Hatch v. Federated Retail Holdings, Inc. et al

Filing 61

ORDER The determination of the defendants, the Long-Term Disability Plan of the May Department Stores and the Metropolitan Life Insurance Company, that the plaintiff, Helena C. Hatch, is not entitled to disability benefits under the Plan beyond Augus t 12, 2005, is UPHELD; the request of the plaintiff, Helena C. Hatch, for an award of attorney fees is DENIED; judgment SHALL ENTER in favor of the defendants, the Long-Term Disability Plan of the May Department Stores and the Metropolitan Life Insur ance Company, against the plaintiff, Helena C. Hatch; and the defendants, the Long-Term Disability Plan of the May Department Stores and the Metropolitan Life Insurance Company, are AWARDED their costs to be taxed by the clerk of the court. By Judge Robert E. Blackburn on 3/28/13. (kfinn, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
Judge Robert E. Blackburn
Civil Action No. 06-cv-01598-REB-CBS
HELENA C. HATCH,
Plaintiff,
v.
FEDERATED RETAIL HOLDINGS, INC., a New York corporation,
d/b/a THE MAY DEPARTMENT STORES COMPANY, and
METROPOLITAN LIFE INSURANCE COMPANY, a New York corporation,
Defendants.

ORDER RE: BRIEFS ON ADMINISTRATIVE RECORD
Blackburn, J.
This matter is before me on the Plaintiff’s Opening Brief [#53]1 filed November
25, 2009. The plaintiff seeks review and reversal of the decision of the defendants to
deny further disability benefits to the plaintiff under a plan regulated by the Employee
Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 - 1461. The
defendants filed a response [#57], and the plaintiff filed a reply [#58]. I deny the relief
sought by the plaintiff.
I. JURISDICTION
I have jurisdiction over this case under 28 U.S.C. § 1331 (federal question) and
29 U.S.C. § 1132(e)(1) and (f) (ERISA).

1

“[#53]” is an example of the convention I use to identify the docket number assigned to a
specific paper by the court’s case management and electronic case filing system (CM/ECF). I use this
convention throughout this order.

III. STANDARD OF REVIEW
This lawsuit arises out of the termination by defendant Metropolitan Life
Insurance Company (MetLife) of the disability benefits of the plaintiff under a long-term
disability (LTD) plan provided by the plaintiff’s quondam employer, The May Department
Stores. The plan is funded by defendant the Long-Term Disability Plan of the May
Department Stores. MetLife is the claim administrator for the plan and is responsible for
determining claims for long term disability benefits. The plaintiff Helena Hatch brings
her claims against the defendants under ERISA.
ERISA provides a detailed and comprehensive set of federal regulations
governing the provision of benefits to employees by employers. Under 29 U.S.C.
§ 1132(a), part of ERISA, a plan beneficiary has the right to review of benefit denials
and terminations in federal court . The statute does “not establish the standard of review
for such decisions.” Chambers v. Family Health Plan Corp., 100 F.3d 818, 824-25
(10th Cir.1996).
However, in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), the
Supreme Court established the basic framework for determining the standard of review
in ERISA cases that challenge the denial or termination of benefits. “(A) denial of
benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard
unless the benefit plan gives the administrator or fiduciary discretionary authority to
determine eligibility for benefits or to construe the terms of the plan.” Firestone, 489
U.S. at 115. If the plan provides for such discretion, then the proper standard of review
is abuse of discretion. Id. Ms. Hatch concedes that the Plan at issue here gives the

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administrator or fiduciary discretionary authority to determine eligibility for benefits, and
the abuse of discretion standard of review is applicable.
Generally, the abuse of discretion standard is applied by determining whether or
not the Plan’s denial of benefits was arbitrary and capricious. Kimber v. Thiokol
Corp., 196 F.3d 1092, 1097 (10th Cir. 1999). Under the arbitrary and capricious
standard of review, the Plan’s decision need not be the only logical decision nor even
the best decision. Rather, the decision need only be sufficiently supported by facts
known to the Plan to counter a claim that the decision was arbitrary or capricious. The
decision will be upheld unless it is not grounded on any reasonable basis. Kimber, 196
F.3d at 1098. The reviewing court “need only assure that the administrator's decision
fall[s] somewhere on a continuum of reasonableness – even if on the low end.” Id.
(quoting Vega v. National Life Ins. Serv., Inc., 188 F.3d 287, 297 (5th Cir. 1999)).
The United States Supreme Court has outlined several considerations that are
relevant to a reviewing court’s application of the arbitrary and capricious standard.
Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 115-119 (2008). These factors
include: 1) any potential conflict of interest; 2) the quality and quantity of the medical
evidence; 3) whether the plan or claims administrator provided greater emphasis to
medical reports favoring a denial of benefits as opposed to those supporting a
determination of disability; 4) whether the plan or claims administrator provided its
reviewing physicians and other experts with all of the relevant evidence; 5) whether the
plan or claims administrator “has taken active steps to remove bias and promote
accuracy;” and 6) whether the plan or claims administrator considered any social
security disability determination, including whether the administrator encouraged the

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claimant to apply for social security disability benefits, and then ignored a social security
disability determination. Id. This list of considerations is not exhaustive.
In this case, the administrative record [#52] provides all of the relevant facts, and
there is no contention that the administrative record is incomplete or inaccurate. The
undisputed and relevant facts are established. The only remaining question is an
evaluation of MetLife’s benefits determination under the arbitrary and capricious
standard. After this review is complete, either the plaintiff or the defendants necessarily
will be entitled to judgment as a matter of law.
III. FACTS
Ms. Hatch worked as a Human Relations Manager for the May Department
Stores. In late 2002, she began to suffer from generalized muscle pain. In late March
2003, she was diagnosed with myositis, an autoimmune disorder. Dr. Vance Bray
made the diagnosis. MetLife does not dispute this diagnosis. By May 2003, Ms.
Hatch’s condition had worsened. Her last day on the job was May 15, 2003.
Ms. Hatch was covered under the Long Term Disability Plan of the May
Department Stores Company (the Plan). The Plan is regulated by ERISA. Ms. Hatch
was approved for benefits under the plan beginning August 13, 2003. R0281.2 Under
the terms of the Plan applicable at that time, total disability is defined as “your inability to
perform the normal functions of your regular occupation during the first two years and
90 days of your absence from work due to disability.” R0281. Ms. Hatch received
benefits under the Plan until August 13, 2005.
Under the terms of the Plan, the applicable definition of total disability changed

2

I refer to the administrative record [#52] by page number, e.g., R0001.

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after Ms. Hatch had received benefits for two years. As of August 13, 2005, the Plan
defined total disability in the case of Ms. Hatch as “being completely unable to perform
any and every duty of any job for wage or profit that you are reasonably qualified by
education, training or experience to perform.” R0281. As August 13, 2005,
approached, MetLife began an evaluation of Ms. Hatch’s claim. Ultimately, MetLife
denied Ms. Hatch coverage under the Plan beyond August 12, 2005. R0113 - R0115.
The denial was based on MetLife’s conclusion that Ms. Hatch no longer met the
applicable definition of totally disabled. R0113 - R0115. In this case, Ms. Hatch
challenges the denial of benefits beyond August 13, 2005, and argues that MetLife’s
decision to deny further benefits was arbitrary and capricious.
While she was receiving benefits, MetLife referred Ms. Hatch to a company
called Occudata, which provides legal representation for individuals making Social
Security disability claims. On April 20, 2005, an administrative law judge rendered a
decision on Ms. Hatch’s Social Security disability claim. R0165 - 0168. Based in
significant part on a “report from consultative examiner Nathan Clifford, M.D., who
examined [Ms. Hatch] in February 2005,” the administrative law judge found that Ms.
Hatch had been under a disability, as defined by the Social Security Act, since May 15,
2003. R0166, R0168. The administrative law judge found that her disability had
continued through at least the date of his decision, April 20, 2005. R0168. In
determining disability, the administrative law judge applied a standard under which a
claimant’s ability to work is determined based on the claimant’s ability to work eight
hours a day, five days a week. R0166. The award of Social Security disability benefits
to Ms. Hatch reduced the amount the Plan was obligated to pay Ms. Hatch. The Social

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Security decision did not impact MetLife financially.
Generally, the medical records for the period from August 2003 through August
2005 show many ups and downs in Ms. Hatch’s condition, including varied subjective
reports from Ms. Hatch to her doctors about how she felt. During this period, she often
suffered constraints on her activity, very limited endurance, and moderate to severe
muscle and joint pain. Information about Ms. Hatch’s condition in the period leading up
to and including August 13, 2005, is the most important information in the file. That
information is the basis for MetLife’s denial of benefits and also is the basis for Ms.
Hatch’s contention that MetLife’s decision was arbitrary and capricious.
In August 2004, Ms. Hatch stopped taking the medications prescribed for her
myositis because of complications related to a surgery for conditions unrelated to her
myositis. In October 2004, Dr. Bray recommended that Ms. Hatch resume use of
specific medications to treat her myositis. R0105. In December 2004, Dr. Bray
reported that Ms. Hatch did not appear to be “under adequate control with regards to
her polymyositis.” R0101. He reported that she was experiencing significant muscle
pain, and he described how the pain was most severe late in the day and through the
night. R0101 - R0102. He reported and opined that the “level of pain would prevent her
from returning to work.” R0101.
March 3, 2005 brought a more positive report from Dr. Bray. On March 3, Dr.
Bray reported that Ms. Hatch was “doing very well” on the medication Enbrel. R0098.
“She still has increased myalgias after increased physical activity, but in general is able
to pace herself. She can tolerate about two hours of exertion each day, but if she does
more than this, she will have a marked increase in pain and fatigue.” R0098. “On

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examination, she appears very healthy and vibrant.” R0098.
June 2, 2005, also brought a positive report. On that day, Dr. Bray reported that
Mrs. hatch feels very well. She generally has noted excellent strength and
minimal muscle pain. She will have an increase in muscle pain after
physical activities such as pulling weeds or carrying a heavy object. She
also will have an increased amount of pain after emotional stress, both
happy and sad. Nonetheless, she is doing well.
R0121 - R0122.
In mid-July 2005, Dr. Bray completed a questionnaire and provided information
about Ms. Hatch to MetLife. R0107, R0120. He reported that she was not able to work
full time or to work at any gainful occupation. R0120. He reported high fatigue levels
and increased pain with any activity lasting two hours or more. R0107. He also
reported objective findings in support of his diagnosis, noting “tenderness to palpation of
her muscles” and pain in her knees. R0107. In addition, he stated limitations on Ms.
Hatch’s activity. He noted that Ms. Hatch is “very fatigued” and suffers “increased pain
with any activity lasting 2 hours or longer.” R0107.
In May 2005, Met Life began its reevaluation of Ms. Hatch’s claim, anticipating
the coming change in the applicable definition of the term totally disabled. R0042. On
July 21, 2005, a MetLife nurse consultant concluded that Ms. Hatch did not meet the
new definition of totally disabled.
The objective records support a diagnosis of polymyositis, which per office
visit of 6/2/05 appears very stable. Per Dr. Bray’s notes, [Ms. Hatch]
states able to weed garden and gets increased muscle pain with
increased activities. [Dr. Bray] states [Ms. Hatch] is stable on Enbrel.
There is another note signed by Dr. Bray on 6/2/05, which states that [Ms.
Hatch] is extremely fatigued, and has tenderness to muscles on palpation.
Neither of these complaints are documented on the office visits. [Nurse
consultant] recommends the objective records submitted for review [do]
not substantiate [Ms. Hatch’s] inability to function at any occ.

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R0049 - R0050. The letter to Ms. Hatch stating the basis for MetLife’s decision to
terminate her benefits recites roughly the same information as the basis for the
decision. R0113 - R0114.
On October 25, 2005, Ms. Hatch filed an appeal of this decision. She relied on a
statement from Dr. Dawson, a brochure about myositis, a note by Dr. Bray describing
Ms. Hatch’s August 17, 2005, office visit, and the decision of the administrative law
judge concerning Ms. Hatch’s Social Security benefits.
Dr. Dawson’s statement, which appears to have been made in October 2005,
defers to Dr. Bray concerning Ms. Hatch’s ability to work as a Human Resources
Manager. R0083. Dr. Dawson indicates severe restrictions on Ms. Hatch’s physical
abilities. R0084. The statement does not indicate that Dr. Dawson examined Ms.
Hatch and does not state the bases for Dr. Dawson’s conclusions about the level of
restriction on Ms. Hatch’s physical abilities. R0083 - R0084. Because Dr. Dawson’s
statement does not state the basis for her conclusions, her October 2005 report does
not carry significant weight. I note that Dr. Bray frequently updated Dr. Dawson about
Ms. Hatch’s condition. See, e.g., R0098, R0101. However, that fact does not establish
a basis for Dr. Dawson’s opinions as expressed in her October 2005 statement.
MetLife did not rely on the brochure about myositis. It did not need to, and it
should not have. The brochure describes generally the symptoms of the disease, but
says nothing about Ms. Hatch in particular. R0085.
Dr. Bray’s August 17, 2005, report states:
Mrs. Hatch continues to experience severe muscle pain, joint pain and
fatigue related to her polymyositis. She has only about one hour of
stamina for performing any work-related activities. After this time, she is
markedly fatigued and notices increased pain . . . .She is not doing most

8

of her household chores . . . . Last evening, she was unable to clean the
table after dinner because of pain and fatigue. * * * * Mrs. hatch continues
to demonstrate active inflammatory disease related to polymyositis. This
is causing her muscle pain and fatigue. I believe that she is totally
disabled because of this problem.
R0086 - R0087. The content of the determination of the administrative law judge
concerning Social Security benefits is as summarized above.
Given this information, MetLife referred Ms. Hatch’s file to a consulting physician,
Dr. Tracey Schmidt. In her report, Dr. Schmidt reviewed the records of Ms. Hatch’s
treatment. R0075 - R0077. Noting that the key question was Ms. Hatch’s functionality
from August 12, 2005, and beyond, Dr. Schmidt summarized the content of the medical
reports discussed above. R0075 - R0077. She noted the positive reports from May and
June 2005 and the negative report from August 17, 2005. Addressing the August 17,
2005, report, Dr. Schmidt noted: (a) there are no reports indicating treatment between
June 2, 2005, and August 17, 2005; (b) although Ms. Hatch reported joint and muscle
pain on August 17, 2005, “there was no evidence of synovitis or muscle weakness on
exam;” (c) although Ms. Hatch reported severe pain during this visit, there is no
indication that her medications were changed; and (d) the reports of May 3, 2005, and
June 3, 2005, describing Ms. Hatch’s activities, suggest more than sedentary activities.
R0075 - R0077. Dr. Schmidt does not mention the award of Social Security benefits to
Ms. Hatch. Dr. Schmidt concluded that Ms. Hatch’s file “lacks sufficient medical [sic] to
support objective evidence of physical functional capacity impairment from a sedentary
occupation with ability to change positions as needed.” R0076.
MetLife’s letter to Ms. Hatch concerning her appeal again summarizes Ms.
Hatch’s medical records, concentrating on the records from 2005. R0072 - R0074. In

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addition, the letter summarizes Dr. Schmidt’s report. R0073 - R0074. Based on that
information, MetLife upheld the denial of benefits, concluding that the “file lacks
objective findings that would indicate an impairment of such a severity as to preclude
you from performing in a sedentary-type job.” R0072 - R0074.
IV. ANALYSIS
Ms. Hatch addresses several of the relevant factors and, based on those factors,
argues that MetLife’s decision, particularly its decision on Ms. Hatch’s appeal, was
arbitrary and capricious. I address in turn each factor raised by Ms. Hatch.
A. Application of the Definition of Total Disability
MetLife determined that Ms. Hatch is not totally disabled. The Plan defined total
disability as “being completely unable to perform any and every duty of any job for wage
or profit that you are reasonably qualified by education, training or experience to
perform.” R0281. Applied literally, Ms. Hatch argues, this language would mean that
any simple job one might hypothesize, such as a job making a phone call, could be
seen as a job Ms. Hatch could perform. Such an interpretation of the Plan, Ms. Hatch
contends, would render its coverage illusory.
Addressing a similarly broad definition of totally disabled, the United States Court
of Appeals for the Tenth Circuit held that a definition of total disability may not be read
to exclude a person who can do any job, no matter how minor the job.
We believe that the policy concerns which underlie ERISA would be
severely undermined if we endorsed a literal reading of the plan's terms.
Thus we join the reasoning of the Eleventh Circuit and hold that a
reasonable interpretation of a claimant's entitlement to payments based on
a claim of total disability must consider the claimant's ability to pursue
gainful employment in light of all the circumstances. The standard to be
applied will require the claimant to establish a physical inability to follow
any occupation from which he can earn a reasonably substantial income

10

rising to the dignity of an income or livelihood, although the income may
not be as much as was earned prior to the disability. If plaintiff meets his
burden, recovery may not be denied on the basis of overly restrictive
interpretations of the plan's language.
Torix v. Ball Corp., 862 F.2d 1428, 1431 (10th Cir. 1988) (emphasis added). The
definition of total disability at issue in Torix was, in relevant part, “totally and
presumably permanently prevented from engaging in any occupation or employment for
wages or profit as a result of bodily injury or disease.” Id. at 1429 n. 1.
MetLife argues that the limitation expressed in Torix is not applicable here
because the Plan’s definition of total disability is different than that at issue in Torix.
Although the definitions do differ in some ways, I conclude that the limitation stated in
Torix is applicable. Taken literally, the phrase “any and every duty of any job for wage
or profit [for which] you are reasonably qualified,” as used in the Plan, could be read to
include a sedentary job requiring 30 minutes of work per day, five days per week. I
conclude that such a broad interpretation of an ERISA regulated plan is not permissible.
However, the administrative record here does not show that MetLife applied an
overly restrictive definition of total disability. MetLife’s letter denying Ms. Hatch’s appeal
states MetLife’s ultimate conclusion. MetLife found that Ms. Hatch’s file lacked
“objective findings that would indicate an impairment of such a severity as to preclude
you from performing in a sedentary-type job.” R0074. This conclusion does not evince
use of an unduly restrictive interpretation of the Plan’s definition of total disability.
B. Insistence on Objective Evidence
Ms. Hatch argues that MetLife insisted improperly on objective evidence of
symptoms that are inherently subjective, such as pain. MetLife counters that it sought
objective evidence of a disabling impairment, and it found none in the record.

11

Subjective and objective evidence of total disability must be considered in a
disability decision regulated by ERISA. See Ray v. UNUM Life Ins. Co. of Am., 224 F.
App'x 772, 786-87 (10th Cir. 2007) (We permit consideration of subjective evidence of
disability in ERISA cases) (citing Clausen v. Standard Ins. Co., 961 F.Supp. 1446,
1456 (D.Colo.1997) (insurer's attempt to ignore diagnosis of chronic fatigue syndrome
and to instead require objective evidence of distinct physical disease violates
established law in circuit)). However, subjective evidence need not be accepted at face
value. Rather, subjective evidence must be evaluated along with all other evidence
relevant to the determination of total disability. When a claimant's subjective,
uncorroborated complaints of pain constitute the only evidence of an ailment's severity,
the medical inquiry is intertwined with questions of the claimant's credibility. Such
credibility questions are the province of the Plan administrator. Meraou v. Williams
Co. Long Term Disability Plan, 221 F. App'x 696, 705 (10th Cir. 2007).
In this case, Ms. Hatch had reported severe muscle and joint pain to her doctor
regularly from 2003 to through 2005. In March 2005, she reported an ability to tolerate
about two hours of exertion per day without a marked increase in pain and fatigue.
R0098. In June 2005, her muscle pain was described as “minimal,” but it was noted
that the pain would increase after physical activity, such as pulling weeds or carrying a
heavy object, or with emotional distress. In August 2005, she reported about one hour
of stamina for work related activities. These are subjective reports. However, these
reports are consistent with the undisputed diagnosis of myositis or polymyositis.
The objective observations reflected in Dr. Bray’s examination on August 23,
2005, are generally consistent with Ms. Hatch’s subjective reports on that date. R0086,

12

¶ 2. The objective observations reflected in Dr. Bray’s examination on June 2, 2005,
tend to minimize the pain experienced by Ms. Hatch at that time. Rather, that report
generally reflects that Ms. Hatch was doing very well. R0121 - 0122. The objective
observations reflected in Dr. Bray’s examination of March 3, 2005, reflect normal
proximal muscle strength and a negative fibromyalgia examination. R0098. These
objective observations tend to minimize the pain experienced by Ms. Hatch at that time.
MetLife was left to judge the objective evidence and the subjective evidence. It is
apparent that Dr. Bray’s ability to provide objective evidence which confirmed the
subjective reports of pain was limited significantly. However, Dr. Bray’s reports do
reflect an effort to provide some objective confirmation. Those objective symptoms
varied over time, as did many of Ms. Hatch’s subjective reports of her symptoms. In this
circumstance, assessment of the reports of subjective symptoms is intertwined with Ms.
Hatch’s credibility. Ultimately, Dr. Schmidt assessed the credibility of Ms. Hatch’s
reports of pain, in light of the other evidence reflecting Ms. hatch’s condition between
May 3, 2005, and August 17, 2005. R0076 - R0077. Implicit within her assessment is
her conclusion that the subjective reports of Ms. Hatch during this time are less credible
in light of the objective evidence reflected in the medical record during the same period.
R0076 - R0077. MetLife’s letter stating its denial of Ms. Hatch’s claim for continued
benefits takes essentially the same position.
Ms. Hatch argues that “(i)nsistence on objective proof of inherently subjective
effects of an illness is nothing more than a gaping escape clause from MetLife’s
obligations under its disability policies.” Reply [#58], p. 4. The record does not
demonstrate that MetLife insisted on the impossible: objective proof of facts that can be

13

shown only via subjective reports. Rather, MetLife evaluated the relevant subjective
reports in light of the relevant objective evidence and, considering both the subjective
and objective evidence, concluded that Ms. Hatch had not demonstrated that she was
totally disabled. Such a reticulated evaluation of the objective and subjective evidence
is not arbitrary and capricious. This factor does not weigh in favor of a finding that
MetLife’s decision was arbitrary and capricious.
C. Selective Use of the Medical Record
Ms. Hatch argues also that MetLife gave greater emphasis to medical reports
favoring a denial of benefits than reports favoring a finding of disability. Such an
emphasis by a claims administrator, such as MetLife, can be seen as a factor that tends
to indicate an abuse of discretion. Rasenack ex rel. Tribolet v. AIG Life Ins. Co., 585
F.3d 1311, 1326 (10th Cir. 2009) (citing Metropolitan Life Ins. Co. v. Glenn, 554 U.S.
105 (2008)). In this case, given the broadened definition of disability that became
effective in August of 2005, there are significant medical records of Ms. Hatch which
weigh in favor of a finding of disability and significant records which weigh against such
a finding.
Here, I conclude that MetLife considered all relevant records and information.
MetLife did not fail or refuse to consider records or information favorable to Ms. Hatch.
MetLife did not prejudge its review of the relevant records and information. MetLife did
not irrationally, arbitrarily, or capriciously consider or weigh the plethora of available
information. Thus, I conclude that, contrary to the assertion of Ms. Hatch, MetLife did
not cherry pick the information to support its ultimate conclusion that Ms. Hatch was not
disabled under the operative definition. Therefore, consideration of this issue weighs in

14

favor of a finding that MetLife did not act arbitrarily and capriciously.
D. Inconsistent Positions Regarding Social Security Disability
To rehearse, MetLife encouraged Ms. Hatch to apply for Social Security disability
benefits. The Plan’s obligations to Ms. Hatch were reduced when Ms. Hatch was
awarded Social Security disability benefits. The decision did not affect MetLife
financially.
When she appealed MetLife’s initial denial of benefits, Ms. Hatch provided
MetLife with a copy of the decision of the administrative law judge awarding benefits to
Ms. Hatch. Based in significant part on a “report from consultative examiner Nathan
Clifford, M.D., who examined [Ms. Hatch] in February 2005,” the administrative law
judge found that Ms. Hatch had been under a disability, as defined by the Social
Security Act, since May 15, 2003. R0166, R0168. The administrative law judge found
that her disability continued through at least the date of his decision, April 20, 2005.
R0168. There is no indication that MetLife considered the decision of the administrative
law judge when MetLife evaluated Ms. Hatch’s appeal of the denial of benefits.
MetLife’s failure to consider and address the Social Security decision suggests
procedural unreasonableness in its decision making process. Metro. Life Ins. Co. v.
Glenn, 554 U.S. 105, 118 (2008). Although the standard applied by the administrative
law judge may be somewhat different than the standard applicable under the Plan, a
finding of disability under the Social Security standard is relevant to MetLife’s disability
determination. The window of time examined by the administrative law judge – May
15, 2003, to April 20, 2005 – is directly relevant to a determination of Ms. Hatch’s
condition in August 2005. At a minimum, the award of Social Security benefits should

15

have been addressed and considered. It appears that MetLife summarily rejected the
value of the administrative law judge’s decision. That unexplained rejection weighs in
favor of a finding of arbitrary and capricious action.
E. Bias of Reviewing Physician
Ms. Hatch argues that the record demonstrates that Dr. Schmidt is biased in
favor of MetLife, and MetLife was aware of this bias. Ms. Hatch relies first on her
criticisms of Dr. Schmidt’s report. Second, MetLife cites a list of cases in which Dr.
Schmidt gave an opinion in favor of MetLife. Opening brief, Exhibit A [#53-1]. Certainly,
one reasonably can take a position contrary to that of Dr. Schmidt. R0075 - R0077.
However, Dr. Schmidt’s analysis does not reflect such a deviation from reason and
common sense such that her analysis reflects that she was driven by bias rather than
reason.
The fact that Dr. Schmidt has given several opinions favoring MetLife, as
reflected in reported cases, also does not demonstrate bias per se. Most often, the
reported cases present close questions that are hard fought. The reported cases do
nothing to show when or how often Dr. Schmidt renders an opinion which favors a
finding of disability. The reported cases do not entail the conclusion that Dr. Schmidt is
unreasonably resistant to a finding of disability.
F. Conclusion
Having reviewed the evidence in the administrative record and the Glenn factors,
I must determine whether MetLife’s decision to deny benefits to Ms. Hatch was arbitrary
and capricious. Stated differently, I must determine whether MetLife’s decision is
grounded on any reasonable basis. Kimber v. Thiokol Corp.,196 F.3d 1092, 1098

16

(10th Cir. 1999). The reviewing court “need only assure that the administrator's decision
fall[s] somewhere on a continuum of reasonableness - even if on the low end.” Id.
(quoting Vega v. National Life Ins. Serv., Inc., 188 F.3d 287, 297 (5th Cir. 1999)).
Addressing the Glenn factors, I find and conclude as follows. The record does
not demonstrate that MetLife had a significant conflict of interest. MetLife’s
determination had no financial impact on MetLife. Thus, this factor carries no weight.
There is a large quantity of quality medical evidence in the record. However, one
of the major symptoms of Ms. Hatch’s condition, pain, cannot be confirmed fully with
objective medical evidence. This factor weighs in favor of MetLife.
The Plain and MetLife provided its reviewing physicians and other evaluators with
all of the relevant evidence. This factor weighs in favor of MetLife
To some degree, MetLife’s ultimate decision to deny benefits necessarily
provides greater emphasis on medical reports favoring a denial of benefits. However,
MetLife’s reviewers, particularly Dr. Schmidt, also address in their analyses the medical
reports which tend to favor a finding of total disability. Those reports were not ignored
or addressed in a cursory fashion. This factor weighs in favor of a finding of arbitrary
and capricious action, but the weight accorded to this factor is small.
Other than the actions of the evaluators in this particular case, the record says
nothing about whether the Plan or MetLife took active steps to remove bias and
promote accuracy. This factor carries no weight.
MetLife did not consider the Social Security determination awarding disability
benefits to Ms. Hatch. This factor augurs in favor of a finding of arbitrary and capricious
action.

17

Considering the record as a whole, I find and conclude that MetLife’s decision
was grounded on a debatable but ultimately reasonable basis. Addressing particularly
August 2005, the relevant point in time, the record contains conflicting medical evidence
about Ms. Hatch’s ability to work for a significant period of hours at a sedentary job for
wage or profit. Although Ms. Hatch often reported increased pain and fatigue after one
or two hours of exertion, that fact does not demonstrate an inability to work at a
productive, profitable sedentary job that requires minimal physical exertion. The record
in this case demonstrates that MetLife’s evaluation of Ms. Hatch’s claim involved a
reasoned and principled process. It was not arbitrary and capricious for MetLife to rely
on the opinions of its medical consultants. The opinions of those consultants,
particularly Dr. Schmidt, provide a reasonable factual basis for MetLife’s denial of
benefits. The ultimate determination of MetLife falls within the continuum of
reasonableness, was amply circumstantiated, and thus was not arbitrary or capricious.
VIII. CONCLUSION & ORDERS
I have reviewed the plaintiff’s claim that the defendants’ termination of her
disability benefits was arbitrary and capricious. I conclude that the plaintiff has not
demonstrated that the defendants’ termination of her disability benefits was arbitrary
and capricious. I conclude, therefore, that the defendants are entitled to judgment as a
matter of law on Ms. Hatch’s claims under ERISA for past due benefits and for
clarification of her right to future benefits, as stated in her complaint [#1]. In addition, I
conclude that Ms. Hatch is not entitled to an award of attorney fees.
THEREFORE, IT IS ORDERED as follows:
1. That the determination of the defendants, the Long-Term Disability Plan of the

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May Department Stores and the Metropolitan Life Insurance Company, that the plaintiff,
Helena C. Hatch, is not entitled to disability benefits under the Plan beyond August 12,
2005, is UPHELD;
2. That the request of the plaintiff, Helena C. Hatch, for an award of attorney
fees is DENIED;
3. That judgment SHALL ENTER in favor of the defendants, the Long-Term
Disability Plan of the May Department Stores and the Metropolitan Life Insurance
Company, against the plaintiff, Helena C. Hatch; and
4. That the defendants, the Long-Term Disability Plan of the May Department
Stores and the Metropolitan Life Insurance Company, are AWARDED their costs to be
taxed by the clerk of the court in the time and manner provided by FED. R. CIV. P.
54(d)(1) and D.C.COLO.LCivR 54.1.
Dated March 28, 2013, at Denver, Colorado.
BY THE COURT:

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