Katherine Castor v. AT&T Umbrella Benefit Plan 3 ( 2018 )

NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 18a0155n.06
No. 17-3400
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
FILED
KATHERINE CASTOR, ) Mar 26, 2018
) DEBORAH S. HUNT, Clerk
Plaintiff-Appellant, )
)
ON APPEAL FROM THE
v. )
UNITED STATES DISTRICT
)
COURT FOR THE
AT&T UMBRELLA BENEFIT PLAN NO. 3, )
SOUTHERN DISTRICT OF
)
OHIO
Defendant-Appellee. )
)
)
Before: MOORE, THAPAR, and LARSEN, Circuit Judges.
LARSEN, Circuit Judge. Plaintiff Katherine Castor challenges the decision of her
disability insurer, AT&T Umbrella Benefit Plan No. 3 (“AT&T”), to deny her claim for
disability benefits. The district court granted judgment on the administrative record to AT&T.
We AFFIRM.
I.
Castor was employed by the Ohio Bell Telephone Company, where she worked as a
customer service representative for approximately fifteen years. As an employee, Castor was
eligible to receive short-term and long-term disability coverage under the AT&T Midwest
Disability Program, a component of a larger plan sponsored by AT&T known as AT&T
Umbrella Benefit Plan No. 3, the defendant in this case. The Plan gave discretion to Sedgwick
No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
Claims Management Services, Inc. (“Sedgwick”), as claims administrator, to decide whether an
employee had a qualifying disability under the Plan.
In early 2014, Castor was diagnosed with clostridium difficile, an infection that caused
abdominal discomfort and intestinal problems. On February 12, 2014, she filed a claim for
short-term disability benefits, which Sedgwick approved. Shortly thereafter, having recovered
from clostridium difficile, Castor was hospitalized for unrelated illnesses—pneumonia and
H1N1. She was hospitalized again in May 2014 for atrial fibrillation and congestive heart
failure. Doctors determined that Castor had a left ventricle ejection fraction of 25%.1 She
underwent successful left ventricular ablation surgery in September 2014. Throughout these
ailments and hospitalizations, Castor continuously received short-term disability benefits.
On November 21, 2014, Sedgwick informed Castor that her eligibility for short-term
disability benefits would expire on February 10, 2015 (the end of the maximum fifty-two week
period provided for in the Plan), but that she might thereafter be eligible for long-term disability
benefits.2 Castor then applied for long-term disability benefits.
Around that time, Dr. Amit Goyal, Castor’s cardiologist, reviewed her test results, which
showed that Castor’s ejection fraction had improved to 40% since her surgery. Dr. Goyal
indicated that Castor should be able to return to work on February 2, 2015. Upon receiving Dr.
Goyal’s notes, Sedgwick ordered an independent file review.
Dr. Chester Conrad, a physician board-certified in internal medicine and cardiovascular
disease, undertook the review. In his report, Dr. Conrad characterized Castor’s job duties as
1
The district court explained, “Although not relevant to the Court’s determination, the Court
notes that, according to the Cleveland Clinic website, normal left ventricle ejection fraction
ranges from 55-70%. An ejection fraction of 40-54% is ‘slightly below normal,’ and a person
with an ejection fraction in this range ‘may not have symptoms.’”
2
To be eligible for long-term disability benefits under the Plan, an employee must have first
“received the maximum amount (52 weeks)” of short-term disability benefits.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
“sedentary, with physical requirements including sitting, typing, and talking.” Dr. Conrad
concluded that Castor’s medical records revealed no disability that would prevent her from
performing her work as of December 11, 2014, finding that “[t]he available information does not
establish a functional impairment or need for restrictions that would preclude sedentary work or
require additional restrictions from 12/11/14 forward from a cardiology perspective.”
Dr. Conrad’s report also included a statement from Dr. Goyal, made to another doctor in
Dr. Conrad’s practice on December 16, 2014, conveying Dr. Goyal’s belief that Castor was
“capable of full-time full duty sedentary work.” In light of this report, Sedgwick sent a letter to
Castor informing her that short-term disability benefits had been terminated as of December 11,
2014. The letter informed Castor that she could submit additional documentation to support her
claim of disability and that she had a right to appeal the decision.
In response, Castor submitted additional medical records from recent office visits and
further discussed her disability claim with Sedgwick, but Sedgwick adhered to its original
decision to terminate her short-term disability benefits as of December 11, 2014. Sedgwick then
denied Castor’s claim for long-term disability benefits because she had not received the
prerequisite fifty-two weeks of short-term disability benefits as set forth in the Plan.
Castor indicated her intent to appeal the denial of short-term and long-term disability
benefits on February 12, 2015, and followed up with a letter of appeal on June 18, 2015. But in
her appeal letter, rather than contest Sedgwick’s determination that she was no longer physically
disabled as of December 11, 2014, Castor claimed that anxiety and depression had rendered her
unable to perform her job duties from December 11, 2014, through February 10, 2015.3 In
3
In the eight-page appeal letter, drafted by counsel, Castor’s only mention of physical disability
appeared in a limited portion of the background section, chronicling her disability claims up until
the time of the appeal. The remainder of the letter focused on mental-health issues. In the
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support of her appeal, Castor offered the opinions of three individuals—Dr. John Murphy, her
primary care physician; Cynthia Shaw, a licensed clinical counselor; and Dr. Jack Lunderman, a
psychiatrist.
Dr. Murphy, whom Castor had been seeing since 2014, stated in an opinion letter that, “in
mid-2014, Mrs. Castor began experiencing severe symptoms of anxiety and depression” and
expressed his belief “that Mrs. Castor has been experiencing anxiety and depression for some
time but was attempting to work through these problems herself.” He stated that this anxiety
would have precluded her from performing her work as a customer service representative and
from returning to work in the future in any occupation. Shaw, whom Castor had first visited in
February 2015, also diagnosed Castor with anxiety disorder and depression. If Castor returned to
work, Shaw believed she would “make more mistakes and then it would be a vicious cycle, the
more mistakes she made, the more anxious she would get.” Shaw admitted that she could not
speak to Castor’s symptoms before February 2, 2015, but, relying on Castor’s explanation of
those symptoms, she surmised that the anxiety had manifested itself before December 2014 and
would have prevented Castor from performing her job duties from December 2014 to February
2015. Dr. Lunderman, whom Castor visited four times from March through May 2015,
explained that Castor had “consistently shown signs of severe depression, and inability to handle
stress” and that “[h]er symptoms would affect her ability to work on a sustained basis more than
one-third of the work day. Her inability to maintain attention and concentration as well as
slowed speech would hinder her ability to deal directly with the public and/or co-workers.”
conclusion, Castor asked that her benefits be reinstated because of anxiety and depression; she
made no mention of her previous physical ailments and did not attempt to challenge Sedgwick’s
conclusion that she was physically able to return to work as of December 11, 2014.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
After receiving Castor’s appeal package, Sedgwick ordered file reviews to determine
whether a disability rendered Castor unable to perform her job duties as of December 11, 2014.
Although Castor’s appeal letter discussed only mental-health concerns, Sedgwick sought the
review of Dr. Jose Perez, Jr., an internist, who concluded that Castor was physically able to
perform her job as of December 11, 2014. Sedgwick also consulted Dr. Michael Rater, a
psychiatrist, who concluded that mental-health issues did not prevent Castor from performing her
job as of December 11, 2014. Finally, Sedgwick asked Dr. Conrad to review Castor’s updated
file; he again concluded that Castor was not physically disabled from her regular job as of
December 11, 2014.
On the basis of these reports, Sedgwick notified Castor that it was upholding the
termination of her disability benefits. The denial letter summarized the findings of the reviewing
physicians and stated: “Although some findings [of disability] are referenced, none are
documented to be so severe as to prevent your client from performing the job duties of Service
Representative with or without reasonable accommodation from December 11, 2014 through
present.” The letter informed Castor that no further administrative review was available. Castor
did not return to work, and she was terminated.
On September 21, 2015, Castor filed suit against AT&T, seeking review of the decisions
to terminate her short-term disability benefits and deny her long-term disability benefits under
the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1132. The parties filed
cross-motions for judgment on the administrative record. In an opinion dated March 20, 2017,
the district court upheld Sedgwick’s decision to terminate Castor’s disability benefits. Castor
appealed to this Court.
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II.
A.
Castor first argues that Sedgwick deprived her of a “full and fair review” of its decision
to terminate her disability benefits, as required by 29 U.S.C § 1133, by consulting Dr. Conrad for
both the initial benefits-denial determination and on appeal. We review de novo the legal
question whether Sedgwick complied with the requirements of § 1133. See McCartha v. Nat’l
City Corp., 419 F.3d 437, 444 (6th Cir. 2005).
The requirements of a full and fair review are set forth in regulations. 29 C.F.R.
§ 2560.503-1. One such requirement is that the plan administrator on appeal consult “a health
care professional who has appropriate training and experience in the field of medicine involved
in the medical judgment,” § 2560.503-1(h)(3)(iii), who “is neither an individual who was
consulted in connection with the adverse benefit determination that is the subject of the appeal,
nor the subordinate of any such individual.” § 2560.503-1(h)(3)(v). These requirements apply
to plans providing disability benefits. See § 2560.503-1(h)(4).
Sedgwick’s actions on appeal did not violate § 2560.503-1(h)(3). Sedgwick terminated
Castor’s short-term disability benefits as of December 11, 2014, based on the opinions of her
own cardiologist, Dr. Goyal, and a reviewing cardiologist, Dr. Conrad, that Castor was no longer
physically disabled and could return to work. Castor appealed the decision, and during that
appeals process, Sedgwick invited Dr. Conrad to review Castor’s updated file to determine
whether his prior opinion had changed. This, Castor claims, violated the regulation’s prohibition
on consulting the same doctor twice.
But Castor’s appeal shifted her focus: while she had previously alleged physical
disability, her appeal complained only of psychiatric disability caused by anxiety and
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
depression.4 AT&T argues that Castor thereby abandoned her claim of physical disability, and
so Dr. Conrad’s second evaluation of that claim could not matter. We need not decide whether
this change of focus constituted abandonment of the physical-disability claim on appeal, because
even if the physical disability remained at issue, Sedgwick complied with § 2560.503-1(h)(3).
Sedgwick responded to Castor’s appeal by asking two new doctors—Dr. Rater, a
psychiatrist, and Dr. Perez, an internist—to review, respectively, Castor’s claims of psychiatric
and physical disability.5 Having engaged one pair of “fresh eyes” to review each of her claims,
4
Before this Court, Castor contends, in cursory fashion, that her appeal letter did, in fact,
challenge Sedgwick’s initial determination regarding her physical fitness for work. As noted
previously, supra note 3, Castor’s appeal letter focused on a psychiatric disability and never
claimed that Castor remained physically disabled as of December 11, 2014. Indeed, shortly after
filing the letter of appeal, Castor’s attorney acknowledged to Sedgwick that the focus had shifted
to a psychiatric disability. Sedgwick’s notes from a phone call with Castor’s attorney state:
“Noted his ltr and the med and rev’d that it appears he is stating that primary disability condition
is psychiatric. He confirmed that as of now it is psychiatric.” (Emphasis added.) Nonetheless,
Sedgwick informed Castor’s attorney that “we will be reviewing both types of conditions.”
5
Castor suggests briefly that Dr. Perez, as an internist, was unqualified to assess her claim of
physical disability. But Castor presented no such challenge in the district court. Indeed, Castor’s
only attack on Dr. Perez’s qualifications in that court related to his inability to judge her
psychiatric disabilities, objecting that “Dr. Perez was incapable by professional limitation of
evaluating claimant’s anxiety and depression.” This was a curious challenge, as there is no
suggestion in the record that Dr. Perez ever evaluated Castor’s claims of psychiatric disability,
only her physical ones. Castor’s failure to challenge Dr. Perez’s fitness to review her claims of
physical disability in the district court forfeits the claim for appeal. See Scottsdale Ins. Co. v.
Flowers, 513 F.3d 546, 552 (6th Cir. 2008). Moreover, Castor’s perfunctory presentation in this
Court states only that we “should be reminded that cardiology is a unique medical speciality that
could not be addressed by other physicians used by [defendant] to evaluate Mrs. Castor’s
appeal.” She cites as support only an unpublished opinion, Loan v. Prudential Ins. Co. of Am.,
370 F. App’x 592 (6th Cir. 2010), that dealt with the need for a toxicologist, not a cardiologist, in
a circumstance in which the plaintiffs “raised a number of issues concerning the reliability of the
toxicology report” at issue and in which defendant’s own in-house doctor essentially conceded
that a toxicologist was necessary. Id. at 598. Loan, moreover, took pains “not to say that a plan
administrator must always consult a specialist to provide a full and fair review of adverse
benefits determinations.” Id. Loan, therefore, has no bearing on this case, except to advance the
unremarkable proposition that whether a specialist is needed will depend upon the facts of the
case. Castor has done nothing, either in this Court or in the court below, to develop the argument
that Dr. Perez in particular, or internists in general, lack the “appropriate training and
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
the regulations did not preclude Sedgwick from also consulting Dr. Conrad. Section 2560.503-
1(a) sets forth the “minimum requirements for employee benefit plan procedures pertaining to
claims for benefits by participants and beneficiaries.” The regulations do not speak to what more
an administrator can do when reviewing an appeal once an appropriate consultation with a new
doctor has been made. They neither affirmatively preclude an administrator from seeking
additional reviews, nor preclude an administrator from asking the original doctor whether his
opinion has changed in light of new medical evidence.
Indeed, it would be odd to suggest that a plan administrator, already armed with
independent reviews from new doctors that had confirmed the initial benefit determination, could
not circle back to the initial doctor to see whether, in light of any new information, his
assessment had changed. This is especially true here, where there are no allegations that Dr.
Conrad’s subsequent report was seen by or in any way influenced Dr. Perez’s independent
review. Sedgwick therefore did not violate § 2560.503-1(h)(3) by consulting Dr. Conrad on
appeal, in addition to Dr. Rater and Dr. Perez.6
B.
Castor next raises two challenges to Sedgwick’s decision to deny her disability benefits.
“A denial of benefits challenged under § 1132(a)(1)(B) 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.” Kalish v. Liberty
Mut./Liberty Life Assurance Co. of Bos., 419 F.3d 501, 505–06 (6th Cir. 2005) (quoting
experience,” § 2560.503-1(h)(3)(iii), to be able to evaluate her claim of physical disability. Her
claim is therefore not preserved for appeal. See United States v. Johnson, 440 F.3d 832, 846 (6th
Cir. 2006).
6
Because we find no violation of § 2560.503-1(h)(3), we need not address the proper remedy for
such a violation.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). Here, it is undisputed
Sedgwick had discretionary authority as administrator. “When such authority is granted, the
highly deferential arbitrary and capricious standard of review is appropriate.” Id. at 506 (quoting
Borda v. Hardy, Lewis, Pollard, & Page, P.C., 138 F.3d 1062, 1066 (6th Cir. 1998)). An
“administrator’s decision will not be deemed arbitrary and capricious so long as ‘it is possible to
offer a reasoned explanation, based on the evidence, for a particular outcome.’” Id. (quoting
Davis v. Ky. Fin. Co.’s. Ret. Plan, 887 F.2d 689, 693 (6th Cir. 1989)). “The arbitrary or
capricious standard is the least demanding form of judicial review.” Davis, 887 F.2d at 693
(citation omitted).
i.
Castor argues that Sedgwick’s decision to terminate her benefits was arbitrary and
capricious because it relied on medical reviews that did not adequately consider and address her
job duties. The Plan told employees they would be considered “disabled” if “sickness,
pregnancy, or an off-the-job illness or injury [] prevents you from performing the duties of your
job (or any other job assigned by the Company for which you are qualified) with or without
reasonable accommodation.” At the time Dr. Conrad conducted his initial December 2014
review of her claim for short-term disability benefits, Castor had complained only that she was
physically disabled from performing her duties as a customer service representative. Dr. Conrad,
although lacking access to Castor’s full job description set forth below, characterized those
duties as “sedentary, with physical requirements including sitting, typing, and talking.” Castor
claims that this summary was inadequate, as her “job description indicates that she was required
to possess technical knowledge; . . . to work with the public; and her job had a sales feature
which clearly involved elements of persuasion and compliance.”
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
According to the job description contained in the claim file, Castor’s job was to assist
“customers with orders, billing, and/or collection related issues.” The job description listed
twenty core duties, which the district court summarized as follows:
handling telephone customer contacts; determining customer
requirements; accessing databases and inputting customer information on
the computer while speaking to customers; negotiating and preparing
service order requests; computing and quoting rates, adjustments and
balances; meeting service and collection goals and deadlines; coordinating
service arrangements with other departments; correcting billing and
service errors; trouble-shooting; preparing letters; recommending and
selling appropriate products and services; investigating and resolving
billing inquiries; obtaining, assessing and establishing customer credit
information; investigating customer complaints of annoyance calls; and
aiding physically challenged customers in their need for
telecommunications.
Even if, as Castor claims, there were sales skills listed in this job description that were not
adequately captured in Dr. Conrad’s shorthand description (“sit, talk, type”), that would not
change the fact that Castor’s job was sedentary in nature, and that the physical duties of the job
could reasonably be summarized as sitting, talking, and typing. Dr. Conrad’s shorthand,
although perhaps inartful, adequately described the physical rigors of Castor’s job for the
purposes of determining whether she was physically disabled under the Plan.
Castor also faults the reviewing doctors’ consideration of her job duties on appeal.
Castor acknowledges that after she filed her appeal, and shifted her focus to whether she was
mentally able to perform the duties of her job, the reviewing doctors had the complete
description of her job duties. Yet she contends that, even with the benefit of the job description,
the reviewing doctors’ reports were devoid of any indication that they understood the skilled
work that she did.7
7
Castor cites Kalish, 419 F.3d at 509–10, for the proposition that a disability denial may not
lawfully “under evaluate[] the actual duties performed by the claimant.” We find no violation of
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
We see no error in the reports. It is evident from each report that the reviewing doctors
read and understood Castor’s formal job description. And because we find no error in Dr.
Conrad’s use of a shorthand description of the physical elements of her job in his initial report, it
follows that we would find no error in Dr. Conrad’s and Dr. Perez’s reports respecting her claim
of physical disability on appeal, which relied on Castor’s actual job description. We are also
unpersuaded that Dr. Rater needed to do more to show that he understood the skills set forth in
the job description. Dr. Rater’s report indicated that he understood that there was a sales and
customer-service aspect to Castor’s job, including the “ability to assist customers with orders,
billing and or/collection related issues.” Reviewing her medical history, Dr. Rater noted that
Castor was “reported to be anxious and/or depressed”; nonetheless, he found no medical
evidence of mental-health issues that would rise to the level of disabling her from work.
Dr. Rater’s conclusion that there was no objective indication of a lack of ability to work at all,
that principle here. In Kalish, this Court faulted a plan administrator for relying on a doctor’s
report that concluded that the plaintiff could return to a position requiring “light activity,” but
which did not explain how the plaintiff could return to her actual position, described by Kalish’s
employer as “‘high stress with many deadlines’ and ‘includes responsibility for directing all
aspects of transportation operations, handling negotiations, travel to other sites, and direct
supervision of employees.’” Id. Such a job, this Court found, could not “reasonably be found to
require only ‘light activity.’” Id. at 509. In this case, by contrast, we believe that the physical
demands of Castor’s job were captured by her job description and could also reasonably be
described by Dr. Conrad’s shorthand: “sedentary, with physical requirements including sitting,
typing, and talking.” And Dr. Rater’s report demonstrated that he understood the sales and
customer-service components of Castor’s job, which he described as the “ability to assist
customers with orders, billing and or/collection related issues.” Kalish cannot be read to stand
for the proposition that a summary is impermissible—that a reviewing doctor’s report must recite
and evaluate each item listed in a job description—and counsel at oral argument conceded that
no such requirement exists. Finally, we do not believe that Castor may reasonably complain that
the reviewing doctors failed to appreciate any stressful or skilled components of her job beyond
those listed in the job description, as it does not appear that Castor ever brought any such
information to Sedgwick’s attention. This further distinguishes her case from Kalish, for in that
case, in addition to providing the disability insurer with a job description, Kalish’s supervisor
informed the insurer that Kalish’s job was a “‘high stress position with many deadlines’ and
significant ‘vendor/customer contact.’” Id. at 503.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
combined with his report’s expression that Castor’s job required sales and customer-relations
skills, is sufficient to demonstrate that he believed Castor mentally able to perform the duties of
her job, whether they were skilled or unskilled.8
We, therefore, conclude that the reports of the reviewing physicians adequately
considered and addressed Castor’s job duties and that Sedgwick did not behave arbitrarily and
capriciously by relying upon them.
ii.
Castor also challenges Sedgwick’s conclusion that she was not disabled as of December
11, 2014. Castor makes a perfunctory argument before this Court that Sedgwick acted arbitrarily
and capriciously when it concluded that Castor was not physically disabled as of December 11,
2014. But Castor did not, at any time during the appeal process, attempt to explain why Dr.
Conrad’s initial report was wrong. Nor did she challenge the opinion of her own cardiologist,
Dr. Goyal, that she could return to sedentary work as of December 11, 2014. Indeed, Castor
offers no report from a doctor explaining why she was physically disabled from performing the
duties of her job. The reviewing internist on appeal, Dr. Perez, agreed with Dr. Conrad’s
8
In Elliott v. Metro. Life Ins. Co., 473 F.3d 613, 618–20 (6th Cir. 2006), this Court determined
that a plan administrator’s denial of disability benefits was arbitrary and capricious, in part
because the administrator provided a denial letter that was “a mere recitation of medical
terminology employed by various physicians in their diagnoses of [the plaintiff’s] condition,
without any reasoning as to why those diagnoses would permit her to function in the workplace,”
and because the reviewing doctor “never discussed [the plaintiff’s] job duties, which implies that
he did not conduct a reasoned evaluation of her condition to determine whether she could
perform those duties.” Here, however, it is clear that the reviewing doctors read and understood
Castor’s job duties. Further, all three reviewing doctors determined that she was not disabled
and explained why that was so. Indeed, even if the reviewing doctors’ reports were not fully
consistent with Elliott, we would see no need to remand to the plan administrator to have those
doctors resubmit reports that make explicit that Castor was not physically disabled from working
at her computer or interacting with customers, or that Castor did not have anxiety or depression
that would preclude her from talking on the phone or entering sales negotiations with customers.
Those conclusions are implicit in the reviewing doctors’ reports.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
findings. It cannot be said, therefore, that Sedgwick’s decision regarding Castor’s alleged
physical disability, which was based on the unchallenged reviews by Dr. Conrad and Dr. Perez,
was arbitrary and capricious.
Likewise, Sedgwick’s decision to rely on the independent review of Dr. Rater over
Castor’s proffered evidence of a psychiatric disability was not arbitrary and capricious. As the
district court here recognized, in order to prevail, Castor needed to show that she was disabled
from December 11, 2014, when her short-term disability benefits were terminated, to February
10, 2015, when she could be eligible for long-term disability benefits.
Much of Castor’s evidence does not fit the relevant time period. Shaw only began seeing
Castor near the end of that period, meeting her first on February 2, 2015. It was not until March
2, 2015, that Shaw saw Castor as an outpatient and made a diagnosis regarding her mental
health. For that reason, Shaw could not speak personally to Castor’s psychiatric disability during
the relevant period, save for the eight days between February 2 and February 10. While Shaw
concluded that Castor’s anxiety was debilitating enough to preclude her from working from
February 2015 to June 2015, she could only speculate that Castor suffered from anxiety between
December 2014 and February 2015. Similarly, Dr. Lunderman first met with Castor on March
5, 2015, after the benefits period had expired. While he believed that Castor suffered from
depression and could not handle stress, conditions he believed severe enough to preclude her
from returning to full-time work, Dr. Lunderman could not speak to whether Castor had been
disabled as of December 11, 2014, nor did he even attempt to speculate.
This left only Dr. Murphy’s diagnosis of anxiety and depression. Sprinkled throughout
Dr. Murphy’s medical reports are specific episodes of anxiety and depression. And in his
opinion letter, Dr. Murphy expressed his belief that Castor’s anxiety and depression had been
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
present since mid-2014, and that her anxiety and depression rendered her unable to perform the
duties of her job.
But Dr. Rater, the reviewing psychiatrist on appeal, disagreed. He reviewed Dr.
Murphy’s reports and conclusions and found that, although Castor reported symptoms of anxiety
and depression, those mental-health issues did not prevent her from performing the duties of her
job on or after December 11, 2014. He found noteworthy that Dr. Murphy could not verify
Castor’s complaints regarding lack of concentration or confusion. Even when the reports from
Shaw and Dr. Lunderman were considered, Dr. Rater did not believe that Castor had a
psychiatric disability that precluded her from working, noting that even though there were self-
reported symptoms of depression and anxiety, the mental-health exams did not show “significant
pathology” or otherwise indicate a lack of work capacity.
Castor argues that Dr. Rater’s report is faulty because Dr. Rater disregarded her self-
reported symptoms and subjective evidence in favor of objective medical evidence. More
generally, she argues that the pursuit by Sedgwick and the reviewing doctors of objective
evidence is inconsistent with the Plan’s definition of “Medical Evidence.”
But the Plan says otherwise. A “disability” for the purposes of the Plan “must be
supported by objective Medical Evidence.” The use of “objective” seems to shut the door on the
subjective. But if the door is left ajar, the definition of “Medical Evidence” closes it. The Plan
defines “Medical Evidence” as:
Objective medical information sufficient to show that the
Participant is Disabled, as determined at the sole discretion of the Claims
Administrator. Objective medical information includes, but is not limited
to, results from diagnostic tools and examinations performed in
accordance with generally accepted principles of the health care
profession. In general, a diagnosis that is based largely or entirely on self-
reported symptoms will not be considered sufficient to support a finding
of Disability. For example, reports of intense pain, standing alone, will be
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
unlikely to support a finding of Disability, but reports of intense pain
associated with an observable medical condition that typically produces
pain could be sufficient.
Castor latches on to the last sentence to suggest that subjective evidence is sufficient to establish
disability. But that is not so. Medical evidence must be “objective,” as demonstrated by the first
two sentences. And self-reported symptoms—i.e., the subjective evidence Castor attempts to
rely on now—generally will not be considered sufficient, unless accompanied by some objective
evidence—an observable medical condition.
Dr. Rater’s report did not, therefore, erroneously disregard Castor’s self-reported
symptoms in pursuit of objective medicine. And in light of the competing reports of Dr. Rater
and Dr. Murphy regarding the severity of Castor’s mental-health issues, we cannot say that
Sedgwick’s conclusion that Castor was mentally able to handle the duties of her job was
arbitrary and capricious. See McDonald v. W.-S. Life Ins. Co., 347 F.3d 161, 169 (6th. Cir. 2003)
(“Generally, when a plan administrator chooses to rely upon the medical opinion of one doctor
over that of another in determining whether a claimant is entitled to ERISA benefits, the plan
administrator’s decision cannot be said to have been arbitrary and capricious because it would be
possible to offer a reasoned explanation, based upon the evidence, for the plan administrator’s
decision.”).
***
For these reasons, we AFFIRM the judgment of the district court in favor of AT&T.
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
KAREN NELSON MOORE, Circuit Judge, dissenting. Short-term and long-term
disability plans offer employees a simple promise: pay premiums now, while you are healthy,
and we will pay benefits later, if you become too sick to work. Katherine Castor bought into this
promise and kept her part of the bargain. Yet when Castor developed a litany of illnesses in
2014—starting with Clostridium difficile, then pneumonia and H1N1, and eventually atrial
fibrillation, congestive heart failure, and anxiety, R. 11 (A.R. at 1, 14, 33–34, 41) (Page ID #62,
75, 94–95, 102)—Sedgwick, as the administrator of Castor’s disability-benefits plans, repeatedly
tried to deny Castor’s claim. Id. at 11, 17, 38, 57 (Page ID #72, 78, 99, 118). Eventually,
Sedgwick consulted with Dr. Chester Conrad, a cardiologist, who concluded that Castor was not
disabled “from a cardiology perspective” as of December 11, 2014. Id. at 543–46 (Page ID
#604–07). Sedgwick issued its final denial of Castor’s benefits on December 19, 2014, id. at
551–53 (Page ID #612–14), and Castor initiated an administrative appeal.
During the appeal, Sedgwick again asked Dr. Conrad to review Castor’s file “from a
cardiology perspective,” and it cited Dr. Conrad’s conclusion that Castor was not disabled in
affirming its denial of benefits. R. 11-2 (A.R. at 1406, 1416) (Page ID #1467, 1477). Though
Sedgwick also consulted with Drs. Jose Perez, Jr. and Michael Rater to review Castor’s file from
“an internal medicine standpoint” and “a psychiatry standpoint,” it did not ask a new,
independent cardiologist to review Castor’s cardiac complaints. Id. at 1399, 1412 (Page ID
#1460, 1473). This is a problem. As the majority recognizes, group-health plans are required to
“consult with a health care professional who has appropriate training and experience in the field
of medicine involved in the medical judgment” when reviewing an appeal from an adverse
benefit determination based on a medical judgment, 29 C.F.R. § 2560.503-1(h)(3)(iii), and that
individual may not be someone “who was consulted in connection with the adverse benefit
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determination that is the subject of the appeal, nor the subordinate of any such individual,” id.
§ 2560.503-1(h)(3)(v). By failing to ask anyone other than Dr. Conrad to assess whether Dr.
Conrad had correctly concluded that Castor’s heart problems did not prevent her from working,
Sedgwick violated the basic protections set forth in 29 C.F.R. § 2560.503-1(h)(3).
The majority reaches the opposite conclusion by treating Sedgwick’s consultation with
Dr. Perez, an internist, as adequate for the purposes of 29 C.F.R. § 2560.503-1(h)(3).1 Dr. Perez,
however, disavowed an ability to opine on the entirety of Castor’s cardiac records. In particular,
he explained that he could not interpret the notes from Castor’s “electrophysiology consult” on
January 23, 2015 because such “notes [were] outside of [his] area of expertise.” R. 11-2 (A.R. at
1412) (Page ID #1473). Dr. Perez’s inability to comment on the January 23 “electrophysiology
consult” is all the more noteworthy because Dr. Goyal (Castor’s cardiologist) had stated ten days
earlier that Castor needed another echocardiogram and had noted that “[i]f there is evidence of
worsening ejection fraction or worsening congestive heart failure, she may need to stay on
disability.” R. 11-1 (A.R. at 1019) (Page ID #1080). It is therefore possible that the results of
the January 23 consult touched on the concerns Dr. Goyal raised on January 13, and Dr. Perez’s
failure to decipher the January 23 notes thereby deprived the plan of important information
regarding Castor’s health. Avoiding these sorts of holes in the review process is, presumably,
why the Department of Labor regulations require plan administrators to consult with an
appropriate “health care professional” in the first place.
1
The majority also intimates that Castor may have “abandoned her claim of physical disability” during the
administrative appeal by telling Sedgwick that her “primary disability condition is psychiatric.” Maj. Op. at 7 & n.4.
As the majority acknowledges, Sedgwick specifically told Castor that it would “be reviewing both types of
conditions (cardio/psych)” on appeal. R. 11 (A.R. at 114–15) (Page ID #175–76). As a result, Sedgwick may not
now justify its failure to comply with 29 C.F.R. § 2560.503-1(h) by arguing that Castor had failed to pursue her
cardiac complaints during the administrative appeal. A plan administrator cannot “issue a conclusory denial”—or a
denial premised on procedural missteps—“and then rely on an attorney to craft a post-hoc explanation.” Corey v.
Sedgwick Claims Mgmt. Servs., Inc., 858 F.3d 1024, 1028 (6th Cir. 2017).
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The majority dismisses Dr. Perez’s limitations by concluding that Castor did not raise this
argument before the district court and thereby forfeited it. Castor argued, however, that
Sedgwick violated 29 C.F.R. § 2560.503-1 by “hir[ing] improper medical reviewers.” R. 17
(Pl.’s Mot. for J. on the A.R. at 3) (Page ID #3422). And even if Castor had not been so explicit,
she undeniably raised the claim that she now presses here—that Sedgwick violated 29 C.F.R.
§ 2560.503-1(h)(3), which requires plan administrators to consult with an appropriate “health
care professional” on appeal who was not involved in the initial “adverse benefit determination.”
29 C.F.R. § 2560.503-1(h)(3)(iii), (v). Having raised this claim before the district court, Castor
may now “formulate[] any argument [she] like[s] in support of that claim here.” Yee v. City of
Escondido, 503 U.S. 519, 535 (1992).
For its part, the plan insists that it need not “always consult a specialist to provide a full
and fair review of adverse benefits determinations.” Loan v. Prudential Ins. Co. of Am., 370 F.
App’x 592, 598 (6th Cir. 2010); see also Appellee Br. at 35. While perhaps true, a plan should
consult a specialist where the claimant raises an issue “that only an expert could adequately
address.” Loan, 370 F. App’x at 598; see also Morgan v. UNUM Life Ins. Co. of Am., 346 F.3d
1173, 1178 (8th Cir. 2003) (holding that physician’s opinion that plaintiff’s activities were
“incompatible with fibromyalgic impairment” were not substantial evidence in favor of plan’s
denial of benefits because the physician lacked “any expertise or experience whatsoever in
dealing with fibromyalgia”). Given that Dr. Perez told Sedgwick that his competence to review
Castor’s cardiac records was limited, Sedgwick bore the burden of consulting a physician with
the proper qualifications. I would therefore remand this case to the district court with
instructions to remand to Sedgwick so that Sedgwick can provide Castor with the full and fair
review that it previously failed to conduct.
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I would remand, also, because Sedgwick failed at every stage of its benefits
determination to account adequately for Castor’s actual job duties. Our precedent on this point is
pellucidly clear: a plan administrator “could have made a reasoned judgment [that Castor could
perform her occupation] only if it relied on medical evidence that assessed [Castor’s] physical
[and psychiatric] ability to perform job-related tasks.” Elliott v. Metro. Life Ins. Co., 473 F.3d
613, 618 (6th Cir. 2006). “Put differently, medical data, without reasoning, cannot produce a
logical judgment about a claimant’s work ability.” Id. “[M]erely recount[ing] the technical
contents of [a claimant’s] various medical evaluations,” without “reason[ing] from [the
claimant’s] condition to her ability to perform her occupation” is not enough. Id. at 618–19.
Despite Elliott’s plain rule, none of the reviewing physicians ever considered whether Castor’s
medical conditions made her unable to work, in light of her actual job duties. Dr. Conrad,
notably, did not even have access to Castor’s job duties when reviewing her file during the initial
benefits determination; he relied instead on a boiled-down description of “sedentary, with
physical requirements including sitting, typing, and talking.” R.11 (A.R. at 543) (Page ID #604).
During the appeal phase, all three reviewing physicians purportedly reviewed the list of Castor’s
job duties, but none then assessed her health problems against the actual demands of her job. See
R. 11-2 (A.R. at 1397, 1406, 1412) (Page ID #1458, 1467, 1473).
The majority is unbothered by Sedgwick’s approach, reasoning first that Dr. Conrad’s
“shorthand” of “sit, talk, type” adequately captured the physical requirements of Castor’s job.
See Maj. Op. at 9–10. But we have previously rejected plans’ efforts to distill claimants’ job
duties into the overarching category of “sedentary” work when the plan language instead
requires—as it does here—that the plan consider whether each claimant can perform the specific
duties of his or her job. See Hunter v. Life Ins. Co. of N. Am., 437 F. App’x 372, 377 (6th Cir.
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2011); Kalish v. Liberty Mut./Liberty Life Assur. Co. of Boston, 419 F.3d 501, 506 (6th Cir.
2005); see also R. 11-4 (A.R. at 1373) (Page ID #3319) (plan summary explaining that “[y]ou
are considered Disabled . . . if the Claims Administrator determines that you are Disabled by
reason of sickness, pregnancy, or an off-the-job illness or injury that prevents you from
performing the duties of your job” (emphasis added)). And even if we were not bound by the
above precedent, Dr. Conrad’s “shorthand” description of Castor’s job duties does not, as the
majority insists, adequately capture the potential cardiac demands of Castor’s job duties. See
Maj. Op. at 10. For instance, Castor’s job duties include possible “premise visits” and a
significant amount of customer contact. R. 11-2 (A.R. at 1347) (Page ID #1408). The fact that
Castor could perform a job that involves “sitting, typing, and talking” does not mean that Castor
could perform a job that requires negotiating with customers, coordinating service arrangements
with other departments, and selling products and services. Cf. Javery v. Lucent Techs., Inc. Long
Term Disability Plan for Mgmt. or LBA Emps., 741 F.3d 686, 702 (6th Cir. 2014) (finding “it
troublesome” that a consulting physician “ignored the intellectual aspects of Plaintiff's job as a
software engineer”); Kalish, 419 F.3d at 510 (criticizing Dr. Conrad for concluding that the
plaintiff “could return to a position requiring ‘light activity’” without considering whether the
plaintiff could “return to his ‘high-stress’ position as Director of National Transportation.”). One
might imagine that Castor’s formal duties implicated far greater cardiac concerns than “sit, talk,
type” would imply. Indeed, imagine we must, for Dr. Conrad never opined on this issue one way
or the other.
Sedgwick’s process during the administrative appeal fares no better. To the majority,
“[i]t is evident from each report that the reviewing doctors read and understood Castor’s formal
job description.” Maj. Op. at 11. This conclusion is far from evident to me, given that Dr.
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Conrad’s sole discussion of Castor’s job duties in his second report is the four-word sentence,
“Job description was reviewed,” R. 11-2 (A.R. at 1406) (Page ID #1467), and Dr. Perez offers
the marginally more expansive statement, “The job description for a service representative did
not include physical requirements,” id. at 1412 (Page ID #1473). Though Dr. Ratner actually
acknowledged some of Castor’s specific duties (i.e., “to assist customers with orders, billing
and/or collection related items,” R. 11-2 (A.R. at 1397) (Page ID #1458)), he did not explain
how Castor’s mental health affected her ability to perform those (or other) tasks. And even if the
doctors reviewed Castor’s job duties, they seemingly never considered how the stress Castor
experienced as a result of her job would affect their medical opinions.2 Ultimately, the majority
acknowledges that “the reviewing doctors’ reports were not fully consistent with Elliott,” but
nevertheless concludes that remand is unnecessary because the physicians “implicit[ly]”
determined that Castor was not disabled from performing her work. Maj. Op. at 12 n.8. This is
precisely the sort of process that our case law disallows. We require plans to “reason[] from [a
claimant’s] condition to her ability to perform her occupation.” Elliott, 473 F.3d at 619. The
plan failed to show its reasoning here. Remand is thus the essential next step. See id. at 622.
Finally, I would hold that Sedgwick’s determination that Castor lacked a physical or
mental disability was arbitrary and capricious. “An administrator acts arbitrarily and
capriciously when it ‘engages in a selective review of the administrative record to justify a
decision to terminate coverage.’” Shaw v. AT&T Umbrella Ben. Plan No. 1, 795 F.3d 538, 549
(6th Cir. 2015) (quoting Metro. Life Ins. Co. v. Conger, 474 F.3d 258, 265 (6th Cir. 2007)).
2
The majority believes that Castor may not “reasonably complain that the reviewing doctors failed to
appreciate any stressful or skilled components of her job beyond those listed in the job description, as it does not
appear that Castor ever brought any such information to Sedgwick’s attention.” Maj. Op. at 11 n.7. But a note from
Castor’s treating cardiologist to her primary care physician, which appears in Sedgwick’s files, stated that Castor
was “quite concerned about the high stress level at work causing recurrence of her congestive heart failure.
Although the job is sedentary, there is a lot of pressure placed on the employees to meet certain productivity
quotas.” R. 11-1 (A.R. at 683) (Page ID #744).
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
Turning first to Castor’s heart problems, the record contains no appeal-level review of Castor’s
health issues from a cardiology perspective—aside, of course, from Dr. Conrad’s second report,
which never should have been submitted. Even if Dr. Perez, as an internist, were qualified to
comment on Castor’s cardiac issues, his sole cardiac-based reason for recommending a denial of
benefits was that Castor “has been diagnos[ed] with a cardiomyopathy with CHF and AF with
initial EF [ejection fraction] of 25–30% and improved to 40%.” R. 11-2 (A.R. at 1413) (Page ID
#1474). Assuming that an ejection fraction of 40% is a good clinical sign, focusing on this
aspect of Castor’s charts ignores the evidence pointing in the opposite direction. For instance,
after the improved EF, Castor continued to complain of “shortness of breath when walking,”
R. 11 (A.R. at 572) (Page ID #633), an inability to “walk more than 100 feet before developing
symptoms,” R. 11-1 (A.R. at 683) (Page ID #744), and “heart palpitations and chest pains,”
R. 11 (A.R. at 625–26) (Page ID #686–87). On January 13, 2015, Dr. Goyal wrote to Dr.
Murphy that he was “not sure what is causing [Castor’s] clinical deterioration.” R. 11-1 (A.R. at
683) (Page ID #744). Although Sedgwick may ultimately conclude that Castor’s cardiac issues
are not disabling, it may not do so by selectively examining a single measure of improved heart
health and ignoring contrary evidence.3
3
Nor may a consulting physician “ignore[] favorable evidence from [the plaintiff’s] treating physicians by
failing to make a reasonable effort to speak with them.” Shaw, 795 F.3d at 549. We have previously held that
giving treating physicians only twenty-four hours to respond to a request for a teleconference before basing a
disability determination “on available medical information” marks an “unreasonable deadline.” Id. Nevertheless,
Dr. Perez stated that he called Dr. Murphy’s office “and left a detailed voicemail message requesting a call back
within 24 hours,” and “indicated that after that time, the report would be completed based on information provided.”
R. 11-2 (A.R. at 1410) (Page ID #1471). Unsurprisingly, “[n]o call back was received.” Id. Dr. Perez did not even
attempt to contact Castor’s other physicians or counsel, including Dr. Goyal, Castor’s cardiologist. Although
consulting physicians “‘are not per se required to interview the treating physician,’ the cursory manner in which the
Plan attempted to contact [Castor’s] treating physicians is evidence that the Plan’s decision was not ‘the result of a
deliberate, principled reasoning process.’” Shaw, 795 F.3d at 549 (first quoting Helfman v. GE Grp. Life Assur. Co.,
573 F.3d 383, 393 (6th Cir. 2009); and then quoting DeLisle v. Sun Life Assur. Co. of Canada, 558 F.3d 440, 444
(6th Cir. 2009)).
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Sedgwick’s treatment of Castor’s mental-health issues is even more troubling. The
majority believes that Sedgwick did not err in crediting Dr. Rater’s conclusions “over Castor’s
proffered evidence of a psychiatric disability,” in part because “[m]uch of Castor’s evidence does
not fit the relevant time period.” Maj. Op. at 13. The majority is wrong, however, to limit the
relevant time period to the months between December 11, 2014 (when Sedgwick initially denied
Castor’s claims) and February 10, 2015 (when Castor became eligible for long-term disability
benefits). When assessing whether a plan acted in an arbitrary and capricious manner, we must
review the entire administrative record, and “[t]he administrative record in an ERISA case
includes all documentation submitted during the administrative appeals process because this
information was necessarily considered by the plan administrator in evaluating the merits of the
claimant’s appeal.” Kalish, 419 F.3d at 511. Here, Sedgwick denied Castor’s appeal on the
ground that she was not unable to perform her job duties “from December 11, 2014 through
present.” R. 11-2 (A.R. at 1417) (Page ID #1478) (emphasis added). Evidence from February
10, 2015 through August 11, 2015, when Sedgwick affirmed its termination of benefits, is
therefore relevant.
When the record is viewed as a whole, it is difficult to understand how Sedgwick could
credit Dr. Rater’s conclusions over those of Castor’s treating doctors, given that Dr. Rater’s
conclusions are in irreconcilable tension with the medical records he purportedly reviewed. For
instance, Dr. Rater stated that “[t]here is no report of problems with concentration and attention
that would indicate an impact on her work capacity.” R. 11-2 (A.R. at 1400) (Page ID #1461).
Yet a note to Sedgwick from Dr. Murphy in June 2015 states that “Mrs. Castor was experiencing
clear symptoms of anxiety and confusion” by December 22, 2014. R. 11-1 (A.R. at 929) (Page
ID #990). He explained that “Castor’s anxiety would have disabled her from performing her
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occupation . . . . She is unable to focus and maintain attention and concentration due to these
symptoms and has maintained a GAF score . . . of 50–55.” Id. at 930 (Page ID #991). Similarly,
Cynthia Shaw (Castor’s therapist) stated in June 2015—in a statement given under oath—that
Castor’s anxiety “was impacting her functioning . . . and her functioning was impaired.” Id. at
949 (Page ID #1010). Shaw also explained that, after five months of treatment, Castor “still has
trouble attending and concentrating.” Id. at 954 (Page ID #1015). Shaw further opined that
Castor’s “fear would stop her from being able to be persistent on a task.” Id. at 942 (Page ID
#1003). And Dr. Jack Lunderman, Castor’s psychiatrist, noted in a letter to Sedgwick on June
15, 2015 that Castor “experience[s] severe consequences on a frequent basis. . . . Her inability to
maintain attention and concentration as well as slowed speech would hinder her ability to deal
directly with the public and/or co-workers.” Id. at 1002–03 (Page ID #1063–64). Dr. Rater did
not explain why these findings were clinically insignificant or unpersuasive; he instead pretended
that they did not exist. A plan may not “completely ignore[] favorable evidence from [a
claimant’s] treating physicians” or “reject summarily the opinions of a treating physician, but
must instead give reasons for adopting an alternative opinion.” Shaw, 795 F.3d at 548–49
(second quote quoting Elliott, 473 F.3d at 620). Dr. Rater’s, and ultimately Sedwick’s, failure to
grapple with the evidence and the opinions supplied by Castor’s physicians and counselor is a
hallmark example of arbitrary-and-capricious decisionmaking.
What is more, Sedgwick relied entirely on a file review of Castor’s claims and failed to
conduct an in-person examination—a maneuver we have criticized as “particularly
‘questionable’” where, as here, the claim “involves a mental illness component.” Okuno v.
Reliance Standard Life Ins. Co., 836 F.3d 600, 610 (6th Cir. 2016) (quoting Javery, 741 F.3d at
702)). “Evaluation of mental health necessarily involves ‘subjective symptoms,’ which are most
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
accurately ascertained through ‘interviewing the patient and spending time with the patient,’
such that a purely record review will often be inadequate where a disability claim includes a
mental component.’” Id. (quoting Smith v. Bayer Corp. Long Term Disability Plan, 275 F.
App’x 495, 508 (6th Cir. 2008)).
The majority, however, reasons that Sedgwick could ignore Castor’s evidence of
subjective, self-reported symptoms because the plan summary requires claimants to provide
“objective medical information” to show their disability. See Maj. Op. at 14–15. But the plan
also states that reports of subjective symptoms “associated with an observable medical condition
that typically produces” those symptoms could be sufficient. R. 11-4 (A.R. at 1397) (Page ID
#3343). Here, Castor’s anxiety and depression are linked to “an observable medical
condition”—namely, her congestive heart failure. See, e.g., R. 11-1 (A.R. at 940, 954) (Page ID
#1001, 1015) (Shaw explaining that Castor “worries consistently since she’s had physical
problems about her heart,” “shows a fear of dying due to a discovery of her congestive heart
failure,” and “over-focuses on her physical now as a result of the heart thing, so it gets in her
way and it stresses her out”). Under the plain terms of the plan, Sedgwick could not discount or
ignore evidence of Castor’s anxiety and depression, which resulted from or was exacerbated by
her physical deterioration, simply because her mental-health conditions were harder to observe.4
***
Sedgwick’s determination that Castor was able to return to work may ultimately prove
correct. But Sedgwick must make that determination in a reasoned way—in the way that its plan
documents, the Department of Labor regulations, and our precedents require. Sedgwick’s failure
4
In any event, not all of Castor’s mental-health evidence was subjective. Dr. Lunderman, for example,
noted that “Castor has consistently shown signs of severe depression, and inability to handle stress and with a GAF
score of 40–45.” R. 11-1 (A.R. at 1002) (Page ID #1063).
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No. 17-3400, Castor v. AT&T Umbrella Benefit Plan No. 3
to comply with these procedural protections was unlawful, and I would therefore remand this
case to the district court with instructions to remand to Sedgwick, so that Sedgwick can provide a
full and fair review of Castor’s claims. Because the majority disagrees, I respectfully dissent.
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