In the

United States Court of Appeals

For the Seventh Circuit

No. 08-1722

NANCY LOVE,

Plaintiff-Appellant,

v.

NATIONAL CITY CORPORATION

WELFARE BENEFITS PLAN,

Defendant-Appellee.

Appeal from the United States District Court

for the Northern District of Illinois, Western Division.

No. 07 C 50048—Frederick J. Kapala, Judge.

ARGUED OCTOBER 21, 2008—DECIDED JULY 23, 2009 

Before RIPPLE, EVANS, and SYKES, Circuit Judges.

SYKES, Circuit Judge. Nancy Love worked for National

City Corporation for twenty years before leaving due to

health problems. After her physician diagnosed her with

multiple sclerosis, Love applied for and received shortterm disability benefits—and subsequently long-term

disability benefits—through National City’s Welfare

Benefits Plan (“the Plan”). Three years after Love began
2 No. 08-1722

receiving disability benefits, the Plan administrator

terminated her benefits, stating that she no longer fit

the Plan’s definition of “disabled.” Love appealed the

benefits-termination decision and the Plan denied her

appeal. Love then sued the Plan under the Employment

Retirement Income Security Act (“ERISA”), 29 U.S.C.

§§ 1001 et seq., alleging that her disability benefits

were terminated without sufficient explanation or

medical support. The district court granted summary

judgment for the Plan. Because the Plan did not adequately explain why it concluded Love was no longer

disabled, we reverse the judgment of the district court

with instructions to remand to the Plan administrator

for further proceedings.

I. Background

Nancy Love worked for National City for more than

twenty years in a variety of positions including bank teller,

teller supervisor, and technical-support analyst. She

stopped working in August 2001 when she began experiencing fatigue, dizziness, and blurred vision. After her

physician diagnosed her with multiple sclerosis, Love

applied for and received short-term disability benefits

for 26 weeks, the maximum period permitted under the

Plan. When her short-term benefits ran out, Love

applied for and received long-term disability benefits. She

continued to receive long-term disability benefits from

February 2002 until December 2005, when Liberty

Mutual, the claims administrator for the Plan, informed her

that she no longer met the Plan’s definition of “disabled.”
No. 08-1722 3

To receive disability benefits, claimants must meet the

Plan’s definition of “disabled.” The Plan sets out two

separate definitions of “disabled.” One definition

controls benefits for the first two years of disability,

and the second, more stringent definition covers any

remaining period of disability:

The definition of disabled during the 26-week [shortterm disability] period and the first 18 months you

receive [long-term disability] benefits is that you

cannot perform the duties of your particular job with

National City or a job with equivalent duties and

responsibilities . . . . After you have been disabled

for two years (that is, you have received six months

of short-term disability benefits plus 18 months of

[long-term disability] benefits), the definition of

disabled changes. The Plan Administrator must determine that your condition makes you unable to

perform the duties of any other occupation for which

you are, or could become, qualified by education,

training or experience.

Phrased another way, a claimant is disabled under the

first definition if she cannot perform her particular job; she

is disabled under the second definition if she cannot

perform any job—including one for which she could

become qualified by additional education or training. If

the recipient fails to meet the applicable definition, disability benefits terminate.

Liberty Mutual initially determined that Love qualified

as “disabled” under the first definition. That definition

controlled for the 26 weeks that Love received short-term
4 No. 08-1722

disability benefits and the first 18 months that she received

long-term disability benefits. In August 2003, two years

after Love began receiving benefits, the second definition

of “disability” kicked in under the Plan. Liberty Mutual

continued to pay Love benefits but did not reassess her

eligibility under the new definition until 2005. At that

time, it enlisted Dr. Jonathan Sands, its medical consultant, to assess Love’s status under the second, more

stringent definition of “disability.” Dr. Sands reviewed

Love’s medical file, which contained reports and records

from several treating physicians. He observed that while

Love probably suffered from multiple sclerosis, she

never suffered a documented clinical attack nor exhibited any documented clinical signs. He also noted

that her neurologic examination was normal. Based on

this information, Dr. Sands concluded that Love was not

“disabled” under the Plan’s second definition and that

“no objective limitations in functional ability or capacity

are noted.” Liberty Mutual sent Dr. Sands’s report to

Dr. Regina Bielkus, Love’s primary physician, and asked

her to explain whether she disagreed with any portion

of Dr. Sands’s report. Dr. Bielkus did not respond to

Liberty Mutual’s inquiries. On December 14, 2005,

Liberty Mutual informed Love that she no longer

qualified for long-term disability benefits. The letter

explained that Dr. Sands had reviewed her medical file

and had found no objective data supporting Love’s assertion that she had limited functional ability.

Love appealed the decision to the Claims Appeal Committee. As support for her continued eligibility, she

submitted various new reports purporting to show ob-
No. 08-1722 5

jective limitations on her functional capacity to work. For

example, she submitted a physical-therapy evaluation, a

functional-capacity evaluation, and a vocational evaluation. Each report was prepared by a different doctor, and

each report concluded that Love had limited functional

ability. The Committee turned this new information, along with Love’s complete medical file, over to

Dr. Gerald Winkler for review. Dr. Winkler agreed with

Dr. Sands’s conclusion that Love was not totally disabled. Specifically, he concluded that Love remained able

to “do a job that can be performed either seated or standing, that entails the use of a telephone, that entails

the intermittent reference to a computer display or

printed material without requirements of speed, and

that requires conversation with members of the general

public.” The Committee denied Love’s appeal, citing

Dr. Winkler’s conclusion that Love could perform a job

with the listed functional limitations. Love subsequently

sued the Plan under ERISA, claiming that the Plan did not

consider all the relevant medical evidence and did not

sufficiently explain its termination decision. The district

court granted summary judgment in favor of the Plan,

holding that the Plan both considered all the relevant

evidence and sufficiently justified its termination decision.

II. Analysis

A. Standard of Review

We review a district court’s grant of summary judgment de novo and view all facts in favor of the nonmoving

party. Tate v. Long Term Disability Plan Salaried Employees,
6 No. 08-1722

We reject Love’s suggestion that the Supreme Court’s 1

decision in Metropolitan Life Insurance Co. v. Glenn, 128 S. Ct. 2343

(2008), “fundamentally altered the paradigm for adjudicating

ERISA claims” by requiring us to conduct a more searching

review. The Supreme Court in Glenn merely held that courts

reviewing benefits determinations under ERISA should

consider any conflict of interest that exists when a plan administrator both evaluates claims for benefits and pays those

benefits. Id. at 2348. The Court explicitly disavowed any

suggestion that it was altering the standard of review. Id. at

2350 (“We do not believe that Firestone’s statement implies a

change in the standard of review . . . .”). We continue to apply

an arbitrary-and-capricious standard to denial-of-benefits

claims after Glenn. See Jenkins v. Price Waterhouse Long Term

Disability Plan, 564 F.3d 856, 861 (7th Cir. 2009).

545 F.3d 555, 559 (7th Cir. 2008). Because the Plan has

discretion to determine an individual’s eligibility for

benefits, we review the Plan’s decision to terminate

Love’s benefits under an arbitrary and capricious

standard. Hackett v. Xerox Corp. Long-Term Disability 1

Income Plan, 315 F.3d 771, 773 (7th Cir. 2003). While this

standard of review is deferential, it is not a rubber

stamp, and “we will not uphold a termination [of benefits]

where there is an absence of reasoning in the record to

support it.” Id. at 774-75. Furthermore, ERISA requires

plan administrators to communicate specific reasons for

a denial of benefits to the claimant and address any

reliable evidence of eligibility put forward by the claimant. See 29 U.S.C. § 1133; Black & Decker Disability Plan v.

Nord, 538 U.S. 822, 834 (2003). We will reverse a Plan’s

determination as arbitrary and capricious if it fails to
No. 08-1722 7

substantially comply with these requirements. Nord,

538 U.S. at 834; Tate, 545 F.3d at 559.

B. Sufficiency of Explanation

ERISA requires employee benefit plans that deny disability benefits to “set[] forth the specific reasons for

such denial, written in a manner calculated to be understood by the participant.” 29 U.S.C. § 1133. The accompanying regulations further require the plan to describe

“any additional material or information necessary for

the claimant to perfect the claim and an explanation of

why such material or information is necessary.” 29 C.F.R.

§ 2560.503-1(g)(iii). These requirements are designed

both to allow the claimant to address the determinative

issues on appeal and to ensure meaningful review of the

denial. Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 689

(7th Cir. 1992). We will reverse any denial of benefits

that does not substantially comply with these regulations.

Id. at 693-94.

In this case neither the initial termination letter nor

the subsequent letter denying Love’s appeal sufficiently

explained the denial. Both letters asserted that all

relevant medical evidence had been considered, but

neither letter explained why the reviewer chose to discredit the evaluations and conclusions of Love’s treating

physicians. See id. at 694. Liberty Mutual conducted the

initial review, retaining Dr. Sands as an independent

medical consultant. After reviewing Love’s medical file,

Dr. Sands concluded that Love was not totally disabled

because there was no “objective” evidence that Love
8 No. 08-1722

suffered any functional limitations. However, Love’s file

contained numerous test reports indicating a reduced

functional capacity, such as an MRI of her spine, evokedresponse tests, several physical-capacity reports, and

various lab reports. The file also contained several evaluations by Dr. Bielkus, Love’s primary physician, opining

that Love’s functional limitations stemming from her

multiple sclerosis made her unable to work. She concluded that Love was “medically disabled on a

permanent basis from any form of gainful occupation.” In

fact, every doctor that personally examined Love concluded that she was unable to work more than a few

hours a day and that she could not stand, sit, or walk

for more than an hour at a time. Dr. Sands did not

address any of these reports in his cursory report, which

dedicated less than half a page to its analysis and recommendation. Liberty Mutual’s termination letter merely

recited the various items in Love’s medical file in a

bulleted list, stated that Dr. Sands had found no objective limitations in Love’s functional ability, and terminated her benefits without any further discussion or

explanation. We are troubled by the fact that neither

Dr. Sands’s report nor Liberty Mutual’s letter addressed

the contrary findings of Love’s treating physicians or

explained why Liberty Mutual chose to discredit them.

On appeal, Love submitted additional reports demonstrating her functional incapacity to the Plan’s internal

appeals committee. These reports showed that Love had

significant impairments: She could not walk, sit, or

stand for more than an hour at a time; she could only

lift light items occasionally; she had limited flexibility,
No. 08-1722 9

serious vision impairments, and diminished muscular

strength; and she experienced frequent spells of

dizziness, vertigo, and fatigue. Dr. Winkler, who was

retained by the Plan to review Love’s file on appeal,

noted these problems but concluded that Love could

perform a job “either seated or standing, that entails

the use of a telephone, that entails the intermittent reference to a computer display or printed material without

requirements of speed, and that requires conversation

with members of the general public.” While acknowledging that Love could not perform her current job,

Dr. Winkler concluded that Love was not totally disabled

but did not adequately explain his conclusion. For example, Dr. Winkler noted Love’s chronic fatigue but dismissed it by asserting that “there are medications that

are used to treat fatigue.” Additionally, Dr. Winkler

noted that Love was limited to a six-hour workday. In

fact, however, only one physical therapist had concluded

that Love would be able to work for up to six hours; the

rest of Love’s treating physicians had concluded that

she was limited to, at most, two or three hours of work

each day. Dr. Winkler did not address the opinions of

these other physicians.

These explanations are insufficient to meet ERISA’s

requirement that specific and understandable reasons

for a denial be communicated to the claimant. Halpin,

962 F.2d at 688-89. As we have noted, “[b]are conclusions

are not a rationale.” Id. at 693. The Plan must provide

a reasonable explanation for its determination and

must address any reliable, contrary evidence presented

by the claimant. Nord, 538 U.S. at 834 (“Plan administra-
10 No. 08-1722

tors, of course, may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a

treating physician.”); see also Kalish v. Liberty Mut./Liberty

Life Assurance Co., 419 F.3d 501, 510 (6th Cir. 2005) (holding

that a plan acted arbitrarily in denying disability benefits

when its medical consultant failed to rebut the contrary medical conclusions of the claimant’s primary

physician). The Plan did not explain why it chose to

discount the near-unanimous opinions of Love’s treating

physicians. While plan administrators do not owe any

special deference to the opinions of treating physicians,

see Nord, 538 U.S. at 834, they may not simply ignore

their medical conclusions or dismiss those conclusions

without explanation. We do not hold that the evidence

here requires a finding that Love is totally disabled, only

that ERISA requires the Plan to provide a more thorough

explanation for its determination than it has here. The

Plan acted arbitrarily by terminating Love’s benefits

without sufficiently explaining its basis for doing so.

One final point bears a brief word. Love complains that

the Plan’s determination is suspect given the Social Security Administration’s (“SSA”) determination that she

qualified for disability benefits. In 2002 the SSA determined that Love met its definition of “disabled” because

of her multiple sclerosis and awarded her retroactive

disability benefits from August 2001—the date she

stopped working at National City. We note, however, that

the Plan’s definition of “disabled” is different from—and

arguably more stringent than—the SSA’s definition. See

42 U.S.C. § 423(d)(1)(A) (defining disability as the “inability to engage in any substantial gainful activity by
No. 08-1722 11

reason of any . . . physical or mental impairment which . . .

has lasted or can be expected to last for a continuous period of not less than 12 months”). But see Diaz v.

Prudential Ins. Co. of Am., 499 F.3d 640, 644 (7th Cir.

2007) (suggesting that the differences between the

Plan’s definition and the SSA definition are minor). In

addition, we have repeatedly emphasized that the SSA’s

determination of disability is not binding on employers

under ERISA. See Mote v. Aetna Life Ins. Co., 502 F.3d

601, 610 (7th Cir. 2007). SSA determinations are often

instructive, but they are not determinative. Id. Because we

are remanding, the Plan will have an opportunity to

consider the SSA’s determination when it reevaluates

Love’s eligibility.

C. Remedy

We conclude that the Plan acted arbitrarily in terminating Love’s disability benefits without giving a sufficient

explanation of its reasons. Love wants us to award her

retroactive benefits, but we decline to do so. Retroactive

reinstatement of benefits is a proper remedy in cases

where the evidence is “so clear cut that it would be unreasonable for the plan administrator to deny the application for benefits on any ground.” Gallo v. Amoco Corp., 102

F.3d 918, 923 (7th Cir. 1996). Here, the evidence is not so

clear. “[W]hen a court or agency fails to make adequate

findings or fails to provide an adequate reasoning, the

proper remedy in an ERISA case . . . is to remand for

further findings or explanations . . . .” Quinn v. Blue Cross

& Blue Shield Assoc., 161 F.3d 472, 477 (7th Cir. 1998). On
12 No. 08-1722

remand, the Plan should conduct a more thorough

inquiry into whether Love meets the Plan’s definition of

“disabled.” If it concludes that she does not meet that

definition, it must adequately explain the reasons supporting its decision, including at a minimum an explanation of why it is discounting the medical opinions of

Love’s treating physicians.

Accordingly, we REVERSE the district court’s entry of

summary judgment and REMAND with instructions to

remand to the Plan administrator for further proceedings

consistent with this opinion.

7-23-09