beside the point; the Court must instead determine whether, in a light
most favorable to the Plaintiff, Equitable's decision based on those
reports in 1998 and 1999 was "without reason, unsupported by substantial
evidence or erroneous as a matter of law," measured by a heightened
scrutiny arising out of the inherent conflict of interest when the Plan
Administrator both funds and determines benefits.
Plaintiff's sole remaining argument is that, even if the doctors'
opinions are admissible, Equitable's decision was arbitrary and capricious
because the doctors' opinions are completely outweighed by the reports
presented by Dr. Conti's own treating physicians. Having reviewed all of
the evidence in the record, the Court agrees that Plaintiff's argument
would have been important if the Court were applying a de novo standard
of review. That having been said, the many conflicting reports have
little bearing on the Court's analysis under an arbitrary and capricious
standard, because the "he said/she said" between the many doctors in this
dispute sheds little light on the internal propriety of Equitable's
decision, or whether there was an adequate foundation for it.
Taking all of the evidence in a light most favorable to Plaintiff, a
reasonable trier of fact could conclude from the reports of Plaintiff's
physicians that Dr. Conti is disabled and cannot perform the material
duties of a chiropractor. But that is not what is at issue here: whether
Equitable acted arbitrarily and capriciously. Viewing the facts in the
same favorable light, a reasonable trier of fact can not escape
un-controverted evidence that Equitable based its decision to terminate
Dr. Conti's benefits on the opinions of several doctors,*fn11 and did so
after giving Plaintiff repeated opportunities to offer rebuttal evidence
from his own doctors. Equitable's records reflect that Dr. Conti's
physicians' reports were considered, and were even forwarded to one of
Equitable's own doctors for review. In the face of such measured
consideration of Dr. Conti's medical condition, even taking all of the
evidence in a light most favorable to Plaintiff, it would be impossible
for a trier of fact to conclude that Equitable acted in an arbitrary and
The decision of Equitable was rational, supported by substantial
evidence and not erroneous as a matter of law. In other words it was not
arbitrary or capricious or an abuse of discretion. Abnathya, 2 F.3d at
45. It withstands a heightened arbitrary and capricious review: the
result was reasonable (particularly in light of the video tapes)and the
process was free of suspicious irregularities and inconsistencies.
Applying the Pinto sliding scale to this case, the decision of Equitable
is entitled to considerable deference. A fact finder could not conclude
that Equitable's decision to credit the medical opinions it relied upon
rather than those Dr. Conti's was the result of self-dealing rather than
a good faith decision of a fiduciary. Since there is no genuine issue of
material fact as to whether Equitable acted arbitrarily and
capriciously, it is entitled to summary judgment.
For all of the foregoing reasons, Defendant Equitable's motion for
judgment is granted. Dr. Conti's motion for summary judgment is denied.
An appropriate Order follows this Opinion.
This matter having come before the Court on Defendant Equitable's
motion for summary judgment pursuant to Fed.R.Civ.P. 56, and Plaintiff
Conti's cross-motion for summary judgment pursuant to Fed.R.Civ.P. 56;
The Court having considered the submissions of the parties; and
The Court having decided this matter without oral argument pursuant to
Fed.R.Civ.P. 78; and
For the reasons set forth in the Court's Opinion filed this day; and
For good cause shown;
It is on this ___ day of October, 2002, hereby ORDERED that Defendant's
Motion for Summary Judgment is granted, and Plaintiff's Cross-Motion for
Summary Judgment is denied.
IT IS FURTHER ORDERED that the Clerk of the Court shall close this