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# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 08

- 2617 B RUCE F IS CHER, Plai nt i f f

-Appe l l ant, v. L IBERTY L IF E A S S URANCE C OM PANY OF B OS T ON an d S T EI N R OE I NVEST MENT C OUN S EL LLC L ONG T E RM D ISABILITY P LA N , D efend a nts-A pp ellees.

Appeal from the United States District Court fo r the N o rthernDi stricto f Illino is, Eas tern Div isi on. No . 05 C3256

—Jo an B. G ott schall, Judge .
A RG UE D J AN UA RY 21, 2009

— D ECI DE D A UGUS T 4, 2009

Befo re P OSNER, F LA UM, a nd W OO D , C ircu it Judges. W OO D , C ircu it Judge. Th is case arose a ft e r Liberty L ife A ssu ra n ce Com pany ofBost on ( “Lib er ty” ) deci ded to ter m i nate the pay m en t of l ong- ter m di sabi l i ty benefi ts to the pl ai nti ff, Bruce Fi scher

. Fi schertr i ed to rev er se that deci si on a t the adm i ni str ati ve l eve l

. W hen he co uld not, h e su ed L ibe rt y an d t h e sp on so r of h is b en efit s p lan , Ste in2 N o. 08

- 2617 Roe Invest m ent CounselL L C Long- Term Dis abi l i ty Pl an (to w hi ch w e r eferco l l ecti vel y a s “ Libe rty”) , se eking an o r derc o m pel li ngLibe r tyt o c o nt i nue hi s be ne fi ts
. The d istr ic t cou rt grante d Liberty’s m otion for su m m ary j udg m en t, a nd F i sc he r a ppea l ed. W e co nc l ude tha t th e distri ct c ourtpro perl y a pp l i ed a defer enti alst andard of re vie w to Liber ty’ s deci si on, and that, under that stan d ard , there is no reversible error.

I A Fi sc he r i s a 5 9

- y e a r - o l d ma n who b e g a n wo r k i ngf or S te i n Ro e I nv es tmentCo uns el, LLC, i n May 19 96 a s th e co m pan y ’ s l ea d pr o g r amm er . On S ept embe r 2 2, 2 00 1, he ended his em plo ym ent with St ei n Roe and ap p lied f or shor t- ter m di sabi l ity benefi ts und erLiber ty’ s be nefi ts pla n ( “Pl an”) , cl ai m i ng m em or y l oss and a tt enti on probl em s. Liber ty approved Fi scher ’ s cl ai m and he be gan r e c e i v i n gs h o r t
- t e r m d i s a b i l i t y b e n e fi t s e ffe c t i v e S e p t e mbe r 2 2, 2 00 1. S ho r tly the r ea fte r, F ische r s o ug htt r ea tment f ro m hi s physi ci an, Dr. Randy Geor gem i l l er . In N ove m ber 2001 , Dr. Geor gem iller di agno sed Fi scherwith “ A xi s I m aj ordepres si on, r ecurr ent, m oder ate co gni ti ve d isorder N OS, and R/O Dem en tia , A l zhei m er ’ s type, ea rl y o nset w ith d ep re ss ion ; A x is II n o d iag n os is; A x is II I m ild cor ti calatro phy, d i abet es m el l i tus, hyper tensi on, ar thri ti s, asthm a a nd ul cer ati ve col i ti s; A xi s I V psychol ogi cal an d e nv i r o nm ental pr o bl ems, o cc upa ti o n pr o bl ems, a nd e c o no mi c p r o b l e m[ s ] ; a nd Axi s V F GAF 5 0 cur r e nt
. ” On N ove m ber28 , 20 01, Fi schersa w neuro l ogi st Dr. J or danN o. 08

- 2617 3 W axm an, wh o diagnose d hi m wi th “ ap r o fo un d dep re ssi on w i th questi onabl e co exi ste nt dem enti a. ” In a F ebr uary18 , 2002 , at tendi ng p hysi ci an’ s s tat em ent ( a f or m used by Libe r ty ’ s cl ai m s depa r tment ) , Dr
. Ro be r t Gr ee nda l e, who had exam i ned F ischerea ch m onth fro m J une 200 1 t o J anuary20 02, di agno sed hi m with m aj ordepre ssio n se co nda r y t o a medi ca l c ond iti on. In a s i m i l ars ta te m en t wri tt eno n Feb r ua r y 2 6, 2 00 2, Dr
. La ur a LaF av e, who had seen Fi scher beginning i n N ove m ber20 01, di agno sed hi m with “ seve re d epres si on di sor der with cogni ti ve i mp a i r me n t ” a n d n o t e d th a tFi s c h e r h a d p r o b l e ms wi thmem o r y a nd c o nc en tr at i o n. On F ebr uary 20, 2002 , Liber ty ackno w l edged thati t had re cei ved a cl ai m fro m Fi sc h er f orl ong- ter m di sabi l i ty benefi ts. L iber ty i nfo rm ed Fi scherthatsince hi s di sabi l i ty o ffi ci al l y b eg ano n S ept embe r 2 2, 2 001 , a 1 80

- daywai ting p er i od w oul d app l y, duri ng wh i ch ti m e Liber ty w ou ld evaluate hi s e l i gibi l i ty f orbene fi ts. Fi schersubm i tte d st atem ents f ro m Drs. W axm an, Gree nd al e, and LaFave to Libe rty. I n additi on, pre su m abl y in an e ff or t t o bol ste r hi s cl ai m , Fi scherso ught di agno ses fro m addit i onal physi ci ans. On M ar ch 21, 20 02, F isc her saw neurol ogi st D r . Z o r a n Gr uj i c . D r . G r uj i c n o t e d th a tF i s c h e r h a d s o me p roblem s w ith atten tion, m em ory enc od ing, an d m em ory re tr i eval, but no probl em s with f or get fulne ss. ( W e a re not sure h ow “m em or y r etr i eval ” di ffer s fro m f or get fulne ss, but Dr. Gruj i c dre w thi s dist i ncti on. ) Dr. Gruj i c al so re cor ded thatFi scherhad a hi sto ryo fen cephal i ti s a s a chi l d and that he suffer ed fro m “per i ods o fzo ni ng o ut” th at w er e o c c as ion ally ac c om p an ied b y u rin ar y in c on tinence. Based o n thes e obser vati ons, D r. G ruj i c sug ges ted4 N o. 08

- 2617 the “ possibi l i ty ofa parti alco m ple x sei zu re d iso rderas a co ntributorto h i s decl i ne” a nd al so note d that Fis c h er ’s p re lim in ar y t es t re su lts an d ag e w er e “ at yp ica l” f orA l zhei m er ’ s di sea se. Dr. Gruj i c thus re com m ended fur th ere xa m inations , i nc lud ing a l ong -term ele ct r o en ce phal ogr aphy( “ EEG ” ) s tud ya nd a posi tr on e m i ssi on t om ogr aphy ( “P ET”) s ca n. O n M ay 2 4 , 2 0 02 , L ibe rt y a p p ro ve d Fisc h er ’s c laim f orl ong- ter m di sabi l i ty b en efi ts, r etr oac ti ve to M ar ch 21, 2002 , ata l eve l r epres enti ng 6 0% o f hi s pre - disabi l i ty ear ni ngs (because hi s co nd i ti on was pre- exi sting)
. Liber ty al so tol d Fi scherthat, as the Pl an r equi re d, his d i sabi l i ty status would be “eva l uated r el ati ve to [ hi s] i nabi l i ty to p er f or m m ate ri aland subst anti alduti es ofhi s o ccupati o n” f o r the fi r st2 4 m o nths , a nd the r ea fter h i s st atus w ou ld be “ e v a lu ated rel ative to [his] i na bil ity to p erform th e m at er i ala nd su bstant i aldut i es o fhi s o wn o r a ny o cc upa ti o n f o r whi chhe ha s tr aini ng, e duca ti o n, o r e xp er ien c e.” L ibe rt y n ot ed th at, bec au se of th e n at u re of h is i l l ness, wh i ch it d escr ibed as m aj ordepres si on, Fi scher w as subj ect to th e Pl an’ s l i m i tat i on f orm entali l l nesse s. U n d er th is p ro vis i on , ben efit s fo r a d isa b ility at tr ibu ta b le to “M entalI l l ness, S ubstance A buse, o r N on- Veri fi ab le S y m pto m s” wer e su bj ec t to a 2 4- m o nth maxi m um . The Pl an al so conta i ned an excepti on t o that rul e: Ben efi ts m ay ex ce ed th i s l i m i ta ti o n o nl y i f th e Cover ed Pers on i s confi ned to a hospi talo r i nsti tuti on for M en ta l I lln es s o r A lco h ol o r D ru g A b u se , or is parti ci pa ting i n an Extended T re atm ent Pl an es tabl i shed i n w rit in g by a Physi ci an i n l i eu o fhos pit al i za-N o. 08

- 2617 5 ti on. The exte nsi on o fbene fi ts beyo nd th e 24 m onth l i m i tat i on i s s ubj ect to re vi ew byLiber ty. Libe r tya l so a l er te d F i sc he r t o the f ac t th atthe r e was no guar antee thathe woul d re c eive bene fi ts f orthe full24

- mon th b e ne fi tp e r i o d. On J uly 25, 20 02 , F i sc he r unde r wenta PET sc an . The re sul ts ofthe t es t w er e fi rs t r evi ew ed by Dr. Gruj i c o n A ugust 13, 20 02. Dr. Gruj i c not ed that the PET scan ra ise d th e p os sib ility of ea rly A lzh eim er ’s d ise as e. In h is vi ew , however, ta ki ng F i scher ’ s m edi calhi sto ryas a w hol e, Fi scherco uld notpro perl y b e d iagno sed with Alz he i m er’ s wi th o utfur th ert es ting . Dr
. Gr uj i c th o ug ht th at th e u n u su al P E T sc an r e s u l t s m igh t b e a tt rib u ta b le to the encephal i ti s that Fi scher had s uffer ed as a chi l d . I n add i ti on, ta ki ng i nto account a 2 4- hour EE G that a l so had been perfor m ed and re turned neg ati ve re sul ts, Dr. Gruj i c co nti nued to bel i eve thatFi scherm i gh t hav e an underl yi n g seiz ure diso rderand thought that Fi scher m i g htb en efi t f r o m medi ca ti o ns f o r tha t co ndi ti o n. On F ebruary3, 20 03, Liber ty’ s co nsul ti ng neur opsychol ogi st, Dr. J am es Tayl or, r evi ew ed Fi scher ’ s ca se. Dr. T ay lorwas unaw ar e that F i scherhad com ple ted EEG an d PET studi es the pr ev i o us sum m er . I n the abse nce o fsuch s tudie s, Dr. Tayl ordeci ded thatfurther neuro psychol ogi calte sting was needed to ev al ua te Fi sc he r ’ s wo r kc a pa c i t y . Dr
. T a y l o r tho ughttha tp r i or ass ess m ents ofFi sch er ’ s neur opsycho l ogi caland neuro

l ogi calst atus did notco ncl usi ve l y e stabl i sh hi s l eve l o f functi onali m pai rm ent a n d w er e in any eve nt to o dated to be u se d to evaluate hi s cur re nt work capaci ty.6 N o. 08

- 2617 Dr
. Ta y l o r wa nt e d t o r ul e o ut the po s s ib i l i t y tha t s om e o f Fi scher ’ s functi onal l oss es w er e the re sul t of a m oo d d i s o r d e r a n d th u s r e v e r s i b l e . A s a r e s u l t, h e r e c o mme n d e d th a t L ib e r t y f o l l o w u p t o s e e wh e th e r EEG an d PET st u d i es had been co m ple ted o r conduct a new ne urop sych ologi cal evaluat ion of Fische r. On A pri l 18 , 20 03, Liber ty advi sed Fi scherthathi s l ongter m di sabi l i ty benefi ts w oul d be di sco nti nued bec ause hi s t re ati n g physi ci ans, Drs. LaFav e a nd Gree nd al e, had f ai l ed to ve ri fy hi s o ngoing d i sabi l i ty sta tus. Liber ty i nfo rm ed him that he coul d ask Libe rty in w ri ti ng to re vi ew thi s dete rm i nati on withi n 180 d ays . Fi scherr esponded to thi s l ett erbysubm i ttingaddit i onalm edi cal re cor d s, i ncl ud i ng a neuro psychol ogi calev al uati on re port f ro m Dr. Georg em i l l er . Dr. Geor gem i l l ernot ed that hi s fi nd i ngs ind i cate d “gl obal, pro gr ess i ve cogni ti ve defi ci ts i n c o nj unc ti o n wi ths i g ni fi ca ntde pr es sion, ” an d w hi l e F i scher ’ s intelle c tu alsk i l l s fel l i nto the “ ver y s up eri or ” ra nge, he ha d “re du ced m entalspeed a nd vi sual spa ti als k i l l s” a s wel l a s r edu ce d “ fl ex ibl e th i nk i nga nd susceptibi l i ty to l osing hi s probl em so l vi ng se t with d istractio n.” D r. Ge orgem il ler state d that w he n Fisch er’s per f o r m an ce was c o m par ed t o hi s per f o r m an ce 1 6 m o nths ea r l i er, “ th er e i s si gni fi ca ntde cr ementi n h i s wor k i ng m em or y, m ental sp eed, at t e nt i o n a nd co ncentr atio n, m en ta l flex ibilit y, an d vis u al s p at ial a b ilitie s.” D r. Ge orgem il ler’ s con clusion w as th at Fisch er w as “very depresse d but hi s m oo d diso rderdoes notappear to be th e s ole et iolog y of h i s c og n itiv e a n d fu n c tio n al d efic its .” The doctor r e com m ended “[a ] ggr ess i ve psychopha rm aco l ogi caltr eat m ent” f orFi scher ’ s depre ssi on t oN o. 08

- 2617 7 “ass i st i n i m proving hi s m oo d and [ to] pro m ote a hi gher l eve l o ffuncti oni ng, ” co up l ed w i th “[ p]har m aco l ogi cal age nts t o m itig ate the effects o fpro gr ess i ve cogni ti ve decl i ne. ” In M ay 2003 , atLiber ty’ s r equest, Dr. J am es B utcher, Liber ty’ s co nsul ti ng physi ci an, al so adm i ni ster ed a num bero fper sonal i ty and behavi or alte sts to Fi scher

. Dr. Bu tcher ’ s re sul ts w er e r epor ted i n hi s “ Ou tpati ent M ental H eal th Inter preti ve Report, ” s ubm i tte d to Libe rty on Se ptem ber 15, 2003
. That re port i nd i cat ed that F i sc he r ’ s r es ul ts w er e co ns i st en t wi thde pr es si o n a nd hy st er i a, an d th at F i sc he r was l i k ely s uffer i ngfr o m a no nor g a ni c dy s thy mi c di s o r de r ( tha ti s , a c hr o ni c , b utl ess seve re, f orm of d ep ression). Fi scherf or m al l y a pp eal ed Libe rty’s deci si on t o discontinue hi s l ong-ter m d i sabi l i ty benefi ts i n a l ett erto Libe r tyda ted J une 1 1, 2 00 3. F i sc he r a ss er te d tha t th e me d i c a l e v i d e n c e e s t ab l i s h e d th a th e w a s , a n d r e ma i n e d, d isabled “as th e resu lt ofa severe ne uroc ogn iti ve im p airm en t.” Liber ty re opened Fi scher ’ s cl ai m o n J une 23, 20 03 , an d r efer r ed hi s ca se to a co ns ul ting phy si ci an, D r. M elvyn A ttfiel d , to d eterm ine p recisely w ha t Fischer’s pri m ar y di sabl i ng co nd i ti on wa s. Dr. A ttfi el d confi ned hi m sel ft o r ev i ewi ngthe fi l e. Ba se d o n tha t r ev i ew, he concl ud ed that ther e was i ns u ffi ci ent e vi dence ofa disord er that w as p rim aril y neu rologi cal and tha t Fischer’s c lin ica l p re se n ta tio n w as p re d om in an tly p sy c h olo gic al, not or gani c. Dr. A ttfi el d a l so sta ted that the ne u ro l ogi cal ex ami na ti o ns pe r f o r m ed byDr
. Ge o r g emi l l erwer e i nc o ns i s t e n ta n d me th o d o l o g i c a l l y fl a we d , a n d he r e c o mm end ed thatFi scherundergo an ind ependent neuro

l ogi calev al uati on. In re sponse, L iber ty re fer re d Fi scherto8 N o. 08

- 2617 Dr
. S te ve n Ro th k e, a c l i nica l ne ur o psy ch o l o g i sta nd reha bil itation ps ych ologi st. O n Feb rua ry 5, 20 04, Dr. Rothke ev al u at ed Fi scher, r evi ew ed hi s m edi calhi sto ry, and p er f or m ed an i nd ependent psychi atr i c ev al uati on ofhi m . Dr. Rothk e co ncl ud ed that Fi scher ’ s t estr esul ts sh ow ed no s i gni fi cant decl i ne i n i ntel l ectualfuncti oni ng, concent ra ti on, r ecal l, o r m em or y. D r. Rothk e no ted that on t he t e s tmo s ts e ns i t i v e t o b r a i n i mpa i r men t, F i s cher perf or m ed w i thi n the nor m al ra nge. Dr. Rothk e s tat ed that he di d not be l i eve thatFi scherhad a ny pro gr ess i ve dem enti ng co nd i ti on. D r. Rothk e’ s di agno sed m i l d dep re ssi on ( al thou gh h e a dm i tte d that the te sting co uld not ru le o ut the prese nce o fa m edi calo r neuro l ogi calco n d iti on o r expla i n the M RI and P E T s c an fi nd i ngs)
. I n re sponse to Dr. Rothk e’ s fi nd i ngs, Fi schersubm i tte d to Libe rty a r ep or t a uthor ed by Dr. Gruj i c, wh o opi ned that Fis c h er ’s Ju ly 2 00 2 a n d Sep te m b er 20 03 P E T sc an s, h is cli nical pres en tation, and his results on sev eral tes ts w ere consi ste nt with or gani c i m pai rm ent, al thou gh the sour ce of that im p airm en t w as u nc lear. On M ar ch 23, 20 04, L iber ty aga i n w ro te to Fi scher and noti fi ed hi m that, bas ed on i ts i ni ti aldeter m i nati on that he was subj ect to th e 2 4- m onth l i m i tat i on f orm ental i l l ne s s e s , h i s b e ne fi t s e xp i r e d o n M a r c h 2 0 , 2 0 0 4
. Liber ty l eftthe do o r o pe n t o c ha ng e , h o we v e r, i ns o f a r a s i tal so tol d h im t h at i t was “cur re ntl y g ather i ng i nfo rm ati on t o as se ss [h is] c on tin u ed eligib ility for b en efit s b e y o n d th is date” and that he would “co nti nue to r ecei ve benefi ts d u rin g th i s r evi ew . ” Tr ue to i ts w or d, Libe rty then submi t t e d F i s c h e r ’ s me d i c a l r e c o r d s t o n e u r o l o g i s tD r . D a wn Kl eindo r fer . Dr
. Kl eindo r ferr ev i ew ed Fi sc he r ’ s fi l e an dN o. 08

- 2617 9 concl ud ed that the obj ecti ve fin d in gs did notsupport a diagnosi s o fdem enti a. S he qual i fi ed that concl usi on wi tha no te that Fi sc he r do es ha ve “ su g g es ti ve PET sc an ni ng o fa dem enti ng pro cess that I w ou l d w ant t o f ol l ow cl i ni cal l y o ver ti m e [ si c]
. ” Dr. Kleind or feral so speci fi ed th at Fisch er’s n e urop sych ologi cal testing “reve als very su per i o r funct i o ni ngo n a l l l ev el s o ft es ting ” an d tha t sh e d i d n o t“ fe e l th a th e h a s a n y o bj e c t i v e e v i d e n c e o fi mpai rm ent. ” Liber ty al so subm i tte d Fi scher ’ s m edi cal re cor ds to Dr. El i zabe th Gal l up wh o, o n A pri l 30 , 20 04, op in ed th at “t h e c or n er st on e o f th e d i a g n o sis of A lzh eim er ’ s o r a ny de m en ti a i s co g ni ti ve i m pai r m en t, pa r ti cularl y i n sh ort-t e r m m em ory . . . [ bu t tha t, in Fischer’s c as e,] . .
. n o c og n itiv e im p air m en t e x ist s.” OnMay2 5 , 2 0 0 4 , r e l y i ng on Fi s c he r ’ s me di c a l r e c o r ds an d the rep o r ts o fDr s. Att fi el d, Ro th k e, Kl eindo r fer, a nd Gall up , as wellas tho se o fFi scher ’ s t re ati ng physi ci ans, Libe rty dete rm i ned that Fi scher ’ s pri m ar y di sabi l i ty w as m ajo r d ep re ss ion, a m en ta l/n er vo u s c on d itio n . Th is m eant that the Pl an’ s 2 4- m ont h l i m i tat i on f orm ental i l ln esses appli ed, and Libe rty there f or e di sco nti nued Fi scher ’ s be nefi ts. Liber ty’s le tte r i nfo rm ed Fi scherthat he had a ri ght o fr evi ew pursuant to the Em plo yee Reti r ementInc o m e S ec ur i ty Act ( “ERI S A”) , a nd tha t an y re q u es t fo r a re vie w n ee d ed to be se n t in w ri t i n g w ith in 60 days o fhi s r ecei pt ofi ts deter m i nati on o fi nel i gibility an d ha d t o b e su ppo r te d b y m ed ical r ec o r ds o ft r ea ting physi ci ans r eco rded afterDecem ber1, 20 03. Fi scher appe al ed Libe r ty ’ s dec i si o n o n Nov embe r 2 3, 20 04 ; he a r g u e d th a th e w a s d i s ab l e d b e c a u s e he su f fe r e d fr o m a se i zu r e di so r der, de m en ti a, an d o th erphy si ca l c o ndi ti o ns10 N o. 08

- 2617

su c h as d iab et es , colit is, h yp er te n sio n, ast h m a, an d art h riti s. Fi sc her conte nd ed that Libe rty’ s deci si on was contr ar y t o L ibe rt y’ s o w n i nter preti ve rul e, wh i ch say s, “O n ly w h en it ca n be d et er m in ed th at th e c laim an t is disabl ed so l el y fro m a psychol ogi calbas i s ca n the l i m i tati on be appli ed .” On D ecem ber20 , 20 04, Liber ty advi sed F i sc he r tha t he ha d unti l J an ua r y 2 0, 2 00 5, t o s ubmi t an y addi t i o na l e v i de nc e h e b e l i e v e d wo ul d s up po r th i s c ase ; Fi sc h er di d not s ubm i t a ny furtherev i dence, and Libe rty proce eded to conduct another re vi ew o fFi scher ’ s ca se. Forthe pu rpos e o fthi s s tag e of the proce edi ngs, Liber ty assign ed a N u rse C ase M an ager to go throu gh Fi sch er’s file an d d e c id e w h et h er Fisc h er w as d isa b led as a re su lt o fa ny phy si ca l c o ndi ti o ns o r o r g an i c br ain di so r der

. The Nu r s e C a s e Ma n a g e r c o n c l u d e d th a tt wo p e e r r e v i e ws w ere nec essary in ord er to answ er this qu estion. Fi sch er’s fi l e was a cc o r di ng l y r efer r ed to i nt erni stDr
. Eug en e Tr uch eluta nd ne ur o psyc ho l o g i stDr
. Cr i s J o hns to n. D r. Tru ch elut w as ask e d to revi ew any p hy sical i m p airm ent that F i scherm i ght ha ve. H e o pined thatFi scher h ad a to rn rot at or cu ff in t h e ri g h t s h ou ld er th at w ou ld l i m i t hi m to l i fti ng no m ore than 20 pound s a nd that suspi c i o n o fp a r t i a l c o mpl e x s e i z ur e s ma de i ta pp r opri ate to r est ri ct F i scher ’ s e xposure to unp ro tect ed hei ghts and l i m i t hi s o perat i on o fm achi nery, bu t h e fo und that th er e w as n o ot h er p h ys ica l co n d itio n th at w ou ld lim it h is abi l i ty to re turn t o w or k. Dr. J ohnsto n w as asked to re vi ew Fi scher ’ s hi sto ryfro m a psychol og icaland neuro

l ogi calper spect i ve; he det er m i ned that a di agno si s o f dem enti a was prem ature. Dr. J ohnsto n conclud ed that, bas ed on Fisch er’s neu rop sych o logical test scores, “thereN o. 08

- 2617 11 i s no questi on that he has the co gni ti ve capaci ty to functi on a dequ ate l y in a wide r ange ofj obs

. ” Base d on these fi nd i ngs, L iber ty up hel d i ts deter m i nati on that Fi scherwas i nel i gibl e forbenefits beyo nd the 24- m onth men t a l i l l ne s s l i mi t a t i o n pe r i o d.

B On June 1 , 20 05, Fi scherfi l ed thi s a cti on pursuant to 29 U .S.C

. § 11 32 (a)( 1)(B ) to rein st at e h is lon g-t er m d isa b ili ty benefi ts. Fo l l ow i ng the cl ose o fpl eadi ngs, the parti es fi l ed cr oss - m oti ons f orsum m ar y j ud gm ent under F ED . R. C IV . P . 5 6 . A lth ou gh th e d ist ric t c ou rtinit ially d en ied bo th p ar tie s’ m ot ion s, on rec on si d er at ion it gran ted sum m ary jud gm en t in Liberty’s favor. T he cou rt expla in ed thati t had m ade an e rr oro fl aw i n i ts i ni ti al ru lin g w h en it co n c lu d ed th at L ibe rt y’s m o tio n sh ou ld be deni ed bec ause a “ re aso nabl e f act fi nd erm i ght di sbel i eve Liber ty’ s doct or s, o r fi nd thatLiber ty’ s d ec isio n to disr ega rd the evi dence ofphysi caldi sabi l i ty provi ded byF i sc he r ’ s do ct o r s to be a rbi tr ar y a nd c apr i ci o us . ” The cou rt conc lud ed that i t had ap p li ed a n inc orrect stan d ard of re vie w , an d w h en th e a p p ro p ria te ar b i t r a r y a n d ca p ricious sta nd ard w as ap p li e d , i t w as clear tha t the “cou rt’s ea r l i erde te r m i na tio n . . . [ was ] i ns uffi ci en t to de fea t th e p resu m p tion of reason ablen ess t o w hich Liberty’s d eterm i nati on i s e nti tl ed und erS eve nth Cir cui t pr ecedent.” Fi scherhas appeal ed fro m the dist ri ct c ourt ’ s fi nal j ud gm ent in f avo r ofLiber ty.12 N o. 08

- 2617 II W hile this court ord inaril y review s a dist rict court’s gr ant of sum m ar y j u d gm ent deno vo, that stan d ard o per at es s o m ewha t di ffer en tly when we a r e l o o k i nga t th e det e r mi na t i o n o fa n ER I S A pl a n a dmi ni s t r a t o r whose deci si ons ar e e nti tled t o defe re nti alr evi ew ( that i s, w hos e d ecisions m ay be set a s id e o n ly ifthey are arbitrary an d cap rici ou s ). U nd er Firesto ne Tire an d R ubb er C o. v. B ruch , 48 9 U.S

. 10 1, 11 5 ( 1989 ) , if a benefi ts pla n confer s di scr eti onary author i ty to deter m i ne el i gibi l i ty an d ben efi ts un d er the p lan, th en j ud ici al r eview i s d eferen ti al ; i fi t do es no t, th en th e co ur t m ak es a n inde pen den t deci si on. S ee K rol nikv. P rud entia l In sura nc e C o ., N o. 08

- 2616 , 20 09 W L 18382 98 at * 1 ( 7th Ci r. J une 29, 20 09). Both p arties agree tha t the arbitrary and cap rici ou s stan d ard i s the appropr i ate st andard ofr evi ew f or F isc her’ s ca se. Fi scherar gues , h owever, thatthi s s tandard has been m o di fi ed by th e S upr eme Cou r t’ s dec i si o n in M e t r opol i t an Life Ins uranc eCo. v. Gl e nn , 12 8 S

. Ct. 23 43 ( 2008 )
. U nd er Gl e nn , he a sse rt s, l ess defer ence i s r equi re d i n case s l i ke thi s o ne, wh er e the adm i ni str ato r oper ate s under a co nfl i ct o fi nter est
. W e re c en tly d ea lt w i t h m u c h th e s am e a rg u m en t in Lege rv. Tr i b uneCo. Long Ter m D i s ab i l i ty Be ne f i tPla n , 55 7 F. 3d 823 ( 7th Ci r. 20 09)
. There , t h e pla i nti ffcl ai m ed that Gle nn cal l s f or “a m or e penetr ating sco pe ofj ud i ci alr evi ew than has previ ousl y b een uti l i zed. ” Id. at83 0 ( i nter nal quotati on m ar ks om i tte d). W e hel d that “ [ o] ur s tudy of Gle nn co nvi nces u s . . . thatthe deci si on i s be st re ad as an ex te n sio n of th e C ou rt ’s p re vio u s d ec isio n in Fi r e s t one. . . . ” Id. at 831. W e e xplained thatN o. 08

- 2617 13 [f]a irly re ad , Gle nn ex p lain s h ow th e g en er al p rin c ip le es tabl i sh ed i n Fi r e s t one sh o ul d be appl i ed to the m or e s peci fi c ca se i n w hi ch r esponsibi l i ty f orbo th cl ai m de te r m i na ti o ns a nd pa y - o ut s i s veste d i n the sam e e nti ty. In such a si tuati on, a cour t i s r equi re d to t ak e su cha n obv i o us c o nfl i ct of int er es t i nt o c o nsi derat i on

— along wi tha l l o fthe o th err el ev an t factors

— in d et er m in in g w h et h er th e e n tit y’s d et er m ina tion w as arbitrary an d cap rici ou s. . . . [ T ]he C ou rt’s dec i si o n in Gl e nn d id notcr eat e a new standard of re vi ew

— a “h ei g ht en ed arbi tr ar y a nd c apr i ci o us s t a nd a r d”

— f orcl ai m s invol vi ng a confl i ct o fi nter est
. Id. T he correct stan d ard of review t o b e ap p li ed therefore r emai ns th e arbi tr ar y an d ca pr i ci o us st an dar d, buto ne o fthe f ac to r s th atmustb e ta k eni nt o a cc o unti n a ppl y i ng th at s ta nd ar d i s a ny co nfl i ct o fi nter est
. S ee Ta t ev . L o ng Ter m D is abil ity P lan forSalari ed Em ployees of Cha m pion Int ’l Corp
. # 506, 54 5 F
. 3d 555, 55 9 ( 7th Ci r. 20 08) ( w here an ERI S A pl ang i ve s di sc r et i o na r y a utho r i tyt o deter m i ne el i gibi l i ty f orbene fi ts , a deni alo fbene fi ts i s r evi ew ed und erthe arbi tr ar y a nd capr i ci ous s tandard) ; se e a l so Je n k i n s v . Pr i c eWat e rh o u s eL o n gTe r m Di s a b i l i tyPl an , 5 64 F. 3d 856 ( 7th Ci r. 20 09) ( “This does n’tm ake us a r ubber sta m p . . . . [ and] w e re m ai n cogni zant ofthe confl i ct o f i nt er es t th ate xi sts w hen the a dm i ni st r at o r ha s bo ththe disc re ti onar y author i ty to deter m i ne el i gibi l i ty f or ben efi ts an d the obligation to pa y ben efi ts w he n d ue . ”). U n d er th e arb itr ar y a n d ca p ric iou s s ta n d ar d , w e w ill u p h old an ad m in ist ra to r’s d et er m in a t i o n u n les s itis14 N o. 08

- 2617 “dow nri ght unr eas onabl e. ” D avi s v. U nu m L ifeIns . Co. of A m. , 44 4 F
. 3d 56 9, 57 6 ( 7th Ci r. 20 06) ( i nter nal quotat i on m arks om itted ). W e hav e held that an ad m inistrator’s deter m i nati on wil l be up hel d so l ong a s i t i s pos sibl e t o offer a re aso ned expla nati on, base d o n the evi denc e, p lan do cument s, a nd r el ev an t f ac tors th ate nc o m pas s th e im p or ta n t asp ec ts of th e p r ob lem

. Sis to v. Am er it ec h Si ck ne s s an d Ac ci de ntD i s ab i l ity B e ne f i tPla n , 42 9 F
. 3d 698, 70 0 ( 7th Ci r . 2 00 5)
. Nev er th el es s, e ve n un derthi s defer en ti als ta nda r d o fr ev i ew, the de te r m i na ti o n t o deny benefi ts and the t er m i nati on pro cedure m ust co m plywith th e ER I S A man da t e tha t “ s pe c i fi c r e a s o ns f o r de ni al be com m unica ted to the cl ai m ant a nd thatthe clai m ant be aff o r ded ano ppo r tuni tyf o r ‘ ful l a nd f ai r r ev i ew’ b y the adm in ist ra tor
. ” Tate, 54 5 F
. 3d at 559 ( quoti ng Hal pi n v . W
. W
. Grainger, Inc. , 962 F.2d 685 , 688 (7th C ir. 19 92)) (in te rn al q u ot at ion m ar ks om itt ed ). W e w ill no t u p h old a te r m i na ti o n o fb en efi ts i fthe r e is no s uppo r t i n the re c or d for t h e u lti m at e d ec isio n . Id

. ( ci ti ng Hac ke t tv. Xerox Corp . Long

- Ter m D i s ab i l i ty Inc om ePla n , 31 5 F
. 3d 771, 774-75 (7th C ir. 2003)). Fis c h er m ain ta in s t h at L ibe rt y’s d ec isio n t h a t h e is in elig ible for b en efit s b ey o n d 24 m on th s is u n re as on ab le b ec au se h is illn es s is th e re su lt of a n org an ic b ra in inj ur y , and therefore he i s not su bj ect to th e Plan ’s m en ta l i l l ne ss l i m i ta ti o n. He u r g es tha t L ib er ty ’ s di sc o ntinua ti o n o fhi s be ne fi ts i s pr es um pti vel y a rbi tr ar y a nd c a p r i c i o u s b e c a u s e L ib e r t y f a i l e d t o f o l l o w i t s o wn i nter nal gui del i nes when i t a pp lied the m entali l l ness li m i ta ti o n t o hi s ca se . He a l so i ns i st s th atLibe r ty’ s deci sio n i s a rbi tr ar y a nd capr i ci ous b ecause i t i gnor edN o. 08

- 2617 15 obj ective evid en ce th at d e m ons trates th at his im p airm en t is org an ic, n otp sy c h olo gic al. I fwe wer e m ak i nga n inde pen den t de ci si o n abo ut Fis c h er ’s d isa b ility , hi s s ec on d arg u m en t w ou ld ce rt ain ly giv e u s p a u se . Th e re c or d , w h ich w e h av e re c ou n te d in detai l abo ve, co ntai ns am ple ev i dence thathi s i l l ness w as i n signi fi cant par t o rg ani c. But w e a re notthe fi nd er of f act h ere. T he prob lem f or Fi sch e r i s th at th e record al so conta in s re pu tabl e e vi dence thatthe sol e ca use o f Fi scher ’ s di sabi l i ty ( i n the sense o fhi s inabi l i ty to perf or m any j ob) w as depressi on, a psychol ogi caldi sea se. W h a t F isc h er is es se n tia lly ar gu in g is t h at L ibe rt y’s d ec isi o n c anb e uphel d o nl y i fa pr epo nde r an ce o fthe evide nc e, o r s o m ethi ngl i k e th at, s uppo r ts i t. As the di st r i ctc o ur t co r r ec tly r ec o g ni ze d o n r ec o ns i der at i o n, ho we v e r, tha ti s n o tthe s t a nd a r d. M easu red against th e a rbitrary an d cap rici ou s stan d ard o fr e v i e w, F i s c h e r c a n no t p r e v a i l

. T h e qu e s t i o n, we re peat, is w hetherLiber ty’ s deci si on t o deny Fi scher b e n e fi t s fi n d s r a t i o n a l s u p p o r t i n th e r e c o r d

. I t d o e s . No few erthan seve n docto rs co ncl ud ed that the s ol e o r p rim ar y c au se of Fis c h er ’s d isa b i l ity w as d ep re ss ion, a psy c ho l o g i c a l di s e a s e , n o ta n o r g a ni c di s e a s e . T hree doctor s thought that hi s di sabi l i ty w as excl usi vel y psy chol ogi cal

. In additi on, o ne o fthe do c to rs w ho co ncl ud ed th at th e c au se of Fisc h er ’s im p air m en t w as p sy c h olo gic al, op ined that the m eth od ology em p loyed by Fi sch er’s tr ea tin g p h ys icia n s t o d iag n os e h im w ith an org an ic bra i n dis or der was fl aw ed. In the f ace ofthi s e vi d en ce, L iberty’s det erm ination ca nn ot b e b ran d ed as arbitrary16 N o. 08

- 2617 and capri ci ous. Thi s i s no t t o saythatthe ev id en c e c o mpelled L ibe rt y’s d ec isio n ; i t is m e r ely to sa y t h at th e e viden ce pe r m i tt ed i t. W hi l e F i sc he r di d pr es en t su bs ta nti alev i dence thathi s co nd i ti on w as o rg ani c, i t was not an abuse of disc re ti on f or Libe rty to rej ect Fi scher ’ s e vid en ce in favor ofcont rary and , at le a s t i n L iberty’s vi ew , m or e co m pel l i ng ev i dence. This i s no t the type of cas e in w hi ch the Gle nn confli ct-ofi nt er es t f ac to r pl ay s ani m po r ta ntr o l e. As we note d, the S upr eme Co ur t i n Gle nn i n stru cted that the p resen ce of a con fl ict w il l “ac t as a tiebreaker w he n th e othe r f acto rs ar e cl ose ly b alanced .

. . . ” Gle nn , 128 S. C t. at23 51 . In o th erwor ds, “ [ w]h enthe c as e i s bo r der l ine
. . . the i nheren t c on fl i ct o fi nter estthatexi sts i n so m any o f these si tuati ons c an p ush i t o verthe edge

— towards a fi nd i ng o fcapr icio u sness . ” Je nki ns , 56 4 F
. 3d at 861- 62. Thi s is nota b o r der l i ne c as e; i n l i g hto fLibe r ty ’ s co nsidera ti on of no few er than thi rt een expert opi ni on s, it i s no t pos sibl e t o saythatLiber ty’ s deci si on w as ev en c los e t o “ d ow n rig h t u n re as on ab le.” The j ud gm ent o fthe dist ri ct c ourti s A FFI RMED .

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