Opinion ID: 1196130
Heading Depth: 2
Heading Rank: 1

Heading: Termination of Tate's benefits was arbitrary and capricious.

Text: Where, as is the case here, the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan, we review a denial of benefits under the arbitrary and capricious standard. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d 771, 773 (7th Cir.2003). The parties do not dispute that the Plan's administrator has discretionary authority and that the district court used the correct standard when it reviewed Tate's denial of benefits under the arbitrary and capricious standard. Notwithstanding the highly deferential nature of this standard, we have held that termination procedures must substantially comply with the ERISA requirement that specific reasons for denial be communicated to the claimant and that the claimant be afforded an opportunity for `full and fair review' by the administrator. Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 688-89 (7th Cir.1992). [W]e will not uphold a termination when there is an absence of reasoning in the record to support it. Hackett, 315 F.3d at 774-75 (standard of review is not a rubber stamp); Halpin, 962 F.2d at 695 ([T]he administrator must weigh the evidence for and against [the denial or termination of benefits], and within reasonable limits, the reasons for rejecting evidence must be articulated if there is to be meaningful appellate review.) (internal quotation marks omitted). The issue in this case is whether the Plan offered a reasonable explanation, based on the evidence, for its determination that Tate was not totally disabled as defined by the terms of the plan. In determining Tate's eligibility for long-term disability benefits, the Plan had to determine whether Tate was incapable of performing any occupation or employment for which [she was] qualified by education, training, or experience. So as a matter of logic, this means the Plan needed to consider (at minimum) Tate's qualifications in determining whether her impairment affects her ability to work. We agree with the district court that the Plan's decision to terminate Tate's benefits was arbitrary and capricious because the Plan's conclusion that Tate's disability did not render her unable to do any job for which she was qualified was not based on any explanation or reasoning. The Plan twice informed Tate of its decision to terminate her benefits, first based on a report by Dr. Tasch, and then based on a report by Dr. Center in response to Tate's appeal. Both determinations are at issue here. Dr. Tasch first reviewed Tate's file and issued the report that provided the basis for the Plan's May 30, 2003 determination that Tate did not qualify for benefits. As an initial matter, the record does not demonstrate that Dr. Tasch even reviewed Tate's employment file so it is not clear how she could have come to any reasonable conclusion about Tate's qualifications. See Quinn v. Blue Cross & Blue Shield Ass'n, 161 F.3d 472, 476-77 (7th Cir.1998) (finding that plan administrator's review was arbitrary and capricious when the reviewer failed to adequately investigate the requirements of the claimant's previous occupation). In her report, Dr. Tasch states that though Tate appears to meet the criteria for a diagnosis of Major Depressive Disorder, she is not unable to perform any occupation. In lieu of an explanation for this conclusion, Dr. Tasch states (and this is the full extent of her analysis) that because Tate was working in a high stress position previously [she] may benefit from a job that is not so intense. We do not know what she means by jobs that are not intense or whether Tate is qualified for those jobs. The Plan's letter informing Tate that her benefits were being denied contains no reasons for the denial other than stating that a physician found that Tate was not totally disabled from any occupation so there is nothing further in the initial denial letter for the court to review. In response to Tate's appeal the Plan had her file reviewed by Dr. Center, whose report indicates that she considered Tate's résumé and job description, in addition to her medical files. But what Dr. Center did with that additional information is less than clear. For example, Dr. Center's report states that Interpersonal relationship difficulties characterized by the patient becoming `enraged' if she feels she is being patronized or if others are incompetent may be limiting in terms of future vocational options. Nevertheless, Dr. Center concludes that Tate (who was employed in sales) is not totally disabled from any occupation at this time because she is able to maintain her own home, complies with treatment, and there is no documentation of suicidal ideation, homicidal ideation, or psychosis. Dr. Center also states that the addition of Adderall to her medication regimen in September 2002 provided her significant benefit. [2] Dr. Center's report is just as defective as Dr. Tasch's because nowhere in the report does Dr. Center connect her conclusion that Tate is not totally disabled to something that is relevant to Tate's ability to work. Similarly, Dr. Center's general conclusion that medication has provided significant benefit to Tate does not prove anything unless the improvement is shown to be connected in some rational way to her ability to work. See Elliott v. Metropolitan Life Ins. Co., 473 F.3d 613, 620 (6th Cir.2006) (`Getting better,' without more, does not equal `able to work.'). The Plan's second letter to Tate informing her that its decision to deny her benefits would remain the same echoes Dr. Center's non-sequitur analysis. The letter states: It is the opinion of the reviewer that you are able to maintain your own home and care for your animals. There is no documentation of suicidal ideation, homicidal ideation or psychosis. You have been compliant with Outpatient psychotherapy and multiple medication trials. You are able to understand and participate in the process regarding disability determinations. It appears that you have had an exacerbation of mood symptoms following the determination regarding disability. However, no specific measurable impairments rendering you unable to do any job for which you are qualified by reason of training, education, and/or experience were noted. That Tate can clean her home and care for her pets after years of treatment and medication does not support a conclusion that she is capable of employment unless the Plan believes she is qualified to care for animals as a living. That she has not contemplated killing herself or others is even less probative of her ability to work. These reasons are not relevant to a conclusion that Tate, a former sales employee, is able to do a job for which she is qualified. The Plan protests that it should not be required to review vocational evidence in making disability determinations. But logically, the Plan could have made a reasoned determination that Tate was not totally disabled only if it relied on evidence that assessed her ability to perform a job for which she is qualified by education, training, or experience. This means the Plan must have made a reasonable inquiry into Tate's medical condition as well as her vocational skills and qualifications for its decision denying benefits to be upheld. Quinn, 161 F.3d at 476. In so holding, we express no opinion as to whether ERISA plan administrators as a rule must hire vocational experts or perform a transferrable skills analysis. But it is the Plan's burden to make sure its determination that Tate could perform a job for which she was qualified despite her medical conditionis reached in a manner that substantially complies with ERISA, see Halpin, 962 F.2d at 688-90. That did not happen here. Although the record shows Dr. Center was given Tate's résumé and job description as part of her materials to consider, nothing in Dr. Center's report or the Plan's specific reasons for denial relates to Tate's job qualifications. Unless the Plan provides a reasonable explanation for its conclusion that Tate was capable of performing another job for which she was qualified, we have no basis to uphold the Plan's decision. Conclusions without explanation do not provide the requisite reasoning and do not allow for effective review. Hackett, 315 F.3d at 775; see also Halpin, 962 F.2d at 695 (rejecting plan administrator's denial of benefits as too conclusory to permit appellate review where administrator did not weigh the evidence for and against a determination that a claimant is ready to return to work). The Plan contends that Tate bears the burden of demonstrating through a vocational expert that she is unable to perform any job for which she is qualified. We disagree. Although she certainly could have provided the affidavit of a vocational expert, there is nothing in our case law that requires her to do so as long as she provides evidence that she has an impairment that affects her ability to work. Tate presented evidence, in the form of her physician's report, that she was not capable of performing any job. In his November 2003 letter to the Plan, Dr. Kayton wrote that Tate is hypomaniac, inefficient in completing tasks, and suffers from pronounced concentration problems, emotional volatility, episodic rages, and an inability to handle even her activities of daily living. Dr. Kayton reported that Tate had not been free from mood swings since 1998, and that because of her unpredictable temper, she had severely limited her interpersonal contacts. Accordingly, Dr. Kayton wrote, her illness did not permit her to work in a job commensurate with her abilities, experience, and previous levels of employment. [3] Without refuting this report or the assertions contained within, the Plan responded with the bare conclusion that Tate could do another job. This does not suffice under the arbitrary and capricious standard of review because there is no reason for this conclusion. It is well within the power of the Plan to reject Dr. Kayton's and Dr. Greenburg's conclusions but it must do so with some explanation, especially in light of the fact that Tate was awarded disability benefits for nearly four years on the basis of those doctors' opinions. See Hackett, 315 F.3d at 775 (termination procedures were arbitrary and capricious when administrator did not explain departure from opinions of previous doctors). For the Plan to make a reasonable determination that Tate was able to work in an occupation for which she was qualified despite her impairments, the Plan was required, at minimum, to assess her qualifications and how they comport with jobs that Tate might be able to perform in spite of her impairments. By not performing this assessment before determining that Tate was not totally disabled, the Plan acted arbitrarily and capriciously.