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Gibson v. Retirement Plan for Hourly Employees of Personal Products Co. Represented by the United Food and Commercial Workers International Union AFL-CIO

September 26, 2007

ARLENE GIBSON, PLAINTIFF,
v.
RETIREMENT PLAN FOR HOURLY EMPLOYEES OF PERSONAL PRODUCTS COMPANY REPRESENTED BY THE UNITED FOOD AND COMMERCIAL WORKERS INTERNATIONAL UNION AFL-CIO, CLC LOCAL 555T, DEFENDANT.



The opinion of the court was delivered by: Stiehl, District Judge

MEMORANDUM & ORDER

Before the Court is defendant's motion for judgment on the administrative record (Doc. 15) to which plaintiff has filed a cross-motion for judgment on the administrative record (Doc. 22). The plaintiff has filed a response to defendant's motion (Doc. 23) and defendant has filed an opposition to plaintiff's cross motion (Doc. 26) and a reply to plaintiff's response (Doc. 25).

BACKGROUND

Plaintiff brought this action under 29 U.S.C. §§ 1132(a), (e), (f), and (g) of the Employee Retirement Income Security Act of 1974 ("ERISA") involving employee benefit plan. Plaintiff was a former employee of Johnson & Johnson Personal Products Company, a subsidiary of Johnson & Johnson, and, by virtue of that employment, a beneficiary under the Retirement Plan For Hourly Employees of Personal Products Company Represented by The United Food and Commercial Workers International Union, A.F.L.-C.I.O., C.L.C. Local 555T ("Plan"). Plaintiff was entitled to benefits pursuant to conditions of the Plan maintained by Johnson & Johnson as the Plan Administrators. Around November 14, 1990, plaintiff developed back problems and commenced receiving Disability Income Retirement (DIR) benefits under the Plan, which she received from November of 1990 to March 10, 2006.

Plaintiff had several doctors review her medical condition to determine if she was totally disabled, and therefore entitled to receive benefits under the Plan. Those doctors had differing opinions. At least three of plaintiff's treating physicians including Dr. Greenwald, Dr. Dworsky, and Dr. Korte at different times, determined that plaintiff was and remained permanently disabled. (Admin. Rec. 145, 164) In particular, Dr. Korte prior to May 2003, stated that plaintiff was disabled from any occupation and was incapable of performing sedentary work. (Admin. Rec. 164). In August of 2004, Dr. Wendy Weinstein, a physician chosen to evaluate plaintiff by defendant's third party administrator to evaluate plaintiff, found that plaintiff was not totally disabled. In December of 2005, Dr. Gocio determined that plaintiff was only partially disabled and could do work on a limited basis.

In an independent medical evaluation (IME) conducted in October 2004, Dr. Guyton was of the opinion that plaintiff is "not totally disabled but significantly partially disabled, capable of working on a very limited capacity . [and would] have significant problem finding a job." (Admin. Rec. 202). In a subsequent IME conducted by the Plan's physician, Dr. Gocio on December 20, 2005, Dr. Gocio concluded that plaintiff was capable of performing satisfactorily in a sedentary job for eight-hour work day without significant difficulty. Based on Dr. Gocio's opinion, plaintiff's disability benefits were terminated on March 10, 2006.

Plaintiff then appealed the decision and the parties, pursuant to the Plan language*fn1 , chose a "third doctor," to evaluate plaintiff. That doctor, Dr. Lori Guyton, then prepared a second report in May of 2006, and found "it is still my professional opinion that Ms. Gibson is not totally disabled, but remains partially disabled, capable of working on a very limited basis." Based on this finding, plaintiff's benefits were terminated as of March, 2006.*fn2 (Admin. Rec. 296).

The crux of the issue raised in these cross motion for judgment on the record is whether plaintiff was entitled to continue to receive benefits from the defendant in light of the fact that although Dr. Guyton had found plaintiff to be only partially disabled, the defendant continued to pay plaintiff's disability benefits for an additional year and a half. The defendant notes that Dr. Gutyon did not issue her first opinion as the jointly selected "third doctor" until her second opinion and therefore, the first opinion was not binding. Moreover, the defendant asserts the fact that it continued to pay benefits after Dr. Guyton's first report did not establish an entitlement in the plaintiff that she would continue to receive benefits under the Plan.

STANDARD OF REVIEW

In actions challenging denials of benefits under 29 USC § 1132(a)(1)(B), a district court reviews decisions of plan administrators de novo, except when the plan gives the administrator discretion to interpret plan terms or otherwise to determine benefits eligibility. Ruttenberg v. United States Life Ins. Co., 413 F.3d 652, 658 (7th Cir. 2005). When the plan administrator is given broad discretion to interpret the plan and determine benefit eligibility under the terms of an employee benefit plan, the administrator's benefit decisions are reviewed under the arbitrary and capricious standard. Dougherty v. Ind. Bell Tel. Co., 440 F.3d 910, 915 (7th Cir. 2006) (citing Sisto v. Ameritech Sickness & Accident Disability Benefit Plan, 429 F.3d 698, 700 (7th Cir. 2005).

Based on such standard, this Court may uphold the decision of the administrator as long as there is "rational support in the record." Dougherty, 440 F.3d at 917 (See Leipzig v. AIG Life Ins. Co., 362 F.3d 406, 409 (7th Cir. 2004)).

1. Arbitrary and Capricious Standard

Courts look to language of plan to determine whether the administrator has discretionary authority. Sanders v. Unum Life Ins. Co. of Am., 346 F. Supp 2d 955 (N.D. Ill 2004). In this case, the Plan specifically provides that "the Designated Administrator has exclusive authority to decide claims under the Plan and the Benefit Committee has exclusive authority to review and resolve any appeal of a denied claim." (Admin. Rec. 44) Accordingly, because, the Plan Administrator is given broad discretion to interpret the Plan and determine benefit eligibility under the terms of an employee benefit plan, the Administrator's benefit decisions are reviewed under the arbitrary and capricious standard.

Therefore, the Court must determine whether the Administrator's termination of plaintiff's benefits has rational basis for its decision and is supported by the Administrative Record. Further, in reviewing the Administrator's decision, this Court is limited to consideration of information actually considered by ...


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