The opinion of the court was delivered by: GARY LANCASTER, District Judge
Before the court are the parties' cross motions for summary
judgment. This is a claim for disability benefits under ERISA,
29 U.S.C. § 1132(a) (1) (B). Plaintiff appeals defendant's denial of
long term disability benefits, arguing that defendant acted in an
"arbitrary and capricious" manner and abused its discretion by
denying plaintiff's claim. Defendant claims to have acted within
its discretionary authority to determine eligibility for benefits
and to construe the terms of the long term disability plan at
Both parties have filed motions for summary judgment under
Fed.R.Civ.P. 56(c), arguing that there are no issues of material
fact. Plaintiff claims that defendant, as both fiduciary and
administrator of the long term disability plan, abused its
discretion in denying plaintiff's claim for extended disability
benefits. To the contrary, defendant argues that it is entitled to summary judgement because its interpretation of the long term
disability plan and the terms therein was reasonable.
For the following reasons, defendant's motion for summary
judgment will be GRANTED and plaintiff's motion for summary
judgment will be DENIED.
Unless otherwise indicated, the following material facts are
Plaintiff is a former employee of Praxair, Inc. As a result of
his employment, he was a participant in Praxair's long-term
disability plan (the "Plan"). Defendant Met Life served as the
claims administrator for the Plan.
Plaintiff began his employment with Praxair in 1991 as a tool
and die maker. He stopped working on June 14, 1998 due to a
diagnosis of major depressive disorder. On December 16, 1998,
defendant approved plaintiff's application for benefits.
According to the Plan, benefits for disability due to mental
illness are limited to 24 months unless the participant is
confined to a legally certified hospital or continues to be a
participant in an "approved managed mental health care program."
On October 10, 2000, defendant notified plaintiff that because he
was not a participant in a managed mental health care program,
his benefits would expire on December 15, 2000. In an effort to keep his benefits from expiring, on December 4, 2000, plaintiff
submitted a psychiatric evaluation and five appointment slips
from his treating psychiatrist as proof that he was being treated
through Allegheny East Mental Health/Mental Retardation. On
January 2, 2001, defendant notified plaintiff that the documents
plaintiff supplied failed to demonstrate that he was a
participant in an approved managed mental health care program.
Plaintiff then brought this ERISA action to challenge the
Administrator's decision under 29 U.S.C. § 1132(a) (1) (B), which
allows an ERISA plan participant to bring a civil action to
recover benefits under the terms of the Plan.
A. The Summary Judgment Standard
Fed.R.Civ.P. 56(c) provides that summary judgment may be
granted if, drawing all inferences in favor of the non-moving
party, "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." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986)
(internal quotation marks omitted). Further, because the instant
case is a review of an administrative decision, it is appropriate
for summary disposition. Couzens v. Equitable Life Assurance Society of the United States, No. Civ. A. 98-527, 1998 WL
695425 (E.D. Pa. Oct. 2, 2005).
The mere existence of some factual dispute between the parties
will not defeat an otherwise properly supported motion for
summary judgment. Anderson, 477 U.S. at 247-48. A dispute over
those facts that might affect the outcome of the suit under the
governing substantive law, i.e., the material facts, however,
will preclude the entry of summary judgment. Id. at 248.
Similarly, summary judgment is improper so long as the dispute
over the material facts is genuine. In determining whether the
dispute is genuine, the court's function is not to weigh the
evidence or to determine the truth of the matter, but only to
determine whether the evidence of record is such that a
reasonable jury could return a verdict for the nonmoving party.
B. The Arbitrary and Capricious Standard Under ERISA
When, as here, a plan administrator has the discretionary power
to construe the terms of a plan or to determine who is eligible
for benefits, the court will review the administrator's decision
according to an "arbitrary and capricious" standard. See
Stoetzner v. United States Steel Corp., 897 F.2d 115, 119 (3d
Cir. 1990). Under the arbitrary and capricious standard, the
court will overturn an administrator's decision only if it is
"`without reason, unsupported by substantial evidence or erroneous as a matter of law.'"
Abnathya v. Hoffmann-La Roche, Inc., 2 F.3d 40, 45 (3d Cir.
1993) (citations omitted). The court's review is narrow; "`the
court is not free to substitute its own judgment for that of the
[administrator] in determining eligibility for plan benefits.'"
Id. (citation omitted). Therefore, the court will not disturb
an administrator's interpretation "if reasonable." See
Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 111
(1989). The court will accept that an administrator acted
reasonably if the administrator ...