HALLMAN v. LIBERTY LIFE ASSURANCE COMPANY OF BOSTON et al
Filing
36
ORDER denying 23 Motion for Summary Judgment; granting 22 Motion for Judgment as a Matter of Law. Ordered by US DISTRICT JUDGE CLAY D LAND on 11/20/2016. (CCL)
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF GEORGIA
ATHENS DIVISION
WILLIAM DAVID HALLMAN,
*
Plaintiff,
*
vs.
*
LIBERTY LIFE ASSURANCE COMPANY
OF BOSTON and NOVELIS
CORPORATION,
*
CASE NO. 3:15-CV-49 (CDL)
*
Defendants.
*
O R D E R
Plaintiff William David Hallman was insured under a long
term
disability
insurance
policy
that
Defendant
Liberty
Life
Assurance Company of Boston (“Liberty”) issued to his former
employer, Novelis Corporation, for the benefit of its employees.
Hallman
asserts
that
he
became
disabled
in
October
2010.
Liberty initially concluded that Hallman was entitled to long
term
disability
Hallman
benefits
contends
that
but
later
Liberty
terminated
improperly
the
terminated
benefits.
his
long
term disability benefits in violation of the Employee Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.
Liberty
benefits
maintains
was
that
its
correct,
administrative record.
and
decision
it
to
terminate
seeks
judgment
Hallman’s
on
the
Hallman argues that the undisputed facts
establish that Liberty’s termination of his benefits was wrong,
and he seeks summary judgment on this issue.
Where,
as
here,
both
sides
rely
on
an
agreed-upon
administrative record, judicial economy favors deciding the case
using findings of fact and conclusions of law under Federal Rule
of Civil Procedure 52, not summary judgment under Federal Rule
of Civil Procedure 56.
See Doyle v. Liberty Life Assurance Co.,
542 F.3d 1352, 1363 n.5 (11th Cir. 2008).
Although the facts
from the administrative record are essentially undisputed, the
Court nevertheless finds it appropriate to decide the case with
factual findings.
In making its findings of fact, the Court “is
limited to ‘the facts as known to the administrator at the time
the decision was made.’”
Glazer v. Reliance Standard Life Ins.
Co., 524 F.3d 1241, 1246 (11th Cir. 2008) (quoting Jett v. Blue
Cross & Blue Shield of Ala., Inc., 890 F.2d 1137, 1139 (11th
Cir.
1989)).
Based
on
the
following
findings
of
fact
and
conclusions of law, the Court grants Liberty’s motion (ECF No.
22) and denies Hallman’s motion (ECF No. 23).
FINDINGS OF FACT
In support
facts
with
of its motion, Liberty filed a statement of
citations
to
the
administrative
record.
Hallman
objected to a handful of the fact statements as irrelevant and
misleading but did not otherwise object.
statement
of
facts,
and
he
cited
2
a
Hallman also filed a
few
portions
of
the
administrative record in his summary judgment brief.
The Court
reviewed the fact statements and the citations to the record,
and the Court’s findings of fact are based on the portions of
the administrative record which the parties cited.1
Hallman does argue that it would be “premature” for the
Court
to
consider
administrative
Liberty’s
record
motion
“since
the
for
Court
judgment
has
not
on
the
had
the
opportunity to review all the facts that are in issue.”
Pl.’s
Resp. to Defs.’ Mot. for J. on the Admin. R. 4-5, ECF No. 30-2.
But, as discussed above, the Court must review the facts as
known to Liberty when it decided to terminate Hallman’s long
term disability benefits.
record,
which
is
before
Those facts are in the administrative
the
Court.
Hallman
had
ample
opportunity to point to those portions of the administrative
record that support his claims.
1
In his response to Liberty’s motion, Hallman attempts to incorporate
by reference his seventy-four page appeal to Liberty following the
September 2013 termination of benefits.
The appeal consists of
counsel’s twenty-seven page (single spaced) appeal letter to Liberty
and an article about chronic back pain.
Under the Court’s local
rules, a response brief may not exceed twenty pages. M.D. Ga. R. 7.4.
Hallman did not seek or receive an extension of the page limitations,
and he did not offer any reason why he could not adequately explain
his legal theories in his summary judgment briefs and his response to
Liberty’s motion for judgment on the administrative record. For these
reasons, the Court declines to review counsel’s appeal letter to
determine whether it raises arguments in addition to those Hallman
presented in his briefs.
3
I.
The Policy
Liberty
issued
Group
Policy
No.
GF3-880-024947-01
(“Policy”) to Hallman’s former employer, Novelis.
Defs.’ Mot.
for J. on the Admin. R. Ex. 2, Admin. R. XV at CL 1057, ECF No.
22-16.
The Policy provided long term disability coverage under
an employee welfare benefit plan sponsored and maintained by
Novelis under ERISA.
benefits
provided
provisions.”
Under the Policy, Liberty “agree[d] to pay
by”
Id.
The
the
Policy
Policy
“in
states
accordance
that
benefits once certain requirements are met.
The
Policy
further
states
that
Liberty
Liberty
with
its
will
pay
Id. at CL 1077.
“shall
possess
the
authority, in its sole discretion, to construe the terms of this
policy and to determine benefit eligibility hereunder. Liberty’s
decisions regarding construction of the terms of this policy and
benefit eligibility shall be conclusive and binding.”
Id. at CL
1095.
The Policy states that “Disability” or “Disabled” means:
i.
that during the Elimination Period and the next
24 months of Disability the Covered Person, as a
result of Injury or Sickness, is unable to
perform the Material and Substantial Duties of
his Own Occupation; and
ii.
thereafter, the Covered Person is unable to
perform, with reasonable continuity, the Material
and Substantial Duties of Any Occupation.
Id. at CL 1064.
The term “‘Own Occupation’ means the Covered
Person’s occupation that he was performing when his Disability
4
. . . began.”
Id. at CL 1068.
The term “‘Any Occupation’ means
any occupation that the Covered Person is or becomes reasonably
fitted
by
training,
mental capacity.”
education,
experience,
age,
physical
and
Id. at CL 1063.
The Policy further states:
When Liberty receives Proof that a Covered Person is
Disabled due to Injury or Sickness and requires the
Regular Attendance of a Physician, Liberty will pay
the Covered Person a Monthly Benefit after the end of
the
Elimination
Period,
subject
to
any
other
provisions of this policy. The benefit will be paid
for the period of Disability if the Covered Person
gives to Liberty Proof of continued:
1. Disability;
2. Regular Attendance of a Physician; and
3. Appropriate Available Treatment.
The Proof must be given upon Liberty’s request and at
the Covered Person’s expense.
Id. at CL 1077.
The term “‘Proof’ means the evidence in support
of a claim for benefits.”
II.
Id. at CL 1070.
Hallman’s Occupation and Short Term Disability Claim
Hallman began working for Novelis in 1983.
was “DC Operations Technician.”
crane.
required
His job title
In that position, he operated a
E.g., Admin. R. I at CL 0048, ECF No. 22-2.
Hallman
molten metal.
to
work
12-hour
rotating
Admin. R. XV at CL 1032.
schedules
The job
around
It also required him to
climb on and off a fork truck several times a day, climb stairs,
and lift up to fifty pounds.
Id.
5
And it required him to work
in
cold
temperatures
during summer.
Hallman
during
winter
and
in
hot
temperatures
Id.
claimed
to
be
disabled
from
his
occupation
on
October 9, 2010 due to back pain caused by lumbar degenerative
disc disease, as well as other physical ailments.
at CL 0031.
Admin. R. I
He submitted a claim for short term disability
benefits, which were self-funded by Novelis.
Novelis paid short
term disability benefits for the maximum short term disability
period, from October 9, 2010 through April 30, 2011.
Admin. R.
XII at CL 0877, ECF No. 22-13.
III. Initial Approval of Hallman’s Long Term Disability Claim
While Hallman was receiving short term disability benefits,
Liberty informed Hallman that it would consider his claim for
long term disability benefits under the Policy.
Id.
Under the
Policy, Hallman had to be “unable to perform the Material and
Substantial Duties of his Own Occupation”
years of disability.
for the first two
Admin. R. XV at CL 1064.
According to
Hallman’s family physician, Dr. Ralph Compton, as of October
2010, Hallman suffered from worsening back pain with occasional
tingling and pain in his right leg.
was also morbidly obese.
Id.
Id. at CL 1038.
Hallman
In November 2010, Dr. Compton
advised Hallman’s wife that Hallman needed to lose weight and
get involved in a physical therapy program.
6
Id. at CL 0990.
Dr. Compton also referred Hallman to a pain clinic for physical
therapy and to Dr. Phillip Tibbs, a neurosurgeon.
Id.
Hallman saw Dr. Tina Fawns, another family practitioner, in
November 2010.
Dr. Fawns noted that Hallman was morbidly obese,
that he reported chest pain, that his wife reported that he had
sleep
apnea,
and
that
foraminal stenosis.
he
had
a
bulging
Id. at CL 1004.
disc
with
bilateral
She also noted that two
neurosurgeons recommended a spinal fusion for Hallman but wanted
him to lose 100 pounds before they would perform the surgery.
Id.
at
CL
1001.
Dr.
obstructive
sleep
apnea
diabetic neuropathy.
Fawns
conducted
and
mild
a
Id. at CL 1019.
testing
bulging
that
disc
at
showed
L-4
and
Dr. Fawns recommended a
CPAP machine for the sleep apnea, as well as a weight loss
program, spinal injections, and physical therapy.
Id.
Hallman,
however, did not want treatment for sleep apnea, and Dr. Fawns
believed that he would not comply with her recommendations for
weight loss and physical therapy.
Id.
Dr. Fawns concluded that
Hallman just wanted “pain meds without making effort.”
Fawns
continued
to
treat
Hallman,
and
she
restrictions form for Hallman on April 7, 2011.
at CL 0850, ECF No. 22-9.
Id.
completed
Dr.
a
Admin R. VIII
She stated that Hallman could not
walk, sit, or stand “for prolonged periods of time,” that he
could lift and carry ten pounds, and that “prolonged sitting
would make [his] back pain worse.”
7
Id.
Dr. Tibbs, the neurosurgeon, also completed a restrictions
form for Hallman in April 2011.
had chronic lower back pain.
that
Hallman
was
capable
of
Dr. Tibbs noted that Hallman
Id. at CL 0842.
full-time
He also noted
sedentary
work,
which
means “lifting/carrying up to 10 pounds occasionally, sitting
over 50% of the time and standing/walking occasionally.”
As
authorized
under
the
Policy,
Liberty
Id.
requested
an
opinion from Dr. Philippe Chemaly, a physician specializing in
pain
management
and
rehabilitation.
Dr.
Chemaly
reviewed
records provided by Dr. Compton, Dr. Tibbs, and Dr. Fawns, as
well as Hallman’s lab results and other documents.
at CL 1101.
Admin. R. XV
Dr. Chemaly concluded that the diagnosis causing
Hallman “significant impairment” was “the diagnosis of lumbar
degenerative disc disease and lumbar facet mediated pain.”
at
CL
1105.
Dr.
Chemaly
noted
that
this
impairment
Id.
“would
result in the following restrictions and limitations”: sitting
for up to seven hours with rest breaks; limited standing; and
lifting limited to ten pounds.”
Id. at CL 1105-06.
Dr. Chemaly
also noted: “No working at elevated heights or operating of
heavy machinery. These restrictions and limitations should be
considered permanent for an eight hour work position.”
Id.
Based on the information provided by Hallman’s doctors and
Dr. Chemaly, Liberty concluded that Hallman was disabled from
his own occupation beginning October 9, 2010.
8
Admin. R. VIII at
CL 0822-23.
On May 17, 2011, Liberty informed Hallman that he
was eligible to receive long term disability benefits under the
Policy
as
of
May
1,
2011.
Id.
at
CL
0823.
Liberty
also
informed Hallman that his claim would be “evaluated periodically
to determine ongoing disability.”
IV.
Id. at CL 0822.
Termination (and Reinstatement) of Hallman’s Benefits: “Own
Occupation”
In April 2011, Hallman consulted two interventional pain
medicine physicians, Dr. Aarti Singla and Dr. Michael Harned.
His physical exam revealed 5/5 motor strength in upper and lower
extremities (normal); intact sensory examination; ability to do
a straight leg raise without pain; and ability to flex and touch
his
mid
thigh,
reproduced
though
increased
“[f]acet
pain
and
loading
somewhat
Admin. R. VII at CL 0717, ECF No. 22-8.
on
on
the
the
right
left
side.”
In May 2011, Hallman
underwent medial branch nerve blocks in his lower back.
CL 0714-15.
side
Id. at
In August 2011, Hallman underwent radiofrequency
thermocoagulation of his lower back. Admin. R. V at CL 0537-38,
ECF
No.
22-6.
At
his
follow-up
visit
in
September
2011,
Hallman’s physical exam showed 5/5 muscle strength (normal) with
some right knee pain.
In
August
questionnaire.
Id. at CL 0532-33.
2012,
Hallman
completed
an
activities
He reported that he sat for three to five hours
per day, stood for two hours a day, and walked forty-five to
9
sixty minutes each day.
Admin. R. VII at CL 0640-42.
Hallman
also reported that the length of time he was able to drive
varied.
Id.
He further reported that he left the house two or
three times per day, ran errands three times per week, and was
trying to take care of his mother.
Id.
Hallman also stated
that he spent three or more hours on his home computer every
day, and that he used the computer to pay bills, read articles,
use
search
photos.
engines,
Id.
processing
software.
at
send
0641.
software,
emails,
He
visit
also
chat
stated
spreadsheet
rooms,
that
software,
he
and
used
and
for
word
database
Id.
In October 2012, Liberty received notice that the Social
Security
Administration
determined
that
Hallman
was
disabled
under its rules and was entitled to a monthly SSDI benefit of
$1,924.80
beginning
in
April
2011,
with
adjustment to $1,994.00 in December 2011.
0591-92, ECF No. 22-7.
medical
consultant,
Dr.
a
cost
of
living
Admin. R. VI at CL
The Social Security Administration’s
Mary
McLarnon,
completed
a
Physical
Residual Functional Capacity Assessment for Hallman in September
2012.
She concluded that Hallman could stand/walk for 1.5 hours
per day, sit for four hours per day, and must alternate sitting
and standing throughout the day.
No. 22-5.
10
Admin. R. IV at CL 0408, ECF
Liberty asked Dr. Jamie Lewis, who is board certified in
physical medicine and rehabilitation pain medicine, to review
Hallman’s
medical
records
and
restriction
forms.
produced a report dated November 13, 2012.
Dr.
Lewis
Based on his review
of the documentation regarding Hallman, Dr. Lewis concluded that
the documentation did “not describe loss of joint stability, ROM
(range of motion), dexterity, or strength to support ongoing
functional limitations.”
Admin. R. V at CL 0498.
Although Dr.
Lewis noted Hallman’s “lack of therapeutic response to his pain
with
multiple
medications,”
he
concluded
that
Hallman
could
“work for a total of eight hours per day and 40 hours per week
with no restrictions and limitations.”
that
the
side
significantly
effects
impair
from
Id.
Hallman’s
Hallman’s
function.
He also concluded
medication
Id.
would
not
Although
Dr.
Lewis noted that he tried to reach Hallman’s neurosurgeon, Dr.
Tibbs, Dr. Lewis did not actually speak with him.
Id. at CL
0497.
On November 20, 2012, Liberty informed Hallman that it had
completed a review of his eligibility for disability benefits
and “determined that benefits are not payable beyond November
13, 2012.”
Id. at CL 0502.
Liberty explained that because it
determined that Hallman could “work for a total of eight hours
per
day
and
40
hours
per
week
with
no
restrictions
or
limitations,” he was no longer disabled from his own occupation
11
and
thus
Policy.
was
no
longer
disabled
Id. at CL 0504.
within
the
meaning
of
the
Hallman appealed.
In reviewing Hallman’s appeal, Liberty employees noted that
Hallman’s records documented low back pain with no significant
relief from conservative treatment.
Liberty
also
received
orthopedic surgeon.
records
Admin. R. I at CL 0015.
from
Dr.
Julian
Price,
an
Hallman visited Dr. Price in June 2013, and
Dr. Price told Hallman that his options included conservative
care, injections, and surgery.
22-3.
Admin. R. II at CL 0308, ECF No.
Hallman told Dr. Price he would like to have the surgery—
a fusion of his L5-S1 vertebrae.
Id.
Liberty’s nurse case
manager, Martha Jones, reviewed Hallman’s file and determined
that
Hallman’s
restrictions
included
“no
lifting,
carrying,
pushing or pulling over 5 lbs, less than occasional standing and
walking, no bending, twisting, squatting or stooping; ability to
sit w[ith] change of position as needed.”
0016.
Admin. R. I at CL
And Liberty’s disability case manager, Richard Tom, noted
that Hallman had been awarded SSDI benefits and acknowledged
that Hallman may only have sedentary work capacity.
0015.
Id. at CL
Tom recommended that Hallman’s benefits should be resumed
as of November 13, 2012.
notified
benefits.”
Hallman
that
By letter dated July 9, 2013, Tom
he
qualified
Admin. R. IV at CL 0371.
12
“for
continuation
of
Hallman’s benefits were
reinstated, and he received a retroactive benefit payment.
Id.
at CL 0370; Admin. R. II at CL 0343.
V.
Termination of Hallman’s Benefits: “Any Occupation”
When Tom notified Hallman in July 2013 that he qualified
for continuation of benefits, he explained that for the first
twenty-four months, Hallman’s disability was “evaluated based on
[Hallman]’s inability to perform the material and substantial
duties of his occupation.”
Admin. R. IV at CL 0371.
After
that, Hallman’s “disability will be evaluated based upon the
employee’s
inability
to
perform
the
material
and
substantial
duties of his own or any occupation for which he has or becomes
reasonably fitted by training, education or experience.”
Id.
Tom also notified Hallman that his claim would be “evaluated
periodically.”
In
August
Id.
2013,
Hallman’s
wife
sent
more
of
Hallman’s
medical records to Liberty, including the medical records from
Dr. Mark Ellis, a pain management doctor.
Dr. Ellis completed a
restrictions form for Hallman dated August 20, 2013, stating
that Hallman was “totally disabled” and could not perform even
sedentary work.
Admin. R. II at CL 0290.
Dr. Ellis further
stated that Hallman was “unable to sit/stand for [a] prolonged
period
of
distances
time,”
only,”
that
that
his
walking
Hallman
could
was
not
“limited
“bend,
to
stoop,
short
[or]
twist[],” and that Hallman could not “carry/lift > 5-10 lbs.”
13
Id.
Dr. Ellis also noted that Hallman was being evaluated for
possible surgery.
Id.
In late August 2013, Tom contacted Dr. Price’s office to
ask whether Hallman had scheduled the fusion surgery.
I
at
CL
0010.
Hallman
contacted the office.
had
not
scheduled
the
Admin. R.
surgery
or
Tom then followed up with Hallman’s wife,
who explained that Dr. Price had recommended that Hallman lose
some weight before the surgery.
Id.
Tom noted that Dr. Price’s
records did not indicate any weight loss goals or state that the
surgery
would
efforts.
be
postponed
pending
Hallman’s
weight
loss
Id.
On September 19, 2013, Tom received a report by Dr. Wayne
Beveridge, a neurosurgeon.
August
8,
2013
intervention.
for
a
Hallman visited Dr. Beveridge on
second
Id. at CL 0261.
opinion
regarding
surgical
Dr. Beveridge told Hallman that
he thought it would be “foolish for him to consider” fusion
surgery.
Id.
Instead, Dr. Beveridge recommended that Hallman
try to lose more than 100 pounds; Dr. Beveridge believed that
weight loss surgery and conditioning would offer “much higher
success in terms of getting [Hallman] to feel better” than the
fusion surgery.
Id.
Tom sent Hallman’s medical records, including records from
Dr. Beveridge, to Dr. Jason Sherman, a physician who is board
certified in pain management and rehabilitation.
14
Dr. Sherman
prepared a report dated September 23, 2013.
that
Hallman
had
“a
number
of
supported
Dr. Sherman noted
diagnoses
including
right knee pain, low back pain, mild L4-L5 degenerative disc
disease,
a
mild
narrowing,
grade
L4-L5
1
annular
anterolisthesis
bilateral pars defect.”
Hallman
nerve
had
“diabetic
conduction
radiculopathy.”
bulge,
L5
mild
on
S1
foraminal
due
to
a
Id. at CL 0239 He also noted that
peripheral
studies,
Id.
of
with
as
neuropathy
well
as
a
per
his
subjective
EMG
and
lumbar
Dr. Sherman concluded that the “objective
findings in the medical documentation provided [did] not support
any
specific
Id.
And
impairments
Dr.
Sherman
related
opined
to
that
[Hallman]’s
Hallman
had
conditions.”
“sustainable
capacity to work full-time without restrictions.”
0240.
Id. at CL
Dr. Sherman further opined that Hallman’s morbid obesity
did not cause “any impairments, restrictions or limitations on
his ability to work.”
Id.
Finally, Dr. Sherman noted that
Hallman made “numerous requests for specific pain medications”
and “did not follow through with a number of recommendations
provided by the physicians that he had seen.”
Id. at CL 0238.
In preparing his report, Dr. Sherman tried to reach Dr. Ellis
but did not actually speak with him.
By
letter
dated
September
Id. at CL 0239.
26,
2013,
Liberty
informed
Hallman that it had concluded, based on a review and assessment
by
an
independent
physician,
15
that
Hallman’s
occupational
restrictions were “no longer supported” and that Hallman thus
was not disabled under the Policy.
Id. at CL 0243.
The letter
acknowledged that Hallman’s medical records confirmed diagnoses
of “right knee pain, low back pain, mild L4-5 degenerative disc
disease, a mild L4-5 annual bulge with mild foraminal narrowing,
and grade 1 anterolisthesis of L5-S1 due to a bilateral pars
defect.”
Id.
The letter also noted that Hallman had been
diagnosed
with
diabetic
obesity.
Id.
peripheral
neuropathy
and
morbid
Hallman appealed.
On April 9, 2014, Hallman’s attorney provided Liberty with
additional records from Dr. Ellis—records dated September 2013
through
January
2014.
According
to
Hallman’s
history
and
physical report, Dr. Ellis found that Hallman still suffered
from chronic low back pain in January 2014 and that there had
been no change in his pain since his previous visit in October
2013.
Id.
at
CL
0116.
Dr.
Ellis
noted
that
Hallman
had
deferred “any further pursuit of bariatric surgery” and that he
encouraged
Hallman
to
try
“some
type
calorie counting to pursue weight loss.”
completed
Disability.
an
Attending
Physician
Id. at CL 0114-15.
of
physical
Id.
Statement
activity,
Dr. Ellis also
in
Support
of
The statement, which is dated
March 31, 2014, lists diagnoses of lumbar degenerative disease
and obesity, states that Hallman’s current symptom is chronic
lower back pain, and states that Hallman “is unable to sit for
16
prolonged
from
periods
seated
of
time,”
position,”
and
prolonged periods of time.”
has
is
“difficulty
“unable
to
. . .
walk
Id. at CL 0114.
or
stand[ing]
stand
for
The form, which
noted that Hallman had been a machine operator before he became
unable to work, asked Dr. Ellis to opine whether Hallman was
“able to perform the duties of any occupation for which he is
reasonably fitted based on education, training, experience, age,
and
mental
and
(full-time).”
physical
capacity
Id. at CL 0115.
with
reasonable
continuity
Dr. Ellis checked “No.”
Id.
The form did not specifically ask whether Hallman could perform
a sedentary occupation.
In connection with Hallman’s appeal, Liberty had Dr. Mark
Kaplan, a physician who is board certified in pain medicine and
rehabilitation, review Hallman’s medical records, the records
Liberty received in connection with Hallman’s SSDI award, and a
number
of
other
documents.
Dr.
Kaplan
also
spoke
with
Dr.
Ellis, who told Dr. Kaplan that Hallman’s “biggest problem is
transitioning
from
sitting
to
standing,”
that
a
“sedentary
capacity at most was endorsed,” and that Dr. Ellis had addressed
bariatric surgery but Hallman had declined.
accord
id.
at
CL
0078-79
(Dr.
Ellis
Id. at CL 0098;
acknowledging
that
Dr.
Kaplan’s notes accurately reflect their conversation).
Dr. Kaplan noted that as of September 2013, Hallman had an
impairment of his lumbar spine that limited activities requiring
17
standing and walking.
that
Hallman
diabetes,
had
Id. at CL 0098.
“obstructive
dyslipidemia,
morbidly obese.”
Dr. Kaplan further noted
sleep
osteoarthritis
Id. at CL 0099.
apnea,
of
the
hypertension,
knees,
and
is
Dr. Kaplan determined that
Hallman’s reported pain level was “consistent with the medical
evidence
provided
for
review.”
Id.
Dr.
Kaplan
further
determined that the following restrictions were reasonable for
Hallman from September 2013 forward:
Restrict lifting
occasionally
and
carrying
up
to
20
pounds
Restrict pushing
occasionally
and
pulling
up
to
20
pounds
Restrict in total balancing and climbing ladders
Restrict in total squatting, kneeling, crouching,
and pedaling
Restrict standing and walking to a cumulative
total of 1 hour in an eight hour day, 15 minutes
continuously
Allow position changes as needed when sitting,
standing, or walking
Id. at CL 0099-100.
Based on his review of Hallman’s medical records and his
discussion with Dr. Ellis, Dr. Kaplan opined:
In terms of a full time capacity, although the
claimant is obese, the medical evidence does not
support impairment from this, and he had previously
worked without restrictions. There is no identified
cardiopulmonary limitation or other impairing physical
condition that would be expected to impact endurance
or the ability for sustained physical activities.
18
Therefore, the available information supports the
ability to sustain a full time capacity within the
restrictions and limitations identified as of 9/25/13
and forward.
Id.
After
Dr.
Kaplan
completed
his
report,
Liberty’s
senior
vocational case manager, Jason Miller, conducted a Transferable
Skills Analysis/Vocational Review, and he prepared a report of
his
findings.
conducted
Miller
resources.
research
reviewed
using
Id. at CL 0073.
a
Hallman’s
number
of
claim
vocational
file
and
research
Miller noted that Hallman graduated
from high school and had both home and work computer experience.2
Miller
found
that
Hallman
had
the
following
non-physical
transferable skills from his job at Novelis:
Follow written and verbal instructions
Utilize basic computer applications
Record information accurately
Complete and keep up production documentation
Complete shipping documentation
Material record database documentation
Ensure product traceability
2
Hallman argues that he had minimal computer experience, but he
pointed to no evidence to support this assertion. On the other hand,
Liberty pointed to a portion of the administrative record suggesting
that Hallman used his home computer extensively and had experience
with several Microsoft programs. See, e.g., Admin. R. VII at CL 064041.
19
Admin.
R.
I
Hallman’s
perform
at
CL
education,
several
0074.
Miller
training,
sedentary
determined
and
that
experience,
occupations
Hallman
consistent
restrictions and limitations outlined by Dr. Kaplan.
0075.
on
could
with
the
Id. at CL
To reach this conclusion, Miller “researched standard
vocational
(DOT),
resources
(e.g.
Occupational
Information
Dictionary
Outlook
Network
Classification
Handbook
(O*NET)
(SOC)
coding
of
/
Occupational
(OOH),
Standard
system,
Guide
0073.
Titles
Occupational
Occupational
for
Occupational
Exploration (GOE), etc.) and Internet job boards.”
that
based
Id. at CL
Based on that research, Miller found several occupations
“require
Hallman’s
acquired
an
prior
from
occupations
equal
work
other
or
lower
level
experience,
pursuits.”
include:
Production
of
skill
education
Id.
at
Clerk
and/or
CL
–
than
Mr.
skills
0075.
Those
Manufacturing
&
Processing; Expediter – Parts, Products & Materials; and Order
Clerk – Industrial & Other.
Id.
Based on the reports by Dr. Kaplan and Miller, Liberty
upheld
its
decision
that
Hallman
was
occupation beyond September 24, 2013.
its
letter
dated
June
30,
2014,
not
from
any
Id. at CL 0066-72.
In
Liberty
disabled
acknowledged
that
Hallman continued to have back pain but stated that the medical
evidence supported its determination that Hallman could perform
full-time sedentary work.
Id. at CL 0071.
20
Liberty stated that
it considered the Social Security Administration’s decision to
approve SSDI benefits but noted that it had access to updated
medical records and medical reviews that were not available when
the Social Security Administration made its decision in October
2012.
Id. at CL 0072.
Finally, Liberty informed Hallman of his
right to file a civil action under ERISA.
VI.
Id.
Hallman’s Requests for Records
In January 2013, Hallman sent Liberty a request for records
relating to his claim.
copy
of
the
Management
doctor
doctor,”
Admin. R. V at CL 0453.
notes
as
from
well
as
[Liberty’s]
He asked for “a
independent
another
copy
November 2012 benefits termination letter.
Id.
of
Pain
Liberty’s
In response,
Liberty sent Hallman “a copy of all medical documentation for
[his] disability file.”
Id. at CL 0451.
On October 7, 2013, Liberty received Hallman’s request for
“ALL
doctor
notes
September 2013.”
from
[Liberty’s]
Independent
Admin. R. I at CL 0219.
Doctor
from
That day, Tom sent
Hallman a thumb drive containing his complete disability file.
Id. at CL 0005-6, CL 0218.
Hallman could not open the thumb
drive files, so he requested a paper copy.
Id. at CL 0005.
Liberty sent the paper copy to Hallman on October 16, 2013.
Id.
at CL 0213.
In
November
2013,
Hallman’s
attorney,
requested the following documents from Liberty:
21
Robert
Kerr,
A complete copy of Liberty Mutual’s underwriting
and claim files for Mr. Hallman’s disability
claim with Liberty Mutual;
A complete copy of the above-referenced insurance
policy(s);
Any and all inter office memoranda, notes,
reports, communications or documents relevant to
your review of Mr. Hallman’s disability claim;
Any and all correspondence (including E-mail)
between Liberty Mutual, and/or any third party
relevant
to
your
review
of
Mr.
Hallman’s
disability claim;
Any and all internal correspondence (including Email) between Liberty Mutual
Representatives
relevant to Mr. Hallman’s disability claim;
Any and all financial analysis, notes or reports
relevant to Mr. Hallman’s disability claim;
C. V. of all doctors and other professionals who
were involved in and/or evaluated Mr. Hallman’s
disability claim;
All reports and all other forms of documentation
generated by specialists, including but not
limited to physicians, vocational experts, and
medical professionals relevant to Mr. Hallman’s
disability claim;
Medical reports and medical records summaries
completed by or at the request of Liberty Mutual
that are relevant to Mr. Hallman’s disability
claim;
Claims
directives,
explanations,
guides,
memorandums,
etc.,
that
discuss
the
administration
and
evaluation
of
claims
by
Liberty Mutual;
Claims Review Training documents used by Liberty
Mutual;
22
Claims Review Training videos and tapes used by
Liberty Mutual;
Guides pertaining to claims resolutions used by
Liberty Mutual; and
Any other documents, reports, communications or
information relevant to Mr. Hallman’s claim for
disability benefits.
Id. at CL 0208-09.
On November 21, 2013, Liberty sent Kerr a
copy of the Policy, as well as Hallman’s complete claim file.
Id. at CL 0204-05.
After Liberty denied Hallman’s second appeal in 2014, Kerr
asked Liberty to send him the same documents he had requested in
November
2013,
documents
doctors
including
relevant
a
copy
of
Hallman’s
Hallman’s
claim,
evaluated
who
to
Hallman’s
claim.
and
claim
the
Id.
CVs
at
CL
file,
of
the
0063-64.
Liberty sent Kerr a copy of the Policy and Hallman’s claim file.
Id.
at
CL
0062.
Liberty
represented
that
the
claim
file
constituted “all information that was received and considered in
[Liberty’s] evaluation of Mr. Hallman’s claim.”
Id.
Liberty
also
“all
reports
represented
generated
by
that
medical
the
claim
and/or
file
vocational
contained
personnel,”
that
the
“names and titles of medical/vocational personnel are contained
in
the
claim
physicians.”
Sherman,
file,
Id.;
Lewis,
and
as
well
accord
as
id.
Kaplan).
the
at
CL
CVs
of
0051-61
According
to
the
(CVs
reviewing
of
Liberty,
Drs.
Dr.
Chemaly’s report was inadvertently misfiled and not placed in
23
Hallman’s file, so it was not included in the documents Liberty
sent to Kerr in July 2014.
Liberty later added Dr. Chemaly’s
report and CV to the administrative record.
Liberty
declined
to
provide
Kerr
with
its
documentation
regarding Liberty’s administration and evaluation of claims and
its training materials and guides.
Id. at CL 0062.
Liberty
asserted that ERISA did not require disclosure of these items
and that it had provided Kerr “with all information that was
received
claim.”
and
considered
in
[Liberty’s]
review
of
[Hallman’s]
Id.
CONCLUSIONS OF LAW
I.
Hallman’s Termination of Benefits Claim Against Novelis
Hallman asserts a termination of benefits claim against his
former employer, Novelis.
Novelis contends that it cannot be
held liable because the Policy states that Liberty agreed “to
pay benefits provided by” the Policy “in accordance with its
provisions.”
Admin. R. XV at CL 1057.
The Policy also states
that Liberty will pay benefits once certain requirements are
met.
Id. at CL 1077.
“shall
construe
possess
the
eligibility
the
terms
The Policy further states that Liberty
authority,
of
this
hereunder.
in
its
sole
policy
and
to
Liberty’s
discretion,
determine
decisions
to
benefit
regarding
construction of the terms of this policy and benefit eligibility
shall be conclusive and binding.”
24
Id. at CL 1095.
In sum, the
Policy delegated authority for claim determination to Liberty,
and the Policy required
claims.
Liberty to pay benefits on approved
Hallman did not respond to this argument and did not
point to any evidence that Novelis exercised control over or
otherwise played a role in Liberty’s determination of his claim.
Novelis is therefore entitled to judgment on the administrative
record as to Hallman’s termination of benefits claim against it.
II.
Hallman’s Termination of Benefits Claim Against Liberty
Hallman’s termination of benefits claim against Liberty is
based on Liberty’s determination that Hallman is not disabled
from any occupation within the meaning of the Policy.
made
this
determination
in
September
2013
and
upheld
Liberty
it
on
appeal in June 2014.
ERISA “permits a person denied benefits under an employee
benefit plan to challenge that denial in federal court.”
Life Ins. Co. v. Glenn, 554 U.S. 105, 108 (2008).
Metro.
The Eleventh
Circuit has “established a multi-step framework to guide courts
in
reviewing”
ERISA
benefits
determinations.
Blankenship
v.
Metro. Life Ins. Co., 644 F.3d 1350, 1354 (11th Cir. 2011) (per
curiam).
The framework has six steps:
(1) 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 end the
inquiry and affirm the decision.
25
(2) If the administrator’s decision in fact is “de
novo wrong,” then determine whether he was vested with
discretion in reviewing claims; if not, end judicial
inquiry and reverse the decision.
(3) If the administrator’s decision is “de novo wrong”
and he was vested with discretion in reviewing claims,
then determine whether “reasonable” grounds supported
it (hence, review his decision under the more
deferential arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the
inquiry and reverse the administrator’s decision; if
reasonable grounds do exist, then determine if he
operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and
affirm the decision.
(6) If there is a conflict, the conflict should merely
be a factor for the court to take into account when
determining whether an administrator’s decision was
arbitrary and capricious.
Id.
at
1355.
Hallman
does
not
contend
that
Liberty
was
influenced by a conflict of interest, Pl.’s Resp. to Defs.’ Mot.
for J. on the Admin. R. 4, so the Court’s review focuses on the
first three steps.
Hallman does not appear to dispute that
Liberty was vested with discretion in reviewing claims.
See
Admin R. XV at CL 1095 (stating that Liberty “shall possess the
authority, in its sole discretion, to construe the terms of this
policy and to determine benefit eligibility hereunder. Liberty’s
decisions regarding construction of the terms of this policy and
benefit eligibility shall be conclusive and binding”).
the
ultimate
established
question
that
for
Liberty
the
was
26
Court
arbitrary
is
and
whether
Thus,
Hallman
capricious
in
terminating Hallman’s benefits.
“As long as a reasonable basis
appears for [Liberty’s] decision . . ., it must be upheld as not
being arbitrary or capricious, even if there is evidence that
would support a contrary decision.”
White v. Coca-Cola Co., 542
F.3d 848, 856 (11th Cir. 2008) (quoting Jett, 890 F.2d at 1140).
Hallman contends that Liberty made two errors in denying
his
benefits
claim.
First,
he
argues
that
Liberty
had
no
reasonable basis for concluding that Hallman had the capacity to
work
a
full-time
Liberty’s
sedentary
vocational
job.
expert
Second,
only
he
identified
contends
that
hypothetical
alternative positions for Hallman, not actual positions.
The
Court addresses each issue in turn.
Hallman argues that he has two conditions—chronic low back
pain and morbid obesity—that render him unable to work in any
occupation.
Liberty does not dispute that Hallman is morbidly
obese or that he has chronic low back pain.
Liberty also does
not dispute that Hallman has been diagnosed with several other
conditions,
including
obstructive
diabetes, and knee pain.
conditions
do
not
sleep
apnea,
hypertension,
Liberty argues, however, that these
render
Hallman
unable
to
work
in
any
occupation.
In
Hallman,
making
its
Liberty
latest
had
the
benefits
following
Hallman’s condition:
27
determination
regarding
information
regarding
Dr. Tibbs’s April 2011 restrictions form for Hallman,
which stated that Hallman was capable of full-time
sedentary work.
Hallman’s August 2012 activities questionnaire, reporting
that he sat for three to five hours per day, stood for
two hours per day, walked forty-five to sixty minutes per
day, ran errands several times a week, and spent three or
more hours on his home computer every day.
The Social Security Administration medical consultant’s
September 2012 conclusion that Hallman could stand/walk
for 1.5 hours per day and sit for four hours per day.
Dr. Price’s records from June 2013 suggesting that
conservative treatment options had not significantly
alleviated Hallman’s pain symptoms.
Dr. Ellis’s August 2013 restrictions form for Hallman,
which stated that Hallman was totally disabled and could
not perform sedentary work because he could not sit or
stand for prolonged periods of time.
Dr. Beveridge’s records from September 2013 suggesting
that fusion surgery was not a good option for Hallman and
that weight loss and conditioning would be a better
option to help Hallman improve.
Dr. Ellis’s January 2014 statement that Hallman’s pain
had not changed since October 2013.
Dr. Ellis’s March 2014 attending physician statement,
which stated that Hallman could not sit for extended
periods of time and had trouble standing from a seated
position.
In addition, Dr. Ellis answered “no” to the
form’s question of whether Hallman could perform the
duties of any occupation for which he is reasonably
fitted, although the form did not specifically ask
whether Hallman could perform full-time sedentary work.
Dr. Kaplan’s report of his conversation with Dr. Ellis,
who told Dr. Kaplan that Hallman’s biggest problem was
transitioning from sitting to standing, that a sedentary
capacity at most was endorsed, and that Hallman had
declined bariatric surgery.
28
Hallman’s medical records documenting a consistent
diagnosis of mild degenerative disc disease and an
impairment of his lumbar spine.
Based
on
reviewer,
this
Dr.
information,
Kaplan,
Liberty’s
determined
that
independent
Hallman
medical
should
several physical restrictions from September 2013 forward.
have
But
he also determined that the available information supported a
conclusion that Hallman could work a full-time sedentary job
within those restrictions.
Under the Policy, Hallman had the burden to provide proof
that he was disabled within the meaning of the Policy.
Liberty
considered information provided by Hallman’s doctors and relied
on the advice of independent medical professionals, including
Dr. Kaplan, to conclude that Hallman had not established that he
was disabled from any occupation.
Hallman emphasizes that Dr.
Ellis stated that Hallman was totally disabled.
But there was
evidence in the administrative record that reasonably could have
led Liberty to doubt that assessment—including Dr. Ellis’s own
clarification of his position to explain that Hallman’s biggest
problem was transitioning from sitting to standing and that a
sedentary capacity at most was endorsed.
In addition, another
of Hallman’s physicians, Dr. Tibbs, cleared him for sedentary
work.
And, even if Dr. Ellis had not clarified his position on
Hallman’s
limitations,
“the
plan
administrator
may
give
different weight to [the treating physicians’] opinions without
29
acting arbitrarily and capriciously.”
1356.
Blankenship, 644 F.3d at
“Plan administrators need not accord extra respect to the
opinions of a claimant’s treating physicians.”
Id.
Hallman did
not point to anything in the record suggesting that Liberty
acted unreasonably in relying on Dr. Kaplan’s opinion regarding
Hallman’s limitations.
Dr. Kaplan’s opinion was similar to that
of Dr. Tibbs, and after Dr. Kaplan asked Dr. Ellis to reflect
further
on
Hallman’s
limitations,
Dr.
Ellis
suggested
that
Hallman could be endorsed for a sedentary occupation.
For these
reasons,
Hallman’s
even
if
Liberty’s
conclusion
regarding
limitations was not de novo correct, it was reasonable and was
not arbitrary and capricious.
Hallman
reasonable
appears
in
to
argue
concluding
that
that
he
even
could
if
work
Liberty
a
was
sedentary
occupation with the restrictions outlined by Dr. Kaplan, Liberty
was
unreasonable
in
determining
occupations that Hallman could do.
that
there
were
sedentary
After Dr. Kaplan concluded,
based on the available information, that Hallman could work a
full-time
sedentary
job
with
several
restrictions,
Liberty’s
vocational case manager, Miller, used a variety of vocational
resources
to
research
sedentary
occupations
that
could
accommodate Hallman’s restrictions and which required an equal
or lower level of skill than Hallman’s prior work experience,
education,
and
skills
acquired
30
from
other
pursuits.
Miller
found
several
occupations
that
restrictions and skill level.
could
accommodate
Hallman’s
Contrary to Hallman’s assertion,
this is not a case where the vocational case manager asserted
that Hallman could work “jobs that exist only hypothetically.”
Kennard v. Means Indus., Inc., 555 F. App'x 555, 558 (6th Cir.
2014).
In Kennard, the plaintiff had significant lung damage
and could only work an “absolute clean-air” job.
Id. at 557.
The plan administrator in Kennard did not present evidence that
such a job existed.
Id. at 558.
In contrast, here, Liberty’s
vocational case manager used several resources to find actual
occupations that could accommodate Hallman’s restrictions and
his skill level.
For the reasons set forth above, the Court concludes that
it
was
reasonable
for
Liberty
to
disabled from “any occupation.”
find
that
Hallman
was
not
Thus, Liberty’s decision to
uphold the denial of Hallman’s benefits was reasonable and was
not arbitrary and capricious.
III. Hallman’s Claims Based on Failure to Respond to Requests
In addition to his claims based on the termination of his
long term disability benefits, Hallman asserts a claim based on
Defendants’
information.
alleged
The
failure
Court
in
to
its
respond
to
his
requests
discretion
may
hold
a
for
plan
administrator personally liable to a plan participant based on
the plan administrator’s failure to comply with a request for
31
information
“which
[the]
administrator
is
required
by
this
subchapter to furnish to a participant or beneficiary.”
U.S.C. § 1132(c)(1).
29
The term “administrator” means either “the
person specifically so designated by the terms of the instrument
under which the plan is operated” or “if an administrator is not
so designated, the plan sponsor.”
(ii).
29 U.S.C. § 1002(16)(A)(i)-
Neither party pointed to evidence that the Policy or any
other document specifically designates a plan administrator, and
the
Court
found
no
such
29 U.S.C. § 1002(16)(A)(ii),
sponsor: Novelis.
provision.
the
Therefore,
administrator
is
under
the
plan
Hallman did not point to any evidence that
Novelis failed to provide him with information it was required
to furnish to him, so Novelis is entitled to summary judgment on
this claim.
Hallman argues that the Court should hold Liberty liable
under § 1132(c)(1) as a fiduciary of Novelis.
The statute does
not state that an entity other than the administrator may be
held liable under § 1132(c)(1).
Even if it did, § 1132(c)(1)
only provides that an administrator may be liable for failing or
refusing
to
administrator
comply
is
with
a
request
required
by
statute
participant’s rights.
for
to
information
provide
the
about
the
See, e.g., Brucks v. Coca-Cola Co., 391
F. Supp. 2d 1193, 1210 (N.D. Ga. 2005) (noting that a plan
administrator
must
provide
certain
32
plan
documents
under
29 U.S.C. § 1024);
29
U.S.C. § 1024(b)(4)
(requiring
plan
administrator to furnish, upon written request of a participant,
“a copy of the latest updated summary, plan description, and the
latest
annual
report,
any
terminal
report,
the
bargaining
agreement, trust agreement, contract, or other instruments under
which the plan is established or operated”).
however,
argue
that
Liberty
failed
to
Hallman does not,
provide
him
with
information that it was required by statute to provide.
For
this reason, even if Hallman could pursue a failure to respond
claim against Liberty, such a claim fails.
Hallman’s real argument is that Liberty did not comply with
a regulation requiring “reasonable access to, and copies of, all
documents,
records,
claimant’s
claim
and
for
other
information
benefits.”
relevant
to
the
29 C.F.R. § 2560.503-
1(h)(2)(iii).
Hallman claims that Liberty failed to provide
(1) a
a
copy
of
March
2012
surveillance
video
and
(2) the
curriculum vitae of all of the experts consulted on Hallman’s
file.
He
contends
that
Liberty’s
failure
to
provide
these
documents deprived him of an opportunity to pursue his claim
adequately.
Regarding the video, Liberty pointed out that the claim
file contained a link to the 2012 video.
CL 0753 (showing the link to the video).
See Admin. R. VIII at
Liberty also pointed
to evidence that it sent the entire claim file to Hallman’s
33
lawyers in February 2013, November 2013, and July 2014.
R. V at CL 0446; Admin. R. I at CL 0206, CL 0062.
Admin.
And Liberty
pointed to evidence that it sent a thumb drive containing the
claim file directly to Hallman in October 2013.
CL 0005-6, CL 0218.
Admin. R. I at
Hallman did not present any evidence to
establish that the video link, which can be accessed by typing
the URL into the address bar of an internet browser, was not
included in any of the four claim file copies that Liberty sent
to Hallman or his attorney.
The Court thus cannot conclude that
Liberty failed to provide Hallman with a copy of the 2012 video.
Regarding the CVs, Hallman asserts that Liberty failed to
provide
them
November 2013.
when
his
counsel
originally
requested
them
It is undisputed that Liberty did not obtain the
CVs or send them to Hallman’s counsel until July 2014.
CL
0003,
CL
in
0062.
But
Hallman
did
not
establish
Id. at
that
the
documents were “relevant” within the meaning of the regulation
because he did not point to evidence that they were relied on,
submitted, considered, or generated in the course of making the
benefit
determination.
(defining “relevant”).
See
29 C.F.R. § 2560.503-1(m)(8)
Even if the CVs were relevant to his
claim, Hallman did not point to any evidence that a delay in
Liberty’s sending of the CVs adversely affected his ability to
pursue
his
claims.
For
these
reasons,
any
Liberty’s delay in sending Hallman the CVs fails.
34
claim
based
on
CONCLUSION
For the reasons set forth above, the Court grants Liberty’s
motion for judgment on the administrative record (ECF No. 22)
and denies Hallman’s motion for summary judgment (ECF No. 23).
IT IS SO ORDERED, this 10th day of November, 2016.
S/Clay D. Land
CLAY D. LAND
CHIEF U.S. DISTRICT COURT JUDGE
MIDDLE DISTRICT OF GEORGIA
35
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