June 1994. By relying only on ‘the original’ medical record and Dr. Deutsch’s report, the Administrative Committee acted arbitrarily.
... By failing to address this unrebutted opinion or refute it in any way, the Administrative Committee acted unreasonably.”
Lozada v. Delta Family-Care Disability and Survivorship Plan, 1998 U.S. Dist. LEXIS 11290, *10-11 (M.D. Fla. 1998).
Delta was the defendant in Lozada. Delta did not consider all available
information and examine the record in its entirety in Lozada. Its decision denying
benefits was found to be arbitrary and capricious for this reason. Delta did the exact
same thing in Ms. Wolf’s case. It did not address or even attempt to refute Dr. Wender’s
opinion in any way; it did not examine the record in its entirety. Given Delta’s conflict of
interest, its decision deserves no deference and should not be upheld. However, even
under the most deferential standard of review, Delta’s decision to terminate Ms. Wolf’s
benefits was arbitrary and capricious and cannot be upheld.
Delta did anything it could to determine that Ms. Wolf was no longer disabled. It
did not act solely in the interests of the plan participants and beneficiaries. Due to its
inherent conflict of interest, Delta unreasonably interpreted terms of the Plan and added
additional requirements for eligibility. Delta did not investigate Ms. Wolf’s claim at all
resulting in an incomplete record before it. Moreover, Delta did not even consider all the
information it did have in its possession and specifically ignored the conclusions of Dr.
Wender. Ms. Wolf has proven that she continues to be entitled to benefits. Delta’s
decision to terminate benefits was arbitrarily and capriciously made and cannot be
upheld. Ms. Wolf should receive all past due benefits and Delta should be ordered to
continue paying her benefits until she reaches age sixty-five.