Summary
stating that, although the SSA's disability determination may not be conclusive, it "is relevant to the plan administrator's determination of disability"
Summary of this case from Gellerman v. Jefferson Pilot Financial Ins. Co.Opinion
Civil Action No. 1:04-CV-073-C.
March 21, 2005
ORDER
Came on for consideration Defendants American Electric Power Service Corporation ("AEP") and American Electric Power System Long-Term Disability Plan's ("the Plan") Motion for Summary Judgment, filed February 15, 2005. Plaintiff did not file a response. The Court having considered the Motion and the evidence submitted concludes that, as required by Rule 56 of the Federal Rules of Civil Procedure, no genuine issue of material fact exists and Defendants are entitled to summary judgment as a matter of law. Therefore, Defendants' Motion for Summary Judgment is GRANTED.
I. PROCEDURAL BACKGROUND
Lorenzo Bell ("Plaintiff") filed his Original Complaint on March 18, 2004, in the United States District Court for the Northern District of Texas, Abilene Division, seeking recovery of long-term disability benefits under the Employees' Retirement Income Security Act ("ERISA") statute Section 502(a)(1)(B) ( 29 U.S.C. § 1132(a)(1)(B)) and Section 502(a)(3) ( 29 U.S.C. § 1132(a)(3)). On April 12, 2004, Defendant American Electric Power Service Corporation ("AEP") filed its original answer to Plaintiff's Original Complaint. Plaintiff filed his First Amended Original Complaint on July 15, 2004, listing both AEP and the Plan as Defendants. AEP filed its First Amended Answer to Plaintiff's Original Complaint on July 16, 2004. On July 28, 2004, AEP and the Plan filed their Original Answer to Plaintiff's First Amended Original Complaint. AEP and the Plan filed a Motion for Summary Judgment on February 15, 2005. Plaintiff did not file a response.II. FACTUAL BACKGROUND
Plaintiff was employed as a shopkeeper for American Electric Power Service Corporation ("AEP"). His job responsibilities included keeping the warehouse clean and safe, managing inventory, ensuring the timely delivery of materials, and operating motorized equipment. In March 2001, the Employee Assistance Program required Plaintiff to undergo a mental health evaluation, and Plaintiff was diagnosed with major depression and severe anxiety. Plaintiff took medical leave from work and began receiving short-term disability benefits in April 2001. Initially, Plaintiff was on leave for one week, but the leave was extended to six weeks until June 1, 2001. By October 2001, when the short-term disability benefits terminated, Plaintiff had not returned to work and claimed that he was still disabled.
In September 2001, Plaintiff applied for long-term disability benefits under AEP's Long-Term Disability Plan. Plaintiff alleged that he was still suffering from major depression and insomnia and could not perform his job responsibilities.
A psychiatrist retained by the Plan reviewed Plaintiff's medical documentation to determine whether Plaintiff was disabled under the Plan. Disability was defined as being unable to perform the duties of your job for up to 24 months from the date of disability. Then, after two years, to continue to fit the definition of disabled, the individual had to be "unable to perform the duties of any job for which [that person is] reasonably qualified due to education, training, and experience." Defs. Mot. Summ. J. App. 26-28.
The Plan denied Plaintiff's claim for long-term disability benefits because Plaintiff was not disabled within the Plan's definition. The letter denying Plaintiff long-term disability benefits justified the denial because "[t]he medical records received do not describe an acuity or severity of illness nor provide objective mental status data that documents [your illness] would preclude you from doing the essential duties of your occupation as Shopkeeper." Defs. Mot. Summ. J. App. 29. Plaintiff appealed the denial of benefits in December 2001.
Following the appeal, additional doctors retained by the Plan reviewed Plaintiff's medical records, including progress since the first evaluation. Again, the doctors determined that Plaintiff was not disabled within the Plan's definition and justified their decision based on a lack of data describing an illness so severe that Plaintiff could not work. The doctors reviewed not only Plaintiff's psychiatric records but also Plaintiff's diagnosis of diabetes mellitus and hypertension. The plan's doctors decided that the letters submitted by Plaintiff's doctors did not provide objective mental status data.
In January 2002, Plaintiff's appeal was denied. Defs. Mot. Summ. J. App. 39-41. In March 2002, Plaintiff's wife requested a final appeal. The Plan requested an additional peer review by a psychiatrist, and Plaintiff's claim was again denied in May 2002. Defs. Mot. Summ. J. App. 49.
III. STANDARDS
Summary Judgment
Summary judgment is proper when "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c). All evidence and justifiable inferences must be viewed in the light most favorable to the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). The moving party has the burden of establishing that no genuine dispute of material fact exists. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). No genuine issue of material fact exists unless a reasonable jury could find for the non-moving party. Anderson, 477 U.S. at 247.
After the moving party initially establishes an absence of a genuine issue of material fact, the non-moving party must provide significant probative evidence showing a genuine issue of material fact to defeat the summary judgment. State Farm Life Ins. Co. v. Gutterman, 896 F.2d 116, 118 (5th Cir. 1990). A factual dispute alone does not defeat summary judgment. Anderson, 477 U.S. at 247. Thus, the nonmoving party cannot submit a "mere scintilla of evidence"; the evidence must be sufficient for a jury to reasonably find in the non-moving party's favor. Id. at 252. Conclusory statements, speculation, and unsubstantiated assertions do not show a genuine issue of material fact. Douglass v. United Servs. Auto Ass'n, 79 F.3d 1415, 1429 (5th Cir. 1996) (en banc).
The court cannot grant a motion for summary judgment simply because the non-moving party has not responded. Hibernia Nat'l Bank v. Administracion Central Sociedad Anonima, 776 F.2d 1277, 1279 (5th Cir. 1985). Yet, if the non-moving party does not identify specific issues of disputed fact, the court may take the moving party's description of the facts as prima facie evidence supporting summary judgment for that party. Eversly v. MBank Dallas, 843 F.2d 172, 173-74 (5th Cir. 1999).
ERISA Review
Denial of benefits under ERISA is reviewed de novo " unless the benefit plan gives the administrator or fiduciary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989) (emphasis added). Further, the Fifth Circuit has also held that an abuse-of-discretion standard applies when the administrator's decision is factual in nature, even if the plan does not grant discretion to the administrator. Sweatman v. Commercial Union Ins. Co., 39 F.3d 594, 597-98 (5th Cir. 1994).
An abuse-of-discretion analysis is also referred to as an "arbitrary-and-capricious" standard. Aboul-Fetouh v. Employee Benefits Comm., 245 F.3d 465, 472 (5th Cir. 2001). Thus, an administrator's decision is affirmed "if it is supported by substantial evidence." Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 168 F.3d 211, 215 (5th Cir. 1999) (citation omitted). A decision is arbitrary when no rational connection exists "between the known facts and the decision or between the facts and the evidence." Hurton v. Prudential Ins. Co. of Am., 2002 WL 31415104 (5th Cir. 2002) (quoting Bellaire Gen. Hosp. v. Blue Cross Blue Shield of Mich., 97 F.3d 822, 828 (5th Cir. 1996)). The court must only consider the administrative record available to the plan administrator when the decision was made, not outside evidence, when reviewing a plan administrator's factual determination. Southern Farm Bureau Life Ins. Co. v. Moore, 993 F.2d 98, 102 (5th Cir. 1993).
IV. DISCUSSION
Defendant American Electric Power Service Corporation is dismissed as an improper party. The ERISA statute authorizes a participant or beneficiary to bring suit against the plan as an entity. See 29 U.S.C.A. § 1132(d) (2004). The statute does not authorize actions to be brought against employers. See id. The Fifth Circuit allows participants to bring suit against employers when the employer self-administers the plan so that the employer and plan are so closely intertwined that the plan does not exist separate from the employer. See Slaughter v. ATT Information Sys., Inc., 905 F.2d 92, 93-94 (5th Cir. 1990) (endorsing the employer as a proper party in an ERISA action where the plan is self-administered by the employer). Accordingly, because Plaintiff has not responded to Defendants' Motion for Summary Judgment, the Plaintiff has not submitted any evidence to support its allegation that AEP is the plan administrator. Defendants, however, in their Motion for Summary Judgment, directed the Court to evidence showing that Kemper National Services is the administrator. Once the moving party has submitted evidence in a motion for summary judgment, the nonmoving party has the burden to submit rebuttal evidence disproving the claim. State Farm Life Ins. Co. v. Gutterman, 896 F.2d 116, 118 (5th Cir. 1990). Plaintiff has not done so; therefore, the Court finds that the Plan is not self-administered but is administered by Kemper National Services. Defs. Mot. Summ. J. App. 20-23. Therefore, American Electric Power Service Corporation is not a proper party. See 29 U.S.C. § 1132(d); Holloway v. HECI Exploration Co. Employees' Profit Sharing Plan, 76 B.R. 563, 570 (N.D. Tex. 1987) (citing Gelardi and 29 U.S.C. § 1132(d)), aff'd, 862 F.2d 513 (5th Cir. 1988); Gelardi v. Pertec Computer Corp., 761 F.2d 1323, 1324-25 (9th Cir. 1985); Riordan v. Commonwealth Edison Co., 128 F.2d 549, 551 (7th Cir. 1997); Lee v. Burkhart, 991 F.2d 1004, 1009 (2d Cir. 1993).
The abuse-of-discretion standard applies for two reasons: First, the plan expressly gives the administrator maximum discretionary authority, and second, the administrator made a factual decision when determining whether Plaintiff fit the definition of disability under the plan.
When reviewing a plan administrator's interpretation of a term, the Fifth Circuit sometimes applies a two-step process when reviewing for abuse of discretion. See Gosselink v. American Tel. Tel., Inc., 272 F.3d 722, 726 (5th Cir. 2001). Yet, the Fifth Circuit has acknowledged that the "reviewing court is not rigidly confined to this two-step analysis in every case." Duhon v. Texaco, Inc., 15 F.3d 1302, 1307 n. 3 (5th Cir. 1994). Other district courts within the Fifth Circuit have not applied the two-step process when the case did not turn on plan interpretation issues but only on a factual determination. See Schaffer v. Benefit Plan of Exxon Corp, 151 F. Supp. 2d 799, 806-07 (S.D. Tex. 2001); Trahan v. BellSouth Telecomm., Inc., 847 F. Supp. 54, 55-56 (W.D. La. 1994).
The Court finds that the two-step abuse-of-discretion test does not apply in this case because the case turns on a factual decision, not on plan interpretation.
1. Section 502(a)(1)(B) Claim
After careful consideration, the Court finds that Plaintiff has failed to demonstrate a genuine issue of material fact as to whether Defendant abused its discretion when it found Plaintiff ineligible to receive long-term disability benefits. The Defendants' denial of benefits was not arbitrary and capricious but was based on four reviews from three separate physicians concluding that there was not enough objective evidence to find that Plaintiff could not perform his job responsibilities. These reports show a rational connection between the administrator's decision to deny the benefits and the evidence. See Bellaire Gen. Hosp., 97 F.3d at 828-29.
Special consideration does not have to be given to the view of the treating physicians. See Black Decker Disability Plan v. Nord, 538 U.S. 822, 830-33 (2003) (stating that "[n]othing in [ERISA] suggests that plan administrators must accord special deference to the opinions of treating physicians."). Even though Plaintiff's physician stated that Plaintiff should not return to work and could not perform his job duties, the plan administrator was free to choose between the position of the Plan's consultants and Plaintiff's physician. See Sweatman, 39 F.3d at 602. Plaintiff's physician stated that Plaintiff was disabled yet did not support that conclusion with objective medical evidence or specify which job tasks Plaintiff could no longer perform. Such conclusory statements do not constitute meaningful evidence in a Section 502(a)(1)(B) case. See Abnathya v. Hoffmann-La Roche, Inc., 2 F.3d 40, 47-48 (3d Cir. 1993). The Fifth Circuit has held that a disability plan administrator's decision to not follow a treating physician's generalized statement was neither irrational nor arbitrary when the statement was not supported by objective medical findings. See Simoneaux v. Continental Casualty Ins. Co., 101 Fed. Appx. 10, 2004 WL 1284198, *2-3 (5th Cir. 2004). See also Dwyer v. Metropolitan Life Ins. Co., 2001 WL 94749, at *6 (4th Cir. Feb. 5, 2001) (stating that a treating physician's conclusory statement that the plaintiff was disabled is insignificant).
Further, the plan administrator could rely on its consultants' recommendations even though the consulting physicians did not physically examine the Plaintiff. A review of Plaintiff's medical records is sufficient to support the opinion of a doctor appointed by the plan administrator. See Gooden v. Provident Life Acc. Ins. Co., 250 F.3d 329, 335 (5th Cir. 2001).
Plaintiff also argues that because the Social Security Administration awarded him benefits, the Plan should also have awarded him long-term benefits. The Social Security Administration's determination of disability is relevant to the plan administrator's determination of disability, but the Fifth Circuit has not ruled on whether the Social Security Administration's finding of disability is conclusive. See Moller v. El Camp Aluminum Co., 97 F.3d 85, 87 (5th Cir. 1996). Courts within the Fifth Circuit and other circuits have refused to hold that an ERISA plan administrator or fiduciary must follow a benefit determination by the Social Security Administration. See Schaffer, 151 F. Supp. 2d 799, 811 (S.D. Tex. 2001); Freeman v. Sickness Acc. Disability Plan of ATT Technologies, Inc., 823 F. Supp. 404 (S.D. Miss. 1993); Anderson v. Operative Plasterers' Cement Masons' Int'l Ass'n Local No. 12 Pension Welfare Plans, 991 F.2d 356, 358 (7th Cir. 1993). This Court holds that the Social Security Administration's determination of disability is not conclusive and that the plan administrator did not act irrationally or arbitrarily by denying Plaintiff long-term disability benefits.
2. Section 502(a)(3) Claim
Plaintiff also seeks equitable relief under Section 502(a)(3) of ERISA. Section 502(a)(3) allows any participant, beneficiary, or fiduciary to bring suit to enjoin any violation of the plan or "to obtain other appropriate equitable relief to redress such violations or to enforce any provisions of [ERISA] or the terms of the plan." 29 U.S.C. § 1132(a)(3). The Supreme Court has interpreted Section 502(a)(3) as a catchall provision, only applying if the plaintiff cannot bring an action to recover relief under another provision of Section 502. See Varity Corp. v. Howe, 516 U.S. 489, 512 (1996). When a plaintiff sues for denial of benefits under Section 502(a)(1)(B), that plaintiff cannot sue for a breach of fiduciary duty for denial of benefits under Section 502(a)(3), even if the Section 502(a)(1)(B) claim is unsuccessful. See Musmeci v. Schwegmann Giant Super Markets, Inc., 332 F.3d 339, 349 n. 5 (5th Cir. 2003) (citing Great-West Life Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002)); McCall v. Burlington Northern/Santa Fe Co., 61 F. Supp. 2d 563, 571 (N.D. Tex. 1999). See also Blum v. Spectrum Restaurant Group-Employees Group Life Supplemental Life Plan, 2003 WL 302218, *2 (E.D. Tex. 2003) (holding that Section 502(a)(3) does not provide relief for an unsuccessful 502(a)(1)(B) claim). Therefore, Plaintiff does not have a claim under Section 502(a)(3) because he was provided a remedy under Section 502(a)(1)(B), even though that action was unsuccessful. See Musmeci, 332 F.3d at 349; Blum, at *2.
Plaintiff is not entitled to recover long-term disability benefits from the Plan under Section 502(a)(1)(B) and is not entitled to equitable relief under Section 502(a)(3). The Plan has established that no genuine issue of material fact exists, that the plan administrator did not abuse its discretion, and that the Plan is entitled to judgment as a matter of law.
V. CONCLUSION
For the reasons stated above,(1) Plaintiff's claims against Defendant American Electric Power Service Corporation are dismissed; and
(2) Defendants' Motion for Summary Judgment is GRANTED.
SO ORDERED.