Mercer v. Unum Life Insurance Company of America et al

Filing 69

MEMORANDUM OPINION AND ORDER: For the foregoing reasons, the Court finds Defendants decision to deny Plaintiff's claim for long-term disability benefits was neither arbitrary nor capricious. Accordingly, Defendants' motion for judgment o n the administrative record (Doc. No. 47 ) is GRANTED, and Plaintiff's motion for judgment on the administrative record (Doc. No. 50 ) is DENIED. As a result, the case is DISMISSED. Signed by District Judge Eli J. Richardson on 1/3/2025. (DOCKET TEXT SUMMARY ONLY-ATTORNEYS MUST OPEN THE PDF AND READ THE ORDER.)(ch)

IN THE UNITED STATES DISTRICT COURT FOR THE
MIDDLE DISTRICT OF TENNESSEE
NASHVILLE DIVISION
NICOLE MERCER,
Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY
OF AMERICA and UNUM GROUP
CORPORATION,
Defendants.

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No. 3:22-cv-337
JUDGE RICHARDSON

MEMORANDUM OPINION
Pending before the Court are cross-motions for judgment on the administrative record filed
respectively by Defendants Unum Life Insurance Company of America and Unum Group
Corporation on the one hand and Plaintiff Nicole Mercer on the other. (Doc. Nos. 47, 50). Each
motion was supported by an accompanying memorandum of law. (Doc. Nos. 48, 51).1 Defendants
and Plaintiff filed respective responses (Doc. Nos. 55, 56) to the other’s motion and filed replies
(Doc. Nos. 57, 58) to those respective responses.
Plaintiff seeks judicial review and reversal of Defendants’ decision to deny her claim for
long-term disability benefits under an employer-provided disability plan pursuant to the Employee
Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1002 et seq. (See Doc. No. 1).

1

Plaintiff filed an amended memorandum (Doc. No. 65), replacing her original memorandum (Doc. No.
51). A review of Plaintiff’s memoranda reveals two substantive changes. The amended memorandum
includes unredacted deposition testimony that was redacted in the original memorandum, and a footnote
explaining the reason for the original redaction has been deleted. (Doc. No. 51 at 26; Doc. No. 65 at 26).
Because there are no other differences between the two memoranda, the Court will cite to the amended
memorandum in its discussion of Plaintiff’s arguments. The Court further directs Plaintiff to Local Rule
7.01(a)(2), which requires that “[n]o memorandum shall exceed twenty-five (25) pages without leave of
Court.” Neither the original memorandum nor the amended memorandum complies with the Local Rules
as each is forty-four (44) pages long. Counsel is admonished to adhere to the Local Rules in all future
filings.

The Complaint sets forth one count, asserting a claim for an award of benefits under ERISA. (Id.
at 8); see also 29 U.S.C. § 1132(a)(1)(B). For the reasons stated below, Plaintiff’s Motion will be
DENIED, and Defendants’ Motion will be GRANTED.
BACKGROUND2
Beginning in 2017, Plaintiff worked as a nurse practitioner and instructor at Vanderbilt
University Medical Center, which provided insurance for employees through Unum. (Doc. No. 26
at 4; Doc. No. 26-4 at 118). Part of her insurance coverage included a long-term disability plan
(“the Plan”). (Doc. No. 26). The Plan provided as follows concerning the definition of “disability”:
HOW DOES UNUM DEFINE DISABILITY?
You are disabled when Unum determines that:
[Y]ou are limited from performing the material and substantial duties of
your regular occupation due to your sickness or injury; and you have a 20%
or more loss in your indexed monthly earnings due to the same sickness or
injury.
(Id. at 17).3 In order to receive benefits under the Plan, an insured “must be continuously disabled
through [their] elimination period.” (Id.) The “elimination period” lasts 180 days from the first day
of disability. (Id. at 17, 32). An insured may still work during the elimination period, but she must
be continuously disabled during that time. (Id. at 17). The Plan further indicated that Defendants
possessed “discretionary authority to make benefit determinations under the Plan,” but that “[a]ll
benefit determinations must be reasonable and based on the terms of the Plan and the facts and

2

The facts herein are taken from the administrative record. (Doc. Nos. 26–26-16). By the Court’s
calculation, the administrative record contains 3,448 pages of documents, records, and information,
although many of the documents therein are duplicative of one another. The Court has thoroughly reviewed
this record.

3

The Court notes that what the Plan does here is provide a definition for “[having a] disability” and also
equate “[having a] disability” with “[being] disabled.” Because the Plan equates these two concepts and
uses them interchangeably without drawing a distinction, the Court does likewise, although it believes it
preferable to refer to someone as a person who has a disability rather than as a person who is disabled.

circumstances of each claim.” (Id. at 43). The making of a benefit determination includes
“determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and
interpreting and enforcing the provisions of the Plan.” (Id.)
Plaintiff’s elimination period began on September 25, 2020. On that day, she reduced her
working hours, citing a disability caused by fibromyalgia, chronic fatigue syndrome, postural
orthostatic tachycardia syndrome, and autonomic dysfunction. (Doc. No. 26-1 at 34–38). Before
her elimination period ended 180 days later on March 23, 2021, she filed with Defendants a claim
for disability benefits on January 31, 2021. (Id.). Defendants thereafter contacted Plaintiff to begin
reviewing her claim. (Id. at 119–24). During conversations with Defendants’ claims investigators,
Plaintiff detailed the extent of her conditions and provided the contact information for several
medical providers, including her treating nurse practitioner, Kathryn Hansen. (Id.). Plaintiff
confirmed that of all of her medical providers, only Hansen recommended that Plaintiff be placed
under work restrictions and limitations given her medical conditions. (Id. at 120).
With this basic information, Defendants began an investigation to determine whether
Plaintiff met the Plan’s definition of being disabled. They obtained Plaintiff’s medical records
(Doc. No. 26-1 at 154–250; Doc. No. 26-2 at 1–24, 40–82, 86–99, 115–72), researched her work
responsibilities (Doc. No. 26-1 at 126–31), exchanged emails with Plaintiff’s employer regarding
her reduced workload (Id. at 141–42, 173–76), contacted pharmacies where Plaintiff received
medication (Id. at 143–48), provided Plaintiff with a questionnaire regarding her work experience
and education (Doc. No. 26-2 at 100–05), and maintained communication with Plaintiff who
provided updates regarding her physical health (Id. at 25, 34–38). Defendants did not, however,
conduct an independent physical examination of Plaintiff. Defendants also completed an internal
review of Plaintiff’s job duties and functions, determining that Plaintiff’s “regular occupation” met

the definition of “Nurse Practitioner.” (Id. at 108) Such a position, Defendants concluded, entailed
what qualified as “light work.” (Id.) The “material and substantial duties” of such light work
involved frequent sitting, occasional standing and walking, and solving problems and supervise
others, among other tasks. (Id.) Defendants then conducted an analysis of the information that they
had obtained during their investigation, tasking three medical professionals with making their own
independent determination as to the extent and effect of Plaintiff’s alleged disability. (Id. at 108–
09).
Patricia Edwards, a registered nurse, reviewed Plaintiff’s claim file and medical records
and concluded that Plaintiff’s medical conditions did not prevent her from performing the
“material duties” associated with her position as a nurse practitioner. (Id. at 237–42). Dr. Sabrina
Hammond, an internal medicine physician, also reviewed Plaintiff’s claim. (Id. at 250; Doc. No.
26-4 at 1–9). She spoke with Hansen, the nurse practitioner who had recommended that Plaintiff
reduce her working hours and limit strenuous activity. (Doc. No. 26-4 at 2). Hansen reported that
Plaintiff had cut back significantly on exercise but still maintained some regular physical activity.
(Id.) She further stated that Plaintiff’s medical conditions prevented her from returning to full-time
work. (Id.) Based on this background, Dr. Hammond then conducted a review of Plaintiff’s
medical records. Dr. Hammond noted that Plaintiff self-reported maintaining a somewhat rigorous
exercise regimen during the elimination period, including cycling, using a treadmill, and strength
training. (Id. at 8). She further highlighted Plaintiff’s own reports of improvement (Id. at 7) and
cited information from the medical records that indicated that Plaintiff’s symptoms were “stable”
and “well controlled.” (Id. at 6–8; Doc. No. 26-3 at 158, 188). Ultimately, Dr. Hammond
concluded that Plaintiff did not suffer from a disability severe enough to warrant the 50% reduction
in work that Hansen had recommended, or indeed any reduction in work. (Doc. No. 26-4 at 5). Dr.

Arlen Green next reviewed Plaintiff’s claim. (Id. at 31–33). His report reiterated the findings
contained in Plaintiff’s medical records, including her diagnoses as well as general findings that
Plaintiff was “stable without any neurological deficits.” (Id. at 32). Dr. Green accordingly
concluded that Plaintiff’s medical records did not support any restrictions on her ability to engage
in the material and substantial duties associated with her role as a nurse practitioner during the
elimination period. (Id.)
Defendants thus ended their months-long investigation and denied Plaintiff’s claim via a
letter to her dated April 14, 2021. (Id. at 64–71). The denial letter reviewed the steps of the
investigation and detailed the medical records that supported the denial, highlighting Dr.
Hammond’s and Dr. Green’s findings. (Id.). On May 30, 2021, Plaintiff ceased working entirely.
(Doc. No. 26-13 at 151). And in October 2021, she retained counsel to appeal Defendants’ denial
of her claim, submitting additional records in support of her appeal. (Doc. No. 26-12 at 62, 74).
Among the additional documentation were records and letters from some of Plaintiff’s
treating medical providers, including Hansen, Dr. Tracy Jackson (one of Plaintiff’s treating
physicians) and Dr. Thomas Whitfield (Plaintiff’s primary care physician). Dr. Whitfield’s records
indicated that Plaintiff reported chronic fatigue and pain for years. (Doc. No. 26-13 at 85–118).
And according to his completed “medical opinion form,” Dr. Whitfield opined that Plaintiff’s
conditions required that she rest for 45 minutes for every 15 minutes of work and be absent from
work for at least 25 days each month. (Id. at 121–22). Hansen shared similar findings in her letter
and opinion form, asserting that medications and treatment were only somewhat helpful, and that
Plaintiff could not “work a full or even a half day without” debilitating fatigue. (Id. at 141–46).
Dr. Jackson likewise opined that Plaintiff experienced significant malaise and fatigue, needing

several days of rest to recover from a half-day of work. (Id. at 161). She concluded that Plaintiff’s
disease was unlikely to improve and asserted that Plaintiff was medically disabled. (Id. at 162.)
In addition to the records of her treating providers, Plaintiff also submitted letters from
personal acquaintances and the findings of Wallace Stanfill, a vocational consultant and
rehabilitation counselor. Stanfill reviewed Plaintiff’s medical and employment records. (Id. at
148). He concluded that Plaintiff had been “totally disabled” from performing the tasks associated
with her job as a nurse practitioner since May 30, 2021—the date on which Plaintiff ceased
working and, notably, a date more than two months after the end of her elimination period. (Id. at
153). Plaintiff also submitted a letter from her ex-wife, who described witnessing Plaintiff’s
significant atrophy and decline in ability to work and live a normal life. (Id. at 155–57). Plaintiff’s
current partner recounted much of the same in a separate letter. (Id. at 159).
Defendants reviewed the additional information that Plaintiff submitted. G. Shannon
O’Kelley, Defendant’s own vocational consultant, completed an independent occupational
analysis of Plaintiff’s claim. (Doc. No. 26-14 at 170–72). He reviewed Stanfill’s findings and
reaffirmed that Plaintiff’s occupation aligned most closely with the Department of Labor’s
definition of “Nurse Practitioner.” (Id.). Such a role, O’Kelley concluded, qualified as involving
“light work,” involving frequent sitting, occasional standing and walking, and other tasks. (Id.).
Amanda Abbott, a registered nurse, then reviewed Plaintiff’s claim. (Id. at 173–78). Abbott noted
that Plaintiff’s medical records showed “essentially normal” testing for postural orthostatic
tachycardia syndrome, improved orthostatic symptoms with Plaintiff’s then-current rest regimen,
and improved tachycardia symptoms after Plaintiff began taking medication. (Id. at 178). Based
on these findings, Abbott concluded that Plaintiff would not be precluded from performing the

tasks associated with her position as a nurse practitioner. (Id.). Nevertheless, Abbott recommended
that a physician review the records as well. (Id.).
Dr. Chris Bartlett, a physician employed by Defendants, thereafter reviewed Plaintiff’s
claim. (Id. at 186–192). He determined that Plaintiff’s medical conditions did not prevent her from
working as a nurse practitioner during the elimination period. (Id. at 188). Dr. Bartlett supported
his conclusion by noting that Plaintiff had worked part-time during the elimination period,
expressed periodic improvements, experienced an abatement in symptoms after taking
medications, and received “normal” results from medical evaluations and tests. (Id. at 188–90).
Still, Dr. Bartlett reached out to Dr. Whitfield to understand why he had recommended that
Plaintiff reduce her workload. (Id. at 194, 198–200). Plaintiff’s counsel protested, citing the
revocation of prior authorizations for Defendants to contact Plaintiff’s physicians. (Id. at 207–08).
Defendants then ceased attempting to contact Dr. Whitfield, provided Plaintiff with copies of Dr.
Bartlett’s investigation files and letter to Dr. Whitfield, and gave Plaintiff a deadline of January
13, 2022, by which to respond to Dr. Bartlett’s findings before closing the appeal process. (Id. at
250; Doc. No. 26-15 at 1–6). On the deadline, Plaintiff submitted letters from Hansen and Dr.
Jackson as well as additional medical records. (Doc. No. 26-15 at 11–12).
The new medical records revealed that Plaintiff hired a caregiver to assist her with daily
care (Id. at 33), continued to experience significant fatigue and renewed low-grade fevers (Id. at
40), and was admitted to the hospital as her symptoms worsened (Id. at 51). Dr. Jackson’s letter
simply acknowledged that she did not agree with Dr. Bartlett’s assessment of Plaintiff’s claim. (Id.
at 56). Hansen’s correspondence likewise disputed Dr. Bartlett’s findings. (Id. at 68–71). Unlike
Dr. Jackson, however, Hansen explained her contrary rationale. She asserted that Plaintiff’s
“fatigue is debilitating,” and that although Plaintiff had shown “periods of improvement,” these

periods “have not been sufficient for her to sustain full[-]time employment.” (Id. at 70). Ultimately,
Hansen concluded that based on her clinical judgment, Plaintiff was not able to sustain full-time
employment despite her relative alertness in a clinical setting and her ability to maintain regular
exercise. (Id. at 70–71). Plaintiff thereafter submitted additional medical records after the January
13, 2022, deadline. (Id. at 88–108, 136–79).
On February 3, 2022, Defendants upheld their denial of Plaintiff’s claim and sent Plaintiff
a letter detailing the basis of their decision. (Doc. No. 26-16 at 111–24). They noted that the new
information that Plaintiff had submitted in January 2022 concerned Plaintiff’s medical conditions
after the expiration of the elimination period and was accordingly not “supportive of disability.”
(Id. at 117). Defendants further appended the relevant provisions of the Plan and explained that
Plaintiff could bring suit under Section 502(a) of ERISA if she disagreed with the outcome of the
appeals process. (Id. at 118–20).
On May 10, 2022, Plaintiff did just that by filing her complaint. (Doc. No. 1). Following a
lengthy period of discovery and unsuccessful attempts to mediate the case, the parties filed the
present cross-motions for judgment on the administrative record.
LEGAL STANDARDS
Courts review the denial of benefits challenged under ERISA de novo, 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 Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115
(1989). If a benefits plan grants such discretion, then the court “will review an administrator’s
benefits denial under an arbitrary-and-capricious standard.” Autran v. Procter & Gamble Health
& Long-Term Disability Benefit Plan, 27 F.4th 405, 411 (6th Cir. 2022). Because the plan in the
present case (i.e., the Plan) afforded Defendants “discretionary authority to make benefit

determinations,” the arbitrary-and-capricious standard applies here.4 (Doc. No. 26 at 17); see
Harmon v. Unum Life Ins. Co. of Am., No. 1:20-CV-318-KAC-CHS, 2023 WL 4166085, at *10
(E.D. Tenn. June 23, 2023) (citing the same policy language to support application of the arbitraryand-capricious standard), aff’d, No. 23-5619, 2024 WL 1075068 (6th Cir. Mar. 12, 2024).
The arbitrary-and-capricious standard “is extremely deferential and has been described as
the least demanding form of judicial review.” McClain v. Eaton Corp. Disability Plan, 740 F.3d
1059, 1064 (6th Cir. 2014) (quoting Cozzie v. Metro. Life Ins. Co., 140 F.3d 1104, 1107–08 (7th
Cir. 1998)). But the reviewing court may not “merely . . . rubber stamp the administrator’s
decision.” Jordan v. Reliance Standard Life Ins. Co., No. 22-5234, 2023 WL 5322417, at *6 (6th
Cir. Aug. 18, 2023) (quoting Jones v. Metro. Life Ins. Co., 385 F.3d 654, 661 (6th Cir. 2004)).
Instead, it must “uphold an administrator’s benefits decision as long as ‘it is the result of a
deliberate, principled reasoning process and . . . supported by substantial evidence.” Autran, 27
F.4th at 411 (omission in original) (quoting Davis v. Hartford Life & Accident Ins. Co., 980 F.3d
541, 547 (6th Cir. 2020)). This inquiry consists of two components, requiring the court to
determine whether “substantively or procedurally, [the administrator] has abused his discretion.”
Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 115 (2008). The claimant5 “bears the burden of proving

4

The parties appear to agree that the Court should apply the arbitrary-and-capricious standard in review of
the administrator’s denial of Plaintiff’s claim. Defendants point to the language of the Plan cited above.
(Doc. No. 48 at 12). Plaintiff’s briefing is less straightforward, but she argues that Defendants acted
arbitrarily and capriciously and never suggests that the Court should apply de novo review of the
administrator’s denial. (See Doc. No. 56 at 14–15; Doc. No. 65 at 15–17, 37).

5

Herein, the Court uses the term “claimant” to refer, unsurprisingly, to an insured who has filed a claim
and is going through the claims process.

that the [p]lan [a]dministrator’s decision was arbitrary or capricious.” Farhner v. United Transp.
Union Discipline Income Prot. Program, 645 F.3d 338, 343 (6th Cir. 2011).6
The substantive prong requires that plan administrators “reach only those conclusions that
are supported by substantial evidence in the administrative record.” Autran, 27 F.4th at 412. An
administrator’s decision is substantively reasonable “if a rational person could conclude that the
evidence was ‘adequate’ to justify the decision.” Id. (quoting Davis, 980 F.3d at 549). If there is
record evidence that could support the award or denial of benefits, then “the administrator’s choice
between this conflicting evidence cannot be considered arbitrary on substantive grounds.” Id.
(collecting cases).
“Procedurally, plan administrators must engage in reasoned decision[-]making.” Id.
(citing Davis, 980 F.3d at 547). And to determine whether a plan administrator engaged in such
reasoned decision-making, the court considers several factors. Glenn, 554 U.S. at 116–17. Which
factors are relevant varies with each case. Some factors include whether “the administrator
consider[ed] all the evidence or overlook[ed] evidence that cut the other way,” Autran, 27 F.4th at
412 (citation omitted), whether “the administrator contracted with physicians to conduct a file
review as opposed to a physical examination of the claimant,” Olah v. Unum Life Ins. Co., No.
1:19-CV-96-KAC-CHS, 2023 WL 7305033, at *5 (E.D. Tenn. Nov. 6, 2023) (quoting Fura v. Fed.
Express Corp. Long Term Disability Plan, 534 F. App’x 340, 342 (6th Cir. 2013)), appeal

6

The standard of review is typically described as the “arbitrary and capricious standard.” See Firestone
Tire & Rubber Co., 489 U.S. at 952 (emphasis added). And consistent with that description, courts typically
state that in order to uphold a denial, a reviewing court must conclude that the plan administrator’s decision
was neither arbitrary nor capricious. See, e.g., Jordan, 2023 WL 5322417, at *6 (“[W]e will reverse the
administrator’s decision only if it is arbitrary or capricious.”) (citation and internal quotation marks
omitted); Duncan v. Minn. Life Ins. Co., 845 F. App’x 392, 402 (6th Cir. 2021) (upholding a denial of
benefits that was “neither arbitrary nor capricious”); McClain, 740 F.3d at 1068 (“We cannot find
Defendants’ denial of benefits arbitrary or capricious . . . .”). However, the Court does not perceive that
courts recognize any real analytical distinction between a denial that is “arbitrary” and a denial that is
“capricious.”

dismissed, No. 23-6067, 2024 WL 2852092 (6th Cir. Mar. 20, 2024), and whether (and if so to
what extent) the administrator operated under a “conflict of interest.” Glenn, 554 U.S. at 108. None
“of the potentially relevant factors is dispositive in its own right,” and the court “must weigh them
all when deciding whether the administrator’s ultimate conclusion resulted from a rational
process.” Autran, 27 F.4th at 412.
DISCUSSION
Plaintiff argues that Defendants’ claim denial should be reversed for three main reasons,
each of which is discussed below. But the evidence on which Defendants relied was substantial,
and their process was eminently reasonable and deliberative. Having reviewed the parties’ briefing
and the administrative records, Defendants’ arguments are more persuasive and their decision to
deny Plaintiff benefits was neither arbitrary nor capricious.
I.

Substantial evidence
A. Disability determination
As a substantive matter, the Court first must address whether Defendants “reasonably

found that [Plaintiff] was not . . . disabled within the meaning of the Plan.” Autran, 27 F.4th at
412. To do so, the Court “start[s] with basics about the Plan’s key terms.” Id. An insured is disabled
for purposes of the Plan (if at all) as of the time (if ever) that, according to Defendants’ subsequent
determination, she is “limited from performing the material and substantial duties of [her] regular
occupation due to your sickness or injury; and [she] ha[s] a 20% or more loss in [her] indexed
monthly earnings due to the same sickness or injury.” (Doc. No. 26 at 17). To receive benefits, the
insured must meet this definition of disability throughout the duration of the elimination period.
(Id.) The critical question, therefore, is whether Defendants’ conclusion that Plaintiff was not
disabled throughout the elimination period was a “rational decision” based on “adequate”

evidence. Id. (quoting Davis, 980 at 549); see also McClain, 740 F.3d at 1065 (quoting Shields v.
Reader’s Digest Ass’n, Inc., 331 F.3d 536, 541 (6th Cir. 2003) (“When it is possible to offer a
reasoned explanation, based on the evidence, for a particular outcome, that outcome is not arbitrary
or capricious.”) The Court looks to the administrative record. Okuno v. Reliance Standard Life Ins.
Co., 836 F.3d 600, 607 (6th Cir. 2016) (“[T]he court’s review is limited to the administrative
record.”).
First, many of Plaintiff’s medical exams and tests revealed normal results despite consistent
self-reported pain. (Doc. No. 26-2 at 89–90; Doc. No. 26-4 at 5; Doc. No. 26-14 at 19–33).
Additionally, providers’ notes from medical appointments conducted during the elimination period
indicate that Plaintiff’s pain was “tolerable,” “improved,” and “so much better” at various times.
(Doc. No. 26-1 at 168–70; Doc. No. 26-3 at 154). Other records contain information showing that
her fibromyalgia was “stable” and that her postural orthostatic tachycardia syndrome was “well
controlled” during the elimination period. (Doc. No. 26-3 at 158, 183). Additionally, Plaintiff was
able to manage her pain and fatigue with treatment and medication during the elimination period.
(Doc. No. 26-3 at 85–86; Doc. No. 26-7 at 159). And just before she reduced her working hours,
Plaintiff reported to her cardiologist that she was able to ride her bike six miles three to five times
a week and perform yoga regularly. (Doc. No. 26-2 at 67). At a follow-up medical appointment
during the elimination period, she reported maintaining her cycling routine and using the treadmill.
(Doc. No. 26-3 at 177). In fact, the provider at the follow-up appointment noted that despite
Plaintiff’s “persistent fatigue,” “[a]lmost all of her orthostatic symptoms are vastly improved on
her current regimen.” (Id.) Furthermore, although Plaintiff’s treatment providers consistently
noted that she suffered from her conditions, only Hansen recommended that Plaintiff reduce her
work hours during the elimination period. (Doc. No. 26-1 at 120; Doc. No. 26-3 at 66; Doc. No.

26-4 at 3). Finally, medical professionals employed by Defendants conducted several independent
file reviews, and all of them concluded that Plaintiff’s medical conditions and symptoms did not
support restrictions on her work as a nurse practitioner. (Doc. No. 26-2 at 237–42; Doc. No. 26-4
at 5, 31–33; Doc. No. 26-14 at 178, 186–92).
Plaintiff counters by pointing to records that detail a litany of diagnoses and symptoms.
(Doc. No. 56 at 5–14; Doc. No. 58 at 3–6; Doc. No. 65 at 40–43). And evidence in the record
might support a finding that Plaintiff suffered from debilitating pain and malaise as a result of her
medical conditions. But the Court’s task is not to determine whether the administrator’s “decision
was the most reasonable decision, or whether it was more reasonable to deny benefits than to grant
them; instead, under the arbitrary and capricious standard—the ‘least demanding form of judicial
review’—[the Court] ask[s] only whether it is possible to offer an explanation for the outcome.”
Holden v. Unum Life Ins. Co. of Am., No. 20-6318, 2021 WL 2836624, at *11 (6th Cir. July 8,
2021) (quoting Davis, 887 F.3d at 693). Defendants have clearly articulated a rational explanation
for the outcome. See Carty v. Metro. Life Ins. Co., 224 F. Supp. 3d 606, 615 (M.D. Tenn. 2016)
(“Under the [arbitrary-and-capricious] standard, the determination of an administrator will be
upheld if it is ‘rational in light of the plan’s provisions.’” (quoting McClain, 740 F.3d at 1064)).
The Court now turns to Plaintiff’s three objections that address the substantive prong of
the inquiry. Although the Court has already found that there was substantial evidence in the record
to support Defendants’ denial of Plaintiff’s claim, the Court endeavors to provide a thorough
analysis of Plaintiff’s arguments. Cf. Holden, 2021 WL 2836624, at *10–15 (first affirming the
denial was rational and supported by substantial evidence and then addressing the plaintiff’s
objections to the adequacy of the evidence).
B. Objective Evidence

Defendants argue that a lack of “objective evidence” supporting Plaintiff’s allegations of a
disability was fatal to her claim. (Doc. No. 48 at 14–18). Plaintiff contends, however, that the Plan
did not require submission of such evidence and that because Defendants failed to raise this issue
in their denials, they have forfeited the argument. (Doc. No. 56 at 6–13).
Although “fibromyalgia can be a severe impairment,” it is difficult to diagnose because
those who suffer from the condition “present no objectively alarming signs.” Rogers v. Comm’r of
Soc. Sec., 486 F.3d 234, 243 (6th Cir. 2007). The same is true of chronic fatigue syndrome, Buxton
v. Halter, 246 F.3d 762, 763 n.1 (6th Cir. 2001), and postural orthostatic tachycardia syndrome,
Outward v. Eaton Corp. Disability Plan for U.S. Employees, 808 F. App’x 296, 304 (6th Cir. 2020)
(noting that symptoms of the disorder “were not demonstrable through medical testing”). The Sixth
Circuit has held, however, that although a requirement of “objective evidence of fibromyalgia
itself” would be “burdensome” on claimants, claimants can furnish “objective evidence of [the]
disability [that allegedly is] due to fibromyalgia.” Huffaker v. Metro. Life. Ins. Co., 271 F. App’x
493, 500 (6th Cir. 2008); see also Boardman v. Prudential Ins. Co. of Am., 337 F.3d 9, 16 n.5 (1st
Cir. 2003) (“While the diagnoses of chronic fatigue syndrome and fibromyalgia may not lend
themselves to objective clinical findings, the physical limitations imposed by the symptoms of
such illnesses do lend themselves to objective analysis.”). Indeed, “[r]equiring a claimant to
provide objective medical evidence of disability is not irrational or unreasonable.” Cooper v. Life
Ins. Co. of N. Am., 486 F.3d 157, 166 (6th Cir. 2007).
Importantly, as Plaintiff observes, the Plan, unlike other benefit policies, did not require
the submission of objective evidence to prove a disability. See Curry v. Eaton Corp., 400 F. App’x
51, 53 (6th Cir. 2010) (the benefit policy defined “objective findings of a disability” as those
findings that “can be observed by your physician through objective means, not just from a

description of your symptoms.”) Defendants rely on Huffaker and Cooper to argue that a plan
administrator can require the submission of objective evidence even when the policy does not
contain language explicitly so requiring. In Huffaker, the policy required proof that the claimant
was “unable to perform each of the material duties” of her occupation. 271 F. App’x at 499. And
in Cooper, the policy required proof that the claimant was “unable to perform all the material
duties of” her position. 486 F.3d at 159. In both cases, the Sixth Circuit determined that although
the policy did not clearly require the submission of explicit evidence, the plan administrator
nevertheless could require explicit evidence based on the policy’s language and the request for
such evidence during the investigatory process. Huffaker, 271 F. App’x at 500; Cooper, F.3d at
166–67.
In the present case, however, Defendants never explicitly cited a lack of objective evidence
as a reason that they were denying Plaintiff’s claim. But their denial letters did thoroughly detail
the reasons for the denials. According to the first denial letter, Plaintiff’s evidence showed an
improvement in symptoms, a moderately active lifestyle inconsistent with her reported symptoms,
and normal test results. (Doc. No. 26-4 at 64–71). And Plaintiff was permitted to appeal the
decision by submitting additional information supportive of her claim that she was disabled as
defined by the plan. (Id. at 70). The second denial letter adopted the findings of the first and
responded to the new information that Plaintiff had submitted, noting that the medical-opinion
forms and vocational assessment did not contain information suggesting that Plaintiff was disabled
continuously through the elimination period. (Doc. No. 26-16 at 114–20). Although Defendants
did not use the words “objective evidence” in explaining the reasons for denying Plaintiff’s claim,
the Court does not require a shibboleth at the expense of substance. Defendants clearly denied her
claim because she failed to submit evidence showing that her symptoms resulted in a disability as

defined by the plan throughout the elimination period and because evidence in the record cut
against her claim. Plaintiff’s contention that Defendants are raising an impermissible post-hoc
argument accordingly falls short. And, for the reasons explained above, Defendants’ decision to
deny Plaintiff’s claim was a rational one supported by substantial evidence.
C. Plaintiff’s activity levels
Plaintiff next argues that Defendants’ reliance on evidence of Plaintiff’s activity level
during the elimination period rendered their denial arbitrary and capricious. (Doc. No. 56 at 13–
14). She suggests that the medical records instead demonstrate a developing inability on her part
to maintain the same active lifestyle that she previously had. (Id.). Defendants assert that evidence
of Plaintiff’s activity level during the elimination period was just one type of evidence that
influenced their denial of her claim. (D.E. 55 at 12–14). And they note that the evidence
demonstrates an inconsistency between Plaintiff’s self-reported symptoms of overwhelming
fatigue and her ability to remain at least somewhat active. (Id.).
Defendants are correct to point out that the essential inquiry is not whether the
administrator’s reliance on discrete pieces of evidence was arbitrary and capricious, but whether
the overall “decision denying benefits” was. Brown v. Fed. Exp. Corp., 610 F. App’x 498, 506
(6th Cir. 2015) (quoting McClain, 740 F.3d at 1066). And as noted above, Defendants adopted a
holistic approach to reviewing Plaintiff’s claim. The initial denial letter cites Plaintiff’s active
lifestyle as one reason supporting their conclusion. (Doc. No. 26-4 at 66). Plaintiff’s normal test
results and self-reported improvement in symptoms during the elimination period, among other
pieces of evidence, are also noted as reasons for denying her claim. (Id. at 66–67). Although
Hansen reported that Plaintiff was unable to exercise or stay active during the elimination period,
(Doc. No. 26-10 at 217), “the Supreme Court [has] made clear that in ERISA cases, ‘courts have

no warrant to require administrators automatically to accord special weight to the opinions of a
claimant’s physician.’” Holden, 2021 WL 2836624, at *11 (quoting Black & Decker Disability
Plan v. Nord, 538 U.S. 822, 834 (2003)). Hansen made her findings in January 2021, and Plaintiff
reported to her cardiologist in February 2021 that she cycled six to eight miles, used a treadmill,
and did “a lot” of strength training. (Doc. No. 26-3 at 177). Defendants cited this inconsistency
within the records and concluded that Plaintiff’s self-reported activity level during the elimination
period was inconsistent with an inability to work as a nurse practitioner. (Doc. No. 26-4 at 66).
Because the arbitrary-and-capricious standard requires that the Court consider the ultimate
decision of the administrator, not simply discrete choices, and because information regarding
Plaintiff’s activity level was inconsistent within her own medical records, Defendants did not act
unreasonably in citing the information in their denial of Plaintiff’s claim for benefits.
D. Consideration of all relevant evidence
Plaintiff’s final substantive objection is that Defendants did not engage in reasoned
decision-making by failing to consider all relevant evidence. (Doc. No. 56 at 14–17; Doc. No. 58
at 4; Doc. No. 65 at 41–42). Defendants respond by making two primary observations. First, they
assert that their decision was guided by an examination of over 3,000 pages of medical records,
documents, and other information, involving months of review by medical professionals. (Doc.
No. 48 at 19–21; Doc. No. 55 at 10–12). This process, Defendants argue, resulted in well-reasoned
denial based on the evidence. Second, Defendants aver that much of the evidence that Plaintiff
submitted concerns events outside of the elimination period and was therefore irrelevant to
determining whether Plaintiff was continuously disabled throughout that period. Defendants have
the better arguments.

Plaintiff asserts that Defendants failed to consider Hansen’s January 2022 letter and the
letters submitted by her current partner and ex-wife. (Doc. No. 56 at 14–17; Doc. No. 58 at 6).7
Hansen’s letter simply reiterated her conclusions revealed in medical records that Plaintiff had
previously submitted and disputed Dr. Bartlett’s findings. (Doc. No. 26-15 at 70–71). The letter
did not, as Defendants correctly point out, provide any new objective evidence to support finding
that Plaintiff was disabled throughout the elimination period. Likewise, although the letters from
Plaintiff’s romantic partners allege that Plaintiff suffers from excruciating malaise and fatigue,
they provide no new medical evidence to support a finding that Plaintiff was unable to work as a
nurse practitioner during the elimination period. (Doc. No. 26-13 at 155–59). Importantly, other
than a brief reference to Plaintiff’s difficulty visiting a zoo in October 2020, none of letters address
whether Plaintiff was continuously disabled throughout the elimination period.
“ERISA was enacted to promote the interests of employees and their beneficiaries, and to
protect contractually defined benefits.” Firestone Tire & Rubber Co., 489 U.S. at 113 (internal
quotation marks and citations omitted). In the present case, the Plan defined disability and required
that a claimant meet that definition continuously throughout the elimination period to receive
benefits. Evidence that Plaintiff submitted needed to prove this contractual definition. Because the
letters “lack any particularity about [Plaintiff’s] ability during the relevant period,” they did not
allow Defendants, and do not allow the Court on review, to “reach a finding a disability.”
Tranbarger v. Lincoln Life & Annuity Co. of N.Y., 68 F.4th 311, 315 (6th Cir. 2023). Indeed, only
evidence that “speaks to Plaintiff’s condition during the relevant time period” is germane. Javery
v. Lucent Techs., Inc. Long Term Disability Plan for Mgmt., 741 F.3d 686, 690 n.1 (6th Cir. 2014).

7

Plaintiff’s argument regarding Hansen’s letter is raised in her amended memorandum (Doc. No. 65 at 41–
42) and is repeated verbatim in her response to Defendants’ memorandum (Doc. No. 56 at 16–17). The
Court will cite only to her response.

Furthermore, as discussed above, the Supreme Court has made clear that plan administrators are
not required to “accord special deference to the opinions of treating physicians,” like Hansen.
Black & Decker Disability Plan, 538 U.S. at 831. For these reasons, Defendants’ failure to consider
the three letters does not render their decision to deny Plaintiff’s claim for benefits arbitrary or
capricious.8
II.

Conflict of interest
Plaintiff devotes much of her briefing to a procedural argument regarding Defendants’

alleged conflict of interest. (Doc. No. 58 at 6–7; Doc. No. 65 at 23–40). The crux of her argument,
which she attempts to support with more than 1,110 pages of exhibits (see Doc. Nos. 51-1 to 5125), is that the denial of her claim was the product of two impermissible conflicts of interest. First,
Defendants allegedly conducted a sham investigation of her claim because of a longstanding
practice of seeking to deny a target number of claims regardless of their merits. (Doc. No. 58 at 6–
7; Doc. No. 65 at 20–40).9 Second, Plaintiff argues that because bonuses for file-reviewing
physicians are partially tied to overall company profitability, the medical opinions of these
physicians are inherently tainted. (Doc. 65 at 34–40).

8

The Court notes that Plaintiff cites to Smith v. Continental Casualty Co., 450 F.3d 253, 261 (6th Cir.
2006), and Oliver v. Coca-Cola Co., 497 F.3d 1181, 1199 (11th Cir. 2007), in support of her argument that
Defendants neglected to consider all relevant evidence and thus rendered an arbitrary and capricious
decision. (Doc. No. 56 at 16). In both of those cases, the court determined that the defendant’s reviewing
physician’s review was flawed due to a failure to consider clearly relevant medical records and evidence.
Oliver, 497 F.3d at 1199 (failing to consider “two EMG tests and the nerve conduction test”); Smith, 450
F.3d at 261 (identifying a failure to provide the reviewing physician with all medical records provided by
the claimant). By contrast, Dr. Bartlett and Defendants explained that they had thoroughly reviewed all
relevant medical records. Only Hansen’s January 2022 letter, which provides no new medical information
and does not address the elimination period, was not provided to Dr. Bartlett.
9

When reviewing claim denials in ERISA cases, district courts are typically constrained to consider the
existing administrative record. Moore v. Lafayette Life Ins. Co., 458 F.3d 416, 430 (6th Cir. 2006). “The
district court may consider evidence outside of the administrative record only if that evidence is offered in
support of a procedural challenge to the administrator’s decision, such as . . . alleged bias on its part.” Id.
Although Plaintiff does not point out this fact, the Court will consider the exhibits outside of the
administrative record to resolve Plaintiff’s procedural challenge.

“The Supreme Court has recognized that an inherent conflict of interest exists when a
defendant plays the dual role of both deciding a plan participant’s eligibility for benefits and paying
out those benefits from its own coffers.” Autran, 27 F.4th at 418 (citing Glenn, 554 U.S. at 108).
When a plan administrator works under such a conflict, “that conflict must be weighed as a ‘factor
in determining whether’” the denial was arbitrary or capricious. Glenn, 554 U.S. at 108 (citing
Firestone Tire & Rubber Co., 489 U.S. at 115). “[T]he significance of the factor will depend upon
the circumstances of the particular case.” Id. But the Sixth Circuit has “emphasized that
‘conclusory allegations of bias’ based on this (relatively common) inherent conflict do not deserve
much weight.” Autran, 27 F.4th at 418 (quoting Judge v. Metro. Life Ins. Co., 710 F.3d 651, 664
(6th Cir. 2013)). Indeed, “an alleged conflict matters only if there is also ‘evidence suggesting that
the conflict materialized in a concrete way to influence the administrator’s decisional process.’”
Harmon v. Unum Life Ins. Co. of Am., No. 23-5619, 2024 WL 1075068, at *4 (6th Cir. Mar. 12,
2024) (quoting Autran, 27 F.4th at 418). And, critically, “that evidence must be ‘significant,’
showing ‘that the conflict actually affected or motivated the decision at issue.’” Holden, 2021 WL
2836624, at *17 n.21 (quoting Cooper, 486 F.3d at 165).
A. Claims denial process
Plaintiff purports that Defendants have maintained a decades-long scheme involving
setting a claims-denial goal and tracking and disseminating these goals in weekly reports. (Doc.
No. 65 at 25–33). She points to emails, excerpts from depositions, sworn testimony, and other
evidence, gathered since 2007, as proof that Defendants have maintained a longstanding and
nefarious plan to deny meritorious claims. The only evidence that this alleged conflict infected the
denial of Plaintiff’s claim, however, comes from the deposition testimony of John Waters, a longterm disability director employed by Defendants who oversaw the team that handled Plaintiff’s

claim. (Doc. No. 51-14). That team included a disability benefits specialist (“DBS”) and an appeals
specialist (“AS”). (Doc. No. 55-2 at 6). The DBS and AS, assisted by a team of medical
professionals reviewing information submitted by Plaintiff, managed the claims process and,
ultimately, decided to deny Plaintiff’s claim. (Id.). Waters simply managed the DBS and AS and
did not make the decision to deny Plaintiff’s claim. (Id.)
However, as a director, Waters had access to weekly tracking reports that tracked
information such as when an insured filed a claim or when a claim was closed (whether the claim
was denied, the insured died, or the insured voluntarily terminated the claim), liability acceptance
rates, social security offsets, and other metrics. (Doc. No. 55-2 at 10). Plaintiff alleges that these
weekly reports also contained a number of “recoveries” that masqueraded as benign statistics, but
in fact were denial goals. (Doc. No. 65 at 25). Defendants note that “recovery” is the term used to
describe when a claim closes for any reason other than the claimant dying or aging out of policy
coverage. (Doc. No. 55 at 4 n.1). According to deposition testimony, the recovery metrics
contained in the weekly reports are generated by Defendants’ finance department to reflect, in any
given period, how many claims closed actually closed and, using historical data, how many claims
are likely to close. (Doc. No. 55-2 at 3–4). This information was shared with directors but not with
the DBS or AS. (Id. at 10–11). In reply, Plaintiff argues that the access of Waters—who did not
make claims decisions—to the weekly tracking report demonstrates that the alleged conflict of
interest tainted the investigation into Plaintiff’s claim. (Doc. No. 58 at 6–7).
A quartet of recent cases from the Eastern District of Tennessee is particularly helpful here.
See, e.g., Olah v. Unum Life Ins. Co., No. 1:19-CV-96-KAC-CHS, 2023 WL 7305033, at *8–9
(E.D. Tenn. Nov. 6, 2023), appeal dismissed, No. 23-6067, 2024 WL 2852092 (6th Cir. Mar. 20,
2024); Harmon v. Unum Life Ins. Co. of Am., No. 1:20-CV-318-KAC-CHS, 2023 WL 4166085,

at *16 (E.D. Tenn. June 23, 2023), aff'd, No. 23-5619, 2024 WL 1075068 (6th Cir. Mar. 12, 2024);
Frost v. Unum Life Ins. Co. of Am., No. 1:21-CV-269, 2023 WL 2261415, at *16–18 (E.D. Tenn.
Feb. 14, 2023); Sandeen v. Paul Revere Life Ins. Co., No. 1:18-CV-248, 2022 WL 966848, at *13–
15 (E.D. Tenn. Mar. 30, 2022), aff'd sub nom. Sandeen v. Unum Grp. Corp., No. 22-5374, 2023
WL 2379012 (6th Cir. Mar. 7, 2023). In each of those cases, Plaintiff’s counsel served as the
claimant’s counsel and raised conflict-of-interest arguments nearly identical to the one here. And
in each of those cases, that argument fell short for the same reason: the plaintiff failed to identify
any evidence that the weekly tracking reports actually influenced the decision to deny their claim.
See Olah, 2023 WL 7305033, at *9; Harmon, 2023 WL 4166085, at *17; Frost, 2023 WL
2261415, at *17; Sandeen, 2022 966848, at *14–15. The same is true in the present case. Plaintiff
has produced hundreds of pages of evidence. But none of it serves to make any connection, beyond
conclusory and tenuous allegations, between Waters’s role as a director, his access to the weekly
tracking reports, and the ultimate decision to deny Plaintiff’s claim. Plaintiff accordingly has failed
to “provide ‘significant evidence’ that the conflict actually affected” Defendants’ denial of her
claim. Cooper, 486 F.3d at 165 (quoting Peruzzi v. Summa Med. Plan, 137 F.3d 431, 433 (6th Cir.
1998)).10

10

The Supreme Court has made clear also that a conflict of interest “should prove less important (perhaps
to the vanishing point) where the administrator has taken active steps to reduce potential bias and to promote
accuracy.” Glenn, 554 U.S. at 117. Defendants undertook extensive efforts to conduct a rigorous
investigation of Plaintiff’s claim. As discussed above, multiple employees and medical professionals
analyzed the merits of the claim by independently combing through thousands of pages of records. Such a
“thorough review of the record” couple with the absence of evidence that “the review was improperly
influenced” by the conflict, is enough to conclude that the conflict of interest did not result in an arbitrary
or capricious denial. Scwalm v. Guardian Life Ins. Co. of Am., 626 F.3d 299, 312 (6th Cir. 2010); see also
supra note 6 (addressing the application of the “arbitrary and capricious” standard).

B. Bonuses for file-reviewing physicians
Plaintiff’s final argument regarding Defendants’ alleged conflict of interest is that the
bonuses that file-reviewing physicians received themselves evince bias. For support, she points to
claims investigation files from 2009 and 2010 and deposition testimony of Dr. Freeman Broadwell,
a file-reviewing physician, as well as deposition testimony from Dr. Bartlett. (Doc. Nos. 51-17 to
51-19, 51-25). According to Plaintiff, Defendants pay file-reviewing physicians bonuses when the
company reaches an internally set level of profitability. (Doc. No. 65 at 35). Because denial of
claims results in higher profits for Defendants, the physicians are financially incentivized to deny
claims. (Id. at 35–36). Dr. Bartlett testified that file-reviewing physicians received bonuses that
were at least partially tied to employee performance and company profitability. (Doc No. 51-25 at
3–4). His testimony does not, however, reveal a sinister scheme to incentivize file-reviewing
physicians to deny as many claims as possible. This second theory of conflict of interest suffers
from the same infirmity as did the first.
Dr. Broadwell did not work on the investigation of Plaintiff’s claim, and Plaintiff otherwise
provides no evidence showing that the alleged bonus scheme “actually affected” the denial of her
claim. Cooper, 486 F.3d at 165. Instead, as before, she relies solely on speculative allegations of
a plot to deny claims for financial gain. See Cook v. Prudential Ins. Co. of Am., 494 F. App’x 599,
605 (6th Cir. 2012) (declining to find bias where the plaintiff “offer[ed] no more than cursory
statements” in support of his allegations). As a result, Plaintiff has failed to show that Defendants’
conflict of interest resulted in an arbitrary or capricious denial of her claim for benefits.
Indeed, having reviewed thousands of pages of records, the Court concludes that
Defendants’ decision to deny Plaintiff’s claim was neither substantively nor procedurally flawed.
Instead, it was the product of “a deliberate, principled reasoning process and . . . supported by

substantial evidence.” Autran, 27 F.4th at 411 (quoting Davis, 980 F.3d at 547) (omission in
original). And under applicable law, this means that the decision—even if it is ultimately debatable
on the merits—survives Plaintiff’s challenge to it.
CONCLUSION
For the foregoing reasons, the Court finds Defendants decision to deny Plaintiff’s claim for
long-term disability benefits was neither arbitrary nor capricious. Accordingly, Defendants’
motion for judgment on the administrative record (Doc. No. 47) is GRANTED, and Plaintiff’s
motion for judgment on the administrative record (Doc. No. 50) is DENIED. As a result, the case
is DISMISSED.
The Clerk shall enter judgment under Federal Rule of Civil Procedure 58 and close the file.
IT IS SO ORDERED.

____________________________________
ELI RICHARDSON
UNITED STATES DISTRICT JUDGE