The Honor able Richa rd Mi lls, Senior United S tates Dist rict Judge f or the Centra l District * of I llinois , sitti ng by

desig nation. NO T R EC OM M EN DE D F OR F UL L- TEX T P UB LIC AT ION F ile Nam e: 06a0844n.06 F iled: Novem ber 15, 2006 No. 05-6633 UN ITED STA TES C OU RT OF AP P EA LS F OR THE SI XT H C IR CU IT

PATRI CI A EL L I OTT, Pla int if f- Ap pe lla nt,

v. METROPOL I TAN L I FE I NSURANCE COMPANY Def endant- Appellee , ) ) ) ) ) ) ) ) ) OnA p p e a l f

r o m t h e U n it e d St ates D is tr ic t C o u rt f

o r th e E a s te rn District of Ke ntucky

Be fore : BO GGS, Chief J udg e; DAUGHTREY, C ircuit J udg e; and MI L L S, District J udg e. * BO GGS, Chief J udg e. This c ase prese nts the questions of whether an E R I S A pl an’s deter mination to deny

benef its was arbitra

ry and ca pricious and, if it wa s, what re medy this court should order. Patric ia El liott s ubmitted a claim for long -term disability benef its to t he administrator of her employ er’ s employ ee benef it plan, M etropolitan L ife (“ MetL ife” ). MetL ife de nied Elliott’s

c la im. Th e re a ft er, El lio tt b ro ug ht t his ERI SA a c tio n, ba se d o n th e a dmi nis tr a tiv e re c or d, a g a ins t MetL ife for

wrong ful denial of be nefits under 29 U.S.C. § 1132(a)(1) (B ). MetL ife mo v ed for judgme nt affir

ming its dec ision to deny benefi ts and Elliott m oved for reve rsal. Holding thatNo. 05-6633

- 2 -

MetL ife’s de termination to deny benef its was not “ar

bitrary and ca pricious,” the district c ourt g rante d MetL ife’s motion and de nied Elliott’s mot ion. Elliot t appea led to this court. Be cause we c oncl u d e t h at MetL ife’s de cision was ar bitrary and ca pricious, we va cate the judgme nt of the district c ourt. The rec ord does not support the conclusion that MetL ife’s de nial of E l l i o t t ’ s c l a i m w a s t h e r e s u l to f a d e l i b e r a t i v e , p r i n c i p l e d r e a s o n i n g p r o c e s s . W e c an n o ts ay, howeve r, that Elliott is clea rly entitled to long- term di sability benef its. Consequently , we r emand to t he dis tr ic t court

wi th i ns tr

uc tio ns to r e mand

to M e tli fe fo r a

fu ll a nd fa ir re vie w c on sis te nt w ith this opini on. I Elliott was injured se vere ly in a ca r ac cident in 1989. At that time, she suffe red sig nificant fra cture s of her

second a nd third cer

vical ver tebra e. Soon afte r, she underwe nt stabiliz ation and spinal surg ery , which involved the place ment of metallic wire s in her nec k. I n 1993, Elliott beg an workingfor Gr eat Ame rica n Financ ial Resource s and joi ned the company ’s employ ee be nefit plan, which MetL ife a dminist ers. I n O c tob e r 2 00 2, El lio tt b e g an e x pe ri e nc ingre ne we d p a in r e late d to the 19 89 a c c ide nt, inc lud ingra diatin g sh ou lde r p a in, numbn e ss, and burn ing se ns a tio ns . She sa w s e ve ra l phy sic ians , beg inning with Dr . Charles Kuntz of the University of Cincinnati’s May field Clinic. I n ear ly 2003, Elliott beg an re ce i v i n g s h ort-ter m disabilit y

benef its, after D r. Kuntz submit ted a f orm to Great Am e ri c an c e rt if

y ingthat sh e c ou ld n ot p e rf or m wo rk of any kin d. Whil e on sh or t- te rm dis a bil ity in

e arl y 20 03 , El liott v isi te d s e ve ra l phy sic ians and ha d nume ro us stu die s c on du c te d. No ne c ou ld explain with precision why Elliott ’s sy

mptoms had reeme rg ed.No. 05-6633

- 3 -

I n May 2003, Dr. Kuntz ref

err ed Elliott to Dr. Alex Schneider at Aring Neur ology at the University

of Cincinnati. Dr. Schne ider c onducted a n initial elec tromy og ram a nd found “no sig ns of motor or my el o p at h i c sy mptoms.” Howeve r, he a lso made finding s “consistent with a c entra l cord- like sy

ndrome.” I n addition, D r. Schneider wrote: “She is better tha n she wa s six months ag o, but continued to have some chronic pain and anxiety related t o this.” Dr. Schneide r re commended,

a mon g oth e r t

hin g s, El a vil (a ps y c ho a c tiv e pr e sc ri pti on dr ugof te n p re sc ri be d f

or de pr e ssi on ), a

Ccollar ( used to stabiliz e the ne ck), phy sical thera py , and a r e-e valuation in three months. Dr. Schne ider saw

Elliott ag ain in Aug ust 2003. He made no signific ant new finding s at that vis it, e xce pt t o n ote : “ sin c e sta rt ingthe El avi l, sh e has done qu ite be tte r [s ic ]. Sh e state s sh e is moving around better and her neck pain is better.” Howeve r, Dr. Schneider did report that she “has

some w e a kn e s s an d nu mb n e s s w h e n s h e is u p to o lo n g , p arti c u la

r ly in h e r le g s an d f

e e t. ” Dr

. Sc hn e ide r i n c r e a se d h e r p re sc ri pti on , o rd e re d mo re ph y sic a l th e ra py , a nd re c omm e nd e d a

re tur n v isi t in t hr e e mon ths , a date that coincides w ith Elli ott’s most recent MRI

. I n September 2003, Elliott beg an the long- t erm disabili ty claims proce ss. Her c laim was denied on Dec ember

1, 2003, in a letter f

rom MetL ife. In the letter, Me tL ife re counts the plan’s t erm s an d re s t at es t ec h n i ca l m ed i ca l t er m s fr o m E l l i o t t ’s d o ct o rs ’ re p o rt s . T h en , wi t h o u tre as o n i n g, the letter c oncludes: “The m edial [ sic] documentation does not support a condition of a sever ity that would preve nt y ou from wor king.” On Dec ember

9, 2003, Elliott sent a letter to MetL ife a ppealingthe dec ision. I n the letter, Elliott wrote that her “ condition has improved since the incre ase of [her] Elavil” prescr iption. S heNo. 05-6633

Sy ring omy elia is “a

slowly prog ressive sy

ndrome of c avitation i n the ce ntral seg ments of 1 the spinal cord, g ener ally in the cer vical re g ion.” D OR L AND ’ S I L L US TR ATED M ED I CA L D I CT I O N A RY 1841 (2003). This portion of Dr. Schne ider’s le tter indicate s that metallic artifa cts from Elli ott’s 1989 2 surg ery limit his ability

to see, using the test methods employ ed, the f unctional par

ts of the re levant portion of her

spinal cord. - 4 - also wrote that “if I stand, sit, bend, walk, or si t up straig ht for too long, I require pain medication.” Ibid. Desc ribing her phy sical abilities, she wrote that “I have improve d in motor skill s since ther apy and ca n tend to my

daily needs w ithout assist ance . Ican do some housework most d ay s but am restric ted to light duty

(dusting, dishwa sher, stra ighte ning, e tc.. [sic] ).” Elliott also included a letter from Dr. S chneide r, dated Dec ember 9, 2003. I n the letter, he de sc ri be d E lli ott ’s c on dit ion a s “ c hr on ic we a kn e ss a

nd nu mb ness that is e xac e rb a te d w he n s he is standing for any leng th of time.” Dr. Schneider also rec ounted Elliott ’s last MRI , dated Nove mber 24, 200 3 , wh i ch showed “ surg ical cha ng es alongwith mild t o moderate diskog enic disea se and deg ener ative cha

ng es.” There was “no clea r sy ring omy elia,” althoug h “metallic artifa ct limit s the

1 pare nchy mal visualiz ation.” Following that discussion, Dr. Schneider specifie d particula

r 2 limit ations on Elliott ’s ability to work. He wrote: I t is my opinion that her work is limited due to her c hronic pa in sy ndrome a nd spinal c or d in jur y that is e xac e rb a te d b y

sp e nd ingany

le ng th o f t ime on

he r f e e t or sittin g in a sing le position for any

leng th of time. She should not do any lifting. She should not b e cr o uching into small spaces or doingany repe titive moti on ty

pe of w ork. She should not do any

work that re quires rea ching above he r hea d. I t is my opinion that he r c hr on ic ne ur olo g ic c on dit ion c a us e s her sig nif

ic ant dis a bil ity . T his c on dit ion

is chronic an d will likely

worsen in the f

uture. F urthermor e, she ma y require further surg ical interve ntion as she deve lops further a rthritic cha

ng es.No. 05-6633

- 5 -

I n response to Elliot t’s appea l, MetL ife e ng ag ed Dr . Robert Menotti to review E lliott ’s file. The r ecor d indicates that MetL ife sent Elliott’s file to Dr. Menotti on Fe bruar y 25, 2004, and that he c ompleted his review the next day . I n the re view, Dr . Menotti recounte d Elliott ’s medical history . Although D r. Menotti conce ded that Dr . Schneider ’s statement “ appea rs to be . .

. c re dib le ,” he ne ve rt

he le ss a sse rt e d th a t E lli ott ’s “ c on dit ion imp ro ve d o ve r t ime wi th r e sp e c t to her c hronic pa in,” espe cially with medication. Dr. Me notti then concluded that: “I am not left wi th t he imp re ssi on

g ive n th e c ur

re nt l e ve l of

do c ume ntatio n th a t th e c la ima nt a pp e ars me dic a lly unable to per form sede ntary work ba sed on the phy sical finding s supplied by Dr. Schne ider a

nd by Dr. Kuntz.” Dr. Menotti was the first phy sician to mention the term “se dentar y work,” which does not appe ar in the pla n at issue. B a se d o n D r. Me no tti ’s fi nd ing s, Me tL if e de nie d E lli ott ’s a

pp e a l. I n it s le tte r t o E lli ott , MetL ife a g ain re counted he r medica l history , including the latest revie ws by Dr. Schne ider a

nd Dr. Menotti. Ag ain without rea soning, Me tL ife then w rote: “The re w as no indication that y our condition cause d impairments which that would have preve nted y our [sic] from per forming the duties of y our job. Ther efor e, the or igina l claim deter mination was appropr iate.” Following the denial of

her a ppeal, Elliott broug ht an ERI SA action ag ainst MetL ife for wrong ful denial of be nefits under 29 U.S.C. § 1132(a)(1) (B ). MetL ife moved f or judg ment aff irming its dec ision to deny benef its and Elliott moved for r ever sal. The district cour t gr anted MetL ife’s motion and de nied Elliott’s mot ion. Elliot t appea led. IINo. 05-6633

- 6 -

We review de novo the de c isi on of a dis tr ic t c ourt

g ra nti ngjud g me nt i n a

n E RI SA d isa

bil ity benef it action based on a

n administrative re cord. See G lenn v. Metro. L ife Ins. Co. , 461 F.3d 660, 66 5- 66 (6 th C ir . 2 00 6) ; W hit ak e r v . Ha rtf

or d Li fe & Ac c ide nt C

o ., 404 F.3d 947, 949 ( 6th Cir. 2005); W ilkins v. Baptist Healthcare Sys., I nc. , 150 F.3d 609, 613 ( 6th Cir. 1998). I n addition, when a plan g rants the a dminist rator disc retionar y authority to interpret the te rms of t h e plan and to determine benef its, courts will only reve rse an administrator’s deter mination if it is “a

rbitrar y and ca pricious.” Firestone Tire & Rubber Co. v. Bruc h , 4 89 U. S. 1 01 , 1 11 -1 5 ( 19 89 ); Glenn , 4 6 1 F.3d a t 666; McD onal d v. W

es t ern-Southern Life Ins. Co. , 347 F.3d 161, 168 ( 6th Cir. 2003). Be cause the Me tL if e pla n at is su e in t

his c a se pr ov ide s f

or dis c retio n, we app ly

the “ arb itr ary

and c a pr ic iou s” standard of

revie w. Although that standard is def ere ntial, it is not a rubbe r stamp for the admi n i s t ra t or’s d e te r mi n a ti o n. Jo n es v. Me t r o. Life Ins. Co. , 3 85 F .3 d 6 54 , 6 61 (6 th C ir . 2 00 4) . In o the r w or ds ,

“ de fe re nti a l r e vie w i s n ot no revie w.” Mc Do na ld , 3 4 7 F. 3 d at 1 7 2 (c i t i n g Hess v. Hartford Li fe & Acc ident Ins. Co. , 274 F.3d 456, 461 ( 7th Ci r. 2 0 0 1 ))

. Un d er that standard, we will uphold the

a dmi nis tr a tor ’s de c isi on

“ if it i s th e re su lt of a del ib e ra te , p ri nc ipl e d r e a so nin g pr oc e ss a nd if it i s supported by

substantial evidence .” Glenn , 4 6 1 F. 3 d at 6 6 6 (c i t i n g Ba k

e r v. U nite d M ineW or k e rs of Am. Health &Ret. Funds , 929 F.3d 1140, 1144 ( 6th Cir. 1991)). The question in a

ny g iven disability case on “ar bitrary and capr icious” re view is whethe r a plan ca n offe r a r easone d explanation, based on the evidenc e, for its judgment that a c laimant was not “disabled” within the plan’s terms. In pertinent pa rt, the MetL ife plan at issue here rea ds as follows: “‘Disable d’ or ‘ Disability ’ mea ns that, due t o sickness, pre g nancy , or ac cidental injury , y ouNo. 05-6633

- 7 -

are rec eiving Appropriate Care and Tre atment from a Doctor on a

continuing ba sis; and . . . during y our Elimination Period and the next 24 mont h period, you are unable to ear n more than 80% of y our Predisability

Earning s or I ndexed Pre disability Earning s at y our Own Oc cupation for any employ er in your L oc a l E c on omy .” Th e pla n d e fi ne s “ Ow n O c c up a tio n” a s: “ the a c tiv ity tha t y ou re g ula rl y pe rf or m and that se rv e s a s y our s ourc e of inc ome . I t is no t li mit e d to the sp e c if ic po sit ion

y ou he ld with y our Employ er. I t ma y be a simil ar activity that could be perf ormed with y our Employ er or any other e mploy er.” Those ter ms are c lear . To asce rtain whether a claimant is disabled, MetL ife must deter mine whether the individual’s con d i t i o n (sickness, pr eg nancy , or ac cidental injury ) pre cludes he r fr om perf orming her “ Own Oc cupation.” O nce Me tL ife makes that judgme nt, its determination is entitled to defe renc e unless it is arbitrar y and ca pricious. Tha t i s , i f M etL ife’s de termination that an individual can perform her occupation “is the result of a deliberate, principled rea soning pr ocess a nd if it is supported by substantial evidenc e,” it will not be disturbed. Glenn , 461 F.3d at 666 (c iting Bake r , 929 F.3d at 1144). III A We must t here fore deter

mine whether

MetL ife made a deliber ate, pr incipled, and

rea soned dec ision that Elli ott’s condition would not preclude he r fr om perfor ming he r occupation. At the district court level, MetL ife submitted an off icial desc ription of the duties ofNo. 05-6633

The district judg e thought that the job de scription meant that Elliott ’s job w as “sedentary 3 in nature.” The c ourt then conc luded t h at MetL ife’s de nial of bene fits, based on Dr . Menotti’s conclusion that Elli o t t co u l d perf orm “sede ntary

work,” was not ar

bitrary and ca pricious. That rea soning, a lso relied on by MetL ife on appeal, was in err or because it relies on a g ener al notion of “sede ntary” wor

k rathe r than on the duties that Ms. Elliot t’s occupa tion entailed. The latter inquiry is the proper

one under

the plan’s ter

ms. I ndeed, a s we rece ntly held, M etL ife’s determination of what duties Elliot t’s job entailed 4 would be entitled to re v i ew u n d er the “a rbitrar y and ca pricious” standa

rd of r eview. Osborne v. Hartford Life & Acc . Ins. Co. , No. 05-5536, 2006 U.S. App. L EXI S 24640, at *5 (6th Cir. Oct. 3, 2006). In Osborne , we held that employing the dictionary to determine someone ’s job duties was not “a rb i t rary

and ca pricious.” Ib id . Certainly , under Osborne , MetL ife’s e mploy ment of the Elliott ’s offic ial job description must also be entitled to defe renc e. - 8 - an employ ee w ith Elli ott’s former occupation as a B usiness Quality Analy st. Elliott does not

3 contest the use of

that descr iption here. As such, we will treat Elliott’s official job desc ription as 4 g ivi ngthe du tie s o f h e r “ Ow n O c c up a tio n” fo r a na ly tic a l pu rp os e s. A B usiness Quality

Analy st’s essential re sponsibili ties, inte r a lia , are to: (1) “De velop

and pr e pa re ro uti ne and

no n- ro uti ne re po rt s n e e de d f ro m a dmi nis tr a tio n s y ste ms t o e ff e c tiv e ly audit business activity ”; (2) “ Coordinate with other business a rea s to clarify

/corre ct data” ; (3) “Edit and re view re ports with manag ement to ensure they meet business nee ds”; and (4) “Work wi th I T/ Pol ic y

Ad min istratio n s up po rt

to d ri ve e ff e c tiv e ne ss o f r e po rt s n e e de d. ” To fu rt he r t ho se objectives, the c ompany

specifie d some of the skills that would be re quired, including proficie ncy

in some computer softwa re. B We must now ask whether MetL ife made a re asoned judg ment that Elliott ’s medica l condition allowed her

to perfor m those or similar duties. L og ically , MetL ife c ould have made aNo. 05-6633

- 9 -

re a so ne d ju dg me nt o nly

if it r e lie d o n me dic a l e vid e nc e that a sse sse d E lli ott ’s ph y sic a l a bil ity to perf orm job-re lated tasks. Mc Do na ld , 3 4 7 F. 3 d

at 1 7 2 (c i t i n g Qu inn v . B lueCro ss & Bl ueSh ie ld Ass’n , 1 61 F .3 d 4 72 , 4 76 (7 th C ir . 1 99 8) (T he pla n “ wa s und e r a

du ty to m a ke a

re a so na ble inquiry into the ty

pes of skills [ the claimant] possesses and whe ther those skills may be used at another job.”). Se e als o Osborne , 2006 U.S. App. L EXI S 24640, at *5 (aff irming the denial of benef its, in part, beca

use cla imant “was onc e ag ain able to pe rfor m the duties of his position”); Glenn , 461 F.3d at 669-70. Put differe ntly , medical data, without rea soning, c annot produc e a logic al judg ment about a c laimant’s work a bility . Despite the nume rous medica l evaluations that took place in this ca se, MetL ife did not rely on an application of the rele vant evidenc e to the occupational standard whe n it denied her claim initially

and on interna l appea l. 1 I n it s f ir st d e nia l le tte r, be fo re havin g El li ot t’ s file re vie we d b y a ph y sic ian c on su lta

nt, MetL ife mer ely

rec ounted the tec hnical conte nt s of Elliott’s various medical e valuations. For example, MetL ife wr ote, “Per the April 22, 2003 off

ice note f rom Dr. Kuntz the finding s of the Janu ary 14 , 2 00 3 E MG re ve a le d n or ma l ne rv e c on du c tio n o f t he bil a te ra l up pe r a

nd low e r l imb s. Review of the CT of the ce rvica l spine dated Mar ch 21, 2003, shows no evidence of signific ant centr al ca nal stenosis. . . . I t was sugg ested that y ou g et a ne urolog ical consultation.” The n the letter say s: “The media l [ sic] documentation does not support a condition of a seve rity that would preve nt y ou from wor

king.”No. 05-6633

- 10 -

We note that, in the first deni al l et t er , MetL ife states that it considered Elliott’s job de sc ri pti on . N e ve rt

he le ss, the re is n o in dic a tio n th a t Me tL if e re a so ne d fr om E lli ott ’s c on dit ion to her ability to perf

orm her oc cupation. The re is no stateme nt or discussion of Elliott’s occupational duties or her

ability , or inability , to perfor m the m. I nstead, the denial letter is a mere rec itation of medical ter

minology employ ed by

various phy sicians in their diag n o s es of Elliott’s condition, without any

rea soning a s to why

those diag noses would permit her to f unction in the workplac e. A court’s de cision that merely said “a ffirm ed” or “re verse d” could not be c onsidered “ rea soned.” Simi larly , MetL ife c annot be sa id to have g iven a reasoned denial of Elliott’s claim, initially

. 2 Elliott appea led that initial determination, adding a letter from Dr. Schneider that related her condition to her work ability

. I n denying her appeal, MetL ife relied on only one other new piec e of

e vid e nc e : th e op ini on

of a ph y sic ian c on su lta

nt, Dr. Rob e rt

Me no tti , w ho c on du c te d a fi le -o nly revie w of Elliott’s claim. Be cause MetL ife’s initial denial lacked a rea soned basis, MetL ife’s se cond de nia l c an o nly

be c ha ra c te ri zed a s “ re a so ne d” if Dr . Men ott i’ s r e vie w p ro vid e d a n a de qu a te ba sis to conclude that Elliot t could perf orm her oc cupation despite he r medica l condition. Dr. Menotti’s review bears a striking r esemblanc e to MetL ife’s f irst denial letter. I

n simil ar fa sh ion , D r. Me no tti state d n e arl y ve rb a timfr om M e tL if

e ’s le tt er th e te c hn ic a l f

ind ing s r e late d to Elliott ’s condition. That re citation occupie s more than ha lf of Dr . Menotti’s two-pag e re view. Cf. Kal ish , 419 F.3d at 509 (re jecting as i nadequate a r eport re counting six pag es of medic al history and

e ng a g ingin o nly

on e pa g e of

ana ly sis ). I n a dd iti on , D r. Me no tti pr e se nt ed no reas ons f or hisNo. 05-6633

Dr. Menotti notes Dr. Schneider’ s findings that Elliot t’s work a bility “is limit ed due to he r 5 chronic pain sy

ndrome and spinal cord injury that is ma de worse by spending any

leng th of time on her fee t or sitting in a sing le position for any leng th of time.” Dr. Me notti also noted Dr. Schneider ’s view that Elliott’s condition “is chronic a nd will likely

worsen in the f

uture and she ma

y require fu rt he r s ur g ic a l in te rv e nti on if sh e de ve lop s fur the r ar thr iti c c ha ng e s. ” He re , how e ve r, Dr . M e no tti m i s qu o t e s D r . S c h n e i d e r ’ s l e t t e r . S c h n e i d e r w r o t e t h a tE l l i o t tm ay r e qu i r e s u r g e r y as she deve lops further arthritic c hang es, indicatingth at an o n go ing pr ocess of arthritic de g ener ation was taking place . Dr. Menotti’s letter ch an g es “a s” to “if,” which alter s the meaningof the sente nce by rende ring further

arthritic c hang e only

a possibility

. - 11 - conclusion that Elliott’s condition would not preclude he r fr om worki n g . He ne ver discusse d El lio tt’ s jo b d

uti e s, wh ic h im

pli e s th a t he did

no t c on du c t a

re a so ne d e va luatio n of

he r c on dit ion

to de te rm ine wh e the r s he c ou ld p e rf or m th os e du tie s. To be sure, Dr. Menotti discussed Dr. Schneider ’s conclusions about Elliott ’s l imited work ability

. I n fac t, he explicitl y stated that Dr. Schne ider’s c onclusions “appe ar[ed] to be cre dible.” 5 Ye t D r. Me no tti of

fe re d no spe c if

ic re bu tta l to Dr . Sch ne ide r’ s con c lus ion s, no r d id h e op ine a s to how Elliott’s medical condition r elated to the demands of her job. I nstead, Dr . Menotti concluded that e arl ie r r e c or ds de mon str a te d th a t Ellio tt’ s con dit ion “ imp ro ve d o ve r t ime ” and that he r “ c hr on ic pain sy ndrome ha s responde d to . . . medica tion.” Howeve r, log ically speaking , evidenc e of a

n improvement, without a startingor ending point, does not help answer the question of whether an indi vi du a l c an p e rf

or m he r o c c up a tio n. “ Ge tti ngbe tte r, ” wi tho ut m or e , d oe s n ot e qu a l “ a ble to work.” Moreove r, base d on his determination that El l i o t t was improving , Dr. Menotti stated a

co n cl u s i o n t h at is arguably on a diffe rent plane than the prope r inquiry . He wr ote: “I am not left wi th t he imp re ssi on

g ive n th e c ur

re nt l evel of

do c ume ntatio n th a t th e c la ima nt a pp e ars me dic a llyNo. 05-6633

- 12 -

un a ble to p e rf or m sed e nta ry wo rk .” Th e te rm “ se de nta ry wo rk ” a

pp e ars no wh e re in t

he pla n’ s te rm s. As we ha ve noted, the pr oper inquiry is whether E lliott could per form her own occ upation. Dr. Menotti never unde rtook such an inquiry

. I n addition, D r. Menotti w as a phy sician consultant fre quently employ ed by

MetL ife. The Supreme Court has acknow ledg ed “that phy sicians repeate dly reta ined by benef its plans may

have

a n in c e n t i v e t o m a k e a f i n d i n g o f ‘ n o t d i s a

b l e d ’ i n o r d e r t o s a v e t h e i r e mp l o y e r s m o n e y a ndto p r e s e r v e th e ir o w nc o n s u lt in g ar

r an g e me nts.” Bl ac k

& De c k e r D isa bil ity

Plan v . No rd , 5 38 U. S. 822, 832 (2 0 0 3 ). Se e als o Ka lis h , 419 F.3d at 507-08. Dr. Me notti’s conclusions have be en questioned in at lea st three f eder al ca ses; in all of them, he wa s hired by MetL ife. See W

h i t e v. Airline Pilots Ass ’n , 364 F. Supp. 2d 747, 754 (N.D. I l l

. 2 0 0 5 ) (“The doc tor' s lang uag e appe ars de lib e rate ly a mbi g uo us and va g ue . . . . ” ); Viglietta v. Metro. Life Ins. Co. , 04 Ci v. 38 74 , 2 00 5 U .S. Di st. L EX I S 42 92 4, a t *3 2 (S .D .N .Y

. Au g . 3 , 2 00 5) (“ I t is , h ow e ve r, hig hly un lik e ly that D r. Me no tti

c on sid e re d Pl a int if

f' s r e vis e d jo b d e sc ri pti on

. . .” ); Smith v

. Home D epot W elfare Bene

fits Plan , No. 8:04-cv-1924- T-23TB M, 2005 U.S. Dist. L EXI S 42916, at *36 (M.D. Fla . Nov. 17, 2005). We e xpre ss no opi nio n on whe the r Dr . Men ott i w a s, in f a c t, i nf lue nc e d in

thi s matte r b y

his fr e qu e nt e mpl oy

me nt by Me tL if

e . I t is c le ar, ho we ve r, that he fa ile d to c on du c t the appropr iateNo. 05-6633

- 13 -

inquiry

. Dr. Menotti’s statements cannot form the basis for concluding that MetL ife e ng ag ed in a deliberate, principled r easoningproce ss in this case . Glenn , 461 F.3d at 666. 3 Nothing e lse in MetL ife’s s econd denial provides a ny indication that Metlife eng ag ed in a principled reasoningproce ss. MetL ife fa iled to offer any rea son for re

jecting Dr. Schne ider’s conclusions about Elliott’s ability to work. Genera lly

speaking , a plan may

not rejec t summarily

the opinions of a treating phy sician, but must inst ead g ive re asons for adopting an alternative opinion. Ev an s v . U

nu mp ro v ide nt C

or p ., 434 F.3d 866, 877 (6th Cir. 2006) (“[A] plan admini strator may not arbitra rily disreg ard r eliable medic al evidenc e prof fer ed by a claimant, including the opinions of a t re at i n g p h y s i ci an . ”) (c i t i n g, inte r a lia , Black &Dec ker , 5 2 8 U

. S

. a t 83 3; McDo na ld , 347 F.3d at 163-66). Dr . Schneider ’s letter indicated that Elliott would have trouble sitting for long pe riods of time and per forming repe titive movements, both of which could we ll fall within her job description. Of c ourse, Me tL ife n eed not de fer automatically

to the treating phy sician’s opinion. Black &Dec ker , 5 3 8 U. S

. at 830-32. However , that MetL ife g ave “ g reater we ight” to a non-tre ating phy sician’sNo. 05-6633

Of c ours e , a s a

g e ne ra l matte r, we wi ll no t ov e rt ur n a pla n a dmi nis tr a tor ’s de nia l of be ne fi ts 6 for c hoosing to re ly

on the opinion of one phy s i ci an o v er that of anothe r. Mc Do na ld , 347 F.3d at 169. Howeve r, that rule is not absolute, pa rticularly wher e, as he re, the re is so l ittle evidenc e of a proce ss that rea sons from the patient’s condition t o her w ork ability

. Ib id

. See also Gle nn , 461 F.3d at 666-72. - 14 - opinion for no app ar en t re as on lends forc e to the conc lusion that MetL ife a cted a rbitrar ily and capr iciously

. Se e Kal ish , 4 1 9 F. 3 d at 5 0 8 (c i t i n g Cal

v e rt , 409 F.3d at 295). 6 I n addition, MetL ife soug ht only a file r eview of

Elliott ’s claim, rather than a phy sical examination. To be sure, we reje cted in Cal v e rt a cla imant’s asser

tion that a plan with au tho rit yto

or de r a dd iti on a l me dic a l te sts wa s required to do so. 409 F.3d at 296. Howeve r, we also held that a plan’ s decision to conduct a file-only revie w–“e specia lly

wher e the ri ght to [ conduct a phy sical examinat i o n ] is specifica lly rese rved in the pla

n–may , in some case s, raise que stions about the thoroug hness and a ccu ra cy o f the be nefits deter mination.” Ibid. Her e, MetL ife de nied Elliott’s benef its based on evidenc e that simply is not analy

zed in relati o n t o h er ability to perfor m her occupation. Although we continue to believe that plans g ener ally are not ob l i gat ed t o order

a dd iti on a l me dic a l te sts , in c a se s su c h a s th is, pla

ns c an a ssi st t

he mse lve s, c la ima

nts , a nd the c ourt s by he lpi ngto p ro du c e e vid e nc e su ff ic ie nt t o s up po rt

re a so ne d, pr inc ipl e d b e ne fi ts d e te rm inatio ns . Cf. Glenn , 461 F.3d at 666.No. 05-6633

- 15 -

We also note that MetL ife may have be en oper atingunder a conflict of interest in this matter. The Supreme Court has rec og nized that an appar ent conflict of interest exis ts w hen an E RI SA plan both decides e ligibility

for be nefits and pa

y s those benef

its. See F

irestone , 4 8 9 U

. S

. a t1 1 5

. In Glenn , we obse rved that “MetL ife is authorized both to decide whether an employ ee is elig ible for benef its and to pay

those bene fits. This dual function cre ates a n appar ent conflict of i ntere st.” 461 F.3d at 666 (citations omitted). MetL ife is under the same a

ppare nt conflict of inter est here as it was in Glenn

. Such a conflict, if shown to ha ve impacted MetL ife’s de termination, would lend g reater weig ht to the conclusion that MetL ife’s de termination was a rbitrar y and ca pricious. We need not dete rmine whe ther MetL ife’s self-inter est play ed a role in its denial of Elliott’s claims. Reg ardle ss of the pre sence or abse nce of a conf lict, MetL ife’s d ec ision cannot withstand scrutiny . We cannot uphold an ERI SA plan administrator’s de termination if it is not t he produc t of “a de liberate , principled reasoning proce ss.” Glenn , 461 F.3d at 666. MetL ife’s de cision-making proce ss was neither deliberate nor based on rea soning. As such, i ts deter mination in this matter wa s

arb itr ary and c a pr ic iou s. IV Now we are left to consider the re medy . I n case s such as these , cour t s m ay ei t h er awar d benef its to t he cla imant or reman d t o t he plan a dminist rator. Se e Sm ith , 4 5 0 F

. 3 d a t 2 6 5 ( “ [W] eNo. 05-6633

- 16 -

va c a te the jud g me nt of the dis tr ic t c ourt and re mand thi s c a se fo r e ntr y of an o rd e r r e qu ir ingCCC to c on du c t a fu ll and fa ir re vie w of Smit h' s dis abi li ty

cla im .”) ; Glenn , 461 F.3d at 675. Se e als o Buffonge v. Prude ntial Ins. Co. of America , 426 F.3d 20, 31 (1st Cir. 2005) (“T here is no question that th is c ourt

ha s th e po we r t o r e mand to t he cla im s adminis tr a tor ; it a lso ha s th e po we r, in ap p ro p ri at e c as es , t o aw ar d b en ef i t s t o t h e d i s ab i l i t y

cl ai m an t
. ”) (c i t i n g Coo k

v . Li be rty

LifeAs su r. Co. , 3 20 F .3 d 11 , 24 (1 st C ir .2 00 3) ; Quinn v. Blue Cross and Blue Shield Ass’n , 161 F.3d 472, 477 (7 th C ir . 1 99 8) ). Th e qu e sti on we mus t a dd

re ss is whi c h r e me dy

–r e tr oa c tiv e be ne fi ts o r r e mand to the administrator–is appr opriate in this case

. The F irst Circuit rece ntly addre ssed such a

question. Buffonge , 426 F.3d at 31-32. I n that

case , the cour

t noted that some courts have adopted the “categ orica l rule” that a “r etroa ctive aw ard is u su a lly pr op e r whe n [th e ] cl a ima nt h a d b e ne fi ts a

nd los t t hem ,” whi le “r e mand is a pp ro pr iate when a decision-make r fails to make ade quate f indings or f

ails to provide [] adequate re asoning .” Ibid. (c i t i n g Quinn , 161 F.3 d at 4 7 7 ). The F irst Circuit declined to adopt such a cate g orica l rule, h o l d i n g i n s t ea d

t h at co u rt s “m u s th av e c o n s i d er ab l e d i s c r et i o nt o cr af ta r em ed y

af t er fi n d i n g a mistake in the denial of be nefits.” Ibid. (c i t i n g Cook , 320 F.3d at 24). I n Bu f f onge , th e c ourt

he ld t hat, whe re the “ pr ob le m is wi th t he int e g ri ty

of [the pla n’ s] de c isi on -m a kin g pr oc e ss, ” rathe r t ha n “ that [a c la ima nt] w a s d e nie d be ne fi ts t o w hic h h e wa s c le arl yNo. 05-6633

This r emedy obviates the need to c onsider Elliott ’s claim that the district c ourt should have 7 allowed f urther disc overy . Sm ith , 450 F.3d at 265 (“O n appea l, Smit h argues that the district cour t e rr e d w he n it

de nie d a dd iti on a l di sc ov e ry int o CCC' s pro c e dure . B e c a us e we are re mand ingthi s c a se fo r a fu ll and fa ir re vie w of Smith' s dis a bil ity c la im, it is unne c e ssa ry fo r u s to c on sid e r t

his c la im on appea l.”). I t should be noted, howev er , t h at wh i le discover y is ge nera lly

impermissible “in an ERI SA action base d on a revie w of the administrative re cord, a n exception to that rule exist s where a plaintiff seeks to pur sue a dec ision-maker’ s bias.” Se e Cal v e rt , 4 0 9 F. 3 d

at 2 9 3 (c i t i n g W

ilkins ,150 F.3d at 618). - 17 - entitled,” the appropr iate remedy g ener ally is remand to the plan a dminist rator. Ibid. We a g re e wi th the Fir st Circuit. S uch a c o u rs e i s consistent with this court’s prec edent a nd we a dopt it here. 7 Se e Sm ith , 450 F.3d at 265 (“[W] e vac ate the judg ment of the district court and rema nd this case f

or entry of an or der r equiringCCC to conduct a f ull and fair r eview of

Smit h' s disability

claim.”)

. I n th is m a tte r, we c ann ot say that Ellio tt is cle arl y e nti tle d to ben e fi ts. Dr . Kun tz, at the tim e he c e rt i f i e d t h a t E l l iott’ s c on dit ion

me t th e re qu ir e me nts fo r s ho rt -t e rm dis a bil ity , in dic a te d s he c ou ld not then perf

orm work of

any kind. Howeve r, i n later reviews, Dr. Kuntz did not elaborate furthe r on why Elliott ’s condition pr eclude d her from working

. Also, while Dr. Schne ider’s e arlier revie ws indicated some improve ment with medication, his letter of Dec ember 9, 2003, indicates that Elli ott’s condition would limi t her abilit y to fulfill her job responsibilities. J ust how much such limitations would aff ect he r ability

to work, howe ver, w e ca nnot say with an y ac cu ra cy . For

example, does El lio tt h ave a

sit -s tand op tio n at he r j ob ? Whe n Dr

. Sc hn e ide r re fe rr e d to re pe tit ive mov e me nts , d idNo. 05-6633

- 18 -

he mea n to include ty

ping? I f so, how much ty

ping? Can Elliott dictate her reports, rathe r than ty pe them? Even pre suming that Dr . Schneider ’s letter a ccur ately states Elliott’s phy sical limitations, we sim ply c ann ot s ay

wh e the r t ho se lim itatio ns wo uld pr e c lud e he r fr om wo rk ing a s a bu sin e ss q ua lity analy st. And, as we ha

ve noted, Dr . Menotti’s review offe rs little support either wa y . Thus, we believe that a remand t o the di strict court with i nstructions to remand to MetL ife for a full and fa ir inquiry

is the proper

reme dy here . This course is c ontem p l at ed b o t h by our prec edent a

nd by ERI SA law. Sm ith , 450 F.3d at 265. See also Black & Dec ker , 538 U.S. at 825 (“ERI SA and the S ecr etar y of L abor’ s regulations under the Act re quire ‘f ull and fair’ assessment of cla ims.”) (c iting 29 U.S.C. § 1133 and 29 C.F.R. § 2560.503-1) . Such a re medy will allow for

a pr op e r d e te rm inatio n o f whe the r, in t he fi rst in sta

nc e , E lli ott

is e nti tle d to lon g -t e rm

dis a bil ity be ne fi ts. We a

re no t m edi cal sp e c ia lis ts a nd that ju dg me nt i s n ot o ur s to make . H ow e ve r, bo th MetL ife a nd the claimant would be well advised to pursue a ppropriate medical data re lating E lliott ’s undeniable me dical limitations t o the demands of her oc cupation. V I n this case, we wer e asked to a ddress whether MetL ife’s deter mination to deny

long- term disability benef its to Patricia Elli ott was arbitrary and capricious and, if it was, what re medy

to order. As a re su l to f

t h e f o r e g o i n g , w e h o l d

t h a tM e t L i f

e ’ s d e t e r m i n a t i o nw a s “ ar

b i t r ar y an d c a p r i c i o us ”No. 05-6633

- 19 -

for wa nt of a de liberate , principled re asoning proce ss. Glenn , 461 F.3d at 666. We also hold that the a pp ro pr iate re me dy

is t o rem and to M e tL if

e fo r a fu ll a nd fa ir inq uir y in a c c or da

nc e wi th t his court’s pr ece dent. Sm ith , 450 F.3d at 265. Acc ording ly , we vacate the district court’s judg ment and

rema nd the ca se for

proce eding s consistent with this opi nion.