Grosvenor v. Qwest Corporation

Full title: J. CHARLES GROSVENOR Plaintiff, v. QWEST CORPORATION, and THE QWEST…

Court: United States District Court, D. Utah, Central Division

Date published: Feb 22, 2005

Case No. 2:03CV00897 DS (D. Utah Feb. 22, 2005)

Opinion

Case No. 2:03CV00897 DS.

February 22, 2005

MEMORANDUM OPINION AND ORDER

DAVID SAM, Senior District Judge

I. INTRODUCTION.

Plaintiff J. Charles Grosvenor brought suit against Defendants, Qwest Corporation ("Qwest Corporation") and the Qwest Disability Plan (the "Plan"), collectively ("Qwest"), alleging that he was improperly denied short-term disability benefits by Defendants in violation of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001. Pending before the court for decision are the parties' cross motions for summary judgment. The Plan is an employee welfare benefit plan covered by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001et seq. Plaintiff applied for, and was denied, short-term disability benefits. The Qwest Employee Benefits Committee ("EBC"), is the Plan Administrator and performed the final review of Plaintiff's claim under the Plan. Plaintiff filed this action pursuant to the provisions of ERISA, 29 U.S.C. § 1131, et seq. seeking judicial review of the decision denying him short-term disability benefits.

Plaintiff is a former employee of Qwest Corporation. After allegedly suffering from severe headaches, dizziness, vertigo and tinnitus, Mr. Grosvenor began a leave of absence from his employment. Mr. Grosvenor applied for short term disability benefits ("STD" benefits) under the Plan. Between October 30, 2000 and November 9, 2000, Grosvenor and Catherine Parks, a registered nurse employed by Qwest to review STD claims, had several discussions regarding Grosvenor's medical condition and the terms of the Plan.

On January 16, 2001, Grosvenor was notified by letter that his claim for STD benefits had been denied for the period after October 30, 2001. Ms. Parks had advised Grosvenor that this denial was based upon his failure to provide objective clinical information to support his disability. Grosvenor appealed the denial of his STD benefit claim by letter dated March 5, 2001. On May 18, 2001, Barry Kern, M.D., Appellate Reviewer upheld the denial of Grosvenor's claim concluding that "no exact etiology" was found and that the findings were not consistent with continued disability.

SUMMARY JUDGMENT STANDARD

Under Fed.R.Civ.P. 56, summary judgment is proper only when the pleadings, affidavits, depositions or admissions establish there is no genuine issue regarding any material fact and the moving party is entitled to judgment as a matter of law. The burden of establishing the nonexistence of a genuine issue of material fact is on the moving party. ¹ E.g., Celotex Corp. v. Catrett, 477 U.S. 317 (1986). In determining whether summary judgment is appropriate, the court views all relevant facts in the light most favorable to the party opposing the motion. Summary judgment is appropriate only where the evidence "is free from doubt so that all reasonable [persons] would come to the same conclusion"Schnuphase v. Storehouse Markets, 918 P.2d 476, 477 (Utah 1996).

III. DISCUSSION

A. Standard of Review.

The court has previously held that the arbitrary and capricious standard of review applies to the Administrator's Decision where, as in this case, the plan gives its administrator broad discretionary authority to decide claims as the Plan does. See, Trujillo v. Cyprus Amax Minerals Co. Retirement Plan Committee, 203 F. 3d 733, 736 (10^th Cir 2000) (quoting Charter Canyon Treatment Ctr. v. Pool Co., 153 F.3d 1132, 1135 (10th Cir. 1998) ("`A court reviewing a challenge to a denial of employee benefits under 29 U.S.C. § 1132(a) (1) (B) applies an "arbitrary and capricious" standard to a plan administrator's actions if the plan grants the administrator discretionary authority to determine eligibility for benefits or to construe the plan's terms.'")

In reviewing the Plan Administrator's decision under the arbitrary and capricious standard, the Court is "limited to the `administrative record' — the materials compiled by the administrator in the course of making his decision." Hall v. UNUM Life Ins. Co. of Am., 300 F.3d 1197, 1201 (10^th Cir. 2002). Further, in making its determination under this standard, the Court looks to whether substantial evidence supported the administrator's decision, whether the administrator based its decision on a mistake of law, and whether the administrator conducted its review in bad faith, or under a conflict of interest. Sandoval v. Aetna Life and Casualty Ins. Co., 967 F2d. 377, 380 n. 4 (10^th Cir. 1992).

To withstand judicial scrutiny, "`the Administrator's decision need not be the only logical one nor even the best one.'" Kimber v. Thiokol Corp., 196 F.3d 1092, 1098 (10<sup>th</sup> Cir. 1999) (quoting Woolsey v. Marion Labs., Inc., 934 F.2d 1452, 1469 (10<sup>th</sup> Cir. 1991). "The reviewing court `need only assure that the administrator's decision falls somewhere on a continuum of reasonableness — even if on the low end.'" Id. (quoting Vega v. Nat'l Life Ins. Serv. Inc., 188 F.3d 287, 297 (5^th Cir. 1999)). Thus, the Court will uphold the administrator's decision unless it is not supported by any reasonable basis.

B. Review of Plan Decision.

Qwest contends that the denial of disability benefits to Plaintiff was not arbitrary or capricious and must be upheld. Plaintiff urges that the decision was arbitrary and capricious and must be set aside.

As stated above, under the arbitrary and capricious standard of review, "`[t]he [administrator's] decision will be upheld unless it is not grounded on any reasonable basis. The reviewing court need only assure that the administrator's decision fall[s] somewhere on a continuum of reasonableness — even if on the low end.'" Cirulis v. Unum Corp., 321 F.3d 1010, 1013 (10^th Cir. 2003) (quoting Kimber v. Thiokol Corp., 196 F.3d 1092, 1097 (10^th Cir 1999). Under the Qwest Disability Plan, Grosvenor was entitled to STD benefits only if he provided objective medical documentation, such as x-rays, CT scans or MRIs, confirming his inability to perform his job duties. Def. Memorandum in Support of Motion for Summary Judgment Statement of Facts Nos. 8, 9. However, Grosvenor's physician confirmed that his x-rays, CT scans and MRIs were "unrevealing" and that he was not able to determine the etiology of his symptoms. Id. at No. 11. Further tests by Grosvenor's physicians were also inconclusive in determining or diagnosing the etiology of Grosvenor's alleged symptoms. Given this evidence, the Plan Administrator reasonably concluded that Plaintiff failed to provide objective evidence that he was disabled under the Qwest Plan.

In Kimber v. Thiokol Corporation et al., 196 F3d 1092 (10^th Cir. 1999), the Plan Administrator denied the Plaintiff's claim for disability benefits after determining that he failed to provide objective medical evidence of disability. Id. at 1099. Similar to this case, Plaintiff argued in Kimber that his physicians' statements that he was "disabled" constituted objective medical evidence. The Tenth Circuit rejected this contention stating:

Second, Mr. Kimber argues that Thiokol acted arbitrarily by finding that there was a lack of objective evidence of total disability based upon diabetes. He points to a letter and two reports by Dr. Williams to support his claim . . . A rational plan administrator could find these documents insufficient because they do not contain supporting data for the conclusions reached; for example, the letter from Dr. Williams merely states that Mr. Kimber is "totally disabled secondary to diabetes, hypertension and the problems associated with this," but does not include any reference to clinical data. . . . Id. As in Kimber, Grosvenor's physician's statements that he was disabled do not constitute objective documentation of disability. Grosvenor's physicians never supported their opinion that Plaintiff was disabled with objective medical evidence and were in fact contradicted by the test results from the IHC Balance Center and corresponding release for Plaintiff to return to work. Thus, in accord with Kimber, this Court determines that the Plan Administrator acted reasonably in denying Plaintiff's claim.

Plaintiff further alleges that the Plan Administrator acted arbitrarily and capriciously in failing to consider evidence submitted after May 2001, when the Apellate Reviewer upheld the denial of Plaintiff's claim.Defendants' Memorandum, pp, 8-9. However, the Tenth Circuit has consistently held that a Plan Administrator's decision is not arbitrary and capricious for failing to consider evidence not before it. The Tenth Circuit has stated that "[i]n effect, a curtain falls when the fiduciary completes its review, and for purposes of determining if substantial evidence supported the decision, the district court must evaluate the record as it was at the time of the decision." Sandoval v. Aetna Life and Casualty Ins. Co., 967 F.2d 377 (10^th Cir. 1992). Therefore the Plan Administrator did not act arbitrarily and capriciously with respect to the evidence submitted after the denial of benefits was upheld.

III CONCLUSION

For the reasons stated as well as those set forth in Defendants' pleadings, Plaintiff's Motion for Summary Judgment is DENIED, and Defendants' Motion for Summary Judgment is GRANTED. The Clerk of the Court is requested to enter final judgment accordingly.

IT IS SO ORDERED.