MULLINS v. THE CONSOL ENERGY, INC. LONG TERM DISABILITY PLAN
Filing
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MEMORANDUM OPINION. Plaintiff's 20 Motion for Summary Judgment is hereby DENIED. Defendant's 28 Motion for Summary Judgment is hereby GRANTED. Signed by Judge J. Nicholas Ranjan on 9/16/2022. (pak)
Case 2:20-cv-01883-NR Document 33 Filed 09/16/22 Page 1 of 8
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
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TIMOTHY MULLINS,
Plaintiff
v.
THE CONSOL ENERGY, INC. LONG
TERM DISABILITY PLAN,
Defendant.
MEMORANDUM OPINION
J. Nicholas Ranjan, United States District Judge
In this ERISA benefits dispute, now before the Court are two competing
summary-judgment motions. 1
Mr. Mullins argues that he is entitled to
reinstatement of his long-term disability benefits as a matter of law. Consol instead
argues that its administrative ruling terminating the benefits should be upheld.
After carefully reviewing the parties’ arguments, the administrative record, and the
relevant caselaw, the Court agrees with Consol.
STANDARD OF REVIEW
Where an ERISA plan gives its administrator “discretionary authority to
determine eligibility for benefits or to construe the terms of the plan, [the Court]
review[s] the administrator’s decision under an ‘abuse of discretion’ standard or an
‘arbitrary and capricious’ standard, which, in this context, are effectively the same.”
Bergamatto v. Bd. of Trs. of the NYSA-ILA Pension Fund, 933 F.3d 257, 263-64 (3d
Cir. 2019) (cleaned up). Consol’s plan gives its administrator such authority. AR61.
This, in turn, is delegated to Lincoln as Claims Administrator.
AR20; AR22.
Accordingly, the parties have already stipulated to this standard of review. ECF 13.
The Court writes primarily for the parties, so the relevant factual background is
incorporated into the analysis.
1
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Under this standard, a Court’s review is narrow; it is “not free to substitute its
own judgment for that of the defendants in determining eligibility for plan benefits.”
Doroshow v. Hartford Life & Accident Ins. Co., 574 F.3d 230, 234 (3d Cir. 2009)
(citation omitted). Instead, a plan administrator’s decision is only arbitrary and
capricious “if it is without reason, unsupported by substantial evidence or erroneous
as a matter of law.” Fleisher v. Standard Ins. Co., 679 F.3d 116, 121 (3d Cir. 2012)
(citation omitted).
“Substantial evidence” means “such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Id.
DISCUSSION & ANALYSIS
The central question in this case is whether Mr. Mullins can perform “any
suitable employment.”
Lincoln concluded that he could – specifically, certain
sedentary work – and therefore denied Mr. Mullins long-term disability benefits
under the plan. To be able to perform “any suitable employment” Mr. Mullins must
have (1) the physical capability, and (2) the relevant vocational education, training,
and experience. The Court addresses each requirement in turn.
I.
Substantial medical evidence supports Lincoln’s findings regarding
Mr. Mullins’s disability.
In determining that Mr. Mullins is capable of sedentary work, Lincoln
reviewed an extensive medical record and reached reasonable conclusions from it.
While Mr. Mullins argues that Lincoln should have deferred to his treating
physicians’ opinions or conducted an independent medical examination, Lincoln’s
assessment of his condition was not arbitrary and capricious.
In its letter terminating benefits, Lincoln identified 35 separate medical
records and test results that were before the administrator. AR573-74. It hired a
rehabilitation and pain specialist, Dr. Neil Patel, to review Mr. Mullins’s file. See
AR807-19. Dr. Patel’s report describes each record he examined, indicating that his
analysis was based on a comprehensive review. Id. His analysis, adopted by Lincoln,
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accounted for “degenerative changes” in Mr. Mullins’s body, leading to permanent
physical impairment. AR815-16. Nevertheless, he opined that Mr. Mullins would be
able to work – with the proper restrictions. Id.
Similarly, when upholding its initial decision to terminate benefits, Lincoln
comprehensively reviewed 37 medical records and hired an additional rehabilitation
and pain specialist, Dr. Kevin Kohan, to review the file. AR631-38. Dr. Kohan also
explained the contents of each record item he analyzed – including test results and
notes from physical examinations – demonstrating a thorough understanding of Mr.
Mullins’s file. AR838-53. Dr. Kohan opined that while some findings pointed toward
functional impairment, others did not. AR847. He agreed that Mr. Mullins should
be able to work, provided he followed physical restrictions. AR847-48. In sum, these
two thorough peer reviews provide substantial evidence supporting Lincoln’s decision
that Mr. Mullins was capable of performing sedentary work.
Nevertheless, Mr. Mullins takes issue with Lincoln’s decisionmaking; he
contends that, taken together, various factors – including discrepancy with treating
physicians’ opinions, failure to conduct an independent exam, and termination of
benefits despite little change to the record – point toward a finding of arbitrariness
and capriciousness. ECF 21, pp. 15-18. The Court disagrees.
To begin with, the Supreme Court has squarely held that “[n]othing in [ERISA]
suggests that plan administrators must accord special deference to the opinions of
treating physicians. Nor does the Act impose a heightened burden of explanation on
administrators when they reject a treating physician’s opinion.” Nord, 538 U.S. at
831. Importantly, Lincoln’s experts’ findings are not fundamentally at odds with Mr.
Mullins’s treating physicians’ assessments. The doctors agreed that Mr. Mullins has
important physical limitations, even if they differed regarding details such as how
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much weight he could lift. 2 Compare AR508, AR2795, AR816, and AR847. But
because Consol’s plan requires long-term claimants be unable to perform any suitable
employment, the key question is whether Mr. Mullins’s conditions prevent him from
performing even sedentary work. And Mr. Mullins’s doctors did not expressly opine
on that issue, including as part of an appeal record. Compare Hession v. Prudential
Ins. Co. of Am., 307 F. App’x 650, 654 (3d Cir. 2008) (“In our case, [claimant’s] treating
physicians opined strongly and repeatedly that she was unable to work full-time.
Indeed, not a single treating physician or therapist ever suggested that [she] could
return to work on a full-time basis.”). So Lincoln did not “arbitrarily refuse to
credit…the opinions of a treating physician” in this regard. Nord, 538 U.S. at 834.
Next, while Lincoln may have been on even firmer footing if it had chosen to
do an independent examination, failure to do so does not in itself render a decision
arbitrary and capricious. See Reed v. CITIGROUP INC, 658 F. App’x 112, 115 (3d
Cir. 2016) (citation omitted) (explaining that failure to do an independent medical
exam is “a factor” to be considered); Potts v. Hartford Life & Accident Ins. Co., 272 F.
Supp. 3d 690, 710 (W.D. Pa. 2017) (Gibson, J.) (“[N]umerous courts in the Third
Circuit have held that there is no legal requirement for a plan administrator to
demand an independent medical examination as part of its review of a claim for
disability benefits under an ERISA-governed plan, even if the plan permits it to do
so.” (cleaned up)). That’s especially true here, where Mr. Mullins’s record involves
ample “objective” evidence, such as descriptions of physical findings, lab tests, and
imaging. AR573-74. Well-versed practitioners routinely view this type of evidence
when treating patients for physical ailments. Compare Haisley v. Sedgwick Claims
Mgmt. Servs., Inc., 776 F. Supp 2d 33, 49-50 (W.D. Pa. 2011) (Conti, J.) (“Unlike types
The Court notes that not all of Mr. Mullins’s doctors were of one voice. While Dr.
McGarry initially imposed a 5-lb. restriction, e.g., AR508, Mr. Mullins’s ankle surgeon
instead listed a 10-lb. limit, AR2795.
2
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of physicians who can formulate medical opinions based upon objective findings
derived from objective clinical tests, a psychiatrist typically treats an individual’s
subjective symptoms.
In contrast to some physical impairments, which can be
verified or discounted solely by reference to reports of objective medical tests, mental
impairments are generally identified on the basis of a psychiatric professional’s
interactions with an impaired individual.” (cleaned up)). Again, this Court “is not
free to substitute its own judgment” and determine if Lincoln’s course of action was
correct medically. Orvosh v. Program of Grp. Ins., 222 F.3d 123, 129 (3d Cir. 2000);
Pini v. First Unum Life Ins. Co., 981 F. Supp. 2d 386, 411 (W.D. Pa. 2013) (McVerry,
J.) (“The relevant inquiry turns on the reasonableness (rather than on the correctness)
of [the] decision.” (emphasis in original)).
The Court finds that employing an
extensive peer review was not unreasonable here.
Finally, contrary to Mr. Mullins’s argument, there was some new medical
information that supported Lincoln’s denial of benefits in 2020. To be sure, there was
certainly some back and forth regarding Lincoln’s decisions; in March 2019, Lincoln
reinstated the benefits it had terminated in November 2018. AR536-37. But that
was based on a “mental nervous limitation” and cabined by the plan’s 12-month
limitation on disability benefits for mental conditions. Id.; AR18. When Lincoln
terminated benefits again in 2020, Mr. Mullins had already maximized those
benefits. Id. Further, Lincoln may have concluded that Mr. Mullins’s physical
condition – specifically his ankle – improved. During Mr. Mullins’s most recent
appeal, Lincoln considered seven records from Dr. Timothy McGarry – Mr. Mullins’s
orthopedist. In an April 2020 visit, Dr. McGarry did not list a 5-lb. lifting restriction,
unlike previously. Compare AR498-99 with AR508; AR511; AR514. When Lincoln
reviewed this new information, it could reasonably determine some improved
function after Mr. Mullins recovered from ankle surgery. See AR631-38.
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At bottom, Lincoln did take Mr. Mullins’s degenerative condition and its
accompanying physical limitations into account. But it reached a different conclusion
regarding its effect on his ability to work a sedentary job. Based on the thoroughness
of that review and the explanation provided, it is apparent that some reasonable
minds might accept this conclusion. Fleisher, 679 F.3d at 121. Therefore, the Court
finds that Lincoln’s decision was backed by substantial evidence and was therefore
not arbitrary and capricious. 3
II.
Substantial evidence supports Lincoln’s vocational determination
that suitable employment existed for Mr. Mullins.
When Lincoln determined that Mr. Mullins could do sedentary work, it
identified specific positions it believed he could perform, based on his education and
experience. AR575; AR637. Its most recent vocational report misidentified Mr.
Mullins’s previous job title when formulating its recommendations, and Mr. Mullins
now raises this mistake as a basis for reversal. AR859. The error, though, was
immaterial; Lincoln still based its decision on substantial evidence about Mr.
Mullins’s actual capabilities and job training and experience.
Importantly, Consol’s plan states that the plan administrator has sole
discretion to determine “suitable employment,” and that such employment could be
inside or outside the company. AR18. Even so, Lincoln did not baldly assert that
“Mr. Mullins could perform some sedentary work somewhere” and end the matter.
Instead, it hired a vocational specialist to examine his skills and qualifications.
AR575; see Gardner v. Unum Life Ins. Co. of Am., 354 F. App’x 642, 649 (3d Cir. 2009)
Mr. Mullins asserts that Lincoln did not “fully consider” his Social Security
Disability award in its decision. ECF 21, p. 25. This argument misses the mark,
because Lincoln’s denial letter clearly explained that it relied on information
including “additional reviews conducted after the approval of Mr. Mullins’ SSD
award[.]” AR638. In a similar case involving the same ERISA plan, the Third Circuit
found this explanation sufficient. Addington v. Senior Vice President Hum. Res.
Consol Energy, Inc., 841 F. App’x 443, 448 (3d Cir. 2020).
3
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(explaining that the insurer “was under a duty to make a reasonable inquiry into the
types of skills [a claimant] possesses, and whether they transfer to another job in
which she can be gainfully employed as defined by the policy”).
Consol concedes that the 2019 vocational report used an incorrect job title for
Mr. Mullins; it referred to him as a Mine Superintendent rather than a Section
Supervisor or Foreman. ECF 29, p. 32. Based on the job description of this erroneous
position, Mr. Mullins contends that the report recommended jobs that would be very
difficult for him to obtain or perform – a Production Planner, Terminal Operations
Supervisor, and Branch Manager. ECF 21, p. 13. On the other hand, an earlier 2016
vocational analysis used his correct former job title and description, and thus
generated other suggested positions – a Transportation-Maintenance Supervisor,
Dispatcher, and Production Control Supervisor. AR862-64. The 2016 report also
described a phone call the vocational analyst had with Mr. Mullins, in which he
described his exact job duties, certifications, and work history.
AR863.
This
information formed the basis for the report’s list of Mr. Mullins’s skills. Id.
The parties dispute whether Lincoln may rely on the older report in defense of
its 2020 final decision to terminate benefits. ECF 30, p. 1; ECF 31, p. 5. The Court
finds that reliance on the earlier report is proper because, importantly, the 2019
report specifically indicated that the vocational analyst reviewed the 2016 report.
AR858
(“The
following
documentation
was
reviewed:
[Transferable
Skills
Analysis]…dated 11/15/2016[.]”). This is significant for two reasons.
First, both reports describe Mr. Mullins experience and skill in largely the
same way.
That is, both reports express that Mr. Mullins had experience in
“obtaining and seeing to the appropriate use of equipment, facilities, and materials
to do certain work” and “assessing performance of…other individuals.”
AR858;
AR863. Both list a general management skill. AR858 (“Planning and directing work
of others”); AR863 (“managing…the time of others”).
7
Both list a general
Case 2:20-cv-01883-NR Document 33 Filed 09/16/22 Page 8 of 8
communication skill. AR858 (“communicating with others in a professional and
tactful manner”); AR864 (“talking to others to convey information effectively”). And
both list basic computer skills.
AR858; AR864.
This suggests that it was not
unreasonable for the vocational analysis to identify the managerial positions it did in
the 2019 report, regardless of the mistake over Mr. Mullins’s specific job title.
Second, even if Mr. Mullins was right that Lincoln considered the wrong job
title in 2019 and identified positions for which he wasn’t suitable, there is no dispute
that the 2016 report identified suitable positions, which would have been appropriate
for Mr. Mullins even in 2019.
In short, between the 2016 and 2019 reports and Lincoln’s understanding of
Mr. Mullins’s skills and experience, Lincoln had substantial evidence to support its
conclusion that Mr. Mullins had the training and skills for suitable sedentary
employment. 4
CONCLUSION
For the foregoing reasons, the Court concludes that Lincoln’s decision to
terminate benefits was not arbitrary and capricious. Plaintiff’s motion for summary
judgement is hereby DENIED, and Defendant’s motion for summary judgment is
hereby GRANTED. 5 An appropriate judgment follows.
DATE: September 16, 2022
BY THE COURT:
/s/ J. Nicholas Ranjan
United States District Judge
Mr. Mullins also objects that the alternate positions Lincoln listed would not be
accessible to him in southwestern Virginia. ECF 21, p. 19. But there is no
requirement under the plan suggesting that geographic accessibility or typical
regional salary are determinative factors.
4
Because the Court is not ordering reinstatement of benefits, it need not reach the
Social Security offset claim.
5
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