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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF TEXAS

DALLAS DIVISION

THERALD WORFORD §

§

Plaintiff, §

§

vs. § 

§ Civil Action No. 3:04-cv-1903-R

MONARCH DENTAL ASSOCIATES, L.P., §

MONARCH DENTAL CORPORATION, & §

MODERN DENTAL PROFESSIONALS, §

P.C., §

§

Defendants. §

MEMORANDUM OPINION

Before the Court are cross-motions for summary judgment. After reviewing the pleadings,

the parties’ briefing, the parties’ submissions, and the applicable law, the Court GRANTS Plaintiff’s

Motion for Summary Judgment (Dkt No. 20) and DENIES Defendants’ Motion for Summary

Judgment (Dkt No. 24).

I. BACKGROUND

Plaintiff Therald Worford sued defendants, Monarch Dental Associates, L.P., Monarch

Dental Corporation, and Modern Dental Professionals, P.C. (collectively Monarch), to recover shortterm disability benefits that he alleges were wrongfully denied to him under Monarch Dental’s

Short-Term Income Replacement Plan (the Plan), a self-funded ERISA employee benefit plan. 

Worford is a former employee of Modern Dental Professionals, P.C., a Texas professional

corporation that employed Worford and the other dentists who worked at the Monarch Dental

Centers where Worford worked. Worford was hired as an associate dentist in 1999. On December

1, 2000, he was promoted to the position of District Director and transferred to the Monarch office

 

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at 2540 Old Denton Road in Carrollton, Texas, which was the position he held when he ceased

coming to work in September 2002. During Worford's employment with Modern, Worford provided

dental services to patients. 

While working at the Carrollton Office, the facility experienced major continuing water

damage. In January 2002, the ceiling collapsed as a result of the leaks in the roof. While repairs were

being done, Worford saw black mold on the ceiling tiles. Later testing confirmed what Worford

suspected – that the office contained mold toxins. In mid-2002, Worford became sick to the point

that he ceased working to find the cause of his illness. 

In October 2002, he submitted a claim for short-term disability benefits under Monarch

Dental’s Short-Term Income Replacement Plan. Monarch denied that claim on December 10, 2002.

Worford appealed and Monarch denied his appeal. Worford then made a claim for long-term

disability. And on February 14, 2004, Monarch’s long-term disability plan found Worford disabled

and granted his long-term disability claim. Worford then filed this suit on August 13, 2004, to

recover the benefits Monarch continued to deny him under his short-term disability policy. 

A. The Plan

At all relevant times, Monarch Dental Corporation funded and maintained the Plan,

providing short-term disability benefits to employees of Monarch and its related companies,

including Modern, Worford’s employer. According to Robert James, Monarch Dental Corporation’s

Benefits Manager, Monarch contracted with Canada Life Assurance Company “to provide certain

claims administration services.” However, Monarch “retained final discretionary authority to

construe the Plan and to determine if short-term disability benefits would be paid under the Plan.”

 

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Canada Life was neither a Plan affiliate nor a source of funding for claims payments. Pursuant to

its Administrative Services Agreement with Monarch Dental Corp., Canada Life made claims

investigations for Monarch and advised Monarch of whether the claims should be paid under the

terms of the Plan. However, Monarch – Robert James specifically – retained “final decision making

authority . . . regarding the approval of claims for short-term disability benefits.” After considering

Canada Life’s advice concerning a claim, Robert James, Monarch’s Benefits Manager, would make

a decision, relay the decision to Canada Life, and then Canada Life would relay Monarch’s decision

to the employee. The final decision on whether to grant or deny claims under the Plan remained

solely under Monarch’s control. 

Under the Plan, an employee is eligible for short-term disability benefits only if he is

"disabled," which means that he is "not able to perform with reasonable continuity the substantial

and material duties of his own occupation in the usual or customary way due to injury, disease,

illness, pregnancy, or mental disorder." 

B. Denial of Worford’s Short-Term Disability Claim

In October 2002, Worford submitted a claim for benefits under the Plan. The claim included

a form that was completed by Worford’s treating physician, Alfred Johnson, D.O. Dr. Johnson made

a “primary diagnosis” of “Toxic effects of substance – nonmedicinal– mold & mold toxins,” and

indicated Worford was suffering from "[m]alaise & fatigue; sleep disturbance; Allergic Rhinitis."

Dr. Johnson further indicated that Worford’s medical condition affected his ability to work in the

following ways: “Memory loss, severe reactions, dizziness, numbness, headaches.”

 

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 In response, Cathy Sanders, Service Disability Specialist for Canada Life, requested

Worford’s medical records from Dr. Johnson. The records that were transmitted contained two

letters concerning Worford. The first one, dated September 24, 2002, stated in part:

Mr. Worford has been under my medical care and is found to have had a toxic

exposure to mold in the workplace. Laboratory data as well as skin tests show

hypersensitivity to mold as well as immune system reaction to mold toxins.

He reports that recently remediation was done in one suite in the office for mold and

that other mold has been found. It is my medical opinion and advice that he should

not have further exposure in the work place until he can be adequately treated and

full remediation completed and verified by indoor air quality measurements.

If you have any further questions, please contact me. 

The second letter, dated October 22, stated in relevant part, “Mr. Worford is under my medical care

and is found to have had a toxic exposure to mold in the work place. He is currently disabled with

the duration of his disability unknown due to continued evaluation and initiation of treatment.”

Worford’s medical records also indicated that when he sought treatment from Dr. Johnson

Worford complained of: lower back pain, fatigue, general malaise, pain in left leg, numbness,

coughing, fever, allergies, asthma, dizzy and spacy feeling, eye itching, inflammation of the eye, eye

swelling eye tearing, nasal drainage, nasal obstruction rhinitis, sinusitis headaches, sinusitis, sleep

apnea, hoarseness, cough, dizziness, memory loss, diarhea, itching - generalized, sleep disturbance,

anxiety - excessive worrying. Dr. Johnson noted that, when examined, Worford’s balance was

unsteady, his tandem gait was abnormal with instability and a tendency to fall, and a Romberg’s

stability test indicated abnormality. 

On the referral form Monarch used to transmit the claim to Canada Life, Monarch noted that

“claimant is [out of work] due to toxic effect of mold. States has exposure in the work place.

[Worker’s Compensation] was denied. Has malaise and fatigue, [sleep] disturbance, allergic rhinitis,

 

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memory loss, dizziness, headaches. . . . Does the medical support total disability from 09-20-02 thru

1/5/03?”

Canada Life's medical staff reviewed the materials received from Dr. Johnson. Specifically,

Dana Popovich, RN, BSN, reviewed the records. Her analysis of Worford’s medical records is as

follows:

I have reviewed Dr. Worford’s medical records from Dr. Johnson. Dr. Johnson has

diagnosed Dr. Worford with an allergic reaction to mold. However, I do not see any

antihistimine medications prescribed by Dr. Johnson to take care of his [Worford’s]

reaction to the mold. Worford is getting Gluathione injunctions from Dr. Johnson

and this has nothing to do with his allergy to mold. Gluathion is found in the liver

tissue and is important for liver function. I’m not sure why Dr. Johnson is giving this

to Worford and it is unclear in the medical records as to why he is giving it. Why Dr.

Johnson needs so long to adjust medication and treatment and why he thinks this

requires time off work is not explained in the records. Many people have allergies

that are treated and treatments that are changed, all while they continue to work.

None of the diagnoses: cough, rhinitis and sleep disturbance requires prolonged

periods out of work. Treatment does not seem geared to relieving symptoms, but to

discovering cause. This is fine, but treatment of the individual with appropriate

medications so they can return to work is paramount. At this time I do not see

objective medical findings that support limited function. [Signed 12/09/02]

The record indicates no attempt to follow up the investigation by contacting Dr. Johnson.

Instead, based on this assessment and review of the medical file, Monarch, specifically Robert

James, decided to deny Worford’s claim and relayed that decision to Canada Life. Thus, on

December 10, 2002, Cathy Sanders, Canada Life’s Senior Disability Specialist, wrote a letter to

Worford explaining that Worford's claim had been denied. In her letter, Sanders wrote the

following:

This letter is in regard to your appeal of Short Term Disability benefits. After careful

review by our medical staff, the medical documentation submitted does not support

preclusion of all work capacity from any underlying physical condition, including

allergies to mold. The documentation that was reviewed was [sic] the treatment

notes and lab reports from Dr. Johnson. None of the diagnoses of cough, rhinitis,

and sleep disturbance require prolonged periods out of work.

 

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The letter also explained Worford’s right to appeal.

On February 18, 2003, Worford submitted a letter appealing the claim denial. He enclosed

two documents from Dr. Johnson: the letter of October 22, 2002, which was already in his file, and

a new letter dated January 20, 2003. In his January 20 letter, Dr. Johnson laid out the chief

complaints that Worford presented and said that Worford “continues under my care at this time for

treatment of backache, allergic rhinitis due to other allergens, toxic effect molds.” He also stated

that Worford “continues to be disabled at this time due to his exposure to mold and mycotoxins at

his office.” 

Canada Life again reviewed the claim. Monarch does not make clear in the record what kind

of review was actually done. Sanders says she discussed the claim with Mitchell Nudelman, M.D.,

a doctor with whom Canada Life contracted to review benefit claims. Sanders claims that Dr.

Nudelman concluded that Worford should have been able to work despite his allergies to mold.

However, Monarch provides no record of Dr. Nudelman’s review. There is no affidavit from him,

there is no indication that he actually reviewed Worford’s medical records, and there is no

explanation of the basis for his opinion, according to Sanders, that Worford was not disabled.

Sanders discussed her conclusions with Monarch’s Benefits Manager, Robert James, who agreed

that Worford’s claim should be denied. Thus, Canada Life sent a letter to Worford dated May 1,

2003, informing Worford that his appeal had been denied and explained, “Many individuals have

allergies that are treated and treatments are changed while they continue to work.”

C. After Short-Term Disability Claim Denied, Long-Term Disability Granted

 

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Worford submitted a claim for long-term disability to his Monarch Dental Group policy. On

February 19, 2004, his claim was granted. The Disability Claims Specialist at The Standard

Insurance Company found that the “medical documentation contained in Dr. Worford’s claim file

including the findings from an independent neuropsychological file review, support that Dr. Worford

has been unable to perform the material duties of his Own Occupation as a Dentist . . . .” Worford’s

award of long-term disability dated back to December 21, 2002, or 90 days after the onset of his

disability – September 20, 2002. 

After receiving his long-term disability under his Monarch policy, Worford filed this

lawsuit, alleging that his claim for short-term disability benefits was wrongfully denied, in violation

of section 502 of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C.

§1132(a)(1)(B). 

II. ANALYSIS

Section 502 of ERISA permits a “participant or beneficiary” of a covered employee benefit

plan to file a civil action in federal court “to recover benefits due to him under the terms of his plan,

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

terms of the plan.” 29 U.S.C. §1132(a)(1)(B). The parties do not dispute that Worford was covered

by the Plan or that his claim arises exclusively under ERISA. 

A. Standards of Review

 

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1. Summary Judgment Standard

“Summary judgment procedure is properly regarded not as a disfavored procedural shortcut,

but rather as an integral part of the Federal Rules as a whole which are designed ‘to secure just,

speedy and inexpensive determination of every action.’” Celotex Corp. v. Catrett, 477 U.S. 317,

327 (1986) (citing Fed. R. Civ. P. 1). Summary judgment under Rule 56(c) of the Federal Rules of

Civil Procedure is appropriate when there is no genuine issue as to any material fact in the case and

the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c); Celotex Corp.,

477 U.S. at 322; Melton v. Teachers Ins. & Annuity Ass’n of Am., 114 F.3d 557, 559 (5th Cir. 1997).

The party moving for summary judgment bears the initial burden of identifying those

portions of the pleadings, depositions, answers to interrogatories, and admissions on file, together

with affidavits, if any, which it believes demonstrate the absence of a genuine issue of material fact.

Celotex, 477 U.S. at 323; Calbillo v. Cavender Oldsmobile, 288 F.3d 721, 725 (5th Cir. 2002).

Where the nonmovant bears the burden of proof on a claim upon which summary judgment is

sought, the movant may also discharge its initial burden by showing that there is an absence of

evidence to support the nonmoving party's case. See Celotex, 477 U.S. at 325. Once the movant has

met its initial burden, the nonmovant must set forth specific facts, by affidavits or otherwise,

showing that there is a genuine issue for trial. See Matsushita Elec. Indus. Co. v. Zenith Radio

Corp., 475 U.S. 574, 587 (1986). To avoid summary judgment, the non-moving party “must do

more than show that there is some metaphysical doubt as to the material facts.” Id. at 586. “If the

evidence [proffered by the nonmovant] is merely colorable, or is not significantly probative,

summary judgment may be granted.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 2549-50

 

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(1986). On the other hand, the evidence of the nonmovant must be believed and all justifiable

inferences must be drawn in its favor. See id. at 255 (1986). 

2. Standard of Review of ERISA Benefits Determinations 

When reviewing a claim for benefits allegedly due under an ERISA plan, the Supreme Court

has held that the denial of benefits is “reviewed under a de novo standard unless the benefit plan

gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or

to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).

Further, the Fifth Circuit demands that this Court review any factual determinations made by the

administrator under an abuse of discretion standard. Vercher v. Alexander & Alexander Inc., 379

F.3d 222, 226 (5th Cir.2004) (citations omitted). 

An abuse of discretion occurs where a plan administrator or other fiduciary acts arbitrarily

or capriciously. See Meditrust Fin. Servs. Corp. v. The Sterling Chems., Inc. Med. Benefits Plan,

168 F.3d 211, 214 (5th Cir. 1999). “An arbitrary decision is one made without a rational connection

between the known facts and the decision or between the found facts and the evidence.” Bellaire

Gen. Hosp. v. Blue Cross Blue Shield, 97 F.3d 822, 828 (5th Cir.1996). Under the abuse of

discretion standard, the Fifth Circuit has also created a sliding scale review where a plan

administrator is given less deference when there is a conflict of interest – that is, where the plan

fiduciary financially gains from each claim denial. Gooden v. Provident Life & Acc. Ins. Co., 250

F.3d 329, 333 (5th Cir. 2001). 

The Court’s review is limited to the evidence contained in the administrative record. Vega

v. Nat'l. Life Ins. Servs., Inc., 188 F.3d 287, 300 (5th Cir.1999). “[T]he administrative record

 

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The evidence submitted to the Court in conjunction with Monarch’s Motion for

Summary Judgment do not include any documents that demonstrate how the Plan was funded. 

However, Robert James’s affidavit states, “Benefits under the Plan are paid by Monarch.” And

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consists of relevant information made available to the administrator prior to the complainant's

filing of a lawsuit and in a manner that gives the administrator a fair opportunity to consider it.” Id.

(emphasis added). “Before filing suit, the claimant’s lawyer can add additional evidence to the

administrative record simply by submitting it to the administrator in a manner that gives the

administrator a fair opportunity to consider it.” Id. In its briefing, Monarch claims that according

to Vega “in reviewing a decision to deny benefits the district court must limit itself to considering

the evidence that was before the plan administrator when it made the decision.” (Emphasis added.)

This conclusion seems more than disingenuous. No fair reading of Vega can support such a claim.

The district court may consider all evidence the plaintiff provided to the administrator prior to the

plaintiff’s filing of a lawsuit, not prior to the administrator’s denial of the claim. 

B. Resolution

This case involves a fact question – whether Worford’s medical condition rose to the level

of a disability. So the court begins with an abuse of discretion standard. Gooden v. Provident Life

& Accidental Ins. Co., 250 F.3d 329, 332 (5th Cir. 2001). But the Court must also consider the extent

to which Monarch had a conflict of interest in denying the claim. A court’s deference to the abuse

of discretion standard is modified downward on a “sliding scale” when the plan fiduciary has a

conflict of interest. Id. at 333; Vega, 188 F.3d at 297. 

Here, Monarch has a very evident conflict. Monarch funds the Plan, not through purchasing

insurance from a third party, but through its own operating expenses.1

 Monarch, therefore, is a

 

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“Monarch . . . retained final discretionary authority to construe the Plan and to determine if

short-term disability benefits would be paid under the plan.”

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completely self-interested administrator of the plan. The fewer claims paid, the higher Monarch’s

profits. Therefore, based on Monarch’s conflict of interest, the Court will apply a less deferential

standard of review than abuse of discretion but more deferential than de novo.

1. The plan administrator cherry picked Dr. Johnson’s records to deny disability.

Monarch’s decision to deny short-term disability benefits to Worford was an abuse of

discretion. Monarch contracted with Canada Life to investigate short-term disability claims under

the plan. When originally presenting the claim to Canada Life, Worford’s treating physician, Alfred

Johnson, D.O., completed a form indicating a “primary diagnosis” of “Toxic effects of substance

– nonmedicinal – mold & mold toxins,” and indicated Worford was suffering from "[m]alaise &

fatigue; sleep disturbance; Allergic Rhinitis." Dr. Johnson further indicated that Worford’s medical

condition affected his ability to work in the following ways: “Memory loss, severe reactions,

dizziness, numbness, headaches.” Worford’s medical records indicate that when he sought treatment

from Dr. Johnson he complained of: lower back pain, fatigue, general malaise, pain in left leg,

numbness, coughing, fever, allergies, asthma, dizzy and spacy feeling, eye itching, inflammation of

the eye, eye swelling, eye tearing, nasal drainage, nasal obstruction rhinitis, sinusitis headaches,

sinusitis, sleep apnea, hoarseness, cough, dizziness, memory loss, diarhea, itching - generalized,

sleep disturbance, anxiety - excessive worrying. In the medical records, Dr. Johnson noted that

when he examined Worford, Worford’s balance was unsteady, his tandem gait was abnormal with

instability and a tendency to fall, and a Romberg’s stability test indicated abnormality. 

 

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When Monarch referred the claim to Canada Life, Monarch noted that “claimant is [out of

work] due to toxic effect of mold. States has exposure in the work place. [Worker’s Compensation]

was denied. Has malaise and fatigue, [sleep] disturbance, allergic rhinitis, memory loss, dizziness,

headaches. . . . Does the medical support total disability from 09-20-02 thru 1/5/03?”

However, when an RN from Canada Life reviewed Worford’s medical records, she ignored

most of Worford’s symptoms, noting only that “[n]one of the diagnoses: cough, rhinitis and sleep

disturbance requires prolonged periods out of work.” And Canada Life’s letter to Worford indicated

that the basis for denial was:

[T]he medical documentation submitted does not support preclusion of all work capacity

from any underlying physical condition, including allergies to mold. The documentation that

was reviewed was [sic] the treatment notes and lab reports from Dr. Johnson. None of the

diagnoses of cough, rhinitis, and sleep disturbance require prolonged periods out of work.

(Emphasis added).

Monarch chose three of Worford’s symptoms – cough, rhinitis, and sleep disturbance – and

based the decision to deny Worford’s claim as if Worford suffered only from those three symptoms.

Monarch and Canada Life ignored the more disturbing of Worford’s symptoms – malaise and

fatigue, memory loss, dizziness, headaches, pain in left leg, numbness, coughing, fever, dizzy and

spacy feeling, eye itching, inflammation of the eye, eye swelling eye tearing, unsteady balance,

abnormal tandem gait with instability and a tendency to fall. There is no explanation anywhere in

the record why Monarch and Canada Life chose to ignore not only most of Worford’s symptoms,

but also the most dangerous symptoms for a dentist wielding a high-speed drill on a daily basis. 

Fittingly, in oral argument before the Court, Monarch’s attorney argued that a cough, a runny

nose and a lack of sleep does not amount to a disability. Of course, this is a gross misreading of the

medical records. Monarch has attempted to cherry pick three symptoms out of a myriad of

 

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symptoms and ignore the rest. And Canada Life and Monarch picked three of the minor symptoms,

symptoms most people suffer and still manage to perform their jobs. 

However, Worford suffered more than those three symptoms, and he has no ordinary job.

Worford is a highly skilled dentist who operates dangerous equipment that can seriously injury his

patients. According to the medical records, he suffered from dizziness, instability, memory loss,

numbness, headaches, eye itching, eye inflammation, and eye swelling and tearing – all symptoms

that would be dangerous to the patients he cared for. Because neither Canada Life nor Monarch

addressed any of these symptoms in either the initial denial of Worford’s claim or on appeal,

Monarch abused its discretion in denying Worford’s claim. 

Further, neither Canada Life nor Monarch made any reference to Worford’s job duties. Any

decision whether a claimant is “disabled” under Monarch’s short-term disability plan requires

assessment of the claimants ability “to perform with reasonable continuity the substantial and

material duties of his own occupation in the usual or customary way.” (Emphasis added.)

Monarch abused its discretion when it denied Worford’s claim without any evidence that it

considered what job duties Worford performed and how they were affected. 

Finally, the record contains no explanation why Canada Life and Monarch completely

ignored most of Worford’s symptoms. This lack of explanation rises to an abuse of discretion. An

abuse of discretion occurs when a “decision is made without a rational connection between the

known facts and the decision.” See Bellaire Gen. Hosp., 97 F.3d at 828. Because Monarch failed

to even address the known facts in denying Worford’s claim – that Worford suffered from 

dizziness, memory loss, numbness, fever, dizzy and spacy feeling, eye itching, inflammation of the

 

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eye, eye swelling, eye tearing, constant itching, unsteady balance, tendency to fall – Monarch abused

its discretion. 

Although this Court finds that Monarch abused its discretion in denying Worford’s claim

under the most deferential abuse of discretion standard, the Court notes that two other factors weigh

against the reasonableness of Monarch’s decision. First, Monarch used nurses, as opposed to

medical doctors to review the claim and a non-medial administrator to make the final determination

to deny the claim. Second, when Worford later claimed long-term disability under his Monarch

disability plan, the benefits were granted. 

3. Other Consideration – Review by an RN

A plan administrator’s decision is given less deference on the sliding scale if the plan

administrator used nurses, rather then doctors to review and make final recommendations regarding

the payment of claims. Sweatman v. Comm. Union Ins. Co., 39 F.3d 594 (5th Cir. 1994); Gellerman,

376 F. Supp. 2d at 735. Further, the plan fiduciary here – that is, the final decision maker – is not

a medical professional at all. And when denying the claim, Monarch relied on advice from an RN

while disregarding Worford’s treating physician. See Gellerman, 376 F. Supp. 2d at 735. (“That is

not to say that an administrator automatically abuses its discretion if it relies on a nurse, but rather

that when an administrator relies on nurses to override highly trained physicians, the court should

decrease the level of deference afforded the administrator.”). 

 

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4. Other Considerations – Grant of Long-Term Disability

The Court may consider a claimant’s long-term disability award when assessing the

reasonableness of the plan administrator’s decision denying the claimant’s short-term disability. 

See, e.g., id. (finding a determination of disability by the Social Security Administration relevant

in assessing the reasonableness of the defendant’s denial of long-term disability). Monarch’s

later determination that Worford was disabled under his long-term disability policy is not

binding on the outcome of Worford’s short-term disability claim, but it is relevant in assessing

the reasonableness of Monarch’s denial. This is especially true because Monarch was the source

of both plans. Further, the determination to grant Worford long-term disability was made before

Worford filed suit to recover his short-term disability. Therefore, under the Vega principle – that

the administrative record consists of anything available to the plan administrator prior to a

claimant filing suit – the grant of long-term disability becomes something the Court could

consider in assessing the reasonableness of Monarch’s denial of short-term disability. Monarch

sponsored both the long-term and short-term disability plans, and Worford was found disabled

under the long-term plan as of September 20, 2002. 

5. Proper Parties

All Defendants argue that their Motion for Summary Judgment should be granted

because Worford has sued the wrong parties. The Court finds this argument unfounded in law

and unsupported in logic or evidence. Defendant’s claim that under ERISA a suit can be

maintained only against the Plan itself and that none of the Defendants is the Plan. However, the

cases Defendants cite do not support this proposition. 

 

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The Court does agree that not all Defendants are liable under ERISA. Instead, the entity

that serves as the Plan sponsor, the Plan fiduciary, the entity with the final discretionary

authority to determine the ultimate payment or denial of benefits is the Plan. Therefore,

according to Robert James’s affidavit, Monarch Dental Corporation is the proper defendant. 

And the Court grants summary judgment for Defendants Monarch Dental Associates, L.P. and

Modern Dental Professionals, P.C. 

6. Attorney Fees

This Court finds that Worford is entitled to an award of reasonable attorney fees. In

deciding whether to award attorney fees in an ERISA action, the court should consider such

factors as (1) degree of opposing parties' culpability or bad faith, (2) ability of opposing parties

to satisfy award of attorney fees, (3) whether award of attorney fees against opposing parties

would deter other persons acting under similar circumstances, (4) whether parties requesting

attorney fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve

significant legal question regarding ERISA itself, and (5) the relative merits of parties' positions. 

Iron Workers Local No. 272 v. Bowen, 624 F.2d 1255, 1266 (5th Cir. 1980). In deciding whether

to award attorney fees in an ERISA suit, courts should consider the five Bowen factors, without

giving predominance or preclusive effect to any one of them, and should also consider any

relevant non-Bowen factors. Riley v. Admin. of Supersaver 401K Capital Accumulation Plan for

Employees of Participating AMR Corp. Subsidiaries, 209 F.3d 780, 782 (5th Cir. 2000).

In awarding attorney’s fees to Worford, the Court relies on the following factors. 

Worford was awarded long-term disability under Monarch’s long-term disability plan well

 

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before Worford filed suit in this case. Although Monarch was given ample time to pay Worford

his short-term benefits, Monarch refused to do so, erroneously arguing in this suit that only the

materials Worford submitted prior to the denial of his claim for short-term benefits were relevant

to the determination. Instead, Vega allows a claimant to supplement the administrative record

until the time suit is filed in order to encourage settlement of claims like these. 

Nothing in the record indicates that Monarch is unable to pay an award of attorney fees. 

In awarding attorney fees to Worford, the Court believes that it will deter Monarch and other

litigants from refusing to comply with the letter and spirit of Vega, which advocates that

claimants continue to provide Plan Administrators or fiduciaries with evidence to settle the claim

rather than rushing to the federal courthouse. Of course, when a Plan Administrator refuses to

consider the later-supplied evidence, then the purpose Vega’s broad interpretation of the

administrative record is thwarted. 

Further, Monarch demonstrated in this case, the need for an attorney fees award. As

counsel for Worford persuasively argued before this Court, without the award of attorney fees,

Monarch has absolutely no incentive to settle Worford’s short-term disability claim. Without the

liability for attorney fees, Monarch merely becomes liable for the amount it should have paid

Worford prior to this suit’s filing, or about $26,000. Worford’s costs and attorney fees have now

surpassed that amount. Therefore, a win for Worford without an award of attorney fees would

actually be a net loss to him. 

Finally, this Court finds little merit in Monarch’s legal claims. The record makes clear

that even under the most permissive abuse of discretion standard, Monarch abused that discretion

when it ignored most of the medical evidence presented by Dr. Johnson, Worford’s treating

 

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physician. Monarch’s only defense seemed to be a misrepresentation of Vega and an

unsupported argument that Worford sued the wrong party. And even when the record contains a

myriad of symptoms from which Worford suffered, counsel for Monarch ignored them all and

argued before this Court that Worford’s claim boiled down to a runny nose, cough and trouble

sleeping – a claim that blatantly misconstrues the record. 

Based on these factors, the Court finds that Worford is entitled to all his attorney fees. 

III. CONCLUSION

For these reasons, the Court DENIES Defendant Monarch Dental Corporation’s Motion

for Summary Judgment and GRANTS Plaintiff’s Motion for Summary Judgment against

Monarch Dental Corporation. Summary judgment is granted in favor of Monarch Dental

Associates, L.P. and Modern Dental Professionals, P.C. Worford shall recover short-term

disability benefits from September 20, 2002, through December 20, 2002, pursuant to the Plan,

plus pre- and post-judgment interest. Worford shall also recover attorney fees. Worford shall file

a request for attorney fees, with supporting documentation, by April 13, 2007. Defendants may

reply to the request no later than April 20, 2007. 

It is so ORDERED.

ENTERED: March 21, 2007.

___________________________________

HON. JERRY BUCHMEYER

SENIOR UNITED STATES DISTRICT JUDGE

NORTHERN DISTRICT OF TEXAS

 

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