HEDRICK v. AT&T UMBRELLA BENEFIT PLAN NO. 1

Filing 34

MEMORANDUM OPINION AND ORDER signed by JUDGE LORETTA C. BIGGS on 2/16/2021; that Defendant's motion to strike, (ECF No. 27 ), is DENIED. FURTHER that Plaintiff's Amended Motion for Summary Judgment, (ECF No. 25 ), is DENIED, and Plaintiff's original Motion for Summary Judgment, (ECF No. 23 ), is TERMINATED AS MOOT. FURTHER that Defendant's Motion for Summary Judgment, (ECF No. 21 ), is GRANTED. (Sheets, Jamie)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

LORETTA HEDRICK,
Plaintiff,
v.
AT&T UMBRELLA BENEFIT
PLAN NO.1,
Defendant.

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1:19-cv-971

MEMORANDUM OPINION AND ORDER
LORETTA C. BIGGS, District Judge.
This matter arises out of a dispute between Plaintiff Loretta Hedrick and Defendant
AT&T Umbrella Benefit Plan No. 1 over the payment of short-term and long-term benefits1
under 29 U.S.C. § 1132(a)(1)(B) of the Employee Retirement Income Security Act of 1974, 29
U.S.C. § 1001, et seq. (“ERISA”) (ECF No. 1 at 1.) Before the Court are cross-motions for
summary judgment pursuant to Rule 56. (ECF Nos. 21; 25.) Additionally, Defendant has
filed a motion to strike pursuant to Local Rule 83.4(a)(3). (ECF No. 27.) For the reasons set
forth below, Plaintiff’s Amended Motion for Summary Judgment will be denied, Defendant’s
Motion for Summary Judgment will be granted, and Defendant’s motion to strike will be
denied.

Though neither party addresses Plaintiff’s entitlement to long-term benefits in depth, the Court does find, that the
language of the Plan clearly indicates that in order for a claimant to be considered for long-term disability benefits, she
much first have received the maximum amount (26 weeks) of short-term disability benefits under the Plan. (ECF No. 151 at 29.) Here, it is undisputed that Plaintiff did not exhaust the potential twenty-six weeks permitted for short-term
disability benefits.

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I.

PROCEDURAL AND FACTUAL HISTORY
Plaintiff is a former employee of AT&T Mobility Services, LLC (“AT&T”), (ECF Nos.

1 ¶ 5; 5 ¶ 5), where she was a Business Customer Service Specialist I during the relevant time
period, (ECF Nos. 22 at 4; 26 at 2, 3). In that role, Plaintiff’s primary duties included:
answering business customers’ inquiries, initiating service orders, handling customer requests,
maintaining a working knowledge of company products and services, making
recommendations to customers, and using operational systems to process purchases. (ECF
No. 15-1 at 117–18.) On October 18, 2018, Plaintiff underwent surgery on her right knee due
to a degenerative tear of her lateral meniscus. (ECF No. 15-4 at 69.) Plaintiff submitted a
short-term disability claim related to this injury and surgery which was approved for the period
of October 25, 2018 through November 4, 2018. (ECF No. 15-2 at 13.) Plaintiff’s disability
benefits were then extended through November 20, 2018. (ECF No. 15-4 at 60.) On
November 28, after review of additional medical documentation, her disability benefits were
again extended through December 16, 2018. (ECF No. 15-4 at 44.)
On December 17, 2018, Plaintiff contacted the Claims Administrator and indicated
that she was scheduled to have surgery on her right shoulder. (ECF No. 15-2 at 29.) The
Plaintiff subsequently informed the Claims Administrator that she in fact had the surgery, (id.),
and the Claims Administrator confirmed her statement, (id. at 30). After that confirmation,
and after Plaintiff and her treating physicians provided additional information and records on
a number of occasions, Plaintiff’s disability benefits were extended several times, (id. at 33;
ECF No. 15-4 at 21), ultimately until February 11, 2019, (ECF No. 15-3 at 127).
By letter dated February 28, 2019, one of Plaintiff’s treating physicians indicated that
she believed Plaintiff should remain out of work until a March 11, 2019, appointment. (ECF
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Id. at 119.) She additionally stated that Plaintiff was continuing to participate in a physical
therapy program. (Id.) Given these ongoing updates, the Claim Administrator sought an
internal review of Plaintiff’s medical information to determine whether the medical
information substantiated Plaintiff absence from work beyond February 12, 2019. (ECF No.
15-2 at 50.) On March 4, 2019, Dr. Brecher, a board-certified orthopedic surgeon, reviewed
Plaintiff’s medical records, including notes of two of Plaintiff’s treating physicians, and
indicated to the Claims Administrator that it was his opinion that Plaintiff was not disabled
from her job as of February 12, 2019.2 (ECF No. 15-3 at 114–16.) After receiving Dr.
Brecher’s opinion, the Claims Administrator determined that the Plaintiff’s benefits would be
terminated as of February 12, 2019, and Plaintiff was informed of this decision by letter dated
March 13, 2019. (Id. at 102–04.) The letter also advised Plaintiff of her right to appeal the
determination.3 (Id. at 104–08.)
Plaintiff, through her attorney, appealed the denial of short-term benefits and requested
that review of her appeal not begin until she had the opportunity to obtain and provide more
medical records for review. (Id. at 65.) Plaintiff also requested copies of all documents the
Claim Administrator relied upon in reaching the denial determination and for information
regarding the process for filing a claim for long-term disability. (Id. at 66.) Defendant obliged
Plaintiff’s request to delay the review of the appeal and indicated that the appeal review process
would continue on June 12, 2019. (Id. at 78.) Plaintiff submitted additional medical records

2 While Dr. Becher’s report refers to the employee as a male and uses male pronouns throughout, there is no dispute that
the report pertained to Plaintiff.

Though the letter indicates that Plaintiff will have the right to bring a lawsuit against the AT&T Umbrella Benefit Plan
No. 3, Plaintiff has brought this claim against AT&T Umbrella Benefit Plan No. 1. In its Answer, Defendant indicates
that the AT&T Umbrella Benefit Plan No. 3 was formerly known as AT&T Benefit Plan No. 1. (ECF No. 5 at 1.)

3

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from Dr. Meryl Snow and a statement from Dr. Amanda Robertson-Shepherd on May 28,
2019. (ECF No. 15-2 at 146–97.) On May 30, 2019, Plaintiff’s attorney informed Defendant
that no additional materials would be submitted for consideration of the appeal. (Id. at 199.)
After reviewing medical records and materials provided by Plaintiff as well as reports from
two independent physicians advisors, the Claims Administrator determined that Plaintiff’s
claim for short-term disability benefits should be granted as to the period of February 12, 2019
through March 11, 2019, and denied for the period of March 12, 2019 forward. (Id. at 94.)
Following Defendant’s decision on Plaintiff’s appeal, Plaintiff initiated the instant
action. (ECF No. 1.) Plaintiff seeks a declaration that she is entitled to short-term and longterm disability benefits under the AT&T Mobility Disability Benefits Program (“the Plan”).
(Id. at 3.) In the alternative, Plaintiff requests that this Court remand her claim back to the
Claims Administrator for further Review. (Id.) Plaintiff and Defendant both moved for
summary judgment on October 2, 2020. (ECF Nos. 21; 23.) Defendant argues that the
evidence contained in the record support its contention that it did not abuse its discretion in
reaching its determination on Plaintiff’s claim for disability benefits. (ECF No. 22 at 19.)
Plaintiff, on the other hand, argues that the Court should find that Defendant abused its
discretion in denying her claim for benefits from March 12, 2019 forward, and therefore she
is entitled to the benefits she seeks. (ECF No. 26 at 20.)
II.

MOTION TO STRIKE
Before reaching the parties’ substantive motions, the Court will first address

Defendant’s motion to strike. Defendant moves to strike Plaintiff’s Amended Memorandum
and Motion for Summary Judgment. (ECF No. 27.) Defendant contends that Plaintiff filed
her amended motion after the deadline for dispositive motions set forth in the Court’s July 20,
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2020 Order and without seeking permission of the Court to file the amended documents in
violation of Local Rule 56.1 (Id. at 2.) According to Defendant, this justifies striking the
documents from the record. (Id. at 3.) Plaintiff asserts that she filed her initial Motion for
Summary Judgement in compliance with the Court’s July 20, 2020 Order, but upon reviewing
the filing realized that the font was not in compliance with Local Rule 7.1(a). (ECF No. 28 at
1.) Accordingly, Plaintiff’s attorney contacted the Clerk’s Office, who directed her to refile
the documents, with the correct typeface, as amended documents. (Id. at 1–2.)
Review of the record supports Plaintiff’s assertion that the amended filings are
substantively the same as the initial filings. The only difference is the corrected typeface. Local
Rule 56.1(g) provides that a “dispositive motion which is not noticed and filed within the
prescribed time will not be reached by the Court prior to trial unless the Court determines that
its consideration will not cause delay to the proceedings.” L.R. 56.1(g). The Court determines
that a purely typographical change to Plaintiff’s motion and corresponding brief will not in
any way cause a delay in the proceedings. As such, the Court will consider Plaintiff’s amended
motion and brief, and those documents will serve as the operative filings for the purpose of
this Opinion and Order. Therefore, Defendant’s motion to strike will be denied. The Court
next considers the cross-motions for summary judgment.
III.

MOTIONS FOR SUMMARY JUDGMENT
A. Standard of Review

Summary judgment is appropriate when “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). “A dispute is genuine if a reasonable jury could return a verdict for the
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nonmoving party.” Jacobs v. N.C. Admin. Off. of the Cts., 780 F.3d 562, 568 (4th Cir. 2015)
(internal citations and quotations omitted). “It is axiomatic that in deciding a motion for
summary judgment, a district court is required to view the evidence in the light most favorable
to the nonmovant” and to “draw all reasonable inferences in his favor.” Harris v. Pittman, 927
F.3d 266, 272 (4th Cir. 2019) (citing Jacobs, 780 F.3d at 568). That means that a court “cannot
weigh the evidence or make credibility determinations,” Jacobs, 780 F.3d at 569 (citations
omitted), and thus must “usually” adopt “the [nonmovant’s] version of the facts” even if it
seems unlikely that the moving party would prevail at trial, Witt v. W. Va. State Police, Troop 2,
633 F.3d 272, 276 (4th Cir. 2011) (quoting Scott v. Harris, 550 U.S. 372, 378 (2007)). Where,
as in this case, the Court has before it cross-motions for summary judgment, the Court reviews
each motion separately to determine if either party is entitled to judgment as a matter of law.
Rossignol v. Voorhaar, 316 F.3d 516, 523 (4th Cir. 2003).
B. Disability Benefits Plan
Under the Plan at issue, eligible employees may receive certain disability benefits if they
are deemed disabled. For the purposes of short-term disability, the Plan defines disabled as
when an eligible employee is “absent from Active Employment and unable to perform the
duties of [her] Customary Job due to illness . . . or injuries.” (ECF No. 15-1 at 19.) For the
purposes of long-term disability under the Plan, an eligible employee is considered disabled if,
during “the first twenty-four (24) months after [her] exhaustion of Short-Term Disability
Benefits, [she is] continuously unable to perform [her] Customary Job.”4 (Id. at 28.) Pursuant

4 After the initial twenty-four month period, a participant would continue to be considered disabled if she is determined
to have a “Total Disability” that is caused by something other than a mental health claim. (ECF No. 15-1 at 28.)

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to the Plan, for a claimant to qualify for long-term disability benefits, she must have first
exhausted twenty-six weeks of short-term disability benefits. (Id. at 29.)
The Plan provides that participants are no longer eligible for short-term or long-term
disability benefits if they cease to be disabled under the terms of the Plan. (Id. at 16, 27, 33.)
The Plan further indicates that whether a participant meets the definition of disability under
the Plan is “determined at the sole discretion of the Claims Administrator.” (Id. at 17.)
C. Discussion
In reviewing a denial of benefits under ERISA, the Supreme Court has explained that
generally a court should be “guided by principles of trust law,” analogizing a plan administrator
to a trustee and deeming their benefit determinations to be fiduciary acts. Metro. Life Ins. Co.,
v. Glenn, 554 U.S. 105, 111 (2008) (quoting and citing Firestone Tire & Rubber Co. v. Bruch, 489
U.S. 101, 111-113 (1989)). “Principles of trust law require courts to review a denial of plan
benefits ‘under a de novo standard’ unless the plan provides to the contrary.” Id. (quoting and
citing Firestone, 489 U.S. at 115).
In reviewing a denial of benefits under an ERISA-governed plan, a district court must
first determine whether the relevant plan documents confer discretionary authority on a plan
administrator to make a determination of whether a claimant is eligible for benefits. DuPerry
v. Life Ins. Co. of N. Am., 632 F.3d 860, 869 (4th Cir. 2011). Where the plan grants “the
administrator or fiduciary discretionary authority to determine eligibility for benefits…[t]rust
principles make a deferential standard of review appropriate.” Glenn, 554 U.S. at 111 (quoting
Firestone, 489 U.S. at 111, 115); see also Booth v. Wal-Mart Stores, Inc. Assocs. Health &Welfare Plan,
201 F.3d 335, 341 (4th Cir. 2000). Thus, an administrator’s denial of benefits is reviewed
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under an abuse of discretion standard in such a case. Booth, 201 F.3d at 341. Courts look to
whether the language of the plan in question is sufficient to convey discretionary authority to
its plan administrator. Gallagher v. Reliance Standard Life Ins. Co., 305 F.3d 264, 268–69 (4th Cir.
2002). The Fourth Circuit has stated that there is no specific phrase or language required to
find that a plan administrator has been granted discretionary authority. Id. at 268. However,
a plan’s “intention to confer discretion” on the plan administrator “must be clear.” Id.
In the instant matter, it is undisputed that the Plan’s express terms provide
discretionary authority to the Claim Administrator. For instance, the Plan provides that:
The Plan Administrator administers claims and appeals for disability Benefits
under this Program on a contract basis with the Claims Administrator. The Plan
Administrator has discretionary authority to interpret the provisions of the
Program and to determine entitlement to disability Benefits. The Claims
Administrator has full discretionary authority to interpret the provisions of the
Program and to determine Benefits available under the Program.
(ECF No. 15-1 at 51.) In a section entitled “Who Decides Your Appeals,” The Plan also
explains that:
The Plan Administrator has delegated discretion and authority to decide appeals
to the Claims Administrator. . . . The Claims Administrator will have full and
exclusive authority and discretion to grant and deny appeals under the Program.
The decision of the Claims Administrator regarding any appeal will be final and
conclusive.
(Id. at 43.) Because the Plan’s language clearly grants the Claims Administrator complete
discretionary authority over both eligibility determinations and the interpretation of applicable
provisions, the Court concludes that the denial of Plaintiff’s benefits here is reviewed under
an abuse of discretion standard. See Carden v. Aetna Life Ins. Co., 559 F.3d 256, 260 (4th Cir.
2009).
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Under this deferential standard of review in the context of ERISA, the test is whether
the administrator’s benefits decision is reasonable. Williams v. Metro. Life Ins. Co., 609 F.3d 622,
630 (4th Cir. 2010). The Fourth Circuit has held that the plan administrator’s determination
is reasonable when it is the result of a “deliberate, principled reasoning process” supported by
substantial evidence. Id. at 630 (citation omitted). “Substantial evidence consists of less than
a preponderance but more than a scintilla of relevant evidence that ‘a reasoning mind would
accept as sufficient to support a particular conclusion.’” Whitley v. Hartford Life & Accident Ins.
Co., 262 F. App’x 546, 551 (4th Cir. 2008) (quoting Laws v. Celebrezze, 368 F.2d 640, 642 (4th
Cir. 1966)). The administrator’s decision must “rest on good evidence and sound reasoning”
and result “from a fair and searching process.” Harrison v. Wells Fargo Bank, N.A., 773 F.3d
15, 21 (4th Cir. 2014) (quoting Evans v. Eaton Corp. Long Term Disability Plan, 514 F.3d 315,
322–23 (4th Cir. 2008)). “[T]he abuse of discretion standard requires a reviewing court to
show enough deference to a primary decision-maker’s judgment that the court does not
reverse merely because it would have come to a different result in the first instance.” Evans,
514 F.3d at 322.
The Fourth Circuit has established an eight-factor, non-exclusive analytical framework
for assessing the reasonableness of a plan administrator’s decision (“Booth factors”). Booth, 201
F.3d at 342–43 (4th Cir. 2000). The eight Booth factors are:
(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 decision-making 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 discretion; and
(8) the fiduciary’s motives and any conflict of interest it may have.
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Id. All eight Booth factors need not be, and may not be, relevant in a given case. Helton v.
AT&T, Inc., 709 F.3d 343, 357 (4th Cir. 2013). Review of the parties’ arguments as well as
the evidence contained in the record indicates that the main Booth factors relevant to the
discussion of the instant matter are: the adequacy of the materials reviewed by the Claim
Administrator, whether the decision-making process was reasoned and principled, and
whether the decision-making process comported with the procedural and substantive
requirements of ERISA. The Court will evaluate each of these factors in turn. However,
before undertaking an analysis of the reasonableness of the Plan Administrators’
determinations, the Court must address the scope of the Administrative Record available for
its review.
1. Scope of the Court’s Review
Defendant asserts that Plaintiff is asking this Court to consider evidence “which she
did not provide to the Claims Administrator,” specifically that she underwent surgery on her
left shoulder in June 2019. (ECF No. 30 at 4.) Though indeed evidence of Plaintiff’s shoulder
surgery was not present in the administrative record the Claim Administrator reviewed,
Plaintiff nevertheless references the surgery on countless occasions in her arguments
concerning the medical conditions that gave rise to the need for surgery. (See e.g., ECF No. 29
at 4.) Out of an abundance of caution, the Court will clarify the scope of its review.
The Fourth Circuit has held that “consideration of evidence outside of the
administrative record is inappropriate when a coverage determination is reviewed for abuse of
discretion. The rationale for this rule is that, to the extent possible, the administration of
ERISA plans should be left to plan fiduciaries, not federal courts.” Helton, 709 F.3d at 352
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(internal citations omitted).

However, a court may consider evidence outside of the

administrative record when such review is necessary to adequately assess the plan
administrator’s decision under the Booth factors, “and the evidence was known to the plan
administrator when it rendered its benefits determination.” Id at 356.; see also Sheppard & Enoch
Pratt Hosp., Inc. v. Travelers Ins. Co., 32 F.3d 120, 125 (4th Cir. 1994) (“[A]n assessment of the
reasonableness of the administrator's decision must be based on the facts known to it at the
time.”).
Rather than presenting an absolute bar to evidence outside of the administrative record,
courts undertaking a review of ERISA cases should take “a more nuanced approach to
consideration of extrinsic evidence on deferential review.” Helton, 709 F.3d at 352. For
instance, the court in Helton permitted the admission of corporate records which a Benefits
Committee could have considered had it made an effort to do so. Id. at 356–67. The court
concluded that consideration of the extra-record evidence was appropriate because a plan
administrator can be charged with knowledge of information in certain circumstances,
particularly if that information was acquired by its employees in the scope of their employment
or if the information was contained in the contents of its books and records. Id.
Here, Plaintiff references an alleged surgery on her left shoulder that took place on
June 20, 2019, in support of her contentions that Defendant abused its discretion in failing to
review her job duties that required use of her upper extremities. (ECF No. 26 at 14.) However,
the evidence does not reflect that Plaintiff informed Defendant that she actually underwent
surgery on her left shoulder prior its determination of her appeal. Moreover, the evidence
does not demonstrate that Defendant had any knowledge that Plaintiff actually underwent the
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surgery from any other source prior to reaching its determination. In fact, after the alleged
surgery had occurred, Defendant offered to suspend its review of her appeal and provided
Plaintiff with the opportunity to submit additional information on August 21, 2019, (ECF No.
15-2 at 101), and Plaintiff, through counsel, declined to do so, requesting instead that
Defendant continue with review of the appeal, (ECF No. 15-2 at 100). Here, there is no
evidence that suggests Defendant could have readily accessed any evidence outside of the
record, particularly as to whether Plaintiff underwent surgery on her left shoulder in June 2019.
Moreover, there is no evidence that this information was somehow in Defendant’s control or
known to Defendant when it rendered its decision denying Plaintiff’s short-term disability
benefits. As such, the Court will limit its review to the information contained in the
administrative record that was before the Claims Administrator in reaching the determination
and will not consider the alleged surgery Plaintiff underwent on her left shoulder in June 2019.
The Court will now proceed to review of the relevant Booth factors.
2. Relevant Booth Factors
i.

The Adequacy of the Materials Considered to Make the Decision and the Degree to
which that Material Supports that Decision

Though the parties do not expressly frame it as such, one of the main disputes before
the Court is whether the Claim Administrator reviewed adequate materials in making the
determination to deny Plaintiff’s benefits. Plaintiff argues that the Claims Administrator
abused her discretion by failing to consider physical duties that were required of Plaintiff in
performing her job duties. (ECF No. 26 at 11.) Plaintiff also contends that the Claims
Administrator abused her discretion by considering the medical opinion of independent
reviewing physicians who did not appropriately assess the physical duties Plaintiff was required
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to perform in completing her job duties,5 (id.), nor consider the totality of Plaintiff’s condition,
(id. at 18.) Defendant responds, on the other hand, that the Claim Administrator and the
independent reviewing physicians did consider Plaintiff’s essential job functions in evaluating
her claims for disability benefits. (ECF No. 30 at 6.) Defendant likewise asserts that the
Claims Administrator and the independent reviewing physicians had considered the totality of
Plaintiff’s medical issues in evaluating her claim for disability benefits. (Id. at 11.)
The Fourth Circuit has made clear that “the primary responsibility for providing
medical evidence to support a claimant's theory rests with the claimant.” Harrison, 773 F.3d
at 24. Plaintiff has provided no authoritative support that suggests that the independent
reviewing physicians and claims administrators are to seek out additional information on
unknown and unprovided job duties or somehow know of medical conditions and/or
procedures that are not contained in the record.
The record is clear that, in deciding Plaintiff’s claims for benefits, Defendant
considered all evidence in the administrative record, as well as the essential functions of
Plaintiff’s job duties that were provided. Moreover, despite Plaintiff’s assertion that the
independent physician reviewers did not consider the totality of her medical conditions, the
record reflects that the physicians did consider the medical records Plaintiff submitted
regarding her left shoulder, including MRI results and physician-provided notes. (ECF No.
15-2 at 107–15, 116–23, 133–138, 139–46.) Defendant further offered to suspend its review
and expressly informed Plaintiff of her ability to submit additional information that could “be

This argument closely aligns with Plaintiff’s argument regarding another Booth factor, namely that Defendant failed to
undertake a reasoned and principled decision-making process. The Court will thus reserve its analysis of this argument
for its discussion below.
5

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in the form of comment, additional medical records, documentation or other relevant
information” that could include “ [a] job description, chart notes, diagnostic tests, and hospital
summaries.” (Id. at 101.) Plaintiff declined to do so, (id. at 100), yet now contends that
Defendant did not consider adequate information in reaching its benefits determination. The
Fourth Circuit has held that a claimant who did not submit supplemental evidence to disprove
the existing record indicating that she was not disabled could not then “prevail on an argument
that [her employer] had insufficient evidence to make a reasoned decision.” Elliott v. Sara Lee
Corp., 190 F.3d 601, 608 (4th Cir.1999)
The evidence in the record supports a finding that the Claims Administrator, as well as
the independent reviewing physicians, did consider the totality of the Plaintiff’s disabilities as
disclosed in the record and known to the Claims Administrator in reaching their conclusions
and determinations. As such, the Court determines that the evidence supports a finding in
favor of Defendant with respect to the adequacy of materials reviewed.
ii.

Whether the Decision-Making Process Was Reasoned and Principled

The fifth Booth factor explores whether a fiduciary’s decision-making process was
reasoned and principled. “A fiduciary that glosses over an analysis that would direct an
award[,] in favor of an analysis that would support denial of benefits[,] does not engage in a
principled and reasoned decision making process.” L.B. ex rel. Brock v. United Behav. Health,
Inc., 47 F. Supp. 3d 349, 360 (W.D.N.C. 2014). Plaintiff’s argument that Defendant did not
undertake a reasoned and principled decision-making process largely mirrors the argument
made with respect to the adequacy of material covered. Plaintiff asserts that Defendant failed
to “undertake any investigation or inquiry of Plaintiff’s employer to inquire as to what the
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physical requirements of her job were” and that such a failure demonstrates that Defendant
did not meet this bar. (ECF No. 26 at 14–15.)
Plaintiff cites to the Fourth Circuit’s decision in Harrison in support of her contention
that the Defendant had an “absolute obligation” to procure information that may have proven
her eligibility for benefits. (ECF No. 26 at 15.) Further, Plaintiff asserts that Wilkinson v. Sun
Life & Health Ins. Co., 674 F. App’x 294 (4th Cir. 2017), demonstrates that a plan administrator
cannot ignore “readily available” information that is needed for review of a claim for benefits.
(ECF No. 26 at 15–16.) The Court does not find either of Plaintiff’s arguments persuasive,
or are they supported by evidence in the record.
In Harrison, the court found that a claims administrator failed to satisfy ERISA’s full
and fair review requirements when it did not contact and obtain records from a medical
provider that it was aware the plaintiff visited for treatment. Harrison, 773 F.3d at 22–23. In
that case, the plan-commissioned independent reviewing physician noted that the record was
incomplete and without that information he could not provide the claims administrator with
an opinion on the claimant’s alleged disability. Id. at 23–24. The facts in Harrison are
distinguishable from the instant matter. Here, the claims administrator was not told by the
independent reviewing physicians that the record was somehow incomplete or that any
additional medical information should be obtained in order to make a benefits determination.
Furthermore, despite Plaintiff’s characterization of what the court found in Wilkinson,
the Fourth Circuit made clear that “[c]laimants are more familiar with their medical and work
history” than a claim administrator would be and that “the primary responsibility for providing

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medical evidence to support a claimant's theory rests with the claimant.” Wilkinson, 674 Fed.
Appx. at 301 (quoting Harrison, 773 F.3d at 24).
In the instant matter, the Plaintiff has pointed to no evidence in the record that
indicates that she notified the plan administrator that the job description in the record for her
was somehow incomplete or inappropriate. It is unclear how Defendant would have been
placed “on notice” that Plaintiff’s job duties extended beyond the listed job description or
how a different job description with additional physical duties that required use of Plaintiff’s
upper extremities was readily available to Defendant. Therefore, the Court concludes that the
evidence supports Defendant’s claim that its decision-making process was reasoned and
principled.
iii.

Consistency with Procedural and Substantive Requirements of ERISA

ERISA requires that every employee benefit plan “afford a reasonable opportunity to
any participant whose claim for benefits has been denied a full and fair review by the
appropriate named fiduciary of the decision denying the claim.” 29 U.S.C. § 1133 (2008).
More specifically, the plan must “provide adequate notice in writing to any participant or
beneficiary whose claim for benefits . . . has been denied, setting forth the specific reasons for
such denial.” Id. A fiduciary reviewing a denial of ERISA benefits must satisfy certain “core
requirements” before its review can be deemed “full and fair.” Sawyer v. Potash Corp. of
Saskatchewan (Potashcorp), 417 F. Supp. 2d 730, 744 (E.D.N.C. 2006), aff’d sub nom. Sawyer v.
Potash Corp. of Saskatchewan, 223 F. App’x 217 (4th Cir. 2007). The “core requirements” set
forth in the Code of Federal Regulations implementing the statutory requirements, mandate
that (1) a claimant have at least sixty days to appeal an initial denial of benefits; (2) a claimant
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have an opportunity to submit written comments, documents, records, and other information
relating to his claim; (3) a claimant have reasonable access to relevant documents in the
administrator’s possession; and (4) the administrator must take into account all comments,
documents, records, and other information submitted by the claimant. Id. (citing 29 C.F.R. §
2560.503-1(h)(2)); see also Gagliano v. Reliance Standard Life Ins. Co., 547 F.3d 230, 235 (4th Cir.
2008).
With respect to Defendant’s process comporting with the requirements of ERISA, here
it is undisputed that Plaintiff was provided a notice in writing that her claim for benefits was
initially denied and the reason for the denial. (ECF No. 15-3 at 102–03.) Second, the record
is clear that Plaintiff was given the opportunity and adequate time to appeal the initial benefits
determination and to submit additional comments or records. (Id. at 104–09.) Not only that,
Plaintiff did in fact exercise her appeal rights with respect to the initial denial of benefits, (id.
at 95–97), and provided additional medical records, (ECF No. 15-2 at 146–97). Finally, it is
undisputed that Plaintiff’s additional medical records and comments were considered, and
Defendant provided a response to the appeal after which Plaintiff failed to respond. (Id. at
94–95.)
Nonetheless Plaintiff contends that Defendant’s review of her claim was somehow
insufficient and failed to provide the full and fair review required by ERISA, including a failure
to review her claim in conjunction with her actual job duties. (ECF No. 26 at 13–14.) It
appears Plaintiff makes this claim because Defendant did not seek information as to what
physical duties Plaintiff may have performed in her customary job other than those disclosed
in the record. (See id. at 14.) Though Plaintiff makes this argument, she fails to provide the
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Court with any indication of what additional physical duties might have existed, nor did she
make any such description when she was asked for additional documentation and responses
on a number of occasions during the review process. Moreover, Plaintiff does not cite to any
relevant code, statutory provision, or any other pertinent authority that would support her
contention.
Review of the evidence contained in the record demonstrates that there is no genuine
dispute over whether the procedures undertaken by Defendant provided a full and fair review
of Plaintiff’s claim. Accordingly, Booth factor six weighs in favor of summary judgment in
Defendant’s favor.
iv.

The Remaining Booth Factors

The remaining Booth factors—the language of the Plan, the purpose and goals of the
Plan, the consistency of the fiduciary’s interpretation, external circumstances relevant to the
exercise of discretion, and the fiduciary’s motives and potential conflicts of interest—have not
been raised by either party, and do not appear to be relevant to the Court’s analysis.
D.

CONCLUSION

Given the evidence in the record, the Court determines that there is no genuine dispute
of material facts concerning whether the Claims Administrator’s decision was reasonable and
the result of a deliberate and principled reasoning process supported by substantial evidence,
and thus Plaintiff’s Amended Motion for Summary Judgment will be denied and Defendant’s
Motion for Summary Judgment will be granted. As such, the Court enters the following:
[ORDER TO FOLLOW ON NEXT PAGE]

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ORDER
IT IS THEREFORE ORDERED that Defendant’s motion to strike, (ECF No. 27), is
DENIED.
IT IS FURTHER ORDERED that Plaintiff’s Amended Motion for Summary
Judgment, (ECF No. 25), is DENIED, and Plaintiff’s original Motion for Summary Judgment,
(ECF No. 23), is TERMINATED AS MOOT.
It is FURTHER ORDERED that Defendant’s Motion for Summary Judgment, (ECF
No. 21), is GRANTED.
This the 16th day of February 2021.
/s/ Loretta C. Biggs
United States District Judge

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