Robison v. Reliance Standard Life Insurance Company

Filing 35

ORDER granting 30 Defendant's Motion for Summary Judgment. Signed by Honorable Timothy D. DeGiusti on 3/10/2017. (mb)

IN THE UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF OKLAHOMA
CHRIS I. ROBISON,
Plaintiff,
v.
RELIANCE STANDARD LIFE
INSURANCE COMPANY,
Defendant.

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Case No. CIV-14-1262-D

ORDER
Plaintiff Chris Robison (Robison) participated in a short-term disability plan
and a long-term disability plan sponsored by her employer, SandRidge Energy,
Inc. (SandRidge) and administered by Defendant Reliance Standard Life Insurance
Company (Reliance). Both plans were subject to the Employee Retirement Income
Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq. Reliance denied Robison’s
claim for benefits, which was affirmed in a subsequent administrative appeal.
Robison now appeals that denial in this Court under ERISA’s civil enforcement
provision, 29 U.S.C. § 1132(a)(1). See Petition, ¶ 9 [Doc. No. 1-2]. Before the
Court are Robison’s Opening Brief on Appeal and Reliance’s Motion for Summary
Judgment [Doc. Nos. 30, 31]. The matter is fully briefed and at issue.

BACKGROUND
Robison was employed by SandRidge as a payroll administrator, where she
was enrolled in SandRidge’s group short-term disability (STD) plan (Policy No.
STD 158778) and long-term disability (LTD) plan (Policy No. LTD 115067). The
STD policy pays weekly disability benefits to an insured who is “disabled due to
Sickness or Injury.” Under the STD policy, “disabled” means that an insured was
“(1) unable to do the material duties of his/her job; and (2) not doing any work for
payment; and (3) under the regular care of a physician.” “Injury” means “bodily
injury resulting directly from an accident, independent of all other causes. The
injury must cause disability which begins while an Insured.”
The LTD policy, which defines “injury” in substantially the same manner as
the STD policy, paid monthly disability benefits following 180 consecutive days of
disability (the “Elimination Period”) to an insured who remains “Totally Disabled”
as a result of an injury or sickness. Throughout the duration of the Elimination
Period and the following twenty-four (24) months, the LTD policy defined “Total
Disability” to mean that an insured cannot perform the material duties of her
regular occupation, and “Total Disability” was, from that point, defined as the
insured’s inability to perform the material duties of any occupation for which she is
qualified by education, training or experience.

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With respect to submitted claims, the STD policy provided that for any
covered loss, written proof must have been sent to Reliance within ninety (90)
days. If it was not reasonably possible to provide notice within the prescribed time
period, the policy stated the claim was not affected if proof was sent as soon as
reasonably possible. In addition, the STD policy provided that no legal action
could be brought on the policy within sixty (60) days after written proof of loss had
been given, and no action could be brought after three years from the time written
proof of loss was required to be given.
The LTD policy stated that written notice of a claim must be provided to
Reliance within thirty-one (31) days after a Total Disability covered by the policy
occurred, or as soon as reasonably possible. If a claimant did not receive the claim
forms within fifteen (15) days after receiving notice, then proof of Total Disability
would be met by giving Reliance a written statement of the type and extent of the
Total Disability within ninety (90) days after the loss began. Written proof of Total
Disability was to be submitted within ninety (90) days after Total Disability
occurred or as reasonably possible. In any event, the LTD policy stated proof of
Total Disability must have been provided within one year after Total Disability
occurred, unless the insured was legally incapable of doing so. With respect to
legal actions, the LTD policy stated no legal action could be brought to recover on
the policy within sixty (60) days after written proof of loss had been given, and no
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action could be brought after three (3) years from the time written proof of loss
was received.
Both the STD and LTD policies stated the following:
Reliance Standard Life Insurance Company shall serve as the claims
review fiduciary with respect to the insurance policy and the Plan. The
claims review fiduciary has the discretionary authority to interpret the
Plan and the insurance policy and to determine eligibility for benefits.
Decisions by the claims review fiduciary shall be complete, final and
binding on all parties.
On September 5, 2007, Robison was involved in a car accident in which she
sustained several injuries. She returned to work on February 25, 2008 and
continued to work until December 14, 2008, when she underwent surgery due to an
infection. According to her statement to Reliance, Robison last worked at
SandRidge on March 31, 2009, when she worked “about 1/3 of [the] day” but left
due to experiencing chronic pain in her back and foot, as well as experiencing
cognitive difficulties. Robison stated her reason for leaving SandRidge was due to
termination.1
During the course of rehabilitation and treatment, Robison was evaluated by
several doctors who monitored her progress. Dr. W. Bentley Edmonds examined
Robison and noted she was experiencing only mild pain while in a walking boot.
Dr. Edmonds noted Robison’s wounds had fully healed and there was no sign of
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In SandRidge’s papers submitted to Reliance, the company stated Robison’s last
day at work was on April 4, 2009 and that she worked a full day, as opposed to 1/3
of a day, and that she was laid off, as opposed to being terminated.
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infection. After seeing Robison on follow up appointments, Dr. Edmonds noted
Robison was doing well, her pain was reasonably controlled, and she was going to
advance her activities and eventually wean off of the boot. Dr. Matthew
Diesselhorst also observed that Robison’s surgical incisions were healing well, and
that although she continued to experience tenderness in her foot, she had good
range of motion and was steadily improving. He also recommended that she slowly
wean herself from the boot.
Following another appointment with Robison, Dr. Edmonds observed she
was “doing as well as could be expected” from her injuries and would likely need
medical management for her pain. Dr. Edmonds referred Robison to Dr. A.J.
Bisson for pain management, who also noted Robison’s surgical incisions were
healing well. Dr. Bisson recommended Robison undergo minimal physical therapy
to alleviate a gait in her walk. Dr. Bisson adjusted Robison’s medication and noted
that Robison “look[ed] to be doing amazingly well.” Dr. Edmonds later observed
that Robison displayed good ankle motion without any pain and that she was very
happy with her progress. Robison was also examined by Dr. Jeffrey Cruzan for a
long history of depression. She was observed as “feel[ing] much better and
happier” and exhibited no signs of homicidal or suicidal thoughts.
Robison subsequently filed for, and received, social security disability
benefits from her inability to be gainfully employed in any occupation since April
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1, 2009. On December 14, 2012, Robison submitted short term and long term
disability claims to Reliance. Reliance classified and evaluated Robison’s claim
based on her ability to perform sedentary work. On July 13, 2013 and July 15,
2013, Reliance denied Robison’s claims on the basis the records did not
demonstrate she was “disabled” as those terms were defined under the respective
policies. Robison administratively appealed the denial, alleging she was unable to
do light duty work without assistance from her co-workers. Robison also submitted
a report by Dr. Darren Elenburg that stated (1) she could not alternately stand, sit,
walk or drive over an eight-hour day and (2) she had reached maximum medical
improvement and could not return to work. Robison also submitted a vocational
evaluation performed by Dr. Lon Huff that stated she met the policy definition of
“long term disability” on April 5, 2009.
Reliance conducted a coordinated review of the LTD and STD claim denials
and Robison’s objections thereto. Its review showed that Dr. Elenburg first
observed Robison in 2008. In October 2009, he noted that Robison’s fractures had
healed, but that her hardware implants were painful and may require removal in the
future, but no surgery was planned at the time. In the report cited by Robison, Dr.
Elenburg noted that over the course of an 8-hour day, Robison could not
alternately stand, sit, walk, or drive. Dr. Elenburg also noted, however, Robison
could perform sedentary work in an 8-hour day, and was not limited in her abilities
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to (1) relate to other people beyond giving and receiving instructions, (2) complete
and follow instructions, (3) perform simple and repetitive tasks, and (4) perform
complex and varied tasks. Dr. Elenburg also noted Robison possessed the mental
capacity to understand her finances and direct the use of her funds and could drive
occasionally.
In his review of Robison’s medical records, Dr. Huff relied on Dr.
Elenburg’s determination that she could not sit, stand, walk or drive over the
course of an eight-hour day, and ten pounds was her maximum weight lifting limit.
Dr. Huff stated Robison’s test results indicated she had the mental ability to learn
and manipulate novel information, but such tests were short and would not cause
fatigue the way an eight-hour work day would. Dr. Huff concluded that based on
Reliance’s definition of “disability” under the STD and LTD policies, Robison met
the definition because she was unable to perform the material duties of her job due
to, inter alia, her chronic pain and inability to concentrate and work accurately.
Thus, he concluded, Robison could not perform her occupation as a payroll
administrator.
Reliance requested an independent medical peer review to review Robison’s
medical records and determine whether there was any support for her claim of
disability. The review, conducted by Dr. Daniel Rosenberg, concluded Robison

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“should be capable of performing work of at least a sedentary basis.” Dr.
Rosenberg expounded by stating,
In my opinion, this claimant should have had work capacity in a full
time consistent basis as of 04/04/09 ongoing, in at least a sedentary
capacity. ... [T]he claimant was apparently working as a payroll
administrator as of April 2009. This would at least be a sedentary type
position, which in my opinion, the claimant should be capable of
performing.
On March 13, 2014, Reliance upheld the denial of Robison’s disability claims.
Robison filed the present suit on July 30, 2014, and Reliance removed to this Court
on November 12, 2014.
STANDARD OF REVIEW
Under ERISA, insurance companies are to provide accurate claims
processing by insisting that administrators provide a full and fair review of claim
denials. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 115 (2008). Under the
standard of review for ERISA claims established by the Tenth Circuit, federal
courts are limited to the administrative record – the materials compiled by the plan
administrator in the course of making its decision. Hall v. UNUM Life Ins. Co. of
America, 300 F.3d 1197, 1201 (10th Cir. 2002). Where, as here,2 an ERISA

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As noted above, both insurance policies provide that Reliance has the
discretionary authority to interpret the policies and to determine eligibility for
benefits. Thus, the “arbitrary and capricious” standard is applicable to the decision
challenged here. Both parties are in agreement on this issue. See Pl. Opening Br. at
10-11; Def. Mot. for Summ. J. at 15.
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provider explicitly retains the authority to interpret its governing provisions, courts
employ a deferential standard of review, asking only whether the denial of benefits
was arbitrary and capricious. Eugene S. v. Horizon Blue Cross Blue Shield of N.J.,
663 F.3d 1124, 1130 (10th Cir. 2011); Weber v. GE Group Life Assur. Co., 541
F.3d 1002, 1010 (10th Cir. 2008). Applying this standard,3 courts ask “only
whether the interpretation of the plan was reasonable and made in good faith.” Id.
(citation omitted). Courts look to the governing provisions of the instrument as a
whole and consider the common and ordinary meaning of the language used. Id. at
1011.
Moreover, a court reviews the plan administrator’s decision to determine if
the decision is supported by substantial evidence, which means “more than a
scintilla of evidence that a reasonable mind could accept as sufficient to support a
conclusion.” Eugene S., 663 F.3d at 1134 (citations and internal quotations

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Robison contends Reliance acted under a conflict of interest as insurer and payor
of claims under the policies. Consequently, she states less deference is owed to its
decision. “[A]ll of the circuit courts agree that a conflict of interest triggers a less
deferential standard of review.” Chambers v. Family Health Plan Corp., 100 F.3d
818, 825 (10th Cir. 1996). Rather than viewing a conflict of interest as presumptive
evidence that the plan administrator’s decision was arbitrary and capricious, the
Tenth Circuit applies a sliding scale, decreasing the level of deference in
proportion to the severity of the conflict. Id. at 826-27. However, although Robison
contends Reliance’s dual role as insurer and payor of claims under the policies
constitutes a conflict of interest, she has presented no evidence showing that the
conflict affected its determination. Nonetheless, based on the record before it, the
Court finds any conflict of interest created by Reliance’s dual role had minimal
impact and did not drive its benefit determination.
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omitted). The Court will uphold the decision of the plan administrator as long as it
is predicated on a reasoned basis. Id. There is no requirement that the basis relied
upon by the administrator be the only logical one or even the best one. Id.; see also
Schandel v. Siebert, 175 F. Supp. 3d 1238, 1245 (D. Colo. 2016) (“The decision
need not be the only logical decision nor even the best decision. Rather, the
decision need only be sufficiently supported by facts known to the plan to counter
a claim that the decision was arbitrary or capricious. The decision will be upheld
unless it is not grounded on any reasonable basis. The reviewing court “need only
assure that the administrator’s decision falls somewhere on a continuum of
reasonableness - even if on the low end.”) (citations and paraphrasing omitted).
Although Reliance has moved for summary judgment pursuant to Rule 56(a)
of the Federal Rules of Civil Procedure, it would be imprudent to utilize the
summary judgment standard of review to this case. “The purpose of a summary
judgment motion is to assess whether a trial is necessary.” Berry v. T-Mobile USA,
Inc., 490 F.3d 1211, 1216 (10th Cir. 2007) (citation omitted). To that end, “ERISA
cases are replete with factual disputes and, in order to treat [Reliance’s brief] as a
motion for summary judgment, the Court would have to disregard the plain
language of Rule 56.” Tinkler v. Level 3 Commc’ns, LLC, No. 07-CV-259, 2008
WL 199901, at *7 (N.D. Okla. Jan. 22, 2008) (citing Wilkins v. Baptist Healthcare
System, 150 F.3d 609, 619 (6th Cir. 1998)).
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Rather, as noted, courts have held the judge’s appropriate role is to act as an
appellate court, where the reasonableness of the administrator’s decision is based
on a review of the record. See Panther v. Synthes, 380 F. Supp. 2d 1198, 1207 n. 9
(D. Kan. 2005). This view is in accord with the Tenth Circuit’s decision in
Olenhouse v. Commodity Credit Corp., 42 F.3d 1560, 1580 (10th Cir. 1994), where
the circuit held a district court should proceed as an appellate court in reviewing
agency action under the arbitrary and capricious standard. Panther, supra (“The
court joins other district courts in this circuit which have applied the Tenth
Circuit’s decision in [Olenhouse] and held that the summary judgment standard is
not the proper standard when evaluating a denial of ERISA benefits under arbitrary
and capricious review.”). The circuit in Olenhouse stated motions for summary
judgment are “conceptually incompatible” with the very nature and purpose of an
appeal. Id. at 1580; see also Leahy v. Raytheon Co., 315 F.3d 11, 17 (1st Cir. 2002)
(discussing the “discongruence” between the ERISA and summary judgment
standards of review).
Accordingly, in an ERISA case where a party has moved for summary
judgment, “summary judgment is merely a vehicle for deciding the case; the
factual determination of eligibility for benefits is decided solely on the
administrative record, and the non-moving party is not entitled to the usual
inferences in its favor.” LaAsmar v. Phelps Dodge Corp. Life, Accidental Death &
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Dismemberment & Dependent Life Ins. Plan, 605 F.3d 789, 796 (10th Cir. 2010)
(citation omitted) (internal quotation marks omitted). The Court, thus, evaluates the
reasonableness of Reliance’s decision based on the evidence contained in the
administrative record.
DISCUSSION
Robison argues that Reliance’s denial of her STD and LTD benefits claim
was arbitrary, capricious, and unreasonable, and that the decision should be
reversed for five reasons: (1) the vocational evidence on record clearly established
Robison was disabled; (2) Reliance relied upon deficient medical evidence; (3)
Reliance failed to consider other key evidence; (4) Reliance failed to consider
additional evidence submitted by Robison or provide a sufficient reason for
disregarding evidence stating Robison was disabled; (5) Reliance failed to
adequately consider the findings of the social security administrative law judge that
determined Robison was disabled as of April 1, 2009. Reliance contends its
decision is supported by substantial evidence and Robison’s claims are timebarred.
As stated supra, under the STD policy, “disabled” means that a claimant was
(1) unable to do the material duties of her job; (2) not doing any work for payment;
and (3) under the regular care of a physician. The LTD policy defined “Total
Disability” to mean a claimant could not perform the material duties of her regular
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occupation, and, after a specified duration, the claimant was unable to perform the
material duties of any occupation for which she is qualified by education, training
or experience. Further, a claimant was required to show that she had been
“disabled” continuously for 180 consecutive days in order to receive LTD benefits.
Robison worked for SandRidge as a payroll administrator, and its
description of her job duties included balancing and controlling earnings and
deduction totals; processing voluntary and involuntary deductions; calculating and
preparing mid-period entries, reviewing timekeeping schedules, and reviewing
taxation and accounting transactions. The Vocational Evaluation noted the job also
included duties such as (1) strong organizational skills and ability to problem solve
with a high level of attention to detail and accuracy, and (2) the ability to work
under time constraints and meet daily and weekly deadlines. Therefore, under the
policies, a payroll administrator would be disabled if she could not materially
perform these listed tasks.
The Court finds the medical evidence in the administrative record supports
Reliance’s denial of benefits. The controlling standard dictates that the Court
reverse Reliance’s decision “only if the evidence clearly shows that the
administrator’s actions were arbitrary and capricious or the case is so clear cut that
it would be unreasonable for the plan administrator to deny the application for
benefits on any ground.” Caldwell v. Life Ins. Co. of North America, 287 F.3d
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1276, 1289 (10th Cir. 2002) (citations omitted). Even if the Court would reach a
different conclusion, the test of an arbitrary and capricious decision is whether the
decision-maker’s conclusion was predicated on a reasoned basis; there is no
requirement that the basis relied upon be the only logical one or even the best one.
Eugene S. v. Horizon Blue Cross Blue Shield of N.J., 663 F.3d 1124, 1134 (10th
Cir. 2011). A plan administrator has the discretion to weigh conflicting evidence in
the record and make a determination regarding a claimant’s eligibility for benefits,
and a final determination will not be found to be unsupported by substantial
evidence merely because there was evidence in the record that would have
supported a finding of disability. See, e.g., Roganti v. Metropolitan Life Ins. Co.,
786 F.3d 201, 212 (2d Cir. 2015) (“[I]f the administrator has cited ‘substantial
evidence’ in support of its conclusion, the mere fact of conflicting evidence does
not render the administrator’s conclusion arbitrary and capricious.”) (citation
omitted); Vonhagn v. Corning Inc., 590 F. Supp. 2d 418, 420 (W.D.N.Y. 2008)
(“The existence of conflicting evidence, even a conflicting opinion from a
claimant’s treating physician, does not necessarily render the Plan Administrator’s
decision arbitrary and capricious.”) (citation omitted).4

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Indeed, “courts have no warrant to require [ERISA Plan] administrators
automatically to accord special weight to the opinions of a claimant’s treating
physician; nor may courts impose a discrete burden of explanation when they
credit reliable evidence that conflicts with a treating physician’s opinion.” Black &
Decker Disability Plan v. Nord, 538 U.S. 822, 830-831 (2003).
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The record evidence shows that Robison did not leave her job due to injury
or disability, but that she was laid off from employment. The medical records in
evidence consistently noted that several treating doctors, over the course of
Robison’s rehabilitation and treatment, noted that she experienced only mild pain,
her pain was gradually improving, and she was happy with her progress. Other
records reflected Robison possessed the mental capacity to understand her
financial affairs and direct the use of her funds. In addition, an independent
medical record peer review ordered by Reliance concluded, among other things,
she was capable of performing sedentary work. Based on the then-existing record
at the time of Robison’s accident, Reliance’s initial denial and subsequent denial of
Robison’s appeal is adequately supported and not arbitrary and capricious. There
was substantial evidence supporting Reliance’s determination that Robison was not
unable to perform the material functions of her job, or that she was continuously
disabled for 180 days. The policies at issue grant Reliance the discretionary
authority to interpret them and determine eligibility for benefits, and Robison has
not submitted sufficient evidence to show that Reliance arbitrarily disregarded the
opinions of her treating physicians and her claims of disability. Therefore, the
Court rejects Robison’s claims and finds that Reliance did not abuse its discretion
in denying those claims.

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CONCLUSION
Having reviewed the administrative record, the Court finds that Reliance’s
decision to deny Robison’s claim for disability benefits was not arbitrary and
capricious. Rather, the record contains sufficient facts to show that Reliance’s
decision was reasonable and based on substantial evidence in the record.
Accordingly, the Court GRANTS Reliance’s Motion for Summary Judgment
[Doc. No. 30] and AFFIRMS the denial of benefits. A judgment shall be issued
forthwith.
IT IS SO ORDERED this 10th day of March, 2017.

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