Savoy v. Federal Express Corporation Long Term Disability Plan

Filing 17

MEMORANDUM OPINION. Signed by Chief Judge Deborah K. Chasanow on 7/30/10. (sat, Chambers)

Savoy v. Federal Express Corporation Long Term Disability Plan

Doc. 17

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND DARRIN SAVOY v. FEDERAL EXPRESS CORPORATION LONG TERM DISABILITY PLAN : : : : : Civil Action No. DKC 09-1254

MEMORANDUM OPINION Presently pending and ready for resolution in this action arising under the Employee Retirement Income Security Act are (1) Defendant's motion for summary judgment (Paper 11), and

(2) Plaintiff's cross-motion for summary judgment. For the reasons will be that follow, Defendant's motion

(Paper 14). for summary for

judgment

granted,

and

Plaintiff's

cross-motion

summary judgment will be denied. I. Background The following facts are undisputed unless otherwise noted. Plaintiff Darrin Savoy became a full-time employee of Federal Express Corporation on March 16, 2003. Plaintiff filed a claim for short-term On February 15, 2006, disability benefits,

which alleged that he had become disabled as the result of a car-jacking and assault. Plaintiff received short-term

disability benefits from the Federal Express Corporation Short Term Disability Plan from February 10, 2006 to June 18, 2006 and

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from June 29, 2006 to August 20, 2006.

Plaintiff then applied

for and received long-term disability benefits from Defendant, Federal Express Long Term Disability Plan, from August 21, 2006 to August 20, 2008. for an "occupational Plaintiff received these long-term benefits disability," which Defendant defines as

"the inability of a covered employee, because of a medicallydeterminable physical or functional impairment or a medicallydeterminable mental impairment (other than an impairment caused by a chemical dependency), to perform the duties of his regular occupation." (Paper 11, at 4). limits period long-term of two longer "occupational To two disability" long-term a covered

Defendant benefits to a

years. than

receive years,

disability

benefits

for

employee must be "totally disabled."

Defendant defines "total

disability" as "the complete inability of a covered employee, because of a medically-determinable than an impairment physical caused by or a functional mental or

impairment

(other

nervous condition or a chemical dependency), to engage in any compensable employment for twenty-five hours per week."

(Paper 1, Attach. 5).

After receiving "occupational disability"

benefits for two years, Plaintiff applied for "total disability" benefits.

2

In Company notified benefits

a

letter

dated

July

11,

2008,

Aetna paying

Life

Insurance

("Aetna"), Plaintiff for a To

Defendant's that his

claims for was

administrator, disability (Paper reviewed 1, the

claim

long-term denied. Aetna

"total make

disability" its

Attach. 4).

determination,

documentation submitted by Plaintiff's medical providers, which included: an attending physician statement from Dr. Khosrow

Davachi, specialty letters, office notes, a work status note, and an attending physician statement from Plaintiff's treating neurologist, Dr. Stuart J. Goodman. (Id.). Aetna also reviewed

all of the medical information in Plaintiff's file related to his previous disability claims, and had Dr. Mark Sementilli, a neuropsychologist neuropsychological and psychologist, of conduct an This independent evaluation

evaluation

Plaintiff.

suggested that Plaintiff's true deficits could not be determined due to symptom exaggeration and suboptimal effort. Attach. 11). psychologist, (Paper 1,

Additionally, Aetna had Dr. Elana Mendelssohn, a conduct a peer review of Plaintiff's file.

(Paper 12, Attach. 2, at 51). clinical "total information did not

Dr. Mendelssohn found that the support Finally, Plaintiff's Dr. Vaughn claim for a

disability."

(Id.).

Cohan,

neurologist, conducted a peer review of Plaintiff's file and

3

came to the same conclusion as Dr. Mendelssohn. Attach. 3, at 63). Based independent reviews, objective on the information in Plaintiff's and were the

(Paper 12,

file, two

the peer

neuropsychological determined to

evaluation, that a there total

Aetna

"insufficient from any

findings

support

disability

occupation" and that "the documentation provided did not support a functional impairment that would preclude [Plaintiff] from

engaging in any compensable employment for a minimum of 25 hours per week." (Paper 1, Attach. 5).

On January 5, 2009, Plaintiff appealed Aetna's decision to the Aetna Appeal Committee ("Committee"). (Paper 1, Attach. 7).

In support of his appeal, Plaintiff submitted additional reports and notes from Dr. Goodman (Paper 1, Attach. 13), and a

vocational assessment conducted by Janine Preston, a vocational consultant. (Paper 1, Attach. 16). The vocational assessment

concluded that Plaintiff's "present skill levels along with the medically applicable Washington documented [sic] D.C. to labor disabilities acquire ­ makes him in not a viable ­ the

employment The

the

Maryland reviewed

markets."

Committee

additional information provided by Plaintiff, as well as all of the medical documentation in his file. The Committee evaluated

the two peer reviews conducted during the initial review, and 4

ordered

a

third Loar,

peer a

review board

that

was

conducted

by

Dr. and

Christopher neurologist.

certified

psychiatrist

Dr. Loar's findings were similar to those of the (Paper 12, Attach. 3, at 67). In a

two other peer reviews.

letter dated March 17, 2009, the Committee denied Plaintiff's appeal. submitted (Paper 1, Attach. 8). documentation, and noted The Committee "considered all the conclusions there are no of the peer

physicians,

determined

that

significant

objective findings to substantiate that a functional impairment exists that would preclude work in any compensable employment for twenty-five hours per week." (Id.).

On May 13, 2009, Plaintiff commenced this action pursuant to the Employee Retirement Income Security Act of 1974

("ERISA"), 29 U.S.C. §§ 1001 et seq., challenging Defendant's denial of his disability benefits. 2009, Defendant filed a (Paper 1). for On November 16, judgment.

motion

summary

(Paper 11).

On December 17, 2009, Plaintiff filed a cross(Paper 14).

motion for summary judgment. II. Standard of Review

It is well-established that a motion for summary judgment will be granted only if there exists no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c); 5 Anderson v. Liberty

Lobby, Inc., 477 U.S. 242, 250 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). In other words, if there clearly

exist factual issues that properly can be resolved only by a finder of fact because they may reasonably be resolved in favor of either party, then summary judgment is inappropriate.

Anderson, 477 U.S. at 250; see also Pulliam Inv. Co. v. Cameo Props., 810 F.2d 1282, 1286 (4th Cir. 1987); Morrison v. Nissan Motor Co., 601 F.2d 139, 141 (4th Cir. 1979). The moving party

bears the burden of showing that there is no genuine issue as to any material fact and that he is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c); Catawba Indian Tribe of

S.C. v. South Carolina, 978 F.2d 1334, 1339 (4th Cir. 1992), cert. denied, 507 U.S. 972 (1993). When ruling on a motion for summary judgment, the court must construe the facts alleged in the light most favorable to the party opposing the motion. See United States v. Diebold,

369 U.S. 654, 655 (1962); Gill v. Rollins Protective Servs. Co., 773 F.2d 592, 595 (4th Cir. 1985). of proof on a particular claim A party who bears the burden must factually support each

element of his or her claim.

"[A] complete failure of proof

concerning an essential element . . . necessarily renders all other facts immaterial." on those issues on Celotex Corp., 477 U.S. at 323. the nonmoving 6 party will Thus, the

which

have

burden of proof, it is his or her responsibility to confront the motion for summary judgment with an affidavit or other similar evidence in order to show the existence of a genuine issue for trial. at 324. See Anderson, 477 U.S. at 256; Celotex Corp., 477 U.S. However, "[a] mere scintilla of evidence in support of

the nonmovant's position will not defeat a motion for summary judgment." Cir.), Detrick v. Panalpina, Inc., 108 F.3d 529, 536 (4th denied, 522 U.S. 810 (1997). There must be

cert.

sufficient evidence favoring the nonmoving party for a jury to return a verdict for that party. If the evidence is merely

colorable, or is not significantly probative, summary judgment may be granted. Anderson, 477 U.S. at 249-50 (citations

omitted). When faced with cross-motions for summary judgment, as in this case, the court must consider "each motion separately on its own merits to determine whether either of the parties

deserves judgment as a matter of law."

Rossignol v. Voorhaar,

316 F.3d 516, 523 (4th Cir.), cert. denied, 540 U.S. 822 (2003) (internal quotation marks omitted); see also havePower, LLC v. Gen. Elec. Co., 256 F.Supp.2d 402, 406 (D.Md. 2003)(citing 10A Charles A. Wright & Arthur R. Miller, Federal Practice &

Procedure § 2720 (3d ed. 1983)).

The court reviews each motion The court

under the familiar standard for summary judgment. 7

must deny both motions if it finds there is a genuine issue of material fact, "[b]ut if there is no genuine issue and one or the other party is entitled to prevail as a matter of law, the court will render judgment." 2720. III. Analysis The parties agree that there is no genuine issue of 10A Federal Practice & Procedure §

material fact in this case, and thus the court must decide which party is entitled to judgment as a matter of law.1 long term disability plan, is governed by ERISA. Defendant, a Pursuant to

Section 502(a)(1)(B) of ERISA, a "civil action may be brought by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." In reviewing a plan 29 U.S.C. § 1132(a)(1)(B). administrator's decision to deny

benefits, the court must first determine whether the plan gives the administrator discretionary authority to construe uncertain terms and determine eligibility for benefits. Booth v. Wal-Mart

In his response to Defendant's motion for summary judgment Plaintiff contends that the pleadings, exhibits, and administrative record demonstrate a genuine issue of material fact. (Paper 14). In his attached memorandum of law, however, Plaintiff concedes that there is no genuine issue of material fact. (Paper 14, Attach. 2, at 9). 8

1

Stores, Inc., 201 F.3d 335, 340-41 (4th Cir.2000); Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the plan

does not give discretionary authority, the court reviews the employee's claim de novo as it would any other contract claim ­ by looking to the terms of the plan and other manifestations of the parties' intent. U.S. at 112- 13. Booth, 201 F.3d at 341; Firestone, 489

If, on the other hand, the plan by its terms

confers discretion on the administrator, the court reviews the administrator's decision for abuse of discretion. F.3d at 341; Firestone, 489 U.S. at 111. Here, Plan's the plan in allows its the sole Committee and to "interpret discretion the in Booth, 201

provisions

exclusive

accordance with its terms with respect to all matters properly brought before it pursuant to this Section 5.3, including, but not limited to, matters relating to the eligibility of a

claimant for benefits under the Plan."

(Paper 1, Attach. 3).

The parties agree that this language grants the administrator discretionary (Paper 11, authority 1, to at make 5; eligibility 14, determinations. 2, at 13).

Attach.

Paper

Attach.

Accordingly, Defendant's decision will be reviewed for abuse of discretion. Under the abuse of discretion standard, an administrator's decision will not be disturbed if it is reasonable. 9 Booth, 201

F.3d at 342.

The United States Court of Appeals for the Fourth

Circuit has set forth a nonexclusive list of factors a court may consider when determining whether a plan administrator's

decision is reasonable: (1)[T]he language of the plan; (2) the purposes and goals of the plan; (3) the adequacy of the materials considered to make the decision and the degree to which they support it; (4) whether the fiduciary's interpretation was consistent with other provisions in the plan and with earlier interpretations of the plan; (5) whether the decisionmaking process was reasoned and principled; (6) whether the decision was consistent with the procedural and substantive requirements of ERISA; (7) any external standard relevant to the exercise of the discretion; and (8) the fiduciary's motives and any conflict of interest it may have. Booth, 201 F.3d at 342-43. Defendant contends that the decision to deny Plaintiff

benefits was reasonable. face a conflict of

Defendant maintains that Aetna did not when denying Plaintiff's claim

interest

because Aetna only makes eligibility determinations, it does not fund or insure was the plan. on "a Defendant deliberate also argues that the

decision

based

principled

reasoning (Paper 11, considered

process" and is supported by substantial evidence. at 19). Defendant notes that the Committee

Plaintiff's entire file and ordered an additional peer physician review before making its decision. (Id. at 20). 10 It also notes

that all three peer reviews found that Dr. Goodman's diagnosis was not supported by any medically-determinable evidence as

required by the plan.

Defendant maintains that the vocational

assessment does not contradict the Committee's decision because the long-term disability plan "requires medically-determinable evidence of a physical impairment" and "has no vocational or transferable skills requirements or standards." (Id. at 23).

Defendant further asserts that the Committee had no obligation to order its own vocational assessment. (Id. at 24).

Plaintiff responds that the decision to deny him benefits was not objectively Plaintiff reasonable, argues that nor Aetna based faced on a substantial conflict of

evidence.

interest when evaluating his claim.

Plaintiff also contends

that Dr. Goodman's reports and the vocational assessment clearly establish that he is "totally disabled." that "the only report supporting Plaintiff maintains position that

Defendant's

Plaintiff is capable of engaging in employment for 25 hours per week is the peer review of Dr. Christopher Loar," which

Plaintiff asserts is "countered by the opinions of Plaintiff's treating neurologist, Dr. Goodman, the vocational consultant, Janine Preston and even the findings of Dr. Sementilli." at 17). (Id.

Plaintiff also points out that Dr. Loar did not examine

him personally, and argues that he should have been given the 11

opportunity findings. should have

to

submit

evidence Plaintiff Plaintiff

in

opposition that

to the

Dr.

Loar's

Finally, referred

maintains for a

Committee capacity

functional

evaluation or employability assessment, and that by not doing so it failed to conduct a full and fair review of his claim. A plan administrator faces a conflict of interest when it "serves in the dual role of evaluating claims for benefits and paying the claims." Champion v. Black & Decker, Inc., 550 F.3d Here, Federal Express Corporation

353, 358 (4th Cir. 2008).

funds and administers the long-term disability plan, but does not make benefit eligibility determinations for the long-term disability plan. Aetna does not fund or administer the long-

term disability plan, but provides claim administration services by paying claims on behalf of the plan. that Aetna faced a conflict to of interest Aetna Plaintiff maintains because and Defendant

retains

the

right

replace

"Defendant's

contributions to the trust fund are directly determined by the extent to which the claims paying administrator finds a claimant eligible for benefits." (Paper 14, at 12). Plaintiff cites

Metro. Life Ins. Co. v. Glenn, 128 S. Ct. 2343 (2008) to support his contention, and notes that the defendant insurance company in Glenn faced a conflict of interest. Plaintiff fails to

acknowledge, however, that the insurance company's conflict of 12

interest was created because the company served the dual role of plan administrator and insurer, and not because the party who funded the plan retained some power over the claims paying

administrator. paying

See id. at 2348. but not did face not a

Here, Aetna was the claims fund or insure of the plan. when

administrator, Aetna did

Therefore,

conflict

interest

evaluating Plaintiff's claim. Additionally, deliberate evidence. reasoning The Defendant's process and decision is was based by on a

supported an

substantial review of

Committee

conducted

in-depth

Plaintiff's medical documentation by evaluating the findings of Dr. Goodman, the two peer peer reviews conducted by during Dr. the initial and the

review,

review

conducted

Loar, The

independent ultimately

neuropsychological sided with the

examination. of Dr.

Committee Dr.

opinions

Mendelssohn,

Cohan, and Dr. Loar, all of whom examined Plaintiff's file, which included the findings of Dr. Goodman, and determined that Plaintiff did not suffer from a "total disability." The Fourth

Circuit has found that it is not an abuse of discretion for an administrator to adopt the opinion of one medical professional over another.2 Stup v. UNUM Life Ins. Co. of Am., 390 F.3d 301,

Plaintiff relies on Stup to support his argument that the evidence Defendant relied on was not substantial. In Stup, 13

2

308 (4th Cir. 2004).

Therefore, the decision-making process was

reasoned and principled and was supported by adequate evidence. Plaintiff's assertion that he should have been given the opportunity to submit rebuttal evidence in opposition to Dr. Loar's findings is also without merit. Plaintiff relies on

Skipp v. Hartford Life Insurance Co., Civil No. CCB-06-2199, 2008 WL 346107, at *31 (D.Md. 2008), where the court determined that the defendant in a similar suit was under no obligation to provide an expert's report obtained during the appeal to the plaintiff before the appeal was denied. In Skipp, the court

noted that there was nothing in the expert's report that would have caught the plaintiff off guard, "save perhaps for his

ultimate conclusion."

Id. at *33-34.

Plaintiff contends that

Dr. Loar's report "provides for the first time an opinion that the Plaintiff is `capable of engaging in compensable employment of a minimum of 25 hours per week.'" (Paper 14, Attach. 2, at

however, the plaintiff offered "overwhelming and uncontradicted evidence" that she suffered from two specific medical conditions that would entitle her to long-term disability benefits. Id. The Fourth Circuit found that it was unreasonable for the defendant to rely on "tentative and ambiguous evidence" that contradicted the plaintiff's claim. Id. at 309. Here, Plaintiff's evidence, which consists primarily of his treating physician's findings, is directly contradicted by the peer reviews, which are neither tentative nor ambiguous. Furthermore, in Stup, the claims administrator was also the plan's insurer and therefore had a financial incentive to deny the claim. Here, as previously mentioned, Aetna had no financial incentive to deny Plaintiff's claim. 14

20).

Plaintiff argues that this is new factual information that Dr.

he should have had access to before the final decision.

Loar, however, did not reference any new factual information related to Plaintiff's condition. Furthermore, Plaintiff should

not have been shocked by Dr. Loar's findings because Dr. Cohan's peer review, which stated Plaintiff that possessed before be the appeal, of

specifically

"claimant

would

capable

performing any compensable work for a minimum of 25 hours per week." (Paper 12, Attach. 3, at 65). Therefore, Dr. Loar's

peer review presented information and opinions that were already available to Plaintiff, and Defendant had no obligation to

provide Plaintiff with copy before the appeal was denied. Finally, the Committee was under no obligation to order a functional capacity evaluation or employability assessment of Plaintiff. Plaintiff relies on Tate v. Long Term Disability

Plan for Salaried Employees of Champion Int'l Corp. No. 506, 545 F.3d 555 (7th Cir. 2008) to support his contention that Defendant failed to conduct a full and fair review by not ordering an assessment. This case, however, is from the United States Court

of Appeals for the Seventh Circuit and is not binding on this court. Confronting a similar situation, Judge Motz explained: [T]his Court finds no evidence that the Fourth Circuit has held that a vocational assessment is needed in the course of a full and fair review. Accord Piepenhagen v. Old 15

Dominion Freight Line, Inc., 640 F.Supp.2d 778[, 789], 2009 WL 528625, at *9 (W.D.Va. 2009) ("Not a single court has held that vocational evidence is required per se."). Because no vocational assessment is required and MetLife nevertheless reviewed the report by the vocational consultant of Plaintiff's choice, the Defendant's decision not to secure an additional vocational assessment does not show an abuse of discretion. See, e.g., Krajewski v. Metropolitan Life Ins. Co., No. RDB 08-2406, 2009 WL 2982959 at *7 (D.Md. 2009)("Considering Piepenhagen holds that some benefits determinations require no vocational analysis in the first place, and that MetLife reviewed the report by the vocational consultant of [Plaintiff's] choice, [Plaintiff's] argument fails."). McDonald v. Metropolitan Life Insurance Co., Civil No. JFM 0802063, 2009 WL 3418527, at *5 (D.Md. 2009). in McDonald, the Committee reviewed Like the defendant vocational The was the

Plaintiff's

assessment even though it was under no obligation to do so. Committee's therefore plan. decision not with to the order its own of assessment ERISA and

consistent

requirements

In light of the above discussion, Defendant's decision was reasonable and based on substantial evidence. Defendant did not

abuse its discretion when denying Plaintiff's claim.

16

IV.

Conclusion For the foregoing reasons, Defendant's motion for summary

judgment

will

be

granted,

and

Plaintiff's

cross-motion

for

summary judgment will be denied.

/s/ DEBORAH K. CHASANOW United States District Judge

17