Court Opinion

ID: 9410872
Source: CourtListenerOpinion
Date Created: 2023-07-24 20:00:54.946644+00
Date Added: 2024-06-11T17:21:00.906246
License: Public Domain

NOT RECOMMENDED FOR PUBLICATION
                                File Name: 23a0338n.06

                                       Case No. 22-1960

                          UNITED STATES COURT OF APPEALS
                               FOR THE SIXTH CIRCUIT

                                                                                 FILED
                                                                            Jul 24, 2023
JACQUELINE AVERY,                                    )                 DEBORAH S. HUNT, Clerk
                                                     )
       Plaintiff - Appellant,
                                                     )
                                                     )        ON APPEAL FROM THE
v.
                                                     )        UNITED STATES DISTRICT
                                                     )        COURT FOR THE EASTERN
SEDGWICK     CLAIMS     MANAGEMENT
                                                     )        DISTRICT OF MICHIGAN
SERVICES, INC. and FCA US LLC LONG-
                                                     )
TERM DISABILITY BENEFIT PLAN,
                                                     )
                                                     )                             OPINION
       Defendants - Appellees.
                                                     )

Before: McKEAGUE, GRIFFIN, and MURPHY, Circuit Judges.

       McKEAGUE, Circuit Judge. For roughly two years, Jacqueline Avery received long-

term disability benefits from her former employer, Chrysler Group LLC (Chrysler), through its

FCA US LLC Long Term Disability Benefit Plan (the Plan). The Plan’s third-party claims

administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), later terminated those

benefits after concluding that Avery no longer qualified as “totally disabled” within the meaning

of the Plan. Avery brought this action under 29 U.S.C. § 1332(a)(1)(B) of the Employee

Retirement Income Security Act of 1974 (ERISA) to recover and reinstate her long-term disability

benefits. The district court granted judgment on the administrative record in favor of Sedgwick

and the Plan, and Avery now appeals. For the following reasons, we affirm.
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

                                                 I

   A. Factual Background

       In 2006, Jacqueline Avery was on a camping trip when she fell and fractured her right

ankle. She largely recovered, but severe pain in her right leg spontaneously returned in 2011. At

the time, Avery worked for Chrysler as a finance specialist, and the persistent pain began to impede

her ability to work. In July 2011, Avery was diagnosed with “advance peripheral deyelinatibe and

axonal polyneuropathy [of the] lower legs,” and her last date worked was July 15, 2011. A.R. 195.

       Avery initially applied for and received short-term disability benefits under Chrysler’s

Disability Absence Plan. But when her eligibility for short-term benefits expired, Avery converted

her claim into one for long-term benefits. To be eligible for long-term disability benefits, the Plan

states in ungrammatical fashion that a participant must “be ‘totally disabled’ because of disease or

injury so as during the first 24 months of disability to be unable to perform the duties of the

Participant’s occupation, and after the first 24 months of disability be unable to engage in regular

employment or occupation with the Corporation.” A.R. 1206.

       Due to the nature of Avery’s condition, Sedgwick referred Avery’s claim to two board-

certified neurologists, Dr. Hermann Banks, M.D., and Dr. David Gaston, M.D., for independent

medical examinations. Dr. Banks opined that Avery suffered from “[r]ight lower extremity pain

with paresthesia and dysesthesia” and recommended that Avery not return to work. A.R. 793. Dr.

Gaston similarly identified “exquisite pain on motion of the right distal leg and foot,” and

diagnosed Avery with Complex Regional Pain Syndrome Type II. Relying on the results of these

medical examinations, among other medical records, Sedgwick approved Avery for long-term

disability benefits effective August 10, 2012, on the basis of “totally disabling condition(s) of

Right Lower Extremity Neuropathy & reflex sympathetic dystrophy lower extremity.” A.R. 1055.

                                                -2-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

       Pursuant to the terms of the Plan, Sedgwick also required Avery to apply for Social Security

Disability Insurance (SSDI) benefits. The Social Security Administration (SSA) awarded Avery

monthly SSDI benefits in the amount of $2,024, retroactive to January 2012. Sedgwick then

requested and received reimbursement for overpayment in the amount of $15,069.42.

       Throughout 2013 and early 2014, Avery continuously furnished medical records from her

treating physicians to substantiate her disability, and Sedgwick repeatedly approved Avery’s long-

term disability benefits under the Plan. But in June 2014, Chrysler’s Special Investigations Unit

surveilled Avery and purportedly observed her driving—something she is medically restricted

from doing. Chrysler also suspected that Avery was running a business out of her home. This

prompted Chrysler to request an additional independent medical examination. Sedgwick scheduled

the requested medical exam with Dr. Joel Shavell, D.O., who is board certified in internal medicine

and rheumatology; he examined her on July 15, 2014. Dr. Shavell observed that Avery “walked in

quickly with a normal gait and had no problems getting undressed, and no problems getting in and

out of the room; no problems moving, and no problems functionally.” A.R. 977. Based on these

observations, Dr. Shavell concluded:

       At this time, I do not see any evidence of a regional complex pain issue, and
       normally with these pain syndromes, they are so severe and difficult that patients
       hardly recover fully. They have some residual, such as walking with a limp, or
       inability to move a leg, as well as sensitivity to touch. These would be some of the
       findings that would be common and Ms. Avery exhibits none of them. . . .

       Based on the fact that I do not find a regional complex pain issue, and because she
       does not have a venous issue, and based on the fact that when I examined her ankle
       she [can] bear weight on the ankle, on her heels and toes despite her weight, I do
       not find any physical evidence to substantiate at this point any disability
       whatsoever. It is my opinion that she can return to full duty work, as of today’s
       date.

A.R. 978–79.

                                               -3-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

        After receiving the results of the independent medical examination, Sedgwick notified

Avery via letter dated July 21, 2014, that she had been found able to work, and requested that she

report to her plant medical department for further evaluation. Sedgwick indicated that Avery’s

benefits “may be suspended effective July 21, 2014, pending the outcome of the ability to work

examination.” A.R. 974. On July 22, 2014, Avery reported to Chrysler’s medical department where

the plant medical doctor determined that Avery was able to return to work.

        During the evaluation, a plant medical nurse provided Avery with a copy of Dr. Shavell’s

narrative report. Believing the report to be filled with “bold face lies,” Avery called Sedgwick to

complain. A.R. 944. A Sedgwick representative instructed Avery to formalize her complaints in

writing, which she did a few days later. On July 28, 2014, Avery sent a letter to Sedgwick “to

appeal [her] recent return to work decision” and “to challenge several statements” made by Dr.

Shavell. A.R. 964–66. On August 4, 2014, Sedgwick acknowledged receipt of Avery’s “request

for appeal” and indicated that her claim would be reviewed by Sedgwick’s Appeals Unit. A.R.

957. On August 8, 2014, Sedgwick called Avery to ask whether she intended to provide any

additional information or documentation. Avery responded that she did not. A.R. 949.

        Internal documents indicate that Sedgwick’s July 21, 2014, letter was neither a formal nor

final denial letter, as it did not “outlin[e] the reason for denial or [detail] appeal rights. The letter

only request[ed] that the claimant RTW [return to work].” A.R. 458. Rather, Sedgwick did not

issue its formal benefits determination until roughly one month later, via letter dated August 20,

2014, wherein Sedgwick set forth the Plan’s eligibility criteria, articulated the reasons for its

benefits denial, and outlined the appeals procedures. Nonetheless, Sedgwick continued to treat

Avery’s July 28, 2014, letter as an appeal and reviewed Avery’s claim in the ordinary course.

                                                  -4-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

       As part of this review process, Sedgwick referred Avery’s claim for an independent record

review (IRR) with Dr. David Hoenig, M.D., a specialist in neurology and pain medicine. Dr.

Hoenig reviewed Avery’s medical records and concluded that “[b]ased on the documentation

provided, and from a neurological perspective only, [Avery] is not disabled from performing any

work as of 07/22/14.” A.R. 663.

       By letter dated September 12, 2014, Sedgwick formally denied Avery’s appeal. The letter

indicated that the decision was “the Claim Administrator’s final decision,” and that Avery had “the

right to bring a civil action under ERISA” and was “entitled to receive[], upon request and free of

charge, reasonable access to, and copies of, all documents, records, and other information relevant

to [her] claim for benefits.” A.R. 659.

       Avery did not respond until more than eight months later, when her attorney sent a letter

to Sedgwick on May 18, 2015, demanding that “Ms. Avery’s benefits be immediately reinstated

with retroactive pay forthwith.” A.R. 654. Attached to this demand was a letter from Dr. Brengel,

Avery’s primary care doctor who specializes in family medicine, wherein Dr. Brengel disputed

Dr. Shavell’s findings and attempted to bolster Avery’s claimed disability. Specifically, Dr.

Brengel referenced “an EMG performed by K. Fram, M.D., in December of 2014,” and indicated

that “Dr. Fram believes that Ms. Avery has reflex sympathetic dystrophy in her right lower

extremity by history, chronic S1 radiculopathy bilaterally, severe peripheral polyneuropathy, and

bilateral tarsal tunnel syndrome.” A.R. 655. On this basis, Dr. Brengel concluded that Plaintiff

“remain[ed] disabled due to the difficulties with her right leg.” Id.

       Despite having no obligation to do so, Sedgwick responded to the letter by initiating a “re-

review” of Avery’s claim. A.R. 651. As part of this voluntary re-review, Sedgwick offered Avery

an opportunity to submit additional medical information and documentation before July 28, 2015,

                                                -5-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

but Avery never submitted additional records.1 Sedgwick also referred Avery’s claim to Dr. Mark

N. Friedman, D.O, a board-certified neurologist and specialist in internal medicine, for another

IRR. Dr. Friedman reviewed Avery’s medical records and concluded that Avery “is not disabled

from performing any work as of 07/22/14.” A.R. 601. Relying on Dr. Friedman’s report, Sedgwick

upheld its decision to terminate Avery’s long-term disability benefits. By letter dated September

30, 2015, Sedgwick informed Avery that she no longer satisfied the Plan’s eligibility requirements.

The letter also outlined her appeal rights. Avery did not appeal that decision.

       B. Procedural Posture

           Avery filed suit in the Eastern District of Michigan pursuant to Section 502(a)(1)(B) of

ERISA, 29 U.S.C. § 1132(a)(1)(B), to recover long-term disability benefits allegedly owed to her

under the terms of the Plan. The complaint appears premised on Sedgwick’s September 12, 2014,

denial, which Avery refers to as “the final decision on Ms. Avery’s claim.” R. 1, PID 11. It does

not reference Sedgwick’s voluntary re-review or the decision issued on September 30, 2015.

           She also filed a “Statement of Procedural Challenge,” alleging various procedural errors

committed by Sedgwick and requesting that the court schedule a status conference to address

discovery. Defendants filed a “Motion to Strike Statement of Procedural Challenge,” which the

district court construed as a motion to review and reject Avery’s Statement. The district court

rejected Avery’s Statement, finding that no valid procedural challenge was presented justifying

further discovery.

           Thereafter, the parties filed competing motions for judgment on the administrative record.

The district court denied Avery’s motion and granted judgment on the administrative record in

favor of Sedgwick and the Plan. This appeal followed.

1
    Avery claims she never received this letter. See Appellant’s Br. at 21.

                                                           -6-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

                                                           II

         “We review de novo the decision of a district court granting judgment in an ERISA

disability action based on an administrative record.” DeLisle v. Sun Life Assurance Co. of Can.,

558 F.3d 440, 444 (6th Cir. 2009) (internal quotation marks omitted). And when the insurance plan

administrator is vested with discretion to interpret the plan, we review the administrator’s decision

to deny benefits under the arbitrary and capricious standard. Helfman v. GE Grp. Life Assurance

Co., 573 F.3d 383, 392 (6th Cir. 2009). Here, neither party disputes that the Plan gives Sedgwick

this discretion. We therefore review Sedgwick’s decision to terminate Avery’s long-term disability

benefits under the arbitrary and capricious standard. See Firestone Tire & Rubber Co. v. Bruch,

489 U.S. 101, 115 (1989).2 Finally, we review de novo “the question of whether the procedure

employed by the fiduciary in denying the claim meets the requirements of Section 1133.” Kent v.

United of Omaha Life Ins. Co., 96 F.3d 803, 806 (6th Cir. 1996).

    A. Sedgwick Satisfied ERISA Procedural Requirements

         On appeal, Avery raises a series of procedural objections, broadly arguing that Sedgwick

violated ERISA claims procedures, and that in so doing, Sedgwick denied her claim a full and fair

review. Specifically, Avery alleges the following: (1) Sedgwick’s initial denial letter failed to

comply with ERISA requirements, (2) Sedgwick did not afford Avery a reasonable opportunity to

appeal, (3) Sedgwick did not provide Avery with an opportunity to supplement the administrative

record, (4) Dr. Shavell lacked the required training and experience, and (5) Sedgwick omitted

2
  Relying on the Second Circuit’s opinion in Halo v. Yale Health Plan, 819 F.3d 42 (2d Cir. 2016), Avery argues that
the de novo standard of review should apply to our review of the administrator’s decision to terminate benefits because
Sedgwick allegedly failed to comply with the claims procedure regulation. Appellant’s Br. at 25. In Halo, the Second
Circuit held that “a plan’s failure to comply with the Department of Labor’s claims-procedure regulation, 29 C.F.R.
§ 2560.503-1, will result in that claim being reviewed de novo in federal court, unless the plan has otherwise
established procedures in full conformity with the regulation and can show that its failure to comply with the regulation
in the processing of a particular claim was inadvertent and harmless.” 819 F.3d at 45. However, this circuit has yet to
adopt such a rule, and we decline to do so here.

                                                         -7-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

relevant documents from the administrative record. Addressing each procedural objection in turn,

we conclude that Sedgwick substantially complied with ERISA claims procedures.

ERISA Procedural Requirements

       We begin with a brief overview of the ERISA regulations that govern employee benefit

claims procedures. ERISA ensures that fiduciaries administer employee benefit plans “solely in

the interest of the participants and beneficiaries.” 29 U.S.C. §§ 1104(a)(1), 1001(b). Under ERISA,

the Secretary of Labor has the authority to enact regulations that govern the administration of

employee benefit claims. Id. §§ 1133, 1135. Section 1133 provides that every employee benefit

plan must:

       (1) provide adequate notice in writing to any participant or beneficiary whose claim
           for benefits under the plan has been denied, setting forth the specific reasons
           for such denial, written in a manner calculated to be understood by the
           participant, and

       (2) afford a reasonable opportunity to any participant whose claim for benefits has
           been denied for a full and fair review by the appropriate named fiduciary of the
           decision denying the claim.

Id. § 1133. We have held that the “essential purpose” of these requirements is twofold: “(1) to

notify the claimant of the specific reasons for a claim denial, and (2) to provide the claimant with

an opportunity to have that decision reviewed by the fiduciary.” Wenner v. Sun Life Assurance Co.

of Can., 482 F.3d 878, 882 (6th Cir. 2007) (emphasis and citation omitted).

       In deciding whether a plan has satisfied the requirements of § 1133, we employ a

“substantial compliance” test. Id. Under this test, all communications between the claimant and

the administrator are considered. “If the communications between the administrator and participant

as a whole fulfill the twin purposes of § 1133, the administrator’s decision will be upheld even

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Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

where the particular communication does not meet those requirements.” Id. (internal quotation

marks omitted).

       Additional procedural safeguards are codified in 29 C.F.R. § 2560.503–1, titled “Claims

procedure.” Specifically, “in the context of an administrative appeal of an adverse benefits

determination, 29 C.F.R. § 2560.503–1(h)(2) outlines the essential procedural requirements for a

full and fair review.” Balmert v. Reliance Standard Life Ins. Co., 601 F.3d 497, 502 (6th Cir. 2010).

That provision provides, in part:

       [T]he claims procedures of a plan will not be deemed to provide a claimant with a
       reasonable opportunity for a full and fair review of a claim and adverse benefit
       determination unless the claims procedures— . . .

              (ii)      Provide claimants the opportunity to submit written comments,
                        documents, records, and other information relating to the claim for
                        benefits;

              (iii)     Provide that a claimant shall be provided, upon request and free of
                        charge, reasonable access to, and copies of, all documents, records, and
                        other information relevant to the claimant’s claim for benefits. . . .

              (iv)      Provide for a review that takes into account all comments, documents,
                        records, and other information submitted by the claimant relating to the
                        claim, without regard to whether such information was submitted or
                        considered in the initial benefit determination.

29 C.F.R. § 2560.503–1(h)(2). Furthermore, “group health plans,” such as the Plan that is at issue

in this case, are required to comply with the following:

       (i)           Provide claimants at least 180 days following receipt of a notification of an
                     adverse benefit determination within which to appeal the determination;

       (ii)          Provide for a review that does not afford deference to the initial adverse
                     benefit determination and that is conducted by an appropriate named
                     fiduciary of the plan who is neither the individual who made the adverse
                     benefit determination that is the subject of the appeal, nor the subordinate
                     of such individual; [and]

       (iii)         Provide that, in deciding an appeal of any adverse benefit determination that
                     is based in whole or in part on a medical judgment, . . . the appropriate
                                                     -9-
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

               named fiduciary shall consult with a health care professional who has
               appropriate training and experience in the field of medicine involved in the
               medical judgment. . . .

Id. § 2560.503–1(h)(3)(i)–(iii).

Notice and an Opportunity to Appeal

       Avery’s first procedural objection takes issue with Sedgwick’s July 21, 2014, letter. She

argues that the letter failed to “inform her that she could submit comments or other information,

that she could obtain documents relevant to her claim in order to prepare an appeal, and did not

describe any appeal procedures.” Appellant’s Br. at 31–32. In response, Sedgwick argues that its

letter was neither a formal benefit determination nor final claim denial. Rather, the letter merely

intended to advise Avery of the results of her independent medical examination and to instruct her

to report to her plant medical department for an ability-to-work determination. Sedgwick contends

that later communications—such as the August 20, 2014, letter terminating Avery’s benefits, the

September 12, 2014, letter denying Avery’s appeal, and the September 30, 2015, letter upholding

the benefits denial upon re-review—constitute benefits determinations, and that each complied

with ERISA.

       We need not resolve whether Sedgwick’s July 21, 2014, letter was in fact a formal benefit

determination, because Sedgwick’s collective communications with Avery substantially complied

with ERISA’s procedural requirements. See Kent, 96 F.3d at 807 (holding that, despite technical

deficiencies in the insurer’s denial letters, “when viewed in light of the myriad of communications

between claimant, her counsel and the insurer, [the letters] were sufficient to meet the purposes of

Section 1133 in insuring that the claimant understood the reasons for the denial of the claim as

well as her rights to review of the decision”). Although Sedgwick’s July 21, 2014, letter

undoubtedly fell short of meeting the requirements articulated in § 2560.503–1(h), its August 20,

                                               - 10 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

2014, denial letter corrected any deficiencies. Avery was made aware of the reasons for

Sedgwick’s benefits denial (i.e., the results of Dr. Shavell’s independent medical examination) and

of her appeal rights. Collectively, therefore, Sedgwick’s communications with Avery satisfied the

dual purposes behind (and plain text of) Section 1133. See Wenner, 482 F.3d at 882; Putney v.

Med. Mut. of Ohio, 111 F. App’x 803, 807 (6th Cir. 2004) (finding that an administrator’s failure

to satisfy ERISA notice requirements was “neither significant nor outcome determinative” where

the “procedural failures did not prevent [the claimant] from gaining information necessary to

contest his denial of benefits”).

       Avery’s argument that Sedgwick deprived her of an opportunity to appeal its adverse

benefit decision fails for similar reasons. First, on July 28, 2014, Avery “appealed” the results of

Dr. Shavell’s independent medical examination, albeit before receiving Sedgwick’s August 20,

2014, letter. Sedgwick ultimately treated Avery’s July 28, 2014, letter as a proper and timely

appeal, and it reviewed Avery’s claim as it would any other appeal. Thereafter, Sedgwick

effectively afforded Avery a second appeal by voluntarily re-reviewing her claim in 2015. And

finally, Sedgwick provided Avery with an opportunity to appeal its September 30, 2015, decision,

which upheld the termination of her long-term disability benefits upon re-review, but Avery chose

not to appeal that decision.

       Given this posture, Avery cannot argue that she was denied a reasonable opportunity to

appeal Sedgwick’s decision. Put plainly, Avery did appeal the termination of her long-term

disability benefits—twice. And when afforded an additional opportunity to appeal Sedgwick’s

final benefits determination in 2015, Avery declined to do so. In sum, we simply cannot see how

Sedgwick’s procedures fell short of providing Avery’s claim a meaningful review.

                                               - 11 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

Opportunity to Supplement and Access the Record

       Next, Avery contends that “Sedgwick did not provide [her] with an opportunity to submit

comments or documents in response to the initial benefit decision before issuing the final

decision,” in violation of 29 C.F.R. § 2560.503–1(h)(2)(ii). Reply Br. at 10. Again, we disagree.

       Before issuing its initial benefits denial, Sedgwick contacted Avery to ask whether she

intended to provide any additional information, to which she responded “no.” A.R. 949. Likewise,

during its voluntary re-review, Sedgwick afforded Avery the opportunity to supplement the record

with any additional medical information or documentation, but Avery declined to do so. Most

important, however, is that Avery did submit comments in response to Dr. Shavell’s independent

medical examination, and those comments were considered throughout the appeals process. For

instance, Dr. Hoenig’s IRR report references Avery’s “appeal letters” dated July 28, 2014. And

Dr. Friedman’s IRR report notes that, “[o]n 07/28/14, the claimant wrote an appeal letter refuting

many of the physical examination findings, observations, and conclusions by Dr. Shavell.” A.R.

607. Nevertheless, the applicable regulations do not require plan administrators (or their

consultants) to reference a claimant’s comments with particularity. They merely require that plans

“[p]rovide claimants the opportunity to submit written comments.” 29 C.F.R. § 2560.503–1(h)(ii)

(emphasis added). And in this case, for the reasons already stated, Sedgwick and the Plan provided

Avery this opportunity.

       Relatedly, Avery argues that Sedgwick failed to provide her “with reasonable access to all

of the information relevant to her claim for benefits,” in violation of 29 C.F.R. § 2560.503–

1(h)(2)(iii). Reply Br. at 10. We find no evidence in the record to support this assertion. While

claimants are entitled to reasonable access to records relevant to their claim, this access is provided

                                                - 12 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

“upon request.” 29 C.F.R. § 2560.503–1(h)(2)(iii). And there is no indication that Avery ever

requested access to records or that she was denied access following such request.

Dr. Shavell’s Training and Experience

        Next, Avery argues that Dr. Shavell “did not have appropriate training and experience in

the field of neurology” necessary to evaluate her condition, in violation of 29 C.F.R. § 2560.503–

1(h)(3)(iii). Appellant’s Br. at 23. Again, Avery’s procedural challenge lacks merit. Although it is

true that Dr. Shavell is not a board-certified neurologist, his independent medical examination was

not the basis for Sedgwick’s final determination. Rather, Sedgwick relied on IRRs conducted by

two board-certified neurologists, Dr. Hoenig and Dr. Friedman, to terminate Avery’s long-term

disability benefits.

        Furthermore, the requirement that a group health plan “consult with a health care

professional who has appropriate training and experience in the field of medicine involved in the

medical judgment,” applies only “in deciding an appeal of any adverse benefit determination.” 29

C.F.R. § 2560.503–1(h)(3)(iii). Because Dr. Shavell was not consulted in deciding an appeal, his

training and experience is procedurally irrelevant.

Documents Omitted from the Administrative Record

        Finally, Avery argues that Sedgwick deliberately omitted relevant documents from the

administrative record. Specifically, she alleges that Sedgwick failed to include evidence of “actual

surveillance” and omitted documents related to her Social Security disability award. Appellant’s

Br. at 33–34. Again, Avery’s allegation lacks support.

        Sedgwick included within the administrative record an email description of surveillance

that took place in April 2014. At the time, Chrysler’s Corporate Investigations department

observed Avery driving on several occasions and suspected that she may be running a business out

                                               - 13 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

of her home. An investigator communicated these observations and suspicions to Chrysler’s

Special Investigations Unit via email. But beyond this email description, which is already included

in the administrative record, there is no indication that any other documentation pertaining to

Chrysler’s surveillance—written, visual, or otherwise—even exists. Avery’s suggestion that

“actual surveillance” has been omitted from the administrative record is pure speculation.

       And the same is true for Social Security Disability records. The administrative record

includes evidence of the following: the Plan’s requirement that Avery apply for Social Security

disability benefits, evidence of Avery’s application for Social Security disability benefits, the

Social Security Administration’s monthly SSDI benefit award of over $2,000, and Sedgwick’s

reimbursement in the amount of over $15,000 for overpayment. Avery speculates that, because

Sedgwick facilitated her Social Security application process, Sedgwick must possess additional

documents related to her Social Security disability award. But again, this is mere speculation.

Avery cannot identify any documents within Sedgwick’s possession that have been omitted from

the administrative record. If Avery wished to include additional Social Security documentation in

the administrative record, she should have requested said documents from the SSA directly and

supplemented the record when given the opportunity to do so.

   B. Sedgwick’s Decision Was Not Arbitrary or Capricious

       Having addressed Avery’s procedural objections—i.e., objections to how the benefits

decision was made—we turn to Avery’s contention that Sedgwick simply made the wrong

decision. As stated above, because the Plan grants Sedgwick the discretionary authority to

determine eligibility for benefits and to construe the Plan’s terms, we review Sedgwick’s decision

to terminate Avery’s long-term disability benefits under the arbitrary and capricious standard.

                                              - 14 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

McClain v. Eaton Corp. Disability Plan, 740 F.3d 1059, 1064 (6th Cir. 2014); see also Firestone,

489 U.S. at 115.

       Arbitrary and capricious review “is the least demanding form of judicial review of

administrative action.” Williams v. Int’l Paper Co., 227 F.3d 706, 712 (6th Cir. 2000). Under this

extremely deferential standard, we need only decide “whether the plan administrator’s decision

was rational in light of the plan’s provisions.” Id. (internal quotation marks omitted). We will

uphold Sedgwick’s decision if “it is the result of a deliberate, principled reasoning process and if

it is supported by substantial evidence.” Baker v. United Mine Workers of Am. Health & Ret.

Funds, 929 F.2d 1140, 1144 (6th Cir. 1991). “[T]he 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.” Spangler v. Lockheed Martin

Energy Sys., Inc., 313 F.3d 356, 362 (6th Cir. 2002). The burden is on the claimant to show that

the administrator acted arbitrarily. Farhner v. United Transp. Union Discipline Income Prot.

Program, 645 F.3d 338, 343 (6th Cir. 2011).

       With that being said, the arbitrary and capricious standard is not “without some teeth.”

McDonald v. W.-S. Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003) (citation omitted). “[M]erely

because our review must be deferential does not mean our review must also be inconsequential.

While a benefits plan may vest discretion in the plan administrator, the federal courts do not sit in

review of the administrator’s decisions only for the purpose of rubber stamping those decisions.”

Moon v. Unum Provident Corp., 405 F.3d 373, 379 (6th Cir. 2005). Instead, “[s]everal lodestars

guide our decision: the quality and quantity of the medical evidence; the existence of any conflicts

of interest; whether the administrator considered any disability finding by the Social Security

Administration; and whether the administrator contracted with physicians to conduct a file review

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Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

as opposed to a physical examination of the claimant.” Shaw v. AT&T Umbrella Ben. Plan No. 1,

795 F.3d 538, 547 (6th Cir. 2015) (internal quotation marks omitted). In conducting our review,

we may generally “consider only the evidence available to the administrator at the time the final

decision was made.” Id.

       Avery alleges that Sedgwick’s benefits denial was arbitrary and capricious because

Sedgwick (1) ignored favorable evidence, (2) improperly relied on file reviews conducted by

physicians who were not provided adequate documentation, and (3) ignored the Social Security

Administration’s disability finding. We will address each substantive challenge in turn.

Sedgwick’s Review of the Evidence

       First, Avery argues that Sedgwick “ignored and selectively reviewed” the evidence.

Appellant’s Br. at 41. Avery is correct that “administrators may not selectively review the

administrative record by picking out the opinions of the doctors that support their decisions while

ignoring the opinions of a participant’s treating doctors that do not.” Autran v. Proctor & Gamble

Health & Long-Term Disability Benefit Plan, 27 F.4th 405, 415 (6th Cir. 2022). Instead,

administrators must “consider all opinions on both sides of a disputed disability question.” Id.

       But here, we find that the physicians whom Sedgwick consulted to evaluate Avery’s claim

engaged in a fulsome review of the record—including the medical evidence provided by Avery’s

treating physicians. Dr. Hoenig, for example, reviewed records from Avery’s primary care

physician, Dr. Brengel. Dr. Hoenig also reviewed the independent medical examination reports

from Dr. Banks and Dr. Gaston, both of whom had previously found Avery totally disabled. Dr.

Hoenig even attempted (to no avail) to contact Dr. Nounou, one of Avery’s treating physicians, to

discuss Avery’s history. Although a plan administrator need not “accord special deference to the

opinions of treating physicians,” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 831

                                               - 16 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

(2003), the record reveals that Sedgwick took Avery’s doctors’ opinions seriously. Indeed, Dr.

Hoenig referred to their findings as “clinical[ly] significant.” A.R. 663. Relying on Dr. Hoenig’s

file review, among other medical records, Sedgwick concluded that the documentation provided

did not support Avery’s claimed disability.

       A year later, upon re-review of Avery’s claim, Sedgwick consulted Dr. Friedman, who also

engaged in a comprehensive review of the record. Like Dr. Hoenig, Dr. Friedman reviewed

extensive medical records, including those provided by Avery’s treating physicians, as well as the

results of Dr. Banks’ and Dr. Gaston’s independent medical examinations. Dr. Friedman contacted

and spoke with a nurse in Dr. Nounou’s office. And Dr. Friedman even credited Avery’s subjective

reports of pain: “the claimant reports that she has ongoing symptoms related to complex regional

pain syndrome including walking with a limp and sensitivity to touch to the legs. She reported that

she was bedridden several days per week and had difficulties doing daily activities such as cooking,

cleaning, and shopping.” A.R. 600. Nonetheless, in reviewing Avery’s medical records, Dr.

Friedman concluded that, “[b]ased on the clinical evidence provided for review, the employee does

not require any restrictions on their work duties at any point during the dates of claimed disability

in order to return to work.” A.R. 601. Relying on Dr. Friedman’s report, Sedgwick upheld its

termination of Avery’s long-term disability benefits, citing “no sufficient clinical evidence to

support any restrictions and limitations.” A.R. 593.

       In rejecting the opinion of a treating physician, a plan administrator need only offer

“reasons for adopting an alternative opinion” to survive arbitrary and capricious review. Shaw,

795 F.3d at 549. And “a lack of objective medical evidence upon which to base a treating

physician’s opinion has been held sufficient reason for an administrator’s choice not to credit [an]

opinion.” Gilewski v. Provident Life and Accident Ins. Co., 683 F. App’x 399, 406 (6th Cir. 2017).

                                               - 17 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

Here, Sedgwick rejected the opinions of Avery’s treating physicians based on the opinions of Dr.

Hoenig and Dr. Friedman, who concluded that the objective medical evidence in Avery’s file did

not support her claimed disability. And we can discern no selective review by the physicians who

reviewed Avery’s files. Indeed, their differences from earlier opinions can be explained by the

“extensive treatment” that Avery underwent in the interim—treatment that drastically reduced her

pain levels. A.R. 608. Accordingly, we find that Sedgwick engaged in a deliberate, principled

reasoning process when it decided to terminate Avery’s long-term disability benefits.

Sedgwick’s Reliance on Independent Record Reviews

       Next, Avery argues that “Sedgwick’s reliance on record review consultants who were not

provided appropriate records . . . was also arbitrary and capricious.” Appellant’s Br. at 36. As an

initial matter, we note that Sedgwick’s decision to conduct IRRs—or “file reviews”—rather than

physical examinations is a factor that we must consider in determining whether Sedgwick acted

arbitrarily or capriciously, but that there is “nothing inherently objectionable about a file review

by a qualified physician in the context of a benefits determination.” Calvert v. Firstar Fin., Inc.,

409 F.3d 286, 296 (6th Cir. 2005). Instead, an administrator’s decision to conduct an IRR in lieu

of a physical examination is “just one more factor to consider in our overall assessment of whether

[the administrator] acted in an arbitrary and capricious fashion.” Id. at 295.

       At different points in the review process, Sedgwick referred Avery’s claim to two

independent physician consultants, Dr. Hoenig and Dr. Friedman, for file reviews. Both doctors

reviewed Avery’s medical records, but neither physically examined her, before providing thorough

reports. In their IRRs, Dr. Hoenig and Dr. Friedman identified the medical records that they

reviewed and provided detailed accounts of Avery’s medical history. Both doctors also

acknowledged Avery’s prior limitations and credited her treating physicians’ observations.

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Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

However, despite this favorable evidence, both Dr. Hoenig and Dr. Friedman identified contrary

evidence that cut against Avery’s claimed disability. For example, Dr. Hoenig noted that “[t]he

last neurological exam in the medical record is from February 6, 2013,” and that “after her spinal

cord stimulator (SCS), she has a normal neurological exam.” A.R. 663. And Dr. Friedman

observed that Dr. Nounou, one of Avery’s treating physicians, had not recommended any specific

restrictions after a July 2014 endovenous ablation procedure. Given this evidence, Dr. Hoenig and

Dr. Friedman concluded that Avery was not disabled from performing any work, and those

conclusions were reasonable.

       Calvert is distinguishable. There we found that an insurance company acted arbitrarily and

capriciously when it based its benefits determination on a “clearly inadequate” file review, because

it, among other things, failed to identify the records reviewed, ignored favorable evidence, and

reached conclusions that squarely contradicted objective evidence. 409 F.3d at 296. But here, both

Dr. Hoenig and Dr. Friedman recited Avery’s medical history in detail, specifically noted

favorable evidence, and even credited Avery’s treating physicians. Furthermore, neither doctor

made any credibility findings. See Judge v. Metro. Life Ins. Co., 710 F.3d 651, 663 (6th Cir. 2013)

(“This court has found fault with file-only reviews in situations where the file reviewer concludes

that the claimant is not credible without having actually examined him or her”). The file reviews

at issue here were thus adequate.

       As for Avery’s assertion that Dr. Hoenig and Dr. Friedman were not provided appropriate

records to review, Avery has not identified any post-termination medical records that exist, let

alone records that support her claimed disability. The closest thing to medical evidence made

available post-termination is Dr. Brengel’s April 2015 letter, which Dr. Friedman reviewed.

However, because Dr. Brengel’s letter “did not include any new examination findings or results of

                                               - 19 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

[EMG] testing,” Dr. Friedman concluded that his position remained unchanged. A.R. 592–93. In

sum, Sedgwick’s reliance on independent record reviews did not render its final benefits

determination arbitrary and capricious.

The Social Security Administration’s Disability Finding

       Finally, Avery argues that Sedgwick’s decision was arbitrary and capricious because it did

not address the fact that Avery successfully applied for Social Security disability benefits. “[I]f the

plan administrator (1) encourages the applicant to apply for Social Security disability payments;

(2) financially benefits from the applicant’s receipt of Social Security; and then (3) fails to explain

why it is taking a position different from the SSA on the question of disability, the reviewing court

should weigh this in favor of a finding that the decision was arbitrary or capricious.” Bennett v.

Kemper Nat. Servs., 514 F.3d 547, 554 (6th Cir. 2008).

       It is undisputed that Sedgwick required Avery to apply for Social Security benefits, and

that Sedgwick benefited financially from reimbursement payments. It is also undisputed that

Sedgwick neglected to reference Avery’s Social Security award in either its initial denial of

Avery’s appeal or in its final determination upon re-review. Nevertheless, Bennett merely instructs

“that a failure to take into account a Social Security disability award is to be weighed in favor of a

finding that the decision was arbitrary and capricious, not that such a decision is arbitrary and

capricious per se.” Morris v. Am. Elec. Power Long-Term Disability Plan, 399 F. App’x 978, 986

(6th Cir. 2010). And it is not necessary for a plan administrator to “expressly distinguish a

favorable SSA determination in denying disability benefits under the plan.” Leffew v. Ford Motor

Co., 258 F. App’x 772, 779 (6th Cir. 2007).

       Although Sedgwick’s decision to terminate Avery’s benefits, despite the SSA’s earlier

disability finding, weighs “slightly in [Avery]’s favor when it comes to evaluating whether that

                                                - 20 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

decision was arbitrary and capricious,” Morris, 399 F. App’x at 986, it is not enough to convince

us that Sedgwick acted arbitrarily on the whole. For one, the SSA’s disability determination was

made two years prior to Sedgwick’s decision to terminate Avery’s benefits. See Cox v. Standard

Ins. Co., 585 F.3d 295, 303 (6th Cir. 2009). And at the time Sedgwick made its decision, it

possessed additional medical evidence that the SSA did not, including the results of Dr. Shavell’s

independent medical examination, the plant medical physician’s ability-to-work determination,

and IRRs from Dr. Hoenig and Dr. Friedman. See id.

       Moreover, the fact that Avery qualified for Social Security disability benefits does not

necessarily mean that she should qualify for benefits under the Plan, because “a claim for benefits

under an ERISA plan often turns on the interpretation of plan terms that differ from SSA criteria.”

Whitaker v. Hartford Life and Acc. Ins. Co., 404 F.3d 947, 949 (6th Cir. 2005). For instance,

Sedgwick—unlike the SSA at the time of its decision—was not required to defer to the opinions

of Avery’s treating physicians. See O’Bryan v. Consol Energy Inc., 477 F. App’x 306, 308 (6th

Cir. 2012) (per curiam). We therefore conclude that Sedgwick’s failure to address the SSA’s

disability determination did not render Sedgwick’s decision arbitrary and capricious.

Sedgwick’s Decision Was Supported by Substantial Evidence

       Sedgwick terminated Avery’s long-term disability benefits after deciding that she was no

longer “totally disabled” under the meaning of the Plan. The district court concluded that

substantial evidence supported Sedgwick’s decision. We agree.

       In reviewing the quality and quantity of the evidence in the administrative record, we have

said that “substantial evidence” is “more than a mere scintilla.” McDonald, 347 F.3d at 171

(citation omitted). “It means such relevant evidence as a reasonable mind might accept as adequate

to support a conclusion.” Id. (citation omitted). “The fact that the evidence might also support a

                                              - 21 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

contrary conclusion is not sufficient to render the plan administrator’s determination arbitrary and

capricious.” Hurse v. Hartford Life & Accident Ins. Co., 77 F. App’x 310, 318 (6th Cir. 2003).

       The administrative record in this case contained more than adequate evidence for Sedgwick

to conclude that Avery was no longer totally disabled under the terms of the Plan. First, Dr. Shavell

examined Avery in July 2014, and offered detailed observations that indicated “good range of

motion,” “no evidence of any loss of strength,” and a generally “normal exam.” A.R. 978. From

these findings, Dr. Shavell concluded, “I do not see any evidence of a regional complex pain issue.

. . . I do not find any physical evidence to substantiate at this point any disability whatsoever.”

A.R. 978–79. Next, Sedgwick required Avery to report to Chrysler’s plant medical department for

an ability-to-work determination. There, the plant medical physician observed, “[s]he is alert and

oriented. . . . Right and left lower legs – no stasis dermatitis. Normal dorsalis pedis pulse. No

pretibial edema. She walked without a limp.” A.R. 946. On that basis, the plant medical department

determined that Avery could return to work with no restrictions.

       Sedgwick then referred Avery’s claim to Dr. Hoenig for a file review. Dr. Hoenig reviewed

Avery’s extensive medical records and concluded that after Avery’s “spinal cord stimulator (SCS),

she ha[d] a normal neurological exam” and was “not disabled from performing any work as of

07/22/14.” A.R. 663. Finally, Sedgwick initiated a voluntary re-review, referring Avery’s claim to

Dr. Friedman for another file review. Dr. Friedman reviewed Avery’s medical records and

concluded that there was “no sufficient clinical evidence to support any restrictions and

limitations.” A.R. 601.

       To be sure, Avery’s treating physicians repeatedly diagnosed Avery with Complex

Regional Pain Syndrome and venous insufficiency. But even when “the evidence may be sufficient

to support a finding of disability, if there is a reasonable explanation for the administrator’s

                                               - 22 -
Case No. 22-1960, Avery v. Sedgwick Claims Mgmt. Servs., et al.

decision denying benefits in light of the plan’s provisions, then the decision is neither arbitrary nor

capricious.” Schwalm v. Guardian Life Ins. Co. of Am., 626 F.3d 299, 308 (6th Cir. 2010). And

here, no fewer than four physicians concluded that Avery is no longer totally disabled. If this did

not amount to “a reasonable explanation for the administrator’s decision,” it would be difficult to

say what would. In conclusion, we find that substantial evidence supported Sedgwick’s decision

to terminate Avery’s long-term disability benefits.

                                                 III

       For the foregoing reasons, the district court’s judgment is affirmed.

                                                - 23 -