Opinion ID: 780140
Heading Depth: 2
Heading Rank: 2

Heading: analysis

Text: 40 This court reviews a decision of a district court in an ERISA benefits case de novo. Gatlin v. National Healthcare Corp., 16 Fed.Appx. 283, 2001 WL 223732, (6th Cir.2001) ( citing Paul Revere Life Ins. Co. v. Brock, 28 F.3d 551, 553 (6th Cir.1994)). The parties agree that the standard of review in this case is whether the denial of benefits was arbitrary and capricious because Met Life had discretionary authority to construe and interpret the benefit plan at issue. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Miller v. Metropolitan Life Ins. Co., 925 F.2d 979, 983 (6th Cir.1991); Elliott v. Lockheed Martin Energy Systems, Inc., 61 F.Supp.2d 745, 748 (E.D.Tenn.1999) A decision regarding eligibility for benefits is not arbitrary and capricious if the decision is rational in light of the plan's provisions. Daniel v. Eaton Corp., 839 F.2d 263, 267 (6th Cir.1988). See also Yeager v. Reliance Standard Life Ins. Co., 88 F.3d 376, 381 (6th Cir.1996). Stated differently, [w]hen it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome, that outcome is not arbitrary or capricious. Davis v. Kentucky Finance Cos. Retirement Plan, 887 F.2d 689, 693 (6th Cir.1989) (internal quotations and citation omitted). See also Perez v. Aetna Life Ins. Co., 150 F.3d 550, 555 (6th Cir.1998) (en banc).
41 In requesting a transferable skills analysis by Crawford, Met Life sent only Dr. MacKay's September 14, 1999, Physical Capacities Evaluation. Based on Dr. MacKay's report, the vocational consultant at Crawford opined that Spangler could perform her own job as well as several other sedentary positions. It is undisputed that the vocational consultant never examined Spangler nor had any other materials other than Dr. MacKay's September 1999, Physical Capacities Evaluation on which to base this opinion. 5 Contrary to Met Life's assertion, Dr. MacKay's September 14, 1999, report of Spangler's capabilities is somewhat aberrant; as noted in detail above, all of his prior reports and statements clearly indicate that Spangler is not able to perform any work. Moreover, Dr. Rice's Physician Capacities Evaluation, also completed in September, reveals a much different picture of Spangler's abilities and is consistent with all of the evidence in the administrative record. 6 Why Met Life did not also send Dr. Rice's report or the rest of Spangler's file Crawford for review by the vocational consultant is inexplicable. Indeed, we can only conclude that Met Life, as Spangler contends, cherry-picked her file in hopes of obtaining a favorable report from the vocational consultant as to Spangler's ability to work. 42 Met Life's action in sending only Dr. MacKay's September 14, 1999, report to Crawford was arbitrary and capricious. Met Life should have provided Crawford with all of the medical records relevant to Spangler's capacity to work. As a result, the report by Crawford's vocational consultant was an incomplete and inaccurate representation of Spangler's ability to work. 43 Regardless of the shortcomings of the vocational consultant's report and Met Life's arbitrary actions with respect to the report, the ultimate issue in an ERISA denial of benefits case is not whether discrete acts by the plan administrator are arbitrary and capricious but whether its ultimate decision denying benefits was arbitrary and capricious. For this, we must examine Met Life's decision in light of the administrative record. Here, as set forth in detail above, virtually all of the evidence in the administrative record shows that Spangler is disabled from working. Met Life, however, chose to base its decision on only the report by Crawford's vocational consultant. Because the report was inherently flawed and because the medical evidence supports a finding that Spangler cannot work, Met Life's decision to terminate Spangler's LTD benefits was arbitrary and capricious.