Mullins v. AT&T Corporation
Filing
UNPUBLISHED PER CURIAM OPINION filed. Originating case number: CA-03-69 Copies to all parties and the district court/agency. [998572244].. [04-2135, 04-2136, 07-1717, 10-2010]
Case: 04-2135
Document: 208
Date Filed: 04/20/2011
Page: 1
UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 04-2135
MARGARET MULLINS,
Plaintiff - Appellee,
v.
AT&T CORPORATION,
Defendant – Appellant,
and
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL
EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES,
Defendants.
No. 04-2136
MARGARET MULLINS,
Plaintiff - Appellant,
v.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY
PLAN
FOR
OCCUPATIONAL
EMPLOYEES;
AT&T
CORPORATION; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL
EMPLOYEES,
Defendants - Appellees.
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Date Filed: 04/20/2011
Page: 2
No. 07-1717
MARGARET MULLINS,
Plaintiff - Appellant,
v.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY
PLAN
FOR
OCCUPATIONAL
EMPLOYEES;
AT&T
CORPORATION; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL
EMPLOYEES,
Defendants - Appellees.
No. 10-2010
MARGARET MULLINS,
Plaintiff - Appellant,
v.
AT&T CORPORATION,
Defendant – Appellee,
and
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL
EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES,
Defendants.
Appeals from the United States District Court for the Eastern
District of Virginia, at Alexandria. Gerald Bruce Lee, District
Judge. (CA-03-69; 1:03-cv-00069-GBL-TCB)
2
Case: 04-2135
Argued:
Document: 208
Date Filed: 04/20/2011
January 26, 2011
Before TRAXLER,
Judges.
Chief
Judge,
Decided:
and
NIEMEYER
and
Page: 3
April 20, 2011
AGEE,
Circuit
Affirmed by unpublished per curiam opinion.
ARGUED: Robert Barnes Delano, Jr., SANDS ANDERSON, PC, Richmond,
Virginia,
for
AT&T
Corporation,
Connecticut
General
Life
Insurance
Company,
AT&T
Long
Term
Disability
Plan
for
Occupational Employees, and AT&T Medical Expense Plan for
Occupational Employees.
Patricia Ann Smith, LAW OFFICES OF
PATRICIA A. SMITH, Alexandria, Virginia, for Margaret Mullins.
ON BRIEF: Jeffrey H. Geiger, SANDS ANDERSON, PC, Richmond,
Virginia,
for
AT&T
Corporation,
Connecticut
General
Life
Insurance
Company,
AT&T
Long
Term
Disability
Plan
for
Occupational Employees, and AT&T Medical Expense Plan for
Occupational Employees.
Unpublished opinions are not binding precedent in this circuit.
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PER CURIAM:
Margaret
granting
Mullins
summary
appeals
judgment
the
district
against
her
court’s
on
her
decision
claim
for
disability benefits under a long-term disability plan (the “LTD
Plan” or “Plan”) self-funded by her employer, AT&T Corporation
(“AT&T”),
Company
administered
Income
(“CGLIC”),
Security
§ 1132(a)(1)(B).
by
and
Act
Connecticut
governed
of
AT&T
1974
by
General
the
Employee
(“ERISA”).
cross-appeals
Life
the
See
Insurance
Retirement
29
district
U.S.C.
court’s
decision imposing a penalty under 29 U.S.C. § 1132(c)(1) for
AT&T’s failure to produce a copy of the Summary Plan Description
(“SPD”) upon Mullins’ request.
We affirm.
I.
Mullins was employed by AT&T as a communications assistant.
In this capacity, she handled “relay” calls for disabled persons
that required her to type telephone conversations as quickly as
possible.
Under
the
While at AT&T, Mullins was covered by the LTD Plan.
Plan,
an
employee
is
considered
disabled,
therefore entitled to LTD benefits, when:
in the sole opinion of [CGLIC], [the employee] is
determined
to
be
incapable
of
performing
the
requirements of any job for any employer (including
non-AT&T employment), (as a management or occupational
employee), for which the individual is qualified or
may reasonably become qualified by training, education
4
and
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or experience, other than a job that pays less than 50
percent of [the employee’s] annual Base Pay.
J.A. 365.
In April 1998, Mullins was diagnosed with bilateral carpal
tunnel
syndrome
(“CTS”)
which
caused
sensitivity and pain in her hands.
her
to
experience
Mullins also had diabetes,
which was thought to aggravate her CTS condition.
In late 1998
and early 1999, Dr. Stephen Schroering, an orthopedic surgeon,
performed carpal tunnel surgery on both of her hands.
Mullins
returned to work at AT&T on April 8, 1999, but her physician
determined that she was unable to perform the continuous and
repetitive keyboarding duties required by her position.
She
stopped working at AT&T effective April 16, 1999.
On
April
condition
forceful
maximum
work
23,
1999,
prohibited
grasping
grip
with
her
with
Schroering
from
“work
either
strength,”
either
Dr.
and
hand,
requiring
hand,
other
including
stated
greater
that
Mullins’
repetitive
than
“work
requiring
keyboard
work.”
50%
of
or
her
repetitive
J.A.
548.
However, Dr. Schroering noted that Mullins “does well as long as
she is not doing” such repetitive work throughout the day.
548.
and
J.A.
He felt that Mullins was unable “to return to her usual
customary
work
as
an
AT&T
vocational rehabilitation.”
Mullins
a
10%
permanent
operator,
J.A. 548.
disability
5
and
w[ould]
require
Dr. Schroering assigned
for
mild
residual
carpal
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tunnel symptoms in the right hand and a 10% permanent disability
for mild residual carpal tunnel symptoms in the left hand, which
equated
to
a
12%
whole
person
permanent
disability.
Dr.
Schroering left his practice in mid-1999.
In September 1999, Mullins applied for benefits under the
LTD
Plan,
claiming
that
the
pain
and
weakness
in
her
hands
rendered her “incapable of performing the requirements of any
job for any employer” under the terms of the Plan.
Mullins,
a
high
education,
was
evaluation
of
medical
school
35
application.
years
Mullins’
records
graduate
from
old
LTD
the
with
at
the
claim
by
two
years
time.
of
CGLIC
obtaining
physicians
J.A. 365.
began
copies
identified
college
of
in
its
the
her
In addition to Dr. Schroering, Mullins listed Dr.
Leopoldo Bendigo, Dr. Robert Strang, Dr. Douglas Williams, and
Dr. N.C. Ratliffe as her treating physicians.
Dr.
Bendigo,
an
orthopedic
surgeon,
performed
independent medical examination of Mullins on May 14, 1999.
an
He
stated that Mullins was unable to return to her duties at AT&T
“at this point in time.”
J.A. 545.
However, he felt that she
had not reached maximum medical improvement and prescribed three
to six months of physical therapy.
Dr. Strang, an orthopedic surgeon, began seeing Mullins in
early August 1999, after Dr. Schroering left his practice.
Dr.
Strang suggested physical therapy and referred Mullins to Dr.
6
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Williams,
a
Document: 208
neurologist,
for
Date Filed: 04/20/2011
his
opinion
and
Page: 7
recommendations
regarding the continued pain and sensitivity in her hands.
Dr.
Williams had previously performed nerve conduction studies on
Mullins in May 1998, prior to her CTS surgeries, but felt that
she did not have CTS at that time.
On September 23, 1999, Dr.
Williams noted that Mullins had “pretty good grip strength,” but
was continuing to experience bilateral hand pain.
J.A. 488.
It
was his impression that she had a “small fiber neuropathy . . .
related to her diabetes.”
that
her
problems
were
J.A. 553.
unrelated
He continued to believe
to
CTS.
He
prescribed
medication and asked Mullins to follow-up with him in two weeks.
On
September
28,
1999,
Dr.
Strang
advised
that
Mullins
had
“neuropathy of both hands due to the carpal tunnel syndrome and
the diabetic neuropathy,” and was unable to return to work “[a]t
this time.”
J.A. 443.
Dr. Ratliff was Mullins’ family doctor.
In October 1999,
he completed a statement of disability, stating that Mullins had
a
“[s]evere
limitation
of
functional
capacity”
“incapable of minimal (sedentary) activity.”
and
J.A. 492.
was
It was
his opinion that Mullins was totally disabled from her position
at AT&T and from “any other work.”
J.A. 492.
However, he noted
that Mullins’ prognosis was “[g]uarded,” and offered no opinion
as to whether a fundamental or marked change was expected.
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In October 1999, Dr. Strang and Dr. Williams each completed
a physical assessment at the request of CGLIC, based on their
evaluation of Mullins.
Dr. Strang stated that Mullins could
sit, stand and walk for eight hours a day, and occasionally
reach above and below her shoulders, but was unable to lift,
carry, push or pull, perform simple or firm grasping, or perform
fingering/keyboarding
or
other
fine
manipulation.
J.A.
444.
Dr. Williams stated that Mullins could sit for 8 hours a day,
stand and walk for 7 hours a day, lift and carry up to 20 pounds
frequently, lift and carry up to 50 pounds occasionally, push
and
pull
occasionally,
frequently,
and
occasionally
Mullins.
perform
perform
manipulation.
reach
above
simple
and
below
grasping
fingering/keyboarding
her
shoulders
frequently,
and
other
and
fine
On January 17, 2000, Dr. Williams reevaluated
He
stated
that
Mullins’
predominant
deficits
were
sensory and assigned Mullins a 4% functional impairment in each
upper extremity, which equated to a 4% overall impairment.
Due
physical
Strang
to
the
conflicting
abilities,
and
Dr.
medical
particularly
Williams,
CIGNA
evidence
from
her
referred
as
to
specialists,
Mullins’
physician advisor, Dr. Thomas Franz, for his review.
advised
that
the
current
information
Mullins’
failed
to
case
Dr.
to
a
Dr. Franz
allow
for
a
definitive diagnosis and failed to support a finding of physical
inability to work at a light or sedentary level.
8
Case: 04-2135
On
January
Document: 208
27,
2000,
Date Filed: 04/20/2011
CGLIC
denied
Page: 9
Mullins’
claim
for
benefits as submitted, advising her that there was insufficient
evidence
to
support
her
claim
that
she
was
“incapable
of
performing the requirements of any job for any employer” under
the terms of the Plan.
J.A. 365.
In support of the decision,
CGLIC noted the differing views of Dr. Strang and Dr. Williams,
as well as the review by Dr. Franz.
Upon Mullins’ request for review of CGLIC’s denial, CGLIC
obtained updated medical records from her treating physicians.
In addition, CGLIC consulted a physician advisor, Dr. Edward
Kern, for an opinion as to whether Mullins had a psychological
condition that would impact her ability to work.
Dr. Pierce
Nelson had previously diagnosed Mullins with major depression in
November 1999, and raised questions as to Mullins’ ability to
function
as
a
result.
However,
Dr.
Nelson
also
noted
that
Mullins was able to drive to her examination and manage her
financial
affairs.
Dr.
Kern,
who
is
board-certified
in
psychiatry and neurology, reviewed Mullins’ records, including
those of Dr. Nelson, and reported that the information did not
address functionality and that malingering was a concern.
The
updated
physicians
demonstrate
for
her
medical
hand
conflicting
and her ability to work.
records
pain
and
opinions
from
Mullins’
sensitivity
regarding
both
treating
continued
her
to
diagnosis
On April 18, 2000, Dr. Strang advised
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that Mullins “has a confusing case of neuropathy of the hands.”
J.A. 528.
He also noted that there was an additional dispute
between two neurologists, Dr. Williams and Dr. Dew, as to the
cause of her pain.
Dr. Strang concluded that “[a]t any rate, it
would appear that [Mullins] does have significant pain in her
hands, and it would appear that she is still unable to do her
work.”
J.A. 528.
On June 13, 2000, Dr. Erdogan Atasoy, a specialist in hand
surgery, evaluated Mullins.
Dr. Atasoy diagnosed Mullins with
“thoracic outlet compression and associating myofascitis.”
581.
J.A.
Dr. Atasoy stated that Mullins could perform “[l]ight work
lifting
20
lbs
maximum
with
frequent
restricted to 10 lbs or less.”
lifting
J.A. 582-83.
or
carrying
She was to avoid
work requiring “constant repetitive/static use of both hands –
pushing/pulling,
pinching/gripping,
flexion/extension
of
wrist/elbow, pronation/supination (palm down/palm up),” the “use
of vibratory tools,” overhead work, climbing poles or ladders,
and unprotected heights.
J.A. 583.
He suggested a “[s]lower
pace work” and limited her to a “[w]ork day not to exceed more
that 6 hours per day/5 days per week.”
In
light
physicians,
of
CGLIC
the
next
continuing
referred
capacity examination (“FCE”).
J.A. 583.
conflict
Mullins
between
for
a
Mullins’
functional
The evaluation took place for
several hours over 2 days, and identified a number of physical
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strengths and limitations.
Date Filed: 04/20/2011
Page: 11
Because Mullins was unable to lift
10 pounds occasionally and right-hand carry, the FCE indicated
that Mullins capabilities could not be classified as “sedentary”
under the Dictionary of Occupational Titles.
However, the FCE
recommendation was that Mullins should be able to return to a
job within the specific capabilities and restrictions set forth
in
the
activity
report
of
the
FCE.
No
additional
physical
rehabilitation was recommended.
CGLIC forwarded the results of the FCE to Drs. Ratliffe,
Strang, Williams, and Atasoy for their review and comment.
Ratliffe did not respond.
still unable to work.
Dr.
Dr. Strang stated that Mullins was
Dr. Williams and Dr. Atasoy, however,
both agreed that Mullins was capable of performing full-time
sedentary work in accordance with the limitations listed in the
FCE.
In
October
2000,
CGLIC
referred
Mullins’
file
for
a
Transferable Skills Analysis (“TSA”) to determine whether there
were
jobs
that
Mullins
identified in the FCE.
could
perform
within
the
limitations
The TSA revealed three jobs that Mullins
could perform based upon her skills, education, and abilities,
and
which
claim.
met
the
salary
Specifically,
restrictions
Mullins
was
able
for
to
resolution
work
scheduler, insurance clerk, or call-out operator.
as
of
a
her
space
In November
2000, CGLIC also referred Mullins’ file for a Labor Market Study
11
Case: 04-2135
(“LMS”),
within
in
Document: 208
order
Mullins’
accommodate
to
Date Filed: 04/20/2011
determine
geographical
her
limitations
whether
area
and
there
the
were
employers
would
that
meet
Page: 12
actually
wage
replacement
requirements of the Plan.
The LMS identified six employers with
existing
that
job
openings
would
accommodate
Mullins’
limitations.
On November 27, 2000, CGLIC sent Mullins a letter upholding
the initial denial of LTD benefits, based upon its determination
that
Mullins
limitations
was
and,
able
to
perform
therefore,
that
sedentary
she
was
work
not
within
her
“incapable
of
performing the requirements of any job for any employer” under
the terms of the Plan.
reconsideration
of
the
J.A. 365.
decision.
Mullins again requested
On
January
9,
2003,
after
review by an appeals team, CGLIC issued its final denial of
Mullins’ claim for LTD benefits.
II.
Mullins brought this lawsuit in district court under 29
U.S.C. § 1132(a)(1)(B), claiming that the defendants improperly
denied her benefits under the LTD Plan.
her
complaint
to
seek
statutory
Mullins later amended
penalties
under
29
U.S.C.
§
1132(c)(1)(B) for AT&T’s failure to produce to her a copy of the
SPD upon her request for the LTD Plan documents.
On cross-
motions for summary judgment, the district court granted summary
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judgment for the defendants on Mullins’ claim for LTD benefits.
However, the district court granted summary judgment to Mullins
on her claim for statutory penalties and ordered AT&T to pay
Mullins
penalties
totaling
$18,400.
Mullins
appealed
the
district court’s decision on her claim for LTD benefits and AT&T
appealed the district court’s imposition of the penalty.
This is the third appeal from the district court’s grant of
summary judgment to the defendants on Mullins’ claim for LTD
benefits.
discretion
Mullins
by
argued
denying
her
below
that
claim
in
CGLIC
part
had
because
abused
its
CGLIC
had
violated its internal procedures during its consideration of her
claim.
However, until recently, Mullins’ attempts to obtain the
production of the claims manuals, protocols, and other internal
guidelines relating to the processing of LTD claims and appeals
from claims denials had been unsuccessful.
Without addressing
the merits of the issues, we twice remanded this matter to the
district court with instructions that it ascertain the existence
of any such claims-processing documents and produce the relevant
documents to Mullins.
See Mullins v. AT&T Corp., 290 Fed. Appx.
642 (4th Cir. 2008) (unpublished).
were
produced
to
Mullins,
the
After the relevant documents
district
summary judgment to the defendants.
court
again
granted
The district court found
that CGLIC had substantially complied with its claims-processing
documents and that Mullins had failed to prove that CGLIC abused
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its discretion in considering and denying her claim under the
LTD Plan.
Accordingly, the parties’ cross-appeals are now back
before us and ready for disposition.
III.
We
begin
decision
with
awarding
Mullins’
summary
appeal
judgment
of
to
the
the
district
court’s
defendants
on
her
claim for LTD benefits.
A.
We review the district court’s grant of summary judgment de
novo, applying the same legal standards that the district court
employed.
See Evans v. Eaton Corp. Long Term Disability Plan,
514 F.3d 315, 321 (4th Cir. 2008).
Where, as here, an ERISA-
covered plan confers discretion on the plan’s administrator to
interpret its provisions and issue a determination, we review
the administrator’s determination under an abuse-of-discretion
standard.
See Metropolitan Life Ins. Co. v. Glenn, 554 U.S.
105, 111 (2008); Evans, 514 F.3d at 321.
discretion
standard,
we
will
not
set
Under the abuse-ofaside
the
plan
administrator’s decision if it is reasonable, even if we would
have reached a different conclusion independently.
See Booth v.
Wal-Mart Stores, Inc. Associates Health & Welfare Plan, 201 F.3d
335,
341
reasonable
(4th
“if
Cir.
it
is
2000).
the
The
result
14
administrator’s
of
a
decision
deliberate,
is
principled
Case: 04-2135
reasoning
process
evidence.”
Document: 208
and
if
Date Filed: 04/20/2011
it
is
supported
Page: 15
by
substantial
Bernstein v. CapitalCare, Inc., 70 F.3d 783, 788
(4th Cir. 1995) (internal quotation marks omitted).
In Booth, we set forth eight nonexclusive factors to be
considered
by
courts
in
reviewing
the
plan
administrator’s
decision:
(1) the language of the plan; (2) the purposes and
goals of the plan; (3) the adequacy of the materials
considered to make the decision and the degree to
which they support it; (4) whether the fiduciary’s
interpretation was consistent with other provisions in
the plan and with earlier interpretations of the plan;
(5) whether the decisionmaking process was reasoned
and
principled;
(6)
whether
the
decision
was
consistent
with
the
procedural
and
substantive
requirements of ERISA; (7) any external standard
relevant to the exercise of discretion; and (8) the
fiduciary’s motives and any conflict of interest it
may have.
Booth, 201 F.3d at 342-43; see also Williams v. Metropolitan
Life Ins. Co., 609 F.3d 622, 630 (4th Cir. 2010). 1
B.
Mullins
contends
that
the
district
court
erred
in
concluding that CGLIC’s decisionmaking process was reasoned and
1
In Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105
(2008), the Supreme Court clarified that an administrator’s
conflict of interest does not alter or modify the abuse-ofdiscretion standard of review.
See id. at 115-16; see also
Williams v. Metropolitan Life Ins. Co., 609 F.3d 622, 630-31
(4th Cir. 2010).
Instead, the conflict of interest is to be
weighed along with other applicable factors.
See Glenn, 554
U.S. at 117; Williams, 609 F.3d at 631. In this case, however,
the parties agree that there was no conflict of interest.
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principled, and erred in concluding that substantial evidence
supported the denial of benefits.
We disagree.
When Mullins first sought LTD benefits under the Plan, she
had been seen by two surgeons and a neurologist for the pain and
sensitivity in her hands.
The medical opinions of Mullins’ own
treating physicians conflicted, however, both as to her specific
diagnosis as well as to her functional capacity to perform work.
Resolving such conflicts in the opinions of Mullins’ treating
physicians
was
CGLIC’s
responsibility
and
well
within
the
discretion conferred to it under the terms of the LTD Plan.
See
Booth, 201 F.3d at 345; Brogan v. Holland, 105 F.3d 158, 162-63
(4th Cir. 1997).
In determining that Mullins had failed to
prove, as was her burden, that she was “incapable of performing
the requirements of any job for any employer,” J.A. 365, CGLIC
reasonably
considered
and
relied
upon
the
opinions
of
Dr.
Williams and Dr. Atasoy, as well as the results of the FCE,
which indicated that she was capable of performing sedentary
work within her limitations.
CGLIC also took the additional
step of obtaining both the TSA and LMS, and determined that
there were actual jobs available in the market which Mullins
could
perform
minimum
wage
within
her
requirement
limitations
necessary
and
for
which
a
finding
disability under the definition in the LTD Plan.
16
exceeded
the
against
Thus, CGLIC’s
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determination was clearly supported by substantial evidence in
the administrative record.
Mullins
acknowledges
that
the
medical
conflicting on the issue of her disability.
evidence
was
However, she argues
that we should find that CGLIC abused its discretion because it
did
not
strictly
adhere
to
its
internal
claims
processing
procedures when considering her claim and, consequently, denied
her
claim
based
upon
evidence
solicited nor relied upon.
CGLIC
was
limited
under
that
it
should
have
neither
Most notably, Mullins contends that
its
claims
processing
procedures
to
considering the opinion of Mullins’ “attending physician,” and
asserts that while Drs. Ratliff, Strang, and Schroering might be
considered
“attending
physicians,”
Drs.
Williams
and
Atasoy
should not have been.
Although the term ”attending physician” is used in CGLIC’s
claims-processing
materials,
it
is
not
defined
therein
and
common medical definitions of that term vary depending upon the
context
in
“attending
different
setting.
which
it
is
physician”
from
the
in
used.
a
meaning
For
example,
the
hospital
setting
might
of
term
that
in
a
meaning
be
of
quite
non-hospital
The district court rejected Mullins’ narrow definition
of the term “attending physician” and found that its use was not
intended to distinguish a claimant’s primary physician from all
other treating physicians, but rather to delineate physicians
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who have actually seen and treated the claimant from those who
have not. 2
At the time that Mullins filed her claim for LTD
benefits, she had been seen on three occasions by Dr. Strang,
the orthopedic surgeon who assumed her care after Dr. Schroering
left his practice, and on one or two occasions by Dr. Williams,
the neurologist who had seen her previously and to whom she was
referred for additional evaluation and treatment by Dr. Strang.
Under these circumstances, we agree with the district court’s
determination
that
the
term
“attending
physician”
did
not
exclude CGLIC’s initial consideration of Dr. Williams’ opinion
or
its
later
consideration
solicited from Dr. Atasoy.
consider
the
term
“attending
of
the
second
surgical
opinion
Furthermore, even if we were to
physician”
to
be
limited
to
a
single physician in other settings or circumstances, we cannot
say
that
CGLIC
abused
its
discretion
or
otherwise
acted
unreasonably in considering Drs. Williams and Atasoy to be an
attending
or
treating
physicians
here,
or
in
requesting
and
considering their medical records and opinions on the issue of
Mullins’ functional capacities and ability to work.
2
We also note that the LTD Agreement between CGLIC and AT&T
similarly defines an “Attending Physician” as “a duly licensed
physician, psychiatrist, or psychologist treating the Claimant
or Covered Person.” J.A. 70.
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Building upon this “attending physician” argument, Mullins
also
claims
that
CGLIC
abused
its
discretion
by
failing
to
strictly follow certain preferred procedures set forth in its
claims-processing
information.
an
documents
for
resolving
conflicting
medical
The district court found that although CGLIC had
obligation
to
some
degree
to
process
Mullins’
claim
in
accordance with these procedures, and that such compliance is
always a consideration on the question of reasonableness of a
decision, strict compliance is not a prerequisite to a finding
that the plan administrator’s overall decision was principled
and reasonable.
We
agree.
It
is
well
settled
that
the
decisionmaking
process by a claims administrator, including external standards
relevant to the exercise of the administrator’s discretion, is a
factor to be considered in the overall determination of whether
the administrator abused its discretion in denying LTD benefits.
See Booth, 201 F.3d at 342-43.
However, it is but one factor to
weigh alongside the other factors and the administrative record.
Cf. Glenn, 554 U.S. at 117; Williams, 609 F.3d at 631.
Indeed,
as noted by the district court, a contrary ruling would rob the
plan
administrator
documents.
of
the
discretion
granted
in
the
same
Having reviewed the administrative record and the
claims processing documents, we agree with the district court’s
determination
that
CGLIC
substantially
19
complied
with
its
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procedures and, to the extent it varied therefrom, did not abuse
its discretion in doing so.
As noted above, CGLIC was presented from the outset with
conflicting medical opinions among Mullins’ treating physicians
regarding both her diagnosis and her ability to work.
the
most
direct
recently
assumed
referred
her
conflict
considered
for
her
the
care
was
further
and
between
the
surgeon
neurologist
evaluation
conflicting
the
opinions
to
and
treatment.
of
Mullins’
Indeed,
who
had
whom
he
CGLIC
treating
physicians, solicited the opinion of a physician consultant, and
obtained an FCE to independently evaluate her physical strengths
and limitations for employment. 3
CGLIC then made a reasonable,
principled determination that Mullins, who was in her mid-30s
with some college education at the time, had failed to prove
that she was “incapable of performing the requirements of any
job
for
any
employer”
reasonably qualified.
for
which
she
was
or
could
become
J.A. 365.
3
As correctly noted by the district court, Mullins’
challenge to CGLIC’s FCE referral under its internal procedures
also fails to demonstrate an abuse of discretion. The procedure
relied upon by Mullins does not, by its terms, apply to the FCE
obtained.
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IV.
We turn now to AT&T’s cross-appeal of the district court’s
decision to impose a statutory penalty upon AT&T under 29 U.S.C.
§ 1132(c)(1).
We review the district court’s decision for an
See Davis v. Featherstone, 97 F.3d 734,
abuse of discretion.
735-36 (4th Cir. 1996).
In February 2001, Mullins’ former counsel requested copies
of the “AT&T [LTD] policy . . . and a copy of all other plan
documents concerning that [LTD] policy.”
later,
AT&T
produced
copies
of
the
LTD
J.A. 63.
plan
Two months
and
AT&T/CGLIC
Agreement, but did not include a copy of the SPD.
In March
2003, after litigation was initiated by Mullins’ new counsel,
AT&T produced a copy of the SPD to Mullins.
Under 29 U.S.C. § 1132(c)(1), the district court may, in
its discretion, impose penalties of up to $100 per day against
plan
administrators
who
fail
to
furnish
certain
requested by plan participants under ERISA.
documents
See Faircloth v.
Lundy Packing Co., 91 F.3d 648, 659 (4th Cir. 1996).
factors
generally
guide
[the]
district
court’s
“Two
discretion:
prejudice to the plaintiff and the nature of the administrator’s
conduct
in
documents.”
responding
to
the
participant’s
request
for
plan
Davis, 97 F.3d at 738; see also Faircloth, 91 F.3d
at 659 (noting that the court may consider prejudice and bad
faith in exercising its discretion).
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The district court found that Mullins’ written request for
“a
copy
of
all
other
plan
documents
concerning
[the
LTD]
policy,” was sufficient to notify AT&T that the response should
include the SPD.
With regard to prejudice, the district court
noted that while the SPD did contain some additional information
not otherwise provided in the documents produced, Mullins was
not
ultimately
information.
prejudiced
by
the
delay
in
obtaining
the
With regard to the conduct of AT&T, the district
court found that AT&T did not act in bad faith, but nevertheless
had failed to produce complete information in violation of the
statute.
Under the circumstances, the district court concluded
that the maximum penalty of $100 per day was unwarranted but
that a penalty of $25 per day would be appropriate.
We
cannot
say
court’s discretion.
that
this
was
an
abuse
of
the
district
“Although prejudice is a pertinent factor
for the district court to consider, it is not a prerequisite to
imposing a penalty.”
necessary
that
the
level of bad faith.
Davis, 97 F.3d at 738.
plan
Id.
administrator’s
It is also not
conduct
rise
to
Rather,
[t]he purpose of the penalty provision is to provide
plan administrators with an incentive to meet requests
for information in a timely fashion.
When there is
some doubt about whether a claimant is entitled to the
information requested, the Supreme Court has suggested
that an administrator should err on the side of
caution.
22
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Id. (citation omitted); see also Faircloth, 91 F.3d at 659 (“The
purpose of [§ 1132(c)(1)] is not to compensate participants for
injuries,
but
to
punish
noncompliance
with
ERISA.”).
Accordingly, we affirm the grant of summary judgment to Mullins
on her claim for statutory penalties under § 1132(c)(1).
V.
For the foregoing reasons, we affirm the district court’s
grant of summary judgment to the defendants on Mullins’ claim
for LTD benefits under 29 U.S.C. § 1132(a)(1)(B), and we affirm
the district court’s grant of summary judgment to Mullins on her
claim for penalties under § 29 U.S.C. § 1132(c)(1).
AFFIRMED
23
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