Beach v. Hartford Life and Accident Insurance Company et al

Filing 21

RULING granting 13 Motion for Summary Judgment. Plaintiffs request for summary judgment under Rule 56(f)(1) of the Federal Rules of Civil Procedure is DENIED as moot for the reasons set forth in this opinion. Judgment shall be entered accordingly. Signed by Judge Shelly D. Dick on 7/28/2014. (LLH)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

RANDOLPH L. BEACH

CIVIL ACTION

VERSUS

NO. 13-362-SDD-SCR

HARTFORD LIFE & ACCIDENT
INSURANCE COMPANY

RULING
This matter is before the Court on the Motion for Summary Judgment1 filed by the
Defendant, Hartford Life & Accident Insurance Company (“Hartford” or “Defendant”). The
Plaintiff, Randolph L. Beach (“Plaintiff”) has filed an Opposition2 to the motion, to which the
Defendant filed a Reply.3 For the reasons which follow, the Court finds that the Defendant’s
motion should be GRANTED.
I.

FACTUAL BACKGROUND
Plaintiff was formerly employed by Electrical Reliability Services, a participant in a

group long-term disability benefit plan (“Policy” or “Plan”) sponsored by its affiliate,
Emerson Electric Company, and underwritten by an insurance policy issued by Hartford.
This Policy is governed by the Employee Retirement Security Act of 1974 (“ERISA”).4 The

1

Rec. Doc. No. 13.

2

Rec. Doc. No. 19.

3

Rec. Doc. No. 20.

4

29 U.S.C. § 1001, et seq.

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terms of the Policy vest Hartford with the discretionary authority to determine eligibility for
benefits and to interpret the Policy. Plaintiff contends that, since around December 30,
2009, he has been and will continuously remain disabled based on a condition of
osteoarthritic changes in his left knee following a 2008 surgery.
While still employed by Electrical Reliability Services, Plaintiff made a claim for
disability benefits under the Policy referred to above. Hartford contends that, under the
terms of the Policy, benefits are not payable during the designated 180 day Elimination
Period. Further, if during the Elimination Period, and for twenty-four months following this
period, a participant is prevented from performing one or more of the essential duties of
his/her own occupation due to accidental bodily injury, sickness, or other qualifying
conditions, the individual would be eligible to receive disability benefits. This twenty-four
months is referred to as the “Own Occupation” period or standard of disability. The Policy
also provided that, if after twenty-four months following the Elimination Period, the
participant continued to be prevented from performing any one or more of the essential
duties of any occupation due to injury, sickness, or other qualifying condition, the participant
may continue to receive long-term disability benefits up to a maximum period of time
designated in the Policy. This is referred to as the “Any Occupation” period or standard of
disability.
With respect to Plaintiff, Defendant contends that the maximum period of benefits
that could be applicable was until age sixty-six. If the participant is eligible for benefits, the
Policy provides that monthly, long-term disability benefits are paid at sixty percent of the
employee’s pre-disability earnings. However, eligible gross disability benefits are subject
to an offset for other income received by the participant, including any Social Security
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disability benefits received.
In 2010, Plaintiff submitted a claim for long-term disability benefits due to an
asserted disability date of December 30, 2009. Plaintiff complained of knee pain due to a
diagnosis of osteoarthritis of the left knee. At the time of this complaint, Plaintiff was
employed by Electrical Reliability Services as a Field Engineer. Following application of
the 180 day Elimination Period, Defendant approved Plaintiff’s long-term disability benefits,
effective June 28, 2010, under the “Own Occupation” standard set forth in the Policy.
Defendant had determined that Plaintiff was prevented from performing the material duties
of his own occupation, which involved medium physical demand level work. Thus,
Defendant approved benefits to Plaintiff for the twenty-four month Own Occupation period.
On December 29, 2011, Defendant sent Plaintiff correspondence advising that his
benefits under the Own Occupation period would end on June 28, 2012. This letter also
advised Plaintiff that the applicable standard for disability would change to the Any
Occupation standard, and the Defendant would begin a review to determine if Plaintiff
would qualify for continued benefits under that standard. As part of this review, Defendant
obtained information from Plaintiff and his treating physicians which included updated
medical information and records from those physicians.

Defendant also obtained an

Independent Medical Examination (“IME”) by a local physician, Dr. Scott Petrie, who
practices in Gonzales, Louisiana, and specializes in Orthopedic Surgery. Defendant
contends Dr. Petrie performed a thorough examination of Plaintiff, both general and specific
to his knee condition, in conjunction with a review of Plaintiff’s medical history and records
from 2008-2012. Part of this examination included an evaluation by Dr. Petrie of Plaintiff’s
knee strength and range of motion. Dr. Petrie’s notes indicate that Plaintiff was treated
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conservatively and had arthroscopic surgery with follow-up treatment until October of 2010;
however, Plaintiff did not have any additional treatment until January of 2012.
Dr. Petrie concluded that Plaintiff was capable of performing sedentary work with
restrictions for climbing and standing for extended periods of time, in addition to restrictions
in kneeling, squatting, and maneuvering. However, Dr. Petrie also concluded that Plaintiff
could be on his feet for up to an hour at a time with periodic breaks.
During this claim review, Hartford also obtained an Employability Analysis to identify
any occupations which Plaintiff would be qualified to perform considering his medical
condition, education, training, and experience. The Employability Analysis was conducted
by a Rehabilitation Case Manager utilizing OASYS (Occupational Access System), which
is a computerized job matching system that cross references an individual’s qualifications
profile with 12,741 occupations classified by the United States Department of Labor in the
Dictionary of Occupational Titles.5 Defendant contends that the Rehabilitation Case
Manager considered Plaintiff’s functional capabilities, limitations noted by his doctors, his
work and education history, and additional considerations and adjustments to Plaintiff’s
overall work profile. Through this analysis, Defendant contends that various occupations
were identified for which Plaintiff was qualified.
Based on the information submitted by Plaintiff and his treating physicians, the IME
conducted by Dr. Petrie, and the Employability Analysis, Defendant determined that Plaintiff
was not qualified for continued disability benefits under the Any Occupation standard of the

5

Rec. Doc. No. 13-4, pp. 12-25 (Bates Nos. H00355-H00368).

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Policy. On June 25, 2012, Defendant advised Plaintiff in writing that he was no longer
qualified for disability benefits under the Any Occupation standard, and he would no longer
receive benefits beyond June 27, 2012.6 This correspondence also contained a summary
of the information considered and reviewed by the Ability Analyst in reaching Plaintiff’s
claim determination. The Ability Analyst also addressed Plaintiff’s Social Security Disability
benefits award and explained that the standards governing the receipt of Social Security
Disability benefits vary from that under Defendant’s Policy.
The letter also advised that Defendant had determined that Plaintiff was not
precluded from performing the material duties of any occupation for which he was
otherwise qualified by his education, training, and experience, and with consideration of his
functional capabilities and medical condition.7 Through his counsel, Plaintiff appealed this
claim determination; however, Defendant contends that, on appeal, Plaintiff did not present
any new medical evidence or information.
During the appeal review, Defendant obtained an Independent Medical Review8 by
a second physician, Dr. Rosaline Vaquez. Dr. Vasquez conducted a detailed review of the
medical records from Plaintiff’s treating physicians,9 laboratory data and imaging, along with
records and information from Dr. Petrie who had performed the IME on behalf of
Defendant. Also considered by Dr. Vasquez were the Attending Physician Statements and

6

Rec. Doc. No. 13-2, pp. 13-17 (Bates Nos. H00083-H00087).

7

Id.

8

Rec. Doc. No. 13-3, pp. 96-109 (Bates Nos. H00303-H00314).

9

Dr. Barry Rills and Dr. Cherie Leblanc.

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Plaintiff’s Affidavit.
Dr. Vasquez also communicated with both of Plaintiff’s treating physicians. She
reported that Dr. Rills indicated that Plaintiff was fine as long as he did not engage in heavy
physical work like squatting, climbing, and lifting heavy objects.10 While he confirmed
reported back pain, Dr. Rills also confirmed that there was never any imaging or medical
intervention related to reported back pain, and that surgery was no longer being considered
for Plaintiff’s knee since he was doing well. When questioned whether Plaintiff could
perform full-time sedentary level activity with the ability to change positions, Dr. Rills
reported that such work “would be fine.”11 Dr. Cherie Leblanc was contacted by Dr.
Vasquez, but was unable to provide any information as Dr. Leblanc’s last clinical note on
Plaintiff was from 2010, and she maintained that she did not have authorization to release
Plaintiff’s medical information.12
Dr. Vasquez’s report ultimately concluded that, based on the totality of information
available regarding Plaintiff’s medical condition, Plaintiff would be capable of performing
a sedentary level occupation on a full-time basis with accommodation for changing
positions and having predictable meal times.13 This sedentary work capability was found
to apply as of June 27, 2012.

10

Rec. Doc. No. 13-3, pp. 96-109 (Bates Nos. H00303-H00314).

11

Id. at p. 107 (Bates No. H00312).

12

Id. Dr. Vasquez reports that she faxed a second release for Plaintiff and left messages for Dr. Leblanc
which were never returned.
13

Id. at p. 109 (Bates No. H00314).

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Defendant concluded on appeal that Plaintiff was not eligible for long-term disability
benefits under the Any Occupation standard for disability under the Policy. Plaintiff was
advised in writing of this decision on February 28, 2013 by Hartford’s Appeal Specialist.14
Plaintiff was provided a detailed summary of the bases for this finding, notice of his ERISA
rights, and informed that all administrative remedies were exhausted.
Plaintiff filed this lawsuit against Hartford on June 5, 2013, seeking review of
Hartford’s claim decision. Hartford has moved for summary judgment.
II.

LAW AND ANALYSIS
A.

Summary Judgment Standard

Summary judgment should be granted if the record, taken as a whole, "together with
the affidavits, if any, show that there is no genuine issue as to any material fact and that
the moving party is entitled to a judgment as a matter of law."15 The Supreme Court has
interpreted the plain language of Rule 56(c) to mandate "the entry of summary judgment,
after adequate time for discovery and upon motion, against a party who fails to make a
showing sufficient to establish the existence of an element essential to that party's case,
and on which that party will bear the burden of proof at trial."16 A party moving for summary
judgment "must 'demonstrate the absence of a genuine issue of material fact,' but need not

14

Rec. Doc. No. 13-2, p. 1-6 (Bates Nos. H00071-H00076).

15

Fed. R. Civ. P. 56(c); New York Life Ins. Co. v. Travelers Ins. Co., 92 F.3d 336, 338 (5th Cir. 1996); Rogers
v. Int'l Marine Terminals, Inc., 87 F.3d 755, 758 (5th Cir. 1996).
16

Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). See also
Gunaca v. Texas, 65 F.3d 467, 469 (5th Cir. 1995).

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negate the elements of the nonmovant's case."17 If the moving party "fails to meet this
initial burden, the motion must be denied, regardless of the nonmovant's response."18
If the moving party meets this burden, Rule 56(c) requires the nonmovant to go
beyond the pleadings and show by affidavits, depositions, answers to interrogatories,
admissions on file, or other admissible evidence that specific facts exist over which there
is a genuine issue for trial.19 The nonmovant's burden may not be satisfied by conclusory
allegations, unsubstantiated assertions, metaphysical doubt as to the facts, or a scintilla
of evidence.20 Factual controversies are to be resolved in favor of the nonmovant, "but only
when there is an actual controversy, that is, when both parties have submitted evidence
of contradictory facts."21 The Court will not, "in the absence of any proof, assume that the
nonmoving party could or would prove the necessary facts."22 Unless there is sufficient
evidence for a jury to return a verdict in the nonmovant's favor, there is no genuine issue
for trial.23

17

Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994) (en banc) (quoting Celotex, 477 U.S. at 323-25,
106 S.Ct. at 2552).
18

Id. at 1075.

19

Wallace v. Texas Tech Univ., 80 F.3d 1042, 1046-47 (5th Cir. 1996).

20

Little, 37 F.3d at 1075; Wallace, 80 F.3d at 1047.

21

Wallace, 80 F.3d at 1048 (quoting Little, 37 F.3d at 1075). See also S.W.S. Erectors, Inc. v. Infax, Inc., 72
F.3d 489, 494 (5th Cir. 1996).
22

McCallum Highlands v. Washington Capital Dus, Inc., 66 F.3d 89, 92 (5th Cir. 1995), as revised on denial
of rehearing, 70 F.3d 26 (5th Cir. 1995).
23

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249-51, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986).

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B.

ERISA - Standard of Review

It is undisputed that ERISA governs Hartford’s Policy and Plaintiff’s claims and that
the LTD Policy at issue vests Hartford with discretionary authority to determine eligibility
for benefits. “Standard summary judgment rules control in ERISA cases.”24 Summary
judgment is appropriate “if the movant shows that there is no genuine dispute as to any
material fact and the movant is entitled to judgment as a matter of law.”25
The Fifth Circuit also reviews de novo a district court's selection of the appropriate
standard of review to be applied to an ERISA administrator's eligibility determination.26
Unless the terms of the plan give the administrator “discretionary authority to determine
eligibility for benefits or to construe the terms of the plan[,]” an administrator's decision to
deny benefits is reviewed de novo.27 However, if the language of the plan does grant the
plan administrator discretionary authority to construe the terms of the plan or determine
eligibility for benefits, a plan's eligibility determination must be upheld by a court unless it
is found to be an abuse of discretion.28 Independent of the administrator's ultimate
authority to determine benefit eligibility, factual determinations made by the plan
administrator during the course of a benefits review will be rejected only upon a showing

24

Cooper v. Hewlett–Packard Co., 592 F.3d 645, 651 (5th Cir. 2009) (quoting Vercher v. Alexander &
Alexander Inc., 379 F.3d 222, 225 (5th Cir.2004)).
25

26

27

Fed. R. Civ. P. 56(a).
Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 168 F.3d 211, 213 (5th Cir. 1999).
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).

28

Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 111 (2008) (citing Firestone Tire & Rubber Co., 489 U.S. at 111,
115).

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of abuse of discretion.29
In the ERISA context, “[a]buse of discretion review is synonymous with arbitrary and
capricious review.”30 This standard requires only that substantial evidence supports the
plan fiduciary's decision.31 Substantial evidence is “more than a scintilla, less than a
preponderance, and is such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.”32 “A decision is arbitrary only if made without a rational
connection between the known facts and the decision or between the found facts and the
evidence.”33 Moreover, this court's “review of the administrator's decision need not be
particularly complex or technical; it need only assure that the administrator's decision fall[s]
somewhere on a continuum of reasonableness—even if on the low end.”34
Where, as here, the insurance carrier is also the claims administrator, courts have
recognized that an inherent conflict of interests exists. However, following the Supreme
Court’s decision in Metropolitan Life Insurance Co. v. Glenn,35 the Fifth Circuit joined the
majority of the other circuits in repudiating application of a “sliding scale” standard of review

29

Meditrust Fin. Servs. Corp., 168 F.3d at 213.

30

Cooper, 592 F.3d at 652 (citing Meditrust, 168 F.3d at 214).

31

Ellis v. Liberty Life Assur. Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004).

32

Id. (quoting Deters v. Sec'y of Health, Educ. & Welfare, 789 F.2d 1181, 1185 (5th Cir.1986)).

33

Holland v. Int'l Paper Co. Ret. Plan, 576 F.3d 240, 246 (5th Cir. 2009) (citing Meditrust Fin. Servs. Corp.,
168 F.3d at 215).

34

Corry v. Liberty Life Assur. Co. of Boston, 499 F.3d 389, 398 (5th Cir. 2007) (quoting Vega v. Nat'l Life Ins.
Servs., Inc., 188 F.3d 287, 297 (5th Cir.1999) (en banc)(overruled on other grounds).
35

554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008).

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of discretionary plan determinations where a possible conflict exists, and adopted the
unitary abuse of discretion standard, weighing any conflict as a factor in that
determination.36 The Fifth Circuit has explained that, “[i]n deciding how much weight to
afford the apparent conflict here, we are guided by our decisions in Holland and
Schexnayder v. Hartford Life & Accident Ins. Co., 600 F.3d 465 (5th Cir. 2010).37 In
Schexnayder, we explained our application of the Glenn test:
In reviewing the plan administrator's decision, we take into account ... several
different considerations. These factors are case-specific and must be
weighed together before determining whether a plan administrator abused
its discretion in denying benefits. Any one factor may act as a tiebreaker
when the other factors are closely balanced, the degree of closeness
necessary depending upon the tiebreaking factor's inherent or case-specific
importance.
The interaction between the factors and the substantial evidence test is a
relatively new issue after the Supreme Court's decision in Glenn. We have
considered the interplay in only one prior published decision—Holland—in
which we found that the conflict of interest was a minimal factor and that the
evidence was more than sufficient to support the denial of benefits.
However, a reviewing court may give more weight to a conflict of interest,
where the circumstances surrounding the plan administrator's decision
suggest “procedural unreasonableness.”38
With these guidelines in mind, the Court turns to a review of the Plan Administrator’s
decision under an abuse of discretion standard.
1.

Does Substantial Evidence Support Hartford’s Decision?

Hartford contends that its “complete, conscientious and thorough” review of Plaintiff’s

36

Holland v. Int'l Paper Co. Ret. Plan, 576 F.3d 240, 247 n. 3 (5th Cir. 2009).

37

Crowell v. CIGNA Group Ins., 410 F. App’x 788, 793-94 (5th Cir. Nov. 7, 2011).

38

Id., quoting Schexnayder, 600 F.3d at 469 (citations and internal quotation marks omitted).

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medical records in conjunction with the assistance of outside medical consultants
demonstrates that Hartford’s denial of Plaintiff’s claim was not arbitrary or capricious and
not an abuse of discretion.39 Hartford also contends it reviewed numerous items of
documentation and medical records in its evaluation of Plaintiff’s claim in addition to an IME
and an Independent Medical Review.

Hartford argues the Employability Analysis

performed further supports its claim determination. Thus, Hartford contends that everything
contained in the administrative record unquestionably establishes a rational connection
between the facts relied upon and the decision to deny Plaintiff long-term disability benefits.
Hartford also avers that the Court must give deference to Hartford’s factual findings and
conclusions.
Plaintiff directs the Court to his Affidavit, wherein he attested that he cannot sit, walk,
or stand, even if alternating these positions at will, for more than two hours without lying
down and elevating his legs for 30 minutes for pain relief.40 Plaintiff also notes that Dr.
Petrie documented that his left knee will not likely improve over time and will, in fact,
probably worsen.41 Further, Plaintiff points to the opinion of his treating physician, Dr. Rills,
who stated that Plaintiff’s condition and limitations are permanent, and that he is totally
disabled from even sedentary work.42
Plaintiff ostensibly contends that Hartford ignored or refused to credit his treating

39

Rec. Doc. No. 13-9, p. 18.

40

Rec. Doc. No. 13-4, p. 50 (Bates No. H00393).

41

Rec. Doc. No. 13-5, p. 144 (Bates No. H00662).

42

Rec. Doc. No. 13-4, p. 11 (Bates No. H00354).

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physician’s opinion. Plaintiff is correct in urging that, “[t]he Supreme Court has held that
‘courts have no warrant to require administrators automatically to accord special weight to
the opinions of a claimant's physician,’ but a plan administrator ‘may not arbitrarily refuse
to credit a claimant's reliable evidence, including the opinions of treating physicians.’”43
Plaintiff cites Schully v. Continental Casualty Company,44 where the district court held, and
the Fifth Circuit affirmed, a finding that Hartford’s plan administrator “deliberately ignored”
Schully’s medical evidence in order to support its “preferential and predetermined
conclusions.” However, the record in this case distinguishes Plaintiff’s case from Schully.
The administrative record reflects that both of the independent physicians obtained
by Hartford to evaluate Plaintiff’s claim took the opinions and medical records of Plaintiff’s
treating physicians into account in rendering their own determinations of Plaintiff’s ability
to work.

Dr. Petrie’s report references Plaintiff’s complaints of pain and functional

limitations, and includes references to Dr. Rill’s medical records.45 Likewise, Dr. Vasquez’s
report indicates that she fully considered all of Plaintiff’s medical records, opinions, and
notes from treating physicians and Dr. Petrie, as well as oral communications with these
physicians, in her evaluation.46

Hartford also contends that, although Dr. Rills did

previously conclude that Plaintiff was disabled even for sedentary work, when contacted

43

Schexnayder v. Hartford Life and Acc. Ins. Co., 600 F.3d 465, 469 (5th Cir. 2010)(quoting Black & Decker
Disability Plan v. Nord, 538 U.S. 822, 834 (2003).
44

380 F. App’x 437, 439 (5th Cir. June 7, 2010).

45

Rec. Doc. No. 13-5, pp. 138-144 (Bates Nos. H00656-H00662).

46

Rec. Doc. No. 13-3, pp. 98-109 (Bates Nos. H00303-H00314).

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by Dr. Vasquez in connection with her review of Plaintiff’s appeal, Dr. Vasquez reported
that Dr. Rills advised that sedentary work, with the ability to change positions, on a full-time
basis, “would be fine.”47

Plaintiff suggests this assertion is “especially ludicrous”

considering that Dr. Rills’ written notes and opinions which indicate Plaintiff’s inability to
perform sedentary work were recorded during the same time frame that Dr. Rills
purportedly advised Dr. Vasquez to the contrary.48
Despite this suggested inconsistency, the Court must find from the totality of the
administrative record that Hartford’s determination was not an abuse of discretion. Dr. Rills’
medical records and notes were clearly considered and evaluated in conjunction with those
of the other physicians. Dr. Rills’ conclusion that Plaintiff could not perform sedentary work
does not undermine Hartford’s ultimate decision. While Hartford clearly could not ignore
or refuse to give credence to Dr. Rills’ records and opinion, it was under no obligation to
give overriding significance in consideration of the other physicians’ opinions and findings
with respect to Plaintiff’s condition. Hartford was not required to accord special weight to
Dr. Rills’ diagnosis. Moreover, it is obvious from the record that Dr. Rills’ notes, records,
and opinions were not disregarded or ignored but were reviewed and referenced by both
of the independent physicians obtained by Hartford and by the analyst during the appeal
review.49

47

Id. at p. 107 (Bates No. H00312).

48

Rec. Doc. No. 19, p. 15.

49

See Black & Decker , 538 U.S. at 834; cf. Sweatman v. Commercial Union Ins. Co., 39 F.3d 594, 602–03
(5th Cir.1994) (accepting an administrator's reliance on diagnoses of independent physicians, where those
diagnoses conflicted with the diagnoses of the claimant's physicians).

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The Court finds that there is substantial evidence in the administrative record to
support Hartford’s decision in this case. Because the record contains sufficient evidence
regarding Plaintiff’s ability to work that “reasonable minds might accept as adequate,” the
Court simply cannot find that there is no rational connection between the known facts and
the decision, or between the found facts and the evidence.50
2.

The Employability Analysis

As discussed above, Hartford obtained an Employability Analysis, conducted by a
Rehabilitation Case Manager utilizing OASYS (Occupational Access System), a
computerized job matching system that cross references an individual’s profile with 12,741
occupations classified by the United States Department of Labor. Taking into account
Plaintiff’s functional capabilities as reported by Dr. Petrie, Plaintiff’s physical limitations, and
work and education history, the case manager identified various occupations for which
Plaintiff would be qualified.
Plaintiff strongly challenges the accuracy of the Employability Analysis, arguing that
Hartford made a crucial error regarding Plaintiff’s earning potential which rendered a fatally
flawed analysis and conclusion. Plaintiff further contends that, even after Plaintiff advised
Hartford of this error, Hartford refused to address it on appeal, stating only that it properly
relied on the findings of the Employability Analysis. Plaintiff argues that “Hartford’s

50

Plaintiff argues that Hartford’s structural conflict of interest requires the Court to give less deference to the
administrator’s decision under Plaintiff’s cited authority. However, the cases cited have been overruled by the
Supreme Court in Glenn, supra. As explained by the Fifth Circuit in Holland and Schexnayder, discussed
previously in this opinion, this structural conflict of interest is only a factor for the Court to consider in
determining whether the plan administrator abused discretion. The Court has given this factor the appropriate
weight and finds that the administrator did not abuse discretion in the determination.

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continued blind reliance upon the ‘expertise’ of its vocational rehabilitation consultant”
demonstrates the arbitrary and capricious nature of the decision.51 Plaintiff also argues that
the Employability Analysis failed to adequately or accurately take into account Plaintiff’s
physical conditions and limitations.
Without conceding that it made an error,52 Hartford responds that such an
inadvertent error does not render the Employability Analysis invalid because, as Plaintiff
conceded, there were two specific occupations identified that met or exceeded sixty percent
of Plaintiff’s pre-disability earnings which satisfied the requisite threshold.53 Hartford also
argues that Plaintiff’s position ignores the fact that the Employability Analysis Report’s
listing of occupations indicates that it represents only a small sampling of the 244
occupations identified. Thus, Hartford asserts it is reasonable to consider that some
significant percentage of those occupations would meet or exceed the pre-disability
earnings amount reflected by the two occupations identified in the example listing. Finally,
Hartford contends that all of Plaintiff’s relevant information was considered in the
Employability Analysis, including Plaintiff’s work history and medical information.
The Court finds that, while the Employability Analysis may have been flawed, the
totality of the administrative record still supports Hartford’s decision. First, Hartford is
correct that the two occupations identified met the requisite threshold despite the alleged

51

Rec. Doc. No. 19, p. 9.

52

Hartford notes that it assumes, only for the purposes of its Motion for Summary Judgment, that the higher
pre-disability earnings index amount asserted by Plaintiff should have been used. Rec. Doc. No. 20, p. 2, n.
4.
53

Rec. Doc. No. 13-4, pp. 12-23 (Bates Nos. H00355-H00366).

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error. Second, it is also true that a plan administrator is not even required by ERISA to
obtain the opinion of a vocational expert. The Fifth Circuit has concluded that: “we will not
hold that absent vocational rehabilitation evidence a plan administrator necessarily abuses
his discretion in making a final determination of disability.”54 Rather, a reviewing court is
to decide, “on a case-by-case basis, whether under particular facts the plan administrator
abused his discretion by not obtaining the opinion of a vocational expert.”55 Finally, the
record is clear that Hartford evaluated and considered much more information than just this
Employability Analysis in arriving at its decision.

Even if the Court excluded the

Employability Analysis from consideration, the totality of the remaining evidence would still
be sufficient to support Hartford’s determination.
3.

The Award of Social Security Disability Benefits

Plaintiff contends that his award of Social Security disability benefits, especially in
light of the fact that Hartford assisted Plaintiff in obtaining such benefits and gained a
financial benefit in the offset from this award, is also evidence that Hartford acted arbitrarily
and capriciously. Hartford counters that the Supreme Court, the Fifth Circuit, and the
District Court for the Middle District of Louisiana have all rejected the argument that a
plaintiff’s receipt of Social Security disability benefits is controlling or binding on an ERISA
plan administrator,56 and that applicable jurisprudence shows that aiding a plan participant

54

Duhon v. Texaco, Inc., 15 F.3d 1302, 1309 (5th Cir. 1994).

55

Id.

56

See Black & Decker, 538 U.S. 822 (2003); Dubose v. Prudential Ins. Co. of America, 85 F. App’x 371 (5th
Cir. Dec. 24, 2003); and Johnson v. Sun Life Assurance Co. of Canada, No. 98-990-A, 2000 WL 33225469
(M.D. La. Nov. 29, 2000).

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in receiving Social Security disability benefits does not preclude a plan administrator from
reaching a contrary disability determination from that of the Social Security Administration.
The Court agrees.
“Differences between the Social Security disability program and ERISA benefits
plans caution against importing standards from the first into the second. ERISA plans are
not subject to the rules and regulations governing Social Security determinations.”57 The
Supreme Court made clear in Black & Decker Disability Plan v. Nord,58 that there are
differences between entitlement to Social Security benefits based on federal criteria and
ERISA plan benefits based on the interpretation of the terms in the plan at issue.
Clearly, an “ERISA administrator's duty is to address a contrary Social Security
determination. An administrator's ‘[f]ailure to address a contrary SSA award can suggest
“procedural unreasonableness” in a plan administrator's decision,’ and can be one factor
supporting that a denial of LTD benefits was arbitrary and capricious.”59 Additionally,
“[e]ven where substantial evidence supports the denial of benefits, a failure to address a
Social Security award can be a ‘tiebreaker’ to conclude that the insurer abused its
discretion.”60 Here, in both the initial claim determination and the appeal review, Hartford

57

Hammond v. UNUM Life Ins. Co. of America, No. 05cv632HTW-LRA, 2008 WL 906522, at *11 (S.D. Miss.
Mar. 31, 2008)(citing 20 C.F.R. § 404.1545; See also 20 C.F .R. §§ 404.1527(d)(2) and 416.927(d)(2), which
sets forth the SSA regulation that accords “special weight” to the medical opinion of an applicant's treating
physician.).
58

538 U.S. 822 (2003).

59

McFadden v. Prudential Ins. Co. of America, 877 F.Supp.2d 481, 492 (S.D. Miss. 2012)(quoting
Schexnayder, 600 F.3d at 471 (citation omitted); see Hamilton v. Standard Ins. Co., 404 Fed.Appx. 895, 898
(5th Cir. 2010) (unpublished).
60

Id., citing Schexnayder, 600 F.3d at 471.

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specifically addressed Plaintiff’s Social Security disability award and explained why this
award, although considered by Hartford as a factor, was not controlling or binding.61 These
acknowledgments are sufficient under binding precedent.62
Hartford also relies on Matney v. Hartford Life Insurance Co.,63 where the district
court rejected the argument that Hartford should be estopped from terminating the plaintiff’s
disability benefits under the plan because Hartford had previously helped her obtain Social
Security benefits. Notably, the court held:
In the Fifth Circuit, furthermore, courts have refused to require that ERISA
plan administrators adhere to a benefit determination by the Social Security
Administration (SSA). Milson v. St. Luke's Episcopal Hospital, 71 F.Supp.2d
634, 639 n. 2. If courts made such findings, “ ‘ERISA fiduciaries would be
stripped of all administrative discretion, as they would be required to follow
the Department of Health and Human Services' decisions regarding social
Security benefits, even where the Plan determines benefits under different
standards or the medical evidence presented is to the contrary.” ’ Id. (quoting
Madden v. ITT Long Term Disability Plan for Salaried Employees, 914 F.2d
1279, 1286 (9th Cir.1990)). Matney has thus failed to demonstrate that
Hartford should be estopped from reaching a determination about her
disability different from that of the SSA.64
Based on the foregoing, Plaintiff’s claim that Hartford was arbitrary and capricious
in its consideration of the Social Security disability benefits award is without merit.
Moreover, the cases relied upon by Plaintiff are not binding on this Court, and are in fact

61

Rec. Doc. No. 13-2, p. 15 (Bates No. H00085) & Rec. Doc. No. 13-2, p. 5 (Bates No. H00075).

62

See Schexnayder, 600 F.3d at 471 n. 3. (“We do not require Hartford to give any particular weight to the
contrary findings; indeed, Hartford could have simply acknowledged the award and concluded that, based on
the medical evidence before it, the evidence supporting denial was more credible.”).
63

No. A.302CV2278LBH, 2004 WL 3187081 (N.D. Tex. Dec. 27, 2004), aff’d, 172 F. App’x 571 (5th Cir. Mar.
27, 2006).
64

Id. at *14.

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distinguishable for the reasons set forth by Hartford in its Reply memorandum.65
III.

CONCLUSION
For the reasons set forth above, the Motion for Summary Judgment66 by the

Defendant is GRANTED. Plaintiff’s request for summary judgment under Rule 56(f)(1) of
the Federal Rules of Civil Procedure is DENIED as moot for the reasons set forth in this
opinion.
Judgment shall be entered accordingly.
IT IS SO ORDERED.
Signed in Baton Rouge, Louisiana, on July 28, 2014.

S
JUDGE SHELLY D. DICK
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

65

The Court is bound by Fifth Circuit precedent and is more inclined