The opinion of the court was delivered by: MALACHY MANNION, Magistrate Judge
Before the court are the plaintiff's and defendants'
cross-motions for summary judgment filed pursuant to Fed.R.Civ.P.
56(c). (Doc. Nos. 19, 27).
On November 20, 2001, the defendant CNA Insurance Company
(Continental Casualty Company) (collectively referred to as
"CCC"), and Kraft Foods, Inc., ("Kraft"), filed a petition for
removal seeking to remove this matter from the Luzerne County
Court of Common Pleas. (Doc. No. 1). The plaintiff ("Sopp") had
filed a complaint in that court seeking reinstatement of Short
Term Disability benefits, and a determination as to his
entitlement to Long-Term Disability benefits under the CCC/Kraft
Disability Insurance Plan, an employee welfare benefit plan
regulated by the Employee Retirement Income Security Act of 1974,
("ERISA"), as amended, 29 U.S.C. § 1001-1461. (Doc. No. 1).
After being granted an extension of time to do so, the
plaintiff filed an amended complaint on March 4, 2002. (Doc. No.
7). The defendants filed an answer to the amended complaint on
May 5, 2002. The parties consented on July 3, 2002, to proceed
before the undersigned United States Magistrate Judge. (Doc. Nos.
11, 12). The defendants filed a motion for summary judgment, a
supporting brief with exhibits, and proposed findings of fact, on
August 18, 2003. (Doc. Nos. 19, 20, 21). After being granted an
extension of time to do so, the plaintiff filed a cross-motion
for summary judgment, proposed findings of fact, and a brief in
opposition to the defendants' motion for summary judgment, with
exhibits, on November 4, 2003. (Doc. Nos. 27, 28). The defendants
filed a reply to the plaintiff's cross-motion for summary
judgment on November 25, 2003, and a brief in opposition, on
December 8, 2003. (Doc. Nos. 34, 37). Because certain
clarifications of the record were necessary for resolution of
this matter, oral argument was held on May 6, 2004, to address
The documents submitted by the parties establish that Mr. Sopp
was involved in a motor vehicle accident on May 5, 1999, which
occurred while he was in the scope of his employment with
co-defendant Kraft Foods. He sustained a number of injuries as a
result of the motor vehicle accident, mostly to his left upper extremity, which are discussed in more
detail below. He applied for and received short term disability
benefits through August 31, 1999.
On September 2, 1999, following receipt of an Independent
Medical Examination report, CCC advised Mr. Sopp that he had been
released to return to his duties as of August 31, 1999. He was
advised that his short term disability benefits would be
discontinued as of that date. (Doc. No. 18, defendants' record in
support of the motion for summary judgment; CCC 322).*fn1
The plaintiff filed an appeal of the determination on November
11, 1999. (CCC 145). On July 6, 2000, CCC's Disability Specialist
Joanne Laurie wrote to the plaintiff's attorney and advised him
that a review had been completed of Mr. Sopp's disability claim,
and that it was determined that the medical records, on the
whole, did not support a claim for on-going disability benefits.
Specifically, Ms. Laurie discussed and described the plaintiff's
job duties, and concluded that there was nothing in the
plaintiff's medical records which would preclude him from
performing the regular duties of his job as a Customer Category
Manager. (CCC 138). The plaintiff made several subsequent attempts to again appeal the decision, usually
incorporating ongoing treatment records. The plaintiff
subsequently filed a complaint in the Luzerne County Court of
Common Pleas seeking a determination as to his rights under the
Kraft short term and long term disability plans. As noted above,
that matter was removed to this court. (Doc. No. 1).
III. ERISA STANDARD OF REVIEW
A denial of benefits challenged under Section 1132(a)(1)(B) of
ERISA 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 (1989). If the plan vests such discretion in
the plan administrator, the decision is to be reviewed under the
more deferential arbitrary and capricious standard of review.
Id.; See also Luby v. Teamsters Health, Welfare and
Pension Trust Funds, 944 F.2d 1176, 1180 (3d Cir. 1991);
Heasley v. Belden & Blake Corp., 2 F.3d 1249, 1256 (3d Cir.
The arbitrary and capricious standard is essentially the same
as the "abuse of discretion" standard. Abnathya v. Hoffman-La
Roche, 2 F.3d 40, 45 (3d Cir. 1993). The scope of review is
narrow and the court is not free to substitute its own judgment
for that of the plan administrator in determining eligibility for
plan benefits. Id. at 45.
Kraft's Plan explicitly confers this discretion on the plan
administrator. The plan provides, in pertinent part:
. . . When making a benefit determination under the
policy, We have discretionary authority to
determine Your eligibility for benefits and to
interpret the terms and provisions of the
policy . . .
. . . The plan administrator has complete
discretionary authority to determine eligibility for
benefits and to construe uncertain plan terms . . .
. . . The Administrator and other Plan fiduciaries
have discretionary authority to interpret the terms
of the Plan and to determine eligibility for and
entitlement to benefits in accordance with the
Plan . . .
(Doc. No. 18, Kraft Choice Summary Plan Descriptions, pp. 7, 11,
20) (emphasis in original). Because this language clearly gives
the plan administrator discretion over the payment of benefits,
the arbitrary and capricious standard of Firestone is
applicable in this case.
Furthermore, under the arbitrary and capricious standard, the
district court is to "look to the record as a whole," which
"consists of evidence that was before the administrator when he
or she made the decision being reviewed." Mitchell v. Eastman
Kodak Co., 113 F.3d 433, 440 (3d Cir. 1997) (emphasis added).
The relevant administrative record has been defined as including
the evidence not only before the administrator at the time of the
original decision in the matter, but also any additional records
which may have been submitted and reviewed in the process of any
administrative appeal. Ernest v. Plan Administrator of the
Textron Insured Benefits Plan, 124 F. Supp.2d 884, 893 (M.D.Pa. 2000). Therefore, the relevant
administrative record in this matter is limited solely to the
period beginning May 5, 1999, the date of the motor vehicle
accident, and the date of CCC's final decision relating to the
termination of short term ...