Simoneaux v. Continental Casualty Co.

United States Court of Appeals
Fifth Circuit
F I L E D
UNITED STATES COURT OF APPEALS June 9, 2004
FOR THE FIFTH CIRCUIT
Charles R. Fulbruge III
Clerk

04-30083
Summary Calendar

GLENN SIMONEAUX,

Plaintiff-Appellant,
VERSUS

CONTINENTAL CASUALTY COMPANY; CNA GROUP LIFE ASSURANCE COMPANY,

Defendants-Appellees.

Appeal from the United States District Court
For the Eastern District of Louisiana
(03-CV-400-F)

Before SMITH, DUHÉ, and WIENER, Circuit Judges.

PER CURIAM:1

This ERISA case presents the question of Petitioner-Appellant

Glenn Simoneaux’s entitlement to long-term disability benefits with

Defendant Continental Casualty Insurance Company, Administrator of

a Group Disability Plan for Simoneaux’s employer, CF Industries,

Inc. Simoneaux was employed by CF Industries until he became

disabled with heart disease on February 25, 2002. After receiving

short-term disability benefits, Petitioner applied for long-term

1
Pursuant to 5TH CIR. R. 47.5, the Court has determined that
this opinion should not be published and is not precedent except
under the limited circumstances set forth in 5TH CIR. R. 47.5.4.
disability benefits with Continental Casualty, who as Plan

Administrator denied long-term benefits. After exhaustion of

administrative remedies, Simoneaux petitioned the district court

for review. The parties jointly submitted the administrative

record on cross-motions for summary judgment, stipulating that the

issues were whether or not the Plan Administrator abused its

discretion and/or whether or not its decision to deny long-term

benefits under the Plan was arbitrary and capricious.2 The

district court would not disturb the Plan Administrator’s

determination, and we affirm.

The district court can hold a decision to be arbitrary only if

it is “‘made without a rational connection between the known facts

and the decision or between the found facts and the evidence.’”3

A court upholds the findings of the Plan Administrator if they are

supported by “substantial evidence.”4 We review the cross motions

for summary judgment de novo, applying the same standard as the

district court.5

This case turns on the Plan Administrator’s factual

2
R. 642.
3
Meditrust Finan. Servs. Corp. v. Sterling Chems., Inc., 168
F.3d 211, 215 (5th Cir. 1999) (quoting Bellaire General Hosp. v.
Blue Cross Blue Shield of Michigan, 97 F.3d 822, 828 (5th Cir.
1996).
4
Meditrust, 168 F.3d at 215.
5
Id. at 214; Sweatman v. Commercial Union Ins. Co., 39 F.3d
594, 601 (5th Cir. 1994).

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determination that Simoneaux did not suffer from a functional

impairment that would preclude him from performing the duties of

his employment. One of the eligibility requirements for benefits

is a physical impairment such that the participant is continuously

unable to perform the material and substantial duties of his

regular occupation.6 The long-term aspect is that the impairment

must continue during the elimination period – 180 days – and for

twenty-four months thereafter.7

Simoneaux contends that Continental improperly disregarded the

opinions of his treating physician and an independent medical

examiner that Simoneaux was permanently disabled from any work.

Defendant contends that the evaluating physician’s report did not

include sufficient findings to support a disability within or

beyond the elimination period. According to Defendant, a

generalized statement that plaintiff is “permanently disabled for

any exertive or stressful work” that is unsupported by the medical

tests, records, or findings is insufficient. We agree.

Continental reviewed Simoneaux’s medical record and determined

that Simoneaux was diagnosed with ischemic heart disease, that the

only medical procedure done was a heart catheter and stent

replacement, reported in March 2002 to have been successful; that

the duration of any physical impairment for the procedure would not

6
R. 188-89.
7
Id.

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exceed seven to ten days in accordance with ADC Guidelines; and

that Simoneaux had no follow-up medical procedures.8

Continental collected information from the employer about the

physical demands of Simoneaux’s job. Investigation revealed that

Simoneaux was a chemical operator who would make equipment rounds

and would periodically climb ladders and check machinery. He was

also required to turn large valves and could use help from

coworkers to turn or adjust valves.9 Continental also interviewed

Simoneaux, who revealed that he was capable of taking care of

himself, that he drove, that he exercised, and that he helped with

work around the house and took care of and played with the pets.10

To perform its review and evaluation, Continental used

Disability Specialist Gwen Hayslip and Registered Nurse Johanna

Cobb. Continental concluded that Simoneaux had no functional

impairment that would have prevented him from performing the

material and substantial duties of his job beyond the six-month

elimination period. Continental’s Appeals Committee upheld the

conclusion, finding that the heart catheterization procedure

resulted in blockage going from 80-90% to zero.11

As Plan Administrator Continental had discretion to determine

8
R. 63.
9
R. 67-69.
10
R. 151-152.
11
R. 70.

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benefit eligibility. The record demonstrates a “rational

connection”12 between the facts developed and the Plan

Administrator’s decision to deny benefits. It obtained and

evaluated information presented by the employer, healthcare

professionals, and Simoneaux himself, as well as additional

submissions during the appeals process. Continental was neither

irrational nor arbitrary in failing to give overriding weight to

the treating physician’s statement that Simoneaux was totally

disabled, a generalized statement not supported by objective

medical findings.13 Accordingly, the decision is properly upheld.

AFFIRMED.

12
See Medi-trust, 168 F.3d at 215.
13
See Gooden v. Provident Life & Accid. Ins. Co., 250 F.3d 329,
333-34 (5th Cir. 2001) (letter from treating physician stating that
patient was disabled, unaccompanied by medical evidence, did not
undermine Plan Administrator’s decision finding no disability);
Sweatman, 39 F.3d at 601-02 (finding no abuse of discretion where
Plan Administrator utilized professionals to review and evaluate
all the medical records, despite plaintiff’s contention that Plan
Administrator “attached insufficient weight to her doctor’s
opinions and too much weight to the results of its own [deficient]
investigation”).

5