden’s medical records. Dr. Marella concluded that the only restrictions on Hayden would be from November 2010 forward due to her syncopal episodes. As for Hayden’s physical condition during the Elimination Period, Dr. Marella concluded that “[n]one of the medi cal conditions have been documented or fully explained in the office notes as to why they would totally limit or restrict the claimant from working.”
Dr. Enrique Olivares, a psychi atrist, reviewed Hayden’s mental-health records. Dr. Olivares agreed that her dia gnoses for depression and anxiety disorders were supported, but concluded that “[t]here was no evidence of cognitive impairment, severe psychiatric symptoms, suicidal ideation, homicidal ideation, hallucinati ons or cognitive impairment that would have precluded [Hayden] from engaging in a full time job during the” Elimination Period.
Liberty upheld its denial of benefits in Ap ril 2011. The letter noted that Hayden had been awarded Social Security disabil ity benefits. It explained that Liberty arrived at a different determination because the Social Security Administ ration and the Plan used different criteria to determine eligibility for benefits.
Hayden brought suit under ERISA. The district court upheld Liberty’s denial of her physical-disability claim. The district court found Liberty’s review of Hayden’s mental-health records “faulty.” Dr. Olivares was not provided with either Dr. Kelley’s or Dr. Lyon’s opinions during his review of Hayden’s files. The district court also faulted Dr. O livares for disregarding entirely Dr. Muehleman’s report. The district c ourt did not believe that the record established Hayden’s entitlement to benefits and remanded the case to Liberty to conduct a full and fair review. On remand, Dr. Olivares reviewed the additional records and re confirmed his initial conclusions. Liberty again deni ed Hayden’s claim for benefits, this time relying only on Dr. Olivares’s report. The case returned to district court, and the district court affirmed Liberty’s
denial of benefits.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 8

II.

We review de novo a district court order granting judgm ent in an ERISA disability action
based on an administrative record. See DeLisle v. Sun Life Assurance Co. of Can. , 558 F.3d 440, 444 (6th Cir. 2009). Where the plan administra tor is vested with discretion to determine eligibility for benefits, the plan administrator’s de nial of benefits will be overturned only if it is arbitrary and capricious. Id . Although the arbitrary and caprici ous standard of review is highly deferential, federal courts are not mere “rubber stamps.” McDonald v. W.-S. Life Ins. Co. , 347 F.3d 161, 172 (6th Cir. 2003). This entails re view of the quality and quantity of the evidence, mindful that the plan administrator’s decision should be upheld if it is the result of a deliberate, principled reasoning process and supported by subs tantial evidence. DeLisle , 558 F.3d at 444.

A.
As a preliminary matter, we address Hayden’s ar gument that Liberty a nd the district court erred in not considering evidence developed afte r the Elimination Period. We have explained that such evidence is relevant, but only to the ex tent that it sheds light on a claimant’s condition during the Elimination Period. See Javery v. Lucent Techs., Inc. Long Term Disability Plan for Mgmt. or LBA Emps. , 741 F.3d 686, 690 n.1 (6th Cir. 2014). “The primary benefit of such evidence” is that it “speaks to the credibility and accurateness of the earlier evaluations and opinions.” Id . Nevertheless, under the terms of the Plan, Hayden can prevail only by establishing that she was unable to perform he r own occupation during th e Elimination Period.

B.
Hayden asserts that Liberty and in turn the di strict court ignored various pieces of record evidence in evaluating her physic al-disability claim. But while she purports to identify
numerous instances where Libert y and the district court ignore d evidence, she does not explain why this evidence shows that she was disabled th roughout the entirety of th e Elimination Period. Consequently, Hayden cannot demonstrate that Liberty’s “ultimate decision denying benefits was arbitrary and capricious.” Spangler v. Lockheed Martin Energy Sys., Inc. , 313 F.3d 356, 362No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 9

(6th Cir. 2002). Indeed, Libert y’s conclusion to the contrary was the result of a principled reasoning process and supported by substantial evidence. See Delisle , 558 F.3d at 444.
We address Hayden’s five arguments in turn . First, she asserts that Liberty and the district court ignored evidence that Dr. Bassi had diagnosed her with severe degenerative arthritis of her hands in 2005. Although Hayden was diagnosed with a degenerative disease, she was still required to demonstrate that on January 4, 2010, th e arthritis prevented her from performing the duties of her occupation. Dr. Bassi’s examination notes from January 6, 2010, do not mention arthritis in Hayden’s hands, although he does menti on arthritis in her shoulders, hips, and knees. Dr. Bassi’s October 2010 examination notes again ma ke no mention of arthritis in her hands and
indicate that her arthritis in he r shoulders, hips, knees, and cervical spine was contro lled with the current regimen. Furthermore, Dr . Bassi never asserted to the reviewing physicians that Hayden could not perform the functions of her job because of arthritis in her hands or elsewhere. While Dr. Bassi did testify that Hayde n’s degenerative arthritis, peri pheral neuropathy, and carpal tunnel would prevent her from using one or both ha nds in a work setting, this testimony relates only to November 2010, eleven months after Ha yden was required to dem onstrate that she was physically disabled. Liberty was not arbitrary or capricious in concluding that there was a lack of medical documentation that arthritis, peri pheral neuropathy, or car pal tunnel prevented Hayden from performing the functions of her job from January 4, 2010, through July 4, 2010.
Second, Hayden asserts that Li berty ignored evidence of a 2-D echocardiogram showing diastolic dysfunction and hyperten sive heart disease in 2008. Bu t Dr. Marella acknowledged the echocardiograms in his report, and a handwritten notation on one of the echocardiogram reports stated “minor clinical finding.” Liberty was no t arbitrary or capricious in denying her claim for
benefits on this basis.
Hayden’s third, fourth, and fifth claims of erro r all relate to her di agnosis of syncope and presyncope. Although the evidence establishes that Hayden was likely disabled from syncope and presyncope by the end of 2010, there is no ev idence demonstrating that these conditions were disabling before July 4, 2010. The first mention of syncope in the record occurs on September 9, 2010, where Dr. Bassi not ed: “She has not told me this before, but she has had 2-3 syncopal episodes this past year. She had one this past week.” There is no mention of syncopeNo. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 10

before that and no suggestion that syncope or presyncope prevented her from being able to perform the functions of her job in January 2010. Liberty was not arbitrary or capricious in concluding that Hayden was not disabled as a result of sync ope or presyncope throughout the
Elimination Period.

Nor does the remainder of the medical evidence disclose that Liberty was arbitrary or capricious in concluding that Hayden was not physically disabled th roughout the Elimination Period. For example, with respect to Hayden’s le ft vocal cord paralysi s, Dr. Kest’s office contacted Liberty and relayed that Dr. Kest ne ver placed Hayden out of work and never placed any restrictions on her. Moreov er, Dr. Kest’s notes indicated only that Hayden was to avoid harsh vocal use, yelling, or throat clearing; ther e is nothing to suggest she could not perform the ordinary communication requ ired of her as an office manager. With respect to her breast cancer, the University of Kentucky Medical Center’s assessment was that she was doing well and
remained in clinical remission. With respect to hypothyroidism a nd gastritis, Dr. Bassi’s notes
indicate that these conditions were controlled dur ing the Elimination Period. Her hepatitis C was chronic and there is no suggestion that it was disabling. And wh ile Dr. Bassi noted that Hayden suffered from neuropathy, Liberty’ s review disclosed that “no wo rkup has been done for it and
no documentation that it is causi ng her any impairments, restri ctions or limitations on medical
record.”
Finally, we disagree with the dissent that, in this particul ar case, Liberty should have taken a cumulative approach to Hayden’s mental and physical health. Wh at distinguishes this
case from Javery , 741 F.3d at 701, and Kalish v. Liberty Mutual/Liber ty Life Assurance Co. of
Boston , 419 F.3d 501, 510 (6th Cir. 2005) , is the fact that the Pl an at issue here clearly contemplates that mental and physical disabilitie s will be considered separately. The Plan caps mental-disability payments at 24 months, while physical-disability payments are uncapped. To combine mental and physical disability in th is case would contravene this express plan requirement, which we are required to follow. Accordingly, Liberty was not arbitrary or capricious in denying Hayden’s physical-disability claim.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 11

C.
Hayden’s primary challenge to Liberty’s de nial of her mental-d isability claim is addressed to Liberty’s reliance on Dr . Olivares’s reports. It is true, as a general matter, that when a plan administrator relies on the opinion of one doctor over that of another, “the plan
administrator’s decision cannot be said to have been arbitrary a nd capricious because it would be possible to offer a reasoned expl anation, based upon the evidence, for the plan administrator’s
decision.” McDonald , 347 F.3d at 169. But ERISA does not grant to a plan administrator carte blanche to adopt the opinions of its reviewing physicians. Wh en a reviewing physician’s report is “inadequate,” a plan administrator cannot be said to engage in a deliberate, principled reasoning process when it adopts the position of that report. Kalish , 419 F.3d 501, 509–11. In particular, where a reviewing phys ician’s opinion applies standard s that conflict with the terms of the plan, that opinion is not evidence supporting a conclusion that the claimant is not disabled within the meaning of the plan. See id .; Elliott v. Metro. Life Ins. Co. , 473 F.3d 613, 619–20 (6th Cir. 2006). 5

Here, disability under the terms of the Plan mean s that the claimant is unable to perform
the material and substantial dutie s of her own occupati on during the Elimination Period and for a period of 24 months and any occupation thereafte r. The term “own occupation” is in turn defined to mean the claimant’s occupation as it is normally performed in the national economy. Dr. Olivares’s opinion is in consistent with this definition in two respects.
First, Dr. Olivares’s reports appear to a pply a significantly height ened standard for a disabling mental illness that cont ravenes the definition provided in the Plan. Dr. Olivares’s first report concluded that there was no evidence of “s evere psychiatric symptoms, suicidal ideation, homicidal ideation, hallucinations or cognitive impairment th at would have precluded the claimant from engaging in a full-time job during the” Elimination Period. As an initial matter, whether Hayden could have engaged in some full time job was irrelevant; the Plan required Dr.
Olivares to consider whether she was disabled from performing the material and substantial

5 We do not hold that reviewing physicians must conduct their reviews using the terms of the plan. We hold only that a reviewing physician’s opinion is not substantial evidence that a claimant is disabled under the terms of the plan if the opinion applies standards inconsistent with the plan.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 12

duties of her own occupation as an office manager. More importantly, Dr. Olivares’s conclusion suggests that Hayden would have had to be suffering from “severe psychiatric symptoms, suicidal ideation, homicidal ideation, hallucinati ons” to be considered disabled. Although the term “cognitive impairment” used by Dr. Olivares is ambiguous and could suggest any mental disorder, including depression and anxiety, Dr. Olivares explained how he used the phrase. On the previous page, Dr. Olivares wrote that he di d not believe that Hayden “had any evidence of cognitive impairment or depres sion of such magnitude that sh e needed to stay off work because of severe suicidal ideation, homicidal idea tion, hallucinations, or reality impairment .” 6 Dr.
Olivares’s definition—which w ould effectively preclude any claimant from establishing depression or anxiety as a disabili ty—is inconsistent with the term s of the Plan, which focus on whether a claimant can perform the material and substantial duties of her own occupation.
Dr. Olivares’s reports were inadequate in another respect. In both Dr. Olivares’s initial and second report, he discounted Hayden’s mental disorders because “[t]he company was going into bankruptcy” and because “she was asked to work long hours with very few breaks.” Dr. Olivares reasoned, for example: “It is not clear wh ether this depression a nd anxiety are related to the medical problems that the claimant is experi encing or that there are issues related to her previous job” and “[t]here are i ssues related to her pr evious job [the bankrupt cy] that could have an impact on her presentation and her inability to go back to that previous job.” This reasoning was pervasive, leaving the firm impression th at Martin Marietta’s bankruptcy significantly
influenced Dr. Olivares’s vi ew of Hayden’s claim.
A straightforward reading of this language sugge sts one of two things, either of which is problematic. It could suggest that Dr. Olivares was assessing Hayden’s disa bility in reference to her job at Martin Marietta. The Plan, however, de fines disability in reference to how her job as office manager was performed in the national ec onomy. Alternatively, his report could suggest that he thought that Hayden’s anxiety and depression were cau sed by job stressors and that,

6 Dr. Olivares’s second report rea ffirmed the conclusions in his initial report and used the same terminology: “There is no evidence of cognitive impair ment, suicidal or homicidal ideation, hopelessness, helplessness, thought disorganization, delusional belie[fs] , psychotic conditions or any other severe psychiatric symptoms described in the record prior to 01/05/14 that would have necessitated the claimant to be placed off work.” The definition put forth by Dr. Olivares, requiring evidence of “severe psychiatric symptoms,” is contrary to the actual terms of the Plan.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 13

although she was incapable of performing her job at Martin Marietta, the anxiety and depression would abate if she performed her job as an office manager elsewhere. But nowhere in the record is there support for the position that Hayden’s disa bility was caused by her job. Dr. Bassi’s chart notes unequivocally conclude that her anxiet y and depression were exacerbated by her rapidly deteriorating health and her husband’s medical condition. Hayden report ed to Dr. Muehleman that “what keeps her from working now is she is overwhelmed with sickness and has many diseases.” Indeed, Hayden never mentioned work stress as a reason for her mental condition in her meetings with Dr. Meyer, as evidenced by th e fact that it was Dr. Olivares who informed Dr. Meyer that Martin Marietta was going into bankruptcy. Having not personally examined Hayden, and finding no support for this conclusion in the record, Dr. Olivar es’s diagnosis from afar is not supported by substantial evidence. See Evans v. UnumProvident Corp. , 434 F.3d 866, 876, 880 (6th Cir. 2006). Dr. Olivares com pounded his error when he relied on Martin Marietta’s bankruptcy to discredi t Dr. Meyer. Dr. Olivares addr essed Dr. Meyer’s conclusion as follows: “[Dr. Meyer] believes she is not ready to go back to work and he is not aware of the problems that she was having before she went on disability; namely that the company was restructuring and it was going in to bankruptcy and her job was very strenuous as described by
the claimant.”
The plan administrator must “give reas ons” for rejecting a treating physician’s conclusions, Elliott , 473 F.3d at 620, and those reasons must be consistent with the terms of the plan and supported by the record, McDonald , 347 F.3d at 169–72. Because Liberty relied on Dr. Olivares’s reports in denying Hayden’s mental-d isability claim and because Dr. Olivares’s reports were inadequate in critical respects, we conclude that Liberty’s denial of Hayden’s claim was arbitrary and capricious. 7 See Elliott , 473 F.3d at 619; Kalish 419 F.3d at 509–11.

D.
What remains is a question of remedy. Remand to the plan administrator is appropriate “where the problem is with the in tegrity of the plan’s decision-making process, rather than that a
claimant was denied benefits to which he was clearly entitled.” Cooper v. Life Ins. Co. of N.

7 Because we find Liberty’s denial of benefits arbitrar y and capricious on these gr ounds, we do not consider Hayden’s alternative arguments.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 14

Am. , 486 F.3d 157, 171 (6th Cir. 2007) (quoting Elliott , 473 F.3d at 622). But “[p]lan administrators should not be given two bites at th e proverbial apple where the claimant is clearly entitled to disability benefits. They need to pr operly 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.” Id . at 172.
Although Dr. Olivares’s errors were procedural in nature, we find no need to remand this matter for additional consideration by Liberty. Hayden has clearly established that she is mentally disabled under the terms of the Plan. She supported her claim with the opinions of Drs. Bassi, Muehleman, and Meyer, each of whom separa tely agreed that she suffered from anxiety and depression and was significantly impaired in her ability to perf orm the functions of her, or any, occupation. Drs. Bassi and Muehleman both found that Hayden was impaired in her ability
to relate to and communicate with others. And Drs. Bassi and Meyer both found that Hayden was markedly impaired in her ability to handle the stress of day-to-day life . Finally, we note that “[c]ompeting evidence in the record showing th at” her anxiety and depression symptoms “were not disabling is conspicuously absent.” Rochow v. Life Ins. Co. of N. Am. , 482 F.3d 860, 866 (6th Cir. 2007). 8

III.

We affirm the district c ourt’s judgment with respect to Hayden’s claim of physical disability. We remand Hayden’ s claim of mental disability for entry of an order requiring Liberty to award benefits consiste nt with the terms of the Plan a nd for such incidental relief as the district court finds appropria te in light of our decision.

8 While Hayden had been diagnosed with anxiety and depression as early as 2007, “there is no ‘logical incompatibility between working full time and being disabled from working full time.’” Rochow , 482 F.3d at 865 (quoting Hawkins v. First Union Corp. Long-Term Disability Plan , 326 F.3d 914, 918 (7th Cir. 2003)).No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 15

_________________________________________________ CONCURRING IN PART A ND DISSENTING IN PART

_________________________________________________ JANE B. STRANCH, Circuit Judg e, concurring in part and dissenting in part. I fully concur in the majority’s decision to reverse and remand for an award of di sability benefits to Gaylon Hayden due to her mental di sability. The record leads me to conclude, however, that Hayden met the definition of disability under the Plan in January 2010 because she demonstrated she is disabled by “sickness” from performi ng her own or any occupation. Because I would
reverse and remand for a full award of disabili ty benefits under the terms of the Plan, I respectfully dissent.
The majority recognizes, as I do, that Hayden suffers from a number of serious medical conditions. The Plan provides disa bility benefits to a covered person who is disabled due to “sickness” from performing the material and s ubstantial duties of he r own occupation for a defined period and from performing the duties of any occupation thereafter. The Plan defines “sickness” as “illness, disease, pregnancy or complications of pregnancy.” The terms “sickness,” “illness,” and “disease” can describe one single medical condition or multiple medical conditions. Because Hayden suffers from chronic illness that is compri sed of multiple physical and mental ailments, Liberty Mutual and this court are required by our precedents to evaluate the integrated or cumulative nature and se verity of Hayden’s entire illness.

In Javery v. Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees , 741 F.3d 686, 690–97 (6th Ci r. 2014), the claimant suffered from several different physical and mental conditions. The Plan provided benefits if the claimant was “‘prevented by reason of . . . di sability . . . from enga ging in [his] occupati on or employment at the Company.’” Id. at 701. The dispositive inquiry, th e court explained, was whether the plaintiff was unable to work “due to his physical condition, his mental condition, or a
combination of the two.” Id. (footnote omitted). The court reversed and remanded for an award of disability benefits becau se the medical evidence submitted by the treating physicians and therapists established that the claimant was unabl e to work “due to a combination of his physical
and mental conditions.” Id. at 702.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 16

In Kalish v. Liberty Mutual/Liberty Life Assurance Co. of Boston, 419 F.3d 501, 510 (6th Cir. 2005), this court reversed for an award of disa bility benefits where th e district court and the parties “treated the diagnosis of depression as distinct from the diagnosis of the heart condition.” The Plan provided for benefits if Kalish was “‘unable to perform all of the material and substantial duties of his occupa tion on an Active Employment Basi s because of an Injury or
Sickness.” Id. at 503, 509. The court pointed to a phys ician’s conclusion that “Kalish was unable to return to work after considering Kali sh’s overall physical and mental health, which included an analysis of the interrelated effect s of the heart condition and the depression.” Id. The court rejected Liberty Mutual’s reliance on a physician’s report th at did not “discuss Kalish’s depression or acknowledge the c onnection between the two ailments.” Id.
The majority opinion acknowle dges the interrelatedness of Ha yden’s physical and mental
conditions when it states that “Dr. Bassi’s chart no tes unequivocally concl ude that her anxiety and depression were exacerbated by her rapidly de teriorating health,” and “Hayden reported to Dr. Muehleman that ‘what keeps her from worki ng now is she is overwhelmed with sickness and has many diseases.’” Maj. Op. at 14. Yet, just as Liberty Mutual did, the majority breaks Hayden’s sickness into separate physical ailments in order to determine whether, during the elimination period, the medical evidence supported a finding of disability as to each separate physical condition. Then the majority makes an additional division by separately evaluating her mental condition without regard to her co-existing physical problems. This approach precludes a comprehensive consideration of Hayden’s co-m orbid conditions as described by her treating physicians and fails to evaluate the whole of her illn ess to determine if she is entitled to disability benefits based on her physical condition, her ment al condition, or a combination of the two. See Javery , 741 F.3d at 701. Like Javery, Hayden proved that she was entitled to disability benefits based on a combination of her physical conditions and her mental condition. See id. I do not dispute that the Plan clearly limits benefits for a mental disability to a period of 24 months. But that very common Plan provisi on does not prevent us or Li berty from considering whether Hayden suffers from a qualifying “sickness”—wheth er physical or a combination of physical and mental—that would entitle her to benefits starting on the first day of claimed disability and extending through and beyond the 24-month period allo wed for mental disability benefits only.No. 13-6319 Hayden v. Martin Marietta Materials, Inc. Page 17

Hayden’s true inability to engage in sustaine d work activity comes clearly into focus if we treat her all of her physical and mental impair ments in combination as one “sickness” as that term is defined under the Plan. Accordingly, I would reverse and remand for an award of disability benefits that is consistent with the terms of the Plan and that is not limited by the 24- month cap for mental disability benefits.