Opinion
Civil Action No. 3-04-CV-0995-P.
March 22, 2005
MEMORANDUM OPINION AND ORDER
Now before the Court are Defendant's Motion for Summary Judgment and Defendant's Motion in Limine, both filed January 18, 2005. Plaintiff did not file a response to either motion. After a thorough review of the briefing, the summary judgment evidence, and the applicable law, the Court GRANTS Defendant's Motion for Summary Judgment and DENIES as MOOT Defendant's Motion in Limine.
I. Background
Plaintiff Linda Barr suffered injuries to her knees and back while working as a Deli/Bakery Manager at Winn Dixie. (Pl.'s Compl. at 1-2; Def.'s App. at 291.) During the relevant times, Plaintiff was a participant in a group long term disability benefits plan sponsored by Winn Dixie. (Def.'s Mem. in Supp. of Summ. J. at 2.) The group long term disability benefits plan was part of an insurance policy issued by Defendant Hartford Life Group Insurance Company under Policy No. SR-201027 (the "Plan"). Id. In February 2002, Plaintiff submitted a claim under the Plan seeking long term disability benefits for her injuries. ( See Def.'s App. at 291.)
Although Plaintiff has referred to the Defendant as CNA Group Life Assurance Company, Defendant's correct and proper name is Hartford Life Group Insurance Company. (Def.'s Mem. in Supp. of Summ. J. at 1.)
Under the terms of the Plan, a participant could be eligible for long term disability benefits for "Own Occupation" and/or for "Any Occupation." ( See Def.'s App. at 20, 64.) If during the applicable time period, the participant, by virtue of her physical condition, was unable to perform the substantial and material duties of her own occupation and was otherwise not working, she qualified for Own Occupation disability benefits. See id. If a participant remained disabled for an additional time period and the participant's injury or illness rendered her unable to perform the duties of any occupation for which she was or could become qualified by education, training and/or experience, the individual could receive Any Occupation disability benefits. See id. Defendant, acting as administrator of the Plan as well as the insurer, held discretionary authority to make eligibility and coverage decisions. Id. at 13.
After receiving Plaintiff's claim, Disability Specialist Frank Matrinko ("Matrinko") conducted an extensive interview of Plaintiff. ( See Def.'s App. at 286-87.) In the interview, Matrinko learned about Plaintiff's injuries, her medical treatment, and the names of her treating physicians. See id. He also obtained information about the activities of her daily living, her duties and functions as Deli/Bakery Manager, and her education. See id. Subsequently, Matrinko requested and/or obtained medical records and information from Plaintiff's treating physicians, including Dr. Ralph Roye, Dr. Adam Arredondo, and Dr. Stephen Ozanne. See id. at 171-280. He also obtained information from Winn Dixie concerning the extent of Plaintiff's job duties. See id. at 167.
Nurse Case Manager Eileen Taylor, R.N. ("Taylor"), conducted a review and evaluation of all the Plaintiff's medical records and evaluated whether Plaintiff's reported medical condition would preclude Plaintiff from performing as the Deli/Bakery Manager of Winn-Dixie. ( See Def.'s App. at 115, 126.) As the Deli/Bakery Manager at Winn Dixie, Plaintiff primarily engaged in management duties, but she also had some physical duties. Id. at 291-93. Taylor concluded that Plaintiff would be unable to work as Deli/Bakery Manager of Winn-Dixie and recommended that Plaintiff receive Own Occupation disability benefits. See id. at 115. Matrinko subsequently approved Taylor's recommendation, id. at 114, and Plaintiff received Own Occupation disability benefits. See id. at 124-25.
Defendant then evaluated Plaintiff to determine whether she qualified for Any Occupation disability benefits. ( See Def.'s App. at 114.) For this evaluation, Matrinko submitted Plaintiff's information to Vocational Case Manager Thomas Casella ("Casella") for review. See id. Casella obtained additional information from Plaintiff's treating physicians, see id. at 144-151, and conducted a vocational assessment to determine Plaintiff's vocational capabilities based on her medical diagnosis, functioning based on medical records, work experience, education, activities of daily living, and geographic location. See id. at 119-20. In particular, Casella considered the following information:
1. Plaintiff's physicians reported that she is able to sit, stand, and drive, but that she is limited in her sitting, standing, walking, bending, squatting, and lifting. See id. at 108, 117-118.
2. Plaintiff reported that she is able to drive, pay bills and assist in performing household chores. Id. at 286-87. Additionally, she has utilized her home computer, attended church and taken care of a fish. Id. She stretches in order to gain more mobility. Id. She cannot perform yard work. Id.
3. With regard to Plaintiff's psychological condition, Plaintiff's treating physician indicated that she only has moderate anxiety and/or depression and that her condition has improved. Id. at 130-131. Her treating physician also noted that it will be important for the Plaintiff to pursue vocational assistance and to possibly start in an educational program. Id. Plaintiff's treating physician does not indicate that Plaintiff cannot perform any work activities based on her psychological condition. See id.
Based on the information Casella considered, he determined that Plaintiff had the ability to perform alternative work activities that were primarily sedentary in nature. (Def.'s App. at 117-18.) Consequently, Defendant determined that Plaintiff was ineligible for Any Occupation disability benefits. Id. Defendant advised Plaintiff of this determination by letter dated June 19, 2002. Id.
Plaintiff then appealed to Defendant's Appeals Committee for formal review, and Defendant's initial decision on Any Occupation benefits was upheld because the medical evidence failed to substantiate a conclusion that Plaintiff was unable to perform any occupation for which she was or could become qualified by education, training and/or experience. ( See Def.'s App. at 100.)
As a result, Plaintiff filed suit against Defendant on April 1, 2004 in state court for breach of contract and violations of the Texas Deceptive Trade Practices and Consumer Protection Act. (Compl. at 2-3.) On May 11, 2004, Defendant removed the case to this Court based on federal-question jurisdiction under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001, et seq. (2005). Defendant now moves for summary judgment.
II. Motion for Summary Judgment
A. Legal Standard
Summary judgment shall be rendered when the pleadings, depositions, answers to interrogatories and admissions on file, together with affidavits, if any, show that there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett., 477 U.S. 317, 323 (1986). A dispute about a material fact is "genuine" if the evidence is such that a reasonable jury could return a verdict for the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The moving party bears the burden of informing the district court of the basis for its belief that there is an absence of a genuine issue of fact for trial, and of identifying those portions of the record that demonstrate such an absence. Celotex, 477 U.S. at 323.
Once the moving party has made an initial showing, the party opposing the motion must come forward with competent summary judgment evidence of the existence of a genuine fact issue. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). The party defending against the motion for summary judgment cannot defeat the motion unless she provides specific facts that show the case presents a genuine issue of material fact, such that a reasonable jury might return a verdict in her favor. Anderson, 477 U.S. at 248. She must "go beyond the pleadings and by her own affidavits, or by the depositions, answers to interrogatories, and admissions on file, designate specific facts showing that there is a genuine issue for trial." Giles v. General Elec. Co., 245 F.3d 474, 493 (5th Cir. 2001) (quoting Celotex, 477 U.S. at 324).
When the non-movant fails to provide a response identifying the disputed issues of fact, the Court is entitled to accept the movant's description of the undisputed facts as prima facie evidence of its entitlement to judgment. Eversly v. MBank Dallas, 843 F.2d 172, 173-174 (5th Cir. 1988); Nordar Holdings, Inc. v. W. Sec. (USA) Ltd., No. 3:96-CV-0427-H, 1996 WL 739019, *2 (N.D. Tex. Dec. 18, 1996). The Court has no duty to search the record for triable issues. Ragas v. Tenn. Gas Pipeline Co., 136 F.3d 455, 458 (5th Cir. 1998).
B. Analysis
Plaintiff asserts claims for breach of contract and violations of the Texas Deceptive Trade Practices and Consumer Protection Act. However, because in asserting these claims, Plaintiff attempts to recover benefits under a benefits plan that is an "employee welfare benefit plan" as defined by ERISA, see 29 U.S.C. § 1002(1), ERISA preempts Plaintiff's state law claims and serves as the exclusive cause of action for her claims. See Vega v. Nat'l Life Ins. Servs., Inc., 188 F.3d 287, 291 (5th Cir. 1999).
Defendant argues that Plaintiff cannot recover under ERISA because Defendant's denial of benefits was not arbitrary and capricious. If the administrator of an ERISA plan had discretionary authority to determine eligibility for benefits or to interpret plan terms, the reviewing court must apply the arbitrary and capricious standard of review to a claim for denial of benefits. Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). There is no dispute that the Plan gave the Plan Administrator, Defendant, discretion to determine eligibility and benefits under the Plan. (Def.'s App. at 13.) Therefore, the arbitrary and capricious standard is the correct standard of review to apply to Plaintiff's claim for denial of benefits.
The arbitrary and capricious standard is also referred to as the "abuse of discretion standard." Brown v. Metropolitan Life Ins. Co., 364 F.3d 624, 629 n. 9 (5th Cir. 2004) (citing Wildbur v. ARCO Chemical Co., 974 F.2d 631, 635 n. 7 (5th Cir. 1992)). "When reviewing for arbitrary and capricious actions resulting in an abuse of discretion, [courts] affirm an administrator's decision if it is supported by substantial evidence. 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." Meditrust Financial Services Corp. v. Sterling Chemicals, Inc., 168 F.3d 211, 215 (5th Cir. 1999) (internal quotes and citations omitted).
Defendant asserts that its denial of long term disability benefits was not an abuse of discretion and was not arbitrary and capricious. Defendant presents evidence that in making the decision to deny Plaintiff Any Occupation benefits, Defendant comprehensively reviewed Plaintiff's information. This information consisted of records from Plaintiff's treating physicians, results of medical evaluations, results of a vocational assessment, and information obtained from Plaintiff and her employer. This information revealed that Plaintiff was capable of sitting, standing, driving, paying bills, doing chores, using a computer, caring for her fish and attending church. Based on this information, Defendant concluded that Plaintiff was capable of performing in a sedentary occupation, and as a result, she did not qualify for Any Occupation benefits. Hence, Defendant has demonstrated that a rational connection exists between the known facts and the decision and between the found facts and the evidence.
Plaintiff does not dispute Defendant's version of the facts, and thus, Plaintiff has failed to raise a fact issue with regard to whether Defendant's decision to deny long term benefits was arbitrary and capricious. Accordingly, Defendant's Motion for Summary Judgment is hereby GRANTED.
III. Motion in Limine
Defendant's Motion in Limine seeks to exclude any documentary evidence or testimony submitted to the Court by Plaintiff that was not also submitted to Defendant in the claims process or as part of the Administrative Record. (Mot. in Limine at 2.) Because Plaintiff has not submitted any documentary evidence or testimony in Response to Defendant's Motion for Summary Judgment and because Defendant's Motion for Summary Judgment is granted, Defendant's Motion in Limine is hereby DENIED as MOOT.
IV. Conclusion
For the reasons stated herein, the Court GRANTS Defendant's Motion for Summary Judgment and DENIES as MOOT Defendant's Motion in Limine.
IT IS SO ORDERED.