Griffin v. Charter Communications Short Term Disability Plan

Filing 41

ORDER granting 37 Motion for Summary Judgment and denying 24 Motion for Judgment. Signed by Chief Judge Terrence W. Boyle on 12/6/2018. (Stouch, L.)

IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF NORTH CAROLINA
WESTERN DIVISION
No. 5:17-CV-308-BO

MELVIN GRIFFIN,

)
Plaintiff,
)
)
v.
)
)
CHARTER COMMUNICATIONS SHORT)
TERM DISABILITY PLAN,
)
Defendant.
)

ORDER

This cause comes before the Court on cross-motions for summary judgment. A hearing
was held before the undersigned on October 17, 2018, and the matters are ripe for ruling. For the
reasons that follow, defendant's motion for summary judgment is granted and plaintiffs motion
for summary judgment is denied.
BACKGROUND
Plaintiff seeks a declaration of entitlement to short-term disability benefits pursuant to the
Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1132(a)(l)(B), as well as
attorney fees and costs pursuant to 29 U.S.C. § 1132(g). During the relevant time period, plaintiff
was employed by Charter Communications as a Time Warner Cable Customer Care Rep I. [DE
39-1] AR 74. 1 Plaintiffs job required that he be able to, inter alia, effectively present information
and respond to questions from groups of managers, clients, customers, and the general public, as
well as work in a fast-paced environment, maintain professional customer service skills at all
times, perform basic mathematical calculations, be able, to the extent possible, to anticipate and
prevent problems, and apply good judgment. AR 74-75.
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Citations to the administrative record relied upon by the parties are to the "Charter" page numbers
imposed.

Plaintiff ceased work as a Customer Care Rep I in December 2016 due to depression and
hypertension, and filed a claim for short-term disability benefits. AR 19; 187. In order to qualify
for short-term disability benefits under the defendant-plan, a claimant must be unable to perform
the essential duties of his or her occupation. AR 402. On December 15, 2016, Luvae Southerland,
P.A.C., completed an attending physician statement which indicated that plaintiff suffered from
headache, fatigue, loss of concentration, depression secondary to family stresses, and extreme
hypertension. AR 152-54. P.A. Southerland indicated that plaintiff would have a limited attention
span and would be unable to concentrate at work, and indicated that plaintiff should stay home
from work from December 2, 2016, to March 9, 2017. On January 4, 2017, Eric Mizelle, M.D., a
psychiatrist, completed an attending physician statement on plaintiffs behalf, diagnosing plaintiff
with severe major depressive disorder and indicating that plaintiffs functioning was poor and that
his medications needed time to work. AR 122-27.
On January 9, 2017, plaintiff was approved for short-term disability benefits from
December 8, 2016, through January 8, 2017. AR 108. The approval letter informed plaintiff that,
in order to determine whether his disability qualified him for additional short-term disability
benefits, plaintiff would need to provide updated return to work information and provide updated
medical documentation on or before January 16, 2017. AR 108. On January 17, 2017, P.A.
Southerland completed a second attending physician statement on plaintiffs behalf. AR 99-101.
P.A. Southerland again opined that plaintiff would be unable to return to work until March 9, 2017,
and noted that plaintiff should continue to have monthly monitoring for blood pressure and
depression.

P.A. Southerland did not indicate any objective or clinical findings to warrant

disability, nor list any specific job functions plaintiff would not be able to perform, although she
indicated that plaintiff would be unable to perform job functions due to his condition.

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Pl~intiffs

short-term disability benefits were extended through January 23, 2017, and

plaintiff was asked to provide additional records in support of his claim by January 31, 2017. AR
91. Plaintiff was informed that absent additional medical information no additional benefits would
be paid.
On February 1, 2017, defendant denied sh9rt-term disability benefits as of January 24,
2017, noting that no additional information had been received to support continued disability
beyond January 23, 2017. AR 85. Plaintiff administratively appealed the denial of benefits on
February 28, 2017. AR 82. In his appeal, plaintiff stated that all documents in support of his claim
were being submitted and that the doctors' paperwork had been sent in late.
In support of his appeal, plaintiff submitted notes from a follow-up visit with Dr. Mizelle
which occurred on January 31, 2017. AR 63. Dr. Mizelle noted that plaintiff had improved
although was now dealing with the death of another person close to him. Plaintiff saw Dr. Mizelle
again on February 28, 2017. AR 53-55. Dr. Mizelle assessed plaintiff as getting better but not at
baseline. P.A. Southerland completed an attending physician statement on March 13-14, 2017.
AR 44-49. P.A. Southerland opined that plaintiff would be able to return to work on April 14,
2017, but did not list any specific job functions that plaintiff would be unable to perform.
Patrick Young, M.D., a psychiatrist, reviewed plaintiffs file at the request of the claims
administrator. AR 28-30. Dr. Young reviewed the medical record and attempted to contact Dr.
Mizelle on three occasions without success. AR 27. Dr. Young attempted to contact P.A.
Southerland on four occasions, and was successful in reaching her on the fourth occasion. Id.
P.A. Southerland informed Dr. Young on March 20, 2017, that she was not seeing plaintiff for
mental health issues and that the main issue she was dealing with was plaintiffs high blood
pressure; P.A. Southerland deferred any opinion about whether plaintiff was impaired for the days

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m review. AR 28. Pamil Sidhu, M.D., a family medicine doctor, also reviewed plaintiffs claim.
AR 18-23. Dr. Sidhu also attempted to contact Dr. Mizelle and P.A. Southerland several times,
all without success. AR 19. Dr. Sidhu concluded that plaintiff did not have any impairments as a
result of his hypertension, and noted there was no evidence of a fundoscopic or neurological exam
to support the presence of impairments from elevated blood pressure.
By letter dated March 27, 2017, defendant denied plaintiffs administrative appeal of the
denial of his short-term disability claim effective January 24, 2017, through plaintiffs return-towork date of April 24, 2017. AR 4; 7. The denial letter stated that the medical information in the
file did not support that plaintiff would be unable to perform his occupation. AR 6. Plaintiff file
this action on June 22, 2017, seeking short-term disability benefits from January 24, 2017, to April
24, 2017. [DE 1].
DISCUSSION
The parties are before the Court on cross-motions for summary judgment pursuant to Rule
56 of the Federal Rules of Civil Procedure. A motion for summary judgment may not be granted
unless there are no genuine issues of material fact for trial and the movant is entitled to judgment
as a matter of law.

Fed. R. Civ. P. 56(a).

The moving party bears the initial burden of

demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S.
317, 323 (1986). If that burden has been met, the non-moving party must then come forward and
establish the specific material facts in dispute to survive summary judgment. Matsushita Elec.
Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 588 (1986).

"It is well-established that a court reviewing the denial of disability benefits under ERISA
initially must decide whether a benefit plan's language grants the administrator or fiduciary
discretion to determine the claimant's eligibility for benefits, and if so, whether the administrator

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acted within the scope of that discretion." Gallagher v. Reliance Stand. Life Ins. Co., 305 F.3d
264, 268 (4th Cir. 2002), as amended (Oct. 24, 2002). Here, the parties agree that the disability
plan provides the claims administrator with the discretion to interpret the plan language and
determine benefit eligibility, and thus that this Court reviews the decision to deny continued shortterm benefits for abuse of discretion. See Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101,
111 (1989); Griffin v. Hartford Life & Accident Ins. Co., 898 F.3d 371, 378 (4th Cir. 2018). 2
When determining whether a plan administrator or fiduciary abused its discretion, a court
considers, but is not limited to, such factors as:
(1) the 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 BRISA; (7) any
external standard relevant to the exercise of discretion; and (8) the fiduciary's
motives and any conflict of interest it may have.
Booth v. Wal-Mart Stores, Inc. Associates Health and Welfare Plan, 201 F.3d 335, 342-43 (4th
Cir. 2000). A court cannot disturb the policy administrator's decision ifit was reasonable, even if
the court would have reached a different conclusion. Id. at 341. "The administrator's decision is
reasonable if it is the result of a deliberate, principled reasoning process and if it is supported by
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substantial evidence, which is evidence which ,a reasoning mind would accept as sufficient to
support a particular conclusion." DuPerry v. Life Ins. Co. of N.A., 632 F.3d 860, 869 (4th Cir.
2011) (internal quotations and citations omitted); see also Griffin, 898

F~,d.

at 381.

The decision to deny plaintiffs claim for continued short-term benefits was reasonable and
not an abuse of the claims administrator's discretion. Plaintiffs argument that the decision to deny
2

There is further no dispute regarding the relevant provisions of the disability plan, and thus the
Court's consideration is limited to determining whether the claims administrator abused its
discretion in denying plaintiffs continued eligibility for short-term disability benefits.
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benefits was not reasonable centers on Booth factors three and five, specifically Dr. Young's and
Dr. Sidhu's failure to contact Dr. Mizelle to discuss plaintiff's psychiatric care prior to rendering
their opinions. Both reviewing physicians attempted to contact Dr. Mizelle three times, by fax and
by phone, prior to rendering their opinions. AR 19; 27. The cases on which plaintiff relies in
making his argument are distinguishable from this matter because those cases involved plan
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administrators who were "willfully blind" to evidence and accessible information which might
support a succes'sful claim. Harrison v. Wells Fargo Bank, NA., 773 F.3d 15, 21 (4th Cir. 2014);
see also Wilkinson v. Sun Life & Health Ins. Co., 674 F. App'x 294, 301 (4th Cir. 2017). Here,
however, Drs. Young and Sidhu made reasonable attempts to contact Dr. Mizelle by sending faxes
and leaving voicemail messages, each on three separate occasions. While plaintiff correctly argues
that the claims administrator could have notified him that it had been unsuccessful in reaching Dr.
Mizelle, see Harrison, 773 F.3d at 21 (notifying a claimant of missing information material to
success of claim proper in the course of a full and fair review), it cannot be said that contacting a
physician six times over a period of days did not satisfy the claims administrator's duty to retrieve
and consider relevant information, which was not readily available given the unrespons,iveness of
Dr. Mizelle. Berry v. Ciba-Geigy Corp., 761 F.2d)003, 1008 (4th Cir. 1985). Additionally, the
reviewing physicians had in the record Dr. Mizelle's notes and statements, and plaintiff had been
_/

notified repeatedly that he must provide continued evidence of disability and failed to do so. Elliott
v. Sara Lee Corp., 190 F.3d 601, 608 (4th Cir. 1999).
Moreover, substantial evidence supports the claims administrator's decision. Two peer
review physicians reviewed the full medical record and determined that as to both his psychiatric
impairments and hypertension, the record did not support ongoing disability for plaintiffs
)

occupation from January 24, 2017, forward. As to the hypertension finding, to which the Court

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would note plaintiff does specifically object, Dr. Sidu pointed to blood pressure readings within
normal range on January 17, 2017, January 31, 2017, and February 28, 2017. AR 21. As to the
psychiatric finding, Dr. Young relied on Dr. Mizelle's reports of plaintiff feeling better, his alert
and oriented status, appropriate affect, and logical, goal directed, and coherent thought processes.
AR 30. Dr. Young noted that there were limited records pertaining to plaintiffs psychiatric
findings during the relevant time period and no mental status exatri findings which addressed
specific impairments.
Treating physician opinions are not accorded greater weight than reviewing physician
opinions in ERISA claims. Black & Decker Disability Plan v. Nord, 538 U.S. 822, 825 (2003).
When a claims administrator is confronted with conflicting medical opinions, denial of benefits is
not an abuse of discretion. Booth, 201 F.3d at 345 (citing Elliott, 190 F.3d at 606). Here, the
claims administrator was confronted with conflicting opinions and elected to deny plaintiffs claim
for continu~d benefits. The Court finds that the undisputed record supports.that the decision of
the claims administrator was reasoned and was not an abuse of discretion.
CONCLUSION
Accordingly, plaintiffs motion for summary judgment [DE 24] is DENIED and
defendant's amended motion for summary judgment [DE 37] is GRANTED.

The clerk is

DIRECTED to enter judgment in favor of defendant and close the case.
SO ORDERED, this~ day of December, 2018.

CHIEF UNITED STATES DISTRICT JUDGE

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