NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 16a0195n.06
No. 15-6010
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
FILED
MICHAEL A. CANNON, Executor for and on ) Apr 07, 2016
behalf of the Estate of Christine Cannon, ) DEBORAH S. HUNT, Clerk
)
Plaintiff-Appellant, ) ON APPEAL FROM THE UNITED
) STATES DISTRICT COURT FOR
v. ) THE WESTERN DISTRICT OF
) KENTUCKY
PNC FINANCIAL SERVICES GROUP AND )
AFFILIATES LONG TERM DISABILITY )
PLAN, )
)
Defendant-Appellee.
BEFORE: MERRITT, SUHRHEINRICH, and DONALD, Circuit Judges.
PER CURIAM. Michael A. Cannon, executor for and on behalf of the Estate of Christine
Cannon, appeals the district court’s judgment on the administrative record in favor of The PNC
Financial Services Group, Inc. and Affiliates Long Term Disability Plan (“Plan”) in this action to
recover long term disability (“LTD”) benefits pursuant to the Employee Retirement Income
Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B).
Christine Cannon worked for The PNC Financial Services Group as an investigations
senior analyst, a sedentary job involving computer and telephone use. After undergoing a
hysterectomy on October 26, 2012, Cannon returned to work on December 31, 2012, but stopped
working a few days later due to abdominal and pelvic pain. Cannon reported that she could
“type[] and do everything except sit.” (RE 22, Page ID # 89). Cannon subsequently made a
claim for LTD benefits under the Plan, which was administered by Liberty Life Assurance
No. 15-6010, Cannon v. PNC Fin. Servs. Group & Affiliates Long Term Disability Plan
Company of Boston (“Liberty”). To be eligible for LTD benefits under the Plan, the participant
must be disabled, which means for the first two years that “your disability makes you unable to
perform the material or essential duties of your own occupation as it is normally performed in the
national economy.” (RE 22-4, Page ID # 283). Liberty initially determined that Cannon was
eligible to receive LTD benefits but advised her that “we will continue to review your claim and
request medical documentation to support your continued disability.” (RE 22-2, Page ID # 202).
After referring her claim for medical and vocational reviews, Liberty discontinued Cannon’s
LTD benefits on the basis that she no longer met the Plan’s definition of disability. Cannon filed
an appeal, which Liberty denied, maintaining that she no longer met the Plan’s definition of
disability.
Cannon then brought this ERISA action to recover LTD benefits under the Plan. The
district court granted judgment on the administrative record in favor of the Plan, concluding that
Liberty’s decision to deny Cannon’s LTD benefits was neither arbitrary nor capricious. This
timely appeal followed.
Where, as here, the plan grants the plan administrator “discretionary authority to
determine eligibility for benefits or to construe the terms of the plan,” we “review the
administrator’s denial of benefits under the arbitrary-and-capricious standard.” Shaw v. AT & T
Umbrella Benefit Plan No. 1, 795 F.3d 538, 546 (6th Cir. 2015) (quoting Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). “Under the arbitrary-and-capricious standard,
we must uphold the plan administrator’s decision if it is ‘the result of a deliberate, principled
reasoning process’ and ‘supported by substantial evidence.’” Id. at 547 (quoting DeLisle v. Sun
Life Assurance Co. of Can., 558 F.3d 440, 444 (6th Cir. 2009)). Our review, however, “is not a
rubber stamp. We must still evaluate the quality and quantity of the medical opinions on both
sides.” Cox v. Standard Ins. Co., 585 F.3d 295, 302 (6th Cir. 2009).
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No. 15-6010, Cannon v. PNC Fin. Servs. Group & Affiliates Long Term Disability Plan
In her initial interview with Liberty, Cannon reported that she was suffering from
abdominal and pelvic pain, that sitting caused the worst pain, and that she could “type[] and do
everything except sit.” (RE 22, Page ID # 89). Cannon’s activities questionnaire submitted in
support of her claim for LTD benefits indicated that she was unable to sit for any length of time
and that she could not engage in any gainful employment because of “sever[e] pain” and an
inability to sit. (RE 22-1, Page ID # 176, 178). Cannon’s records from several physicians and
from physical therapy reflected her complaints of severe pelvic or vaginal pain, particularly
when sitting. (RE 22, Page ID # 129; RE 22-1, Page ID # 158, 163; RE 22-2, Page ID # 186,
189, 191, 214-15, 217-18, 231-32). After performing a cystoscopy and laparoscopy on March
26, 2013, Dr. Robert McQuady with the Pelvic Pain Regional Specialty Center diagnosed
Cannon with pelvic abdominal pain, intra-abdominal adhesions, and pudendal neuralgia. (RE
22-2, Page ID # 237). Dr. McQuady instructed Cannon to be off work from the date of the
surgery until approximately April 23, 2013, and noted that her “[r]eturn to work will be further
discussed at post-operative appointments.” (RE 22-2, Page ID # 230).
Liberty discontinued Cannon’s LTD benefits on April 15, 2013. In doing so, Liberty
relied on a peer review prepared by Dr. Stuart Glassman with the Medical Consultants Network.
Dr. Glassman stated that Cannon’s “impairments currently are subjective complaints of
abdominal pain, no clear etiology,” failing to mention Dr. McQuady’s diagnosis of pudendal
neuralgia. (RE 22-3, Page ID # 263). Dr. Glassman concluded:
It is felt that she does have a work capability, and it is at least light duty, lifting 20
pounds maximally, 10 pounds frequently, 8 hours a day, 5 days a week. Her
motor examination was normal, even with complaints of abdominal pain. It is felt
that based upon her pain complaints, only occasional bending, kneeling, and
squatting would be appropriate for her. She could drive occasionally, as well.
(Id.). Although Cannon’s sedentary job involved sitting most of the time and she complained of
pain while sitting, neither Liberty nor Dr. Glassman addressed her ability to sit.
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No. 15-6010, Cannon v. PNC Fin. Servs. Group & Affiliates Long Term Disability Plan
In support of her appeal from the denial of LTD benefits, Cannon submitted a letter from
Dr. McQuady stating:
She is unable to work. Her job requires that she be able to sit and patient has
intense pain with sitting. She was diagnosed with pudendal neuralgia as well as
pelvic floor muscle dysfunction and these conditions are associated with pain with
sitting and it is not possible for the patient to perform a job that requires that she
sit.
(RE 22-3, Page ID # 269). In denying Cannon’s appeal, Liberty noted receipt of Dr. McQuady’s
letter but stated that “no further contemporaneous examination or treatment records have been
provided to validate his assertions that Ms. Cannon remained restricted and limited such that she
was unable to work.” (RE 22-3, Page ID # 274). Liberty once again recited the restrictions
identified by its medical reviewers without addressing Cannon’s ability to sit.
Liberty’s decision to deny benefits was arbitrary and capricious for two reasons. First,
Cannon asserted that she could not perform her job because her pelvic pain made her unable to
sit. Liberty failed to consider that Cannon’s two diagnoses—pudendal neuralgia and pelvic floor
muscle dysfunction—are associated with pain while sitting. Those diagnoses and their effects
are precisely the anatomic explanation we require for a demonstration of pain. To fail to address
them is an arbitrary and capricious denial of benefits. See Yeager v. Reliance Standard Life Ins.
Co., 88 F.3d 376, 382 (6th Cir. 1996) (“In the absence of any definite anatomic explanation of
plaintiff’s symptoms, we cannot find that the administrator’s decision was arbitrary and
capricious.”).
Second, Liberty’s failure to consider Dr. McQuady’s letter without supplemental medical
evidence was arbitrary and capricious. See Glenn v. MetLife, 461 F.3d 660, 672 (6th Cir. 2006)
(“[T]he failure to consider evidence that is offered after an initial denial of benefits renders a
final denial of benefits arbitrary and capricious.”). Dr. McQuady’s letter provided an
explanation for Cannon’s need for disability based on existing medical evidence—namely,
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No. 15-6010, Cannon v. PNC Fin. Servs. Group & Affiliates Long Term Disability Plan
Cannon’s two diagnoses as a result of the recent surgery that he performed on her and that she
was still recovering from—and should have been addressed by Liberty.
“[W]here the problem is with the integrity of the plan’s decision-making process, rather
than that a claimant was denied benefits to which [s]he was clearly entitled, the appropriate
remedy generally is remand to the plan administrator.” Shaw, 795 F.3d at 551 (quoting Elliott v.
Metro. Life Ins. Co., 473 F.3d 613, 622 (6th Cir. 2006)). Because we cannot say that Cannon
was clearly entitled to benefits, the appropriate remedy is to remand to Liberty for a full and fair
inquiry into her claim for LTD benefits.
For the foregoing reasons, we VACATE the district court’s judgment and REMAND the
case for proceedings consistent with this opinion.
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