United States Court of Appeals
FOR THE EIGHTH CIRCUIT
___________
No. 10-2924
___________
Charles Green, *
*
Plaintiff - Appellee, *
*
v. * Appeal from the United States
* District Court for the Western
Union Security Insurance * District of Missouri.
Company, *
*
*
Defendant - Appellant. *
___________
Submitted: May 12, 2011
Filed: July 22, 2011
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Before RILEY, Chief Judge, SMITH, Circuit Judge, and STROM,1 District Judge.
___________
STROM, District Judge.
After defendant-appellant Union Security Insurance Co. (“Union”) denied
plaintiff-appellee Charles Green’s claim for long-term disability benefits (“LTD
benefits”), Green filed a complaint against Union pursuant to the Employee
Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. The district
court granted summary judgment in Green’s favor finding Union had abused its
1
The Honorable Lyle E. Strom, United States District Judge for the District of
Nebraska, sitting by designation.
discretion in denying benefits to Green. Union appealed, challenging the district
court’s summary judgment order. We have jurisdiction pursuant to 28 U.S.C. § 1291.
We find the district court improperly determined Union abused its discretion when it
ultimately denied Green’s LTD-benefits claim.
I.
In November 2000, when he was thirty-five years old, Green began working as
a light industrial warehouse worker for Andersen Distribution, Inc. (“Andersen”).
Previously, Green had obtained a GED in 1985 and had worked as a light industrial
and warehouse worker for at least eight years. When he started working at Andersen,
Green began participating in Andersen’s LTD-benefits disability plan, pursuant to
Group Policy No. G 4,015,784 (“Policy”), which Union insured. Under the Policy,
participants are eligible for LTD benefits if they are “disabled.” The Policy, as it
pertained to Green, provided a participant is “disabled” if:
• during the first 24 months of a period of disability (including a
qualifying period), an injury, or sickness, or pregnancy requires that you
be under the regular care and attendance of a doctor, and prevents you
from performing at least one of the material duties of your regular
occupation;2 and
• after 24 months of disability, an injury, sickness, or pregnancy prevents
you from performing at least one of the material duties of each gainful
2
Hereinafter the “own occupation definition.”
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occupation3 for which your education, training, and experience qualifies
you.4
The Policy gave Union “sole discretionary authority to determine eligibility for
participation or benefits and to interpret the terms of the Policy” and required Green
to “furnish whatever items [Union] decide[s] are necessary as proof of loss or to
decide [Union’s] liability.”
On February 20, 2001, Green stopped working at Andersen citing physical pain
as preventing him from being able to work. Steven Rettinger, M.D., who was Green’s
primary care physician, examined Green and noted the cause of Green’s pain seemed
consistent with fibromyalgia. Despite this diagnosis, Dr. Rettinger anticipated Green
would be able to return to work at some point and discussed with Green “how he
needs to take control of his own life and call his place of employment so that he can
get off disability and back to work.”
In November 2001, Green submitted an LTD-benefits claim to Union. In
support of his claim, Green attached an Attending Physician Initial Statement of
Disability completed by Dr. Rettinger, which stated Green suffered from chronic back
pain, neck pain, fibromyalgia, and tremor. According to Dr. Rettinger, Green was
unable to perform any physical work and needed a sedentary work position due to
these conditions. After conducting its review, Union found Green eligible for LTD
benefits under the Policy’s own occupation definition and began paying LTD benefits
to Green on February 6, 2002.
3
The Policy defines “gainful occupation” as “an occupation in which you could
reasonably be expected to earn at least as much as your Schedule Amount.” Green’s
Schedule Amount was $1,306.67 per month (or $7.54 per hour).
4
Hereinafter the “any occupation definition.”
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Soon thereafter, Union began investigating whether Green qualified for LTD
benefits under the Policy’s any occupation definition. Union requested Green undergo
a functional capacity evaluation (“FCE”) to be performed by Healthsouth, which took
place on February 20 and 21, 2002. The FCE acknowledged Green had several
musculoskeletal deficits but ultimately concluded he “demonstrate[d] the ability to
perform sedentary work for an eight hour day.” The Healthsouth FCE stated Green
was capable of “lifting in the sedentary category of work” and could tolerate walking,
climbing stairs, bending and twisting at the trunk, reaching overhead, reaching
forward, and sitting.
In April 2002, Union sent a letter to Green encouraging him to apply for Social
Security Disability Benefits (“SSD benefits”). Green submitted a claim for SSD
benefits, but the Social Security Administration (“SSA”) initially denied the claim
because Green’s “condition was not severe enough to keep [him] from working.”
Also in April 2002, Union referred Green to its Vocational Services department. In
an interview with a Vocational Services employee, Green stated his hobbies included
fishing and camping, which he still enjoyed even after the onset of his painful
condition. Green also stated he could use his home computer and could drive locally.
With this information and the Healthsouth FCE in hand, Union requested Allen
Parmet, M.D., an occupational medicine specialist, review Green’s file. Dr. Parmet
diagnosed Green as suffering from fibromyalgia and migraines, but stated Green was
“capable of performing sedentary activities.” Dr. Parmet also acknowledged the
findings of the Healthsouth FCE that Green was capable of working a full-time
sedentary job.
In May and July 2002, Green submitted supplemental reports from Dr.
Rettinger to Union regarding Green’s condition. In assessing Green’s work
capabilities, Dr. Rettinger wrote that Green could not sit or stand for extended periods
and that he was incapable of doing minimal manual labor due to his neck and back
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pain. He also wrote Green was not a candidate for physical therapy. However, Dr.
Rettinger continued to recommend vocational rehabilitation for Green.
On August 26, 2002, Union’s rehabilitation counselor, Julie Finnegan,
conducted a Transferable Skills Analysis (“TSA”) with Green to help identify
potential occupations into which Green could transition. Finnegan determined
Green’s medical conditions and work experience qualified him to work in several
sedentary jobs. Finnegan believed suitable work could be found locally for Green at
his Schedule Amount wage rate ($7.54 per hour). Thereafter, Union engaged an
outside consultant, Brenda Umholtz, to conduct a Labor Market Survey (“LMS”).
Umholtz identified ten potential employers with positions available at or above
Green’s Schedule Amount wage rate for which Green was qualified and physically
able to perform. Umholtz wrote that positions were “readily available” for which
Green was qualified, that Green would not require vocational training to obtain a
position paying between $8.00 and $10.00 per hour, and that “[e]mployers appeared
very flexible and willing to accommodate someone with [Green’s] restrictions.”
In February 2003, Union had a psychologist on its staff, Patricia Neubauer,
Ph.D., review Green’s records. In discussing Green’s condition, Dr. Neubauer stated
Green’s “primary pain disorder relate[s] to both a general medical condition,
fibromyalgia and migraines and has psychological factors that impact his pain
complaints.” Dr. Neubauer suspected Green’s chronic pain condition was a
psychological issue, but she stated she could not confirm this suspicion for lack of a
psychological evaluation of Green to review. Dr. Neubauer and Union requested to
have access to a psychological evaluation that Green underwent in connection with
his application for SSD benefits, but Green did not provide this information. Union
attempted to schedule a psychological evaluation of Green, but the two times the
evaluation was scheduled (September 15 and October 22, 2003) Green did not attend,
explaining his absence was due to illness.
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On February 28, 2003, an SSA administrative law judge (“ALJ”) awarded
Green SSD benefits, reversing the SSA’s initial determination. The ALJ determined
Green had been “disabled” within the meaning of the Social Security Act due to
“panic disorder/anxiety[,] depression[,] chronic pain syndrome and fibromyalgia.”
The ALJ based his finding on the opinions of Green’s treating physicians.
On October 31, 2003, Union denied Green’s application for LTD benefits,
citing that Green did not meet the Policy’s any occupation definition, and therefore
was not disabled. Based on the medical and vocational evidence in Green’s file,
Union stated Green’s physical condition did not prevent him from performing the
material duties of each gainful occupation which Green was qualified to perform.
Because Green had failed to undergo Union’s requested psychological evaluation,
Union stated there was no proof of a claim based on a non-physical condition. In
support of the denial, Union cited the supplementary reports completed by Dr.
Rettinger that indicated Green could potentially hold a sedentary work position and
the Healthsouth FCE that concluded Green could perform a sedentary work position
for eight hours per day. Union also referenced the TSA and the LMS.
Green administratively appealed Union’s decision on July 8, 2004. As part of
its review of Green’s administrative appeal, Union began requesting additional
information in August 2004. On August 30th, Patsy Maikranz, M.D., submitted a
report to Union summarizing Green’s relevant medical history and concluding Green
“appears to have the capacity to do sedentary work that would allow for position
change hourly based on the diagnosis of fibromyalgia.”
On September 14 and 15, 2004, Union’s Investigative Services Unit conducted
a two-day video surveillance of Green to observe his daily practices. On the first day,
the investigator observed Green leave his house for approximately forty minutes to
visit the doctor’s office and post office. On the second day, the investigator observed
Green leave his house to run errands, which included pumping gas and making two
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trips to a cable television provider’s retail store, during which he loaded, unloaded,
and carried VCR-sized boxes to and from the trunk of his car. After conducting the
surveillance, Union presented the video recordings to Dr. Maikranz. Dr. Maikranz
noted that Green was observed engaging in activities his treating physicians did not
believe he could do, such as “grasping, handling and reaching.” Dr. Maikranz
concluded that Green’s observed activities on September 14th and 15th were
consistent with his performance on the Healthsouth FCE and were inconsistent with
his treating physicians’ restrictions and limitations.
On November 4, 2004, psychologist Mike Jones, Ph.D., a Union employee,
submitted a Behavioral Health Services Assessment regarding Green. In the
assessment, Dr. Jones stated Green did not have “significant mental health symptoms”
and suggested Green “might have another agenda regarding his lack of response to
treatment.”
Union wrote to Green’s attorney to inform of Union’s intent to have Green
undergo an independent medical evaluation (“IME”) with an occupational medicine
specialist. An IME was eventually scheduled for January 26, 2005, with Chris
Fevurly, M.D. After examining Green, Dr. Fevurly stated there were “no permanent
restrictions or limitations” preventing Green from returning to work.
With the new information in hand, Union resubmitted Green’s file to Dr.
Maikranz to review. On July 11, 2005, Dr. Maikranz issued a report to Union in
which she concluded Green “appears to have the physical functional capacity to
perform at least sustained sedentary work as long as he has the ability to change
positions hourly and do bending, twisting, stooping and overhead work on no more
than an occasional basis.” Union also obtained a Vocational Services General
Assessment from Richard Hubbard, a Union employee, in which Hubbard reviewed
the 2002 TSA and LMS studies completed for Green. Hubbard concluded after
reviewing Dr. Maikranz’s report that Green was physically capable and qualified to
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obtain at least three of the positions identified in the 2002 LMS, which were jobs in
customer service and private security.
On September 15, 2005, Union denied Green’s appeal upholding its prior
decision that he did not meet the Policy’s any occupation definition of disabled. In
making its decision, Union cited the findings of many of the medical professionals
who examined Green, the 2002 Healthsouth FCE, the 2004 two-day video surveillance
of Green’s activities, the 2005 IME performed by Dr. Fevurly, and the various
vocational assessments Green had undergone. Union also cited a lack of cooperation
by Green and some of his treating physicians, such as the failure of Dr. Rettinger to
provide comments on the Healthsouth FCE when requested, the failure of Green’s
attorney to provide medical records from the SSA’s evaluation of Green when
requested, and the failure of Green to attend the psychological evaluations Union
scheduled in Fall 2003. Upon review, Union concluded “there is no condition that
limits Mr. Green from performing at least one of the material duties of each gainful
occupation for which his education, training and experience qualifies him.”
Green appealed the decision to Union’s Disability Claims Appeals Committee
(“Appeals Committee”), the final level of administrative review. As an initial step,
the Appeals Committee requested Hubbard complete a revised Vocational Service
General Assessment. Hubbard submitted the revised assessment to the Appeals
Committee on April 28, 2006, in which he stated Green would not be able to perform
a private security job, but that he remained capable of performing a customer service
position.
In connection with the final appeal, Green submitted several documents to
Union. One of these documents was a letter from Dr. Rettinger. In the letter, Dr.
Rettinger commented on the 2002 Healthsouth FCE Green underwent, stating that
Green’s performance on the FCE was consistent with Dr. Rettinger’s evaluation of
Green, but that this performance did not demonstrate Green could perform a sedentary
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job for eight hours per day five days per week. Green also submitted the
psychological evaluation conducted by Gerald Vandenberg, Ph.D., in connection with
Green’s 2002 SSD-benefits application. In summarizing Green’s mental state in 2002,
Dr. Vandenberg wrote Green “seemed more dependent than depressed or seriously
distressed” and “may be showing mild Dysthymic Disorder, but without significant
dysfunction.
The Appeals Committee upheld Union’s denial of LTD benefits to Green on
July 31, 2006. After reviewing the materials on file and the new materials Green
submitted, the Appeals Committee determined Green had not met the Policy’s any
occupation definition of “disabled” and determined Green had “sufficient functional
capacity to perform sustained sedentary work activity as long as he is able to change
positions hourly.” In support of its determination, the Appeals Committee cited the
2002 Healthsouth FCE and the 2004 video surveillance of Green. The Appeals
Committee also considered Green’s TSA and LMS and determined Green was capable
of working as a customer service representative, which is “sedentary in nature and
allows for alternating sitting/standing and no lifting over 10 pounds.” With the
Appeals Committee’s final administrative denial, Union closed Green’s claim for LTD
benefits.
Green initiated this action on March 11, 2008. After granting leave for Green
to conduct limited discovery regarding Union’s structural conflict of interest, the
parties filed cross-motions for summary judgment. The district court denied Union’s
summary judgment motion and granted Green’s summary judgment motion on March
31, 2010, awarding Green $38,381.67 in past due benefits and prejudgment interest.
Union timely filed this appeal.
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II.
A. Legal Standard
Union challenges the district court’s determination that Union abused its
discretion when it denied Green’s LTD-benefits claim under the Policy’s any
occupation definition for “disabled.” Union effectively concedes that Green suffers
from fibromyalgia. However, Union argues that this condition has not rendered Green
“disabled” under the Policy’s any occupation definition, i.e., incapable of performing
at least one material duty of each gainful occupation for which Green’s education,
training, and experience qualifies him.
We review a district court’s summary judgment ruling de novo, applying the
same standard of review the district court used. Midgett v. Wash. Group Int’l Long
Term Disability Plan, 561 F.3d 887, 893 (8th Cir. 2009). Where an ERISA plan
grants the administrator discretion to determine eligibility for benefits and to interpret
the plan’s terms, courts must apply a deferential abuse-of-discretion standard of
review. Id.; see Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).
Because the Policy in this case gave Union discretionary authority to determine a
participant’s eligibility for benefits and to interpret the Policy, the district court
properly determined Union’s LTD-benefits decision of Green’s claim was subject to
an abuse of discretion standard.
In reviewing for an abuse of discretion, the administrator’s decision should be
reversed “only if it is arbitrary and capricious.” Midgett, 561 F.3d at 896 (internal
quotation marks and citation omitted). The administrator’s decision should be
affirmed if it is reasonable, meaning it is supported by substantial evidence. Groves
v. Metro. Life Ins. Co., 438 F.3d 872, 875 (8th Cir. 2006). Substantial evidence is
more than a scintilla but less than a preponderance. Midgett, 561 F.3d at 897. “‘The
requirement that the plan administrator’s decision be reasonable should be read to
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mean that a decision is reasonable if a reasonable person could have reached a similar
decision, given the evidence before him, not that a reasonable person would have
reached that decision.’” Id. (quoting Jackson v. Metro. Life Ins. Co., 303 F.3d 884,
887 (8th Cir. 2002)) (internal brackets omitted); see also Groves, 438 F.3d at 875
(quoting Ferrari v. Teachers Ins. & Annuity Ass’n, 278 F.3d 801, 807 (8th Cir. 2002))
(same).
B. Union Did Not Abuse Its Discretion
We find the district court improperly granted summary judgment in Green’s
favor when it determined Union abused its discretion in denying Green’s LTD-
benefits claim. Based on the record before Union, there was more than a scintilla of
evidence supporting Union’s conclusion that Green’s condition did not render him
“disabled” under the Policy’s any occupation definition. Union’s decision was
supported by substantial evidence, and “a reasonable person could have reached a
similar decision.” Midgett, 561 F.3d at 897.
First, the district court improperly discounted the 2002 Healthsouth FCE, which
was conducted over a period of two days and concluded Green was capable of
working in a full-time sedentary job. The district court assigned “limited value” to the
Healthsouth FCE because Green’s symptoms were variable, which prevented the FCE
from establishing that Green could work “40 hours a week, week after week.”
This court has stated an FCE “alone constitutes more than a scintilla of
evidence” when the FCE concludes a benefits claimant does not meet an ERISA
plan’s “disability” definition. Jackson, 303 F.3d at 888. The district court improperly
evaluated the Healthsouth FCE when it concluded the Healthsouth FCE was of
“limited value” because it did not establish Green could work “40 hours a week, week
after week.” It is true an FCE can only provide a “snapshot” of a claimant’s
functional capacities, but this does not render the FCE of “limited value.” An FCE
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provides “objective clinical evidence” regarding how a benefits claimant’s medical
conditions affect his or her ability to work. Gannon v. Metro. Life Ins. Co., 360 F.3d
211, 213 (1st Cir. 2004). This court has endorsed the use of FCEs in evaluating the
effect of fibromyalgia on ERISA benefits claimants. See, e.g., Pralutsky v. Metro. Life
Ins. Co., 435 F.3d 833, 841 (8th Cir. 2006) (stating plaintiff’s failure to submit an
FCE in support of her disability may have affected the benefits determination);
Farfalla v. Mutual of Omaha Ins. Co., 324 F.3d 971, 974 (8th Cir. 2003) (stating
functional capacity assessment that indicated plaintiff was not disabled supported plan
administrator’s benefits denial decision).
An FCE need not establish conclusively that a benefits claimant will be capable
of working day after day, week after week, year after year. Rather its value is in
objectively evaluating a person’s work capacities. In this case, an evaluation of Green
over the course of two days in February of 2002 established that he was capable of
working in a sedentary position, in contradiction to the other evidence Green
submitted that tended to indicate he was disabled. The district court made no criticism
of the methodology Healthsouth used in evaluating Green, and we see nothing in the
record sufficient to question the accuracy of the Healthsouth FCE’s results. The
Healthsouth FCE constitutes evidence in support of Union’s decision to deny LTD-
benefits to Green.
Second, the district court also improperly determined the medical opinions of
Drs. Parmet and Maikranz did not support Union’s denial of Green’s LTD-benefits
claim because those opinions were based on the Healthsouth FCE. The district court’s
conclusion that these opinions were based entirely or substantially on the Healthsouth
FCE is not supported by the doctors’ reports. Each doctor reviewed Green’s entire
medical record and concluded Green was capable of working in a sedentary job.
While both doctors referred to the Healthsouth FCE in their conclusions, their reports
do not indicate the FCE was given more weight than any of the other evidence in
Green’s file. Given the utility of the Healthsouth FCE as an objective source of
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evidence regarding Green’s condition, it was proper for these doctors to base their
conclusions in part on the Healthsouth FCE’s results. The district court should have
determined Drs. Parmet’s and Maikranz’s opinions constituted evidence supporting
Union’s decision.
Third, the district court improperly determined the two-day video surveillance
Union conducted in September 2004 of Green’s activities did not support its decision
to deny Green’s LTD-benefits claim. Like the Healthsouth FCE, the district court
determined this evidence only established that Green was capable of performing
sedentary work for a short period of time but did not establish that he could work a
full-time job. During the surveillance, Union’s investigator observed Green leave his
house on several occasions to run errands, such as pumping gas and carrying VCR-
sized boxes to his cable television provider’s retail store. This evidence tended to
contradict Green’s claim of total disability and was consistent with the Healthsouth
FCE.
Like an FCE, video evidence need not establish conclusively that a benefits
claimant can work full time. Rather, video evidence provides another form of
objective evidence upon which an ERISA plan administrator may base its claims
determinations. The use of video surveillance to observe a benefits claimant’s
condition is reasonable. Cusson v. Liberty Life Assur. Co. of Boston, 592 F.3d 215,
229 (1st Cir. 2010); see also Mote v. Aetna Life Ins. Co., 502 F.3d 601, 609 (7th Cir.
2007) (“In short, the videotapes show [the claimant] engaging in many of the activities
that she claimed to be unable to accomplish in her application for long-term disability
benefits and, consequently, the Plan properly considered them.”).5 Union’s
5
This court’s decision in Morgan v. UNUM Life Ins. Co. of Am., 346 F.3d 1173
(8th Cir. 2003), does not compel a conclusion that Union’s video surveillance of
Green cannot constitute evidence in support of its denial of Green’s LTD-benefits
claim. In Morgan, the court determined video surveillance of a benefits claimant’s
activities was not substantial evidence because the insurer was already aware that the
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observations of Green over a two-day period functioning with little to no apparent
difficulty (when Green had no reason to believe he was being observed) is evidence
supporting Union’s denial of Green’s benefits claim.
Fourth, the district court improperly discounted the findings of the vocational
labor market studies that indicated Green could find gainful employment. The district
court concluded “a reasonable person cannot have any confidence in Union’s labor
market survey because of the way it has been repeatedly revised.” Neither the district
court nor Green cite to any authority, and we find none in our review, standing for the
proposition that a labor market study cannot constitute evidence supporting an ERISA
plan administrator’s denial of benefits merely because it has been revised to eliminate
certain jobs the study initially found a benefits claimant was capable of performing.
Transferrable skills and labor market studies, like the ones Union conducted in this
case, can constitute substantial evidence supporting a denial of benefits. Ferrari v.
Teachers Ins. & Annuity Ass’n, 278 F.3d 801, 805, 808 (8th Cir. 2002); see also
Russell v. Paul Revere Life Ins. Co., 288 F.3d 78, 82 (3d Cir. 2002) (acknowledging
administrator’s reliance on a labor market report, which concluded benefits claimant
was only partially disabled, supported administrator’s denial). The fact that Union
revised its LMS and eliminated positions that Green was unable to perform suggests
Union fairly and reasonably reviewed Green’s claim. After these revisions to the
LMS, Union ultimately concluded Green could work in a customer service position,
and this is evidence supporting Union’s decision.
Finally, beyond the evidence the district court discounted, there is other
evidence in the record supporting Union’s decision. In an interview with a Union
claimant “routinely engaged in the type of activity that [the insurer] later observed
through surveillance and used as the basis for discontinuing [the claimant’s] benefits.”
Id. at 1178. In Green’s case, Union’s surveillance disclosed Green was capable of
engaging in activities that his treating physicians did not believe he could perform,
including “grasping, handling and reaching.”
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Vocational Services employee in April 2002, Green stated he could still fish and camp
after the onset of his disability. Green’s treating physician, Dr. Rettinger, also
repeatedly stated he anticipated Green would be able to return to work in a sedentary
job even with his fibromyalgia diagnosis. Further, as the district court correctly
concluded, the record did not establish that Green suffered from a disabling
psychological condition. We think the cumulative nature of this and the other
evidence constitutes more than a scintilla of evidence indicating Green is not
“disabled” under the Policy’s definition.
Although Green likely suffers from fibromyalgia, it does not automatically
follow that this condition renders Green “disabled.” See Coker, 281 F.3d at 798-99
(recognizing insurer determined ERISA benefits claimant suffered from diabetes, but
that this condition did not render the claimant disabled under the ERISA plan).
Reasonable minds can differ, based on the record, as to how Green’s condition affects
him. However, our duty is to determine whether Union’s decision was supported by
substantial evidence, not to weigh the evidence anew. Ferrari, 278 F.3d at 807 (“We
do not … substitute our own weighing of the evidence for that of the administrator.”)
Substantial evidence supports Union’s decision to deny LTD benefits to Green, and
“a reasonable person could have reached a similar decision.” Midgett, 561 F.3d at
897. Union did not abuse its discretion in denying Green’s LTD-benefits claim.
C. Union’s Structural Conflict of Interest
The fact that Union operates under a structural conflict of interest, as both plan
administrator and insurer, does not warrant a finding that Union abused its discretion
in denying Green’s claim. A plan administrator’s conflict of interest “‘should be
weighed as a factor in determining whether there is an abuse of discretion.’” Wakkinen
v. UNUM Life Ins. Co. of Am., 531 F.3d 575, 583 (8th Cir. 2008) (quoting Metro. Life
Ins. Co. v. Glenn, 554 U.S. 105, 115 (2008)). The weight of an administrator’s
conflict will depend on the circumstances.
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The conflict of interest … should prove more important (perhaps of great
importance) where circumstances suggest a higher likelihood that it
affected the benefits decision, including, but not limited to, cases where
an insurance company administrator has a history of biased claims
administration.… It should prove less important (perhaps to the
vanishing point) where the administrator has taken active steps to reduce
potential bias and to promote accuracy, for example, by walling off
claims administrators from those interested in firm finances, or by
imposing management checks that penalize inaccurate decisionmaking
irrespective of whom the inaccuracy benefits.
Glenn, 554 U.S. at 117 (internal citation omitted).
The importance of Union’s conflict is at or near the “vanishing point.”
Although the district court ordered discovery on Union’s conflict of interest, the
district court cited none of this disclosed information in concluding that Union’s
conflict influenced its decision to deny LTD benefits to Green. Further, there is no
other indication that Union has a history of biased claim decisions.
Although the SSA ultimately determined Green was disabled for the purposes
of receiving SSD benefits, this determination was not binding on Union. The
evidence presented to the SSA was different from the evidence before Union. See
Jackson, 303 F.3d at 889 (recognizing it was not certain whether the SSA would have
concluded the benefits claimant would be entitled to SSD benefits if the SSA had
reviewed the same record that was before the ERISA plan administrator). Also, the
SSA was required to (and the ALJ did) give special deference to Green’s treating
physicians. Union, however, was not required to give special deference to Green’s
treating physicians. Black & Decker Disability Plan v. Nord, 538 U.S. 822, 825
(2003). The circumstances of this case do not warrant increasing the importance of
Union’s structural conflict of interest as a factor for evaluating whether Union abused
its discretion in denying LTD benefits to Green.
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III.
The district court’s order granting summary judgment for Green is
REVERSED and the case is REMANDED for further proceedings consistent with
this opinion.6
______________________________
6
We need not address whether the district court abused its discretion in granting
leave to Green to conduct limited discovery on Union’s structural conflict of interest.
Cf. Werdehausen v. Benicorp Ins. Co., 487 F.3d 660, 669 (8th Cir. 2007) (“As we
have reversed the grant of summary judgment dismissing the Werdehausens’ ERISA
claims under 29 U.S.C. § 1132(a)(1)(B), we need not address their arguments that the
district court committed evidentiary and discovery errors in the summary judgment
proceedings.”).
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