Full opinion text
FINDINGS OF FACT AND CONCLUSIONS OF LAW PATRICIA C. FAWSETT, District Judge. This matter was considered by the Court in a bench trial held on April 8, 2013 (Doc. No. 67), as well as on the submission of the Administrative Record (Joint Exhibit 1; Doc. No. 40-1-40-10), the Joint Final Pretrial Statement (Doc. No. 53, jointly filed by the parties on Mar. 6, 2013), and the parties’ respective Trial Briefs (Doc. No. 58, filed by Plaintiff Deborah Wilson on Mar. 13, 2013; Doc. No. 57, filed by Defendants Sedgwick Claims Management Services, Inc., Walgreen Income Protection Plan for Pharmacists and Registered Nurses, and Walgreen Co. on Mar. 12, 2013). Pursuant to Rule 52 of the Federal Rules of Civil Procedure, the Court makes the following findings of fact and conclusions of law. Judgment will be entered for the Plaintiff and against Defendants. Findings of Fact I. The Procedural History A. The Pleadings This action was brought by Plaintiff Deborah Wilson (“Plaintiff’) pursuant to the Employment Retirement Income Security Act, 29 U.S.C. § 1001 et seq. (“ERISA”) against the Defendants Sedgwick Claims Management Services, Inc. (“Sedgwick”), Walgreen Income Protection Plan for Pharmacists and Registered Nurses (the “WIPPPRN”), and Walgreen Co. (“Walgreen”) (collectively, “Defendants”). (Doc. No. 1; Doc. No. 21 ¶¶ 1-4, 8, 11-18; Doc. No. 40 at 3.) Alleging that Defendants violated ERISA by depriving her of long-term disability (“LTD”) benefits to which she was entitled under the Income Protection Plan for Pharmacists and Registered Nurses (the “IPPPRN”), Plaintiff requests that this Court enter judgment in her favor and against Defendants as follows: (a) [declare that] Plaintiff is entitled to [LTD] benefits from April 8, 2011 through the date of the filing of this lawsuit [January 12, 2012]; and (b) [a]ward benefits in the amount not paid to Plaintiff from April 8, 2011 to the date of filing this lawsuit [January 12, 2012] — a total of $26,316.00, together with prejudgment interest on each monthly payment from the date it became due until the date it is paid; and (c) [a]ward reasonable attorney fees and costs incurred in this action; and (d) [award] such other further relief as this court deems just and proper, including but not limited to ... remanding Plaintiffs claim to the Plan Administrator for further action to address continuing benefits after the final date of benefits awarded by this Court.... (Doc No. 1 ¶ 28 (emphasis in original, footnote added).) On February 28, 2012, Defendants jointly filed their Answer and Defenses. (Doc. No. 21.) B. The Parties’ Pre-Trial Filings and the Court’s Orders 1. Cross-Motions for Summary Judgment and Motion for Reconsideration In an Order dated February 28, 2013 (the “February Order”), on cross-motions for summary judgment, the Court ruled that Sedgwick’s final determination was wrong under a de novo review and that Plaintiff met her burden to establish that she was “disabled” through at least May 11, 2011. (Doc. No. 49.) Nonetheless, the Court denied the parties’ cross-motions for summary judgment because questions of fact existed as to whether the grant of discretion to Sedgwick under a Summary Plan Description for the IPPPRN (the “SPD”) was effective to entitle Defendants to a review of Sedgwick’s resolution of Plaintiffs LTD claim under a deferential standard of review. (Id.) To resolve this issue, the Court set the matter for a bench trial in the April 2013 trial term. (Id.) In an Order dated March 21, 2013 (the “March Order”), the Court denied the Defendants’ Motion for Reconsideration and affirmed its February Order. (Doc. No. 61.) Specifically, the Court held that judgment was properly denied pending receipt at the bench trial of either: (1) the entirety of the documents comprising the IPPPRN (properly authenticated), or (2) admissible evidence establishing that the SPD is the only operative document for the IPPPRN. (Id. at 5-6.) 2. Trial Briefs In anticipation of the bench trial, the parties filed trial briefs. (Doc. No. 57 (“Defendants’ Brief’), and Doc. No. 58 (“Plaintiffs Brief’).) In Plaintiffs Brief, she argues that the Court should enter judgment in her favor because: (1) the Court already has determined that Sedgwick’s claim determination was de novo wrong, and Defendants cannot meet their burden to establish entitlement to review of such claim determination under a deferential standard; and (2) even considered under a deferential standard of review, Sedgwick’s claim determination was unreasonable, and Plaintiff has met her burden to establish entitlement to LTD benefits under the IPPPRN. (Doc. No. 58.) In the Defendants’ Brief, Defendants argue that the Court should enter judgment in favor or Defendants because: (1) Sedgwick’s final claim determination should be reviewed under a deferential standard of review based on language in the SPD; and (2) under a deferential standard of review, Plaintiff cannot meet her burden to establish that Sedgwick’s final determination of her LTD claim was unreasonable and that she is entitled to LTD benefits under the IPPPRN. (Doc. No. 57.) II. The Bench Trial The bench trial was conducted on April 8, 2013. (Doc. No. 67), during which the Court heard testimony from two defense witnesses, attorney Timothy McGrory and Cynthia Craig. In addition, nine exhibits were entered into ewdence. (Id.) A. Trial Exhibits The Defendants submitted the following exhibits, which the Court admitted into evidence without objection from Plaintiff: (1) a document titled “Delegation of Authority Regarding Employee Welfare Benefit Plans” dated January 16, 2004, and executed by Julian A. Oettinger, as Secretary of Walgreen (“Defendants’ Exhibit 1”); and (2) a document titled “Service Agreement for Administration of a Claims Program” dated July 1, 2004, and executed by Sedgwick and Walgreen (the “Service Agreement”), which included a document titled “Addendum to the Service Agreement” effective July 1, 2010, and executed by Sedgwick and Walgreen (the “Addendum”) (collectively, “Defendants’ Exhibit 2”). In addition, the parties submitted seven joint exhibits, including: (1) the Administrative Record of Plaintiffs Claim (the “AR”) (Joint Exhibit 1, previously filed at Doc. Nos. 40-1-40-10); (2) Walgreen’s corporate records concerning income protection plans (Joint Exhibits 2-5, previously filed at Doc. No. 1-1 at 1-7); and (3) Internal Revenue Service (“IRS”) Form 5500 for Walgreen’s “Income Protection Plan” for the years 2010 and 2011 (the “Form 5500s”) (Joint Exhibits 6-7). 1. Joint Exhibits 6 and 7 The two Form 5500s indicate that the “name” of the “plan” is “Income Protection Plan.” (Joint Exhibits 6-7.) Further, the “effective date” for the “plan” is listed as January 1, 1993. (Id.) Finally, the Form 5500s indicate that the plan “funding” and “benefit” arrangements are the “general assets of the sponsor” as opposed to insurance, insurance contracts, or a trust. (Id.) The “plan sponsor” is identified in the Form 5500s as “Walgreen Company.” (Id.) 2. Joint Exhibits 2 through 5 Joint Exhibits 2 through 5 are titled and dated as follows: (a) “Resolution of the Board of Directors Walgreen Income Protection Plan” dated January 29, 1993 (Joint Exhibit 2); (b) ‘Walgreen Income Protection Plan for Managers and Professionals” dated October 4, 1993 (Joint Exhibit 3); (c) “Amendment of Walgreen Co. Welfare Plans” dated April 13, 2000 (Joint Exhibit 4); and (d) “Resolution Regarding Employee Welfare Benefit Plans” dated July 12, 2000 (Joint Exhibit 5). Walgreen’s corporate representative, Mr. McGrory, testified that Joint Exhibits 2 and 3 do not relate to the IPPPRN, and he was unsure whether Joint Exhibits 4 and 5 relate to the IPPPRN. 3. Joint Exhibit 1, The Administrative Record (the “AR”) The parties submitted the Administrative Record as Joint Exhibit 1. The Court will cite to the AR by its numbered pages, “AR000001-AR000484.” In summary, the AR is comprised of the following: (a) Documents related to Plaintiffs claim for short term disability (“STD”) benefits, including: (1) the notes of Sedgwick’s case managers for Plaintiffs STD claim (AR000003-27); (2) correspondence dated March 1, 2010 from Sedgwick to Plaintiff: (a) acknowledging receipt of Plaintiffs “request for disability benefits,” (b) advising that Walgreen “is sending” Plaintiff a copy of the SPD, which “contains all of the provisions about how benefits are determined and how you can qualify for them,” and (c) providing copies of a medical release form and “Instructions to the Physician” for Plaintiff to provide to her doctor (AR000030-41); (3) authorization forms for “Release of Protected Health Information” executed by Plaintiff (AR000046, AR000049), and an “Agreement for Recovery of Overpayment of Benefits Under the Walgreen’s Disability Plan” executed by Plaintiff on March 5, 2010 (AR000047); (4) requests from Sedgwick to Hani H. El Kommos, M.D. (“Dr. Kommos”) for information and “medical documentation (office visit notes, exam results, etc.)” related to Plaintiff (AR000042-44, AR000084); (5) treatment notes of Dr. Kommos for the following dates: (a) March 24, 2008 and February 25, 2010 (AR000045, AR00051), (b) March 4, 2010 (AR000057, AR000063), (c) April 1, 2010 (AR000073-74, AR000077-79), (d) May 13, 2010, May 18, 2010, and May 24, 2010 (AR000089-92), (e) June 3, 2010 (AR000097), and (f) July 28, 2010 (AR000101); (6) a treatment form from Dr. Kommos dated March 4, 2010, indicating that Plaintiff should not work until her “next evaluation” on April 1, 2010 (AR000048); (7) a facsimile dated March 11, 2010 from Dr. Kommos’ office to Sedgwick regarding the extension of Plaintiffs “disability status” to April I, 2010 and providing treatment notes (AR000054), and a facsimile dated March 12, 2010 from Plaintiff to Sedgwick regarding the same (AR000064-68); (8) a facsimile dated April 2, 2010, from Plaintiff to Sedgwick providing a treatment form from Dr. Kommos and office notes indicating that Plaintiff cannot work for two months from April 1, 2010 (AR000072-74); (9) a facsimile dated April 6, 2010 from Dr. Kommos’ office to Sedgwick regarding the extension of ■ Plaintiffs disability status for three months from April 9, 2010 (AR000075-79); (10) a facsimile dated March 27, 2010 from Dr. Kommos’ office to Sedgwick stating that Plaintiff will be unable to work “for approx. 6 months from [her] surgery date 5/14/2010” and her “disability status” should be extended from June 11, 2010 through November 15, 2010 “or longer to be determined” together with notes of Plaintiffs surgical procedures, summary office notes, and a hospital discharge summary (AR000085-86, AR000088-92); (11) facsimiles from Dr. Kommos to Sedgwick providing various treatment notes from June 3, 2010 (AR000096-98, AR000100-101); (12) a completed form provided by Sedgwick to Dr. Kommos concerning the expected duration of Plaintiffs inability to work (AR000099); (13) a “Physical Capacities Evaluation” dated July 28, 2010 (the “PCE”) (AR000102); and (14) “Walgreen’s Disability Benefit Notice(s)” approving disability benefits for the following periods and correspondence to Plaintiff regarding the same: (a) March 4, 2010 through March 12, 2010 (AR000053, AR000060); (b) March 4, 2010 through April 9, 2010 (AR000070, AR000071); (c) March 4, 2010 through June 11, 2010 (AR000081, AR000082, AR000087); (d) March 4, 2010 through July 30, 2010 (AR000094, AR000095); (e) March 4, 2010 through August 23, 2010 (AR000104, AR000106); (b) Documents related to Plaintiffs claim for LTD benefits, including: (1) the notes of Sedgwick’s case managers for Plaintiffs LTD claim (AR000107-156); (2) correspondence from Sedgwick to Plaintiff dated August 6, 2010, advising Plaintiff that she may be eligible for LTD benefits and asking her to complete and return enclosed forms (AR000157-164), and informing Plaintiff that Sedgwick approved her “claim for [LTD] benefits” for the period of August 24, 2010 through September 2, 2010 and instructing Plaintiff to apply for “Social Security Disability benefits” (AR000165-166 (the “Initial LTD Approval Letter”)); (3) an “Employee Application for Benefits” and an “Authorization for Claim Evaluation and Administration” executed by Plaintiff and dated August 10, 2010 (AR000167, AR000172-174); (4) a “Training, Education and Experience Statement” completed and executed by Plaintiff and dated August 10, 2010 (AR000168-170) and Plaintiffs CV (AR000171); (5) correspondence dated May 27, 2004 to Plaintiff from Thomas H. Magee, M.D. (“Dr. Magee”) summarizing findings from the MRI of Plaintiffs lumbosacral spine (AR000320); (6) treatment notes of Dr. Kommos for the following dates: (a) March 2, 1998 and March 16, 1998 (AR000317), (b) February 10, 2004 (AR000318), (c) May 26, 2004 and May 27, 2004 (AR000319), (d) July 1, 2004 (AR000321), (e) May 18, 2005 and May 25, 2005 (AR000322), (f) September 27, 2006 (AR000323), (g) March 24, 2008 (id.), (h) March 4, 2010 and March 11, 2010 (AR000324), (i) April 1, 2010 and May 13, 2010 (AR000325), (j) May 14, 2010 (AR000326), (k) July 28, 2010 (AR000327), (l) September 2, 2010 (AR000178, AR000180, AR000327), (m) October 14, 2010 (AR000190), (n) December 2, 2010 (AR000216, AR000328), and (o) January 13, 2013 (AR000258, AR000328); (7) treatment notes from Stanley Golovac, M.D. (“Dr. Golovac”) from February 8, 2011 (AR000261-264); (8) facsimiles from Plaintiff and Dr. Kommos to Sedgwick providing treatment notes from Dr. Kommos (AR000175-179 (related to an office visit on September 2, 2010), AR000196 and AR000215-216 (related to an office visit on December 2, 2010)); (9) a memo dated September 13, 2010 from Dr. Kommos indicating that Plaintiff would be unable to work for approximately “6-7 months (1 year from surgery dated 5/14/10)” but that Plaintiff “may be able to do a teaching job at community college part time 2-4 hours/day (sitting/sedentary position) in early Spring 2011)” (AR000181); (10) correspondence from Sedgwick to Plaintiff dated September 15, 2010, advising Plaintiff that she is approved for LTD benefits through October 14, 2010 (AR000183); (11) correspondence from Dr. Kommos to Sedgwick dated October 19, 2010, providing office notes, the surgery report, and advising that Plaintiffs inability to work (or stand or walk for long periods) would continue through January 30, 2011 (AR000184-192); (12) correspondence from Sedgwick to Plaintiff dated October 21, 2010, advising Plaintiff that she is approved for LTD benefits through December 2, 2010 (AR000194-195); (13) a Functional Capacity Evaluation dated November 11, 2010 (AR000197-213); (14) a December 17, 2010 Referral Form for an initial independent physician advisor (“IPA”) review (AR000217-240); (15) an IPA Report by Howard Schuele, M.D. dated December 30, 2010 (AR000241-243); (16) correspondence from Sedgwick to Plaintiff dated January 4, 2011, advising that her claim for LTD benefits “is terminated effective December 3, 2010” (AR000245-250 (the “Initial Termination Letter”)); (17) a January 17, 2011 request for appeal of the Initial Termination Letter from Plaintiff to Sedgwick (AR000251-252), and correspondence from Sedgwick to Plaintiff dated January 18, 2011, acknowledging receipt of Plaintiffs appeal (AR000253-256); (18) a facsimile dated January 26, 2011 from Dr. Kommos to Sedgwick providing additional treatment notes and information (AR000257258); (19) a facsimile from Dr. Golovac to Sedgwick providing records supporting Plaintiffs disability claim (AR000259-265), including a “Certification of Health Care Provider for Employee’s Serious Health Condition” completed by Dr. Golovac (AR000266-268); (20) Sedgwick’s “External Physician Advisor Referral Form” dated February 17, 2011 (AR000270-271); (21) the Report of Martin G. Mendelssohn, M.D. (AR000273-277), and a Supplemental Report of William C. Andrews, Jr., M.D. (AR000291292); (22) the Report of Jamie Lee Lewis, M.D. (AR000278-280), and the Supplemental Report of Jamie Lee Lewis, M.D. (AR000293-294); (23) a facsimile dated February 28, 2011 from Plaintiff to Sedgwick regarding her ongoing treatment with Drs. Kommos and Golovac (AR000281-282); (24) correspondence dated March 10, 2011 from Sedgwick to Plaintiff affirming the Initial Termination Letter (AR000297-302 (the “Appellate Decision”)); (25) correspondence dated May 10, 2011 to Sedgwick from Plaintiff appealing the Appellate Decision (the “Second Appeal” (AR0003 03-329)) and submitting a letter from the Social Security Administration (“SSA”) awarding disability benefits to Plaintiff effective April 27, 2011 (the “SSA Determination Letter” (AR000309-316; Doc. No. 53, Part IX, ¶ 9)) and additional medical records (AR000317-328); (26) correspondence to Sedgwick from Plaintiff concerning the overpayment to her resulting from the SSA award (AR000330-336) and providing a copy of correspondence from the SSA concerning calculations of Plaintiffs award (AR000331-336); (27) correspondence dated May 11, 2011 from Sedgwick to Plaintiff acknowledging her Second Appeal (AR000337); (28) correspondence dated June 24, 2011 from Sedgwick to Plaintiff providing notice that Sedgwick was extending the deadline to resolve the Second Appeal as “permitted by the Walgreens Family of Companies Income Protection Plan (LTD) ” (AR000338) (emphasis added); (29) Sedgwick’s referral for a physician advisor’s review dated July 7, 2011 (AR000339); (30) John M. Graham, D.O.’s report concluding that Plaintiff is not “disabled” as of December 3, 2010 (AR000340-343); (31) Charles Brock, M.D.’s report concluding that Plaintiff is disabled from “a pain management perspective” from “12/03/10 through 04/08/11” (AR000344-347); (32) Curriculum Vitae for Drs. Andrews, Brock, Graham, Lewis, and Schuele (AR000375-395); (33) correspondence dated July 28, 2011 from Sedgwick to Plaintiff resolving her second appeal (AR000351-354 (the “Final Determination”)); (34) correspondence dated October 3, 2011 from Plaintiffs counsel to Sedgwick requesting a “review/appeal” of the Final Determination (AR000362-369 (the “Appeal Request”)); (35) correspondence dated October 11, 2011 from Sedgwick to Plaintiffs counsel denying the Appeal Request because “the Walgreen Income Protection Plan only allows for two appeals” (AR000371); (36) . a copy of the SPD (AR000398410); and (37) a copy of “Walgreen’s LTD Step Process” manual for “Management of New and Ongoing LTD Claims” (AR000411-462) and handling appeals (AR000463-486) (collectively, the “Manual”). B. Testimony of Timothy McGrory Mr. Timothy McGrory testified as the corporate representative for Walgreen. (Doc. No. 53 at 11.) Mr. McGrory is an attorney licensed to practice law in the State of Illinois. He works for Walgreens in its employee relations department, providing advice and counsel concerning employee benefit matters, particularly employee benefit plans and ERISA compliance. Mr. McGrory reviews Walgreen’s various benefit plans, including the IPPPRN, and he provides advice concerning such plans. Mr. McGrory testified that the SPD is the “plan document” for the IPPPRN, and there are no “other governing plan documents that relate to”, the IPPPRN aside from the SPD. According to Mr. McGrory, the SPD sets forth: (1) the “obligations” of the plan provider; (2) the “employee rights” as to making a claim under the plan; (3) the procedures for making a claim; and (4) the procedures for appeals of claims and claim denials. He further testified that: ERISA requires that a plan have a plan document. And they require each plan document have a summary plan description so that the plan is written in a plain English manner understandable to everybody, not just to lawyers. So the terms of this plan, we include all of the ERISA bells and whistles to make it the plan document, but it’s also written in a plain English manner so it can serve as a summary plan description. And I believe there’s court cases from around the country that say it’s perfectly acceptable. With respect to the source of Sedgwick’s authority to independently and finally resolve LTD claims under the IPPPRN, Mr. McGrory pointed to language in both the SPD and the Addendum. Specifically, Mr. McGrory pointed to language at page 17 of the SPD (AR000407), which is intended to “clarify ... the function Sedgwick performs, it’s their sole discretion, so it is not any other entities involved in their determinations” and to make “clear that there is not going to be an appeal to Walgreens outside of this process [set forth in the SPD].” In addition, Mr. McGrory pointed to language in the Addendum at page 10 as granting “discretion to Sedgwick.” (Defendant’s Exhibit 2, Addendum, at 10.) Mr. McGrory further testified that Walgreen’s involvement in LTD claims administration was limited to “reviewing employee records” to determine if an employee was eligible under the IPPPRN. With respect to Plaintiff, Mr. McGrory testified that Walgreen did not “review ... medical records with regard to her claim.” On cross-examination, Mr. McGrory could not state when the IPPPRN came into existence, and he did not know if a document exists concerning the initial creation of the IPPPRN. Mr. McGrory further testified that no document exists that “lays out the procedures for delegating discretion to a third-party administrator like Sedgwick” for the IPPPRN. Mr. McGrory confirmed that other summary plan descriptions existed before June 2007, .and such summary plan descriptions named “a third-party administrator other than Sedgwick.” C. Testimony of Cynthia Craig Ms. Craig is the “Manager Operations/Client Services and Assistant Vice President for Sedgwick.” (Doc. No. 53 at 11.) As such, Ms. Craig manages “the day-to-day operations of the Walgreens disability program for all fifty states, including Puerto Rico” and including the IPPPRN. Ms. Craig managed the supervisors and examiners who considered Plaintiffs claim, and she released the initial correspondence advising Plaintiff that her LTD benefits were terminated (the “Initial Termination Letter” (AR000245247)). On cross-examination, Ms. Craig confirmed that Sedgwick approved Plaintiffs claim for LTD benefits on August 6, 2010, after which Plaintiffs claim fell within the “LTD step process for ongoing claims” provided in the Guidelines. .(AR000165166 (providing correspondence dated Aug. 6, 2010); AR000183-184 (providing correspondence dated Sept. 15, 2010 advising Plaintiff that “after review of the medical documentation submitted by your physician, you have been approved to receive” LTD benefits until October 14, 2010); AR000194-195 (providing correspondence dated Oct. 21, 2010 advising Plaintiff that “after review of the medical documentation submitted by your physician, you have been approved to receive” LTD benefits until December 2, 2010).) Ms. Craig explained that Sedgwick geographically and organizationally separates the appeals process from the process of initial claim determination. Nonetheless, the appellate division and the initial claim determination divisions of Sedgwick use the same vendors for their medical peer reviews. In addition, Ms. Craig testified that after a second appeal, LTD claimants have no additional recourse with Sedgwick or Walgreen. With respect to social security determinations and benefits, Ms. Craig testified that “typically,” Walgreen will pay LTD benefits, and then when a notice of a Social Security Administration award “comes in” Sedgwick sends Walgreen a letter so that Walgreen “can reduce the monthly payment” and “calculate if there’s an overpayment.” Similarly to Mr. McGrory, Ms. Craig testified that the sources of Sedgwick’s discretion to resolve a Walgreen” employee’s claims for LTD benefits is the SPD, the Service Agreement and the Addendum. Specifically, Ms. Craig testified that: (1) the SPD is the “governing plan document that Sedgwick utiliz[es] to determine whether someone would be eligible under the plan,” and (2) there are no other “governing plan documents that Sedgwick” uses “in its initial claims examining process.” Like Mr. McGrory, Ms. Craig also testified that Walgreen has no “role” in determining whether a disability “claim has merit with regard to medical documentation.” III. Documents Concerning the Plan and Claims Administration A. The SPD Both of Defendants’ witnesses testified that the SPD is the primary “plan document” for the IPPPRN. The SPD identifies the “Plan Name” as ‘Walgreen Income Protection Plan for Pharmacists and Registered Nurses”, the “Plan Sponsor” as Walgreen Co., the “Plan Administrator” as the “Director of Risk Management and Benefits”, and the “Claim Administrator” as Sedgwick. (AR000409.) In addition, the SPD provides that costs for the plan are paid by Walgreen “from general assets, and from a trust” and the “trustee” is “Northern Trust” located in Chicago, Illinois. (Id.) 1. Eligibility for Benefits Under the SPD According to the SPD, claimants are “eligible for plan benefits when a disability resulting from illness, injury or pregnancy prevents [the claimant] from working.” (AR000402.) For purposes of STD benefits, “the words ‘disabled’ or ‘disability’ ” mean that, “due to sickness, pregnancy, or accidental injury, you are receiving appropriate care and treatment from a doctor on a continuing basis and you are prevented from performing one or more of the essential duties of your Walgreens occupation.” (Id.) For purposes of LTD benefits, the SPD provides a similar definition for “ ‘disabled’ or ‘disability.’” (Id.) Specifically, the SPD provides that “disabled” or “disability” means that due to sickness, pregnancy, or accidental injury, [the claimant] is prevented from performing one or more of the essential duties of [her] own occupation and are receiving appropriate care and treatment from a doctor on a continuing basis; and ... for the first 18 months of [LTD] benefits [the claimant] is unable to earn more than 80% [of her] predisability earnings or indexed pre-disability earnings at [her] own occupation from any employer in [claimant’s] local economy.... (AR000402.) 2. Submission and Resolution of Claims Under the SPD The SPD provides guidance concerning “How to File a Claim,” the “Procedures for Reviewing Claims,” and how to obtain review of a denied claim. (AR000406-407 (instructing employees to “call Sedgwick CMS Disability Claim Center” to “submit a claim”).) The SPD explains that Sedgwick and the Claim Administrator will make “final and binding” benefit determinations as follows: The authority granted to the Claim Administrator [Sedgwick] and the Plan Administrator to construe and interpret the Plan and make benefit determinations, including claims and appeals determinations, shall be exercised by them (or persons acting under their supervision) as they deem appropriate in their sole discretion. Benefits under this plan will be paid or provided to you only if the Claim Administrator [Sedgwick] or the Plan Administrator, as the case may be, decides in its discretion that you are entitled to them. All such benefit determinations shall be final and binding on all persons, except to the limited extent to which the Claim Administrator’s [Sedgwick] decisions are subject to further review by the Plan Administrator. (AR000407.) The SPD further provides that “Walgreen Co. and Sedgwick CMS reserve the right to determine whether your disability qualifies for benefits.” (AR000406.) 3. Preparation, Amendment, Modification, and Termination of the SPD As indicated on its cover page, the SPD was “Prepared by the Walgreen Co. Benefits Department for Walgreen Employees” (the “Benefits Department”). (AR000398.) According to Mr. McGrory, the Benefits Department referenced in the SPD is located “a floor below” his office, and it “prepare[s] all of the benefit plan communications for the various welfare and profit-sharing plan [s]” for Walgreen. Mr. McGrory further testified that he “review[s] the work product” of the Benefits Department, and every “communication” from them comes through Mr. McGrory “for legal compliance.” Mr. McGrory reviewed the SPD itself “before it was sent to the printer,” and it was not “supposed to be signed by anyone.” In addition to identifying the Benefits Department as its preparer, the first page of the SPD provides the following information concerning the purpose of the SPD and the possible amendment, modification, or termination of the IPPPRN: This Summary Plan Description booklet describes the Walgreen Co. Income Protection Plan for Pharmacists and Registered Nurses (the “Plan”) as in effect as of June 1, 2007. You should read the information provided in this booklet so that you will have a full understanding of the benefits provided and the other relevant terms and conditions of the Plan. This Summary Plan Description is the official Income Protection Plan governing document for purposes of describing the various plan provisions. Please understand that [Walgreen] reserves the right to amend, modify or terminate this plan, including any benefits provided under this plan, at any time and for any reason. You will be notified of any changes to the Plan within a reasonable amount of time, but not always prior to the time the change goes into effect. To determine the proper benefits at any given time, it is necessary to consult the Summary Plan Description booklet that is in effect at the relevant time. (AR000399 (emphasis in original).) With respect to amendments, modifications, and terminations, the SPD further provides that “Walgreen Co. reserves the right to alter, amend or cancel the Plan at its sole discretion.” (AR000409.) Further, “[m]odification to the Plan, including amendment and termination, will be implemented at the written direction of the Chief Executive Officer of the Company.” (Id. (emphasis added).) B. The Service Agreement and Addendum Defendants’ witnesses identified the Service Agreement and Addendum as the documents addressing the arrangement between Sedgwick and Walgreen for Sedgwick to provide “Claim Administration” services in relation to several sources of claims, including workers’ compensation and disability claims. Specifically, Mr. McGrory testified that the “purpose” of the Service Agreement is “to establish a relationship, a more formal relationship between Walgreens and Sedgwick” and to document payment terms. Under the Service Agreement, the Claim Administration services provided by Sedgwick include: (1) Reviewing each “Qualified Claim” and processing each claim “in accordance with all applicable local, state and federal laws, rules and regulations” (Defendants’ Exhibit 2, Service Agreement, ¶ l.A.(l)); (2) Conducting an investigation of each Qualified Claim to the “extent deemed necessary” by Sedgwick in the performance of its obligations under the Service Agreement (id. ¶ l.A.(2)); (3) Arranging for “independent” medical experts “to the extent deemed necessary by Sedgwick in the performance of its obligations hereunder” (id. ¶ l.A.(3)); and (4) Paying benefits, expenses and “adjusting or settling each Qualified Claim ....” (id. ¶ l.A.(4)). As -recognized by Defendants’ witnesses, several provisions of the Service Agreement address the discretion afforded to Sedgwick in conducting its Claim Administration duties. For instance, under the terms of the Addendum, Sedgwick acknowledged that it received a “summary plan description” for the “Income Protection Plan for Pharmacists and Nurses.” (Id. Addendum, at 10.) And, Sedgwick agreed “to administer STD and LTD claims in compliance with the applicable summary plan descriptions, as well as [ERISA], as amended, IRS and Department of Labor guidance, and all applicable federal, state and local laws and regulations.” (Id.) As to Sedgwick’s Compensation for administration of long term disability claims, under the Addendum, Walgreen agreed to pay Sedgwick $0.58 per employee per month, plus $75 per open claim per month. (Defendants’ Exhibit 2, Addendum, at 8.) In addition, Walgreen paid Sedgwick $325 per “non-eligibility appeal” and $175 per “eligibility appeal.” (Id.) According to Ms. Craig, Sedgwick has “a financial advantage by having an LTD claim remain open” because Sedgwick is paid monthly for every open claim. Further, if an LTD claim is granted, then the claim remains “open” for purposes of calculating the fee collected by Sedgwick. C. The “Step Process” Manual Sedgwick’s LTD claims handling guidelines are set forth in the Manual provided at AR000411-486. According to Ms. Craig, the Manual provides “the process that examiners would follow” in handling a claim. For instance, the initial claim determination process includes eighteen possible steps, including: (1) the “10-week Review Process” (Step 1); (2) “Follow-up of LTD Application and Other Requests” (Step 5); (3) “PA” (physician advisor) “and IME” (independent medical examination) “Referral Requirements” (Step 8); (4) “Claim Denial Workflow” (Step 10); (5) “Ongoing Claim Review Process” (Step 14); and (6) “Surveillance Request Procedures” (Step 18). (AR000411-462.) The appeal process guidelines include eleven steps, including: (1) “Receipt of Appeal in the National Appeals Unit” (Step 1); (2) “Additional Medical Submitted with Appeal” (Step 3); (3) “Tolling Extensions” (Steps 7a through 7e); and (4) “Completion of the Appeal Review” (Step 11). (AR000463^186.) IV. Plaintiffs Occupation In 2010, Plaintiff was employed by Walgreen as a staff pharmacist for more than three years. (AR000167-175; Doc. No. 53, Part IX, ¶ 6.) “Staff pharmacist” is Plaintiffs “own occupation” under the terms of the SPD. (AR000168.) The position of pharmacist is considered “light” work which requires “continual walking and standing” and some bending and reaching. (AR000218, AR000352.) V. Plaintiffs Medical Conditions In February 2004, Plaintiffs medical records indicate that Dr. Kommos began treatment in relation to Plaintiffs complaints of back pain. (AR000318.) Treatment notes for an office visit on May 26, 2004, describe Plaintiff as “[n]eurologically ... intact,” although an x-ray of Plaintiffs “lumbar spine” showed “retrolisthesis of L4 over L5, extensive DJD [degenerative disc disease, and] loss of disc height in that area.” (Id.) Dr. Kommos recommended spinal fusion surgery for Plaintiff “as there is only one disc at L4-5 with major degenerative changes with instability and traction spur.” (Id.) In treatment notes from May 27, 2004, Dr. Kommos noted that an MRI confirmed “extensive DJD” as well as “edema around the disc at L4-5 with collapse and foraminal stenosis.” (Id.) Dr. Magee’s findings in relation to the MRI further indicate that Plaintiff suffered from “disc desiccation” and “posterocentral annualar bulge” of disc at L3-4 and L4-5. (AR000320.) In July 2004, Plaintiff proceeded with spinal surgery. (AR000321.) Two years after her surgery in 2004, Plaintiff again sought treatment from Dr. Kommos related to back pain on September 27, 2006. (AR000323.) Dr. Kommos noted that he did “not see any evidence here that anything has gone wrong,” and her x-rays showed that her “fusion looks real good and looks solid.” (Id.) Dr. Kommos prescribed ibuprofin and recommended physical therapy. (Id.) Two years later, in March 2008, Plaintiff returned to Dr. Kommos complaining of back pain. (AR000323.) This time, Plaintiffs x-ray showed “DJD at L3-L4 and progression of the disease at a higher level.” (Id.) Dr. Kommos noted that “[n]eurologically,” Plaintiff was “okay.” (Id.) Dr. Kommos again recommended physical therapy and “anti-inflammatories.” (Id.) On February 25, 2010, Plaintiff did not report to work at Walgreen due to pain in her back. At that time, Plaintiff again sought treatment from Dr. Kommos. Plaintiff saw Dr. Kommos on February 25, 2010, complaining of back and hip pain. (AR00045.) X-rays showed that Plaintiffs hip was “entirely normal;” however, her • back showed “complete collapse at L3-L4 with osteophyte formation suggestive of instability at the level of L3-L4.” (Id.) Dr. Kommos noted that “[njeurologically, [Plaintiff was] otherwise intact.” (Id.) Dr. Kommos gave Plaintiff an injection, prescribed Darvocet, and ordered an “MRI.” (Id.) Treatment notes from March 4, 2010, indicate that Plaintiff reported problems working as a pharmacist because the standing and lifting “aggravated” her back. (AR000324; AR000048.) The “most recent MRI” showed DJD “at L4-L5” that “is quite patent,” and x-rays showed “severe DJD at L3-L4 with near collapse in that area.” (AR00063.) Dr. Kommos still described Plaintiff as neurologically “intact.” (Id.) Dr. Kommos excused Plaintiff from work for four weeks and wrote: In the meanwhile, I am going to give her epidural blocks. She does understand that she may require to [sic] have extension of fusion to level above if she continues to be symptomatic. She does understand that if she ... has [the] fusion that she may not be able to return back to do her work on the long run [sic]. (Id. (emphasis added).) On March 11 and March 25, 2010, Plaintiff received epidural blocks, but they did not provide her with relief. (AR000324-325.) On April 1, 2004, Dr. Kommos wrote that Plaintiff is neurologically intact, but she “has severe [DJD] at L3-L4 resulting in mild-to-moderate foraminal stenosis, ... traction spur, and solerosis at the endplate,” (AR000077), and she should not work for “2 months” from April 1. (AR000073.) The following day, on April 2, 2010, Dr. Kommos noted that he would “set [Plaintiff] up for” an “extension and fusion of L3^,” and he again noted that “[njeurologically, [Plaintiff] is intact.” (AR000325.) On May 14, 2010, Dr. Kommos performed surgery on Plaintiff, including the following procedures: (1) exploration of previous fusion mass; (2) removal of hardware; (3) spinal decompression; (4) neurolysis of L3 and L4 nerve root; (5) bone graft harvested from the left iliac crest; (6) posterolateral fusion; and (7) spinal fusion. (AR00090-91.) Postoperative notes indicate that Plaintiff “did very well,” the “post-operative period was unremarkable,” and Plaintiff was “released home” with pain medication, muscle relaxant, and instructions concerning follow-up. (AR000092.) On June 3, 2010, Plaintiff had a follow-up appointment as a result of which Dr. Kommos noted that her wound was “healed” and there was “no tenderness over the incision site.” (AR000097.) Dr. Kommos warned Plaintiff to watch for infection and to “continue the same regime.” (Id.). Dr. Kommos further noted that Plaintiffs “disability status” would extend past her next appointment in July. (Id.) On July 28, 2010, Plaintiff had another follow-up appointment with Dr. Kommos. The treatment notes from that day provide as follows: [Plaintiffs] x-rays are quite satisfactory. She did have 2-level fusion. This lady does have only 4 lumbar vertebrae and I explained that to her. The fusion seems to be solid. She is doing well. She is going to come back and see me again in another 4 weeks. Meanwhile continue wearing the brace. (AR000101.) Dr. Kommos also completed a PCE on July 28, 2010 indicating the following physical restrictions for Plaintiff for “up to 1 year from surgery” — (a) only 30 minutes to 1 hour of sitting, standing, and walking; (b) no pushing, pulling, or “floor-to-waist” lifting; (c) rare reaching and over shoulder lifting; and (d) occasional keyboarding and “waist-to-shoulder” lifting of 4-5 pounds. (AR000102.) On September 2, 2010, the Plaintiff visited Dr. Kommos for an “evaluation.” (AR000178.) At that time, Plaintiff reported that she was “still having a lot of back pain, [and] she cannot return back to work, ... [s]he cannot stand or sit for any extended period of time.” (Id.) Dr. Kommos noted that Plaintiffs “x-rays do show a good fusion mass and good interbody fusion ..., [n]eurologically, she is intact .... [and Plaintiff] has four lumbar vertebrae.” (Id.) Dr. Kommos further noted that “the final long-term outcome of this back surgery may not be determined before one year from the day of surgery.” (Id. (emphasis added)) Dr. Kommos extended Plaintiffs “excuse from work” for six weeks to her “next visit.” (Id.) At Plaintiffs next visit with Dr. Kommos on October 14, 2010, the treatment notes indicate that Plaintiff is still “having a lot of back pain, ... she cannot do all the tests and she cannot stand” or bend or stoop for “any extended period of time.” (AR000190.) Dr. Kommos noted that Plaintiffs “x-rays are quite satisfactory.” (Id.) The treatment notes also state that Plaintiff is waiting to have a functional capacity evaluation (“FCE”), and she applied for permanent disability with Social Security. (Id.) Dr. Kommos advised Plaintiff to continue to wear her brace and follow up in another six weeks. (Id.) Plaintiffs next visit with Dr. Kommos on December 2, 2010 was after her FCE “which revealed that [Plaintiff] could not be evaluated from the functional level.” (AR000216.) At that appointment, Dr. Kommos “extended” Plaintiffs “disability for another three months.” (Id.) Although the December 2, 2010 treatment notes indicate that Dr. Kommos would not see Plaintiff for three months (id.), Plaintiff had an appointment with him on January 13, 2011. (Id.) At the January 13, 2011 appointment, Plaintiff complained of “still having a lot of pain in her back radiating down [her] left lower extremity.” (AR000258.) Dr. Kommos opined that “the continuation” of Plaintiffs pain “could be related to perineural scar tissue.” (Id.) Dr. Kommos refilled her pain medication, advised Plaintiff to continue physical therapy, and noted that Plaintiff may require “a series of lumbar epidural.” (Id.) In February 2011, Plaintiff sought treatment from Dr. Golovac for her continued pain. (AR000260-264.) Dr. Golovac’s treatment notes state that Plaintiffs back pain is “aggravated by ... prolonged standing ... and bending forward” among other things. (AR000261.) Dr. Golovac diagnosed Plaintiff with Postlaminextomy, Lumbar Syndrome, and Chronic Pain Syndrome. (AR000262.) Dr. Golovac suggested that Plaintiff be treated with a “spinal cord stimulator.” (AR000263.) Finally, Dr. Golovac completed a “Certification of Health Care Provider for Employer’s Serious Health Condition” indicating that Plaintiff was “incapacitated” due to her medical condition. (AR000267.) VI. Plaintiffs STD and LTD Claims and Sedgwick’s Claims Handling A. Plaintiffs STD Claim Plaintiff ceased working as a pharmacist for Walgreen on February 25, 2010 (Doc. No. 53, Part IX, ¶ 7), and she submitted a claim under the SPD for STD benefits. (AR00027; AR00030-41.) At the outset, Sedgwick advised Plaintiff to forward documentation concerning any award from the SSA (AR000032), and Plaintiff executed an “Agreement for Recovery of Overpayment of Benefits” resulting from an SSA award or other income sources. (AR00047.) Plaintiff also submitted authorizations for the release of her medical information to Sedgwick. (AR000046, AR000049.) Sedgwick then requested and received medical records from Dr. Kommos, which Dr. Kommos updated throughout the Spring and Summer of 2010. (AR000045, AR000051, AR000057, AR000063, AR000073-74, AR000077-79, AR00008992, AR000097, and AR000101.) In addition to providing treatment notes, Dr. Kommos also sent Sedgwick periodic facsimiles indicating time periods that Plaintiffs medical conditions prevented her from working. (AR000048, AR000054, AR000064-68, AR000072-74, AR00007579.) Dr. Kommos completed the PCE on July 28, 2010, which identified Plaintiffs anticipated significant physical restrictions for “up to 1 year from surgery.” (AR000102 (emphasis added) (advising that Plaintiff could stand for no longer than 30 minutes to one hour).) Dr. Kommos also provided a written response to Sedgwick’s question: “When do you expect Ms. Wilson will be able to return to her job as a Pharmacist?” (AR000099.) In response, Dr. Kommos wrote that Plaintiff ‘Will be able to return in Teaching Capacity in the Spring of 2011 — (may be permanently disabled from her current position).” {Id. (emphasis added).) In a series of “Disability Benefit Noticed” and correspondence to Plaintiff, Sedgwick incrementally approved Plaintiffs STD claim from February 25, 2010 through August 23, 2010. (AR000053, AR000060, AR000070-71, AR000081-82, AR000087, AR000094-95, AR000104, and AR0000106; see also Doc. Nos. 1 and 21.) According to Sedgwick, August 23, 2010 was “the maximum time allowed under the Walgreens Co. Income Protection Plan.” (AR000106; Doc. No. 53, Part IX, ¶ 11.) At the conclusion of the period of STD benefits, Sedgwick advised Plaintiff to “fill out the appropriate forms” for LTD benefits and to return them to Sedgwick “as soon as possible.” (AR000106.) B. Plaintiff s LTD Claim 1. Plaintiffs LTD Application When Plaintiffs STD benefits expired, Sedgwick advised Plaintiff that she may be eligible for LTD benefits (the “Initial LTD Correspondence”). (AR000157-164.) In the Initial LTD Correspondence, Sedgwick advised Plaintiff that she must apply to the SSA for disability benefits and provided information concerning the entity Walgreen “contracted with” to “help” her coordinate the “required application for Social Security benefits,” to “track” the progress, and to “keep Walgreens informed.” (AR000157-158.) In accordance with Sedgwick’s instructions, Plaintiff submitted an application for LTD Benefits (AR000167-175 (the “Application”).) In her Application dated August 10, 2010, Plaintiff stated that her “lower lumbar vertebra are fused,” and she had the following physical limitations: she “cannot bend, twist, or stoop down ... lift anything over 4-5 lbs ... [perform] repetitive motion like pulling or pushing ..., [or] reach above [her] head to retrieve objects.” (AR000172.) Plaintiff further stated that she is limited to about 30 minutes to an hour at a time of sitting or standing, which causes her pain, and she is limited in driving. {Id.) In addition, Plaintiff stated that she has to wear a hard “thorasic [sic] / lumbar” brace. {Id.) All of Plaintiffs claims were substantiated by the PCE and medical documentation submitted to Sedgwick in relation to Plaintiffs STD Claim. (AR000102; see also AR000045, AR000051, AR000057, AR000063, AR000073-74, AR000077-79, AR000089-92, AR000097, and AR000101.) 2. Sedgwick’s Initial Approval of Long Term Disability Benefits In a letter dated August 6, 2010, Sedgwick approved Plaintiffs claim for LTD benefits “payable as of August 24, 2010 through September 2, 2010.” (AR00016566 (the “Initial LTD Approval Letter”); Doc. No. 53, Part IX, ¶ 13.) In the Initial LTD Approval Letter, Sedgwick again advised Plaintiff that she was required to: (1) apply for “Social Security” benefits; (2) provide a receipt of such application to Sedgwick; (3) provide a copy of any correspondence from the SSA notifying Plaintiff when a decision is reached; and (4) call Sedgwick to advise it when the SSA decided her claim. (AR000166.) Sedgwick also advised Plaintiff that she would have to submit “additional medical information” throughout her “absence” from work. (AR000165 (stating that Sedgwick’s LTD “Specialist” would “partner” with Plaintiff “to ensure that requested medical documentation is provided in a timely manner”).) Following the Initial LTD Approval Letter, Sedgwick continued to approve, in increments of several weeks to a month, Plaintiffs requests for continuation of LTD benefits under the Plan. (AR000183 (correspondence dated September 15, 2010, approving LTD benefit payments through October 14, 2010); (AR000194-95 (correspondence dated October 21, 2010, approving LTD benefit payments “through December 2, 2010”).) Sedgwick also continually requested “specific additional information” to substantiate “extension” of Plaintiffs LTD benefits. (AR000183 and AR000194 (requesting Plaintiffs “most recent ... office notes,” operative and diagnostic “test results,” rehabilitation or therapy notes, names and “dosages of all medications,” and “[djetails on restrictions and limitations”).) Plaintiff and Dr. Kommos responded to Sedgwick’s requests for information by providing updated treatment notes (AR000178, AR000180, AR000190, AR000216, and AR000258), as well as facsimiles and memos concerning Plaintiffs inability to work (AR000175-179, AR000184-192, AR000196, AR000215-216, and AR000257-258.) For instance, in a memo dated September 13, 2010, Dr. Kommos advised that Plaintiff would be unable to work for approximately six to seven months from the date of the memo, which was “1 year from surgery dated 5/14110,” although Plaintiff “may be able” work at a “sedentary position ” for two to four hours a day in the “early Spring 2011.” (AR000181 (emphasis added).) Dr. Kommos’ prediction of Plaintiffs recovery was consistent with the estimations he previously provided to Sedgwick and Plaintiff. (AR000102 (advising Sedgwick that Plaintiff could stand for no more then thirty minutes to an hour at a time for “up to 1 year from surgery”); AR00099 (advising Sedgwick that Plaintiff “may be permanently disabled from her current position”); AR00063 (advising Plaintiff that if she has the second spinal fusion surgery, “she may not be able to return back to do her work [in] the long run”).) 3. The Functional Capacity Evaluation (“FCE”) Approximately six months after her spinal surgery, on November 11, 2010, Plaintiff presented for a Functional Capacity Evaluation (the “FCE”). (AR000197240; Doc. No. 53, Part IX, ¶17.) The FCE was conducted by physical therapist, Warren Chinyanganya (the “Therapist”). (AR000197-240.) The Therapist identified the following “deficits” during the FCE: “range of motion deficits, muscle strength deficits, palpable findings and flexibility restrictions.” (Id.) With respect to musculoskeletal screening, the Therapist noted that Plaintiffs gait “is slow and antalgic without reciprocal trunk rotation.” (AR000200.) Plaintiffs posture showed “a posterior trunk lean with a loss in lumbar lordosis, increased thoracic kyphosis and a forward head position.” (Id.) Plaintiffs “soft tissues” had “palpable tenderness,” and Plaintiff exhibited “muscle guarding in the lower lumbar paraspinals ... [and] a 6 inch surgical incision that has healed well.” (Id.) Nonetheless, “due to self-limitation and lack of physiologic changes throughout the testing,” the Therapist concluded that he could not classify Plaintiffs Physical Demand Level. (Id.; Doc. No. 53, Part IX, ¶ 18.) Plaintiff provided . Sedgwick with a copy of the FCE on December 8, 2010. (AR000141.) 4. The Medical Review by Howard M. Schuele, M.D. (“Dr. Schuele”) Soon after receipt of the FCE, Sedgwick arranged for board-certified orthopedic surgeon, Dr. Schuele, to review Plaintiffs medical records, including the FCE, and to opine on two questions. (AR000217-240 (the “Initial Referral”).) Importantly, Sedgwick did not provide Dr. Schuele with available treatment notes from Dr. Kommos for the following seven dates: March 24, 2008, February 25, 2010, March 4, 2010, April 1, 2010, May 13, 2010, May 18, 2010, and May 24, 2010 (AR000045, AR00051, AR000057, AR000063, AR000073-74, AR000077-79, AR00008992). (Compare supra Findings of Fact, Part II.A.3, at Paragraph (A)(5) (listing all of the treatment notes submitted by Plaintiff and Dr. Kommos in support of STD claim), with AR000241 (listing progress notes provided from Dr. Kommos as covering the period from June 3, 2010 through December 2, 2010).) Instead, Sedgwick only provided Dr. Schuele with medical documentation of Plaintiffs surgery on May 14, 2010, and Dr. Kommos’ post-surgery notes from June 3, 2010 through December 2, 2010. (AR000241.) Based on this incomplete medical information, the first question Sedgwick submitted to Dr. Schuele was what “conditions have been indicated by the treating provider to. affect the employee’s ability to work? Explain.” (AR000242.) Dr. Schuele responded as follows: There are subjective findings on office visits 09/02/10, 10/14/10, and 12/02/10 of continued back, pain with difficulty standing, stooping, and bending. Objective findings on 09/02/10 state that she is neurologically intact and x-rays of 09/02/10 and 10/14/10 show good fusion mass and good interbody fusion. No other objective findings have been documented and these objective findings do not prevent her ability to perform her job. (Id.) The second question Sedgwick submitted to Dr. Schuele asked “[i]s there objective medical information in the medical records or from the teleconference to support the employee’s complete inability to work? Explain.” (Id.) To this question, Dr. Schuele opined: No. As above, the objective findings do not support the employee’s complete inability to work. The FCE does document problems with physical demands secondary to self-limitation. Further, the rapid exchange grip test showed submaximal effort. Her surgery was on the lower back which would affect the lower extremities. Strength in the upper extremities would not be affected from her surgery and from her diagnosis. (Id.) Nowhere in the three-page Schuele Report does Dr. Schuele note that the job at issue is pharmacist, nor does he identify the physical tasks that were pertinent to whether Plaintiff could “perform her job.” (Id.) The Sehuele Report was conclusory at best. 5. Sedgwick’s Initial Termination of Benefits Following receipt of the Sehuele Report, Sedgwick provided correspondence to Plaintiff dated January 4, 2011, advising that “it has been determined that you do not qualify for continued disability benefits under the Plan ..... [and, as] a result, your claim benefits terminated effective December 3, 2010.” (AR000245-50 (the “Initial Termination Letter”).) The. Initial Termination Letter provided the following as the grounds for Sedgwick’s decision: Upon review of the medical .documentation, Dr. Sehuele reported you underwent an exploration of previous fusion mass at L4-L5, removal of hardware from L4-L5, spinal decompression at L3-L4, neurolysis of the L3 and L4 nerve root, bone graft harvest from the left iliac crest, posterolateral fusion at L3-L4 and L4-L5, as well as interbody fusion at L3-L4 using a PEEK cage 7 mm wide, and spinal fusion from L3 to L5 using variable axis Synthes pedicular screws on May 14, *2010. The exam on September 2, 2010 showed you were neurologically intact. The x-ray showed good fusion mass and good interbody fusion. At the visit of October 14, 2010, Dr. El Kommos reported the x-rays showing good fusion mass and good interbody , fusion. The [FCE] indicated there was self-limitation and sub-maximal effort and was not useful to determine functional capacity. Finally, Dr. Sehuele [sic] the medical documentation does not support restrictions and limitations which would preclude you from performing your job duties as a Pharmacist as of December 3, 2010. (AR000246.) In the Initial Termination Letter, Sedgwick advised Plaintiff that she or her “authorized representative” may appeal Sedgwick’s decision “by submitting a written request for review of your denied claim (first level appeal) within 180 days after your receipt” of the Initial Termination Letter. (AR000246.) Sedgwick further instructed Plaintiff to “state the reason(s)” she believed her “claim was improperly denied.” (Id.) Finally, Sedgwick informed Plaintiff that she “may also submit additional medical or vocational information, and any facts, data, questions or comments you deem appropriate for [Sedgwick] to give [her] appeal proper consideration.” (Id.) C. Plaintiffs First Appeal Plaintiff appealed the decision set forth in the Initial Termination Letter. (AR000251-52 (the “First Appeal”).) In relation to her First Appeal, Plaintiff submitted additional medical documentation to Sedgwick, including: (1) medical records from Dr. Kommos opining that “the continuation” of Plaintiffs “pain could be related to perineural scar tissue” (AR000258); (2) documentation concerning her referral to and treatment by pain management specialist, Dr. Golovar (AR000257-258); (3) a “Certification of Health Care Provider for Employee’s Serious Health Condition” executed by Dr. Golovar (AR000266-269); and (4) Plaintiffs summary of her ongoing medical treatments, epidural block injections, aquatic physical therapy, and use of a “Select 1.5 TENS unit at home.” (AR000251.) 1. Sedgwick’s Additional Medical Reviews In relation to Plaintiffs First Appeal, Sedgwick obtained medical reviews from three additional doctors, Board Certified Orthopedic Surgeons, Martin G. Mendelssohn, M.D. and William C. Andrews, Jr., M.D., and Jamie Lee Lewis, M.D., who was Board Certified in Physical Medicine and Rehabilitation and Pain Medicine. (AR000270-271.) As it did in seeking an opinion from Dr. Schuele, Sedgwick failed to provide Drs. Mendelssohn, Andrews, and Lewis with all of Dr. Kommos’ treatment notes. In particular, Sedgwick again omitted the treatment notes from Dr. Kommos for the following seven dates: March 24, 2008, February 25, 2010, March 4, 2010, April 1, 2010, May 13, 2010, May 18, 2010, and May 24, 2010 (AR000045, AR00051, AR000057, AR000063, AR000073-74, AR000077-79, AR00008992). Compare supra Findings of Fact, Part II.A.3, at Paragraph (A)(5) (listing all of the treatment notes submitted by Plaintiff and Dr. Kommos in support of STD claim), with AR000273 (listing progress notes provided from Dr. Kommos as covering the period from June 3, 2010 to January 13, 2011). With the incomplete medical documentation, Sedgwick also provided Drs. Lewis and Mendelssohn with the Schuele Report and the FCE. (AR000273, AR000278.) Based upon this limited record, Drs. Lewis and Mendelssohn both concluded that Plaintiff was “not disabled.” (AR000273-277; AR000278-280; infra Findings of Fact, Part VI.C. l.a., and Part VI.C. l.b.) Dr. Andrews simply opined that he would not change Dr. Mendelssohn’s opinion based upon a consideration of Dr. Kommos’ PCE for Plaintiff. (Infra Findings of Fact, Part VI.C. l.c.) a. Martin G. Mendelssohn, M.D. (“Dr. Mendelssohn”) In a five-page memorandum dated February 24, 2011 (the “Mendelssohn Report”), Dr. Mendelssohn provided the following “rationale” for his opinion that Plaintiff was not disabled: This claimant, who is 57 years of age and is a pharmacist, underwent a two-level fusion by Dr. El Kommos. Postoperatively, there was no evidence of any complication. X-rays revealed that the fusion matured. There was no evidence of any failure of hardware. However, the claimant continued to have subjective complaints. Dr. El Kommos did not provide a comprehensive examination that indicated that the claimant had functional or neurological deñcits nor were there any supporting diagnostic studies. An FCE indicated the claimant provided a self-limiting effort and an accurate estimation of her physical capacities could not be provided. It should be noted that the claimant’s upper extremity gripping tests were found to be weak and below the levels that one would expect; however, this would not be related to her back surgery and again indicated that there is self-limiting factor. The findings do not support the inability of the claimant to perform her regular unrestricted occupation as a pharmacist as of 12/03/10 to return to work. (AR000276 (emphasis added).) Dr. Mendelssohn dismissed Plaintiffs reports of continued pain after her second spinal surgery as “subjective” and unsupported by “any clinical findings” from Dr. Kommos. (Id.) In his Report, Dr. Mendelssohn also responded to five specific questions posed by Sedgwick. (AR000275.) The first question was “Is the employee disabled from her regular unrestricted job as of 12/03/10 to the return to work?” (Id.) Dr. Mendelssohn responded: No. Based on medical documentation, the claimant underwent a lumbar fusion and has continued to have subjective complaints. However, a comprehensive examination from Dr. El Kommos outlining functional deficits or neurological deficits is not provided. X-rays revealed that there was no evidence of a