United States Court of Appeals
Fifth Circuit
F I L E D
UNITED STATES COURT OF APPEALS
August 20, 2007
FOR THE FIFTH CIRCUIT
Charles R. Fulbruge III
Clerk
No. 06-11370
Summary Calendar
ANDREA D. PYLANT,
Plaintiff-Appellant,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, and
THE FIRST AMERICAN CORPORATION GROUP LIFE, MEDICAL, DENTAL,
DISABILITY BENEFITS TRUST NO. 502,
Defendants-Appellees.
Appeal from the United States District Court for the
Northern District of Texas, Dallas Division
Before DAVIS, WIENER, and BENAVIDES, Circuit Judges.
BENAVIDES, Circuit Judge:
Plaintiff-Appellant Andrea Pylant appeals the district court’s
grant of summary judgment in favor of Defendants-Appellees Hartford
Life and Accident Insurance Co. (“Hartford”) and The First American
Corporation Group Life, Medical, Dental, Disability Benefits Trust
No. 502 (“Plan”). This case arises from the termination of long-
term disability benefits (“LTD benefits”) by the administrator of
an employee welfare benefit plan governed by the Employee
Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §
1001, et seq. We AFFIRM.
We review a grant of summary judgment de novo, using the same
criteria as the district court. Hanks v. Transcont. Gas Pipe Line
Corp., 953 F.2d 996, 997 (5th Cir. 1992). Summary judgment is
appropriate if the record reflects “that there is no genuine issue
as to any material fact and that the moving party is entitled to a
judgment as a matter of law.” FED. R. CIV. P. 56(c); see also
Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). A court’s role
at the summary judgment stage is not to weigh the evidence or
determine the truth of the matter, but rather to determine only
whether a genuine issue exists for trial. Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 249 (1986). A genuine issue of material
fact exists “if the evidence is such that a reasonable jury could
return a verdict for the nonmoving party.” Id. at 248.
Pylant worked as a technical writer for First American
Financial Corporation (“First American”) from September 2000 until
November 2001, when she quit because of fatigue and pain. In
February 2002, Pylant filed a claim for LTD benefits after being
diagnosed with chronic fatigue, Epstein Barr, cytomegalovirus, and
psoriatic arthritis. Her claim was approved on May 30, 2002, and
she began receiving LTD benefits. In October 2002, Hartford
reevaluated her eligibility for LTD benefits and, based upon an
Attending Physician Statement (“APS”) and Physical Capabilities
Form (“PCF”) completed by Pylant’s doctor, and her own self-
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completed questionnaire, determined that Pylant continued to
qualify for benefits.
Hartford again reviewed Pylant’s eligibility for LTD benefits
in June 2003. This time, Pylant’s claimant questionnaire and the
APS and PCF presented divergent accounts of Pylant’s abilities.
While the questionnaire stated that she could perform almost all
activities of daily living without assistance, and occasionally
attended church and her children’s sporting activities, the APS and
PCF stated that she could never drive a vehicle and could only sit,
stand, or walk for less than fifteen minutes at a time. Based upon
this discrepancy, Hartford’s claims examiner referred Pylant’s
claim to Hartford’s Special Investigations Unit (“SIU”) for further
fact-gathering.
Hartford’s SIU conducted video surveillance of Pylant’s daily
activities for two days in August 2003. During that time, the SIU
observed and recorded Pylant engaged in various activities that
contradicted assessment in the APS and PCF of her condition,
including driving her children to school, removing a child weighing
in excess of twenty pounds from the rear of her car, carrying that
child with both hands into her home, and holding an infant for
eighteen minutes while standing. Based on this surveillance, SIU
conducted an in-person interview with Pylant. Pylant admitted that
she was readily capable of performing the observed activities and
conceded that she had absolutely “no limitations or restrictions”
on how long she could sit.
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In September 2003, Hartford requested that Pylant submit
another claimant questionnaire and have her treating physician
complete another APS and PCF. Pylant’s revised questionnaire
reiterated her disabilities and contradicted her interview
admissions by stating that she could not sit for more than fifteen
minutes. Her doctor’s APS and PCF opined that she could sit,
stand, walk, and drive for approximately an hour at a time. Upon
receiving these documents, Hartford sent Pylant’s doctors copies of
the surveillance video and in-person interview, and asked them,
based on their contact with Pylant and those materials, whether she
could return to work subject to various, specified limitations.
One doctor left a voice mail stating that she agreed that Pylant
could return to work with those limitations. The other doctor
responded to Hartford’s request by stating that Pylant could return
to work on a full-time basis with the restrictions stated.
Hartford then notified Pylant that further benefits would not be
payable beyond January 31, 2004.
Pylant appealed Hartford’s discontinuation of her LTD
benefits. Hartford referred her claim to another doctor, Dr. David
Trock, for independent medical review. Dr. Trock reviewed Pylant’s
medical records and surveillance video and contacted her previous
doctors. Dr. Trock subsequently concluded that Pylant was able to
return to work in a sedentary capacity with restrictions. Hartford
decided to uphold its termination of Pylant’s LTD benefits and sent
Pylant a letter on January 7, 2005, advising her that the appeal
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had been denied. Pylant filed this lawsuit on February 24, 2005,
and the district court granted summary judgment for Hartford.
In analyzing a claim for benefits allegedly due under an ERISA
plan, the district court reviews the plan administrator’s
determination for abuse of discretion when the plan expressly gives
the administration discretionary authority. Vecher v. Alexander &
Alexander Inc., 379 F.3d 222, 226 (5th Cir. 2004). If an
administrator’s decision is supported by substantial evidence, the
court must affirm that decision. Ellis v. Liberty Life Assurance
Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004). However, if
there is a potential conflict of interest, the abuse of discretion
inquiry is altered. Vega v. National Life Ins. Services, Inc., 188
F.3d 287, 297 (5th Cir. 1999). Here, because Hartford is both the
insurer and the administrator, but Pylant has not produced evidence
showing any greater conflict, Hartford’s decision is afforded “only
a modicum less deference” than it would receive in other
circumstances. Id. at 301.
As a preliminary matter, Pylant argues Hartford incorrectly
defined the Plan term “your occupation,” which serves to establish
the minimal baseline of ability necessary to perform her job,
through reference to the Department of Labor’s Dictionary of
Occupational Titles, rather than according to the duties she
actually performed as a technical writer for First American. As a
result, the essential duties of her occupation were lesser than
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those she actually performed with First American. Moreover, Pylant
argues that Hartford incorrectly included functional limitations in
her job description to accommodate her disability.
This Court uses a two-step analysis in determining whether a
plan administrator abused its discretion in construing plan terms.
Rhorer v. Raytheon Eng’rs & Constructors, Inc., 181 F.3d 634, 639
(5th Cir. 1999). First, we determine the legally correct
interpretation of the plan and whether the administrator’s
interpretation accords with that interpretation. Id. If that
construction is legally sound, then no abuse of discretion occurred
and the inquiry ends. Id. at 639–40. If, however, we conclude
that the administrator has not given the plan the legally correct
interpretation, we determine whether the administrator’s
interpretation constitutes an abuse of discretion. Id. at 640. A
substantial factor in determining whether the administrator’s
interpretation is a legally correct interpretation is whether the
interpretation is “fair and reasonable.” Lain v. UNUM Life Ins.
Co. of Am., 279 F.3d 227, 244 (5th Cir. 2002).
The district court cited to a district court opinion from the
Eleventh Circuit in determining that reference to the Department of
Labor’s Dictionary of Occupational Titles was appropriate because
“insurers issuing disability policies cannot be expected to
anticipate every assignment an employer might place upon an
employee outside the usual requirements of his or her occupation.”
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Richards v. Hartford Life & Accident Ins. Co., 356 F.Supp. 2d 1278
(S.D. Fla. 2004), aff’d, 153 Fed. Appx. 694 (11th Cir. 2005). We
agree. Moreover, while Pylant argues that Hartford’s inclusion of
“functional limitations” in the definition of her occupation was
legally incorrect, courts have consistently upheld administrative
claim denials where medical evidence indicates that some
limitations would enable the employee to perform sedentary work.
See, e.g. Walker-Stewart v. Fed. Express Corp., No. H-04-2187, 2005
WL 1185799, at *7 (S.D. Tex. 2005)(upholding denial of benefits
when treating physician and occupational therapist cleared
plaintiff for work with restrictions); Graham v. L&B Realty
Advisors, Inc., No. 3:02-CV-0293-N, 2003 WL 22388392, at *3–4 (N.D.
Tex. Sept. 30, 2003) (upholding denial where physician cleared
plaintiff for work with restrictions). In sum, we find that
Hartford’s interpretation was fair and reasonable, and that
Hartford did not abuse its discretion by relying on the Department
of Labor Dictionary to determine Pylant’s job duties.
Turning to Pylant’s argument that there is no substantial
evidence that she can perform her occupation given her cognitive
problems and inability to do frequent keyboarding, Hartford based
its decision on various sources. The surveillance videotape showed
a mobile person capable of performing a sedentary occupation. When
interviewed post-surveillance, Pylant herself conceded that she
could sit without restriction, contradicting her previous and later
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assertions. Pylant’s own treating physicians stated that she could
return to work as a technical writer. The independent doctor to
whom Hartford subsequently referred Pylant agreed with that
assessment.
It is true that one of the treating physicians later retracted
his statement and asserted that Pylant had “a lot of pain and
cognitive problems” and “was taking some medications that affect
her cognitive function,” but he only did so during the appeals
process, after meeting with Pylant’s attorney. Moreover, he never
mentioned either the type of medications taken or the extent to
which Pylant was affected. During Pylant’s interview, she stated
that she was taking no medications and had not filled a
prescription relating to her disability in a year. As such,
Hartford could rightly afford the doctor’s retraction and
subsequent statements lesser weight. See Gooden v. Provident Life
& Accident Ins. Co., 250 F.3d 329, 333-34 (5th Cir. 2001) (finding
no abuse of discretion when administrator did not give treating
physician’s changed opinion determinative weight because it was
contrary to physician’s previous opinion and was unaccompanied by
evidence that plaintiff’s medical condition had changed since most
recent evaluation).
Even viewing all evidence in a light most favorable to Pylant,
it is apparent that Hartford based its decision on substantial
evidence. See Sweatman v. Commercial Union Ins. Co., 39 F.3d 594,
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601–03 (5th Cir. 1994) (finding no abuse of discretion when
administrator relied on independent review of medical records and
hired investigator to interview plaintiff). Consequently, Hartford
did not abuse its discretion in terminating Pylant’s LTD benefits,
and the district court did not err in granting summary judgment as
there was no question of material fact. See FED. R. CIV. P. 56(c).
For the foregoing reasons, we AFFIRM the district court.
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