United States Court of Appeals
Fifth Circuit
F I L E D
IN THE UNITED STATES COURT OF APPEALS
June 27, 2007
FOR THE FIFTH CIRCUIT
Charles R. Fulbruge III
Clerk
No. 06-50386
c/w 06-50564
SUSAN GOTHARD,
Plaintiff-Appellee,
versus
METROPOLITAN LIFE INSURANCE CO.;
BUSINESS MEN’S ASSURANCE COMPANY OF AMERICA,
Defendants-Appellants.
Appeals from the United States District Court
For the Western District of Texas
Before HIGGINBOTHAM, DAVIS, and WIENER, Circuit Judges.
PATRICK E. HIGGINBOTHAM, Circuit Judge:
Susan Gothard sued her disability-plan fiduciary, MetLife, for
terminating her long-term disability payments. The district court
granted Gothard's motion for summary judgment, ruling that MetLife
abused its discretion because its decision was not supported by
substantial evidence. We must reverse because we conclude that it
was.
I
A
Susan Gothard worked as a legal secretary until she injured
her back on Feburary 6, 2001. She had surgery for a herniated
disc, but her recovery was cut short by a car accident, which made
her injury permanent. On May 4, 2001 she applied for long-term
disability benefits, was approved, and collected benefits until
MetLife terminated them in July 2003, finding that she could
perform sedentary work. Gothard filed this suit in federal
district court, and on cross-motions for summary judgment, the
district court held that MetLife’s decision to terminate her
benefits was arbitrary and capricious.
B
After her surgery, Gothard was under the care of Dr. Hunley
Chapman. On November 26, 2002, Dr. Chapman examined Gothard and
found that she would never return to work. He noted that she
reported pain as 8 out of 10, that it came on suddenly, that it was
better while she was lying down or had her legs elevated, and that
it was worse while sitting in a soft chair, walking for more than
10 minutes, or standing for more than five minutes. He noted a 50%
limitation in her lumbar range of motion. Dr. Chapman also
completed an assessment for MetLife. He reported that Gothard
could not lift over 10 pounds, but that she could do any of the
following activities for up to 33% of the time: bend, sit, drive,
push/pull, stand, walk, climb, craw, and squat/stoop. In the
“other limitation” section he noted that Gothard should not do any
long-term sitting or standing.
Upon reviewing this medical report, the MetLife case manager
notified Gothard that her file was being refered to a Nurse
2
Consultant for review because, in the case manager’s opinion,
Gothard should have been able to return to work as a legal
secretary. The Nurse consultant agreed, noting that even though
Gothard had been awarded SSI benefits, her medical file did not
support her claim that she couldn’t perform sedentary work.
Indeed, Dr. Chapman had noted that Gothard might be a candidate for
evaluation by the Texas Rehabilitation Commission.
MetLife’s decision to terminate Gothard’s benefits was soon
put on hold. In late January of 2003, Gothard received an epidural
steroid injection, and MetLife decided to wait for the updated
medical records. Those records indicated that Gothard had
progressed and responded to treatment. Dr. Chapman removed the
limitation on lifting up to 10 pounds, stating that Gothard could
occasionally, up to 33% of the time, carry up to 10 pounds. He
also reduced her medication, from six prescriptions to two. He
reiterated his 33% restriction on bending and sitting and standing.
In the same report, Dr. Chapman noted that Gothard could “never”
return to work. A few months later, in April of 2003, Gothard
reported that her pain was only of moderate discomfort, that it
came on gradually, and that it was better when she was sitting.
The plan’s definition of disability is time dependant, and May
8, 2003 was an important transition date under the plan. For the
first 24 months of benefits, disability is defined as when “the
insured cannot perform the essential duties of his or her regular
3
occupation on a full-time basis.” After 24 months, disability is
defined as when “the insured cannot perform the essential duties of
any occupation for which he or she is reasonably fitted by
training, education, or experience on a full-time basis.”
After May 8, 2003, MetLife conducted a labor market survey to
determine whether any jobs were available for Gothard. The survey
classified Gothard as a “secretary,” using the Department of
Labor’s Dictionary of Occupational Titles. The survey reported
that
all of the employers contacted regarding possible
sedentary jobs indicated sedentary work requirements with
no greater lifting than 10 lbs. And primarily sitting,
although this type of job would allow for change in
position. All of the positions would require occasional
bending (accommodations could be made).
MetLife concluded from this survey that Gothard could work several
jobs in the Waco area based on her training, education, and
experience. MetLife terminated Gothard’s LTD benefits in a letter
dated July 21, 2003.
Gothard filed an administrative appeal. Her record was
reviewed by Dr. Amy Hopkins, who found that Gothard’s medical file
contained no objective support for the proposition that Gothard was
unable to perform sedentary work. Dr. Hopkins reported that
Repeated exams by Dr. Chapman were notable only for LS
junction tenderness and reduced LS [range of motion].
There was not objective evidence of any radiculopathy,
neuropathy, myopathy, or plexopathy. Dr. Chapman also
noted on both 11/26/02 and 1/17/03 that [Gothard] had a
sedentary work capacity. Since [Gothard’s] own
4
occupation was sedentary, there was no objective support
in this file for [Gothard’s] inability to perform the
material duties of her own occupation.
Indeed, according to Dr. Hopkins’s review of the medical records,
there was nothing preventing Gothard from returning to her own
occupation. That is, Dr. Hopkins opined that nothing in the
medical record supported any restrictions on sitting, walking,
standing, or bending. Based on this opinion, on March 22, 2004,
MetLife upheld its own decision to terminate Gothard’s benefits.
Gothard then filed this lawsuit in federal district court, and the
district court granted Gothard’s cross motion for summary judgment.
II
A
MetLife is the plan fiduciary, vested with the discretionary
authority to determine disability claims under the plan. As such,
a district court may reverse MetLife’s decision regarding benefits
only for an abuse of discretion that yields an arbitrary and
capricious decision.1 A decision is arbitrary only if “made
without a rational connection between the known facts and the
decision or between the found facts and the evidence.”2 Our
standard of review is informed by MetLife’s conflict of interest,
for it is both the insurer and administrator of the disability
1
Meditrust Financial Services Corp. v. Sterling Chemicals, Inc., 168 F.3d
211, 214–15 (5th Cir. 1999); Vega v. National Life Ins. Services, 188 F.3d 287,
295 (5th Cir. 1999) (en banc).
2
Bellaire, 97 F.3d at 828-29.
5
plan.3 We therefore apply a “sliding scale standard” and accord
MetLife’s decision less than full deference,4 reviewing the
district court’s grant of summary judgment de novo.5
B
MetLife urges this court to reverse, arguing that it did not
abuse its discretion in terminating benefits because there is
substantial evidence that Gothard could do sedentary work. Gothard
responds that, according to her treating doctor’s orders, she can
only sit for up to 33% of the work day, too little time for full-
time sedentary work. Gothard also notes that her treating doctor
opined that she could “never” return to work.
There is substantial evidence in support of Metlife’s
conclusion. Its labor market survey adopted the 33% sitting
limitation that was proposed by Gothard’s treating physician. The
survey found that even though sedentary jobs primarily involve
sitting, such sedentary jobs “would allow for change in position”
and that though all of the positions would require occasional
bending, “accommodations could be made.”
Even if this were not the case, the report of MetLife’s
consulting physician still provides substantial evidence in support
of MetLife’s decision. The Supreme Court has held that “plan
3
Id. at 295–97.
4
Id.
5
Baker v. Metropolitan Life Ins., 364 F.3d 624, 628 (5th Cir. 2004).
6
administrators are not obliged to accord special deference to the
opinions of treating physicians.”6 Accordingly, this court has
held that an administrator does not abuse its discretion when it
relies on the medical opinion of a consulting physician whose
opinion conflicts with the claimant’s treating physician.7 This is
so even if the consulting physician only reviews medical records
and never physically examines the claimant, taxing to credibility
though it may be.8
Dr. Hopkins reviewed the same medical records as the treating
physician and reached a different conclusion, opining that the
medical records did not support any restrictions that would prevent
Gothard from working as secretary. This conclusion, reached from
a desk in Connecticut, is in plain conflict with the treating
physician’s note that Gothard could “never” return to work. Yet
plan fiduciaries are allowed to adopt one of two competing medical
views, a rule which resolves this appeal in favor of MetLife.
We do not hold that a plan fiduciary has no obligation to
consider the basis of the expert opinion on which they are relying
at summary judgment, or that a fiduciary may rely on an opinion
that is in plain conflict with medical records. That is not this
6
Black & Decker Disability Plan v. Nord, 538 U.S. at 831.
7
Gooden v. Provident Life, 250 F.3d 329, 335 n.9 (5th Cir. 2001); MediTrust
v. Fin. Servs. Corp. v. Sterling Chems, 168 F.3d 211, 213 (5th Cir. 1999);
Sweatman v. Commercial Union Ins., 39 F.3d 594, 597 (5th Cir. 1994).
8
Id.
7
case. Dr. Hopkins opinion can be arguably supported by the medical
record, two assessments by Dr. Chapman, and the office visit notes.
Further, the labor market survey conducted by MetLife indicates
that sedentary jobs, requiring less than 33% sitting without change
of position, are available in the Waco labor market. We cannot say
that this finding is sustained by our experience or that it does
not conflict with our own judgment of what is required of a legal
secretary, yet the relevant question, by the terms of the plan, is
whether Gothard is “suited for any occupation for which he or she
is reasonably fitted by training, education, or experience on a
full-time basis.” MetLife’s decision may not be correct, but we
cannot say that it was arbitrary.9 The judgment of the district
court is REVERSED and REMANDED with instructions to enter judgment
in favor of MetLife.
9
We are not persuaded by MetLife’s suggestion that the district court gave
undo weight to a finding of disability under the federal social security scheme.
8