[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
FILED
No. 05-13632 U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
Non-Argument Calendar February 2, 2006
________________________ THOMAS K. KAHN
CLERK
D. C. Docket No. 04-00403-CV-T-24-TBM
REBECCA PORTER,
Plaintiff-Appellant,
versus
PROVIDENT LIFE AND ACCIDENT
INSURANCE COMPANY,
Defendant,
SMITHKLINE BEECHAM CORPORATION,
d/b/a GlaxoSmithKline,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Middle District of Florida
_________________________
(February 2, 2006)
Before TJOFLAT, PRYOR and RONEY, Circuit Judges.
PER CURIAM:
Plaintiff Rebecca Porter appeals the district court’s grant of summary
judgment to defendant SmithKline Beecham Corporation, d/b/a GlaxoSmithKline
(GSK), her former employer, in her case brought pursuant to the Employee
Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. Porter
alleged that on May 31, 2001, her long term disability benefits were improperly
terminated, despite 1997 medical diagnoses of fibromyalgia, asthma, and
depression, after defendant had gathered conflicting medical examination
information about the extent of her medical condition. After the denial of Porter’s
fourth internal appeal, defendant offered to suspend a final determination as to her
long term disability benefits if Porter was willing to submit to an independent
medical evaluation, offering to reinstate long term benefits if the findings of such
an evaluation supported her claim that she was totally disabled. Porter twice
refused to submit to an independent evaluation. On October 22, 2003, defendant
denied Porter’s fifth appeal, reasoning that her failure to submit to an independent
medical evaluation was a failure to comply with her obligations under the long
term plan and establishes a new justification for disability benefits. We affirm
based on the reasons set forth in the detailed and well-reasoned order of the
district court.
2
The district court did not err by finding that defendant had the authority to
make a final determination as to the denial of plaintiff’s long term benefits due to
her refusal to submit to an independent medical evaluation during the pendency of
the appeals process. Although her long term benefits were initially suspended due
to conflicting evidence gathered by defendant as to whether she was not totally
disabled under the terms of the plan, her subsequent refusal to submit to an
independent medical evaluation during the pendency of the appeals process
constituted an independent ground for denial of long term benefits.
The plan, which states that defendant has the absolute right “to make all
determinations of fact and eligibility for benefits,” explicitly states, “If you do not
submit to a timely independent medical examination or if you do not provide
timely and satisfactory proof of continued disability, your benefits will be
suspended.” Given this clear language, which required proof of a “continued
disability,” the district court did not err in holding that defendant’s request for an
independent medical evaluation was not “wrong” under the plan and, even if
“wrong,” was reasonable given the factual circumstances, where defendant’s
reasons to terminate her long term benefits conflicted with her proffered evidence
concerning her asserted disability. See Williams v. BellSouth Telecomm., Inc., 373
F.3d 1132, 1138–39 (11th Cir. 2004) (explaining that even if a plan
3
administrator’s decision under a plan is “wrong,” a reviewing court must still
uphold if reasonable grounds support it).
The record does not support plaintiff’s argument that the plan administrator
“automatically” gave “blind adherence” to a non-treating medical director’s
opinion without regard to other medical opinions, through what Porter calls an
improper “anti-physician rule.” The record evidence was not that the plan
administrator blindly adhered to the reviewer’s decision to deny long term benefits
due to a lack of disability but instead gave credence to his recommendation that
she submit to an independent medical evaluation to assist in resolving the conflict
between defendant’s and plaintiff’s medical experts as to her medical condition.
The district court’s grant of summary judgment to the defendant is
AFFIRMED.
4
Rebecca Porter v. Provident Life & Accident
Combined Opinion