In August 1997, Vaughn submitted a claim under the May
Company's Long-Term Disability Plan ("Plan"). (Appendix, Exh. 1,
Long-Term Disability Claim Submission, at 273-87). Attached to
that claim was a Physician's Statement of Disability form,
completed by Dr. Rosenzweig, which identified four diagnoses:
acute cervical strain and myofascitis; acute bilateral trapezius
myositis; acute thoracic and lumbosacral strain and myofascitis;
and acute exacerbation of fractured odontoid compression fracture
at T5, and sacral fracture. (Appendix, Exh.1, Attending
Physician's Statement, at 282). Dr. Rosenzweig concluded on the
form that Vaughn was totally disabled for her occupation and any
other. (Id. at 284). The claim was forwarded to defendant
Metropolitan Life Insurance Company ("MetLife"), which
administers the May Company's Plan. (Appendix, Exh. 1, Letter to
MetLife from the May Company, at 273).
The information submitted on Vaughn's behalf included Dr.
Rosenzweig's notes, physical therapy records, and letters from
Dr. Mark J. Reiner, an orthopedic physician to whom Vaughn had
been referred by Dr. Rosenzweig. After examining Vaughn in June
1997, Dr. Reiner noted that she continued to experience back pain
and limited mobility, and concluded that Vaughn was unable to
work full duty. (Appendix, Exh. 1, Letter from Dr. Reiner, June
19, 1997, at 184). Following an October 1997 office visit, Dr.
Reiner observed that while Vaughn sensed some improvement, she
still complained of back pain and suffered from restricted
mobility. (Appendix, Exh. 1, Letter from Dr. Reiner, Oct. 9,
1997, at 187).
MetLife requested an independent medical examination of Vaughn,
which was performed by orthopedic specialist Dr. Francis Mattei.
He concluded that Vaughn had fully recovered from her March 1997
injury and reached her pre-injury level of activities, and
therefore was capable of returning to full-time work duty.
(Appendix, Exh. 1, Independent Medical Examination Report of Dr.
Mattei, Sept. 29, 1997, at 198). Dr. Rosenzweig took issue with
Dr. Mattei's conclusions in a November 1997 letter. (Appendix,
Exh. 1, Letter from Dr. Rosenzweig, Nov. 19, 1997, at 177).
MetLife then arranged for Vaughn's medical records to be
reviewed by an independent physician certified in occupational
medicine, Dr. Robert D. Petrie. In a December 1997 report to
MetLife, Dr. Petrie concluded that the medical records did not
support a finding of total disability. (Appendix, Exh. 1,
Independent Medical Review Report, Dec. 10, 1997, at 166). Aside
from Vaughn's restricted range of motion, Dr. Petrie observed,
there was no evidence of muscle atrophy, muscle weakness, or any
other serious impairment. (Id. at 167). According to Dr.
Petrie, Dr. Rosenzweig's diagnoses were largely based on Vaughn's
subjective pain complaints, and were not accompanied by objective
findings or medical evidence such as x-rays or other
In a February 1998 letter to Vaughn, MetLife summarized its
investigation of her claim and concluded that her physician had
not provided sufficient objective medical evidence to support a
claim that Vaughn was totally disabled from work. (Appendix, Exh.
1, Letter from MetLife Agent Edward Manley, Feb. 2, 1998, at
158). Her claim was therefore denied. (Id.).
In March 1998, Vaughn appealed the denial, attaching a letter
from Dr. Rosenzweig and a "Key Functional Capacity Assessment,"
prepared by Vaughn's physical therapist to measure Vaughn's
physical limitations. The assessment concluded that she was not
capable of returning to work on a full-time basis. (Appendix,
Exh. 1, Key Functional Capacity Assessment Report, Mar. 23,
1998). MetLife arranged for the additional information provided
by Vaughn to be reviewed by Dr. Petrie, who also spoke with Dr.
Rosenzweig. Dr. Petrie's conclusion that Vaughn's medical records
did not support a finding of total disability was unchanged.
(Appendix, Exh. 1, Appendix, Exh. 1, Independent
Medical Review Report, May 13, 1998, at 117).*fn1
In September 1998, MetLife informed Vaughn that her appeal had
been denied. (Appendix, Exh. 1, Letter from MetLife Agent Sal
Marchese, Sept. 14, 1998, at 8). Citing the lack of objective
medical evidence of neuromuscular impairments and Dr.
Rosenzweig's failure to provide such evidence despite numerous
requests, MetLife concluded on the evidence in its possession
that Vaughn was not totally disabled.
Vaughn then brought this suit under the Employee Retirement
Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), seeking
past and future benefits due under the Plan and attorneys fees.
This Court has jurisdiction over this case under
28 U.S.C. § 1391(a), as it presents a question arising under federal law.
According to Rule 56(c) of the Federal Rules of Civil
Procedure, "if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment
as a matter of law," then a motion for summary judgment must be
granted. The question before the Court at the summary judgment
stage is "whether the evidence presents a sufficient disagreement
to require submission to a jury or whether it is so one-sided
that one party must prevail as a matter of law." See Anderson v.
Liberty Lobby, 477 U.S. 242, 251-52, 106 S.Ct. 2505, 2511, 91
L.Ed.2d 202 (1986). The Court's role at summary judgment is not
to weigh the evidence, but to determine whether there is a
genuine issue for trial; that is, an issue upon which a
reasonable jury could return a verdict in the non-moving party's
favor. See id. at 249, 106 S.Ct. at 2511.
The moving party "bears the initial responsibility of informing
the district court of the basis for its motion, and identifying
those portions of `the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any,' which it believes demonstrate the absence of
a genuine issue of material fact." Celotex Corp. v. Catrett,
477 U.S. 317, 323, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986).
The nonmoving party must then "go beyond the pleadings and by her
own affidavits, or by the `depositions, answers to
interrogatories, and admissions on file,' designate `specific
facts showing that there is a genuine issue for trial.'" Id. at
324, 106 S.Ct. at 2553.
In deciding whether there is a disputed issue of material fact,
the "inferences to be drawn from the underlying facts . . . must
be viewed in the light most favorable to the party opposing the
motion." Matsushita Elec. Indus. Co. v. Zenith Radio Corp.,
475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986)
(quoting United States v. Diebold, Inc., 369 U.S. 654, 655, 82
S.Ct. 993, 994, 8 L.Ed.2d 176 (1962)).
A. The Plan Administrator as Proper Defendant
Defendant MetLife argues that under ERISA, only the Plan may be
sued to recover benefits due, and that MetLife, merely the Plan's
administrative services provider, is therefore not a proper
defendant. There is some confusion among district courts of this
circuit and among other circuits on the issue of whether a plan
is the only proper defendant in a suit under ERISA to recover
Defendant cites three cases decided by judges of this district
to support its contention that only the Plan may be a defendant
in a suit to recover benefits under § 1132(a)(1)(B): Reinert v.
Giorgio Foods, Inc., No. 97-2379, 1997 WL 364499 (E.D.
Pa. June 25, 1997); Lehigh Valley Hosp. v. Rallis, No. 94-3082,
1994 WL 327619 (E.D.Pa. July 8, 1994); Charter Fairmount Inst.,
Inc. v. Alta Health Strategies, No. 93-3258, 1993 WL 541675
(E.D.Pa. Dec. 30, 1993). Each case relies upon a decision by the
Court of Appeals for the Ninth Circuit, Gelardi v. Pertec
Computer Corp., 761 F.2d 1323 (9th Cir. 1985), which held that
ERISA permits suits to recover benefits only against the plan and
does not allow suits against the plan administrator. See id. at
Standing in direct contrast to Gelardi is a case decided by
the Court of Appeals for the Third Circuit, Curcio v. John
Hancock Mut. Life Ins. Co., 33 F.3d 226 (3d Cir. 1994). There,
the court of appeals considered a suit brought against a plan
administrator for recovery of benefits under § 1132(a)(1)(B). The
court held that a fiduciary of a plan could be liable under ERISA
and observed that a party is a plan fiduciary if the party
"maintained any authority or control over the management of the
plan's assets, management of the plan in general, or maintained
any responsibility over the administration of the plan." Id. at
233.*fn2 Upon a review of the plan literature, the court held
that the plan administrator "had sufficient discretionary
authority and responsibility in the administration of the plan,
so as to satisfy the statutory definition of a fiduciary . . .
thus making it a proper party under ERISA." Id. The Curcio
court dismissed Gelardi, calling it "easily distinguishable"
and expressing "surpris[e]" at Gelardi's holding that a plan
administrator was not a fiduciary under ERISA and therefore not a
proper party. See Curcio, 33 F.3d at 234 n. 12.*fn3
I am bound to follow the interpretation of the Court of Appeals
for the Third Circuit,*fn4 and I read Curcio to hold that a
fiduciary or plan administrator may be sued for recovery of
benefits under § 1132(a)(1)(B). See Welch v. CoreStates Fin.
Corp., No. 98-3533, 1999 WL 387276 (E.D.Pa. June 2, 1999) (plan
administrator, Corestates, and administrative services provider,
MetLife, had sufficient discretionary control within the context
of the plan to warrant fiduciary status and thus were proper
defendants in a suit for recovery of benefits) (citing Curcio,
33 F.3d at 233); see also Parelli v. Bell
Atlantic-Pennsylvania, No. 98-3392, 1999 WL 1060706 (E.D.Pa.
Nov. 22, 1999) (plan administrators
may be held liable in suit for recovery of benefits); Carr v.
Reliastar Employee Benefits, No. 98-3393, 1999 WL 961252
(E.D.Pa. Oct. 14, 1999) (plan administrator may be proper
defendant in suit for disability benefits due). To the extent
that they hold to the contrary, Reinert, 1997 WL 364499,*fn5
Lehigh Valley, 1994 WL 327619, and Charter Fairmount, 1993 WL
541675, contravene the holding of Curcio.
Thus, MetLife's fate as a defendant under ERISA turns on
whether it exercised sufficient "discretionary authority or
discretionary responsibility in the administration of the plan."
Curcio, 33 F.3d at 234. For the answer, I look to the Plan's
literature. See id. The summary plan description provided to
employees identifies MetLife as the "Administrative Services
Provider" for the plan. (Appendix to Defendant's Motion for
Summary Judgment, Exh. 1, Summary Plan Description, at 451). The
summary plan description states, "The Administrative Services
Provider interprets the Plan and makes all determination as to
when benefits are payable for particular claims . . ." (id. at
456) and that all "decisions by the Administrative Services
Provider will be final." (Id. at 451.) Furthermore, under the
Administrative Services Agreement, in which responsibility for
managing the Plan was delegated to MetLife, MetLife has
responsibility for evaluating claims, determining eligibility,
notifying claimants of approvals and denials of claims, computing
benefit amounts, and paying out benefits. (Appendix, Exh. 2B,
Administrative Services Agreement, at 3-5). Finally, an affidavit
by the Senior Counsel and Secretary of the May Company states
that the authority for administering the plan was delegated to
MetLife. (Appendix, Exh. 2, Affidavit of Richard A. Brickson, at
This evidence demonstrates that MetLife possesses broad
discretion in the interpretation of the plan, sole responsibility
for the evaluation of claims, and final decisionmaking authority
over the payment of benefits. This strikes me as more than
sufficient "discretionary authority and discretionary
responsibility in the administration of the plan" to endow
MetLife with fiduciary status under ERISA. See Curcio, 33 F.3d
at 234.*fn6 Because I have concluded
that MetLife was a fiduciary of the Plan under the terms of
ERISA, § 1002(21)(A), I must also conclude that MetLife is "a
proper party under ERISA." Curcio, 33 F.3d at 235. Therefore,
defendant's first argument for summary judgment fails.
B. The Merits of the Denial of Benefits
MetLife argues that the Court may overturn the denial of
Vaughn's benefits only if the Court finds that the denial was
"arbitrary and capricious." The record, according to MetLife,
demonstrates that the denial was not arbitrary and capricious.
Plaintiff contends that the denial of Vaughn's benefits was
arbitrary and capricious.
The Supreme Court has held that "a denial of benefits
challenged under § 1132(a)(1)(B) is to be reviewed under a de
novo standard unless the benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility for
benefits or to construe the terms of the plan." Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956-57,
103 L.Ed.2d 80 (1989). Where an administrator has been given
discretion, its decisions are reviewed under an "abuse of
discretion" or "arbitrary and capricious" standard*fn7 and they
"will not be disturbed if reasonable." Mitchell v. Eastman Kodak
Co., 113 F.3d 433, 437 (3d Cir. 1997) (quoting Firestone, 489
U.S. at 111, 109 S.Ct. at 954).
Based on the evidence cited in the above discussion of
MetLife's status as a proper defendant under ERISA, I conclude
that MetLife, as a fiduciary and de facto plan administrator,
was given discretionary authority to determine eligibility for
benefits and construe the terms of the plan. See supra text,
pp. 426-27. Therefore, I will review MetLife's benefits decision
under the "arbitrary and capricious" standard. See Mitchell,
113 F.3d at 439.
The sole argument advanced by Vaughn in opposition to MetLife's
motion for summary judgment is that MetLife's decision to deny
benefits should be reviewed under a more exacting arbitrary and
capricious standard. Plaintiff's argument is rooted in the
Supreme Court's suggestion in Firestone that the possibility or
actuality of a conflict of interest can be a factor in applying
the arbitrary and capricious standard to a benefits decision.
See Firestone, 489 U.S. at 115, 109 S.Ct. at 957; see also
Lang v. Long-Term Disability Plan of Sponsor Applied Remote
Tech., 125 F.3d 794 (9th Cir. 1997).
The Court of Appeals for the Third Circuit has held that no
conflict of interest exists when plan assets are restricted
solely to plan uses, because under such a regime, the plan, the
administrator, and the fiduciaries "incur no direct expense as
a result of the allowance of benefits, nor [do they] benefit
directly from the denial or discontinuation of benefits."
Mitchell, 113 F.3d at 437 n. 5 (quoting Abnathya v.
Hoffmann-La Roche, Inc., 2 F.3d 40, 45 n. 5 (3d Cir. 1993)). The
Plan at issue in this case contains a clause that states, "[N]o
part of the corpus or income of the Trust Fund shall be used for,
or diverted to, purposes other than for the exclusive benefit of
Members under the Plan and for the payment of the expenses of the
Plan." (Appendix, Exh. 2A, Long Term Disability Plan of the May
Department Stores Company, § 9.1).*fn8 The Plan thus restricts
use of Plan assets to the Plan itself, and there is no financial
incentive for MetLife to deny a claim for benefits. Therefore,
there is no possible or actual conflict of interest in this case,
and no heightened scrutiny of MetLife's denial of benefits.
The question facing this Court is thus merely whether MetLife's
denial of benefits was arbitrary and capricious, and was made
"without reason, unsupported by the evidence or erroneous as a
matter of law." Mitchell, 113 F.3d at 439 (quoting, 2 F.3d at
45). On the record now before me, I cannot conclude that it was.
MetLife set forth its reasons for the denial of benefits in
detailed letters to Vaughn on February 2, 1998, and September 14,
1998. (Appendix, Exh. 1, Letter from MetLife Agent Sal Marchese,
Sept. 14, 1998, at 8; Letter from MetLife Agent David Liddy, Feb.
2, 1998, at 158). The reasons for the denial included: (1) an
independent medical evaluation performed by orthopedic specialist
Dr. Francis Mattei, who concluded that plaintiff was not totally
disabled and could return to work (Appendix, Exh. 1, Summary of
Independent Medical Evaluation, Sept. 29.1997, at 158); (2) two
independent reviews of Vaughn's medical records by occupational
medicine specialist Dr. Robert D. Petrie, who concluded that the
Vaughn's medical records did not support a finding of total
disability (Appendix, Exh. 1, Independent Medical Review Report,
Dec. 10, 1997, at 166; Supplemental Medical Review, May 14, 1998,
at 117); (3) medical records and physical therapy records
submitted by Dr. Rosenzweig and Dr. Reiner that lacked objective
medical evidence of total disability. I conclude that this
evidence provides a reasonable basis for MetLife's decision to
deny long-term disability benefits under the Plan. Defendant's
motion for summary judgment will therefore be granted.
If the denial of benefits were being reviewed de novo, a
different conclusion might have been reached as to Vaughn's
eligibility for long-term disability benefits under the plan.
There is evidence from which it could have been concluded that
Vaughn suffered a serious injury that rendered her unable to
work. However, the arbitrary and capricious standard is a highly
deferential test that gives Court very little power to overturn a
benefits-related decision. The Court of Appeals for the Third
Circuit has held that in the ERISA setting, a plan administrator
or fiduciary's interpretation "should be upheld even if the court
disagrees with it, so long as the interpretation is rationally
related to a valid plan purpose and not contrary to the plain
language of the plan." Moats v. United Mine Workers of America
Health and Retirement Funds, 981 F.2d 685, 688 (3d Cir. 1992)
(quoting Gaines v. Amalgamated Ins. Fund, 753 F.2d 288, 289 (3d
Cir. 1985)). Whether or not I agree with MetLife's decision to
deny Vaughn benefits, I cannot conclude on this record that the
decision was irrational or contrary to the Plan. Therefore,
summary judgment will be granted in favor of defendant on the
merits of plaintiff's claim.
An appropriate Order follows.
AND NOW, this 13th day of March, 2000, upon consideration of
the motion of defendant Metropolitan Life Insurance Company for
summary judgment (Document No. 13), plaintiff's response
(Document No. 15), and the memoranda and evidence submitted
therewith, pursuant to Rule 56 of the Federal Rules of Civil
Procedure, and having found for the reasons set forth in the
foregoing memorandum that there is no genuine issue of material
fact and that defendant is entitled to judgment
as a matter of law, it is hereby ORDERED that the defendant's
motion for summary judgment is GRANTED.
It is FURTHER ORDERED that JUDGMENT IS HEREBY ENTERED in
favor of defendant, Metropolitan Life Insurance Company and
against plaintiff Alisesha Vaughn.