Rogers v. Eaton Corporation et al
Filing
47
ORDER denying 36 Motion for Summary Judgment; granting 27 Motion for Summary Judgment(Written Opinion) Signed by Senior Judge David S. Doty on 10/9/2018. (DLO)
UNITED STATES DISTRICT COURT
DISTRICT OF MINNESOTA
Civil No. 17-4391 (DSD/KMM)
Doris Rogers,
Plaintiff,
v.
ORDER
Eaton Corporation,
Eaton Corporation Health
and Welfare Administrative Committee,
and Eaton Corporation Disability
Plan for U.S. Employees,
Defendants.
Michael J. Kemmitt, Esq. and Fields Law Firm, 9999 Wayzata
Blvd., Minnetonka, MN 55305, counsel for plaintiff.
Patrick O’Keefe Peters, Esq., Jennifer A. Nodes, Esq. and
Jackson Lewis P.C., 150 South Fifth Street, Suite 3500,
Minneapolis, MN 55402, counsel for defendants.
This matter is before the court upon the cross-motions for
summary judgment by plaintiff Doris Rogers and defendants Eaton
Corporation, Eaton Corporation Health and Welfare Administrative
Committee, and Eaton Corporation Disability Plan for U.S. Employees
(collectively Eaton).
Based on a review of the file, record, and
proceedings herein, and for the following reasons, the court denies
Rogers’ motion and grants Eaton’s motion.
BACKGROUND
This ERISA dispute arises out of Eaton’s termination of
Rogers’ long-term disability benefits. Eaton is a power management
company, headquartered in Dublin, Ireland; Rogers worked for Eaton
at its Searcy, Arkansas location as a hydraulic tester.
Nodes
Decl. Ex. A-3 at 228.
Rogers suffers from degenerative disc disease in the cervical
and lumbar spine.
Id. at 24.
surgery. Id. at 22.
In April 2014, Rogers underwent back
Rogers’ disease and resulting surgery reduced
her shoulder mobility and walking and standing capacity.
Id. at
22-24.
As an Eaton employee, Rogers was covered under a long-term
disability insurance policy (Plan).
Id. Ex. A-1 at 30-49.
Under
the Plan, a claimant has a covered disability when:
During the first 24 months, including any period of short
term disability, [she is] totally and continuously unable
to perform the essential duties of [her] regular position
with [Eaton], or the duties of any suitable alternative
position with [Eaton];
Following the first 24 months, [she is] totally and
continuously unable to engage in any occupation or
perform any work for compensation or profit for which
[she is], or may become, reasonably well fit by reason of
education, training or experience — at Eaton or
elsewhere.
Id. at 11 (emphasis added).
and
funder,
administrator.
In
March
and
Eaton acted as the Plan administrator
Segdwick
CMS
acted
as
the
Plan
claims
Id. at 25-26.
2014,
Rogers
benefits under the Plan.
applied
for
long-term
Id. Ex A-3 at 13.
disability
In September 2014,
Sedgwick approved Rogers’ application because her back and shoulder
injuries precluded her from performing her regular, or a suitable
2
alternative, positon with Eaton.
the
Social
Security
insurance benefits.
In
March
Id. at 22-27.
Administration
awarded
In October 2014,
Rogers
disability
Id. at 229-232.
2016,
Sedgwick
re-evaluated
Rogers’
long-term
disability coverage under the Plan’s post twenty-four month, “any
occupation” standard.
Id. at 84-86, 216-17.
As part of that
evaluation, Sedgwick requested an independent medical examination,
functional capacity evaluation, transferable skills analysis, and
labor market survey.
Id. at 84, 184.
The independent medical
evaluation, performed by Dr. William Blakenship, found that Rogers
could work “in the medium physical demand level with occasional
reaching overhead.”
Id. at 85.
The transferable skills analysis
identified six occupations that could accommodate Rogers’ work
limitations:
electronics
tester,
machine
operator,
product
assembler, production assembler, small product assembler, and
security guard.
Id.
The labor market survey identified two
employers within fifty miles of Rogers’ home that would allow her
to perform those occupations within her limitations.
Id. at 86.
As a result, Sedgwick terminated Rogers’ long-term disability
benefits.
On
Id.
May
termination.
2,
2016,
Rogers
Id. at 88-92.
appealed
Sedgwick’s
initial
In support, Rogers submitted updated
medical records and test results. Id. at 92-93. Sedgwick referred
Rogers’ medical records and the independent medical examination,
3
transferable skills analysis, labor market survey, and an updated
functional capabilities evaluation to Dr. Victoria Knoll, a thirdparty independent reviewer, for a report and recommendation.
Id.
at 97, 157-62.
Dr. Knoll concluded that Rogers could perform occupational
duties consistent with the independent medical examination and
functional capabilities evaluation.
Id.
On August 22, 2016,
Sedgwick upheld its termination of Rogers’ long-term disability
benefits.
Id. at 85-87.
On October 18, 2016, Rogers appealed Sedgwick’s termination to
Eaton.1
Id. at 110-11.
As part of its evaluation, Eaton referred
the entire record to the Medical Review Institute of America (MRIA)
for an independent medical review.
Id. at 20.
On January 31,
2017, Dr. William Tontz completed the independent review for MRIA,
and concluded that Rogers was not disabled under the Plan’s “any
occupation” standard.2
Id. at 168-177.
Following Dr. Tontz’s review, Rogers submitted a personal
statement and additional medical records from her primary care
physician and pain management specialist.
Id. Ex. A-2 at 112.
Eaton accepted the records and submitted them to Dr. Tontz for an
Under the Plan, a claimant can appeal directly to Eaton
for a final review.
1
Dr. Tontz noted that the Social Security Administration’s
disability award had no bearing on his determination for longterm benefits under the Plan.
2
4
updated review.
Rogers
was
standard.
not
Id.
On June 30, 2017, Dr. Tontz again found that
disabled
under
the
Plan’s
“any
occupation”
Id. Ex. A-3 at 171.
On February 3, 2017, Eaton upheld Sedgwick’s termination of
Rogers’ long-term disability benefits.
Id. at 16-23. On September
26, 2017, Rogers filed the instant ERISA suit, alleging that Eaton
abused its discretion in terminating her long-term disability
benefits.
Both parties now move for summary judgment.
DISCUSSION
I.
Standard of Review
“The court shall grant summary judgment 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.”
Fed. R. Civ.
P. 56(a); see Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986).
A fact is material only when its resolution affects the outcome of
the case.
(1986).
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
A dispute is genuine if the evidence is such that it could
cause a reasonable jury to return a verdict for either party.
See
id. at 252 (“The mere existence of a scintilla of evidence in
support of the plaintiff’s position will be insufficient ....”).
On a motion for summary judgment, the court views all evidence
and inferences in a light most favorable to the nonmoving party.
Id. at 255.
The nonmoving party, however, may not rest upon mere
5
denials or allegations in the pleadings, but must set forth
specific facts sufficient to raise a genuine issue for trial.
Celotex, 477 U.S. at 324. A party asserting that a genuine dispute
exists - or cannot exist - about a material fact must cite
“particular parts of materials in the record.”
56(c)(1)(A).
Fed. R. Civ. P.
If a plaintiff cannot support each essential element
of a claim, the court must grant summary judgment because a
complete
failure
of
proof
regarding
an
necessarily renders all other facts immaterial.
essential
element
Celotex, 477 U.S.
at 322-23.
II.
Denial of Benefits
Under ERISA, a plan participant may bring a civil action to
“recover benefits due to [her] under the terms of [her] plan, or to
clarify [her] rights to future benefits under the terms of the
plan.” 29 U.S.C. § 1132(a)(1)(B). The parties agree that the Plan
gives Eaton discretion to construe the Plan terms.
Therefore, the
court reviews Eaton’s benefits termination under an abuse of
discretion standard.
See Firestone Tire and Rubber Co. v. Bruch,
489 U.S. 101, 115 (1989).
Under this standard, a plan administrator’s denial of benefits
is reversed only when the decision is arbitrary and capricious.
Green v. Union Sec. Ins. Co., 646 F.3d 1042, 1050 (8th Cir. 2011).
That is, the court must uphold Eaton’s decision if it was supported
by substantial evidence. McGee v. Reliance Standard Life Ins. Co.,
6
360 F.3d 921, 924 (8th Cir. 2004). Substantial evidence means more
than a scintilla, but less than a preponderance, of relevant
evidence that a reasonable person might accept as adequate to
support a decision.
Waldoch v. Medtronic, Inc., 757 F.3d 822, 832
(8th Cir. 2014). The court will not disturb a plan administrator’s
decision supported by substantial evidence even if a different or
more reasonable decision could have been made.
Id. at 833.
Furthermore, when reviewing a denial of ERISA benefits, a
court
must
focus
on
the
evidence
available
to
the
plan
administrator at the time of its decision and may not admit new
evidence or consider post hoc rationales.
See Marolt v. Alliant
Techsystems, Inc., 146 F.3d 617, 620 (8th Cir. 1998). In doing so,
the
court
reviews
determination.
the
record
as
a
whole
and
Eaton’s
final
See, e.g., Whitley v. Standard Ins. Co., 815 F.3d
1134, 1141 (8th Cir. 2016) (internal citation omitted) (holding
that the “court reviews the claim administrator’s final decision to
deny a claim, rather than the initial denial that was reconsidered
during the internal appeal.”).
A.
Conflict of Interest
Rogers first argues that Eaton has a conflict of interest
under the Plan because it both pays benefits and adjudicates
appeals.
If the plan administrator or fiduciary having discretion
is operating under a conflict of interest, that conflict must be
weighed as a “[f]actor in determining whether there is an abuse of
7
discretion.”
Firestone, 489 U.S. at 115.
interest
should
...
prove
more
important
“The conflict of
(perhaps
of
great
importance) where circumstances suggest a higher likelihood that it
affected the benefits decision, including, but not limited to,
cases where an insurance company administrator has a history of
biased claims administration.”
U.S. 105, 117 (2008).
Metro Life Ins. Co. v. Glenn, 554
Nevertheless, when the plan administrator
uses independent medical consultants to review claims, any conflict
is mitigated.
See, e.g., Whitley, 815 F.3d at 1140 (finding that
when the plan administrator hires independent medical consultants
to review claims, the conflict of interest is reduced “to the
vanishing point.”).
Here, to the extent Eaton is conflicted under
the Plan as both funder and adjudicator, the record shows that it
took the necessary measures to mitigate the conflict.
Eaton referred Rogers’ medical record to MIRA for third-party
review.
Dr. Tontz, who performed the review, was affiliated with
that organization, not Eaton.
Nodes Decl. Ex. A-3 at 176-77.
Moreover, Dr. Tontz certified that he was not paid for a specific
review outcome.
Id. at 176.
Dr. Tontz considered the entirety of
the record and applied that evidence to the Plan’s long-term
disability benefit criteria.
Id. at 163-77.
As such, there is no
evidence that Dr. Tontz’s findings were biased in Eaton’s pecuniary
favor or that Eaton has a history of biased claims administration.
8
B. Consideration of the Evidence
Rogers
next
argues
that
Eaton
improperly
findings of her treating medical providers.
discounted
the
However, in an ERISA
claim, the plan administrator is not required “to accord special
weight to the opinions of a claimant’s physician.” Weidner v. Fed.
Express
Corp.,
492
F.3d
925,
930
(8th
Cir.
2007).
A
plan
administrator is free to rely on the reports of consulting, nonexamining physicians over the reports of treating physicians.
Id.
Indeed, a plan administrator has no “discrete burden of explanation
when they credit reliable evidence that conflicts with a treating
physician’s evaluation.”
Id.
Here, the record shows that Eaton accepted all of Rogers’
medical records and tests, but was more persuaded by Dr. Knoll’s
and Dr. Tontz’s findings, as well as the independent medical
examination,
transferable
capabilities evaluation.
skills
analysis,
and
functional
That evidence provides more than a
scintilla of reliable evidence that Rogers could work in some
occupation, and, as a result, that she was not continuously
disabled under the Plan.
Accordingly, Eaton did not abuse its
discretion in terminating Rogers’ long-term disability benefits.
C.
Social Security Disability Determination
Finally, Rogers argues that Eaton’s decision to terminate her
long-term benefits was arbitrary and capricious because it failed
to provide a sufficient explanation as to why its decision differed
9
from the Social Security Administration’s disability finding.
The
law is clear, however, that an “ERISA plan administrator or
fiduciary
generally
is
not
bound
by
a
[Social
determination that a plan participant is disabled.”
Security]
Jackson v.
Metro. Life Ins. Co., 303 F.3d 884, 889 (8th Cir 2002).
Here,
there is no evidence that the Social Security Administration’s
disability finding applied the same criteria as the Plan or took
into
consideration
the
same
independent
medical
examination,
functional capacity evaluation, transferable skills analysis, and
labor market survey.
In addition, it is unlikely that the Social
Security Administration and Eaton examined the same medical records
given that the former awarded benefits in October 2014, and the
latter’s
final
benefit
termination
was
issued
in
June
2017.
Therefore, Eaton did not abuse its discretion in explaining why it
did not follow the Social Security Administration’s disability
finding.
CONCLUSION
Because Eaton did not abuse its discretion in terminating
Rogers’ long-term disability benefits, its motion for summary
judgment must be granted.
Accordingly, based on the above, IT IS
HEREBY ORDERED that:
10
1.
Eaton’s motion for summary judgment [ECF No. 27] is
granted;
2.
Rogers’ motion for summary judgment [ECF No. 36] is
denied; and
3.
The case is dismissed with prejudice.
LET JUDGMENT BE ENTERED ACCORDINGLY.
Dated: October 9, 2018
s/David S. Doty
David S. Doty, Judge
United States District Court
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