Clark v. Nationwide Mutual Insurance Company
MEMORANDUM OPINION AND ORDER granting defendant's 14 MOTION for Summary Judgment; denying plaintiff's 17 MOTION for Summary Judgment; granting plaintiff's 16 MOTION to exceed the page limit for her supporting memorandum of law; and directing that this action be dismissed. Signed by Judge John T. Copenhaver, Jr. on 3/22/2013. (cc: attys; any unrepresented parties) (taq)
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF WEST VIRGINIA
Case No. 2:12-cv-0045
NATIONWIDE MUTUAL INSURANCE CO.,
MEMORANDUM OPINION AND ORDER
Pending are cross motions for summary judgment by
plaintiff Anita Clark and defendant Nationwide Mutual Insurance
Co. (“Nationwide”), each filed on July 27, 2012.1
reasons that follow, the court grants summary judgment in favor
This matter arises from Nationwide‟s denial of Clark‟s
long term disability benefits claim and is before the court
pursuant to the Employee Retirement Income Security Act of 1974
(“ERISA”), 29 U.S.C. § 1132(a)(1)(B).
Clark is a West Virginia
resident who began working for Nationwide on September 21, 1998.
The court grants Clark‟s motion to exceed the page limit for
her supporting memorandum of law, filed July 27, 2012.
Admin. Record 37.
While a Nationwide employee, Clark was
covered under the Nationwide Insurance Companies and Affiliates
Plan for Your Time and Disability Income Benefits (“the Plan”).
Compl. ¶ 6; Admin. Record 210.
Clark contends that Nationwide
wrongly denied her claim for disability benefits.
A. Plan Language
Nationwide is the “Plan Sponsor.”
Admin. Record 224.
Nationwide‟s Board of Directors appoints the members of the
“Benefits Administrative Committee.”
Id. at 217.
Administrative Committee in turn is the “Plan Administrator.”
Id. at 224.
The Plan Administrator “has the power to take all
actions required to carry out the provisions of the Plan.”
This includes the power and duty “to exercise
discretion and authority to construe and interpret the
provisions of the Plan, to determine eligibility to participate
in the Plan, and make and enforce rules and regulations under
the Plan to the extent deemed advisable.”
Plan Administrator has the power to “decide all questions as to
the rights of Participants under the Plan and such other
questions as may arise.”
As a result of these provisions,
the parties agree that the court‟s review of the Plan
Administrator‟s decisions is under the abuse of discretion
See Pl.‟s Mem. Supp. Mot. Summ. J. 16.
The Plan provides qualifying employees with long term
disability (“LTD”) benefits of 60% of the employee‟s covered
compensation in effect on the Date of the Disability, less any
amount provided by certain other benefit plans, including Social
Admin. Record at 246-47.
The Date of Disability is
the date an employee “first misses a day of work due to her
Id. at 219.
LTD benefits commence on the first
day after 1) Short-Term Disability benefits are exhausted and 2)
the claimant then provides written proof of loss and medical
evidence that the employee is LTD Disabled.
Id. at 245.
Section 4.03.03 of the Plan sets forth the proof of
loss and medical evidence requirements:
(a) To commence LTD Disability Income Benefits, an
Active Associate must present evidence to the
satisfaction of the Plan Administrator of the
(1) that the Active Associate‟s LTD Disability is
the direct and proximate result of an illness,
(2) that, as of the Active Associate‟s Date of
Disability, there is a demonstrated, substantial
change in medical or physical condition as the
result of a specific physical injury or the
specific onset of a physical or mental illness,
demonstrated by new, significantly increased
physical or mental impairments such as a
significant loss of physical functional capacity,
(3) that her LTD Disability is an Eligible
Id. at 246.
“LTD Disability” is defined in section 1.34 as
a disability or disablement that results from a substantial
change in medical or physical condition as a result of
Injury or Sickness and that prevents an Active Associate
from engaging in Substantial Gainful Employment for which
she is, or may become, qualified. Continuation of an
existing medical or physical condition will generally not
constitute a substantial change in medical or physical
condition if Claimant previously demonstrated through
attendance and/or work that Claimant has been able to
engage in Substantial Gainful Employment, or such medical
or physical condition could be or has been accommodated. A
substantial change in medical or physical condition may be
evidenced by the change or loss of at least one of the
Activities of Daily Living.
Id. at 221-23.
The Plan defines Substantial Gainful Employment
any occupation or employment from which an individual
may receive an income equal to or greater than onehalf of such individual‟s Covered Compensation as of
her Date of Disability.
Id. at 225.
When, as found by the Plan here, a LTD Disability
is the result of “mood, anxiety, somatoform or other disorder as
defined by the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association,”
benefits have a maximum duration of 36 months.
Id. at 251.
B. Claim History
Clark was 52 years of age when she filed this action,
on January 10, 2012.
Compl. ¶ 1.
Nationwide on September 21, 1998.
She began working at
Pl.‟s Mem. Supp. Mot. Summ.
Her initial duty was to assist insurance claims managers;
however, she later became an Administrative Service Manager,
responsible for building maintenance and supply.
described in a psychiatric evaluation, her duties included
“supervising/managing seven buildings in three different states,
supervising seven (7) people, performing a considerable amount
of driving, monitoring budgeted expenditures and answering
customers as well as department of insurance complaints.”
Admin. Record 22.
The precise timeframe is unclear from the record, but
the demands of Clark‟s job began to increase in response to
Clark‟s supervisor told Clark that
she needed to work 12 to 14 hours a day, and on some days Clark
She had to personally move computers and
other equipment into buildings on occasion, sometimes with the
help of her husband due to her fibromyalgia.
extended hours, she received complaints from managers and was
told to spend more time at work or alternatively to improve her
She also began having conflicts with
Pl.‟s Mem. Supp. Mot. Summ. J. 4.
As a result of the increased work demands, Clark began
suffering from anxiety and depression, with which she was
diagnosed on June 21, 2005.
She received psychiatric
treatment and therapy in 2005 and 2006, but the psychiatric
symptoms did not subside and the problems at work escalated.
Id. at 5.
She requested assistance from a nurse employed by
Nationwide and discussed with the nurse the possibility of
modifying her job.
By Clark‟s account, the nurse reported
that Nationwide denied the modification request because the
duties were considered an integral part of the job.
began on occasion to stutter and to have difficulty articulating
herself, and she became increasingly unable to keep up with work
She received a written reprimand for forgetting
to maintain computer records, and her condition further
Admin. Record 22.
Clark first missed work due to
her disability on May 29, 2007 (her Date of Disability).
Her psychiatrist at the time, Lawrence B. Kelly, M.D.,
completed the physician‟s section of her application for ShortTerm Disability Benefits on June 8, 2007.
Dr. Kelly diagnosed
Clark with Major Depression Recurrent, with symptoms of
“[a]nxiety, tearfulness, depression, poor concentration,
excessive sleep, reduced activities of daily life.”
He selected a box on the form noting that Clark had
“significant loss of psychological, physiological, personal and
social adjustment (severe limitations).”
Short-Term Disability Income Benefits for six months, expiring
on November 30, 2007.
See id. at 237-38, 241.
C. Plaintiff‟s Claim for Long Term Disability Benefits
She applied on or around December 6, 2007 for the long
term disability benefits that are the subject of this
Id. at 15; Pl.‟s Mem. Supp. Mot. Summ. J. 5.
Nationwide informed Clark in a December 7, 2007 letter that she
was eligible for LTD benefits beginning December 1, 2007.
Admin. Record 1; Pl.‟s Mem. Supp. Mot. Summ. J. 6.
letter from Nationwide, written on the same day, specified that
Clark‟s diagnosis was categorized as a “mood, anxiety,
somatoform or other disorder” and was subject to a 36-month
maximum benefit period.
Admin. Record 2.
Both letters were
signed by Karen L. Muetzel, identified as the “Absence
Management Administrator” for the “Nationwide Associate Service
On January 30, 2008, Nationwide had an independent
medical examination of Clark conducted by psychiatrist Mark N.
Id. at 21.
During her interview with Dr.
Casdorph, Clark described how the symptoms had increased with
She stated, “I can do the job that I took.
can‟t do the job they made it into.”
Id. at 22.
administered a Test of Memory Malingering, which “assists
neuropsychologists in discriminating between bona fide memoryimpaired patients and malingerers.”
Clark received a “VALID”
score, indicating that she did not exaggerate her impairment.
Id. at 24.
Dr. Casdorph reviewed two documents in making his
He reviewed the Nationwide Disability Attending
Physician Statement, in which Dr. Kelly diagnosed Clark and
described her symptoms.
He also reviewed a copy of Dr. Kelley‟s
handwritten response to a question posed by a Nationwide nurse,
in which Dr. Kelly wrote that any modifications made to Clark‟s
job should include eliminating complaint handling and contact
with a particular coworker.
Id. at 25.
Dr. Casdorph diagnosed Clark with “[d]epressive
disorder, not otherwise specified.”
He wrote the following
in his evaluation in response to a question on a Nationwide form
asking whether Clark is LTD Disabled:
No - Ms. Clark provides a history of some degree of
chronic depression with the degree of impairment that
she is alluding to. This began once she receives a
written reprimand from her employer. The symptoms
that she now describes, particularly those regarding
changes in cognition, are not consistent with known
psychopathology. Further she made it plain during
this interview that her primary stressors began when
she was given work assignments in excess of her
He recommended no change in Clark‟s current treatment or
restrictions or modifications to her job description.
Following the evaluation, Dr. Casdoph‟s report was
forwarded to Clark as outlined in a “Nationwide Staffing Form,”
dated March 13, 2008.
Id. at 32.
The “Reason for Staffing” is
given as “Termination of benefits due to IME [Independent
Medical Examination] results.”
The name Gina Lewis appears
atop the form in a box specifying the “DMC.”
believes that this means that Ms. Lewis completed the form, and
Clark notes that Ms. Lewis is a Nationwide employee.
Supp. Mot. Summ. J. 8.
In a letter dated March 17, 2008 (the “first denial”),
Ms. Muetzel notified Clark that the Disability Assessment
Committee had reviewed her claim and terminated her benefits as
of April 5, 2008.
Admin. Record 43.
After providing this
conclusion in its first paragraph, the first denial gives the
Plan definition of disability and states that the Committee
reviewed two documents, the Plan and Dr. Casdorph‟s evaluation.
It highlights Dr. Casdorph‟s conclusion that changes
in Clark‟s cognition “are not consistent with known
psychopathology” as well as Clark‟s interview comment that the
primary stressors began when she was given work in excess of her
Id. at 44.
It concludes, “Based on this
information, The Committee has determined that you do not meet
the definition of Disability under the Plan specifically that
you are capable of engaging in Substantial Gainful Employment.”
The first denial then summarizes procedures for appeal.
1. First Appeal
Clark appealed the first denial by letter dated June
Id. at 46.
In the letter, she states, “I do not
believe Dr. Casdorph (or any Doctor) is capable of accurately
evaluating me, interpreting my action, or translating my
statements, during a one hour visit.”
If you will check my past Performance Evaluations, I
you [sic] will find that I was perfectly capable of
performing the duties and requirements as listed in my
job description. During the last few months before I
left my position, these duties were steadily
increasing in volume and pace; as were the hours
required to perform them.
A July 16, 2008 form completed by Mary Miller, the
Secretary to the Benefits Administrative Committee, summarizes
Id. at 49.
The first paragraph of the form
describes Clark‟s June 16, 2008 appeal letter, and the second
paragraph outlines Dr. Casdorph‟s evaluation.
paragraph sets forth the Plan‟s definition of disability, and
emphasizes that the “illness must prevent you from engaging in
Substantial Gainful Employment.”
It then defines
Substantial Gainful Employment (any employment yielding half or
more of one‟s compensation as of the date of disability) and
ends with the Committee members‟ initials, marking the denial of
On July 17, 2008, Clark received a letter from Mary
Miller denying the appeal (the “second denial”).
Id. at 51.
The second denial notes that the Committee reviewed the original
letter of appeal, “Information contained in Disability Case
Management note,” Dr. Casdorph‟s evaluation, and the Plan.
The second denial then summarizes Dr. Casdorph‟s evaluation and
the plan provisions, using language largely identical to the
internal July 16, 2008 form.
Id. at 51-52.
It concludes, “This
is the final decision of the administrative review process.
have exhausted your appeal rights under [ERISA].
You have the
right to bring a civil action under ERISA Section 502(a).”
2. Second Appeal
Clark retained counsel and, nearly two years later on
June 8, 2010, initiated a second appeal.
Summ J. 9.
Pl.‟s Mem. Supp. Mot.
She submitted medical records from Dr. Kelly and a
letter dated December 4, 2009 in which he summarized his medical
Id. at 9-10.
In the letter, Dr. Kelly wrote,
Anita Clark . . . has been a patient under my care
since 06/21/2005. At that time she was complaining of
Fibromyalgia pain and depressive symptoms (low energy,
irritability, poor concentration, crying spell, low
interest/motivation, anxiety) that reduced her
functional capacity by 60% - by her estimation. I
diagnosed Major Depressive Disorder - inattentive
type. She has been treated with a variety of
medications with only modest response. The severity
of her symptoms prevented her from maintaining her
standard work duties. The stress of attempting work
duties only worsened her condition. Elimination of
work stress in conjunction with medication and
psychotherapy has allowed her some improvement in
mood, concentration, energy, and motivation. She has
not had remission of her illness and in my opinion she
has been and remains totally disabled, due to her
Admin. Record 61.
Clark also submitted an August 24, 2009
Social Security decision that found her disabled beginning May
23, 2007; notes of psychological counseling sessions from
Laberta Salamancha, MA; medical records from her primary care
physician at the Living Well Center, W. J. Chapman, D.O.; and
performance management reports regarding her work activities.
Pl.‟s Mot. Summ. J. 10.
On July 21, 2010, in response, Mary Miller completed a
form titled “Request to Reopen a Previously Denied Appeal.”
Admin. Record at 203.
The first four paragraphs of the form
summarize the evidence Clark provided for her second appeal.
Id. at 203-04.
The following two paragraphs, titled “Research,”
summarize Clark‟s first appeal and Dr. Casdorph‟s evaluation.
Id. at 204.
The final section, “Plan‟s Reason for Denial,”
again provides the definitions of Disability and Substantial
It states, “your illness must prevent
you from engaging in Substantial Gainful Employment.”
A July 26, 2010 letter (the “third denial”) rejects
Clark‟s second appeal.
Id. at 200.
According to the third
denial, the Committee “reviewed and/or considered” the letter of
appeal; the notes and letter from Dr. Kelly; the favorable
Social Security decision; records from Dr. Chapman at the Living
Well Center; progress notes from Laberta Salamacha, MA; the
performance management reports; Dr. Casdorph‟s evaluation; and
The third denial states that the Committee
considered but “is not swayed” by the Social Security decision
because LTD Disability uses a different standard.
Id. at 200-
The Committee reached similar conclusions respecting the
Living Well Center records and Dr. Kelly‟s notes: “[T]he records
from the Living Well Center do not address the LTD approved
diagnosis of Major Depressive Disorder and the office notes
largely address Ms. Clark‟s standard work duties and do not
address the definition of LTD Disability under the Plan.”
By contrast, the Committee found Dr. Casdorph‟s evaluation
persuasive because “it specifically addressed whether Ms. Clark
met the definition of LTD Disability under the Plan.”
II. The Parties‟ Motions
As noted, Clark initiated this action on January 10,
Nationwide‟s March 9, 2012 Answer asserts fourteen
defenses, including that Clark improperly named Nationwide as a
The pending cross motions for summary
judgment then followed.
In her motion for summary judgment, Clark argues that
Nationwide‟s denial of her LTD benefits was not the result of a
deliberate and principled reasoning process because the three
decisions consist of “simple regurgitations” of Dr. Casdoph‟s
evaluation and citations to Plan language.
Mot. Summ. J. 17.
Pl.‟s Mem. Supp.
She further contends that the denial is not
supported by substantial evidence because it places too great an
emphasis on Dr. Casdoph‟s report and fails to address evidence
favorable to Clark, such as the social security decision.
Nationwide responds by emphasizing that the abuse of
discretion standard applies for the court‟s review of the Plan
Administrator‟s decision to deny benefits.
Mot. Summ. J. 6.
Def.‟s Opp‟n Pl.‟s
Nationwide argues that it was not required to
defer to the Social Security ruling and that it properly weighed
Dr. Casdorph‟s independent evaluation.
Id. at 9.
the thoroughness of Dr. Casdoph‟s method, and notes deficiencies
in various aspects of alternative evidence.
Id. at 11.
Consequently, it seeks summary judgment on the merits.
Nationwide also moves for summary judgment on the
ground that it is an improper defendant for the action in that
it is not the Plan.
Def.‟s Mot. Summ. J. 1.
In addition, it
asserts that the plan specifies a one-year limitations period
for challenging the denial of benefits and that Clark failed to
challenge the denial of her claim within that period.
In response, Clark contends that Nationwide, through
its continued litigation of this case, has waived any claim that
it is an improper defendant.
Pl.‟s Opp‟n Def.‟s Mot Summ. J. 2.
Alternatively, Clark argues that Nationwide became a proper
defendant due to its direct involvement with her claim‟s denial.
Regarding the statute of limitations, Clark argues that
Nationwide imprudently seeks a ruling by the court that the
limitations period expired before she was able to file suit.
Clark asserts that the Plan is ambiguous in that a three year
limitations period applied when she became disabled, whereas the
one year limitations period to which Nationwide refers did not
become part of the Plan until it was added by amendment in
Id. at 3.
Clark adds that a one year limitation
is in any event contrary to West Virginia public policy.
III. The Governing Standard
It is the plaintiff‟s burden to demonstrate
entitlement to benefits under an ERISA plan.
Ruttenberg v. U.S.
Life Ins. Co., 413 F.3d 652, 663 (7th Cir. 2005) (cited in
Donnell v. Metro. Life Ins. Co., 165 F. App‟x. 288, 296 n.9 (4th
“Judicial review of an ERISA plan administrator‟s
decision is „under a de novo standard unless the plan provides
to the contrary.‟”
Carden v. Aetna Life Ins. Co., 559 F.3d 256,
259-60 (4th Cir. 2009) (quoting Metro. Life Ins. Co. v. Glenn,
128 S.Ct. 2343, 2348 (2008)).
Where, however, the plan gives
the administrator discretion to determine benefit eligibility or
to construe plan terms, the review is conducted under the abuse
of discretion standard.
Glenn, 128 S.Ct. at 2348; Carden, 559
F.3d at 260.
At its “immovable core,” the abuse of discretion
standard requires that a court not overturn a plan
administrator‟s decision “merely because it would have come to a
different result in the first instance.”
Evans v. Eaton Corp.
Long Term Disability Plan, 514 F.3d 315, 322 (4th Cir. 2008).
Our court of appeals has set forth a “more particularized
conception” of the abuse of discretion standard to be applied in
the ERISA context.
First, the abuse of discretion standard
“equates to reasonableness” and an ERISA administrator‟s
discretionary decision should be not overturned if it is
Second, the reasonableness standard is less
deferential than an “arbitrary and capricious standard.”
“[T]o be unreasonable is not so extreme as to be irrational.”
Third, a “decision is reasonable „if it is the result of a
deliberate, principled reasoning process and if it is supported
by substantial evidence.‟”
Id. (quoting Bernstein v.
CapitalCare, Inc., 70 F.3d 783, 788 (4th Cir.1995)).
finally, “the decision must reflect careful attention to „the
language of the plan,‟ as well as the requirements of ERISA
Id. (quoting Booth v. Wal-Mart Stores, Inc. Assocs.
Health & Welfare Plan, 201 F.3d 335, 342 (4th Cir. 2000)).
Booth sets forth these considerations in a
nonexclusive list of factors to be weighed in conducting an
ERISA abuse of discretion review:
(1) the language of the plan; (2) the purposes and
goals of the plan; (3) the adequacy of the materials
considered to make the decision and the degree to
which they support it; (4) whether the fiduciary‟s
interpretation was consistent with other provisions in
the plan and with earlier interpretations of the plan;
(5) whether the decisionmaking process was reasoned
and principled; (6) whether the decision was
consistent with the procedural and substantive
requirements of ERISA; (7) any external standard
relevant to the exercise of discretion; and (8) the
fiduciary's motives and any conflict of interest it
Booth, 201 F.3d at 342-43.
Of particular note is the eighth
factor, respecting conflicts of interest, such as when an
administrator serves in the dual role of evaluating and paying
Williams v. Metro. Life Ins. Co.,
609 F.3d 622, 632 (4th Cir. 2010).
Previously, our circuit had
used a modified abuse of discretion standard to account for a
conflict of interest.
Carden, 559 F.3d at 259-61.
the Supreme Court‟s decision in Glenn, “a conflict of interest
became just one of the „several different, often casespecific, factors‟ to be weighed together in determining whether
the administrator abused its discretion.”
259-61 (quoting Glenn, 128 S. Ct. at 2351).
Carden, 559 F.3d at
The weight accorded
to the conflict “depend[s] largely on the plan‟s language and on
consideration of other relevant factors.”
Id. at 261.
There are compelling reasons for the deferential
standard of review, not the least of which is that it
“„ensure[s] that administrative responsibility rests with those
whose experience is daily and continual, not with judges whose
exposure is episodic and occasional.‟”
Brogan v. Holland, 105
F.3d 158, 161, 164 (4th Cir. 1997) (quoting Berry v. Ciba-Geigy
Corp., 761 F.2d 1003, 1006 (4th Cir. 1985)); Lockhart v. United
Mine Workers of Am. 1974 Pension Trust, 5 F.3d 74, 77 (4th Cir.
1993) (“[The] dispositive principle remains . . . that where
plan fiduciaries have offered a reasonable interpretation of
disputed provisions, courts may not replace it with an
interpretation of their own.”).
Nevertheless, there are circumstances where a
reviewing court will direct an administrator to have another
look at a claim through the device of remand.
justifying a remand, however, are quite exceptional:
If the court believes the administrator lacked
adequate evidence on which to base a decision, “the
proper course [is] to „remand to the trustees for a
new determination,‟ not to bring additional evidence
before the district court.” As we have previously
indicated, however, “remand should be used sparingly.”
Remand is most appropriate “where the plan itself
commits the trustees to consider relevant information
which they failed to consider or where [the] decision
involves „records that were readily available and
records that trustees had agreed that they would
verify.‟” The district court may also exercise its
discretion to remand a claim “where there are multiple
issues and little evidentiary record to review.”
Elliott v. Sara Lee Corp., 190 F.3d 601, 609 (4th Cir. 1999)
(citations and quoted authority omitted); Berry, 761 F.2d at
1008 (“The case for a remand is strongest where the plan itself
commits the trustees to consider relevant information which they
failed to consider or where decision involves „records that were
readily available and records that the trustees had agreed that
they would verify.‟” (quoting Le Febre v. Westinghouse Elec.
Corp., 747 F.2d 197, 204, 206 (4th Cir.1984))).
The parties agree that the Plan grants the Plan
Administrator the power to “exercise discretion and authority to
construe and interpret the provisions of the Plan.”
The court reviews any decisions made pursuant to
that authority for abuse of discretion.
A. Improper Defendant
With respect to Nationwide‟s contention that it should
be dismissed as an improper defendant in this case, Nationwide
cites Gluth, as does the plaintiff.
In Gluth, an unpublished
per curiam opinion, it was noted that the plaintiff “named the
wrong defendant from the beginning by initially bringing this
action against his employer, Wal-Mart, who had no control over
the administration of the Plan.”
Gluth v. Wal-Mart Stores,
Inc., No. 96–1307, 1997 WL 368625, at *6 n.8 (4th Cir. July 3,
Gluth concluded that Wal-Mart waived the defense by
proceeding with the litigation without moving for a dismissal on
The Order and Notice in this case directed
parties to file motions to dismiss by April 2, 2012.
Nationwide did not move to dismiss, it raised this very defense
in its Answer and presented it in its motion for summary
judgment, which came at a relatively early stage as in most
The argument does not appear to have been waived.
However, Nationwide‟s apparent control over Clark‟s
claim justifies Nationwide being named as a defendant.
(noting that Wal-Mart was initially an improper defendant in
part because it “had no control over the administration of the
The record shows a “Nationwide Staffing Form” which
summarizes Clark‟s claim and recommends denial.
As Clark points out, the form does not mention the
designated Plan Administrator, which is the Benefits
Pl.‟s Mem. Supp. Mot. Summ. J. 14.
Additionally, Karen Muetzel, the Absence Management
Administrator for Nationwide Insurance Company, appears
throughout the transcript and authored the first denial.
(citing Admin. Record 43-45).
Clark also emphasizes that that the secretary of the
Benefits Administrative Committee later emailed Ms. Muetzel to
request Clark‟s file and to inquire why Clark had been
Id. (citing Admin. Record 40).
This suggests that
Nationwide and not the Benefits Administrative Committee may
have taken the lead on Clark‟s initial denial.
Muetzel‟s email correspondence concerning Clark‟s claim
prominently display the Nationwide logo, and the second denial
is drafted on Nationwide letterhead.
Admin. Record 40-42, 51-
Nationwide appears to have had adequate control over
Clark‟s claim to justify being named as the defendant.2
B. The Limitations Period
The Plan contains two limitations provisions.
10.11 provides a three year limitations period:
No action at law or in equity may begin prior to 60
days after the Plan Administrator receives a valid
written proof of loss. No such action may begin after
three years from the day written proof of loss was
Admin. Record 269.
Effective October 12, 2009, the Plan was
amended to include Section 10.13, which contains a limitations
provision with a one-year period:
All current and former Plan participants shall have 1
year from the date an expense is incurred or from
which benefits could have commenced under the terms of
the Plan to commence legal action related to the
benefits provided under the Plan.
Id. at 290.
LTD benefits can commence on the first day after a
claimant has exhausted Short-Term Disability benefits and
provided proof of continued disability.
Id. at 245.
ERISA contains no express statute of limitations
provision and does not specify when a limitations period should
begin to run.
White v. Sun Life Assurance Co. of Can., 488 F.3d
Nationwide also makes a one-sentence argument that dismissal is
required by Federal Rule of Civil Procedure 12(b)(7) because
Clark has failed to join necessary parties. Def.‟s Mem. Supp.
Summ. J. 11. The Order and Notice deadline for motions to
dismiss expired on April 2, 2012.
240, 245 (4th Cir. 2007); see also 29 U.S.C. § 1132.
will enforce a valid contractual provision in the plan documents
governing limitations if the provision sets forth a reasonable
White, 488 F.3d at 250; see also Order of United
Commercial Travelers v. Wolf, 331 U.S. 586, 608 (1947) (“[I]t is
well established that, in the absence of a controlling statute
to the contrary, a provision in a contract may validly limit,
between the parties, the time for bringing an action on such
contract to a period less than that prescribed in the general
statute of limitations, provided that the shorter period itself
shall be a reasonable period.”).
Absent a valid contractual
provision, courts borrow the state law limitations period
applicable to claims most closely related to the federal cause
White, 488 F.3d at 245.
Regarding the time from which the limitations period
should be run, the general rule is that “„[a]n ERISA cause of
action does not accrue until a claim of benefits has been made
and formally denied.‟”
Id. at 246 (quoting Rodriguez v. MEBA
Pension Trust, 872 F.2d 69, 72 (4th Cir. 1989)).
of limitations begins to run at the moment when the plaintiff
may seek judicial review, because ERISA plaintiffs must
generally exhaust administrative remedies before seeking
Id. at 245-46.
Nationwide concedes that the
limitations period begins to run with the final decision denying
the claimant‟s benefits.
Def.‟s Mot. Dismiss 12.
date is July 26, 2010.
Nationwide asserts that Clark‟s claim is subject to
the one-year limitations provision found in section 10.13.
Section 10.13 runs the limitations period from the date the
benefits could have commenced, which as stated above, is the
first day after a claimant has exhausted Short-Term Disability
benefits and provided proof of continued disability.
Clark‟s Short-Term Disability Benefits ended on November
30, 2007 and she submitted a disability statement signed by Dr.
Kelly on December 6, 2007.
Id. at 15-16.
The date the LTD
benefits “could have commenced” under the Plan therefore appears
to be December 7, 2007.
Since accrual on that date would be inconsistent with
the Fourth Circuit‟s holding that a limitations period may not
begin prior to a claim‟s final denial, see White, 488 F.3d at
246, Nationwide requests that the limitations period be deemed
tolled until the final denial of Clark‟s benefits.
Supp. Mot. Summ. J. 12.
on July 26, 2010.
Nationwide denied Clark‟s final appeal
Inasmuch as Clark filed the complaint well
over a year later on January 10, 2012, Nationwide contends that
the claim is stale when timed one year from the final denial of
Clark argues that section 10.13 should be voided
because it conflicts with the three-year provision of section
Pl.‟s Opp‟n Def‟s Mot. Summ. J. 5.
She contends that it
is unclear which provision‟s limitations period should control.
She adds that only section 10.11 was in effect when she
initially applied for and received long term disability
benefits; the Plan was amended to include section 10.13 nearly
two years later, effective October 12, 2009.
Id. at 5 & n.1.
In light of this alleged ambiguity, Clark cites
Gallagher v. Reliance Standard Life Ins. Co. for the proposition
that “[a]ny ambiguity in an ERISA plan „is construed against the
drafter of the plan, and it is construed in accordance with the
reasonable expectations of the insured.‟”
305 F.3d 264, 269
(4th Cir. 2002) (quoting Bynum v. Cigna Healthcare of N.C.,
Inc., 287 F.3d 305, 313-14 (4th Cir. 2002)).
She asserts that
the conflict should be resolved against Nationwide‟s interests
and that section 10.11‟s longer three-year limitations period
Pl.‟s Opp‟n Def.‟s Mot. Summ. J. 5.
Nationwide disputes the premise that the two
limitations provisions conflict.
Def.‟s Reply Supp. Mot. Summ.
It explains that section 10.11‟s three-year period is
“applicable to any type of claim,” whereas the one-year period
of section 10.13 applies only to “legal action[s] related to the
benefits provided under the Plan.”
Def.‟s Reply Supp. Mot.
Summ. J. 6.
Also, Nationwide contends that the Plan
Administrator can waive the one-year period, while the threeyear period is inflexible.
The court observes that Nationwide‟s Plan
interpretation warrants de novo review in this instance.
as discussed above, the Plan Administrator‟s decisions are
accorded discretion, Nationwide‟s interpretation of the
limitations provisions does not appear to be based on a Plan
Since neither party has requested that
the court remand the action to seek the Plan Administrator‟s
formal interpretation, the court proceeds with a de novo review
of the plan language.
When interpreting an ERISA health insurance plan de
novo, the court applies “ordinary principles of contract law,
enforcing the plan‟s plain language in its ordinary sense.”
Wheeler v. Dynamic Eng‟g, Inc., 62 F.3d 634, 638 (4th Cir.
Ambiguous terms are therefore construed “against the
drafter” and “in accordance with the reasonable expectations of
As stated above, Clark cites Gallagher, 305 F.3d at 269, for
this proposition. The court observes that Gallagher quotes the
proposition from Bynum v. Cigna Healthcare of North Carolina,
Inc., 287 F.3d 305 (4th Cir. 2002), which in turn used it in the
context of curbing a plan administrator‟s discretion when a
conflict of interest exists. Id. at 311, 313-14. The Fourth
Circuit has since concluded that the Supreme Court‟s decision in
Glenn “foreclose[d]” the rule whereby a conflict of interest
The court must also take into account the special
considerations that attach in the ERISA context.
Our court of
appeals has enthusiastically endorsed the ability of plans to
set limitations periods.
White, 488 F.3d at 250 (“We could not
agree more that ERISA generally affords plans the flexibility to
set limitations periods, nor do we take issue with those
decisions enforcing contractual limitations periods of varying
It has reasoned that “[p]lans may legitimately wish
to avoid extended limitations periods, because the disability
status of a particular plaintiff may shift significantly over
time, and because both the interests of claimants and a plan‟s
own accounting mechanisms may be served by prompt resolution of
The limitations period must, however, provide
fair notice to claimants.
The court finds the Plan‟s limitations provisions are
ambiguous and should be construed to allow for the longer threeyear period.
Nationwide‟s attempted reconciliation of section
10.11 and section 10.13 is not convincing.
Even if, as
Nationwide argues, section 10.13 applies only to legal actions
related to benefits, nothing in section 10.11 indicates that its
three-year period does not apply to those some actions.
Moreover, as formatted in the version on the record, section
necessarily curbs discretion. Carden, 559 F.3d at 260.
Nevertheless, this pro-insured approach to construction appears,
at a minimum, to have continued viability where no discretion is
warranted and the court conducts de novo review, as was the
context of Wheeler.
10.13 is buried in an amendment to the Plan, thirty-one pages
behind the ostensibly controlling three-year period of section
Section 10.11 does not direct the reader to section
10.13 or otherwise indicate that other provisions might modify
the three-year limitations period.
The ambiguous language and
indirect construction of the Plan did not give Clark fair notice
that her claim faced a one-year limitations period.
therefore bound only by the three-year provision of section
Having found that section 10.13‟s limitations period
is inapplicable, the court need not consider Clark‟s argument
that a one-year limitations period is contrary to West Virginia
Additionally, the court need not consider the
parties‟ thoroughly briefed arguments regarding how the court
should treat limitations provisions that designate invalid
accrual times -- i.e., accrual before the final denial of
Nationwide had advocated retaining the Plan‟s
limitations period but tolling accrual until the final claim
denial, whereas Clark had advocated replacing the Plan
limitation provision in its entirely with the West Virginia
Code‟s five or ten year limitations period.
Given the court‟s
determination that the three-year period of section 10.11
applies under the circumstances of this particular case and is
deemed to run from the date of final denial of benefits, Clark
has timely filed this action.
C. Denial of the Claim
The determination to deny Clark‟s benefits was made
pursuant to the Plan Administrator‟s discretion, so the court
reviews the decision using the abuse of discretion standard in
view of the factors from Booth.
The parties‟ arguments
principally concern the first, third, and fifth Booth factors.
1. The First Factor: the Plan Language
Regarding the first Booth factor, the Plan language,
the parties dispute the meaning of a provision relating to
Social Security determinations.
Section 4.05.02(a) provides in
pertinent part as follows:
[T]he maximum period of LTD Disability Income Benefits
based on months of continuous disability coverage is
(ii) For Disabilities that commence on or after
January 1, 2005:
Months of Continuous
61 or more months
Maximum Period of
Disability Income Benefits
To age 65
(iii) Notwithstanding (ii) above, if the Disabled
Employee or Disabled Person is approved for Social
Security disability income benefits (“SSDI”),
benefits under the Long-Term Disability Income
Benefits Program will recommence from date of [sic,
the] award is issued until age 65, subject to the
requirements of Section 4.05.01 [that she remain
Clark argues that under the plain language of section
4.05.02(a)(iii), her favorable Social Security determination
entitles her to LTD Benefits.
Pl.‟s Mem. Supp. Mot. Summ. J.
She contends that her Plan benefits “recommence”
automatically with the Social Security ruling, regardless of the
Plan Administrator‟s previous denial.
Nationwide argues that
Clark misreads the provision by ignoring its context within the
Plan and its relation to the subsections it references.
Opp‟n Pl‟s Mot. Summ. J. 6-7.
Nationwide contends that the
provision relates only to the duration of benefits, and is
irrelevant to Clark‟s claim.
The court finds, and Clark all but acknowledges, that
Nationwide‟s interpretation is correct.
See Pl.‟s Reply Supp.
Mot. Summ. J. 7 (“While the Defendant may have a legitimate
argument that the Plaintiff is not entitled to benefits based on
the Social Security section, said section is nonetheless in the
Plan and is worthy of discussion.”).
Section 4.05.02 concerns
the maximum duration for an employee‟s LTD Disability benefits,
not the employee‟s initial eligibility.
provides the maximum period of benefits based on an employee‟s
total months of coverage under the Plan.
Admin. Record 250.
For example, (a)(ii) states that an employee with only 12 months
of coverage is limited to a maximum period of benefits of one
year, whereas an employee with as much as “61 or more months” of
coverage has a maximum period of benefits “To age 65.”
The language “Notwithstanding (ii) above” in
subsection (a)(iii) operates to reinstate benefits that have
reached their maximum period and expired.
with Clark‟s benefits.
Such was not the case
Since Clark had belonged to the Plan for
more than 61 months at the time of her claim, subsection (a)(ii)
already specified that her maximum duration of benefits was
until age 65, the same age to which (a)(iii) permits an
extension if Social Security disability income benefits are
Subsection (a)(iii)‟s instruction that it be applied
“subject to the requirements of Section 4.05.01” also
contradicts Clark‟s interpretation.
Section 4.05.01 lists the
requirements with which an LTD Disabled claimant must comply for
continued receipt of benefits.
Admin. Record 249-50.
foremost requirement is that a claimant must continue to be LTD
The Plan Administrator‟s finding that Clark was not
LTD Disabled cannot be upset by a provision whose operation is
contingent on a claimant being LTD Disabled.
A plain reading of
the Plan language shows that Clark‟s position respecting section
4.05.02(a)(iii) is untenable.
If, as was originally found, the plaintiff‟s disability is the
result of a mood, anxiety, or somatoform disorder, section
4.05.03 of the Plan specifically limits the maximum duration of
LTD Disability Income Benefits to 36 months. It is noted that
“schizophrenia and other psychotic disorders” are excluded from
In her reply brief, Clark makes the additional
argument that even if section 4.05.02(a)(iii) is inapplicable to
her claim, Nationwide‟s denial letters should have included a
discussion of the provision.
Inasmuch as the provision‟s
language is clear and Clark did not rely on the provision in
presenting her original claim or appeals, the court finds no
error in the lack of discussion in the denial letters.
2. The Fifth Factor: Whether the Decisionmaking
Process Was Reasoned and Principled
Turning to the fifth Booth factor, Clark argues that
Nationwide‟s denial of her LTD Benefits was not the result of a
deliberate and principled reasoning process.
that the initial denial of benefits and the two subsequent
denials of her appeals each “show simple regurgitations of one
or two sentences by Dr. Casdorph and thereafter . . . simply
cite Plan provisions.”
She further disputes Nationwide‟s
explanation, found in the third denial, that it accorded Dr.
Casdorph‟s findings greater weight because he “specifically
addressed” the Plan definition of LTD Disability.
Supp. Mot. Summ. J. 17.
She believes that the explanation
“twists the facts to justify the ends” because Dr. Casdorph did
not specifically address why Clark failed to meet the plan
When reviewing evidence of a claimant‟s disability,
“it is not an abuse of discretion for a plan fiduciary to deny
. . . benefits where conflicting medical reports are presented.”
Elliott, 190 F.3d at 606.
Nor are plan administrators required
to give special weight to the opinions of treating physicians
over other credible opinions and records.
See Black & Decker
Disability Plan v. Nord, 538 U.S. 822, 834 (2003).
reviewing decisions of plan administrators, district courts
“have no warrant to require administrators automatically to
accord special weight to the opinions of claimant‟s physician;
nor may courts impose on plan administrators a discrete burden
of explanation when they credit reliable evidence that conflicts
with a treating physician‟s evaluation.”
“[p]lan administrators, of course, may not arbitrarily refuse to
credit a claimant‟s reliable evidence, including the opinions of
a treating physician.”
The court finds Nationwide‟s reasoning process to be
adequate; Clark‟s contentions rely on a far too shortsighted
reading of the decision letters and Dr. Casdorph‟s evaluation.
Dr. Casdorph sufficiently sets forth his reasons for concluding
that Clark is not LTD Disabled.
Clark asserts that Dr. Casdorph
“simply circled the word „no‟” on the evaluation request form
but ignores that Dr. Casdorph‟s separate written evaluation
concludes with a discussion of the form‟s questions.
In that evaluation, Dr. Casdorph answers that he
does not believe that Clark is LTD Disabled and offers two
The first reason, that “the symptoms that [Clark] now
describes . . . are not consistent with known psychopathology,”
is somewhat ambiguous in import regarding the definition of LTD
Dr. Casdorph‟s second reason remedies the deficiency.
He states that Clark “made it plain during this interview that
her primary stressors began when she was given work assignments
in excess of her capabilities.”
While a direct reference to
Plan provisions might have been helpful, it is clear, if not
explicit, that Dr. Casdorph found Clark to be capable of
“Substantial Gainful Employment,” and therefore not LTD
The content of Dr. Casdorph‟s evaluation supports this
He outlines in detail Clark‟s account of how her
gradually increased job duties brought on her symptoms.
quotes her as stating in her interview, “I can do the job I
I can‟t do the job they made it into.”
Id. at 22.
thus unequivocally told Dr. Casdorph that despite her current
symptoms, she would be able to perform her original duties, and
accordingly, he concluded that she was capable of Substantial
Nationwide more directly sets forth the reasoning in
its denial letters.
The first denial, for example, quotes the
definition of LTD Disability and specifies, “As stated in the
definition of Disabled, your illness must prevent you from
engaging in Substantial Gainful Employment.”
It then defines
Substantial Gainful Employment (any employment yielding half or
more of one‟s compensation as of the date of disability) and
quotes Dr. Casdorph‟s conclusions, including the statement that
the stressors began with Clark‟s increased workload.
and definitively, the letter concludes, “The Committee has
determined . . . specifically that you are capable of engaging
in Substantial Gainful Employment.”
The second denial parallels the first denial letter
and again highlights the definition of Substantial Gainful
No additional explanation was necessary given that
Clark‟s June 16, 2008 letter of appeal only reinforced the Plan
Administrator‟s decision: Clark reiterates in the appeal that
she “was perfectly capable of performing the duties and
requirements as listed in my job description” and left as a
result of her duties “steadily increasing in volume and pace.”
Id. at 46.
The third denial similarly explains that “based on
the [independent medical examination] conducted by Dr. Casdorph,
the BAC upheld their initial decision based [on] the following
Plan provisions,” thereafter providing the definition of LTD
Disability and highlighting Substantial Gainful Employment.
The denial letters could have more expressly paired
aspects of Dr. Casdorph‟s evaluation to the Plan Administrator‟s
finding that Clark was capable of Substantial Gainful
The second denial could have highlighted that
Clark‟s appeal letter suggested her misunderstanding of the
Plan‟s definition of disability.
Nonetheless, the reason for
the denial and the factual basis thereof are clear.
letters‟ shortcomings do not indicate that the underlying
decisions arose without a deliberate and principled reasoning
Clark further argues that Nationwide‟s treatment of
her favorable evidence was not the result of a deliberate and
principled reasoning process.
She contends that Nationwide
imposed an “unreasonable double standard” by discounting her
evidence for not specifically addressing why she met the Plan
definition of disability.
Pl.‟s Mem. Supp. Mot. Summ. J. 18.
As discussed above, and contrary to Clark‟s assertion, it is
apparent that Dr. Casdorph based his conclusion that Clark is
not LTD Disabled on his knowledge of specific Plan provisions,
particularly the definition of Substantial Gainful Employment.
By contrast, Clark‟s evidence suffers from deficiencies and
contradictions, which the third denial adequately describes.
Regarding Dr. Chapman‟s records from the Living Well
Center, the third denial explains that “the records from the
Living Well Center do not address the LTD approved diagnosis of
Major Depressive Disorder.”
Admin. Record 201.
supported in the record.
Clark acknowledges in her second
letter of appeal that Dr. Chapman‟s records only show that Dr.
Chapman was “aware of Mrs. Clark‟s treatment with Dr. Kelly and
Mrs. Clark‟s inability to work.”
Id. at 54.
records specify Major Depressive Disorder as an ongoing ailment,
list the medications taken “per Dr. Kelley [sic],” and state
that Clark is “continuing to follow up with Dr. Kelly.”
106, 117, 122, 132.
The entries continue,
Assessment & Plan Reviewed today and discussed with
patient to continue current course of action; pt is
following with dr Kelly he is currently adjusting her
meds pt is still no stable for the workplace will keep
off work for now and pt is to continue following with
This merely relates Clark‟s description of Dr. Kelly‟s
treatment and does not represent an independent conclusion
from Dr. Chapman.
Also, whether Clark is able to return to
her current position is of little consequence because
Substantial Gainful Employment by definition includes less
Apart from that entry, the Living Well Center records
describe various ailments which are irrelevant to Clark‟s Major
Depressive Disorder diagnosis.
For example, multiple records
chronicle treatment for complaints such as migraines, cough,
abdominal pain, upper respiratory infection, headaches,
hypothyroidism, and edema.
E.g., id. at 122-28; 133, 137-38.
Further, records describing Clark‟s “General Status” as “Mood
appropriate” with “No Distress” could be considered contrary to
a finding of disability.
See, e.g., id. at 121, 126, 131, 136.
Regarding Dr. Kelly‟s findings, the third denial
states that “the office notes largely address Ms. Clark‟s
standard work duties and do not address the definition of LTD
Disability under the Plan.”
Admin. Record 201.
criticizes this explanation because it “does not even mention”
Dr. Kelly‟s December 4, 2009 opinion letter.
The court finds no
fault with the Plan Administrator‟s treatment of Dr. Kelly‟s
The third denial discusses Dr. Kelly‟s notes, and it
states that it “reviewed and/or considered” Dr. Kelly‟s letter.
Because Dr. Kelly‟s notes and letter are different formulations
of the same underlying medical opinions, consideration of the
notes necessarily involves consideration of the letter.
This is especially evident given that Dr. Kelly‟s
handwritten notes are rather illegible, and the third denial
appears to have taken the phrase “standard work duties” directly
from Dr. Kelly‟s letter.
See id. at 62-69.
Additionally, the court finds reasonable the Plan
Administrator‟s decision to deemphasize Dr. Kelly‟s finding for
addressing “standard work duties” rather than “the definition of
LTD Disability under the Plan.”
Dr. Kelly‟s conclusions appear
to relate to Clark‟s job as she left it and not lesser
responsibilities that might constitute Substantial Gainful
As Nationwide points out, Dr. Kelly‟s June 22,
2007; July 06, 2007; October 8, 2007; and December 6, 2007
reports opine that Clark was capable of returning to work with
Admin. Record 9-10, 14, 16.
Read in the context
of his statements about “standard work duties,” the conclusion
of Dr. Kelly‟s December 4, 2009 letter that Clark “has been and
remains totally disabled” can fairly be interpreted to mean
merely that she remains unable to perform her standard job work
Such an understanding is consistent with Dr. Kelly‟s
previous opinions as well as Clark‟s own statement that she
became unable to do her job once the responsibilities were
increased, and it leaves open the possibility that she could
engage in Substantial Gainful Employment.
Further, the Plan Administrator was not obligated to
give increased weight to the opinions of Clark‟s treating
See Nord, 538 U.S. at 834.
As a result, even had
Dr. Kelly unequivocally opined that Clark was unable to perform
work in any capacity, that opinion would not have precluded the
Plan Administrator from denying Clark‟s benefits.
190 F.3d at 606 (“Even if Dr. Liesegang‟s report suggested that
Elliott could perform no work at all, that fact would not
preclude the Plan Administrator from denying benefits.”).
Finally, in reference to Clark‟s favorable Social
Security Disability determination, the third denial states that
“the Committee is not swayed because an LTD Disability is of a
different standard than Social Security‟s standard and as you
point out the definitions differ.”
Admin. Record 201.
second letter of appeal acknowledged the different standards in
particular with respect to continuation of existing conditions.
Id. at 54.
Also, as Nationwide notes, the Social Security
determination relied on a different evidentiary foundation.
Unlike a Plan Administrator, the Administrative Law Judge
(“ALJ”) reviewing Clark‟s claim was required to give special
deference to Clark‟s treating physician.
Additionally, the ALJ
did not have available for consideration the Plan
Administrator‟s principal evidence, Dr. Casdorph‟s report.
Instead, the ALJ considered the opinion of Dr. Boggess, who as a
non-examining source appears to have based his opinion
exclusively on Clark‟s existing medical records.
Nationwide points out that had the ALJ also considered Dr.
Casdorph‟s opinion, Social Security regulation would have
required the ALJ to give Dr. Casdorph‟s examining physician
opinion more weight than Dr. Boggess‟s non-exmaining physical
Def.‟s Mem. Supp. Mot. Summ. J. 18.
Because the Plan did not tie the award of benefits to
Social Security determinations, the Plan Administrator had the
discretion to give limited weight to Clark‟s favorable Social
Security determination based on these distinctions.
v. CNA Ins. Cos., 189 F.3d 1310, 1314 n.8 (11th Cir. 1999)
(“[T]he approval of disability benefits by the Social Security
Administration is not considered dispositive on the issue of
whether a claimant satisfies the requirement for disability
under an ERISA-covered plan.”).
In sum, the Plan Administrator fairly considered
evidence both favorable to and unfavorable to Clark‟s claim.
While the Plan Administrator could have better articulated its
decision letters and provided additional details, the
explanations are sufficiently clear and, as indicated from the
record, appear to have arisen from a deliberate and principled
3. The Third Factor: the Adequacy of the Materials
Considered to Make the Decision
Turning to the third Booth factor, Clark next contends
that the decision is not supported by substantial evidence.
argues that the Plan Administrator placed too great an emphasis
on Dr. Casdoph‟s two year old report, which could not alone
constitute substantial evidence.
Substantial evidence is that
“which a reasoning mind would accept as sufficient to support a
DuPerry v. Life Ins. Co. of N. Am., 632
F.3d 860, 869 (4th Cir. 2011).
It has been described as “more
than a scintilla, but less than a preponderance.”
Int‟l Bus. Mach. Corp., 123 F. App‟x. 534, 536 (4th Cir. 2004).
The evidence on the record is sufficient to support
the Plan Administrator‟s determination.
Dr. Casdorph‟s report
is based on a thorough review of Clark‟s medical history, an
extensive interview, and psychological testing administered by
The five-page, single-spaced report summarizes
that evidentiary basis before adequately setting forth resulting
It is inconsequential that Dr.
Casdorph‟s evaluation was over two years old at the time the
second appeal was denied.
Plan section 4.03.03(a)(2) requires
that a medical or physical condition be present “as of the
Active Associate‟s Day of Disability,” which as defined by
section 1.18(a) is “the date an Active Associate first misses a
day of work due to her disability.”
Admin. Record 219, 246.
The question continued to be whether Clark was disabled as of
May 29, 2007, the date she initially missed work.
Moreover, contrary to Clark‟s assertion, Dr.
Casdorph‟s report is not the only supporting evidence on the
Dr. Kelly‟s 2007 opinions repeatedly concluded that
Clark‟s condition required only job modifications.
Clark‟s own statements regarding the stresses of additional
responsibilities, made to Dr. Casdorph and again in her first
letter of appeal, indicated her belief that she could perform
her original duties.
Clark casts further doubt on her claim‟s
legitimacy with an April 12, 2006 response on her therapist‟s
personal history form: she answered that a goal of therapy was
to “get me to retirement, early or medical or something.”
Admin. Record 149.
The Plan Administrator possessed sufficient
evidence reasonably to deny Clark‟s benefits.
Remand for review
of further evidence is justified only in exceptional
circumstances and is inappropriate here.
See Elliott, 190 F.3d
4. Other Factors
Two other Booth factors merit attention.
the sixth factor, a plan administrator substantially complies
with ERISA‟s procedural requirements when it has “supplied the
beneficiary „with a statement of reasons that, under the
circumstances of the case, permitted a sufficiently clear
understanding of the administrator‟s position to permit
Brogan, 105 F.3d at 165 (quoting Donato v.
Metro. Life Ins. Co., 19 F.3d 375, 382 (7th Cir. 1994)).
discussed above in reference to the Plan Administrator‟s
reasoning process, the denial letters adequately set forth the
reasons for denial to permit effective review.
Regarding the eighth Booth factor, the court notes
that a conflict of interest is present.
The record, however,
indicates no sign of biased decision making, and Nationwide‟s
willingness to consider an appeal beyond that which the Plan
required gives extra credence to the determination.
Black & Decker (U.S.) Inc., 550 F.3d 353, 362 (4th Cir. 2008
(“This second appeal, which was not required by the Plan
language, increased the likelihood of an accurate final
decision, thereby also reducing the conflict factor „to the
vanishing point.‟” (quoting Glenn, 128 S.Ct. at 2351)).
Given the deferential standard of review, and taking
into account the eight Booth factors to the extent they are
relevant, the court finds that the Plan Administrator made a
The Plan Administrator thus did not
abuse its discretion by denying Clark‟s disability claim.
Based on the foregoing discussion, it is ORDERED as
That defendant‟s motion for summary judgment be, and
it hereby is, granted;
That plaintiff‟s motion for summary judgment be, and
it hereby is, denied; and
That this action be, and it hereby is, dismissed.
The Clerk is directed to forward copies of this
written opinion and order to all counsel of record and any
March 22, 2013
John T. Copenhaver, Jr.
United States District Judge
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