United States Court of Appeals
For the First Circuit
No. 04-1986
MICHAEL J.M. WRIGHT,
Plaintiff, Appellant,
v.
R. R. DONNELLEY & SONS CO. GROUP BENEFITS PLAN, et al.,
Defendants, Appellees.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW HAMPSHIRE
[Hon. Paul J. Barbadoro, U.S. District Judge]
Before
Torruella, Circuit Judge,
Stahl, Senior Circuit Judge,
and Oberdorfer,* Senior District Judge.
Stephen L. Raymond, for appellant.
John-Mark Turner, with Sheehan, Phinney, Bass + Green, P.A.,
on brief, for appellees.
March 25, 2005
*
Of the District of the District of Columbia, sitting by
designation.
OBERDORFER, Senior District Judge. Plaintiff-appellant,
Michael J. M. Wright, appeals the district court’s entry of summary
judgment in favor of defendants-appellees, R. R. Donnelley & Sons
Co. Group Benefits Plan, and Hartford Life and Accident Insurance
Company (“Hartford”). Wright alleged that Hartford’s termination
of his short-term disability benefits, and its failure to grant his
long-term disability benefits, violated the Employee Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461. For
the reasons stated below, we affirm.
I. BACKGROUND
A. The Plan
In connection with his employment with financial services
firm R. R. Donnelley & Sons Company (“Donnelley”), Wright was
covered as a participant under Donnelley’s Group Benefits Plan (the
“Plan”). Benefits under the short term disability (“STD”) portion
of the Plan are administered by Hartford and funded by Donnelley
through a trust. App. at A150. Benefits under the long term
disability (“LTD”) portion of the Plan are administered by Hartford
and funded in full by an insurance policy issued by Hartford. Id.
The Plan states that, “Hartford has sole authority to approve or
reject claims according to the program rules, and follow through
with the ERISA appeals process.” Id. at A147. Benefits are not
payable unless, among other requirements, an employee submits
“proof of loss satisfactory to The Hartford.” Id. at A170.
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B. Wright’s Application for STD Benefits
On June 19, 2001, Wright took a medical leave from work,
claiming he was suffering from headaches and irregular memory loss
which prevented him from carrying out his job functions. See App.
at A111-A113. Wright subsequently applied for STD benefits in
accordance with the Plan’s provisions. Id. at A207. Wright
submitted Attending Physician Statements (“APS”) from his primary
care physician, Dr. Maurice B. Cohen, and his psychologist, Ron
Michaud, Ph.D. See id. at A188-89; id. at A210-11. Both Drs.
Michaud and Cohen reported that Wright’s subjective symptoms were
memory problems. See id. at A188-89; id. at A210-11. Dr. Cohen
recommended that Wright be kept out of work pending the results of
neuropsychological testing. Id. at A210-11. Dr. Michaud indicated
that Wright’s ability for sustained concentration “has severely
impaired current job performance.” Id. at A210-11. He declined to
indicate any specific psychiatric impairments, stating that it was
unclear if the “process is psychiatric or neurological.” Id.
Based on this information, Hartford granted Wright’s STD benefits
through July 29, 2001. Id. at A379. Pending results of the
neuropsychological testing, Hartford extended Wright’s STD benefits
through August 20, 2001. Id. at A380.
In a status report to Hartford, on August 20, 2001, Dr.
Cohen diagnosed Wright with memory loss and indicated the necessity
of additional neurological testing. See id. at A198-99. Dr. Cohen
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again recommended that Wright not return to work until an
appropriate diagnosis was made. Id. By letter dated August 24,
2001, Hartford notified Wright that it was extending his STD
benefits through September 23, 2001. Id. at A381. The letter
further stated:
If you remain disabled beyond September 23,
2001, your physician must submit supporting
medical information to our office. This must
include the specific results of your July 11
and August 28, 2001 tests. We will also
require an evaluation by your primary care
physician that addresses a specific diagnosis,
restrictions and limitations that prevent you
from returning to work, your treatment plan
and any changes in your treatment, and a
return to work plan.
Id.
On September 20, 2001, Dr. Cohen provided another update
to Hartford, explaining that Wright had difficulty finding a
neuropsychologist covered by his health insurance but finally was
able to schedule an appointment with Dr. Ann Avery for October 2,
2001.1 Id. at A248. Based on this information, Hartford extended
STD benefits until October 14, 2001, to allow time for his
physicians to review the results of Dr. Avery’s testing. See id.
at A196.
On October 15, 2001, after reviewing the results of Dr.
1
Wright also submitted a letter to Hartford detailing his
attempts to obtain formal testing and indicating that his health
carrier refused to approve full neuropsychological testing,
allowing Wright only an “initial set of tests.” Id. at A208-09.
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Avery’s neuropsychological assessment of Wright, Dr. Cohen
submitted a new APS to Hartford, which addressed for the first time
the level of Wright’s psychiatric impairments. See id. at A190-91.
Dr. Cohen indicated an impairment of less severe than “[m]oderate
impairment in occupational functioning” but more severe than
“slight difficulty.” Id. Dr. Cohen also telephoned Hartford and
explained Dr. Avery’s tests showed that Wright’s “short term memory
is good” but that Wright had “weakness recalling long term events
and narriatives[sic].”2 Id. at A193. Dr. Cohen further reported
that an MRI was normal and there was no diagnosis for Wright yet.
Id. at A193. Hartford extended Wright’s STD benefits until October
28, 2001, pending the results of Wright’s examination by a new
psychiatrist, Dr. Clive D. Dalby.
On October 26, 2001, Dr. Dalby submitted an APS to
Hartford diagnosing Wright with Amnestic Syndrome Not Otherwise
Specified. Id. at A212-13. Dr. Dalby indicated that Wright
suffered “severe short term memory loss & thought blocking,” and
described this as causing a “moderate impairment in occupational
functioning,” but did not specify such limitation. Id.
C. Wright’s Application for LTD Benefits
Wright applied for LTD benefits on November 13, 2001.
Meanwhile, Hartford referred Wright’s STD claim to one of its
2
According to Dr. Avery’s findings, Wright’s memory was
generally good, though he had a below average score on a single
sub-test of delayed recall. Id. at A223.
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Behavioral Health Case Managers for review. The Case Manager noted
that “[t]he only thing we have with all of these tests that were
reportedly done is [Wright’s] self-reported memory loss . . . .
There are not other impairment[sic] noted and the info doesn’t
indicate how severe or mild that memory loss is as substantiated by
neuropsychological testing.” Id. at A282-83.
Concluding that there was no sufficient medical evidence
of the severity of Wright’s reported symptoms or any occupational
limitations, Hartford denied Wright’s STD benefits effective
October 28, 2001. See id. at A185-87. On the same day, Hartford
denied Wright’s LTD claim, because its conclusion that Wright was
not prevented from performing his job meant that one prerequisite
under the LTD portion of the Plan (disability throughout the 26-
week elimination period) was not satisfied. See id. at A214-16.
In its denial letters, Hartford specifically invited Wright to
submit “test results and reports which document deficits in short
term memory and how it affects your occupational functioning beyond
October 28, 2001.” See id. at A185-87; id. at A214-16.
D. Wright’s First Appeal
On December 3, 2001, Wright appealed Hartford’s initial
denial. See id. at A384-89. Wright provided explanatory
statements by himself and his wife as well as the
Neuropsychological Assessment of Dr. Avery dated October 2, 2001
and a December 6, 2001 letter of Dr. Dalby, indicating Dr. Dalby’s
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conclusion that Wright was disabled from performing his occupation.
See id.; id. at A222-24; id. at A220-21. Hartford considered this
additional evidence, as well as a job description submitted by
Wright’s employer. See id. at A217-19. By letter dated March 12,
2002, Hartford reaffirmed its denial, claiming that the documents
submitted did not provide any medical evidence regarding the
severity of any cognitive deficits suffered by Wright and, thus,
did not establish any specific occupational limitations. Id. at
A218. Hartford found the “results of the neuropsychological
testing is[sic] consistent with an ability to perform the essential
duties of [Wright’s] occupation.” Id.
E. Wright’s Second Appeal
Wright filed a second appeal on June 3, 2002, in which he
submitted an APS from a new neurologist, Dr. Bryan Lieberman. See
id. at A285-326. Dr. Lieberman diagnosed Wright with sleep apnea
and memory disorder. See id. at A355-56. In describing Wright’s
cognitive deficit, Dr. Lieberman termed it a “neurologic cognitive
disorder” including impaired memory, attention, and executive
function, as well as daytime somnolence, and fatigue. Id. Dr.
Lieberman concluded that the “above deficit disables [Wright] for
his job--working as a software engineer.” Id.
Hartford referred Wright’s entire file to two Independent
Medical Examiners at the University Disability Consortium for
review--Dr. Alvin McElveen, Neurologist, and Milton Jay, Ed.D,
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Neuropsychologist. Upon review of Wright’s case file, Dr. McElveen
concluded that sleep apnea had been documented; thus the medical
evidence “support[ed] cognitive impairment as a result of the
physical conditions present on 10/28/2001.” Dr. McElveen referred
to Dr. Jay’s report for an assessment of the effect of any
impairments on Wright’s cognitive functioning. Id. at A351. Dr.
Jay concluded that, although sleep apnea had been confirmed by a
polysomnogram ordered by Dr. Lieberman, the medical evidence did
not confirm that the apnea was causing even “mild difficulties in
cognition secondary to interrupted sleep and subsequent fatigue.”
Id. at A338.
Based on the opinions of Drs. Jay and McElveen, the
additional medical records from Drs. Cohen and Lieberman, the
information submitted by Wright in his appeal, and all the other
information already in the claim file, Hartford reiterated its
denial on October 2, 2002. Hartford reasoned that even assuming
minor cognitive difficulties existed, none were severe enough to
prevent Wright from performing the essential functions of his
occupation. See id. at A352-54.
F. District Court
Wright filed suit in the United States District Court for
the District of New Hampshire on June 10, 2003. Wright claimed
that Hartford acted under an inherent conflict of interest because
it both administered and funded the LTD benefits. Wright also
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alleged that Hartford acted under an actual conflict of interest,
evidenced by its bad faith in handling Wright’s claims for STD and
LTD benefits. Hartford’s conflict of interest, according to
Wright, required a less deferential review of Hartford’s denial of
Wright’s benefits. Furthermore, even under deferential arbitrary
and capricious review, according to Wright, Hartford’s denials of
STD and LTD benefits were not based upon substantial evidence,
reasonably sufficient to support Hartford’s decisions.
Defendants filed a Motion for Summary Judgment on
February 4, 2004, and Wright filed a cross Motion for Summary
Judgment on March 8, 2004. After extensive oral argument, the
district court granted Defendants’ Motion for Summary Judgment and
denied Wright’s Motion for Summary Judgment on June 17, 2004. The
district court considered but rejected Wright’s claim that Hartford
acted out of an improper financial motivation. The court similarly
rejected Wright’s other arguments for heightened scrutiny of
Hartford’s decisions. Applying the arbitrary and capricious
standard of review, the district court found that, despite some
contradictory evidence, substantial evidence existed to support
Hartford’s decision that any cognitive deficits were minor and not
disabling. The court entered a Final Judgment on June 18, 2004.
Wright filed a timely Notice of Appeal on July 14, 2004.
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II. DISCUSSION
A. Standard of Review
The Court reviews a district court’s grant of summary
judgment de novo. See Boardman v. Prudential Ins. Co. of Am., 337
F.3d 9, 15 (1st Cir. 2003). The district court generally reviews
an ERISA plan administrator’s benefits determinations de novo.
Allen v. Adage, Inc., 967 F.2d 695, 697-98 (1st Cir. 1992). If,
however, by its terms, the ERISA plan grants the plan administrator
discretionary authority in the determination of eligibility for
benefits, the administrator’s decision must be upheld unless it is
“arbitrary, capricious, or an abuse of discretion.”3 Doyle v. Paul
Revere Life Ins. Co., 144 F.3d 181, 183 (1st Cir. 1998).
The operative inquiry under arbitrary, capricious or
abuse of discretion review is “whether the aggregate evidence,
viewed in the light most favorable to the non-moving party, could
support a rational determination that the plan administrator acted
arbitrarily in denying the claim for benefits.” Twomey v. Delta
Airlines Pension Plan, 328 F.3d 27, 31 (1st Cir. 2003) (citing
Leahy v. Raytheon Co., 315 F.3d 11, 18 (1st Cir. 2002)). A
decision to deny benefits to a beneficiary will be upheld if the
3
For purposes of reviewing benefit determinations by an ERISA
plan administrator, the arbitrary and capricious standard is
functionally equivalent to the abuse of discretion standard. See
Pari-Fasano v. ITT Hartford Life & Accident Ins. Co., 320 F.3d 415,
419 (1st Cir. 2000). We refer to the relevant standard as “abuse
of discretion review.”
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administrator’s decision “[was] reasoned and supported by
substantial evidence.” Gannon v. Metro. Life Ins. Co., 360 F.3d
211, 213 (1st Cir. 2004); see also Boardman, 337 F.3d at 15
(holding that a district court can “overturn [an administrator’s]
termination decision only if ‘the insurer’s eligibility
determination was unreasonable in light of the information
available to it’”)(internal citation omitted). Evidence is
substantial when it is “reasonably sufficient to support a
conclusion.” Id. Evidence contrary to an administrator’s decision
does not make the decision unreasonable, provided substantial
evidence supports the decision. See Gannon, 360 F.3d at 213; see
also Doyle, 144 F.3d at 184 (“Sufficiency, of course, does not
disappear merely by reason of contradictory evidence.”).
In applying the arbitrary and capricious standard,
however, the existence of a conflict of interest on the part of the
administrator is a factor which must be considered. Firestone Tire
& Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). In this Circuit,
if a court concludes there is an improper motivation amounting to
a conflict of interest, the court “may cede a diminished degree of
deference--or no deference at all--to the administrator’s
determinations.” Leahy, 315 F.3d at 16. However, “[a] chimerical,
imagined, or conjectural conflict will not strip the fiduciary’s
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determination of the deference that otherwise would be due.”4 Id.
If no conflict of interest is apparent, a court must proceed to
ensure that the decision was not objectively unreasonable in light
of the available evidence, recognizing that the existence of a
potential conflict of interest will affect the court’s
determination of what was reasonable conduct by the insurer under
the circumstances. Pari-Fasano, 230 F.3d at 419.
Here, there is no dispute that the Plan confers
discretion on the Plan Administrator. See App. at A147. The
parties disagree, however, as to whether Hartford labored under a
conflict of interest. Thus, before addressing the substantive
merits of the district court’s decision, it is necessary to
determine whether there was a conflict of interest, such that the
district court should have considered this as a factor in its
arbitrary and capricious review.
B. Conflict of Interest
Wright argues that Hartford labored under a conflict of
interest, as evidenced by (1) its dual status as payor of benefits
and administrator with respect to the LTD benefits and (2) other
factors that Wright claims evidence an “improper motivation.”
Upon a de novo review of the evidence, we conclude that
the district court properly rejected Wright’s claims that Hartford
4
The burden is on the claimant, here Wright, to demonstrate a
conflict of interest. Pari-Fasano, 230 F.3d at 418.
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acted under a conflict of interest.
1. Conflict Based on Status
Turning first to Wright’s structural conflict of interest
claim, the district court concluded that, although Hartford clearly
had a financial incentive to maximize profits with respect to the
LTD Plan, which it fully insured, the potential that it would deny
claims based on self-interest was not alone sufficient to alter the
standard of review. See App. at A89. Under the law of this
Circuit, “[t]he fact that [] the plan administrator[] will have to
pay [the plaintiff’s] claim[] out of its own assets does not change
[the arbitrary and capricious] standard of review.” Glista v. Unum
Life Ins. Co. of Am., 378 F.3d 113, 125-26 (1st Cir. 2004) (noting
that simply because a plan administrator has to pay a claim does
not deprive the administrator of discretion when the terms of the
plan grant discretion); see also Doe v. Travelers Ins. Co., 167
F.3d 53, 57 (1st Cir. 1999); Doyle, 144 F.3d at 184.
In Pari-Fasano, the Court acknowledged that an insurer
“does have a conflict of sorts when a finding of eligibility means
that the insurer will have to pay benefits out of its own pocket,”
but determined that the market presents competing incentives that
substantially minimize the apparent conflict of interest. 230 F.3d
at 418. In Doyle, the Court identified the competing incentives,
explaining that employers have benefit plans to please employees
and, consequently, will not want to keep an overly tight-fisted
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insurer. 144 F.3d at 184. Thus, according to the Court, an
insurer could “hardly sell policies if it is too severe in
administering them.” Doe, 167 F.3d at 57.
Wright acknowledges this precedent but argues that the
rationale relied upon in these decisions overstates the ability of
market forces to minimize the apparent conflict. The district
court similarly was troubled by what it deemed the “false premise”
that an ERISA plan administrator that also has a financial stake in
the benefit decisions can act as a disinterested trustee. Bound by
well-established precedent, however, the court properly declined to
apply a less deferential standard due to the alleged structural
conflict.5
5
We also are bound by decisions of prior panels of this
Circuit, absent an opinion by the Supreme Court, an en banc opinion
of the Circuit or statutory overruling. See Iguarta-De La Rosa v.
United States, 386 F.3d 313, 313 (1st Cir. 2004). We are
nevertheless mindful that other circuits have rejected the market
forces rationale and specifically recognized a conflict of interest
when the insurer of an ERISA plan also serves as plan
administrator, although there is no consistent approach in
accordingly adjusting the standard of review. See, e.g., Fought v.
UNUM Life Ins. Co. of Am., 379 F.3d 997 (10th Cir. 2004) (holding
that plan administrators acting under an inherent conflict of
interest have the burden of showing that their decision to deny
disability benefits is supported by substantial evidence); Davolt
v. Executive Comm. of O’Reilly Auto., 206 F.3d 806, 809 (8th Cir.
2000) (noting that de novo review may apply where “relationship
places the ERISA benefits plan administrator in a perpetual
conflict of interest”); Atwood v. Newmont Gold Co., 45 F.3d 1317,
1323 (9th Cir. 1995) (presuming conflict and shifting burden of
proof to insurer); Brown v. Blue Cross & Blue Shield of Ala., Inc.,
898 F.2d 1556, 1566-67 (11th Cir. 1990) (same); Pinto v. Reliance
Standard Life Ins. Co, 214 F.3d 377, 393 (3rd Cir. 2000) (adopting
sliding scale approach); Doe v. Group Hospitalization & Med. Serv.,
3 F.3d 80, 87 (4th Cir. 1993) (same); Wildbur v. ARCO Chem. Co.,
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2. Conflict Based on Improper Motivation
Having rejected Wright’s structural conflict of interest
argument, the district court turned to an examination of Wright’s
claims that Hartford was improperly motivated, see Doyle, 144 F.3d
at 184, finding each unpersuasive. On appeal, Wright claims that
the district court erred in failing to find a conflict of interest
on the part of Hartford based on: (1) the timing of the benefit
denial, coming immediately before Hartford would be financially
exposed under the LTD plan; (2) the fact that the medical evidence
supporting Wright’s claim was never reviewed by a physician prior
to Hartford’s denial of the STD and LTD claims on November 29,
2001; (3) the fact that the same examiner made both the STD and LTD
benefit determinations; (4) the fact that Hartford did not have a
copy of Wright’s job description prior to its denial of STD and LTD
benefits on November 29, 2001; and (5) Hartford’s refusal to
fulfill Wright’s requests for certain documentary evidence
concerning his claim.
a. Timing of Denial of STD and LTD Benefits
Wright claims that the timing of the rejection of both
his STD and LTD benefits—-as the LTD benefit date was approaching—-
demonstrated an actual conflict of interest. According to Wright,
Hartford granted STD benefits to Wright when it did not have a
974 F.2d 631, 638-42 (5th Cir. 1992) (same); Van Boxel v. Journal
Co. Employees’ Pension Trust, 836 F.2d 1048, 1052-53 (7th Cir.
1987) (same).
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financial stake in the payment of benefits and then denied benefits
to Wright as the time approached when Hartford would be financially
liable. After a thorough review of the evidence, however, the
district court found that it was apparent that the decision to
terminate benefits was based on the evolving state of plaintiff’s
medical record. This conclusion was amply supported by the
evidence.
Hartford granted Wright’s STD benefits beginning on June
27, 2001. See App. at A379. Hartford extended the STD benefits
until August 20, 2001, after being informed by Plaintiff’s primary
care physician, Dr. Cohen, that Wright had undergone or would be
undergoing neuropsychological testing shortly. See id. at A189;
id. at A201; id. at A380. During the summer and fall of 2001, no
test results were provided to Hartford. Hartford, nevertheless,
extended STD benefits to September 23, then to October 14, and
finally to October 28, 2001, based on Dr. Cohen’s statements that
Wright should not return to work until the results of
neuropsychological testing were known. See id. at A189; id. at
A197; id. at A248. During that time, Hartford consistently
informed Wright that it was awaiting the results of
neuropsychological testing that would document the severity of his
self-reported memory loss. See id. at A192-A200. Following Dr.
Avery’s Neuropsychological Assessment on October 2, 2001, Dr. Cohen
submitted an APS, indicating a level of impairment below that of
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“[l]imited in performing some occupational duties.” Id. at A191.
Dr. Cohen additionally reported to Hartford that the tests showed
that “short term memory is good” but that Wright had some “weakness
recalling long term events and narriatives[sic].” See id. at A193.
Dr. Cohen indicated that Wright’s MRI was normal. See id. Dr.
Dalby submitted an APS shortly thereafter, stating that Wright
suffered “severe short term memory loss.” This finding directly
contradicted the neuropsychological test results, as reported by
Dr. Cohen. See id. at A213.
Wright, thus, did not present a consistent
diagnosis or opinion on functional limitation. Hartford’s
decision to deny further benefits was reasonably based on evidence
indicating that Wright did not suffer the limitations in performing
his essential job functions that would qualify him for the
disability benefits. The timing of the denial of benefits did not
evidence an improper motivation on the part of Hartford, amounting
to a conflict of interest.
b. Denial of Benefits Initially Made Without
Review by Physician
Wright argues that Hartford did not have a physician
review his medical record before denying his STD and LTD claims on
November 29, 2001, evidencing that the decisions were based on an
actual conflict of interest. The district court properly rejected
this argument.
As Appellees indicate, courts have not required that an
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ERISA claimant’s medical records always be independently verified
by medical doctors as a prerequisite to a benefit determination.
See generally Brigham v. Sun Life, 317 F.3d 72, 85 (1st Cir. 2003)
(concluding administrator not required to conduct independent
medical evaluation when treating physician’s reports supported
finding of no disability).
Here, it is clear that the plan administrator reviewed
the documentation submitted by Wright’s primary care physician, Dr.
Cohen, who opined in his APS that Wright’s symptoms were not so
severe as to prevent him from performing occupational functions.
See App. at A245. Hartford was not acting in bad faith, or under
an improper motivation, in relying on Dr. Cohen’s conclusions to
deny benefits to Wright without an independent medical evaluation.
c. Use of Same Examiner for STD and LTD Benefit
Determinations
Wright argues that the same claims examiner denied both
the STD and LTD claims, thus indicating that there was no
“independence between Hartford’s STD and LTD departments.”
Appellant’s Br. at 28. The district court correctly determined
that the fact that the same examiner made both LTD and STD benefits
determinations did not demonstrate a conflict of interest.
There are no statutory or regulatory provisions under
ERISA requiring independence, and Wright cites to no authority
indicating that such an overlap makes benefits decisions suspect.
Furthermore, it is clear that the claims administrator reviewed the
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medical evidence submitted by Wright and based the benefits
determination largely on the conclusions of Wright’s own physician,
Dr. Cohen. See App. at A245.
d. Hartford Did Not have a Copy of Wright’s Job
Description Before Denying Benefits
Wright claims that Hartford’s failure to obtain a copy of
his job description before denying benefits on November 29, 2001
evidences Hartford’s bad faith. The district court properly
rejected this argument.
It was Wright’s burden to provide evidence that he was
unable to perform the duties of his occupation. See Boardman, 337
F.3d at 16. An integral part of that evidence would be a statement
of what his job required. Wright never submitted such a statement.
Instead, Hartford actively sought out and obtained a copy of
Wright’s job description during the review process.6 See App. at
A102-103.
e. Hartford’s Refusal to Fulfill Wright’s Requests for
Certain Documentary Evidence
Wright claims that Hartford declined to provide him with
a transcript of a telephone conversation between them, and with a
6
Wright also contends that Hartford’s criticism of Dr. Dalby’s
conclusion that Wright was disabled from performing his job because
Dr. Dalby was not aware of Wright’s job description evidenced
Hartford’s improper motivation. Although Dr. Dalby indicated to
Hartford that he was aware that Wright’s job required giving
presentations, see App. at A273, the district court properly found
no indication of bad faith in Hartford’s concern about Dr. Dalby’s
lack of information about the specific requirements of the
occupation for which Wright claimed disability.
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copy of the Summary Detail Report--which contained summaries of
Hartford’s communications with Wright, his doctors, and among
examiners--despite his written requests. Hartford responds that it
did provide one requested telephone transcript and that a second
one was requested for an occasion when, in fact, only a recorded
message had been left on Wright’s voicemail. As for the Summary
Detail Report, Hartford indicates that the substance thereof was
either already known to Wright, or was communicated to him in
letters, telephone conversations and copies of his claim file from
Hartford.
It appears that Hartford did provide adequate documentary
evidence to Wright, and we decline to interpret the omission of the
Summary Detail Report as an indication of bad faith.
Wright, thus, failed to establish any improper
motivations on the part of Hartford, amounting to a conflict of
interest. Accordingly, the district court properly reviewed the
substantive merits of Wright’s claims under an arbitrary and
capricious standard.
C. Review of Denial of Wright’s STD and LTD Claims
Wright argues that even under the deferential arbitrary
and capricious standard Hartford’s denial of Wright’s STD and LTD
benefits was not supported by substantial evidence. Specifically,
Wright claims that Dr. Lieberman’s diagnosis of sleep apnea, along
with his opinion that Wright was totally disabled, “cannot
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reasonably be diminished by any other evidence in Mr. Wright’s
file.” Appellant’s Br. at 32.
The district court found that there was not substantial
disagreement that Wright suffered from sleep apnea or that Wright’s
memory was generally average or above, except for some limited
areas--causing some impairment to his cognitive capacities. See
App. at A93. The district court noted, however, that based on the
entire medical record there was disagreement among all the
physicians (including Wright’s treating physicians and Hartford’s
independent medical examiners) as to the extent of the impairment
and the impact on Wright’s ability to perform his essential job
functions. Id.; see Matias-Correa v. Pfizer, Inc., 345 F.3d 7, 12
(1st Cir. 2003) (noting that it is not the court’s role to evaluate
how much weight an insurer should have accorded the opinion of an
independent medical consultant relative to the opinions of a
claimant’s own physicians). The district court reasoned that
although there was conflicting medical evidence, there was
sufficient evidence that Wright’s impairments were minor and not
disabling according to the STD and LTD Plan provisions. Id.; see
also Vlass v. Raytheon Employees Disability Trust, 244 F.3d 27, 30
(1st Cir. 2001) (“[T]he existence of contradictory evidence does
not, in itself, make the administrator’s decision arbitrary.”).
Mindful of the deferential nature of arbitrary and
capricious or abuse of discretion review, we conclude that the
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district court properly granted summary judgment in favor of the
defendants.
III. CONCLUSION
For the reasons set forth above, we agree with the lower
court’s conclusion that the termination of Wright’s STD benefits
and denial of Wright’s LTD benefits, as a matter of law, did not
violate ERISA. We therefore affirm the summary judgment dismissing
Wright’s action.
AFFIRMED.
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