Dorris v. Cummins Engine Co., Inc. Group Ins. Plan

Citations: 470 F. Supp. 2d 797; 2006 U.S. Dist. LEXIS 92122; 2006 WL 3759898Docket: 3:04-0983

Court: District Court, M.D. Tennessee; December 19, 2006; Federal District Court

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Karen Dorris, the plaintiff, is seeking long-term disability (LTD) benefits under a policy maintained by her former employer, Cummins Engine Company, Inc. The case is currently before the United States District Court for the Middle District of Tennessee, with both the plaintiff and defendants filing cross-motions for judgment on the administrative record. 

Dorris was employed by Cummins for nearly 15 years as a customer service representative, a position requiring extensive sitting, reaching, and occasional walking and standing. Starting in 2001, she experienced severe health issues, including fatigue, pain, headaches, and cognitive difficulties, which severely impacted her daily activities and social participation. 

Between 2001 and 2003, multiple specialists diagnosed her with fibromyalgia, with significant corroboration from various medical professionals regarding her condition's severity and the presence of related ailments such as migraines and sleep disorders. 

The defendants in the case include the Cummins Group Insurance Plan and the insurance companies involved in administering the LTD benefits, specifically the Connecticut General Life Insurance Company (CGLIC), which was responsible for making decisions regarding Dorris's disability claims. The policy was originally issued by Equitable Life Assurance Society. CGLIC would cover the first 24 months of any awarded disability benefits, while Cummins would handle any further payments.

Cummins, Inc. offers self-insured health care and dental coverage, with employee contributions required. The company maintains a long-term disability (LTD) policy governed by CIGNA Group Insurance. To qualify as 'totally disabled,' Ms. Dorris needed to prove she could not perform all job duties for the first two years of her disability, after which she must be unable to work in any capacity for compensation or profit. Disability status is contingent upon being under a doctor's care, starting from the initial examination. Benefits may be reduced by Social Security payments, and claimants must apply for Social Security disability benefits to receive full LTD payments.

Ms. Dorris received short-term disability benefits from November 3, 2001, to May 3, 2002, and filed for LTD benefits on March 28, 2002, citing conditions such as fibromyalgia and chronic pain, with her disability onset dated December 13, 2001. She identified four treating physicians and submitted an Attending Physician's Statement from Dr. Acosta, who diagnosed her with obstructive sleep apnea and fibromyalgia and detailed her physical limitations. Dr. Acosta concluded that Ms. Dorris was totally disabled both in her current occupation and any other, recommending further rehabilitation. On May 1, 2002, CIGNA acknowledged receipt of her application and requested authorization to access her medical records.

CIGNA received medical records solely from Dr. Acosta, who confirmed Ms. Dorris’s primary diagnosis of fibromyalgia and secondary diagnosis of obstructive sleep apnea. Ms. Dorris reported various symptoms including sleep disturbances, headaches, fatigue, and pain. Dr. Acosta's clinical findings indicated severe pain in multiple body areas and he had employed several treatment methods including physical therapy and medication. In a Physical Ability Assessment from May 10, 2002, Dr. Acosta classified Ms. Dorris's functionality as sedentary, allowing for occasional light work.

On May 8, 2002, Ms. Dorris's employer, Cummins, submitted a job requirements questionnaire indicating her role as a customer service representative necessitated continuous sitting, seeing, and hearing, along with frequent reaching and occasional standing or walking.

CIGNA case manager William Smith denied Ms. Dorris’s claim for long-term disability benefits on June 3, 2002, citing a lack of clinical evidence demonstrating severe impairments that would prevent her from performing her job duties as of her last working day. Smith acknowledged Ms. Dorris's reported symptoms but concluded they did not provide sufficient grounds for benefits. He informed her of her right to appeal and suggested materials that could strengthen her case, such as personal statements and medical records.

Ms. Dorris sought Social Security Disability Benefits after CIGNA informed her on May 10, 2002, that her long-term disability (LTD) policy required her to apply for Social Security Disability Insurance (SSDI) and that CIGNA would assist her through Advantage 2000 Consultants, Inc. (A2K), at no cost. On June 10, 2002, she filed her SSDI claim, which was denied by the Social Security Administration (SSA) on July 22, 2002, citing that her medical conditions, including fibromyalgia and lupus, were not severe enough to prevent her from working.

Dorris argued that A2K terminated her representation after CIGNA denied her claim, which diminished their interest in her Social Security offset. She appealed CIGNA's decision on July 24, 2002, and provided additional medical records indicating ongoing issues such as fatigue and pain, along with treatments received from several doctors. After a review, CIGNA denied her appeal on October 23, 2002, stating that the medical information did not support her inability to perform her duties as a Customer Service Representative. CIGNA noted no evidence of a change in her condition since she last worked on November 3, 2001, and highlighted the absence of restrictions from her treating physicians regarding her capacity for sedentary work.

Ms. Rudeen informed Ms. Dorris of her right to pursue benefits under ERISA Section 502(a). On April 29, 2003, Cummins reviewed Ms. Dorris's long-term disability (LTD) claim, including materials she submitted and CIGNA's claim file. Cummins clarified that CIGNA held the final authority on disability determinations and verified that CIGNA applied the correct plan terms and reached a reasonable decision based on the documentation. However, Cummins expressed concern that Ms. Dorris may not fully understood the reasons for CIGNA's denial and requested that CIGNA allow her another appeal, which was granted.

Margaret Gray-Mayer from Cummins sought clarification from CIGNA regarding the specific evidence needed to support Ms. Dorris's appeal, noting that while CIGNA acknowledged her symptoms and fibromyalgia diagnosis, they required medical evidence demonstrating her inability to perform her job. Ms. Dorris was provided with three specific types of evidence that would be beneficial for her appeal.

On August 12, 2003, CIGNA acknowledged receipt of Ms. Dorris's second appeal, providing details on the process. By September 10, CIGNA announced it would conduct a peer review of her claim, encouraging her to facilitate communication between her doctors and the reviewing physician. Dr. Kenneth Graulich, a board-certified neurologist, reviewed Ms. Dorris's medical records and communicated with her doctors, ultimately concluding that the documentation did not support her inability to work in a full-time sedentary position during the specified timeframe. He characterized fibromyalgia as a controversial diagnosis lacking definitive pathological evidence, stating that the symptoms were largely self-reported and did not warrant full impairment from sedentary work.

On October 17, 2003, CIGNA denied Ms. Dorris's appeal for disability benefits, stating the decision was based on previous denial letters and a lack of sufficient information to alter their conclusion. CIGNA Appeals Claims Examiner Pattie Holt referenced Dr. Graulich's findings, which indicated that Ms. Dorris's symptoms were self-reported and lacked medical evidence to support a severe condition preventing sedentary work. Holt informed Ms. Dorris that she had exhausted her administrative remedies and could pursue legal action under ERISA Section 502(a).

On September 14, 2004, Ms. Dorris, through her attorney, notified CIGNA of a favorable Social Security award dated August 25, 2004, which recognized her disability due to fibromyalgia and depressive disorder. She requested that CIGNA reconsider her claim in light of this award. However, on September 24, 2004, CIGNA stated that all appeal rights had been exhausted and no further appeals would be considered.

Ms. Dorris filed suit on October 29, 2004, and later sought limited discovery and inclusion of the SSA award in the administrative record. On November 8, 2005, the court ordered CIGNA to reconsider the claim considering the SSA award. CIGNA subsequently filed for relief under Rule 60(b), which the court denied on December 21, 2005, affirming the remand.

On May 26, 2006, Ms. Dorris moved to reinstate the case, citing a lack of communication from CIGNA regarding the SSA award review. CIGNA had Dr. Paul D. Seiferth, Medical Director for Life Insurance Company of North America, review Ms. Dorris's claims file, including the SSA award, and found no objective evidence of functional impairment supporting limitations below sedentary work.

On May 31, 2006, CIGNA upheld its prior determination that Ms. Dorris was ineligible for benefits, asserting that her medical evidence was consistent with her ability to perform sedentary work, despite acknowledging the established diagnosis of fibromyalgia.

Mr. Sharp informed Ms. Dorris that Dr. Seiferth found the SSA's medical records insufficient to support a disability claim under the Policy, which requires the inability to perform "all duties" of her job for total disability qualification. He noted that LINA KD 1868 indicates the standards for disability assessment may differ between the SSA and Ms. Dorris's policy. Without adequate documentation of her conditions since November 3, 2001, Mr. Sharp concluded that CIGNA could not support her disability claim. Ms. Dorris argues that CIGNA's denial was incorrect and requests that the court reverse the decision to award her long-term disability (LTD) benefits per the Policy.

The standard of review for ERISA benefit denials is de novo unless the plan grants the administrator discretionary authority, which would invoke the arbitrary and capricious standard. The court must assess the plan's language to determine the applicable standard. Defendants assert that CGLIC's decision is reviewable only under the arbitrary and capricious standard due to a clear grant of discretion in the plan, citing LINA KD 1824. In contrast, Ms. Dorris argues for a de novo review, claiming inconsistencies in the plan documents and administrator representations prevent a clear grant of discretion. She highlights a specific instance—Linda Weisbord's communication on November 6, 2003—where a plan document was provided without clear indication of discretion.

Ms. Dorris's attorney confirmed the governing plan document with CIGNA, noting discrepancies in the file. The plan previously provided by CIGNA required proof of disability to satisfy Fleetguard, Inc. or Separation Technologies, Inc., and did not grant discretionary authority to CIGNA or other defendants. In October 2005, defendants identified a different document, "Fleetguard Insurance Benefits," asserting it contradicted Ms. Dorris's claims. This document also required proof of disability to be given to the Equitable and did not confer discretion upon the defendants. Defendants later stipulated that this was the correct plan document, which stated the need for proof that satisfies the Claims Administrator. The court found this language sufficient to confer discretionary authority, thus applying the arbitrary and capricious standard of review, as established in prior case law. However, since defendants did not produce the document until October 2005, years after Ms. Dorris's claim was filed in March 2002, and had relied on various plan documents during that time, the court determined that CGLIC had not clearly established its discretionary authority to deny benefits. Consequently, the court concluded that the de novo standard of review applies to CGLIC's denial of Ms. Dorris's long-term disability benefits.

The court applies a de novo standard of review to assess CGLIC's determination regarding Ms. Dorris's total disability claim. This standard allows the court to evaluate the decision independently, without bias or presumption of correctness, focusing solely on the existing administrative record. The court aims to interpret the ERISA plan in accordance with the parties' intent as expressed in the plan language.

In its review, the court finds that Ms. Dorris has provided sufficient evidence of total disability linked to her medical condition, fibromyalgia, and demonstrates that she has not worked for compensation while under medical care. The review of the administrative record indicates that Ms. Dorris meets the plan's definition of total disability, particularly concerning her inability to perform essential duties of her former role at Cummins.

CGLIC's initial denial of Ms. Dorris's claim relied on a more stringent definition of total disability, requiring proof that she could not perform "any and every duty" of her job, a standard that is significantly more challenging than the one ultimately identified as controlling. This stricter interpretation, which was applied inconsistently throughout the claims process, contradicts the plan's language stating that a claimant is considered totally disabled if they cannot perform "all duties pertaining to" their employment. The court concludes that the evidence supports Ms. Dorris's claim for long-term disability benefits and cannot uphold CGLIC's denial based on the misapplication of policy language.

CIGNA denied Ms. Dorris's benefits claim multiple times, initially applying a strict standard before later using a less stringent one from the October 2005 Policy. This inconsistency raises concerns about the reasonableness of CIGNA's decision and suggests a potential conflict of interest. Ms. Dorris provided substantial medical evidence supporting her fibromyalgia diagnosis, including evaluations from several treating physicians. Dr. Acosta, her primary doctor, confirmed the diagnosis and indicated that she could not meet her job's physical demands, specifically the requirement to sit for 5.5 hours and reach for 2.5 hours daily. Other specialists, including Dr. Ozenne and Dr. Nwofia, supported this diagnosis, with Dr. Nwofia noting that she met all criteria for fibromyalgia syndrome. Notably, even CIGNA's own reviewing physician concurred with the diagnosis. Despite this, CIGNA's initial denial claimed a lack of clinical evidence demonstrating severe findings that would impair functionality. This discrepancy highlights the challenges Ms. Dorris faces in proving her disability under the terms of her "regular occupation" policy.

CIGNA denied Ms. Dorris's claim based on Dr. Acosta's assessment, which indicated she could perform sedentary work. However, Dr. Acosta's findings also noted significant functional impairments: specifically, Ms. Dorris was unable to sit for 5.5 hours daily and reach at desk level for 2.5 hours, both of which were essential for her former job. Additionally, Dr. Acosta consistently indicated that Ms. Dorris was totally disabled from her job and daily activities. Other medical evaluations corroborated this, with Dr. Ozenne stating her fibromyalgia incapacitated her, and Dr. Nwofia reporting she could only manage self-care. Physical therapist Marcus Franco documented her inability to perform even sedentary work due to severe pain and weakness. Although Dr. John noted some improvement with medication, his assessments did not confirm Ms. Dorris's capacity to fulfill her job duties. Legal precedent supports that symptom improvement does not equate to work capability, as established in cases like Glenn v. MetLife and Green v. Prudential Ins. Co., where the courts emphasized the necessity of evaluations addressing the claimant's ability to perform job requirements. Ultimately, multiple medical professionals had concluded that Ms. Dorris remained totally disabled despite any reported improvements.

Mrs. Dorris has been totally incapacitated and unable to work since November 1, 2001, qualifying her for disability. Despite medical evidence supporting her condition, CIGNA denied her claim on June 3, 2002, citing that her doctor, Dr. Acosta, indicated limitations that supposedly allowed her to perform sedentary work. CIGNA's denial did not adequately address the opinions of Drs. Ozenne and Nwofia, nor did it consider the observations from Mrs. Dorris's physical therapist. Internal communications within CIGNA revealed a misinterpretation of Dr. Acosta's assessment, suggesting an unfounded belief that her limitations would permit her to work at a higher level. Medical evaluations from Drs. Acosta and others confirmed Mrs. Dorris's total disability, contradicting CIGNA's selective interpretation of her condition. The court highlighted that a treating physician's comments regarding the claimant's capacity for sedentary work cannot justify denial of benefits when other findings indicate total disability. Moreover, CIGNA's reliance on Dr. Kenneth Graulich, a file reviewer who had not examined Mrs. Dorris and who questioned the legitimacy of fibromyalgia, was inadequate. Following a remand to assess her Social Security Administration (SSA) award, CIGNA's internal medical director, Dr. Paul Seiferth, also provided an opinion based solely on a records review rather than a personal examination. Ultimately, CIGNA's denials of benefits were deemed unjustified given the comprehensive evidence of Mrs. Dorris's inability to perform her job duties.

Failure to conduct a physical examination can question the thoroughness and accuracy of a benefits determination. While reliance on a file review alone does not imply impropriety by a plan administrator, it is a factor in evaluating the decision-making process. The absence of a physical examination by a consulting physician is considered when determining if the administrator acted arbitrarily in favoring that physician's opinion over treating physicians. 

In this case, Dr. Acosta and Dr. Ozenne, who treated Ms. Dorris throughout her dispute with CIGNA, consistently found her totally disabled due to fibromyalgia. Their conclusions were supported by Dr. Nwofia and Ms. Dorris's physical therapist. In contrast, Drs. Graulich and Seifert, who had not examined Ms. Dorris, disagreed, yet failed to adequately explain their differing opinions. The court has noted that a plan administrator cannot arbitrarily dismiss treating physicians' opinions without proper justification. 

CIGNA's reliance on a "sedentary" job classification from the U.S. Department of Labor, while denying benefits, contradicts the terms of the Long-Term Disability (LTD) Plan, which defines disability based on a claimant's inability to perform all job duties for the first two years of disability, rather than solely on job classification.

The court emphasizes the importance of analyzing the specific requirements of Ms. Dorris's former job in relation to the Policy, rather than merely relying on the DOT's sedentary classification. The Social Security Administration's (SSA) determination of total disability is a crucial factor in reviewing the plan administrator's denial of benefits under the ERISA plan. Although the SSA's decision alone does not necessitate overturning a denial, it is a significant consideration within the broader context of the case.

The court notes that MetLife should have given appropriate weight to the SSA's finding of total disability, especially since Ms. Dorris was financially supported by this determination. CIGNA's failure to consider the SSA's favorable ruling, despite having directed Ms. Dorris to seek legal representation, is also a critical point. The SSA's findings included documented symptoms and functional limitations related to Ms. Dorris's fibromyalgia and depressive disorder, backed by credible assessments from various medical professionals. The SSA found her subjective allegations credible, taking into account her testimony, demeanor, and substantial work history.

CIGNA's assertion that Ms. Dorris lacked objective evidence for her claims is challenged by the fact that no CIGNA physician had direct contact with her to assess her credibility. The SSA concluded that Ms. Dorris had a residual functional capacity for less than a full range of work activities, indicating a severely eroded occupational base. This finding is particularly relevant for evaluating her disability status under the Policy's "any occupation" criteria and has not been addressed by the defendants.

Additionally, the defendants suggest that Ms. Dorris did not fully comply with CIGNA's requests for further evidence during her appeal. However, CIGNA had specifically asked for documentation such as a personal letter explaining her inability to work, an independent medical examination report, and a complete medical record from her treating physicians since November 2001.

Mrs. Dorris submitted comprehensive medical documentation, including records from six doctors who diagnosed her with fibromyalgia, alongside a Physical Abilities Assessment (PAA) from Dr. Acosta and a Job Requirements Form requested by CIGNA. She also provided clinical evaluations detailing her disability, a personal letter explaining her inability to work, and sought clarification on any further documentation needed, such as a Functional Capacity Evaluation. CIGNA indicated it would notify her if additional information was required but subsequently denied her claim for the fourth time, citing a lack of medical evidence to support the severity of her condition for sedentary work. Notably, CIGNA's team leader had instructed staff not to request functionality evaluations during this process.

CIGNA's rationale for denial hinges on the absence of "clinical" or "objective" evidence of Ms. Dorris's incapacity to perform her job duties, which contradicts the policy language. The policy does not impose additional requirements for evidence type beyond what is specified, nor does it suggest that subjective evidence should be deemed less credible. Legal precedents highlight that it is unreasonable for a plan to dismiss subjective complaints, especially in cases like fibromyalgia, where objective tests for symptoms are unavailable. The absence of a clear and conspicuous standard for objective medical evidence in the policy further complicates CIGNA's position, as it risks undermining the claimant’s reasonable expectations for coverage. Fibromyalgia is characterized by entirely subjective symptoms, with no definitive laboratory tests for diagnosis or severity.

Fibromyalgia is characterized by symptoms including fatigue, disturbed sleep, stiffness, and the presence of multiple tender spots—specifically, 18 designated locations on the body, with a diagnosis requiring at least 11 tender points. The claimant, Ms. Dorris, is confirmed to have fibromyalgia, but assessing the severity of her condition is challenging due to the lack of objective clinical tests. CIGNA previously treated Dr. Acosta's physical assessment as objective when denying benefits, while Dr. Acosta followed the American College of Rheumatology's criteria for diagnosing fibromyalgia, which is recognized by courts as objective evidence for long-term disability claims.

Lab tests revealed that Ms. Dorris had infections linked to fibromyalgia, and her physical therapist indicated she could not perform sedentary work. Additionally, an SSA determination supported her treating physicians' findings, offering further objective backing for her condition. CIGNA contended that there was no evidence of a change in Ms. Dorris's condition between her working and ceasing work; however, the Seventh Circuit, in Hawkins v. First Union Corp., clarified that a person can be disabled yet still attempt to work despite their condition not worsening. The argument that a change in condition is required upon stopping work was deemed arbitrary, and CIGNA cannot penalize Ms. Dorris for her efforts to work while her health declined.

CIGNA's handling of Ms. Dorris's claim has been deemed unfair, particularly regarding the governing plan document, the standard of disability used for denials, and the identification of the claims administrator. CIGNA's inconsistent communication regarding the burden of proof has raised doubts about whether Ms. Dorris could have adequately met its requirements. The governing Policy states that Ms. Dorris must demonstrate an inability to perform "all duties" of her job to be considered "totally disabled" for the first two years.

Multiple physicians, including CIGNA's own Dr. Graulich, diagnosed Ms. Dorris with fibromyalgia based on established testing criteria, aligning with her reported symptoms. These doctors assert that she is "totally disabled" from her former job and daily activities. CIGNA has not seriously questioned the credibility of Ms. Dorris or her physicians. The Social Security Administration (SSA) found her a credible witness, noting her consistent testimony and work history.

CIGNA's reliance on vague terms like "sedentary" without considering the specific demands of Ms. Dorris's job was inappropriate. The demands of her prior role, such as continuous sitting and frequent reaching, were specified by Dr. Acosta, who indicated that Ms. Dorris could not fulfill these requirements. CIGNA's file review doctors, who did not examine Ms. Dorris or engage with her directly, failed to address these limitations.

CIGNA ignored significant evidence documenting Ms. Dorris's diagnoses and functional limitations and acted with a financial conflict of interest, contrary to the SSA's disability determination. Consequently, the court finds that the evidence supports Ms. Dorris's claim of total disability due to fibromyalgia, ruling that she is entitled to long-term disability (LTD) benefits under the Policy. The court reverses CIGNA's denial and orders the award of all past-due LTD benefits. Defendants have suggested remanding the matter for another review if the court overturns their denials.

Ms. Dorris's disability claim remains unresolved regarding her ability to perform "any work" for which she is reasonably fitted, as the defendants have only assessed her capability to carry out her employment duties at Cummins. The defendants argue that the court's jurisdiction is limited to awarding benefits for a two-year period, as claims should not extend beyond that timeframe without a formal decision. The last denial of her long-term disability (LTD) claim occurred on May 31, 2006, after she had been out of work for over four and a half years, exceeding the "own occupation" evaluation period. The defendants should have evaluated her claim under both "own occupation" and "any occupation" criteria at that time. The court finds no reason to permit the defendants to reconsider Ms. Dorris's disability status retroactively, especially given their previous remand which resulted in a delayed ruling. The court cites a precedent indicating that remanding would be futile where no factual determinations are required. Evidence from the administrative record indicates that Ms. Dorris is unable to perform any work due to her medical conditions, with multiple doctors affirming her total disability and incapacity for any job or normal activities. The Social Security Administration (SSA) also concluded that her functional capacity is severely limited, rendering her unable to find significant employment. Additionally, a doctor advised against her participation in vocational rehabilitation. Ms. Dorris's benefits are contingent upon her continued proof of total disability as defined by her policy. She also seeks an award for attorney's fees and costs, which the court may grant at its discretion under 29 U.S.C. 1132(g)(1).

The court evaluates the request for attorney's fees based on five factors: 1) the culpability or bad faith of the opposing party, 2) the opposing party's ability to pay the fees, 3) the deterrent effect of the award on similar cases, 4) whether the fee requester aimed to benefit all ERISA participants or resolve significant legal issues regarding ERISA, and 5) the merits of the parties' positions. No single factor is decisive. In this case, most factors favor Ms. Dorris, despite the absence of a common benefit to the ERISA plan participants. The defendants' extended misconduct justifies an award of fees and costs to Ms. Dorris. Consequently, the court grants her motion for judgment, denies the defendants' motion, reverses the denial of her long-term disability benefits, and orders the defendants to pay her past-due benefits and reinstate ongoing benefits. Ms. Dorris is also entitled to attorney's fees and costs. 

Furthermore, Ms. Dorris requests to amend the judgment to clarify her entitlement to prejudgment and postjudgment interest, extend the timeframe for the parties to reach an agreement on past-due benefits, and require submission of briefs if an agreement is not reached. The court notes that any motion to alter or amend must be filed within ten days of judgment per Federal Rule of Civil Procedure 59.

Most courts regard the ten-day filing requirement as jurisdictional, meaning it must be adhered to strictly (Feathers v. Chevron USA, Inc.). The plaintiff filed a timely motion under Rule 59 within this period. A judgment can be altered or amended for three primary reasons: 1) an intervening change in controlling law; 2) newly available evidence; or 3) to correct a clear error of law or prevent manifest injustice (GenCorp, Inc. v. Am. Int'l Underwriters Co.). The court grants the plaintiff's motion for clarification on significant issues pertinent to a just resolution, particularly concerning an award of prejudgment interest as part of damages. 

In ERISA cases, the district court has the discretion to award prejudgment interest based on equitable principles (Ford v. Uniroyal Pension Plan). This interest compensates beneficiaries for the lost time value of withheld funds. Although federal law does not specify a prejudgment interest rate, the Sixth Circuit has endorsed using the 52-week Treasury Bill rate from 28 U.S.C. § 1961 as a guideline (Caffey v. UNUM Life Ins. Co.). The "stream-of-benefits" model is preferred for calculating prejudgment interest in ERISA cases, which calculates interest on each monthly payment due (Gaffey). This model, using a blended interest rate, prevents overcompensation by only applying interest to payments when they are due.

The court finds it appropriate to award prejudgment interest due to the defendants' wrongful withholding of long-term disability benefits for over four years, both to compensate the plaintiff for the delay and to deter future wrongful denials. Additionally, the plaintiff seeks post-judgment interest, which is mandated by 28 U.S.C. § 1961 to be calculated from the judgment's entry date, accruing daily until paid. This statute applies to all money judgments, including those in ERISA cases (Hoover v. Provident Life).

The plaintiff is entitled to post-judgment interest on the entire judgment amount, including any prejudgment interest, as established by the Sixth Circuit. The court is granting the plaintiff's request to amend the November 17, 2006 Order, allowing an additional thirty days for the parties to negotiate the valuation of past-due benefits and the associated prejudgment and post-judgment interest. If the parties cannot reach an agreement within this timeframe, they must submit briefs addressing the outstanding issues and any necessary information from the defendants. Additionally, it is noted that CIGNA Group Insurance is not a separate legal entity from CGLIC, the correct defendant responsible for Ms. Dorris's long-term disability (LTD) benefits claim. Although a conflict of interest exists due to CGLIC's role in the denial of the claim, it does not alter the standard of review but is a factor in assessing potential abuse of discretion. CGLIC's decisions directly impact its financial responsibilities for any awarded benefits.

In *Killian v. Healthsource Provident Adm'rs, Inc.*, the court highlighted the inherent conflict of interest for insurance companies that both manage benefits and aim to generate profit, emphasizing that their fiduciary responsibilities are compromised by this dual role. Furthermore, it was noted that Dr. Seiferth's review of the patient's condition was potentially insufficient. While Dr. Seiferth acknowledged variability in the patient's health, the attending physician, Dr. Acosta, provided a more detailed account, indicating significant fluctuations in the patient's abilities, including periods of being nearly bed-bound without any substantial recovery to perform even half a day's work. Additionally, in relation to procedural matters, the court ruled that the relevant time frame for the plaintiff's motion did not include the day the order was entered, weekends, or the Thanksgiving holiday, in accordance with Federal Rule of Civil Procedure 6.