IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
___________________
No. 95-30588
___________________
EDWARD EARL LYND,
Plaintiff-Appellant,
versus
RELIANCE STANDARD LIFE INSURANCE
COMPANY; FORD BACON & DAVIS, INC.
Defendants-Appellees
________________________________________________
Appeal from the United States District Court for the
Western District of Louisiana
________________________________________________
August 30, 1996
Before GARWOOD, EMILIO M. GARZA and DENNIS, Circuit Judges.
GARWOOD, Circuit Judge:
Bringing this action under ERISA, 29 U.S.C. § 1001, et seq.,
plaintiff-appellant Edward E. Lynd (Lynd) alleged in his complaint
that the benefits he had been receiving pursuant to a long-term
disability plan were wrongfully terminated. In his appeal of the
district court’s rulings on the parties’ cross motions for summary
judgment, Lynd presently contends that the district court reviewed
the plan administrator’s decision to terminate these benefits under
an inappropriate standard of review, and that the grant of summary
judgment dismissing his suit was erroneous.
Facts and Proceedings Below
Lynd was employed by defendant-appellee Ford, Bacon & Davis,
Inc. (FBD) on December 18, 1989. In September of 1990, Lynd became
unable to work and began receiving short-term disability benefits
under FBD’s Employee Welfare Benefit Plan (the plan). After six
months, Lynd applied for and began receiving long-term disability
benefits. The group policy associated with this long-term
disability plan was issued by defendant-appellee Reliance Standard
Life Insurance Company (Reliance).
Long-term disability payments were made to Lynd for twenty-
four consecutive months. At the close of this two-year period, on
March 9, 1993, the plan administrator terminated these payments to
Lynd. The administrator made this decision to terminate benefits
based on a limitation provision found in both the master policy and
the certificate of insurance which stated that, “Monthly Benefits
for Total Disability due to mental or nervous disorders will not be
payable beyond twenty-four (24) months unless you are in a Hospital
or Institution at the end of the twenty-four (24) month period.”
Following the termination of these benefits, Lynd filed a
petition in the Fourth Judicial District Court of Louisiana
alleging that his disability did not result from a “mental or
nervous disorder[],” and that his benefits under the plan were
therefore wrongly terminated by defendants-appellees. The action
was removed to federal district court pursuant to 28 U.S.C. § 1331,
2
and the parties thereafter filed cross motions for summary
judgment. The district court denied Lynd’s motion and, in granting
appellees’ motion, held that the plan administrator had not abused
its discretion in deciding to terminate benefits.
On appeal, Lynd contends that the district court erred by
reviewing the plan administrator’s decision under an abuse of
discretion standard. Lynd argues that the district court should
have reviewed the plan administrator’s decision de novo.
Furthermore, Lynd maintains that, regardless of the standard of
review employed, his long-term disability benefits were wrongfully
terminated.
Discussion
Whether the district court employed the appropriate standard
in reviewing an eligibility determination made by an ERISA plan
administrator is a question of law. See Chevron Chemical Co. v.
Oil, Chemical and Atomic Workers Local Union 4-447, 47 F.3d 139,
142 (5th Cir. 1995). Therefore, we review the district court’s
decision de novo.
In Firestone Tire and Rubber Co. v. Bruch, 109 S.Ct. 948, 956-
57 (1989), the Supreme Court established that a denial of ERISA
benefits by a plan administrator should be reviewed de novo by the
courts unless the plan gives the administrator “discretionary
authority to determine eligibility for benefits or to construe the
terms of the plan.” However, it remains unclear precisely what
3
language must be employed in the plan to confer such discretionary
authority upon the plan administrator. In Duhon v. Texaco, Inc.,
15 F.3d 1302 (5th Cir. 1994), this Court applied the analysis from
Bruch to the language of an ERISA plan and held that de novo review
was inappropriate because:
“[I]t is clear that the plan administrator has the
discretionary authority to make a final and conclusive
determination of the claim. This court has not imposed
a linguistic template to satisfy this requirement . . .
but in this case the plan’s plain language provides that
the administrator may make an independent and final
determination of eligibility.” Id. at 1305-06 (citations
omitted).1
Additionally, we have observed that the requisite grant of
discretionary authority cannot be inferred from the language of an
ERISA plan. In Chevron Chemical Co., supra, in the course of
holding abuse of discretion was the proper standard of review, we
stated that:
“[T]he Supreme Court ‘surely did not suggest [in Bruch]
that ‘discretionary authority’ hinges on incantation of
the word ‘discretion’ or any other ‘magic word.’ Rather,
the Supreme Court directed lower courts to focus on the
breadth of the administrators’ power——their ‘authority to
determine eligibility for benefits or to construe the
terms of the plan’. . . .’ On the other hand,
discretionary authority cannot be implied . . . ‘an
administrator has no discretion to determine eligibility
1
The plan at issue in Duhon addressed the discretionary
authority of the administrator in two passages: (1) “The decisions
of the Plan Administrator shall be final and conclusive with
respect to every question which may arise relating to either the
interpretation or administration of this Plan;” and (2) “After you
undergo the necessary physical examination(s) and upon review of
all facts in the case, the Plan Administrator will make the
decision to authorize or deny payments.” Id. at 1305.
4
or interpret the plan unless the plan language expressly
confers such authority on the administrator.’” 47 F.3d at
142 (citations omitted).
In the present case, however, we pretermit the issue regarding
which standard of review the district court should have employed in
reviewing the plan administrator’s eligibility determination. We
do so because, regardless of whether the district court reviewed
the administrator’s eligibility determination for abuse of
discretion or de novo, the nature of Lynd’s disability compelled
the district court to conclude that Lynd’s long-term benefits under
the plan were properly terminated.2
Section 8.0 of the instant plan includes the limitation that
“Monthly Benefits for Total Disability due to mental or nervous
disorders will not be payable beyond twenty-four (24) months unless
you are in a Hospital or Institution at the end of the twenty-four
(24) month period.” The parties do not dispute that Lynd remains
disabled. Neither, however, is there any suggestion that Lynd was
hospitalized or institutionalized on March 9, 1993, at the end of
the two-year period during which he received long-term disability
benefits. Therefore, this dispute turns on the proper
characterization of Lynd’s disability; specifically, it must be
determined whether or not his disability constituted a “mental or
2
Lynd concedes that, if he is found to be disabled as a result
of a “mental or nervous disorder,” then he cannot recover under the
plan; he allows that “it makes absolutely no difference” which
standard is employed to review the administrator’s determination of
eligibility should his disability be so characterized.
5
nervous disorder” within the meaning of this plan. We hold that
the district court correctly affirmed the plan administrator’s
determination that Lynd’s disability was due to a “mental or
nervous disorder”; therefore, the district court’s holding is
affirmed regardless of the standard of review employed by the
district court in reviewing the plan administrator’s eligibility
determination.
The undisputed evidence before the district court was that
Lynd was diagnosed on September 19, 1990, as suffering from “major
depressive disorder.” This diagnosis, documented on Lynd’s
benefits claims form, has remained static since that time.3
However, Lynd contends that this general diagnosis of his
disability——as a “major depressive disorder”——comports with his
claim that his condition is physical in nature. In support of this
position, Lynd presented to the district court the deposition
(taken well after benefits were denied) of his treating physician,
3
The following characterizations of Lynd’s disability were
attached to Reliance’s motion for summary judgment:
(1) In a letter of October 22, 1990, Lynd’s treating physician,
psychiatrist Dr. Arthur Dumont III, described Lynd’s disability as
“major depression”;
(2) In a letter of April 24, 1991, Dr. Dumont described Lynd’s
disability as “a severe treatment resistant depression”;
(3) In a letter of January 14, 1992, Dr. Dumont described Lynd’s
disability as “a severe major depressive disorder”;
(4) In a letter of May 12, 1993, Dr. Dumont characterized Lynd’s
disability as a “major depressive illness.”
6
psychiatrist Dr. Dumont, in which Dr. Dumont asserted his belief
that depression is a “physical” disorder:
“Q: All right, sir. But I guess the question I am
driving at is, depression itself, that is not something
caused from a physical disorder itself?
A: Yes, it is. Yes, it is. We think of depression as
being a chemical imbalance. It is a malfunction in the
part of the brain that controls mood regulation. And we
see it as usually an inefficiency of the
neurotransmitters or a relative deficit of certain
neurotransmitters and we try to treat that by utilization
of medications that can help elevate or increase the
efficiency of the neurotransmitters.
. . . Q: All right, sir. So depression in essence
results from a nervous disorder as I understand?
A: From a disorder of the central nervous system.”
Dr. Dumont further testified that:
“Major depression is a disease and it has a physiologic
basis every bit as much as diabetes, hypertension,
cardiomyopathy or any other”
and that in his opinion “every major depressive disorder
implicate[s] inefficiency of neurotransmitters in the central
nervous system.”
Dr. Dumont testified regarding the symptoms experienced by
Lynd as a consequence of his “major depressive disorder”:
“[Lynd] reported symptoms of lack of physical stamina,
loss of energy and interest, unable to deal with
pressure, unable to make decisions, he had sleep
disturbance, he would wake up in a cold sweat with
apprehension. He had to leave the office early one day
or went to the office early one day and found anxiety so
great he had to leave. He has been very anergic meaning
no energy and ahdonia [sic] meaning unable to experience
pleasure. He thus contacted Dr. Nichols who then
referred him to me.”
7
Dr. Dumont expressed the view that “resolution of Mr. Lynd’s major
depressive disorder would remove his disability.”
Dr. Dumont described himself as “a physician who specializes
in the practice of psychiatry.” He saw Lynd on referral from
Lynd’s regular physician, but received from the referring physician
no “documentation” or “medical reports.” When asked if his records
reflected “whether Mr. Lynd had any physical disorder or diseases,”
Dr. Dumont responded, “not of any consequences that would have been
connected with this, no.” Dr. Dumont treated Lynd with
psychoreactive medication and psychotherapy.4 When asked “You did
not conduct a physical examination” of Lynd, Dr. Dumont
unqualifiedly responded “No, I did not.”
This Court has not previously addressed the interpretive
issues raised by the allegation that the “physical” aspects of
“mental” illnesses necessarily impact the construction of such
qualifying phrases as “mental or nervous disorders” used in ERISA
plans. However, we find the Eighth Circuit’s approach to be
instructive:
“It would be improper and unfair to allow experts to
define [ERISA plan] terms that were specifically written
for and targeted toward laypersons. This requirement
provides a source from which we may fashion a federal
common law rule; the terms should be accorded their
ordinary, and not specialized, meanings.
The cause of a disease is a judgment for experts,
while laymen know and understand symptoms. Laymen
4
The medication included Prozac, Wellbutrin, Lithium, Desyrel,
Klonopin, Buspar, Anafranil, Depakote, Cylert, Zoloft, and Serzone.
8
undoubtedly are aware that some mental illnesses are
organically caused while others are not; however, they do
not classify illnesses based on their origins. Instead,
laypersons are inclined to focus on the symptoms of an
illness; illnesses whose primary symptoms are depression,
mood swings and unusual behavior are commonly
characterized as mental illnesses regardless of their
cause.
. . . By focusing upon the disease’s etiology, the
district court considered factors that are important to
experts but not to laypersons. The court thus failed to
examine the term “mental illness” as a layperson would
have, which is the examination we conclude ERISA and
federal common law require.” Brewer v. Lincoln National
Life Ins. Co., 921 F.2d 150, 154 (8th Cir. 1990), cert.
denied, 111 S.Ct. 2872 (1991); see also Stauch v. Unisys
Corp., 24 F.3d 1054, 1056 (8th Cir. 1994) (observing that
when an ERISA plan participant complained of depression,
sleeplessness, impaired concentration and other symptoms,
the court concluded that the participant “suffered from
what laypersons would consider” a “mental” or “nervous”
disorder).5
In its DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS,
the American Psychiatric Association (APA) acknowledges that there
is no bright-line distinction between “mental” disorders and
“physical” disorders. Nevertheless, the APA also recognizes that,
while “there is much ‘physical’ in ‘mental’ disorders,” the phrase
5
In identifying the “causes” and “symptoms” of illnesses, it
seems that an argument could always be fashioned that the illness
itself should be viewed as a “symptom” of some underlying
“physical” cause; this is particularly true if one is willing to
trace the origins of the illness ad infinitum. An illustration of
this is provided by Dr. Dumont’s testimony that depression
represents a “chemical imbalance” and stems from “an inefficiency
of the neurotransmitters . . .” The Eighth Circuit reasonably
concludes that, within this analytical framework, laymen will look
to the “symptom” of an illness in order to characterize that
illness, and the symptom “depression” is indicative of a “mental”
illness.
9
“mental disorder” persists “because we have not found an
appropriate substitute.” American Psychiatric Association,
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS xxi (Fourth
Edition, 1994). Accordingly, the APA has not wavered from its
classification of Lynd’s disability——“major depressive disorder”——
as a “mental disorder.” Id. at 339. Thus, it is not just the lay
population that holds to the view that certain disorders are
properly and necessarily characterized as “mental disorders,” even
though what is thus referred to may have a “physical” aspect and/or
origin, as well.
The approach taken by the Ninth Circuit in Patterson v. Hughes
Aircraft Co., 11 F.3d 948 (9th Cir. 1993), is also instructive. In
Patterson, the court confronted an ERISA plan pursuant to which
benefits resulting from “mental, nervous or emotional disorders of
any type” would be limited to two years. Id. at 949. The court
observed that the plan did not define “mental disorder,” and held
that ambiguities in the plan were to be resolved in favor of the
plan participant. Id. at 950. In reaching its conclusion that
the term “mental disorder” was ambiguous in this context, the court
asserted its view that, when a disability was caused by
“depression,” then that disability would be properly characterized
as resulting from a “mental disorder”: “If Patterson’s disability
was caused solely by his depression, . . . then his condition is
subject to the two-year limitation by any possible meaning of the
10
Plan’s term ‘mental disorder.’” Id. at 951.6
The court ultimately remanded the case to the district court,
concluding that, “[I]f Patterson’s headaches contributed to his
total disability, or they are either a cause or symptom of his
depression, then Patterson’s disability does not fall within the
‘mental disorder’ limitation interpreted in his favor.” Id. at 951
(emphasis added). The court reached this conclusion because the
cause of Patterson’s disability had not been determined. Id.7
However, the language quoted above would apparently sanction the
conclusion that, even if it were established that the cause of
6
The court’s view that disabilities caused by depression fall
within the classification of “mental disorders” is further
underscored by the following:
“First, the Plan does not specify whether a disability is
to be classified as ‘mental’ by looking to the cause of
the disability or to its symptoms. Since the ambiguity
is to be resolved in Patterson’s favor, his disability is
not a mental disorder subject to the two-year limitation
on payments if it is either manifested by headaches
though caused by depression, or caused by headaches but
manifested by depression.
Second, the Plan does not make clear whether a
disability qualifies as a ‘mental disorder’ when it
results from a combination of physical and mental
factors. Patterson’s disability may result solely from
depression, or solely from headaches, or from a
combination of the two. Since this ambiguity must also
be resolved in Patterson’s favor, he is not within the
limitation for mental disorders if his disability is
caused in any part by headaches.” Id. at 950 (citations
omitted).
7
Patterson filed his claim for benefits under the ERISA plan
at issue in that case “for disability benefits due to headaches.”
Id. at 949.
11
Patterson’s disability was “depression”——and that Patterson’s
headaches were only a symptom of his depression——then Patterson’s
disability would nevertheless fail to constitute a “mental
disorder.” We disagree with this view, particularly if the court
intended that this analysis apply not only to Patterson’s
headaches, but to all “physical” symptoms of “mental” disabilities.
If we begin with the premise that the cause of a disability is
“mental”——and the Eighth and Ninth Circuits, as well as the American
Psychiatric Association, characterize “depression” as a “mental”
disorder——then to find that a disability falls outside of the term
“mental disorder” (as used in an ERISA plan) because the disability
has “physical” symptoms would render the term “mental disorder”
obsolete in this context. As the ERISA plan in the instant case
pointedly refers to “mental or nervous disorders,” it would be
inappropriate to effectively collapse the term “mental disorder” to
include only those illnesses, if any exist, which have no
“physical” manifestations. If the exclusion of disability, lasting
more than twenty-four months, due to “mental or nervous disorders”
is to mean anything——and we think it must——then there is no
principled basis on which to exclude Lynd’s “major depressive
disorders” from the reach of that exclusion.
Lynd suffers from “major depressive disorder”. There has been
no suggestion that Lynd’s major depression is in some relevant
aspect unusual, nor that his disability is caused by anything other
than this disorder. As noted, Dr. Dumont testified that
12
“resolution of Mr. Lynd’s major depressive disorder would resolve
his disability.” Instead, Lynd maintains that his condition falls
outside the phrase “mental or nervous disorder” simply because
“every major depressive disorder,” according to Lynd’s
psychiatrist, has “physical” origins and symptoms. Based on this
evidence, the district court was compelled to affirm the plan
administrator’s eligibility determination, regardless of the
standard of review employed by the district court in reviewing this
determination.
Accordingly, the judgment of the district court is
AFFIRMED.
13