Opinion
Case No. 02-CV-5906 (FB) (LB)
July 1, 2003
CHRISTINE A. FULLER, Long Island City, NY, Pro Se.
TALEE S. ZUR, ESQ., J.P. Morgan Chase Legal Department, J.P. Morgan Chase Co., New York, NY, For Defendant.
MEMORANDUM AND ORDER
On April 28, 2003, the Court sua sponte amended pro se plaintiff Christine Fuller's ("Fuller") complaint to include a claim for an ERISA violation by defendant J.P. Morgan Chase Benefits Appeal Committee ("J.P. Morgan Chase"). See Fuller v. J.P. Morgan Chase Benefits Appeal Committee, No. 02-CV-5906 (E.D.N.Y. April 28, 2003). The Court also converted J.P. Morgan Chase's motion to dismiss the claim to a motion for summary judgment, and afforded Fuller thirty days to respond. The motion is now fully briefed, and for the reasons that follow, the Court grants summary judgment in J.P. Morgan Chase's favor, dismissing Fuller's complaint.
In 1996, Fuller, who suffers from bi-polar disease, applied for long-term disability benefits under J.P. Morgan Chase's long-term disability plan ("LTD Plan" or "Plan"). Under the terms of the Plan, employees with long-term physical disabilities could receive benefits through age 65, see LTD Plan ¶ 7.2(b) (Ex. C, Aff. of Talee Zur, Jan. 17, 2003), but if "the Total and Permanent Disability . . ., on which the [long term disability is] based ar[ose] from a mental or emotional disease or disorder," the employee was entitled to only eighteen months of benefits. Id. ¶ 7.2(d) (emphasis added). The plan administrator, and the committee overseeing the administrator, had the "exclusive right and full discretion to interpret any and all of the provisions of the Plan and to determine any questions arising thereunder or in connection with the administration of the Plan," id. ¶¶ 9.6, 10.3 — including deciding whether an employee's disability was a physical or mental disorder. See id. ¶¶ 7.2(b), (d).
Fuller received eighteen months of benefits after the plan administrator designated her bi-polar disorder as a long-term mental disability. See Aff. of Paula J. McGee ¶ 2 (Ex. A, Aff. of Talee Zur, June 11, 2003). The plan administrator made this determination because bi-polar disorder is listed in the Diagnostic and Statistical Manual of Mental Disorders IV, published by the American Psychiatric Association ("DSM-IV"). See id. ¶ 7; Aff. of Patricia Bailer ¶ 4. (Ex. B, Aff. of Talee S. Zur, June 11, 2003). The plan administrator "consistently defer[ed] to the DSM IV for determination on psychiatric and psychological disorders, as an authority on the subject matter." Aff. of Paula. J. McGee ¶ 8.
Although the DSM-IV lists bipolar disease under the category of "mood disorders," see DSM-IV, at 350-62, it also contains the following caveat in its introduction:
Although this volume is titled the Diagnostic and Statistical Manual of Mental Disorders, the term mental disorder unfortunately implies a distinction between "mental" disorders and "physical" disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much "physical" in "mental" disorders and much "mental" in "physical" disorders. The problem raised by the term "mental" disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute.Id. at xxi. In an unsuccessful appeal of her limited benefits determination, Fuller emphasized the physical nature of bi-polar disorder by submitting affidavits to the plan administrator from medical experts who contended that she suffered from a physical disability. An expert from the National Alliance for the Mentally Ill opined that "the causes of bipolar disorder are rooted in the complex biochemical processes that occur within the human brain. . . . [and] would therefore properly be classified as a `physical' rather than a `mental or nervous' condition." Letter from Ron S. Honberg Rex W. Cowdry, Nov. 27, 2000 (Pl.'s Affirm., Feb. 24, 2003, Attach. 2). Fuller's treating doctor opined that Fuller suffers from "bipolar disorder which is a chemical imbalance — a medical and physical illness of the brain. . . . Ms. Fuller has a medical condition with emotional symptoms[.]" Letter from Alan Manevitz (Pl.'s Affirm., Feb. 24, 2003, Attach. 3); see also Aff. of Alan Manevitz, May 27, 2003 ¶ 15 (Opp'n to Mot., May 22, 2003, Ex. 1) (describing bi-polar disorder as a "medically and physically caused illness treated by a medical doctor").
II
The Court grants a motion for summary judgment when, in the absence genuine issues of material fact, the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). The Court resolves "all ambiguities and draw[s] all factual inferences in favor of the party opposing the motion[,]" reading "pleadings of a pro se plaintiff liberally and interpret[ing] them to raise the strongest arguments that they suggest." McPherson v. Coombe, 174 F.3d 276, 280 (2d Cir. 1999) (quotations omitted).
Where, as here, a long-term disability plan grants the plan administrator full discretion to interpret its terms, the Court reviews the administrator's decision under the deferential arbitrary and capricious standard of review. See Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 956-57 (1989) ("[D]enial 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."); Pagan v. Nynex Pension Plan, 52 F.3d 438, 441 (2d Cir. 1995) ("[W]here the written plan documents confer upon a plan administrator the discretionary authority to determine eligibility, we will not disturb the administrators ultimate conclusion unless it is `arbitrary and capricious.'"). Under this standard of review, the Court "may overturn a decision to deny benefits only if it was without reason, unsupported by substantial evidence or erroneous as a matter of law." Pagan, 52 F.3d at 442 (internal quotation omitted). Substantial evidence is "such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the decisionmaker and requires more than a scintilla but less than a preponderance." Miller v. United Welfare Fund, 72 F.3d 1066, 1072 (2d Cir. 1995) (internal quotation and alterations omitted). In reviewing decisions of plan fiduciaries, the Court is limited to reviewing the administrative record that "the fiduciaries themselves considered." Id. at 1071. In addition, when the Court reviews a plan administrator's decision under the deferential standard of review, the rule of contra proferentum, under which ambiguities in the terms of a plan are resolved against the drafter, is inapplicable, see Pagan, 52 F.3d at 443-44; "the rule of contra proferentum is limited to those occasions in which this Court reviews an ERISA plan de novo." Id. at 443.
The Court cannot conclude that J.P. Morgan Chase acted in an arbitrary and capricious manner in labeling bi-polar disorder a mental disability. Although "mental disability" is not defined in the Plan, the plan administrator resolved any ambiguity about the meaning of the term by relying on the DSM-IV, the American Psychiatric Association's compendium of mental disorders. See Tolson v. Avondale Indus., Inc., 141 F.3d 604, 610 (5th Cir. 1998) (labeling depression a mental disability because the "Eighth and Ninth Circuits, as well as the American Psychiatric Association, characterize `depression' as a `mental' disorder") (citing Lynd v. Reliance Standard Life Ins. Co., 94 F.3d 979, 984 (5th Cir. 1996)).
Although the DSM-IV recognizes that many mental conditions have physical aspects, and many experts, including the doctors who submitted letters on Fuller's behalf, believe that bi-polar should properly be designated a "physical" disease, the DSM-IV notes that there is no clear method of classifying mental and psychological diseases. In time, the medical authorities may resolve this issue in favor of finding bi-polar disorder to be a physical condition. Compare Fitts v. Federal Nat'l Mortgage Assoc., 191 F. Supp.2d 67, 76-77 (D.D.C. 2002) (employing de novo standard of review, finding bi-polar disorder to be physical, not mental, disability); with Prudential Ins. Co. of America v. Doe, 140 F.3d 785, 791 (8th Cir. 1998) ("the term `mental illness' should be considered from a layperson's reading and is therefore not ambiguous[,]" and applies to both affective mood disorder and major affective disorder). However, the split among the experts is not material to the disposition this motion, given the Court's deferential level of review, the inapplicability of the rule of contra proferentum, and the reasonableness of J.P. Morgan Chase's reliance on the authority of the DSM-IV. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986) ("As to materiality, the substantive law will identify which facts are material. Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment.").
III
Summary judgment is granted in favor of J.P. Morgan Chase, and Fuller's complaint is dismissed.