F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
NOV 15 1999
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
JOSEPH P. ROCK, JR.,
Plaintiff-Appellant,
v. No. 98-1387
(D.C. No. 94-WY-2939-AJ)
UNUM LIFE INSURANCE (D. Colo.)
COMPANY OF AMERICA,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before EBEL , LUCERO , and MURPHY , Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument.
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
Plaintiff Joseph P. Rock, Jr. appeals the district court’s judgment in favor
of defendant UNUM Life Insurance Company of America (UNUM) on his claims
for insurance payments based on his permanent disability. The insurance policy
at issue was governed by the Employees Retirement Income Security Act,
29 U.S.C. §§ 1001-1461 (ERISA). We exercise jurisdiction under 28 U.S.C.
§ 1291 and affirm.
Plaintiff was employed by Boettcher & Co. from 1981 to 1988, and again
from February through June of 1989. Defendant issued a group long-term
disability policy to Boettcher & Co., effective March 1, 1982, to cover Boettcher
& Co.’s employees. Plaintiff was covered by the UNUM policy for permanent
disability. On July 1, 1989, plaintiff filed for temporary, and then permanent,
disability benefits based on evidence that he suffered from a mental illness. The
UNUM policy limited benefits for total disability for mental illness to twenty-four
months. UNUM paid benefits to plaintiff for twenty-four months, through
December 1991.
In April 1994, plaintiff requested that UNUM reopen his claim to consider
evidence that his disability was not, and had never been, caused by a mental
condition, but, instead, was due to physical causes. Plaintiff sought
a determination that his disability was caused by physical conditions.
Consequently, he claimed he was entitled to reinstatement of his disability
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payments to continue until he attained the age of sixty-five, as provided by the
UNUM policy for a physically caused disability. UNUM declined to reclassify
plaintiff’s condition and denied additional disability payments. Plaintiff then
filed suit, pursuant to 29 U.S.C. § 1132(a)(1)(B), to challenge the denial of
benefits. He claimed that UNUM failed to consider his medical evidence of
a physically disabling condition and that UNUM based the amount of disability
payments only on his income during the few months plaintiff worked for
Boettcher & Co. in early 1989, and not on his previous employment with
Boettcher & Co.
Following a trial to the court, submission of deposition testimony and
closing arguments, the district court issued its findings of fact and conclusions of
law. It concluded that UNUM had properly denied reconsideration of plaintiff’s
disability claim and determined that the amount of benefits paid to plaintiff was
correct.
On appeal, plaintiff asserts that the district court erred in (1) failing to
review his physician’s opinion that plaintiff’s condition was the result of chronic
fatigue syndrome, a physical illness; (2) finding that UNUM’s review of his case
was adequate; (3) holding that the UNUM mental illness limitation was not
ambiguous; (4) finding that plaintiff was not disabled based on Dr. Levy’s report;
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(5) refusing to consider exhibits and testimony proffered by plaintiff; and
(6) concluding that the monthly benefit payment amounts were correct.
“‘[A] denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed
under a de novo standard unless the benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility for benefits or to
construe the terms of the plan.’” McGraw v. Prudential Ins. Co. of Am. , 137 F.3d
1253, 1258 (10th Cir. 1998) (quoting Firestone Tire & Rubber Co. v. Bruch ,
489 U.S. 101, 115 (1989)). The district court found, and the parties do not
dispute, that the UNUM policy under review here does not provide the plan
administrator or fiduciary with discretion to determine eligibility for benefits or
construe the plan’s terms. Therefore, we review de novo UNUM’s decision to
deny plaintiff benefits based on his claim of a physical disability. Pursuant to the
order in limine, review of the decision to deny further benefits was limited to the
evidence before the plan administrator at the time the decision was made. See
Sandoval v. Aetna Life & Cas. Ins. Co. , 967 F.2d 377, 380 (10th Cir. 1992)
(reviewing administrator’s decision under arbitrary and capricious standard). For
matters not covered by the order in limine, we review the district court’s findings
of fact for clear error and its conclusions of law de novo . See State Ins. Fund v.
Ace Transp. Inc. , No. 98-6368, 1999 WL 961184, *2 (10th Cir. Oct. 20, 1999).
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We first address plaintiff’s claim that the district court found that plaintiff
was not disabled. This argument is based on the district court’s finding number
fifty-three, stating that an independent psychiatric examiner, Dr. Levy, “[a]ttached
to [his] report . . . a Mental Disorders Functional Assessment Form, indicating
that plaintiff was capable of working.” Appellant’s App., Vol. III at 1039
(findings of fact and conclusions of law). The statement does not constitute an
independent district court finding that plaintiff was not disabled. Moreover, the
district court’s judgment does not rely on Dr. Levy’s opinion. Accordingly, there
was no reversible error.
Similarly, we are not persuaded that the district court refused to consider
evidence plaintiff submitted pertaining to his income records and depositions to
support his claim that the amount of disability payments was incorrect. The
district court determined that UNUM had correctly calculated the payment amount
pursuant to the unambiguous policy language. Therefore, plaintiff’s proffered
evidence was irrelevant to the district court’s conclusion.
Our review of the record on appeal, the briefs submitted by the parties, and
the district court’s ruling does not indicate any reversible error in the district
court’s judgment. Applying the standards set out above, we affirm the district
court’s judgment for substantially the reasons stated in the Findings of Fact and
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Conclusions of Law, dated September 9, 1998, and entered on the docket
September 17, 1998.
The judgment of the United States District Court for the District of
Colorado is AFFIRMED.
Entered for the Court
Michael R. Murphy
Circuit Judge
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