The opinion of the court was delivered by: A. Richard Caputo United States District Judge
(MAGISTRATE JUDGE CARLSON)
Presently before the Court is Magistrate Judge Carlson's Report and Recommendation ("R&R") recommending that Plaintiff Robert T. Miller's motion for summary judgment be granted and that Defendants' motion for summary judgment be denied. The Court has jurisdiction over this matter pursuant to 28 U.S.C. § 1331.
Plaintiff was employed as a commercial airline pilot with Defendant American Airlines, Inc. ("American") between 1989 and 1998. (Doc. 40 at ¶ 1.) In August 1998, while acting as co-pilot, Plaintiff's mental state became unstable and his airplane had to be taxied back to terminal; Plaintiff had to be removed from the cockpit, and was committed to a psychiatric hospital and diagnosed with "severe psychosis." (Id. at ¶¶ 2-5.) Upon discharge, Plaintiff began treating with a psychiatrist, Dr. Abel Gonzalez, who diagnosed Plaintiff with Anxiety Disorder NOS, R/O Generalized Anxiety Disorder with Soft Obsessive Compulsive Features and S/P (status post) Brief Reactive Psychosis. (Id. at ¶ 7.)
As a result of Plaintiff's condition, he applied for, and qualified for, long-term disability benefits ("LTD benefits") pursuant to the American Airlines, Inc. Pilot Retirement Benefit Program Fixed Income Plan ("the Plan"); Plaintiff began receiving LTD benefits in 1999. (Doc. 46, Ex. Z.) The plan grants the American Airlines Inc., Pension Benefits Administration Committee ("the PBAC") fiduciary responsibility to "decide questions concerning the application or interpretation of the Plan . . . including, but not limited to determinations of eligibility for benefits. (American Airlines Pilot Retirement Benefit Program at 11.3(c)(iii), Doc. 46, Ex. A.)
The Plan defines "Disability" as "an illness or injury, verified through qualified medical authority . . . which prevents a Member from continuing to act as an Active Pilot Employee in the Service of the Employer." (Pilot Retirement Benefit Program at 2.1(af), Doc. 46, Ex. A.) As amended in 2004, the plan states that a Member's disability will be considered to have ceased to exist if "verification of such Disability can no longer be established." (Pilot Retirement Benefit Program at 5.4(c)(ii), Doc. 46, Ex. A.) Any disability under the plan is subject to re-verification every ninety (90) days, where appropriate. (Pilot Retirement Benefit Program at 5.4(d), Doc. 46, Ex. A.) In the case of a dispute regarding "the continuation of the illness or injury," the claim "shall be referred to a clinical authority selected by agreement between [American] and the [Pilots' Union], and the findings of such authority regarding the nature and extent of such illness or injury shall be final and binding upon the Administrator, the [Pilots' Union] and the Member and his Beneficiaries." (Pilot Retirement Benefit Program at 5.4(e), Doc. 46, Ex. A.). The cost of review by the agreed-upon clinical authority is shared equally between American and the Pilots' Union. (Pilot Retirement Benefit Program at 5.4(e), Doc. 46, Ex. A.)
Between 1999 and 2003, Plaintiff received his LTD benefits. (Doc. 40, ¶ 9.) On February 10, 2003, American's Director of Occupational Health Services, Dr. Thomas Bettes, wrote Plaintiff a letter that assigned Jeanne Spoon, R.N., as the case manager for his LTD benefits case and requested updated medical records from Plaintiff's treating physician. (Doc. 46, Ex. AA.) On May 7, 2003, Dr. Bettes wrote a letter to Paul Barry, the Managing Director for Flight Operations, stating that he had been unsuccessful in his attempts to contact Plaintiff for further medical information regarding his disability and recommending suspension of further benefits. (Doc. 46, Ex. AC.)
Dr. Gonzalez wrote a letter to Ms. Spoon on June 10, 2003, stating that he had been following up with Plaintiff's psychiatric treatment since 1998. (Doc. 46, Ex. K.) He stated that Plaintiff's use of medication and psychotherapy had ended in 2000 and Plaintiff "ha[d] been asymptomatic and able to safely return to his usual work since spring of 2001." (Id.) On July 15, 2003, Plaintiff was deemed "medically qualified for the disability pension program" and his benefits were reinstated.*fn1 (Doc. 46, Ex. AD.)
On August 26, 2005, Dr. Gonzalez sent another letter to the American Airlines Medical Department noting that Plaintiff was not taking psychotropic medications and that "[h]is condition is stable and he is completely a symptomatic (sic) without any ongoing or active treatment." (Doc. 46, Ex. L.) Dr. Gonzalez's progress notes from June 13, 2006, note that Plaintiff was "asymptomatic" and that there was "no treatment necessary." (Doc. 46, Ex. W.) On September 1, 2006, Dr. Gonzalez's progress notes stated that Plaintiff was "[i]n general asymptomatic." (Doc. 59, Ex. R.)
On September 21, 2006, Ms. Spoon wrote Plaintiff a letter alerting him that, pursuant to the plan's allowance for re-verification every ninety (90) days, his medical file had been reviewed for continued medical disability. (Doc. 46, Ex. AH.)The letter said that the American Airlines "medical doctor has requested an update in order to verify your disability status" and asked Plaintiff to have his treating doctor send updated medical information within thirty (30) days. (Id.)
On October 23, 2006, Dr. Bettes sent Plaintiff a letter stating that his LTD benefits would be discontinued because American was "unable to verify either the existence of a continuing medical disability or your continued substantial progress towards obtaining your FAA medical certification." (Id.) The letter added that "[i]n order to receive further favorable consideration, you will need to demonstrate that you are actively pursuing obtaining your FAA medical certification." (Id.) Notably, obtaining or pursuing FAA medical certification is not a requirement for receiving LTD benefits under the plan. (Teklitz Dep. 144:14-16, Aug. 28, 2008.) The letter also stated that "verification of your continued disability cannot be established and your disability benefits under the Plan will end immediately upon notification of this status to the Flight Office." (Doc. 46, Ex. AH.) The letter also informed Plaintiff of his right to appeal the decision, included the pertinent language from the plan regarding the appeals process, and advised him to "submit all information and documentation you believe pertinent to your appeal." (Id.)
Plaintiff filed his appeal to the PBAC on November 30, 2006. (Doc. 46, Ex. AH.) Additional evidence submitted by Plaintiff included a letter from Dr. Gonzalez dated November 22, 2006. (Id.) Dr. Gonzalez wrote that Plaintiff "has been continually and permanently disabled from obtaining a Class One Medical Certificate as required by F.A.A. regulations since August of 1998." (Doc. 46, Ex. Y.) The letter added that Plaintiff's "diagnosis reveals and refers to latent vulnerability on his mental status so that prevention and medical treatment, when adequate, may be sufficient. However, no medical treatment has the capacity to neither revert, undo, nor cure such condition." (Doc. 46, Ex. Y.)
On March 27, 2007, American requested that a peer review be performed in Plaintiff's case by Western Medical Evaluators ("WME") (Doc. 46, Ex. AI); WME was the agreed-upon clinical authority selected by the Pilots' Union and American. (Teklitz Dep. 81:11-14.) As such, any decision made by WME regarding the continuation, nature, and extent of the illness that gave rise to Plaintiff's disability was to be final and binding on both Plaintiff and the plan administrator. (See Pilot Retirement Benefit Program at 5.4(e), Doc. 46, Ex. A.)
On April 20, 2007, WME forwarded the reports of Dr. Crain and Dr. Seskind to American. (Doc. 46, Ex. AJ.) Dr. Crain's report included a lengthy review of the medical records, up to and including the November 22, 2006 letter from Dr. Gonzalez. (Doc. 46, Ex. AK.) Dr. Crain's report noted that Plaintiff's treating psychiatrist had suggested that Plaintiff was able to resume work in the spring of 2001, but had not pursued his FAA medical certificate for six years. (Id.) Dr. Crain also opined that "[t]he psychiatric records show no objective evidence of continuing disability" and that Plaintiff's ongoing treatment with Dr. Gonzalez was for the purposes of monitoring him, "not actually treating symptoms." (Id.) Dr. Crain concluded that Plaintiff there was "no evidence of a continuing mental disorder that requires treatment by a psychiatrist." (Id.)
Dr. Seskind also noted that Plaintiff had made no attempt to regain an FAA medical certificate. (Doc. 46, Ex. AK.) However, he suggested that the FAA might favorably regard Plaintiff as being able to fly with proper supervision because of the lengthy time period during which Plaintiff had experienced no relapses in his psychosis and had not been taking psychoactive drugs. (Id.) Dr. Seskind stated that he has "seen such cases [as Plaintiff's] be given clearance" by the FAA and opined that "there is no evidence for continuing mental disorder that requires treatment by a psychiatrist." (Id.) On May 22, 2007, American sent a letter to Plaintiff's counsel informing him of the PBAC's decision that terminating Plaintiff's LTD benefits "was both proper and in accordance with the provisions of the Plan." (Doc. 46, Ex. AL.)
Plaintiff filed his Complaint on February 13, 2008 (Doc. 1); an Amended Complaint was filed on June 16, 2008 (Doc. 15). The only count in the Amended Complaint is for benefits pursuant to 29 U.S.C. § 1132(a)(1)(B). Plaintiff and Defendants filed cross-motions for summary judgment on December 8, 2008. (Docs. 38, 44) On November 30, 2009, Magistrate Judge Carlson issued a Report and Recommendation that recommended that Plaintiff's Motion for Summary Judgment be granted and that Defendants' Motion for Summary Judgment be denied. (Doc. 79.) Defendants filed an ...