May v. AT&T Integrated Disabilty
MEMORANDUM OPINION Signed by Judge William M Acker, Jr on 7/26/13. (SAC )
2013 Jul-26 PM 02:57
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
DORIS W. MAY,
AT&T INTEGRATED DISABILITY,
AT&T CORPORATION, AND
SEDGWICK CLAIMS MANAGEMENT,
CIVIL ACTION NO.
All claims brought by plaintiff, Doris W. May (“Ms. May”),
against defendants, AT&T Integrated Disability, AT&T Corporation,
and Sedgwick Claims Management Services, Inc. (“Sedgwick”), except
her claim against Sedgwick under 29 U.S.C. § § 1001, et seq.
consideration only Ms. May’s ERISA claim against Sedgwick for
alleged wrongful denial of short-term disability benefits.
case was originally assigned to a magistrate judge to whom the
parties did not concede full jurisdiction.
F.R.Civ.P., for deciding ERISA disability cases, but acknowledges
that Sedgwick was following well recognized routine when it filed
magistrate judge entered a report and recommendation (“R&R”),
recommending that Sedgwick’s motion be granted, and that Ms. May’s
ERISA claims be dismissed.
The R&R, insofar as it addressed the
ERISA claims, is set forth below in haec verba.
The emphasis on
the word “merely” was placed on that word by the magistrate judge.
He emphasized no other word.
Plaintiff’s ERISA Claims
Plaintiff alleges that defendant Sedgwick violated
her rights under ERISA by improperly denying her ShortTerm Disability benefits under AT&T Services, Inc.’s,
To determine whether plaintiff was improperly
denied benefits under ERISA, the court must apply the
Telecommunications, Inc., 373 F.3d 1132, 1138 (11th Cir.
Plan, No. 06-12193, 2007 WL 117712, at *1 (11th Cir.
The Williams test is as follows:
(1) The court must apply the de novo
standard to determine whether the claim
administrator’s benefits-denial decision is
“wrong” (i.e., the court disagrees with the
administrator’s decision); if it is not,
then the inquiry ends and the decision is
(2) If the administrator’s decision is, in
fact, “de novo wrong,” then the court must
determine whether the administrator was
vested with discretion in reviewing claims;
if not, the inquiry ends the decision is
(3) If the administrator’s decision is “de
novo wrong” and he was vested
discretion in reviewing claims, the court
must determine whether “reasonable” grounds
supported the decision (hence, the court
must review the decision under the more
(4) If no reasonable grounds exist for the
decision, the inquiry ends and the court
must reverse the administrator’s decision;
if reasonable grounds do exist, the court
must determine whether the administrator
operated under a conflict of interest.
(5) If there is no conflict
inquiry ends and the court
(6) If there is a conflict of interest, the
conflict should merely be a factor for the
court to take into account when determining
whether an administrator’s decision was
conflict of interest exists when the plan administrator
benefits out of its own funds.
Where a conflict
exists and the court must reach step six, the burden is
on plaintiff to show that the administrator’s decision
conflict exists, the court still owes deference to the
administrator’s decision was “de novo wrong” under the
Sedgwick’s decision denying benefits to plaintiff for
certain periods of time was not de novo wrong.
the Plan, entitlement to STD benefits depended on having
made a participant unable to perform any
type of work as a result of a physical or mental illness
or an accidental injury.
“Any type of work” includes
accommodations, any other company job with or without
accommodations, or temporary modified duties.
4 Ex. A ¶ 2.10).
Defendant Sedgwick denied plaintiff benefits for
the periods at issue because her treating physicians did
disabled under the Plan.
Further, upon both a first-
level and a second-level appeal from these conclusions,
independent medical examiners opined that
support the conclusion that she was unable to perform
the sedentary work associated with her job.
period of May 24 to June
At that time,
plaintiff’s condition was described as being a cervical
plaintiff was hospitalized for a few days after May 17,
by May 24 she was out of the hospital and receiving
Physician’s Statement dated June
2010, Dr. Wilson
reported that plaintiff was being treated with epidural
blocks and “will be off work day of block and day after
(Doc. 30-6, DEF 000084).
This plainly implies
that, but for the day of and the day after an epidural
The epidural block occurred on June 16, and
plaintiff was awarded STD for that day and day after
The decision to deny STD benefits from May
24 to June 15 was not wrong.
The next period of time for which plaintiff sought
STD benefits was from June 21 to July 15, 2010.
plaintiff returned to work on June 18, she remained only
four hours and left, and she did not return to work on
the next scheduled work
As a result, she was
deemed to have had a relapse of the condition involved
in her previous period of STD and a new claim for STD
was started on June 21.
(Doc. 30-8, DEF 000281).
June 24, plaintiff was diagnosed with a ruptured and
corrective surgery on July 16, 2010.
In an Attending
Physician’s Statement by Dr. Carter Morris on July 1,
2010, Dr. Morris reported his findings of a herniated
cervical disc, with surgery scheduled for July 16.
only work restriction he reported at that time was “No
working during post op recovery period.”
Five days later, however, Dr. Morris wrote
a letter “To Whom It May Concern,” saying “For Medical
work prior to her surgery.”
(Doc. 30-10, DEF 000467).
requested that plaintiff be excused
prior to surgery
Nevertheless, two medical advisors, Dr. Mickle
and Dr. Lewis, reviewed plaintiff’s records, and both
concluded that plaintiff was capable of working
restrictions in the preoperative time frame of June 21
to July 15, 2010.
(Doc. 30-10, DEF 000484 and DEF
incapable of working prior to her surgery on July 16.
While Dr. Morris wrote at least two work excuses for
evidence of disability in that, as Drs. Mickle and Lewis
noted, the plaintiff’s medical records indicated that
contention that plaintiff was incapable of working with
appropriate restrictions to reduce her pain.
decision by Sedgwick that plaintiff was not entitled to
STD from May 21 to June 15 was not wrong.
The third and final time period plaintiff claims
she was improperly denied STD benefits was from November
granted STD benefits.
As noted earlier, plaintiff’s
own treating physicians, Dr. Morris and Dr. Leong, both
beginning November 15, 2010.
(Doc. 30-14, DEF 000776-
Furthermore, an independent medical reviewer, Dr. Levy,
opined also that plaintiff was able to return to work by
plaintiff continued to suffer neck pain, for which she
medical evidence that plaintiff was incapable of working
decision to deny STD benefits after November 15 was not
Telecommunications, Inc., 318 Fed. Appx. 829 (11th Cir.
Lee is a
diagnosis of “chronic pain syndrome,” a fundamentally
different diagnosis than plaintiff’s.
It is in cases
involving this diagnosis of chronic pain syndrome, and
diagnosis of a distinct medical condition, that it is
unreasonable for a plan administrator to ignore both
objective and subjective medical evidence submitted by
Lee, 318 Fed. Appx. at 837.
cases involving chronic pain when, in fact, the holding
applies only to cases involving a diagnosis of chronic
pain syndrome, a diagnosis which inherently relies upon
subjective evidence of pain.
Furthermore, in Lee,
the court noted that there is no objective laboratory
test for diagnosing chronic pain syndrome.
same cannot be said of plaintiff’s diagnoses of cervical
Plaintiff’s range of motion and strength tests indicated
essentially normal function, and the X-rays of her neck
after surgery revealed a successful fusion of the C6-7
reveal a condition so debilitating as to make plaintiff
Moving to the second step in the Williams process,
periods of time was de novo wrong, that would not end
are approved under the Plan and to interpret the terms
and provisions of the Plan pertaining to STD benefits.
(Doc. 30-4 ¶ 4-5).
Thus, once the second step of the
Williams test is reached, the arbitrary and capricious
standard of review applies.
Now that the court has found that Sedgwick was
vested with discretionary authority under the Plan, the
third step of the Williams test requires the court to
At this stage, the court’s role is
whether it was right; Sedgwick’s decision need not be
the best possible decision, only one with a rational
Welfare Fund, 877 F.2d 37, 38 (11th Cir. 1989); Griffis
v. Delta Family-Care Disability Plan, 723 F.2d 822, 825
(11th Cir. 1984).
Furthermore, the court cannot require
impose upon Sedgwick a burden of explanation because it
credited reliable evidence that conflicts with treating
Black & Decker Disability Plan
v. Nord, 538 U.S. 822, 834 (2003).
A plan administrator
may give different weight to the opinions of treating
physicians over those of independent physicians employed
Blankenship, 644 F.3d at 1356.
first claim for disability benefits, after all appeals
plaintiff for the period from May 24, 2010 to June 15,
(Doc. 30-7, DEF 000191-000192).
appeal, in upholding the denial of plaintiff’s benefits
between May 24 and June 15 of 2010, Sedgwick relied on
the reports of medical doctors, J. Parker Mickle and
Jamie Lee Lewis.
(Doc 30-6, DEF 000113, 000138-000144).
The stated reason for the denials was that the medical
did not provide enough objective
documentation to substantiate a finding that plaintiff
The denial was upheld on second-level appeal
doctors Imad Shahhal and Howard Grattan.
plaintiff’s records did not present evidence that she
was unable to perform a sedentary job for the denial
Plainly, Sedgwick had a rational and good
faith basis for
exercising its discretion to deny STD
payments to plaintiff during this period of time.
denied benefits to plaintiff for the period from June
21, 2010 to July 15, 2010.
(Doc. 30-4 ¶ 8).
medical records on second-level appeal.
(Doc 30-7, DEF
records indicated that plaintiff was unable to perform
a sedentary job between June 21 and July 15 of 2010.
discretion to deny STD payments to the plaintiff.
benefits, except for three two-days
periods when plaintiff received epidural blocks, for the
entire period from November 11/16/2010, to May 9, 2011.
Michael T. Levy, Dr. J. Parker Mickle, and Dr. Charles
based on her medical records, plaintiff was capable of
performing her normal sedentary job during the denial
Id. These were a rational basis for doing so.
She relies on the statements of her treating
doctors that, during the relevant periods, she could not
bend or stoop, sit or stand for prolonged periods, lift
over ten pounds, and could only work for four hers per
(Doc. 30-8, DEF 000240; Doc. 30-11, DEF 000532).
She further relies on Dr. Cezayirli’s statements that
plaintiff, during the relevant periods, was unable to
“return to a sitting position in one position working at
a computer terminal until January 1, 2011.”
11, DEF 000537).
However, the evidence on file shows
that plaintiff, while performing her job duties as a
service representative, was not required to be seated in
her chair continuously; she was able to get up, walk
throughout the day.
not dispute this.
(Doc. 30-3 ¶ 7).
Further, her job did not require any
(Doc. 30-1, 15).
Thus, had she returned
to work during the denial periods, the evidence shows
that plaintiff would not have been required to sit or
stand for prolonged periods nor lift over ten pounds.
Most importantly, that she was allowed to stand up and
walk around at any time during the day means that she
would not have been required to sit in one position at
a computer had she returned to work during the denial
plaintiff benefits during the relevant time periods may
not have been the correct or best decision, the court
However, as noted, the court does not
Because the court finds that defendant Sedgwick’s denial
of benefits to plaintiff over certain periods of time
was not de novo wrong and, even if it was, the decision
to deny benefits was reasonable under the Williams test,
plaintiff’s ERISA claim.
Because Ms. May timely filed objections to the R&R, the court
is obliged to consider Sedgwick’s motion for summary judgment de
novo, and to accord the R&R no deference, treating it only as a
high quality brief amicus curiae on behalf of Sedgwick.
several intriguing, provocative, and unique aspects to this case.
The first and foremost unique aspect is the fact that Ms. May
only sought short-term disability benefits and was denied them only
for portions of the short terms for which she applied.
not mean, of course, that she does not have the right to seek
judicial relief to recover money she claims to have been wrongfully
denied her, plus, of course, attorneys’ fees attributable to the
denial if in violation of ERISA.
However, this court has never
before been called upon to rule on ERISA liability for a series of
“off-and-on” or intermittent periods of short-term disability.
is apparent from the record that Sedgwick responded to Ms. May’s
relatively small claims just as vigorously and with just as much
adversarial zeal as if they had been a single monumental long-term
disability claim, something that these three claims might well have
become if Ms. May had presented an LTD claim. Ms. May, who was pro
se during the claims process, was hopelessly out-classed.
instance, David could not slay a well-armed Goliath.
which admittedly was the ERISA claims fiduciary, demonstrated more
loyalty to the funding entity which had employed it, than to its
cestui que trust during the administrative process.
jealously guarded its client’s money.
This is one of the most
bothersome aspects not only of this case, but of ERISA benefits
cases in general.
Ms. May was faced with the unenviable task of
separately appealing to a conflicted judge each of the judge’s
three short-term denials.
She hit a stone wall each time.
A second noteworthy and equally bothersome feature of this
case arises from the fact that Ms. May, because she was obligated
to do so by the terms of the Plan, applied to the Social Security
Administration (“SSA”) for disability benefits. After being denied
SSA, she appealed.
Her SSA appeal was pending when the
magistrate judge issued his R&R.
Between the time the R&R was
entered and Ms. May’s objections were filed, the SSA granted Ms.
May’s appeal and impressively found that she was totally disabled
as of May 16, 2010, and from that time forward she lacked the
capacity to perform any job whatsoever.
The time period of Ms.
May’s disability, as determined by the SSA, embraces all three of
the time periods investigated by Sedgwick and considered by the
“administrative record”, it was not considered by the magistrate
judge, who agreed with Sedgwick that Ms. May was not disabled
Ms. May now insists that the SSA finding be considered
by this court and heavily weighed in her favor, both in evaluating
de novo the R&R, and in evaluating the Sedgwick denials, whether de
novo or with the deference that automatically follows the fact that
Sedgwick was granted discretionary authority to interpret the Plan
and to rule dispositively on claims.
Not unexpectedly, Sedgwick moves to strike the SSA finding,
and to limit this court’s review of the R&R to the “administrative
record”, namely, the materials that were before Sedgwick and before
the magistrate judge, both of whom knew of Ms. May’s pending SSA
appeal when they reached their respective identical conclusions.
Neither Ms. May nor Sedgwick has cited any case on all fours with
a case having the sequence of events of this case.
faced with a sui generis situation.
The court is
What is the court to do with
the belated SSA finding under these procedural circumstances?
In Sedgwick’s original brief
the magistrate judge in
support of its motion for summary judgment, it argued:
Another interesting fact about May’s claims under the ADA
and Rehabilitation Act is that she testified that she has
applied for Social Security Disability Benefits. (May
Depo., p. 19). May’s initial request for Social Security
Disability Benefits was denied, and she has appealed that
(May Depo., p. 19).
May’s appeal remains
pending. (May Depo., p. 20). As stated by the Eleventh
Circuit, “to obtain Social Security Disability Benefits,
an applicant must prove he is disabled.” Kurzweg v. SCP
Distributors, LLC, 424 Fed. Appx. 840, 843, 2011 U.S.
App. LEXIS 8281, 24 Am. Disability Cas. (BNA) 1555 (11th
Cir. 2011), citing Jones v. Apfel, 190 F.3d 1224, 1228
(11th Cir. 1999).
For purposes of obtaining Social
Security Disability Benefits,
A disability is defined as the “inability to
engage in any substantial gainful activity by
reason of any medically determinable physical
or mental impairment which can be expected to
result in death or which has lasted or can be
expected to last for a continuous period of
not less than 12 months.”
42 U.S.C. §
423(d)(1)(A). The impairment must be “of such
severity that he is not only unable to do his
previous work but cannot, considering his age,
education, and work experience, engage in any
other kind of substantial gainful work which
exists in the national economy.”
Kurzweg, 424 Fed. Appx. At 843.
The SSA disability standard is correctly outlined by Sedgwick.
the SSA finding is given the weight some courts give it in ERISA
disability cases, there is a strong basis for Ms. May’s following
May has now been determined to be fully disabled by the
Social Security Administration. This determination was
made after all briefing was completed. Usually such a
Administrator, but in this case, considering that the
District Court reviews de novo (Moon v. Am. Home, 888
F.2d 86, 89 (11th Cir. 1989) a remand is unnecessary
since any determination by the Plan Administrator, when
considering the Administrative Record as a whole along
with this new determination of disability, that May is
not disabled and not entitled to benefits would be
arbitrary and capricious.
This is especially true
considering the strong and broad language used by the
Administrative Law Judge and the determination that no
job is available to May nationwide.
Ms. May’s opposition to a remand to the plan administrator is an
entirely reasonable position for Ms. May to take in light of the
reconsideration by an inherently conflicted plan administrator is
rarely, if ever, worthwhile.
It is not only expensive and time
consuming, but it only challenges the conflicted decision-maker to
find a new, if sophistic, reason for reaching the same conclusion
it reached earlier.
What are lawyers and “independent” medical
Sedgwick, itself, is careful not to mention the remand option.
Instead, it places its eggs in the basket of eliminating from
affidavit that accompanies it. Sedgwick and its lawyers would have
to test their forensic abilities if they had to deal with the SSA
On more than one occasion, this court has expressed its
disagreement with what this court believes to be the Eleventh
Circuit’s badly flawed, and highly peculiar way of responding to
the instructions laid down by the Supreme Court in Metropolitan
Life v. Glenn, 128 U.S. 2343 (2008).
Yet, this court is unwilling
to repeat unsuccessful arguments that have fallen on deaf ears.
Blankenship v. Metropolitan Life, 644 F.3d 135 (11th Cir. 2011).
Shortly thereafter, in Ray v. Sun Life, 443 Fed. Appx 529 (11th
concrete that it had poured around its feet in Blankenship, by
Based on the administrative record available to Sun Life
when it made its decision, see Blankenship, 644 F.3d at
1354 (review of benefits denial is limited to
consideration of the material available to
administrator at the time it made its decision), we can
not say that Sun Life’s denial of benefits is de novo
wrong. (emphasis added).
contained in the “administrative record” before the magistrate
case, namely, an
Despite this fact, Sun Life easily preferred the
findings of its “two non-examining medical experts” over
Blankenship positions with two pregnant sentences: (1) “No special
weight is to be accorded the opinion of a treating physician”; and
considered, it is not conclusive on whether a claimant is also
disabled under the terms of an ERISA plan.”
In Ray, the Eleventh
Circuit had no problem in agreeing with the lower court that Sun
Life was not de novo wrong when it found no entitlement
Not only does the
Eleventh Circuit now give dispositive
tampered with or supplemented with new, albeit important
relevant evidentiary material, but if this court were to be so
innovative and adventurous as to deny Sedgwick’s motion to strike,
and if Sedgwick were ordered to take another look at Ms. May’s
claims in light of the favorable SSA decision, Sedgwick could and
probably would treat the SSA finding simply as something else to
discount in comparison with its “independent non-examining medical
Assuming arguendo that this court has the power to
remand the case to the Sedgwick briar patch, that briar patch is
one in which Sedgwick is accustomed to navigate.
It is easy to detect that the magistrate judge was operating
under what he realized are the severe constraints imposed by
Even if he had expended monumental effort, he could
not have found a way around the Eleventh Circuit’s multi-step
framework for reviewing an ERISA denial. No other circuit court of
appeals in the United States has adopted the Eleventh Circuit’s
strange six step scheme. The Eleventh Circuit stands starkly alone
in its reading of MetLife v. Glenn.
One proof of the magistrate
judge’s complete understanding of the Eleventh Circuit is that he
places emphasis on the word “mere” employed by the Eleventh Circuit
in its Step Six. The magistrate judge never really arrived at Step
Six in his analysis, because he found that Sedgwick’s decision was
not de novo wrong (was it de novo right?).
The magistrate judge
avoided a need to consider whether Sedgwick’s clear, but “mere”,
conflict-of-interest played a part in the denial decision.
word “mere” rhymes with the word “sneer”.
It is like saying “she
has a mere
After Blankenship, no
case of terminal cancer.”
district court within the Eleventh Circuit, and certainly not the
Eleventh Circuit itself, has ever found that the inherent and
inevitable conflict-of-interest recognized by the Supreme Court in
MetLife v. Glenn is a serious factor that must always be considered
as something that can be, and often is, sufficient to topple an
otherwise justifiable denial decision.
Not only did the magistrate judge understand what “mere”, as
used by the Eleventh Circuit, means, but on several occasions he
echoes the Eleventh Circuit’s many affirmances of denials that were
based on a lack of “objective” proof of disability, something the
Eleventh Circuit, perhaps aberrantly, criticized in Oliver v. Coca
Cola Co., 497 F.3d 1187, 1196 (11th Cir. 2009), as follows:
Coca-Cola based its rejection of Oliver’s claim on its
contention that Oliver failed to provide “objective
evidence” of his disability, stating that the “true
organic etiology” of Oliver’s pain had not been
determined. R3-61, Exh. 30. Yet much medical evidence,
especially as it relates to pain, is inherently
“subjective” in that it cannot be quantifiably measured.
Indeed, the only evidence of a qualifying disability may
be the sort of evidence that Coca-Cola and Broadspire
characterize as “subjective”, such a physical examination
and medical reports by physicians, as well as the
patient’s own reports of his symptoms.
The Eleventh Circuit’s Step Five and Step Six both begin with
the word “IF”: (5) “IF” there is no conflict...., and (6) “IF there
is a conflict.....” (emphasis added).
IF the Supreme Court in
MetLife v. Glenn made nothing else clear, it made it absolutely
clear that a conflict-of-interest always exists under circumstances
like these, and that the conflict is a substantial factor that must
be considered in evaluating wether the denial was arbitrary and
For a long period of time, the Eleventh Circuit found
that some of the schemes and disguises used by ERISA decisionmakers were sufficient to demonstrate that they operated without a
interest cannot be explained away, the decision-makers no longer
try to prove the non-existence of the conflict still theoretically
recognized in Step Five.
The depreciation of the conflict-of-
decision-maker happily to skip over Step Five and go straight to
The word “IF” does not fit.
There is no “IF”. Although
Sedgwick may argue that it itself is not obligated to pay benefits
that the Plan may be obligated to pay to Ms. May, it is clear that
its loyalty is to the owner of the pocket from which those benefits
would be drawn.
If any proof were needed of the fact that for
ERISA purposes, Sedgwick is the alter ego of the funding entity, it
is the fact that the decision-maker and the payor are represented
by the same lawyers.
They are all in this together.
Without this court’s considering the SSA determination, which
will be separately stricken on Sedgwick’s motion, this court
respectfully disagrees with the magistrate judge’s conclusion that
Sedgwick’s decision was not de novo wrong. The magistrate judge is
saying that if he had been the decision-maker, he would have
reached the same conclusion that was reached by Sedgwick.
de novo review limited to the “administrative record”, this court
finds that Sedgwick’s decision was “de novo wrong”, and if that
were the end of the inquiry, this court would have granted Ms.
May’s claims for short-term benefits.
This court is just as
demeanor and the interests of the witnesses.
This court finds Ms.
May believable and finds that she suffered from the debilitating
pain she sought to have corrected by surgery.
Her claims were of
such small amounts that they cannot suggest a motive for fraud or
No sane person would submit to two dangerous
surgeries just to obtain small amounts of disability benefits.
In the last paragraph of the R&R, the magistrate judge,
inconsistent with his finding that Step One was as far as he needed
to go, said:
[D]efendant Sedgwick’s decision to deny plaintiff
benefits during the relevant time periods may not have
been the correct or best decision. (emphasis added).
reservations about the correctness of a decision he had found to be
This court not only believes that Sedgwick’s decision
“may not have been correct”, but that it was incorrect.
There is no purpose to be served by this court’s writing a
full scale opinion to show why Sedgwick was de novo wrong.
undertaking becomes academic in light of the rule enunciated in
Firestone Tire & Rubber v. Bruch, 489 U.S. 101 (1989), namely, that
judgment on the correctness of its own rulings, and that despite
its glaring self-interest, it can be objective and fair to the
ERISA beneficiary against whom it has an adversarial relationship.
Perhaps some day the Supreme Court will recognize the “due process”
implications in Bruch.
This court’s quarrel with the Eleventh Circuit’s ERISA regime
cannot form a basis for ignoring binding precedent.
Based on the
“administrative record”, this court agrees with the magistrate
judge that it was not “unreasonable” for Sedgwick to prefer the
opinions of its own hired physicians over the findings of Ms. May’s
treating physicians, who could not satisfy Sedgwick “objectively”
surgery, was so disabling that she could not perform any job.
“mere” factor that can be discounted into virtual oblivion, this
court defers to Sedgwick’s exercise of the discretion which Bruch
“administrative record” to mention the fact that Metropolitan Life
had such a big balance sheet that a disability claim of a “mere”
Blankenship, this court readily adopts the Blankenship idea for
Sedgwick should have had no hesitancy in dipping into
AT&T’s deep pocket when Ms. May was only seeking chump change.
This court respectfully declines Ms. May’s invitation to be
the first district court within the Eleventh Circuit to find that
a “mere” conflict-of-interest tips the balance in favor of a
There are many cases elsewhere in which the
inherent conflict-of-interest tips the balance in favor of the plan
beneficiary, but this court has found none in the Eleventh Circuit.
penetrating article written by Marc Galanter, entitled “Why The
Change”, found at 9 Law & Soc’y Rev. 95 (1974).
out of a seminar held at Yale Law School.
The article grew
Inter alia, Professor
Most analyses of the legal system start at the rules end
and work down through institutional facilities to see
what effect the rules have on the parties. I would like
to reverse that procedure and look through the other end
of the telescope. Let’s think about the different kinds
of parties and the effect these differences might have on
the way the system works.
Because of differences in their size, differences in the
state of the law, and differences in their resources,
some of the actors in the society have many occasions to
utilize the courts (in the broad sense) to make (or
defend) claims; others do so only rarely.
divide our actors into those claimants who have only
occasional recourse to the courts (one-shotters or OS)
and repeat players (RP) who are engaged in many similar
litigations over time. (emphasis added).
Ms. May has only one ERISA case, this one.
Sedgwick, and other
professional claims administrators and insurers, have many cases
and are represented by highly competent lawyers who are well
trained in ERISA jurisprudence, which has mutated far away from
original Congressional intent.
The “one-shotters” cannot compete
with the “repeat players”.
This court’s unsolicited advice to Ms. May is to forget the
possibility that her case will be the first case in the Eleventh
Circuit since Blankenship in which an adverse decision by a plan
administrator will be set aside as an abuse of discretion.
appeal by Ms. May would require the Eleventh Circuit to review de
novo this opinion, which has reviewed de novo the magistrate
which, in turn, reviewed de novo Sedgwick’s
If Ms. May does not take this court’s advice, and if the
Eleventh Circuit should find a way to commiserate with her in a
more tangible way than this court has been able to do, this court’s
feelings will not be hurt.
By separate orders, the motions of Sedgwick to strike and for
summary judgment will be granted.
DONE this 26th day of July, 2013.
WILLIAM M. ACKER, JR.
UNITED STATES DISTRICT JUDGE
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?