UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF OHIO

WESTERN DIVISION AT DAYTON

RANDY SMITH, : Case No. 3:17-cv-285 

: 

Plaintiff, : Judge Thomas M. Rose

: 

v. : 

: 

RELIASTAR LIFE INSURANCE : 

COMPANY, INC., : 

: 

Defendant. : 

ENTRY AND ORDER GRANTING DEFENDANT’S MOTION FOR 

JUDGMENT ON THE ADMINISTRATIVE RECORD (DOC. 5), DENYING 

PLAINTIFF’S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE 

RECORD (DOC. 11), AND TERMINATING CASE

This case is before the Court on the Motions for Judgment on the Administrative 

Record (Docs. 5, 11) filed by Defendant ReliaStar Life Insurance Company, Inc. 

(“ReliaStar”) and Plaintiff Randy Smith (“Smith”), respectively. Smith brought this 

action under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et 

seq. (ERISA), for review of the denial of disability benefits under his employer-provided 

life insurance plan. Smith seeks reversal of the denial of benefits and an order remanding 

this matter for payment of benefits. ReliaStar, the issuer of the plan, seeks a judgment 

upholding the denial of benefits. Smith and ReliaStar agree on the standard of review 

and their Motions are fully briefed. (Docs. 10, 12, 13.) As discussed below, the Court 

finds that ReliaStar’s denial of benefits was neither arbitrary nor capricious and therefore
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GRANTS ReliaStar’s Motion (Doc. 5) and DENIES Smith’s Motion (Doc. 11) for 

Judgment on the Administrative Record. 

I. BACKGROUND

The Court’s review is limited to the administrative record at the time that 

ReliaStar’s ERISA review committee issued its decision. Accordingly, the Court “may 

not consider new evidence or look beyond the record that was before the plan 

administrator.” Wilkins v. Baptist Mem’l Healthcare Sys., Inc., 150 F.3d 609, 615 (6th Cir. 

1998); see also Crews v. Central States, 788 F.2d 332 (6th Cir. 1986). The following facts are 

taken from that administrative record. 

Smith was employed as a Coater Team Operator at Appvion, Inc. (“Appvion”). 

(Doc. 5-2 at 2.) Smith participated in the Appvion, Inc. Group Life Insurance Plan (“the 

Plan”), which was issued by ReliaStar. (Doc. 5-3 at 3.) The Plan provides qualified 

employees Basic Life Insurance and Accidental Death and Dismemberment Insurance

(“Basic Life Insurance”) and a Total and Permanent Disability Income Benefit (“Benefit”) 

equal to the value of the Basic Life Insurance in force on the date that the employee 

becomes totally disabled. (Id. at 4.) 

The Plan provides that the Benefit will be paid if the employee is permanently 

disabled. (Id. at 9.) To qualify for the Benefit, the employee must meet the following 

three conditions:

You are insured for this benefit on the date you became totally disabled.

You become permanently disabled before age 65.

ReliaStar Life receives proof, within 12 months or as soon as reasonably 

possible after the date you become totally disabled, that you are 

permanently disabled.
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(Id.) The Plan defines permanently disabled as a “total disability, which is expected to 

continue for 10 years or for the rest of the disabled person’s expected lifetime, whichever 

is shorter.” (Id. at 19.) The Plan defines totally disabled as “your inability, due to sickness 

or accidental injury, to work at or perform the material and substantial duties of any job 

suited to your education, training or experience.” (Id.) 

On October 24, 2016, Smith filed a Waiver of Premium Disability Claim (“Smith’s 

Claim”). (Doc. 5-2 at 4–5.) Smith identified his conditions as chronic back and body pain, 

osteoarthritis, heart trouble, and fibromyalgia. (Id. at 4.) His last date of work was April 

19, 2016. (Id. at 5.) Smith noted that he had been approved for disability payments under 

the Social Security Administration. (Id.) Smith attached a form titled Attending 

Physician’s Statement of Disability, which was completed by Smith’s treating physician, 

Dr. O’Connell. (Id. at 8–10.) On the form, in response to the question, “Is patient totally 

disabled FOR ALL OCCUPATIONS?” Dr. O’Connell responded, “No.” (Id. at 8.) 

Conversely, when asked, “Is patient totally disabled FOR PATIENT’S REGULAR 

OCCUPATION?” Dr. O’Connell responded, “Yes.” (Id.) Dr. O’Connell noted that Smith

would need a nonphysical job. (Id.) Dr. O’Connell indicated that Smith’s back problems 

were permanent. (Id. at 9.) 

On November 9, 2016, ReliaStar sent a letter to Smith notifying him that he was 

not eligible for the Benefit. (Doc. 5-4 at 1.) ReliaStar stated:

Under the terms of this policy, you may be eligible for this benefit if you are

permanent[ly] and totally disabled. The policy states that Permanent 

Disability is “expected to continue for 10 years or for the rest of the disabled 

person’s expected lifetime, whichever is shorter”. Total Disability is, “your 
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inability, due to sickness or accidental injury, to work at or perform the 

material and substantial duties of any job suited to your education, training 

or experience”.

According to the medical information contained in the Attending 

Physician’s Statement you are not totally disabled for all occupations. 

Because you could work in some capacity, you do not meet the definition 

of total disability as contained in this policy. Therefore, you are not eligible 

for the Total and Permanent Disability Income Benefit and we must deny 

your claim.

(Id.) 

On November 21, 2016, Smith appealed the denial of his Claim for the Benefit. 

(Doc. 5-2 at 12–13.) His appeal attached medical records, including Smith’s treatment 

history with Dr. O’Connell, a psychologist, a cardiologist, and a pain management 

physician. (Id. at 14–268.) 

On December 12, 2016, ReliaStar notified Smith that it had forwarded his appeal 

to its ERISA review committee. (Id. at 269.) On February 1, 2017, the ERISA review 

committee determined that Smith was not eligible for the Benefit and upheld ReliaStar’s 

original claim decision. (Id. at 275.) The ERISA review committee stated:

Though your doctor completed the Attending Physician’s Statement of 

Disability and certified that you are currently disabled from performing 

your own occupation, the policy defines total disability as the inability to 

perform ANY occupation. Furthermore, permanent disability is defined as 

a total disability from performing any occupation that is expected to 

continue for a period of 10 years.

Because the medical information does not support that you are unable to 

work in any occupation, and because it does not support that any inability 

to work is expected to continue for a period of 10 years, you do not meet 

the definition of permanently disabled as contained in this policy. 

Therefore, you are not eligible for the Total and Permanent Disability 

Income Benefit and we must uphold our initial decision to deny your claim.

(Id. at 276.) 
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Smith brought this action and alleges that ReliaStar wrongfully denied his benefits 

under 29 U.S.C. § 1132. (Doc. 3 at 4–5.) He seeks, among other things, to recover $50,000, 

the amount that he would be entitled to if he were qualified under the terms of the Plan. 

(Id. at 6.) 

II. LEGAL STANDARD 

The parties agree that the arbitrary and capricious standard of review applies 

because the Plan gives ReliaStar “final discretionary authority to determine all questions 

of eligibility and status and to interpret and construe the terms of” the Plan. (Doc. 5-3 at 

22, ¶ 8; see also Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).) 

The arbitrary and capricious standard “is the least demanding form of judicial 

review of administrative action.” Williams v. Int’l Paper Co., 227 F.3d 706, 712 (6th Cir. 

2000). It is not, however, a “rubber stamp” of the plan administrator’s decision. Cox v. 

Standard Ins. Co., 585 F.3d 295, 305 (6th Cir. 2009). When applying this standard, the Court 

“must decide whether the plan administrator’s decision was ‘rational in light of the plan’s 

provision.’” Id. (quoting Daniel v. Eaton Corp., 839 F.2d 263, 267 (6th Cir. 1988)). “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. Ky. Fin. Cos. Ret. Plan, 887 

F.2d 689, 693 (6th Cir. 1989) (quoting Pokratz v. Jones Dairy Farm, 771 F.2d 206, 209 (7th 

Cir. 1985)). The Sixth Circuit has held that a plan administrator’s decision must be upheld 

under the arbitrary and capricious standard if it is supported by substantial evidence and 

“the result of a deliberate, principled reasoning process.” Shaw v. AT&T, 795 F.3d 538, 
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547 (6th Cir. 2015), quoting DeLisle v. Sun Life Assur. Co. of Canada, 558 F.3d 440, 444 (6th 

Cir.2009) (internal quotes omitted). 

III. ANALYSIS

Under the Plan, Smith had to meet three conditions to qualify for the Benefit: (1) 

be insured for this benefit on the date you became totally disabled, (2) become 

permanently disabled before age 65, and (3) provide ReliaStar proof, within 12 months 

or as soon as reasonably possible after the date he became totally disabled, that he was

permanently disabled. (Doc. 5-3 at 9.) The Plan defines totally disabled as the employee’s 

“inability, due to sickness or accidental injury, to work at or perform the material and 

substantial duties of any job” suited to the employee’s “education, training, or 

experience.” (Id. at 19.) The definition of permanent disability encompasses the

definition of total disability, and is defined as a “total disability, which is expected to

continue for 10 years or for the rest of the disabled person’s expected lifetime, whichever 

is shorter.” (Id.) 

ReliaStar asserts that it denied Smith’s Claim because he failed to prove that he 

was unable to perform “the material and substantial duties of any job” suited to his 

education, training, or experience. ReliaStar’s notification letter to Smith referenced Dr. 

O’Connell’s Attending Physician Statement, in which he indicated that, although Smith 

was unable to perform his regular occupation, he was not totally disabled for all 

occupations. (Doc. 5-2 at 8.) ReliaStar compares this case to Vanderklok v. Provident Life 

& Accident Insurance Co., 956 F.2d 610 (6th Cir. 1992). 
7 

In Vanderklok, the plaintiff filed a claim for disability benefits under an employersponsored life insurance plan. Id. at 612. The plaintiff’s treating physician submitted a 

report, at the insurance carrier’s request, stating that plaintiff would never be capable of 

returning to his regular job as a manual laborer, but would be able to engage in some 

type of compensable work. Id. Plaintiff was referred to a second physician, who opined 

that plaintiff was totally disabled for his usual occupation, although he could not say 

whether the disability would be permanent. Id. at 612-13. The second physician further 

stated that he would not object to the plaintiff returning to work that did not require 

“heavy pushing, pulling, repetitive lifting, or work out at arm reaches or over chest 

level.” Id. at 613. The insurance carrier subsequently denied the plaintiff’s claim based 

on its finding that he was not total and permanently disabled under the plan. Id.

The Sixth Circuit rejected the plaintiff’s argument that he needed to prove only 

that he was totally and permanently disabled from performing his current occupation in 

order to qualify for benefits. Id. at 614. The policy at issue was a life insurance policy, 

not a disability insurance policy, that required total and permanent disability to 

accelerate payments on the life insurance policy in the form of disability benefits. As a 

result, the plaintiff was required to show that he was unable to engage in any occupation 

to qualify for benefits. Id. The Sixth Circuit clarified, however, that any occupation 

should not be construed to include “nominal employment, such as selling peanuts or 

pencils which would only yield a pittance.” Id. at 615. Instead, a claim of total disability 

must be based on the claimant’s ability to pursue “gainful employment in light of all the 

circumstances.” Id., citing Torix v. Ball Corp., 862 F.2d 1428, 1430 (10th Cir. 1988). 
8 

The Sixth Circuit then turned to a claim overlooked by the district court, namely 

that the insurance carrier failed to give plaintiff timely written notice of the denial of 

benefits in violation of the plan and ERISA, 29 U.S.C. § 1133(1). Id. at 615. The Sixth 

Circuit found that the notice was both untimely and substantively defective because it 

failed to provide “the specific reason or reasons for denial and the specific reference to 

pertinent plan provisions on which the denial [was] based.” Id. The carrier’s notice had 

stated:

We regret that the claim does not qualify under the total and permanent 

disability benefits provision of the policy, because the proof submitted does 

not establish that the insured is totally and permanently disabled from all 

work for the remainder of his life. We will be happy to review any 

additional medical information which Mr. Vanderklok may wish to submit. 

Id. at 616. The Sixth Circuit reversed the denial of benefits and remanded the case to the 

district court with instructions to reconsider the issue of disability after the plaintiff had 

been given the opportunity to submit additional evidence. Id. at 619. 

Here, ReliaStar argues that, like the plan in Vanderklok, the Plan is a life insurance 

policy, not a disability insurance policy, that requires Smith to prove his permanent and 

total disability generally—not just for his then current occupation. Because Smith’s 

physician indicated that he was not totally disabled, argues ReliaStar, he was not entitled 

to the Benefit. Unlike the notice in Vanderklok, ReliaStar argues that its notice to Smith 

was not defective because it adequately explained the basis for the denial, the portion of 

the record upon which it relied, and how Smith could supplement and appeal the 

decision.
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Smith argues that ReliaStar’s notice was deficient because it did not sufficiently 

explain the basis for the denial or identify the specific type of employment available to 

him. Smith specifically faults ReliaStar for failing to discuss Smith’s limitations and their 

impact on his ability to work.

Section 1133 of ERISA requires employee benefit plans to, among other things, 

provide adequate notice in writing to any participant whose claim has been denied, 

“setting forth the specific reasons for such denial.” (Doc. 12 at 2, quoting 29 U.S.C. § 

1133(1).) The regulations promulgated under that section provide, in relevant part, that 

the written notification for a denial of a life insurance benefit must set forth, “in a manner 

calculated to be understood by the claimant”: 

(i) The specific reason or reasons for the adverse determination;

(ii) Reference to the specific plan provisions on which the determination is 

based;

(iii) A description of any additional material or information necessary for 

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

or information is necessary; [and] 

(iv) A description of the plan’s review procedures and the time limits 

applicable to such procedures, including a statement of the claimant's right 

to bring a civil action under section 502(a) of the Act following an adverse 

benefit determination on review;

29 C.F.R. § 2560.503-1(g)(i)-(iv). 

ReliaStar notes that, in the 25 years since Vanderklok was decided, the Sixth Circuit 

has adopted the substantial compliance rule for ERISA notice requirements. Moore v. 

Lafayette Life Ins. Co., 458 F.3d 416, 436 (6th Cir. 2006). Under this rule, the court asks 

whether the plan administrator’s notice provided a sufficiently clear understanding of its 
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decision to permit effective review. Id. (citing Brehmer v. Inland Steel Indus. Pension Plan, 

114 F.3d 656, 662 (7th Cir. 1997)). “To decide whether there is substantial compliance, 

this Court considers all communications between an administrator and plan participant 

to determine whether the information provided was sufficient under the circumstances.” 

Id. ReliaStar argues that its notice met this standard. The Court agrees.

As required by the regulations, ReliaStar clearly set forth the reason for its denial: 

“According to the medical information contained in the Attending Physician’s Statement 

you are not totally disabled for all occupations. Because you could work in some 

capacity, you do not meet the definition of total disability as contained in this policy.” 

(Doc. 5-4 at 1.) ReliaStar also identified the specific benefit at issue—the Total and 

Permanent Disability Income Benefit, explained that Smith must qualify as permanently 

and totally disabled to qualify for the Benefit, and provided the definitions relevant to its

determination that he did not qualify. (Id.) ReliaStar also directed Smith to the evidence 

upon which its decision was based—the Attending Physician’s Statement. (See id.) 

Finally, ReliaStar provided a summary of Smith’s ERISA rights, including his right to 

appeal the decision. (Id. at 1–2.) Although ReliaStar’s notice was succinct, it contained 

the details necessary to permit a fair and effective review of the decision.

Smith’s argument that ReliaStar’s decision was not the result of a deliberate and 

principled reasoning process also fails. Smith accuses ReliaStar of selectively relying on 

only Dr. O’Connell’s statement that Smith could perform some work, while ignoring 

other medical evidence that, according to Smith, precludes any employment. (Doc. 10 at 

5.) This is not a case, however, where the plan administrator independently weighed 
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conflicting medical evidence and then cherry-picked the evidence that supported its 

decision. Cf. Metropolitan Life Insurance Co. v. Conger, 474 F.3d 258, 265 (6th Cir. 2007) 

(insurance company acted arbitrarily and capriciously when it “focused on slivers of 

information that could be read to support a denial of coverage and ignored—without 

explanation—a wealth of evidence that directly contradicted its basis for denying 

coverage.”). ReliaStar did not weigh the medical evidence and come to a conclusion at 

odds with Smith’s physicians. Instead, it relied on Dr. O’Connell’s review of the medical 

record and his determination that Smith was capable of working in some occupation. It 

was reasonable for ReliaStar to rely on Dr. O’Connell, as Smith’s treating physician, for 

guidance in its own review of the record. 

Smith argues that additional materials were submitted on appeal that proved his 

inability to engage in any gainful employment. None of the cited evidence, however, 

directly contradicts Dr. O’Connell’s work-related findings or would render ReliaStar’s 

reliance on those findings unreasonable. Cf. Glenn v. MetLife, 461 F.3d 660, 671 (6th Cir. 

2006) (criticizing plan administrator’s reliance on treating physician’s indication that 

claimant was capable of sedentary work when his subsequent letters clearly stated that 

claimant was not capable of returning to any type of work). Smith even concedes that 

“[r]ead as a whole, the record demonstrates that [he] is limited to, at most, sedentary 

work with the need for significant breaks throughout the day to combat his pain and 

fatigue related limitations.” (Doc. 13 at 7.) The ability to perform sedentary work, albeit 

subject to restrictions, does not qualify as totally disabled under the Plan. Smith goes on 

to conclude that these limitations, combined with his need for frequent breaks and 
12 

absenteeism, “likely erodes any potential for gainful work.” (Id. at 7.) Smith’s conclusion 

might be reasonable, but so was ReliaStar’s decision. It certainly cannot be said that 

ReliaStar’s decision was arbitrary and capricious based on the administrative record. 

Smith also argues that ReliaStar’s decision was flawed because it did not request 

any additional records from him or order him to undergo further examination. Smith 

has not shown that ReliaStar had the right to order a physical examination, even if it had 

deemed that necessary. ReliaStar cites Plan provisions that reserve that right only with 

respect to a pending claim for AD&D insurance, not the life insurance benefit at issue in 

this case. (Doc. 5-2 at 18.) Moreover, ReliaStar’s decision not to seek additional medical 

evidence is not suspect because, as previously discussed, the information in the record 

did not contradict Dr. O’Connell’s opinion that Smith was capable of some work. 

IV. CONCLUSION

For the reasons above, the Court GRANTS ReliaStar’s Motion for Judgment on 

the Administrative Record (Doc. 5). Smith’s Motion for Judgment on the Administrative 

Record (Doc. 11) is DENIED. This case is terminated on the Court’s docket.

DONE and ORDERED in Dayton, Ohio, this Thursday, May 10, 2018. 

s/Thomas M. Rose

________________________________ 

THOMAS M. ROSE 

UNITED STATES DISTRICT JUDGE