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_______________A part i ci panti n the pl an i s ent i t l ed t o r ece i ve LT D benef i t s i f he be comes 1 di s abl ed, m eani ng thathe i s pr event ed “f r om per form i ng one orm or e of the Ess ent i al D ut i es of [H i s ] O ccupa t i on” as a r es ul tof ac ci dent al bodi l yi nj ury , s i cknes s , m ent al i l l nes s , s ubs t ance abus e, orpr egnanc y , and cons equent l yearns l es s than 80% of hi s pr ed is a b ility e a rn in g s . (S u p p . A p p . a t A M E R 0 0 0 5 .) 2 J O R D A N , C i r cui tJudge . E dw i n Y oung appea l s fr om an or derof the U ni t ed St at es D i s tr i ctC our tforthe W es t ern D i s tr i ctof Penns y l vani a gr ant i ng s um m aryj udgm entt o A m er i can Li fe A s s ur ance C om panyof N ew Y or k ( “A I L i fe” ) on Y oung’ s cl ai m forbenef i t s underthe E m p lo y e e R e tir e m e n t I n c o m e S e c u ri ty A c t o f 1 9 7 4 (“ E R IS A ” ), 2 9 U .S .C . § 1 0 0 1 , et s eq. ( “ ERI S A” ) . F o rth e f

o l l o wi n g r e a s o n s , we wi l l a f f i r m. I . Backg r ound Y o u n g , as a m an ag ing att o rne yfo r A m erican Intern ati o n al G rou p , Inc . (“A IG ”), w as an el i gi bl e part i ci pantunderG r oup D i s abi l i tyI ns ur ance Pol i cyG L T - 10761 ( the “Pol i cy ”) , an empl oy ee s pons or ed bene fi tpr ogr am gover ned byE R I SA and i s s ued and insu red b yA I L ife. O n N o v em b er 2 6 , 2 0 0 1 , h e e x p erien ce d sev ere ch est p ains at w o rk an d w as tak en to the h o sp it al. T ests rev ea led th at Y o u n g d id n o t suf fe r fro m a h ea rt c o n d i t i o n , wh i c h l e d h i s c a r d i o l o g i s t , Dr . De n n i s Eb e r z , t o b e l i e v e th a tth e s ymp t o ms re s u lte d f

ro m d e p re s s io n a n d s tr e s s th a t Y o u n g s u f f e re d in c o n n e c tio n w ith h is jo b . O n A pr i l 25, 2002, Y oung fi l ed forl ong- t erm di s abi l i ty( “LT D ”) benef i t s under th e Po l i c y , a l l e g i n g th a th e h a d b e e n d i s a b l e d s i n c e Nov e mbe r2 6 , 2 0 0 1 . I n h i s LTD 1 b e n e f its c laim s f

o rm , Y o u n g re p o rte d th a t h e w a s d isa b led d u e to “ m a jo r d e p re ss io n /p a n ic3

d isord er c au sed b ystr essf u l w o rk e n v ir o n m en t/w o rklo ad . ” (S u p p . A p p . at A M E R 0 7 9 4 . ) T he phy s i ci an’ s por t i on of the LT D benef i t s cl ai m s form , fi l l ed outbyD r . E ber z, s i m i l ar l yr eport ed a di agnos i s of “maj ordepr es s i on/pani c di s or der . ” ( Supp. A pp. at A M E R 07 88 -89. ) Y ou ng ’s app l i cat i on al so i ncluded a l et t er fr om his psy chiatri st i ndi cat i ng thatY oung w as r ece i vi ng tr eatm entform aj ordepr es s i ve di s or der . A I L i fe d e ter m in e d th a t Y o u n g w a s e lig ib le f o r L T D b e n e f

its a n d in f

o rm e d Y o u n g th a t h e w o u ld begi n r ece i vi ng thos e bene fi t s on M ay28, 2002, pur s uantt o the ment al i l l nes s and s ubs t ance abus e pr ovi s i on of the Pol i cy . I n contr as tt o benef i t s forphy s i cal di s abi l i ty , the Pol i cy ’ s m ent al i l l nes s and s ubs t ance abus e pr ovi s i on l i m i t ed LT D benef i t s form ent al illn e s s , in c lu d in g p h y s ic a l m a n if e s ta tio n s o f

m e n ta l illn e s s , to a tw e n ty-f o u r m o n th p e ri o d . A c c o rd in g ly, Y o u n g ’s b e n e f its w o u ld e x p ir e o n M a y2 7 , 2 0 0 4 . I n 2003, w hi l e r ece i vi ng benef i t s underthe Pol i cy , Y oung appl i ed forSoci al Secur i tyD i s abi l i tybenef i t s , des cr i bi ng hi s condi t i on as “s ever e cl i ni cal depr es s i on – u n a b le to f

o c u s o r c o n c e n tr a te .” (S u p p . A p p . a t A M E R 0 7 0 5 .) T h e S o c ial S e c u rity A dm i ni s tr at i on aw ar ded Y oung benef i t s on J anuary25, 2004, bas ed on i t s det erm i nat i on th a t h e h a d b e c o m e d is a b le d o n N o v e m b e r 2 6 , 2 0 0 1 . J us tpr i ort o the expi r at i on of hi s benef i t s underthe Pol i cy , Y oung not i fi ed the in d iv id u a l at A I L if

e w h o w a s h a n d lin g h is c laim (th e “ c laim s a d m in istra to r” ) th a t h is di s abi l i tyw as ongoi ng, and he r eques t ed i nform at i on t o chal l enge the upcomi ng ex p ir ati o n o f h is L T D b en ef it s. O n Ju ly1 , 2 0 0 4 , D r. E b erz w rote a let ter on Y o u n g ’sT he lett er i s addressed t o “A IG L i fe C om pan i es ( U . S . ), A pp eal s U nit , ” and say s, 2 a m o n g o th e r th in g s, “ I d o b e liev e th a t th e tw o y e a r lim itatio n f o r m e n tal d isa b ili tyis hi ghl ydi s cr i m i nat oryand w oul d notbe r ece i ved fa vor abl ybythe court s . . . . ” ( Supp. A p p . at A M E R 0 6 1 8 .) T h u s, d e sp ite h is c laim o f a p h y sic a l d isa b ili ty , Y o u n g c o n tin u e d to a d v o c a t e h i s c a s e a s i f

i tw e r e b a s e d o n a m e n t a l d i s a b i l i ty.

4 beh al f st at i ng “I do no tun derst and the d i vis i on betw een the m ental and ph y si cal i l l ness and do beli eve that[t he term i nati on of Y ou ng ’s L T D ben efi t s] i s di scr i m i nati ng against p a tien ts w ith m e n tal illn e ss .” (S u p p . A p p . at A M E R 0 6 1 9 .) T h e d o c to r f u rth e r n o ted th a t, in a d d iti o n to m e n tal illn e ss , Y o u n g su f f e re d f ro m p h y sic a l sym p to m s a ss o c iate d w ith w o rk-related str ess s u ch as c h est p ain a n d g astroe so p h ag ea l r ef lux . R ely ing o n this l ett er, Y oung, i n an A ugus t4, 2004 l ett ert o an A I L i fe a ffi l i at e, as s ert ed forthe fi r s tt i m e that h is d isa b ili tyw a s “ p h y sic a l in n a tu re ” a n d th u s n o t su b jec t to th e P o licy ’s tw o -y e a r lim it o n L T D b e n e f

its f o r m e n ta l d is a b ility. (S u p p . A p p . a t A M E R 0 6 1 8 .) 2 T h e re a f ter , A I L if

e re q u e ste d Y o u n g ’s m e d ica l re c o rd s to d e ter m in e w h e th e r h e in f a c ts u f f e r e d f r o m a p h y s i c a l d i s a b i l i ty . On c e th e r e c o r d s we r e r e c e i v e d , th e c l a i ms admi ni s tr at ors oughtan i ndepende ntm edi cal r evi ew byD r . R os e H o, a B oar d C ert i fi ed p h y s i c i a n i n p h y s i c a l me d i c i n e a n d r e h a b i l i t a t i o n . I n c o n n e c t i o n wi th h e rr e v i e w, Dr . Ho cons ul t ed w i th D r . E ber z. D r . H o r eport ed thatD r . E ber z “rul ed out[Y oung] forany c a rd iac p ro b lem s” a n d “ d id n o t f e e l th a t [ Y o u n g ’s] p h y sic a l co n d iti o n ro se to a lev e l in w hi ch he w oul d be phy s i cal l yi m pai r ed, ” butr atherthatY oung w as “s ever el yl i m i t ed s e c o n d a ry to d e p re s s io n a n d a d yn a m ic m o o d .” ( Supp. A pp. atA M E R 0512. ) I n a F e b ru a ry1 , 2 0 0 5 re p o rt, D r. H o a c k n o w led g e d Y o u n g ’s d iag n o se s o f d e p re ss io n , p a n icT h e P o licyd e f in e s “ Y o u r O c c u p a tio n ” a s “ y o u r o c c u p a tio n a s it is re c o g n ize d in 3 the g en era l w o rkp lace . Y o u r oc cu p ati o n d o es n o t m ea n the s p ec ifi c job y o u are per form i ng fora s peci fi c empl oy erorata s peci fi c l ocat i on. ” ( Supp. A pp. at A M E R 0 0 0 9 .) 5 di s or der , carpal tunnel s yndr om e, a pos s i bl e r ot at orcuff t ear , arthr i t i s , j oi ntarthr i t i s and as thm a. She concl uded how ever , that , bas ed on Y oung’ s m edi cal r ecor ds and her di s cus s i on w i th D r . E ber z, Y oung’ s phy s i cal condi t i ons di d notr i s e t o the l evel of a p h y sical disab il ity . In a M arc h 1 4 , 2 0 0 5 let ter, the c lai m s ad m inistrator d en ied Y o u n g ’s requestfor ben efi t s becau se hi s di sabi l i ty“w as a r esul tof a m ental i l l ness” and becau se hi s phy s i cal condi t i ons di d notequat e t o a phy s i cal di s abi l i ty . ( Supp. A pp. at A M E R 0 4 9 7 -99 . ) Y o u n g a p p e a led th a t d e c isio n a n d se n t A I L if e a d d iti o n a l in f

o rm a tio n re lev a n t to h is cl aim , inclu d ing a S ep tem b er 2 0 , 2 0 0 5 let ter fro m D r. E b erz in w h ich D r. E b erz id e n tifie d se v e ra l o f

Y o u n g ’s p h y sic a l co n d iti o n s – a m o n g th e m c h e st p a in , as th m a tic b ron ch it is, an d g astroe so p h ag ea l r ef lux – an d o p ined that Y o u n g w o u ld su ff er a “m ed icall yu n ac ce p table risk” o f d isab il ityin ca rdiac , g astrointesti n al, an d resp ir atory funct i ons i f he r eturned t o w or k. ( Supp. A pp. atA M E R 0471. ) Y oung al s o s entan a f f id a v it i n w h ich h e a ttes ted th a t h e w a s p h y sic a llyin c a p a b le o f c o n tin u in g in h is occupa t i on due t o hi s r ot at orcuff i nj ury , as thm at i c br onchi t i s , carpal tunnel s yndr om e, 3 and ca r di ac s ym pt om s . U pon r evi ew of the fi l e, i ncl udi ng thataddi t i onal i nform at i on, the c la im s a d m in is tr a to r u p h e ld th e d e n ia l o f b e n e f its .6

Y oung appea l ed aga i n. U pon r ece i vi ng Y oung’ s up- t o- dat e medi cal r ecor ds , the cl ai m s admi ni s tr at orarr anged f oranotheri ndepende ntm edi cal r evi ew , thi s one conduct ed byD r . R obertL . M arks , a B oar d C ert i fi ed phy s i ci an i n phy s i cal m edi ci ne and reh ab il it ati o n an d n eu rolo g y . In a d d it ion to rev iew ing Y o u n g ’s m ed ical reco rds, D r. M arks s poke w i th D r . E ber z, w ho s t at ed thatw hen he l as ts aw Y oung, on J une 28, 2005 (eigh teen m o n ths p ri o r), h e f o u n d n o m ajor c ard iac a b n o rm ali ti es d esp it e Y o u n g ’s c o m p lain ts o f

c h e st p a in . D r. E b e rz b e liev e d th a t th e c h e st p a in w a s lik e lyre late d to gas tr oes ophagea l r efl ux di s eas e. I m por t ant l y , D r . E ber z al s o “i ndi cat ed thathe di d not b e lie v e th a t [ Y o u n g ’s ] p h y s ic a l c o n d itio n w a s o f a m a g n itu d e to p re c lu d e re tu rn to w o rk .” (S u p p . A p p . at A M E R 0 1 8 5 , 1 8 9 . ) D r. M ark s also sp o k e w ith Y o u n g ’s ph y siatri st, D r. H ender s on, w ho al s o s t at ed thatY oung w as “s uffi ci ent l yfunct i onal t o be abl e t o w or k. ” ( Supp. A pp. atA M E R 0185, 192. ) B oth doct or s r eturned l ett er s t o D r . M arks cert i fy i ng M a rk s ’s re n d itio n o f

th e irc o n v e rs a tio n s . In a Ja n u a ry1 9 , 2 0 0 7 re p o rt, D r. M a rk s c o n c lu d e d th a t Y o u n g w a s a b le to ph y si cal l yperform his j ob as of N ov em ber 27, 2001 w i th som e l i m i t at i on s – w ri stspl i nts , change s i n pos i t i on, and fi l e ca rr i er s – t o acc om m odat e hi s s houl derpr obl em and carpal tu n n e l syn d ro m e . D r. M a rk s f u rth e r n o ted th a t m o st o f th o se lim itatio n s “ a re a c tu a lly r ecomm endat i ons foras ym pt om at i c i ndi vi dual s i n an otherw i s e ‘ nor m al ’ w or k s i tuat i on. ” (S u p p . A p p . at A M E R 0 1 8 7 .) D r. M a rk s’s re p o rt w a s b a se d o n h is d isc u ss io n s w ith Y o u n g ’s tr e a tin g p h y s ic ia n s a n d a re v ie w o f Y o u n g ’s e n tir e f

ile .7

U pon r evi ew of D r . M arks ’ s r eport , the cl ai m s admi ni s tr at ors entY oung’ s fi l e t o a re h a b ilita tio n c a s e m a n a g e r t o d e te rm in e w h e th e r Y o u n g c o u ld p e rf o rm h is o c c u p a tio n . T he r ehabi l i t at i on cas e managerconcl uded that , bas ed on D r . M arks ’ s r eport , Y oung c o u l d p h ys i c a l l y p e r f

o r m h i s o c c u p a t i o n , a s e d e n t a ry l e v e l j o b i n th e n a t i o n a l e c o n o m y, w i th the ac comm odat i ons i dent i fi ed byD r . M arks . B as ed on a r evi ew of Y oung’ s fi l e, i ncl udi ng D r . M arks ’ s r eportand the r ehabi l i t at i on cas e manager ’ s concl us i ons , the cl ai m s admi ni s tr at oruphel d the det erm i nat i on thatY oung w as notent i t l ed t o benef i t s for p h y s ic a l d is a b ility . H a v in g e x h a u ste d h is a d m in istra tiv e re m e d ies , Y o u n g f iled th is la w su it p u rsu a n t to E R I SA , 29 U . S. C . § 1132( a) ( 1) ( B ) , t o r ecove rbenef i t s underthe Pol i cy . T he part i es fi l ed cro ss-m o ti o n s fo r sum m aryjud g m en t. In a n aly zing Y o u n g ’s claim , the D istri ct C o u rt appl i ed a “ m oder at el yhei ght ened [ arbi tr aryand capr i ci ous ] s t andar d of r evi ew , atthe l ow erend of the s l i di ng s cal e” f i ndi ng thata conf

l i ctof i nt er es texi s t ed bec aus e “the ent i tyfundi ng the pl an . . . al s o m ade the fi nal deci s i on r egar di ng el i gi bi l i ty . ” Y oung v. Am. I n t ’ lL i f e As s u r a n c e Co . o

f N. Y. , Ci v . A. No . 0 7 - 6 2 6 , 2 0 0 8 WL 4 1 5 5 0 8 2 , a t* 6 ( W. D. P a. S ep t. 9 , 2 0 0 8 ). T u rn i n g t o th e me r i t s o f Yo u n g ’ s c l a i m, th e Di s tr i c tCo u r th e l d th a tAI L i fe’ s deni al of bene fi t s w as notarbi tr aryand capr i ci ous underthats t andar d and, a c c o rd in g ly, iss u e d a n o rd e r g ra n tin g s u m m a ry ju d g m e n t to A I L if e a n d a g a in s t Y o u n g . I d. a t * * 6 -8 . Y o u n g tim e ly ap p e a le d .T he D i s tr i ctC our thad s ubj ectm att erj ur i s di ct i on pur s uantt o 28 U . S. C . § 1331 4 and 29 U . S. C . § 1132( e) . O urj ur i s di ct i on ar i s es under28 U . S. C . § 1291. 8 I I . D i s cus s i on 4 W e e x e rc is e p le n a ry re v ie w o v e r a n a p p e a l f ro m a g ra n t o f

s u m m a ry ju d g m e n t. Jacobs C ons tr uctors , I

nc. v. N P S E ner gy Ser vs . , I

nc. , 2 6 4 F .3 d 3 6 5 , 3 6 9 (3 d C ir . 2 0 0 1 ). Sum m aryj udgm enti s appr opr i at e i f ther e i s no genui ne i s s ue of mat er i al fac tand the m o v in g p a rt yis e n title d to ju d g m e n t a s a m a tte r o f la w . I d. ( ci t i ng F ED . R. C IV . P . 5 6 (c )) . “I n m aki ng thi s det erm i nat i on, w e mustcons i derthe evi dence i n the r ecor d i n the l i ght m os tfavor abl e t o the nonmovi ng party . ” I d. A . ER I

SA Standar d of

R evi ew “[ A ] de n ial o f b en ef

it s ch all en g ed u n d er § 1 1 3 2 (a)(1)(B ) i s to b e re v iew ed u n d er a de novo stan d ard u n less the b en ef itp lan g ives the a d m inistrator o r fidu ciaryd iscreti o n ary author i tyt o det erm i ne el i gi bi l i tyforbenef i t s ort o cons true the t erm s of the pl an. ” F i r es t one Ti r e & R ubberC o. v. B r uch , 489 U . S. 101, 115 ( 1989) . I f a pl an gi ves the admi ni s tr at ordi s cr et i on, w e r evi ew the admi ni s tr at or ’ s deci s i ons underan arbi tr aryand c a p ri c io u s s ta n d a rd . D or os how v. H ar t f or d Li f e and Acc. I

ns . C o. , 574 F. 3d 230, 233 ( 3d C ir . 2 0 0 9 ). W e had pr evi ous l yadopt ed a he i ght ened f or m of arbi tr aryand capr i ci ous r evi ew forthos e ca s es i n w hi ch an a dm i ni s tr at oract s undera conf l i ctof i nt er es t , us i ng a “s l i di ng s cal e” appr oach t o addr es s how m uch def er ence s houl d pr oper l ybe af for ded t o a c o n f lic te d a d m in is tr a to r’ s d e te rm in a tio n . See Post v. H ar t f or d I ns . C o. , 501 F. 3d 154, 161 ( 3d C i r . 2007) . I n the w ake of the Supr eme C our t ’ s deci s i on i n Me tro p o lita n L ifeY oung does notcl ai m thatA I L i fe l acks di s cr et i on t o det erm i ne bene fi t s underthe 5 P o licy . In ste a d , Y o u n g a rg u e s th a t th e f a c t th a t A I L if

e a b u se d its d isc re tio n b yf a ili n g to cons i der“al l of the pr obat i ve and r el evantevi dence i n the admi ni s tr at i ve r ecor d” r equi r es us t o appl ya de novo st and ard of revi ew . (A pp el l ant’ s O p. B r. at19 . ) I n o ther w ords, b e c a u se A I L if

e a b u se d its d isc re tio n , arg u e s Y o u n g , A I L if e is n o t en tit led to th e b e n e f it of the arbi tr aryand capr i ci ous s t andar d buts houl d be pena l i zed w i th a de novo stan d ard o f r e v i e w . Y o u n g c i t e s n o l a w i n s u p p o r to f h i s n o v e l th e o ry. T he D i s tr i ctC our tal s o di d notm ent i on G l enn , w h ich issu ed v erysh o rt lyb ef o re 6 the C ou rtrul ed o n the part i es’ m oti on s. 9 I ns ur ance Co. v. G l enn , 128 S. C t . 2343 ( 2008) , how ever , ours l i di ng s cal e appr oach i s no lo n g e r t e n a b le . Es tat e of Schw i ng v. The Li l l

y H eal th P lan , 5 6 2 F . 3 d 5 2 2 , 5 2 5 (3d C ir . 2 0 0 9 ). N e v e rth e les s, c o n f licts o f in ter e st re m a in a f

a c to r th a t co u rts m u st c o n sid e r in e v a lu a tin g w h e th e r a n a d m in is tr a to r’ s d e n ia l o f b e n e f its is a rb itr a ry a n d c a p ri c io u s . I d. at 526. T he Pol i cycl ear l ygi ves A I L i fe the ki nd of di s cr et i on thattr i gger s an arbi tr aryand c a p r i c i o u s s t a n d a r d o f

r e v i e w. ( See Supp. A pp. atA M E R 0- 024 ( “A I L i fe A s s ur ance

5 C om panyof N ew Y or k has ful l di s cr et i on and author i tyt o det erm i ne el i gi bi l i tyfor benef i t s and t o cons true and i nt erpr etal l t erm s and pr ovi s i ons of the G r oup I ns ur ance P o licy .”).) U n f

o rtu n a tely , the D istric t C o u rt d id n o t h a v e th e b e n e f it o f o u r o p in io n in Es tat e of Schw i ng , w hich i ssued m on ths aft er the D i stri ctC ou rtrul ed o n the part i es’

6 m ot i ons , s o the C our tanal y zed Y oung’ s cl ai m underthe s l i di ng s cal e appr oach, det erm i ni ng thata “moder at el yhei ght ened s t andar d of r evi ew , atthe l ow erend of the s l i di ng s cal e” w as appr opr i at e bec aus e of a fi nanci al confl i ct , s i nce the i ns ur erof theA I L i fe c oncede s , as i tdi d befor e the D i s tr i ctC our t , thata fi nanci al confl i ctof 7 in te re s t e x is ts in th is c a s e . Y oung , 2008 W L 4155082, at*5.

10 Pol i cyal s o act ed as a dec i s i on- m akeron benef i t s cover age. Y

oung , 2008 W L 4155082, 7 at*6. B eca us e w e no l ongerus e the s l i di ng s cal e appr oach, w e w i l l appl yan unmodi fi ed a rb itrar ya n d c a p ric io u s re v iew to A I L if e ’s d e c isio n , b u t in d o in g so , w e w ill tak e in to a c c o u n t th e a d m itte d f

in a n c ia l c o n f

lic t a s o n e f

a c to r i n o u r a n a lysis . See G l enn , 1 2 8 S .C t. a t 2 3 5 1 (“ [ C ]o n f

licts a re b u t o n e f

a c to r a m o n g m a n yth a t a r e v iew in g ju d g e m u st ta k e in to acc ount . ”) . “U ndera tr adi t i onal arbi tr aryand capr i ci ous r evi ew , a courtcan ove r turn the deci s i on of the pl an admi ni s tr at oronl yi f i ti s w i thoutr eas on, uns uppor t ed bys ubs t ant i al evi dence orerr oneous as a mat t erof l aw . ” D or os how , 574 F. 3d at234. B . A I L ife D id

N o t A b u se Its D isc re tio n in D e ny in gY o u n gB e n e

fit s A s t o the mer i t s of hi s cl ai m , Y oung cont ends thatA I L i fe’ s det erm i nat i on thathe w as n o t ph y sicall yd isab led is arb itraryan d ca p ri ciou s b ec au se itis co n tr ad ict ed b yD r. E b e rz ’s S e p te m b e r 2 0 , 2 0 0 5 le tte r, a s w e ll a s b e in g u n s u p p o rt e d b yth e re c o rd . S pecifi cal l y , Y ou ng rel i es on D r. E berz’ s st at em ents that Y ou ng “def i nit el ysuffers a r i sk of di s abi l i tyw er e he t o go back t o w or k and thatdi s abi l i tycoul d occurei theri n the car di ac a r ea, gas tr oi nt es t i nal ar ea a nd fr om the r es pi r at orys t andpoi ntas w el l , ” and that “ther e i s a medi cal l yunacc ept abl e r i s k forM r . Y oung t o go back t o w or k fr om the s t andpoi ntof perhaps even a m y ocar di al i nfar ct i on orothers uch ca l ami tyi n the other are as o u tl ined ab o v e.” (S u p p . A p p . at A M E R 0 4 7 1 . ) T h e d o ctor’s c o m m en ts, h o w ev er, h a v e b e e n s e r i o u s l yu n d e r mi n e d a n d wi l l n o tb e a rth e we i g h tYo u n g p u t s o n th e m.Y o u n g ’s a s s e rt io n s th a t A I L if e f a ile d to c o n s id e r D r. E b e rz ’s le tte r a re m e ri tle s s . 8 T h e c laim s a d m in istra to r e x p licitlyid e n tifie d th e lette r a s a m o n g th e item s re v iew e d in connec t i on w i th the deni al of Y oung’ s fi r s tappea l , butr ej ect ed D r . E ber z’ s concl us i ons as uns uppor t ed byobj ect i ve fi ndi ngs . T he mer e fa ctthatnei therD r . M arks ’ s r eportnor th e c laim s a d m in istra to r’s f in a l lette r d e n y in g Y o u n g ’s s e c o n d a p p e a l sp e c if ica lly r e f e r e n c e d Dr . Eb e r z ’ s l e t t e r , wh e n i ti s c l e a rth a tb o th M a r k s a n d th e c l a i ms admi ni s tr at orr evi ew ed Y oung’ s ent i r e fi l e i n det erm i ni ng Y oung’ s di s abi l i tys t atus , does n o t re q u ire u s to f

in d in Y o u n g ’s f

a v o r, es p e c iallyin lig h t o f D r. E b e rz ’s c h a n g e in 11 Fi r s t , D r . E ber z’ s s t at ementthatY oung’ s phy s i cal condi t i ons pr es ent ed “a m edi cal l yunacc ept abl e r i s k [i f Y oung w ent ] back t o w or k fr om the s t andpoi ntof perhaps even a m y ocar di al i nfar ct i on [i . e. , a hea r tatt ack] ” i s fl at l ycontr adi ct ed byhi s di s cus s i ons w ith D rs. H o a n d M a rk s in w h ich h e a c k n o w led g e d th a t Y o u n g c o u ld in d e e d re tu rn to wo r k . F u r th e r , Dr . E b e r z ’ s o wn r e c o r d s – wh i c h i n d i c a t e n o r ma l s tr e s s t e s t s a n d E KGs and no phy s i cal abnorm al i t i es – contr adi ctthe not i on thatY oung i s phy s i cal l ydi s abl ed d u e to a h e a rt c o n d iti o n o r th a t Y o u n g m ig h t su f f e r a h e a rt a ttac k sh o u ld h e re tu rn to w o rk . In f

a c t, D r. E b e rz h a s in d ica ted o n m o re th a n o n e o c c a sio n th a t Y o u n g ’s c h e st p a in r es ul t ed fr om gas tr oes ophagea l r efl ux di s eas e, appar ent l ycaus ed bym ent al s tr es s . T he doct or s tr eat i ng Y oung forotherphy s i cal s ym pt om s , s uch as carpal tunnel s yndr om e and shou l der pai n, did not i nd i cat e t hat Y ou ng w as phy si cal l ydis abled du e t o those c o n d iti o n s, n o r d o th e ir re c o rd s s u g g e st th a t Y o u n g ’s c o n d iti o n s re n d e r h im p h y sic a lly di s abl ed. G i ven the l ack of m edi cal evi dence s ugges t i ng phy s i cal di s abi l i tyand the adequa t el ys uppor t ed opi ni ons of D r s . H o and M arks , A I L i fe di d notabus e i t s di s cr et i on i n d i s r e g a r d i n g Dr . E b e r z ’ s u n s u p p o r t e d d i s a b i l i tyc o n c l u s i o n , wh i c h c o n tr a d i c t s h i s o wn st at em ents and recor ds. See B lack & D ecker D isabil i t y P lan v. N

ord , 538 U . S. 822, 825 8p o sit ion . Y o u n g also arg u es th at i t i s n o t cl ea r w h ethe r D r. E b erz ’s st atem en t t o D r.

M arks , thatY oung coul d phy s i cal l yw or k, r efe rr ed t o w or k i n Y oung’ s ow n occupa t i on or “w or k i n gener al ” s uch as “part - t i m e uns ki l l ed w or k. ” ( A ppel l ant ’ s O p. B r . at21. ) E ven a ss u m in g th a t D r. E b e rz ’s s tate m e n t co u ld b e g iv e n th e m e a n in g Y o u n g a ttribu tes to it, D r . M arks cl ear l yunder s t ood Y oung’ s pos i t i on, and the conc l us i ons i n hi s r eport , w hi ch w er e r eac hed i n l i ghtof thatunder s t andi ng, ar e s uffi ci ent l ys uppor t ed bythe medi cal re c o rd . L ik e w is e , H

ooverv. P r ovi dent

Li f e and Acci dentalI

ns ur ance Co. , on w hi ch 9 Y o u n g also reli es, co n ce rne d a c lai m an t suf fe ri n g fro m a h ea rtco n d it ion : coro n aryartery d isease w ith str ess-ind u ce d an g ina. 29 0 F . 3 d 8 0 1 , 8 0 3 (6th C ir . 2 0 0 2 ). 12 ( 2003) ( “[P] l an admi ni s tr at or s ar e notobl i ged t o acc or d s peci al defe r ence t o the opi ni ons o f tre a tin g p h y sic ian s.” ); Str at t on v. E . I . D uP ontD e N

em ours & Co. , 363 F. 3d 250, 258 (3 d C ir. 2 0 0 4 ) (“ A p ro f e ss io n a l d isa g re e m e n t d o e s n o t am o u n t to a n a rb itrar yre f u sa l to cr edi t . ”) . Fur therm or e, s i nce the ca s e bef or e us i s cl ear , the conf l i ctof i nt er es ti dent i fi ed bythe D i s tr i ctC our tdoes nott i p the s cal es i n favorof Y oung, es peci al l ys i nce ther e i s no in d ic a tio n th a t th e c o n f lic t a f f e c te d A I L if

e ’s d e c is io n . See G l enn , 128 S. C t . at2351 (n o tin g th a t a c o n f

lict o f in ter e st “ w ill a c t as a tieb re a k e r w h e n o th e r f a c to rs a re c lo se ly bal ance d” and “ s houl d pr ove more i m por t ant. . . w her e ci r cumst ance s s ugges ta hi gher li k eli h o o d that itaf

fe cted the b en ef

it s d ec isi o n ”). Y oung r el i es heavi l yon Lass erv. R el i ance Standar d Li f e I ns ur ance Co. , 344 F. 3d 381 ( 3d C i r . 2003) i n s uppor tof hi s ar gum entthatA I L i fe a ct ed arbi tr ar i l yand c a p ric io u slyb yd isre g a rd in g th e u n a c c e p tab le m e d ica l risk id e n tifie d b yD r. E b e rz , b u t Lass eri s di s t i ngui s habl e. U nl i ke Y oung, the cl ai m anti n L asser su f f e re d f ro m a w e lldocument ed hea r tcondi t i on. 344 F. 3d at383 ( not i ng thatthe pl ai nt i ff “ s uffe r s fr om 913

cor onaryart erydi s eas e”) . Fur therm or e, i n Lass er , w e h eld th at th e a d m inistrator’s d e c i s i o n wa s a rb i tr a rya n d c a p r i c i o u s b e c a u s e “ a l l e v a l u a t i n g p h y s i c i a n s [ i n c l u d i n g two d o ctors e n g ag ed b ythe a d m inistrator] – w ith the e x ce p ti o n o f [ o n e d o ctor] w h o se re p o rt the other s di s cr edi t ed – agr eed that[the pl ai nt i ff’ s ] heartcondi t i on pr ecl udes hi m fr om s afe l yper form i ng [the dut i es of hi s j ob] . ” I d. a t 3 9 1 . In c o n tra st, th e e v id e n c e in th is c a s e s tr o n g l y s u g g e s t s th a tY o u n g c a n p e r f o r m h i s j o b w i th o u tr i s k i n g p h ys i c a l i n j u ry. A lth o u g h o c c u p a tio n a l stre ss m ig h t h a v e b e e n h a z a rd o u s to Y o u n g ’s m e n tal c o n d iti o n , it w a s n o t arb itrar ya n d c a p ric io u s f o r A I L if e to c o n c lu d e th a t Y o u n g c o u ld p h y sic a lly w ork athis occu pati on and han dle w ork-r el at ed st res s. Fur therm or e, w e ca nnotover l ook th e f a c t th a t Y o u n g c o n sis ten tlyc h a ra c ter ize d h is d isa b ili tya s d e p re ss io n – b o th in h is L T D b e n e f

its c laim f

o rm a n d h is a p p lica tio n f o r so c ial s e c u rityb e n e f its – a n d o n ly change d hi s pos i t i on w hen he r eal i zed thathi s benef i t s had bee n exhaus t ed underthe P o lic y ’s m e n ta l illn e s s p ro v is io n . Y o u n g also arg u es th at A I L ife’s reli an ce o n D r. M ark s’s o p inion w as a rbitrary a n d c a p ric io u s b e c a u se D r. M a rk s n o ted Y o u n g w o u ld n e e d so m e a c c o m m o d a tio n s to re tu rn to w o rk b u t th e P lan ’s d e f in iti o n o f “ d isa b ili ty ” d o e s n o t ac c o u n t f o r re a so n a b le acc om m odat i ons orl i m i t at i ons . A I L i fe r es ponds thatthe Pol i cys peaks i n t erm s of “es s ent i al dut i es , ” def

i ned bythe Pol i cyas , among ot herthi ngs , “a dutythat. . . can notbe r eas onabl yom i tt ed orchange d. ” ( Supp. A pp. atA M E R 0006. ) T hi s l anguage , A I L i fe ar gues , “exe m pl i fi es a modi fi cat i on pr ovi s i on, w hi ch i m pl i cat es r eas onabl e w or kpl aceFur therm or e, s i nce Y oung’ s j ob as an att orneyi s cons i der ed s edent aryw or k that 10 re q u ire s o n lyth e o c c a sio n a l li f tin g o f u p to ten p o u n d s, it is u n lik e lyth a t th e n e e d to engage i n heavyl i ft i ng can f ai r l ybe cons i der ed an e s s ent i al dutyof the j ob. A l though Y o u n g a ss e rts in h is a f

f id a v it th a t, as a n a tto rn e yf o r A IG , h e w a s re g u lar lyre q u ire d to carryfi l es , exhi bi t s , and books r angi ng betw een tw entyand one- hundr ed pounds , w hether Y oung can pe r form hi s occupa t i on as r equi r ed bythe Pol i cydepends on w hetherhe ca n p e rf o rm th e d u tie s o f

th a t jo b a s it e x is ts in th e g e n e ra l w o rk p la c e .

14 a c c o m m o d a tio n s,” th e re b yp e rm itt in g A I L if e to tak e re a so n a b le a c c o m m o d a tio n s in to a c c o u n t in d e te rm in in g w h e th e r a c la im a n t c a n p e rf o rm th e e s s e n tia l d u tie s o f h is jo b . (A p p e lle e s ’ A n s w e ri n g B r. a t 4 9 .) D r . M arks concl uded thatY oung “s houl d have be en abl e t o phy s i cal l yper form the dut i es of hi s w or k, butw i th s om e l i m i t at i ons , ” namel y , avoi di ng heavyl i ft i ng, changi ng pos i t i on everyforty - fi ve mi nut es , and us i ng a w r i s ts pl i ntt o as s i s tw i th w r i t i ng, typi ng, and us i ng the phone. ( Supp. A pp. atA M E R 0186. ) T o the ext entthatcarry i ng fi l es and typi ng w oul d be di ffi cul tforY oung due t o hi s s houl derpr obl em and carpal tunnel s yndr om e, i ti s cl earthatthe ef fec t s of thos e t as ks can be amel i or at ed byal l ow i ng Y oung t o us e w r i s ts pl i nt s and devi ces , s uch as a w heel ed br i efc as e, t o fac i l i t at e the tr ans ferof l arge fi l es. T hu s, w hil e D r. M arks m ayhav e i nco rporat ed li m i t at i on s i nto hi s anal y si s,

10 he w as s i m pl ydoi ng w hatw as r equi r ed underthe Pol i cybyout l i ni ng the manneri n w hi ch Y o u n g w a s c a p a b le o f

p h y sic a llyp e rf

o rm in g th e e ss e n tial d u ties o f h is jo b . A I L if

e d id n o t ab u se its d isc re tio n in re ly in g o n D r. M a rk s’s re p o rt b e c a u se it co u ld re a so n a b ly concl ude thatthe as pect s of the j ob w i th w hi ch Y oung m i ghts truggl e coul d be addr es s ed byadopt i ng the s ugges t ed l i m i t at i ons , m os tof w hi ch w oul d be r ecomm ended e ven “f or15

as ym pt om at i c i ndi vi dual s i n an otherw i s e ‘ nor m al ’ w or k s i tuat i on. ” ( Supp. A pp. at A M E R 0187. ) Si m pl ybeca us e D r . M arks di d notus e l anguage thattr acks the Pol i cydoes notm ean thatA I L i fe a bus ed i t s di s cr et i on. Fur therm or e, the Pol i cydi ct at es thatbenef i t s w i l l be t erm i nat ed i f a c l ai m ant

“ re f u se s to c o o p e ra te w ith o r try.. . m o d if ica tio n s m a d e to th e w o rk site o r jo b p ro c e ss to a c c o m m o d a te [ th e c laim a n t’s] id e n tifie d m e d ica l li m itatio n s to e n a b le [ th e c laim a n t] to per form the Ess ent i al D ut i es of [the cl ai m ant ’ s ] O ccupa t i on ora r eas onabl e al t ernat i ve. ” ( Supp. A pp. atA M E R 0017. ) I ti s cl earthen that , t o the ext entY oung can pe r form the essent i al du t i es of h i s j ob w i th acco m m od at i on s, he is no tenti t l ed to ben efi t s. I I I . C oncl usi on D e sp ite Y o u n g ’s a ttem p t to tra n sf o rm h is d e p re ss io n a n d a ss o c iate d m e n tal h e a lth i s s ues i nt o a phy s i cal di s abi l i ty , the r ecor d adequa t el ys uppor t s A I L i fe’ s det erm i nat i on thatY oung’ s m ent al and phy s i cal condi t i ons di d notequat e t o a phy s i cal di s abi l i tythat pr ecl udes hi m fr om w or ki ng i n hi s ow n occupa t i on. A ccor di ngl y , i tw as notarbi tr aryor capr i ci ous forA I L i fe t o denyhi m benef i t s . W e w i l l ther efor e af fi r m the j udgm entof the D is tr ic t C o u rt .