Lowery v. McElroy Metal Mill Inc et al
Filing
37
MEMORANDUM RULING re #25 MOTION Decision on Stipulated Record filed by Genevieve Lowery, 27 MOTION to Dismiss Plaintiff's Claim filed by United of Omaha Life Insurance Co, #29 MOTION to Dismiss Plaintiff's Claim on the Stipulated Record filed by McElroy Metal Mill Inc. Signed by Judge S Maurice Hicks on 03/25/2013. (crt,McDonnell, D)
UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF LOUISIANA
SHREVEPORT DIVISION
GENEVIEVE LOWERY
CIVIL ACTION NO. 11-1491
VERSUS
JUDGE S. MAURICE HICKS, JR.
MCELROY METAL MILL, INC., ET AL.
MAGISTRATE JUDGE HORNSBY
MEMORANDUM RULING
Before the Court is Plaintiff Genevieve Lowery’s (“Lowery”) Motion for Decision on
Stipulated Record. See Record Document 25. Both Defendant United of Omaha Life
Insurance Company (“United”) and Defendant McElroy Metal Mill, Inc. (“McElroy Metal”)
opposed the motion and also filed Cross Motions to Dismiss Plaintiff’s Claim. See Record
Documents 27 & 29.1 The Court also has before it the Joint Stipulation of Facts, the
relevant plan documents, and the administrative record. See Record Documents 19 & 36.
For the reasons set forth below, all of Lowery’s claims against United and McElroy Metal
are DISMISSED.
I.
BACKGROUND2
United issued a Master Policy for disability benefits to McElroy Metal pursuant to
policy number GUG-937J. See Record Document 19 at ¶ 1. The policy provided coverage
to Lowery through her employment with McElroy Metal. See id. at ¶ 2. Lowery last worked
for McElroy Metal on August 27, 2010, in the position of Estimator II, which is classified as
1
In its motion, McElroy Metal maintains that it has no liability for paying disability
benefits and expressly adopts/incorporates the arguments of United. See Record
Document 29-1 at 1-2.
2
The facts set forth in the Background Section are primarily drawn from the joint
stipulation (Record Document 19) submitted by the parties and from documents contained
in the administrative record (Record Document 36).
a “Light Strength Duty” job. See id. at ¶ 3.
Lowery was a participant in the aforementioned disability benefit plan sponsored by
McElroy Metal. See id. at ¶ 4. The disability benefits under the plan were provided by a
policy of insurance issued by United, Group Policy No. GLTD-937. See id. The disability
benefits under the applicable plan were fully insured by United. See id. at ¶ 6. United, as
the administrator, made all decisions regarding the acceptance or denial of disability claims
and other benefits determinations. See id. at ¶ 7. McElroy Metal played no decisionmaking role regarding disability benefits. See id. at ¶ 8.
On August 28, 2010, upon referral from Dr. Huan Le, Lowery was hospitalized at
Willis-Knighton South in the Behavioral Medicine unit. See id. at ¶ 10; Record Document
36 at 000272-000273. She complained of “crying all the time”; described herself as being
“overpowered by stress”; and stated that she had “become overwhelmed by her job.” Id.
at 000272. At the time of admission, Lowery “appeared sad and had a strong depressed
mood.” Id.
Lowery was discharged, at her request, on September 2, 2010. See Record
Document 19 at ¶ 10; Record Document 36 at 000273. At discharge, the treating physician
stated that “she was alert and responsive”; “was improved”; “was not suicidal, homicidal or
gravely disabled.”
Record Document 36 at 000273.
She never returned to her
employment as an Estimator II for McElroy Metal.
On September 10, 2010, Lowery completed and submitted to United a short-term
disability claim form, seeking payment of short-term disability benefits under the terms of
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the policy. See Record Document 19 at ¶ 9.3 She was granted a month of benefits postdischarge, from September 4, 2010 through September 28, 2010, to establish care and to
obtain outpatient services. See id. at ¶ 11.4 In order to review Lowery’s claim for disability
benefits, United obtained certain information from Lowery as well as other medical data
about Lowery. See id. at ¶ 12. United’s initial determination was based on its review of the
following:
– Short Term Disability Claim Form, Part I-Employee Statement, Part IIEmployer Statement and Part III-Attending Physician Statement signed
September 21, 2010 by Huan Le, internal medicine.
– Letters from Kim Cunningham, LPC LMFT, LAC dated September 15,
2010, and October 25, 2010.
– Mental Status Report completed September 30, 2010 by Michael Bell, MD.
– Letter from Michael Bell, MD, dated October 5, 2010.
– Records from Dr. Bell dated September 21, 2010 and September 29, 2010.
– Records from Dr. Huan Q. Le dated April 16, 2010 through October 26,
2010.
– Records from Willis-Knighton South dated August 28, 2010 through
September 2, 2010.
Id. at ¶ 13. United ultimately denied Lowery’s application and by correspondence dated
November 9, 2010, her claim for disability benefits was denied from September 29, 2010
forward. See id. at ¶¶ 12, 14. The denial was based on the following policy language:
. . . Disability and Disabled mean that because of an Injury or Sickness, a
significant change in Your mental or physical functional capacity has
3
Lowery never submitted any claim for long-term disability benefits.
4
The elimination period was August 28, 2010 to September 4, 2010. See Record
Document 19 at ¶ 11.
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occurred in which You are:
– Prevented from performing at least one of the Material Duties of Your
Regular Job on a part-time or full-time basis; and
– Unable to generate Current Earnings which exceed 99% of Your Weekly
Earnings due to that same Injury or Sickness
Disability is determined relative to Your ability or inability to work. It is not
determined by the availability of a suitable position with Your employer.
Id. at ¶ 15.
On November 29, 2010, Lowery appealed United’s initial decision to deny short-term
disability benefits. See id. On March 28, 2011, Lowery’s former attorney, William R. Long
(“Long”), forwarded additional records to United. See id. at ¶ 16. These records included
documents from:
(1)
Dr. Huan Le (Tri-State Medical Clinic) dated August 27, 2010,
September 10, 2010, October 26, 2010, and October 29, 2010;
(2)
Dr. Kathryn Kennedy dated November 29, 2010 and December 13,
2010;
(3)
Dr. Tena Malone dated February 16, 2011; and
(4)
Cypress Vocational Solutions, LLC, Chris Babin, rehabilitation
counselor dated March 28, 2011.
Id. at ¶ 16. Long also notified United on March 28, 2011, via facsimile, that Lowery had
been “verbally advised by a representative of the Social Security Administration’s on March
25, 2011, that she was approved for Social Security Disability Insurance Benefits.” Id. at
¶ 17; Record Document 36 at 000130.
He also advised United that Lowery was to be
evaluated by Dr. Richard Williams, a psychiatrist, on March 29, 2011. See id.
On March 29, 2011, United responded to Long and stated that Lowery’s appeal was
currently in review. See Record Document 36 at 000127. United asked that Long forward
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a copy of the award letter for Social Security Disability benefits and a copy of the report
from Dr. Richard Williams. See id.
On April 6, 2011, United informed Lowery that the review of her appeal was
completed and the denial of the claim for additional short-term disability benefits was
appropriate. See Record Document 19 at ¶ 18. Specifically, United stated:
No restrictions or limitations can be assigned from a psychiatric perspective
that would have prevented Ms. Lowery from doing her light duty strength job
from September 29, 2010 forward. Therefore, this claim has been denied.
At this time, you have exhausted all administrative rights to appeal. United
. . . will conduct no further review of the claim and the claim will be closed.
Id. at ¶ 24; see also Record Document 36 at 000126. To reach its April 6, 2011 decision,
United reviewed the following documents:
– STD Claim Form, 9/10/10
– STD Employer’s Statement, 9/2/10
– STD Physician’s Statement, 9/21/10
– Behavioral health attending physician statement, Dr. Kathryn Kennedy,
2/1/11
– Records of Michael Bell, MD, Psychiatrist, 9/21/10 and letter from 10/5/10
– Letters from Kim Cunningham, LPC, LMFT, LAC, Therapist, 9/15/10,
10/25/10 & 12/26/10
– Records of Huan Lee, MD, Internist, 4/6/10-10/26/10
– Records of Kathryn Kay Kennedy, MD, Psychiatrist, 11/29/10-12/3/10
– Records of T.L. Malone, Ph.D., Psychologist, 3/4/11
– Vocational Rehabilitation Report, 3/28/11
– Pharmacy Record
Page 5 of 17
– Appeal letter from Genevieve Lowery, 11/29/10
– Letter from Attorney, 3/28/11.
Record Document 19 at ¶ 19.
On April 12, 2011, Long sent correspondence, via facsimile, to United stating that
he was attaching the report of Dr. Richard Williams dated March 29, 2011 as well as the
Social Security Award Notification concerning Lowery dated March 28, 2011. See id. at ¶
20. On April 13, 2011, United sent correspondence to Long stating that Dr. Williams’ report
was reviewed and did not change the previous claim decision of April 6, 2011. See id. at
¶ 21. United also informed Long that the Social Security Award Notification had not been
included with his April 12th letter. See id.
On April 27, 2011, Long faxed the Social Security Award Notification to United. See
id. at ¶ 22. The parties disagree as to whether the Award Notification (Record Document
36 at 000100-000105) should be included as part of the administrative record. See id. at
¶ 23. Lowery argues that the administrative record to be considered for review by this
Court should include the Award Notification, as United was aware of the existence of such
award at the time it rendered its April 6, 2011 decision. See Record Document 25-1 at 4.
Conversely, United contends that it was under no obligation to consider the Award
Notification because it was not received until nearly a month after the administrative record
has been closed and the appeal was decided. See Record Document 27 at 9. Lowery filed
the instant lawsuit on July 25, 2011, appealing United’s denial of additional short-term
disability benefits. See Record Document 19 at ¶ 25.
Page 6 of 17
II.
LAW AND ANALYSIS
A.
Standard of Review Under the Employee Retirement Income Security
Act (“ERISA”).
ERISA authorizes a civil action by a participant “to recover benefits due to him under
the terms of his plan.” 29 U.S.C. § 1132(a)(1)(B). The standard of review in an ERISA
case is governed by the language of the plan at issue. Generally, a denial of benefits under
an ERISA plan is reviewed under a de novo standard. See Firestone Tire & Rubber Co.
v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956 (1989). Courts are to apply an abuse of
discretion standard, however, when “the benefit plan gives the administrator or fiduciary
discretionary authority to determine eligibility for benefits or to construe the terms of the
plan.” Id. at 115, 109 S.Ct. at 956–957. Here, the policy specifically and expressly
conferred discretionary authority upon United. See Record Document 36 at 000009.
Therefore, the abuse of discretion standard applies.
Additionally, regardless of the
administrator’s ultimate authority to determine benefit eligibility, factual determinations
made by the administrator during the course of a benefits review should be reviewed for
an abuse of discretion. See Chacko v. Sabre. Inc., 473 F.3d 604, 609–610 (5th Cir. 2006);
McCall v. Burlington Northern/Santa Fe Co., 237 F.3d 506, 512 (5th Cir. 2000).
An “administrator abuses its discretion where the decision is not based on evidence,
even if disputable, that clearly supports the basis for its denial.” Holland v. Int’l Paper Co.
Retirement Plan, 576 F.3d 240, 246 (5th Cir.2009). “If the plan fiduciary’s decision is
supported by substantial evidence and is not arbitrary or capricious, it must prevail.”
Schexnayder v. Hartford Life & Acc. Ins. Co., 600 F.3d 465, 468 (5th Cir.2010).
“Substantial evidence is more than a scintilla, less than a preponderance, and is such
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relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.” Anderson v. Cytec Indus., Inc., 619 F.3d 505, 512 (5th Cir.2010). The
administrator’s 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.” Holland, 756
F.3d at 246–247. Under the abuse of discretion standard, a 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 somewhere on a continuum of reasonableness—even
if on the low end.” Holland, 576 F.3d at 247.
B.
United’s Determination in Light of the Administrative Record.
In evaluating whether an administrator abused its discretion in making a factual
determination, a district court may only consider the evidence that was available to the
administrator at time of the decision. See Southern Farm Bureau Life Ins. Co. v. Moore,
993 F.2d 98, 102 (5th Cir.1993); see also Meditrust Fin. Servs., Corp. v. Sterling
Chemicals, Inc., 168 F.3d 211, 214 (5th Cir. 1999). Evidence which was not a part of the
administrative record cannot be admitted in the district court to resolve a factual issue
which the administrator relied upon when resolving the merits of the claim. See Vega v.
National Life Ins. Serv., Inc., 188 F.3d 287, 289, abrogated on other grounds by
Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 125 S.Ct. 2343 (2008).5 As the Fifth
Circuit clarified:
[A] district court must inquire only whether the record adequately supports
the administrator’s decision; from that inquiry it can conclude that the
5
“Vega continues to be good law for propositions unrelated to the ‘sliding scale’
method of reviewing alleged conflicts of interest.” McDonald v. Hartford Life Group Ins.
Co., 361 F.App’x 599, 606 (5th Cir. 2010).
Page 8 of 17
administrator abused its discretion if the administrator denied the claim
[w]ithout some concrete evidence in the administrative record.
Gooden v. Provident Life & Accident Ins. Co., 250 F.3d 329, 333 (5th Cir. 2001).
C.
Conflict of Interest.
In Glenn, 554 U.S. at 115, 128 S.Ct. at 2350, the Supreme Court stated that a
structural conflict of interest created by the administrator’s dual role in making benefits
determinations and funding the benefit plan “should be taken into account on judicial review
of a discretionary benefit determination.” “If the administrator has a conflict of interest, [the
court should] weigh the conflict of interest as a factor in determining whether there is an
abuse of discretion in the benefits denial, meaning [the court should] take account of
several different considerations of which conflict of interest is one.” Holland, 576 F.3d at
247. The weight that this conflict will have relative to other factors changes, however,
depending on the circumstances of a particular case. See Glenn, 554 U.S. at 116, 128
S.Ct. at 2350–2351. If claimants do not present evidence of the degree of the conflict, the
court will generally find that any conflict is “not a significant factor.” Holland, 576 F.3d at 249
(finding that where claimant “adduced no evidence . . . that [administrator’s structural]
conflict affected its benefits decision or that it had a history of abuses of discretion,” any
conflict was insignificant in abuse of discretion analysis).
Here, Lowery briefly noted an administrator’s conflict of interest as a factor to be
considered but she has not pointed to any specific evidence of a history of abuses of
discretion or biased claims administration on the part of United. She has likewise failed to
specifically allege how United’s structural conflict of interest may have affected its benefits
decision in this particular case. Therefore, to the extent that United’s dual role as both
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insurer and administrator may create a conflict, that conflict is not a significant factor that
would justify a change in the standard of review.6
D.
Analysis of Lowery’s Claim.
Lowery contends that United’s determination was not legally correct and was
unreasonable. See Record Document 25-1 at 3. Alternatively, she maintains that the
decision was an abuse of discretion. See id. The crux of her argument is that United “did
not give any consideration to the Social Security Administration’s determination of disability”
and “chose to deny the claim, rather than request the Social Security information which
they had been timely notified of.” Id. She believes that United’s failure to acknowledge the
Social Security Administration’s disability award was “procedurally unreasonable.” Id. at
3. She further contends that United failed to timely notify her or provide her notice that the
Social Security information was missing. See id. Finally, she argues that there is not
substantial evidence in the record to support United’s decision that she is not disabled.
See id. at 4.
United’s decision that Lowery was not disabled under the terms of the policy was a
factual determination.
See Meditrust Fin. Servs., 168 F.3d at 214.
This factual
determination was supported by the following concrete evidence contained in the
administrative record at the time of United’s April 6, 2011 decision:
August 27, 2010:
Lowery returned to Dr. Le claiming that she had
6
The court is cognizant of the Fifth Circuit’s finding in Schexnayder that failure to
address a contrary SSA award can suggest “procedural unreasonableness” in an
administrator’s decision and that this procedural unreasonableness may justify “the court
in giving more weight to the conflict.” Schexnayder, 600 F.3d at 471. Because Lowery has
used the phrase “procedurally unreasonable” in her motion and also cited Schexnayder,
this issue will be fully addressed infra.
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a nervous breakdown for the past three days.
Dr. Le diagnoses Lowery with depression and
anxiety, but makes no adjustments to her
previously prescribed medications (Lunesta and
Effexor). See Record Document 36 at 000330.
August 28, 2010:
Lowery admitted herself into Willis-Knighton
South. See id. at 000272.
September 2, 2010:
Lowery was discharged at her own request. Her
condition has improved and she “was not
suicidal, homicidal, or gravely disabled.” Id. at
000272-000273.
September 21, 2010:
Lowery had her first visit with Dr. Michael Bell,
Psychiatrist. The mini mental status exam score
for Lowery was 30 out of 30 and her global
assessment of functioning score was 40. Dr.
Bell diagnosed her with Panic Disorder,
Generalized Anxiety Disorder, Major Depressive
Disorder, and Adjustment Disorder with Mixed
Mood Conduct Disturbance. He prescribed
Effexor, Klonopin, and Neurontin. Pharmacy
records revealed that Lowery did not have the
Effexor prescription filled at that time of her visit
with Dr. Bell. There is also no record that she
ever filled the Neurontin prescription ordered by
Dr. Bell. See id. at 000365-000366.
September 27, 2010:
United advised Lowery that it had received her
application for short-term disability benefits and
that disability benefits were to be paid through
September 28, 2010. United’s letter further
advised that if Lowery believed her disability
benefits should be extended beyond September
28, 2010, she had to submit medical records
documenting what complications occurred that
prevented her from returning to work. See id. at
000370-000371.
September 29, 2010:
Lowery followed up with Dr. Bell at which time
her mini mental status exam score was 30 out of
30. Dr. Bell added a prescription of Seroquel.
She failed to report to Dr. Bell at this visit that
she had not filled the Effexor prescription. See
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id. at 000364.
October 13, 2010:
A case review for United was made by Sadie
Burr, Nervous and Mental Health Coordinator.
She recommended that additional records be
reviewed in order to determine whether benefits
should be extended. See id. at 000406-000408.
November 5, 2010:
Sadie Burr performed a follow up review for
United. She noted that Lowery repeatedly
scored 30 out of 30 on mini mental status exams
suggesting no cognitive impairments. Ms. Burr
concluded that there was no evidence to
establish that Lowery remained impaired from
performing essential duties of her job, which
would warrant an undefined lengthy absence
from work. See id. at 000402-000404.
November 9, 2010:
United sent a letter to Lowery denying her
request for disability benefits beyond September
29, 2010. See id. 000267-000269.
November 12, 2010:
Lowery filled the Effexor prescription that she
had been given months earlier.
November 29, 2010:
Lowery exercised her right to appeal.
December 13, 2010:
Lowery returned to Dr. Kennedy for one follow up
visit, at which time she reported feeling better
and less anxiety. See id. at 000207-000208.
January 21, 2011:
A claim review was performed by Dr. Timothy
Tse of United. He recommended that additional
records be provided for consideration, including
medical records from Dr. Kennedy, medical
records from Ms. Cunningham, and pharmacy
records.
He also recommended that Dr.
Kennedy complete a Behavioral APS before any
decision was reached on appeal. See id. at
000398-000400.
March 4, 2011:
Lowery was examined by another psychologist,
Dr. T.L. Malone, who found Lowery’s short term,
immediate, and long term memory intact. Dr.
Malone further opined that Lowery “is able to
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function psychologically and in an adequate
manner within the work place on a sustained
basis.” See id. at 000146-000147.
March 14, 2011:
A follow up review was done by Dr. Tse.
Records from Dr. Kennedy’s office, including the
Behavioral APS, were provided. However, the
requested notes from Ms. Cunningham’s office
were never made available for review and no
additional pharmacy records were provided. Dr.
Tse recommended that a follow up request be
made to Lowery to provide pharmacy records
before reaching a decision on the appeal. See
id. at 000393-000397.
April 6, 2011:
Dr. Tse performed a third follow up review for
United after receiving the pharmacy records.
Upon review, he reached the following
conclusions: (1) the diagnosis of fibromyalgia
cannot be substantiated and even if it was
supported, no physical impairment from
fibromyalgia could be substantiated; (2) both Dr.
Le and Dr. Bell indicated that while Lowery
claimed she had poor concentration, their
objective findings consistently did not support
such findings, including the perfect 30 out of 30
mini mental status exam scores; (3) the
pharmacy records supported the findings that
Lowery may not have been compliant with her
medication recommendation; and (4) no
restriction or limitation of work activities could be
assigned from a psychiatric perspective that
would have precluded Lowery from doing her
light strength job. See id. at 000387-000392.
Based on this time line of evidence, the Court finds that United did not act arbitrarily or rush
to judgment. There was a “rational connection” between the known facts and United’s final
decision on appeal. The administrative record in this matter reveals that United performed
at least five case reviews and sought additional information from Lowery and medical
providers several times before reaching its final decision. The record also shows that
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Lowery repeatedly scored 30 out of 30 on the mini mental status exams performed by her
own doctors. Therefore, the Court believes United’s determination of April 6, 2011 was
supported by substantial evidence and was reasonable.
Now the Court turns to Lowery’s argument that United failed to give any
consideration to the Social Security Administration’s determination of disability and that
such failure rendered the denial of benefits procedurally unreasonable. Lowery relies solely
upon Schexnayder, 600 F.3d 465, to support her argument of procedural
unreasonableness. In Schexnayder, the Fifth Circuit reasoned that failure to address a
contrary Social Security Administration award can suggest “procedural unreasonableness”
in a plan administrator’s decision and that this procedural unreasonableness may justify
“the court in giving more weight to the conflict.” Id. at 471. The Schexnayder court stated:
We do not require Hartford to give any particular weight to the contrary
findings [Social Security Administration award]; 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. It is the
lack of any acknowledgment which leads us to conclude that Hartford's
decision was procedurally unreasonable and suggests that it failed to
consider all relevant evidence.
Id. at 471 n. 3.
A review of the key dates relating to the Social Security Administration’s
determination of disability aids the Court in its consideration of this argument. On March
28, 2011, Long first informed United that Lowery had been verbally advised on March 25,
2011 that she was approved for Social Security Disability Insurance Benefits. See Record
Document 36 at 000130. United requested a copy of the award letter on March 29, 2011.
See id. at 000127. On April 6, 2011, United upheld the denial of Lowery’s claim and closed
the appeal. See id. at 000121-000126. On April 12, 2011, Long acknowledged, via
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facsimile, United’s letter of March 29, 2011. See id. at 000108-000109. Long stated that
he was “attaching the report of Dr. Richard Williams dated March 29, 2011 as well as the
Social Security Award Notification concerning Ms. Lowery dated March 28, 2011.” Id. at
000109 (emphasis added). On April 13, 2011, United responded to Long:
Thank you for your letter of April 12, 2011 regarding Genevieve Lowery.
Please be advised that the Social Security Award Notification was not
included with your letter.
A review of the March 29, 2011 evaluation by Dr. Richard Williams has been
made. While we appreciate the opinion of Dr. Williams, his report does not
change the claim decision from our letter of April 6, 2011.
Id. at 000107. Long did not forward a copy of the award letter to United until April 27, 2011.
See id. at 000098-000105.
First, it is important to note that at the time of United’s April 6, 2011 decision, Lowery
had not submitted the Social Security award letter, despite the fact that the award
notification concerning Ms. Lowery was dated March 28, 2011. It is apparent to the Court
that Long, Lowery’s former attorney, simply failed to submit the Social Security award in
a timely fashion. The record establishes that Long had routinely used facsimile as a means
to communicate with United on behalf of Lowery and there is no justification given as to
why the award notification of March 28, 2011 was not immediately faxed to United.7 Thus,
the award letter was not available and was not part of the administrative record at the time
7
United requested a copy of the award letter on March 29, 2011. Long did not
submit the award letter until April 27, 2011. At that time, the administrative record had
been closed for approximately three weeks and the appeal had been decided. In light of
the factual circumstances of this case, the Court does not believe there was an additional
burden upon United, as the administrator, to generate evidence relevant to Lowery’s claim
when the award letter was within the possession and control of Long/Lowery no later than
March 28, 2011.
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of the April 6, 2011 decision. See Southern Farm Bureau Life Ins. Co., 993 F.2d at 102
(holding that in evaluating whether an administrator abused its discretion in making a
factual determination, a district court may only consider the evidence that was available to
the administrator at time of the decision); Vega, 188 F.3d at 289 (stating that evidence
which was not a part of the administrative record cannot be admitted in the district court to
resolve a factual issue which the administrator relied upon when resolving the merits of the
claim).
The Court further finds that the instant matter is distinguishable from Schexnayder.
It cannot be said that United failed to give “any acknowledgment” to the Social Security
award. United’s April 6, 2011 denial letter references the documents reviewed to make a
decision on the appeal. See Record Document 36 at 000122. This document list includes
“Letter from Attorney, 3/28/11,” which is Long’s letter informing United that Lowery had
been verbally advised on March 25, 2011 that she was approved for Social Security
Disability Insurance Benefits. Id. at 000122, 000130. United also “acknowledged” the
Social Security award when it informed Long that he had failed to include the award
notification in his letter of April 12, 2011. See id. at 000107.
Finally, the Court notes that “while an ERISA . . . administrator might find a social
security disability determination relevant or persuasive, the plan administrator is not bound
by the social security determination.” Horton v. Prudential Ins. Co. of America, No.
02–30439, 2002 WL 31415104, *3 (5th Cir. Oct. 8, 2011). Here, the only information in the
record regarding the Social Security award is the basic seven-page award notice. See id.
at 000099-000105. The record is devoid of anything detailing the basis and reasoning for
the Social Security Administration’s determination of disability. Thus, there was no way for
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United to even begin to compare the Social Security Administration’s determination of
disability with the information United had before it. In addition, Lowery has not shown that
the definition of “disability” employed by the Social Security Administration is the same, or
even similar to, the definition contained within the United policy at issue.
The Court concludes that United’s determination was legally correct, reasonable,
and supported by substantial evidence in the record. More specifically, Lowery’s Social
Security disability benefits award in no way renders United’s contrary determination at issue
here procedurally unreasonable and/or an abuse of discretion.
III.
CONCLUSION
For the reasons stated above, all of Lowery’s claims, including her claims for
reasonable attorneys fees, costs, and expenses, against United and McElroy Metal are
DISMISSED. A judgment consistent with the terms of this Memorandum Ruling shall issue
herewith.
THUS DONE AND SIGNED, in Shreveport, Louisiana, this 25th day of March, 2013.
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