12-718-cv
Ianniello v. Hartford Life & Accident Ins. Co.
UNITED STATES COURT OF APPEALS
FOR THE SECOND CIRCUIT
SUMMARY ORDER
RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A
SUMMARY ORDER FILED ON OR AFTER JANUARY 1, 2007, IS PERMITTED AND IS
GOVERNED BY THIS COURT’S LOCAL RULE 32.1.1 AND FEDERAL RULE OF APPELLATE
PROCEDURE 32.1. WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS
COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN ELECTRONIC
DATABASE (WITH THE NOTATION “SUMMARY ORDER”). A PARTY CITING A SUMMARY
ORDER MUST SERVE A COPY OF IT ON ANY PARTY NOT REPRESENTED BY COUNSEL.
At a stated Term of the United States Court of Appeals for the Second
Circuit, held at the Thurgood Marshall United States Courthouse, 40 Foley Square,
in the City of New York, on the 24th day of January, two thousand thirteen.
Present: SUSAN L. CARNEY,
CHRISTOPHER F. DRONEY,
Circuit Judges,
PAUL G. GARDEPHE,
District Judge.*
______________________________________________________
|
VIRGINIA IANNIELLO, |
|
Plaintiff–Appellant, |
|
v. | No. 12-718-cv
|
HARTFORD LIFE AND ACCIDENT INSURANCE |
COMPANY; GROUP LONG TERM DISABILITY PLAN |
FOR EMPLOYEES OF AMERICAN INTERNATIONAL |
GROUP, INC., |
|
Defendants–Appellees. |
______________________________________________________|
Appearing for Appellant: ROBERT J. ROSATI, ERISA Law Group LLP, Fresno,
CA.
The Honorable Paul G. Gardephe, United States District Judge for the Southern District of
*
New York, sitting by designation.
Appearing for Appellee: MICHAEL H. BERNSTEIN (Matthew P. Mazzola, on
the brief), Sedgwick LLP, New York, NY.
Appeal from the United States District Court for the Eastern District of New
York (Sandra J. Feuerstein, Judge; Arlene R. Lindsay, Magistrate Judge).
UPON DUE CONSIDERATION, it is hereby ORDERED, ADJUDGED, and
DECREED that the judgment of the district court be and it hereby is AFFIRMED.
Plaintiff Virginia Ianniello appeals from the February 1, 2012 order of the
district court granting summary judgment to defendants Hartford Life and Accident
Insurance Company (“Hartford”) and Group Long Term Disability Plan for
Employees of American International Group, Inc. (the “Plan”). Ianniello has been
an employee of American International Group (“AIG”) since 1981, most recently
serving as “Manager-Multinational Accounts.” She participates in the Plan, an
employee benefit plan sponsored by AIG, administered by Hartford, and governed
by the provisions of the Employee Retirement Income Security Act, 29 U.S.C.
§§ 1001–1461 (“ERISA”). After several hospitalizations, Ianniello filed a claim for
long-term disability benefits under the Plan, attaching a physician’s statement
advising of Ianniello’s diagnoses of chronic fatigue, fibromyalgia, and
hypothyroidism. Hartford denied Ianniello’s claim. She then filed suit in the
district court, alleging that Hartford failed to conduct a full and fair review of her
claim. See 29 U.S.C. § 1133(2); 29 C.F.R. § 2560.503-1(h)(1). We assume the
parties’ familiarity with the facts and record of prior proceedings, which we
reference only as necessary to explain our decision to affirm.
2
In an ERISA action, “we review the district court’s grant of summary
judgment based on the administrative record de novo and apply the same legal
standard as the district court.” Hobson v. Metro. Life Ins. Co., 574 F.3d 75, 82 (2d
Cir. 2009). When “written plan documents confer upon a plan administrator the
discretionary authority to determine eligibility,” as they do in this case, “we will not
disturb the administrator’s ultimate conclusion unless it is arbitrary and
capricious.” Id. (internal quotation marks omitted).1 Under this standard, we may
overturn the administrator’s decision to deny benefits “only if it was without reason,
unsupported by substantial evidence or erroneous as a matter of law.” Id. at 83
(internal quotation marks omitted). Ianniello bears the burden of proving that she
is eligible for disability benefits. See Critchlow v. First UNUM Life Ins. Co. of
America, 378 F.3d 246, 256 (2d Cir. 2004).
Ianniello asserts that Hartford committed a number of errors in its review of
her claim, and that these errors render its decision arbitrary and capricious.
First, Ianniello challenges Hartford’s description of the essential duties of
the job she held when she filed her claim. Hartford incorrectly classified her job as
“sedentary,” Ianiello claims, because her job required travel. Hartford’s own doctor
conceded that Ianniello is limited in the amount of time she can walk and stand,
and would therefore be unable to perform a job that requires travel. The record
reflects that AIG initially represented to Hartford that Ianniello’s job required some
1
We need not address Ianniello’s argument that the district court applied the wrong
standard of review when affirming Magistrate Lindsay’s Report and Recommendation, because we
review the administrative record de novo to determine whether Hartford abused its discretion.
Hobson, 574 F.3d at 82.
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airplane travel, but subsequently amended its representation and informed
Hartford that Ianniello’s job was a sedentary one, requiring little or no travel.
Ianniello submitted a declaration stating that she had traveled once since being
employed in this position, and that six trips had been budgeted for her for the
upcoming year, but that much of her workday consisted of using the computer and
talking on the phone. In light of AIG’s final representation and statements in
Ianniello’s declaration strongly suggesting that travel was not an essential part of
her job, we cannot say that Hartford’s conclusion was “without reason” or
“unsupported by substantial evidence.”
Second, Ianniello argues that Hartford abused its discretion when it required
her to produce objective evidence showing that she suffered from fibromyalgia.
According to a National Health Institute publication submitted by Ianniello to
Hartford, fibromyalgia is “a common and chronic disorder characterized by
widespread muscle pain, fatigue, and multiple tender points.” App. 3396, 3412. A
physician retained by Hartford to review Ianniello’s records expressed doubt about
Ianniello’s diagnosis of fibromyalgia because Ianniello had not been tested for
“tender points.”2 The absence of this test was mentioned in Hartford’s rejection of
Ianniello’s claim. Ianniello argues that requiring her to provide such testing was
unreasonable, because her policy does not require it and she was not asked
specifically to provide it. She maintains further that no objective test for
fibromyalgia has been generally recognized by the medical community.
2
The National Health Institute publication explains that tender points are “specific places
on the body — on the neck, shoulders, back, hips, and upper and lower extremities — where people
with fibromyalgia feel pain in response to slight pressure.” App. 3396.
4
In Hobson v. Metropolitan Life Insurance Co., 574 F.3d 75 (2d Cir. 2009), we
addressed — and rejected — virtually identical arguments. The claimant in Hobson
sought disability benefits based on a diagnosis of fibromyalgia; the insurer denied
coverage because the claimant had not provided documented evidence of tender
point testing. We held that, although the terms of the policy did not require
objective evidence of disability, it was “not unreasonable for a plan administrator to
require [tender point testing] so long as the claimant was so notified.” Id. at 88.
Hartford made only minimal attempts to notify Ianniello that the absence of
tender point testing might adversely affect its assessment of her claim. The letter
initially denying Ianniello’s claim does not reference the lack of a tender point test;
only in its rejection of Ianniello’s appeal of the denial of her claim did the insurer
mention the test. While considering Ianniello’s claim, Hartford in this regard only
requested that Ianniello’s physician submit “all current clinical findings and
diagnostics to support [Ianniello’s] continued limited activity level.” App. 1558.
Nonetheless, the record shows that Ianniello was well aware of the use of tender
points as a diagnostic criterion for fibromyalgia, and had the opportunity to obtain
and present such testing results to Hartford. Indeed, Ianniello’s counsel began his
client’s appeal letter to Hartford with an extensive discussion of the American
College of Rheumatology’s criteria for diagnosis of fibromyalgia, noting that “[t]he
patient must . . . report abnormal pain over at least 11 of 18 predesignated sites
(known as tender points), when a standard quantifiable degree of pressure is
5
applied to these areas.” App. 2917.3 Because Ianniello bore the burden of showing
that she was disabled, Critchlow, 378 F.3d at 256, Hartford’s demand for objective
evidence was neither arbitrary nor capricious.
Third, Ianniello argues that in making its determination, Hartford failed to
consider the decision of the Social Security Administration (“SSA”) to award her
disability benefits. An SSA award is by no means determinative of a claimant’s
eligibility under an ERISA plan. See Black & Decker Disability Plan v. Nord, 538
U.S. 822, 833–34 (2003). But in this case the SSA award bears even less on
whether Hartford abused its discretion, because the only document Ianniello
provided Hartford was a letter from the SSA confirming the amount of disability
benefits she received each month. Ianniello has identified no documents that reveal
the basis for the SSA’s determination. Without more, we cannot fault Hartford for
failing to discuss the award in its decision denying coverage.
Finally, Ianniello asserts that the district court erred by giving insufficient
weight to Hartford’s conflict of interest as concurrent evaluator and payor of claims,
a conflict exacerbated by the use of retained consulting physicians. It is true that
such a dual role creates adverse incentives, but Hartford took steps to separate
claims administrators from the firm’s financial departments, and ensured that the
salaries of its claims adjudicators were not tied to their denial rates. We agree with
the district court that, by taking these steps, Hartford adequately mitigated the
effects of the conflict in its management practices. See McCauley v. First Unum
3
We express no view on whether such a test is required for a definitive diagnosis of
fibromyalgia. See Hobson, 574 F.3d at 79–80 n.1; Green-Younger v. Barnhart, 335 F.3d 99, 108 (2d
Cir. 2003). We conclude only that Hartford did not abuse its discretion in denying Ianniello’s claim.
6
Life Ins. Co., 551 F.3d 126, 133 (2d Cir. 2008). Hartford also acted properly in
relying on the opinions of consulting doctors external to Hartford, even though it
selected (and presumably compensated) those doctors. See Hobson, 574 F.3d at 90.
Indeed, Hartford’s retained physicians made multiple attempts to contact
Ianniello’s treating physician to discuss his findings, but he did not return the
consulting physicians’ phone calls.
We have considered Ianiello’s other arguments on appeal and, after a
thorough review of the record, find them to be without merit. Accordingly, we
AFFIRM the judgment of the district court.
FOR THE COURT:
Catherine O’Hagan Wolfe, Clerk
7