Summary
In Seddon v. Wal-Mart Stores, Inc., 174 F.Supp.2d 991 (W.D.Mo. 2001), the Court stated, "`Trustees are obligated to set forth the rationale underlying their decision so that the claimant may adequately prepare an appeal to the federal courts... and so that a federal court may properly review the Trustees' decision.'"
Summary of this case from Lankford v. Webco, Inc.Opinion
Case No. 01-4129-CV-C-5
November 28, 2001
MEMORANDUM AND ORDER
Plaintiff Florence E. Seddon ("Seddon") asserts that Defendant Hartford Life and Accident Insurance Company ("Hartford") wrongfully denied her requests for short and long-term disability benefits, in violation of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001, et seq. Pending before the Court is Defendants' Motion for Summary Judgment [Doc. 12]. For the reasons stated below, the Motion will be granted.
I. Factual Background
A. Introduction
The following facts are undisputed unless otherwise noted. Seddon was a cashier for Defendant Wal-Mart Stores, Inc. ("Wal-Mart"), and a participant in an employee welfare benefit plan sponsored by Wal-Mart that provided short-term disability ("STD") and long-term disability ("LTD") benefits to qualified, eligible employees (hereinafter "Plan"). Hartford fully insures and administers the benefits provided under the Plan.
For purposes of STD benefits, the Plan provides as follows:
Totally Disabled means that you are unable to do the material and substantial duties of your occupation. Your occupation includes similar job positions with the employer which may be offered to you with a rate of pay 60% or greater of your pre-disability earnings.
[Adm. Rec. at 266]. A Plan participant may begin receiving STD benefits after the 14th day of continuous disability, and can receive STD benefits for only eight weeks. [Plan at 30].
For purposes of LTD benefits, the Plan provides as follows:
Total Disability or Totally Disabled means that: (1)during the Elimination Period; and (2) for the next 12 months, you are prevented by (a) accidental bodily injury; (b) sickness; (c) Mental Illness (d) substance abuse; or (e) pregnancy; from performing the essential duties of your occupation, and are under the continuous care of a Physician and as a result you are earning less than 20% of your Pre-disability Earnings, unless engaged in a program of Rehabilitative employment approved by us.
After that, you must be so prevented from performing the essential duties of any occupation for which you are qualified by education, training or experience.
"Your occupation" includes similar job positions with the Employer which may be offered to you, with a rate of pay 60% or greater of your Indexed Pre-disability Earnings.
[Adm. Rec. at 240].
The Plan also vests Hartford with discretion to determine eligibility for benefits and to construe and interpret all terms and provisions of the Plan. It provides as follows:
The Hartford has full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.
[Adm. Rec. at 240, 262].
B. Seddon's Claim for Benefits
Seddon was a Wal-Mart employee in April 2000 when she claims to have become disabled. In May 2000, she submitted a claim for STD benefits claiming that she was disabled as a result of fibromyalgia, a condition she had suffered for approximately ten years. As a part of her claim form, Seddon submitted a physician's statement in which Dr. William Pierce, a family practitioner, opined that she was disabled for the remainder of her life. Prior to ruling upon Seddon's claim, Hartford gathered all medical records from Dr. Pierce as well as from Dr. Nancy Becker, a board certified rheumatologist, who had examined Seddon in February 2000 at the request of Dr. Pierce. Dr. Becker, as a part of her February 2000 examination, reported that "All symptoms have been present for many years." [Adm. Rec. at 31]. Nowhere in her report did Dr. Becker opine that Seddon was disabled, that she was unable to work, or that any work restrictions or limitations should apply to Seddon. Dr. Becker recommended three courses of action for Seddon: (1) increase calcium intake; (2) pursue a program of regular exercise; and (3) stop smoking.
The claim form submitted by Seddon provides in relevant part as follows:
Primary diagnosis: Fibromyalgia
Secondary diagnosis(es): _______________
Subjective symptoms: Pain in ankles, feet, toes, upper back, neck, shoulders,. wrists, elbows, muscles and joints.
Test results (list all results, or enclose test)
Test: ____________________________ Date: _____ Results: ____________
Test: ____________________________ Date: _____ Results: ____________
Physical examination findings: Tender at multiple fibromyalgia trigger points.
[Adm. Rec. at 184]. Seddon agrees that fibromyalgia was her primary disabling condition but disputes that she limited her disability claim to fibromyalgia. Seddon has not presented any evidence, however, suggesting that she filed a claim for disability benefits based on any other condition or injury.
The Court notes that Wal-Mart and Hartford cite to page 36 of the administrative record in support of this proposition. Page 36 was omitted from the copy of the administrative record provided to the Court. Nevertheless, Seddon does not dispute this factual assertion; the Court will therefore accept it as true.
Based upon this information, Hartford denied Seddon's STD claim in early August 2000. On September 6, 2000, Seddon, through her attorney, appealed from the denial of her STD benefits claim. Together with the appeal, Seddon submitted an August 28, 2000 form completed by Dr. Pierce. On this form, Dr. Pierce concluded that Seddon's strength factors were unlimited. He also concluded that Seddon's ability to lift or carry, her ability to stand or walk, her ability to sit and her ability to push or pull were unlimited. Dr. Pierce, responding to questions regarding whether Seddon could climb, balance, stoop, kneel, crouch, or bend frequently, occasionally or never, found that she could perform all these activities frequently. Dr. Pierce further opined that Seddon had an unlimited ability to reach, handle, finger, feel, see, hear, and speak. He also believed that no environmental restrictions applied to Seddon. When asked to briefly describe in what ways the impaired's activities were limited, Dr. Pierce stated, "N/A."
Seddon also attached to her appeal an August 29, 2000 memorandum from Dr. Pierce addressed "To Whom It May Concern." In this memorandum, Dr. Pierce stated that Seddon had fibromyalgia, that it was disease of chronic pain which did not decrease her range of motion or strength. He further opined that activity caused the pain to worsen and that he considered her pain severe enough to totally disable her from ever working in any occupation. [ See Adm. Rec. at 155].
On October 19, 2000, Hartford upheld its denial of Seddon's STD benefits claim. Hartford, in its denial letter, acknowledged receipt of Dr. Pierce's August 28 and 29 documents. It then explained:
There are no restrictions and limitations given at all to support the inability to perform the job duties of Cashier. According to the physical ability statement, Ms. Seddon is capable of standing, lifting, kneeling, bending, which are essential in performing her occupation. Pain is given as the reason for total disability. Pain in [and] of itself is not a disabling condition and based upon the policy, you have to be totally disabled from performing the material and substantial duties of your occupation.
While we recognize that Dr. Pierce feels that your client is totally disabled from any occupation, he has not provided any medical evidence to support that Ms. Seddon is functionally incapable of performing her job duties as a cashier. Consequently, we are upholding our decision to deny STD benefits.
[Adm. Rec. at 143].
On November 20, 2000, Seddon questioned whether Hartford had all relevant medical records, and enclosed all the medical records Seddon had in her possession. She also asked that Hartford consider a claim for LTD benefits. On November 29, 2000, Hartford wrote and advised Seddon that it had already reviewed all the post April 2000 records provided by Seddon in her attorney's November 20, 2000 letter, and that records regarding treatment prior to the alleged date of disability would not be considered because her condition prior to her alleged disability was not relevant. Hartford again affirmed its denial of Seddon's claim.
During the next several months, Seddon's attorney attempted to obtain other medical records that potentially supported Seddon's claim. During May 2001, Hartford contacted the offices of Dr. Pierce and Dr. Becker in an attempt to obtain the most current medical information regarding Seddon. During these calls, Dr. Pierce's office acknowledged that he had not placed any physical limitations upon Seddon's activities, and admitted that he was a family practitioner who considered it outside his purview to assess functional limitations due to fibromyalgia. Dr. Pierce's office directed Hartford to consult Dr. Becker, the rheumatologist to whom Dr. Pierce had referred Seddon. Dr. Becker's office advised that Dr. Becker had not seen Seddon since last year and at that time, there were no restrictions or limitations provided. These statements were consistent with the medical records Hartford had already reviewed.
On June 7, 2001, Hartford advised Seddon that her appeal was being denied and that she would not receive either STD or LTD benefits, referring Seddon to its previous correspondence indicating the reason for denial of her claim. Seddon then filed the instant lawsuit.
II. Summary Judgment Standard
A moving party is entitled to summary judgment "if 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). A defendant who moves for summary judgment bears the burden of showing that there is no genuine issue of material fact for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256 (1986). When considering a motion for summary judgment, a court must scrutinize the evidence in the light most favorable to the nonmoving party and the nonmoving party "must be given the benefit of all reasonable inferences." Mirax Chem. Prods. Corp. v. First Interstate Commercial Corp., 950 F.2d 566, 569 (8th Cir. 1991) (citation omitted).
The main purpose of a motion for summary judgment, however, is to identify factually unsupported claims. If a plaintiff has the burden of proof at trial on a claim and the defendant has filed a motion for summary judgment, the plaintiff must identify admissible evidence sufficient to make a submissible case at trial. Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). If the plaintiff cannot identify such facts, the defendant is entitled to judgment as a matter of law. Lujan v. National Wildlife Fed'n, 497 U.S. 871, 884 (1990) (quoting Celotex, 477 U.S. at 322)).
To establish a genuine issue of fact sufficient to warrant trial, the nonmoving party "must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Instead, the nonmoving party bears the burden of setting forth specific facts showing there is a genuine issue for trial. Anderson, 477 U.S. at 248 (quoting First Nat'l Bank of Ariz. v. Cities Serv. Co., 391 U.S. 253 (1968)).
III. Discussion
A. Standard of Review for Denial of Benefits Pursuant to ERISA
The ERISA statute does not define the standard of review to be applied to decisions made by plan administrators. See Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 640 (8th Cir. 1997). The Supreme Court has held that these determinations should be reviewed de novo unless a plan gives an administrator discretionary authority. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). When such discretionary authority exists, then federal courts review the decisions of plan administrators only for abuse of discretion. Id.; see also Solger v. Wal-Mart Stores, Inc., Assoc. Health and Welfare Plan, 144 F.3d 567, 568 (8th Cir. 1998). This deferential standard of review requires courts to uphold reasonable determinations, even when the courts would have reached a different conclusion. Solger, 144 F.3d at 568. A decision is not an abuse of discretion if a "reasonable person could have reached a similar decision, given the evidence before him [or her], not that a reasonable person would have reached that decision." Donaho v. FMC Corp., 74 F.3d 894, 899 (8th Cir. 1996). Reasonable determinations must be supported by substantial evidence. Cash, 107 F.3d at 641.
Both parties agree that the language of the Plan gives Hartford discretionary authority to determine eligibility for benefits. [ See Dft's Sugg. at 3; Pltf's Opp. at 7]. The Court therefore finds that Hartford had discretionary authority to determine whether Seddon was Totally Disabled.
The abuse of discretion standard will therefore apply unless Seddon can "present material, probative evidence demonstrating that (1) a palpable conflict of interest or a serious procedural irregularity existed, which . . . caused a serious breach of the plan administrator's fiduciary duty to her." Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir. 1998) (citation omitted). Woo has been interpreted as establishing the following two prongs: (1) "a palpable conflict of interest or a serious procedural irregularity"; and (2) "that the conflict or irregularity has a connection to the substantive decision reached." Barnhart v. UNUM Life Ins. Co. of Am., 179 F.3d 583, 588-89 (8th Cir. 1999). If these two prongs are met, then courts apply a "sliding scale" of review. Woo, 144 F.3d at 1161.
Seddon suggests that a conflict of interest exists in this case in that Hartford is both the administrator of the Plan and the insurer in this case. If a plan administrator is also the insurer, then a palpable conflict of interest may exist. Barnhart, 179 F.3d at 588 (reaching this conclusion); but see Davolt v. Executive Committee of O'Reilly Automotive, 206 F.3d 806, 809 (8th Cir. 2000) (finding that district court erred in assuming automatic conflict of interest simply because plan administrator was also self-insured provider of benefits), and Farley v. Arkansas Blue Cross and Blue Shield, 147 F.3d 774, 776 (8th Cir. 1998) (insurer's interest in maintaining competitive insurance rates did not justify less deferential standard of review).
Even assuming that Seddon meets the first prong, however, she cannot meet the second. To meet the second prong, Seddon must show a connection between the conflict and the decision. This connection will not be inferred from the existence of a conflict. See Buttram v. Central States, Southeast and Southwest Areas Health and Welfare Fund, 76 F.3d 896, 901 (8th Cir. 1996) (applying abuse of discretion standard because plaintiff failed to establish that the administrator's conflict of interest affected the decision to deny benefits). Further, "[t]he evidence must give rise to `serious doubts as to whether the result reached was the product of an arbitrary decision or the plan administrator's whim.'" Sahulka v. Lucent Technologies, Inc., 206 F.3d 763, 768 (8th Cir. 2000) (quoting Barnhart, 179 F.3d at 589 (quotation omitted)). Seddon has failed to submit any evidence to establish this causal connection. Thus, Seddon has failed to show that Hartford's decision was influenced by this potential conflict of interest.
Seddon also appears to assert the existence of a serious procedural irregularity in this case that she apparently believes warrants heightened review. Seddon suggests that she was denied a full and fair review of her benefits claim because Hartford did not consider all of her pre-claim medical records, which were provided to Hartford in November 2000, after denial of her claim for benefits. The Court agrees with Wal-Mart and Hartford that Seddon's argument lacks merit.
Seddon does not point to any evidence suggesting that her disability claim was based on anything other than fibromyalgia. The medical evidence that Seddon claims Hartford failed to consider includes the following: evidence regarding an instance in 1995 when a 35 to 40 pound box fell on Seddon's head; evidence that Seddon subsequently was noted to have a narrowing of the spine at C5-6 and C6-7, along with spurs at C5 and C6 and compression of the thecal sac at C5-6; evidence of an injury suffered by Seddon in late 1997, when she was twisting and turning to get equipment, which caused difficulties with her right shoulder blade; evidence that Seddon fell off of a ladder in February 1998, while working at Wal-Mart, resulting in a severely comminuted fracture of the distal radius, requiring five days of hospitalization and a prolonged recovery from surgery; evidence of a left wrist arthroscopy, debridement and open ulnar shortening osteotomy in September 1998, including placement of plates and screws, followed by a subsequent surgery in February 1999, to remove the wrist plate and screws; evidence that Seddon's wrist continued to lock up after the hardware was removed and evidence of increasing arm pain; evidence that the workers' compensation doctor selected by Wal-Mart, Dr. Scott Swango, recommended in April 1999, that Seddon undergo vocational rehabilitation training to find other work; evidence that in May 1999, another doctor selected by Wal-mart, Dr. Jeffrey Woodward, recommended a permanent partial impairment rating of 30% for Seddon's work-related injury; and evidence that November 1999 medical records revealed the presence of osteopenia with slight scoliosis. [ See Pltf's Opp. at 9-10]. As Wal-Mart and Hartford indicate, however, despite Seddon's contentions that her previous injuries resulted in work restrictions, Seddon has failed to show how any of these medical records have anything to do with fibromyalgia, the claimed basis of her disability. Moreover, Wal-Mart and Hartford point out that Hartford, in making its determination to deny benefits, did consider Dr. Becker's medical records. Dr. Becker examined Seddon several months prior to Seddon's disability onset, specifically for the purpose of evaluating fibromyalgia at Dr. Pierce's request. In making that evaluation, Dr. Becker did not review Seddon's prior medical records. [ See Adm. Rec. at 30-35].
In addition to the medical evidence noted above, Seddon does point to two pieces of evidence in the administrative record that are apparently related to the existence of fibromyalgia. First, Seddon suggests that the beginnings of fibromyalgia are apparent in records from 1995, at which time Seddon was prescribed Elavil. Seddon asserts that Elavil, also known as amitriptyline, is one of the primary treating medications for fibromyalgia. Seddon's point is based upon pure speculation, however, as there is no indication in the records from 1995 that Seddon was diagnosed with fibromyalgia. [ See Adm. Rec. at 72-75]. Rather, the impression at the time was that Seddon suffered from a "Cervicothoracic sprain/strain with involvement of bilateral sternocleidomastoid." [Adm. Rec. at 47]. Second, Seddon points to records from Dr. Pierce dated November 24, 1999, in which Dr. Pierce appears to have diagnosed Seddon with fibromyalgia and prescribed Elavil. [See Adm. Rec. at 189]. While such records are arguably relevant to Seddon's claim, the Court does not believe that Seddon suffered any prejudice by Hartford's failure to consider Dr. Pierce's records from November 1999. Hartford did consider more recent findings by Dr. Pierce and Dr. Pierce's records from November 1999, do not suggest any work restrictions that would bear on Seddon's ability to perform her job.
In sum, Seddon fails to cite any authority for the proposition that Hartford's failure to consider largely irrelevant medical records dated prior to Seddon's disability onset amounts to a serious procedural irregularity. The Court does not believe that, under the facts of this case, Hartford's failure did constitute such an irregularity. Further, even assuming that Hartford's failure constituted a serious procedural irregularity, Seddon again cannot meet the second prong of the Woo test. Seddon has failed to suggest how this alleged procedural irregularity resulted in a breach of Hartford's fiduciary duty to Seddon. Wal-Mart and Hartford point out that in October 2000, Seddon's counsel was informed that:
Ms. Seddon ceased work April 23, 2000 due to fibromyalgia. The claim was denied due to the medical evidence on file did not document a severity of the condition to prevent your client from performing her job duties.
[Adm. Rec. at 142]. There is no evidence suggesting that Seddon sought further appeal of the denial of benefits based on contentions that she was unable to work due to conditions other than fibromyalgia. "The mere assertion of apparent procedural irregularities, without more, does not give rise to heightened review." Barnhart, 179 F.3d at 589. Accordingly, the Court will review Hartford's decision under the abuse of discretion standard.
B. Whether Hartford Abused its Discretion
Wal-Mart and Hartford argue that Hartford did not abuse its discretion in this case because Dr. Becker, the only rheumatologist to examine Seddon and who was selected by Seddon, did not state that Seddon was disabled or unable to work. Further, Wal-Mart and Hartford point out that Dr. Pierce, who opined that Seddon was disabled, later acknowledged that it was outside his expertise to opine regarding the disabling effects, if any, of fibromyalgia. Moreover, Dr. Pierce also opined that Seddon had unlimited ability to lift, carry, stand, walk, sit, push and pull. Additionally, he opined that Seddon could frequently climb, balance, stoop, kneel, crouch and bend. Under the deferential standard of review, Hartford's decision will stand if it is "reasonable" — that is, supported by "substantial evidence." Farley, 147 F.3d at 777 (citing Donaho, 74 F.3d at 899-900).
Seddon argues in opposition that Hartford's decision was an abuse of discretion for several reasons. First, as discussed above, she asserts that Hartford's failure to consider certain pre-claim medical evidence was an abuse of discretion. The Court has already addressed that issue.
Next, Seddon asserts that Hartford's conclusion that pain is not in and of itself a disabling condition is an unsupported and improper judgment resulting in an abuse of discretion. Seddon contends that Hartford twists and contorts Dr. Pierce's opinions to arrive at its conclusion that Dr. Pierce "has not provided any medical evidence to support that Ms. Seddon is functionally incapable of performing her duties as a cashier." [Adm. Rec. at 143]. The Court does not believe that Seddon's contention warrants relief.
At the heart of Seddon's contention are two forms completed by Dr. Pierce. First, on May 9, 2000, Dr. Pierce completed a Hartford form assessing Seddon's condition. In that form, Dr. Pierce opined that Seddon's ability to stand, walk, sit, lift, carry, reach, work overhead, push, pull and drive were all "limited indefinitely." [Adm. Rec. at 165]. Subsequently, on August 28, 2000, Dr. Pierce completed a Medical Source Statement-Physical ("MSS-P"), in which he opined that Seddon had unlimited ability to lift, carry, stand, walk, sit, push and pull. Dr. Pierce further opined that Seddon could frequently climb, balance, stoop, kneel, crouch, and bend, and that she had unlimited abilities in reaching, handling, fingering, feeling, seeing, hearing, and speaking. Dr. Pierce also noted that Seddon had no environmental restrictions. In response to a question regarding the ways in which Seddon's activities were limited, Dr. Pierce responded, "N/A." [Adm. Rec. at 154]. Seddon points out, however, that Dr. Pierce checked the box on the form indicating that pain, discomfort and/or other subjective complaints were not taken into consideration. Dr. Pierce also opined on the MSS-P that Seddon had a permanent disability that would prevent her from engaging in employment or gainful activity. Seddon suggests that there is no conflict between the two forms filled out by Dr. Pierce. She argues that Hartford's decision did not consider that Dr. Pierce's MSS-P assessment was completed without consideration of Seddon's pain and that Hartford did not consider the May 9, 2000 form at all. Seddon further suggests that Hartford instead placed too much emphasis on Dr. Becker's report, which was completed prior to Seddon's disability onset date and which gave no opinion of disability and did not state whether Seddon's abilities were limited.
It is apparent that Hartford clearly discounted Dr. Pierce's opinion regarding Seddon's alleged permanent disability. The Court does not believe, however, that this was an abuse of discretion. As Wal-Mart and Hartford point out, in a follow-up phone call from a Hartford claims investigator to Dr. Pierce's office after Dr. Pierce opined that Seddon was totally disabled due to fibromyalgia, it was acknowledged that it was outside Dr. Pierce's purview to even opine regarding the disabling effects, if any, of fibromyalgia. [Adm. Rec. at 3-4]. Seddon does not dispute this fact. Thus, Hartford was left to consider the opinion of a treating physician who acknowledged it was outside his expertise to opine on the disabling effects, if any, of fibromyalgia and the opinion of an examining rheumatologist who did not note any restrictions on Seddon's abilities. Under the circumstances, the Court cannot say that Hartford abused its discretion in discounting Dr. Pierce's opinion. Further, there is no evidence that any of Seddon's physicians, other than Dr. Pierce, concluded that she was Totally Disabled as that term is defined in the Plan. Thus, the Court does not believe that Hartford abused its discretion in denying Seddon's claim for benefits.
Finally, Seddon argues that Hartford's decision should be overturned because it failed at all levels "to apply the definition of short term or long term disability to the facts of this case." [Pltf's Opp. at 17]. Seddon does not expressly argue or point to evidence that she actually met the definition of short-term or long-term disability under the Plan. Rather, her argument appears to be that Hartford failed to set forth the essential duties of her job and that it failed to specifically apply the definitions of short-term and long-term disability to her circumstances. Seddon cites no legal authority, however, suggesting that such a failure constitutes an abuse of discretion. Moreover, the Court agrees with Wal-Mart and Hartford that Hartford properly applied the express provisions of the Plan.
As noted above, for purposes of STD benefits, the Plan provides as follows:
Totally Disabled means that you are unable to do the material and substantial duties of your occupation. Your occupation includes similar job positions with the employer which may be offered to you with a rate of pay 60% or greater of your pre-disability earnings.
Further, for purposes of LTD benefits, the Plan provides as follows:
Total Disability or Totally Disabled means that: (1) during the Elimination Period; and (2) for the next 12 months, you are prevented by (a) accidental bodily injury; (b) sickness; (c) Mental Illness (d) substance abuse; or (e) pregnancy; from performing the essential duties of your occupation, and are under the continuous care of a Physician and as a result you are earning less than 20% of your Pre-disability Earnings, unless engaged in a program of Rehabilitative employment approved by us.
After that, you must be so prevented from performing the essential duties of any occupation for which you are qualified by education, training or experience.
"Your occupation" includes similar job positions with the Employer which may be offered to you, with a rate of pay 60% or greater of your Indexed Pre-disability Earnings.
In its October 19, 2000, letter upholding denial of Seddon's claim for benefits, Hartford explained as follows:
There are no restrictions and limitations given at all to support the inability to perform the job duties of Cashier. According to the physical ability statement, Ms. Seddon is capable of standing, lifting, kneeling, bending, which are essential in performing her occupation. Pain is given as the reason for total disability. Pain in [and] of itself is not a disabling condition and based upon the policy, you have to be totally disabled from performing the material and substantial duties of your occupation.
While we recognize that Dr. Pierce feels that your client is totally disabled from any occupation, he has not provided any medical evidence to support that Ms. Seddon is functionally incapable of performing her job duties as a cashier. Consequently, we are upholding our decision to deny STD benefits.
The Court believes that Hartford's letter provided a reasonable application of the provisions of the Plan to Seddon's claim for benefits.
The Eighth Circuit has stated that "Trustees are obligated to set forth the rationale underlying their decision so that the claimant may adequately prepare an appeal to the federal courts . . . and so that a federal court may properly review the Trustees' decision." Collins v. Central States, Southeast Southwest Areas Health Welfare Fund, 18 F.3d 556, 561 (8th Cir. 1994) (citations omitted). In Collins, the final denial letter received by the claimant stated that the claimant was not eligible for benefits because he did not meet the definition of "employee" under the benefit plan. Id. The letter then quoted the definition of "employee" under the plan. Id. The court held that while the denial letter was "not overly detailed or analytical," when coupled with other correspondence sent to the claimant, it sufficiently set forth the rationale for denial of benefits. Id. Similarly, the October 19, 2000 denial letter from Hartford is not lengthy and lacks detailed analysis of the evidence on Seddon's claim. It states clearly, however, that "[t]here are no restrictions and limitations given at all to support the inability to perform the job duties of Cashier." Further, it indicates that Hartford found Seddon not to be Totally Disabled under the Plan. Therefore, like in Collins, the Court believes that Seddon was provided with sufficient notice of the basis for denial of benefits to enable her to challenge the denial in federal court and to enable this Court to review Hartford's decision. Accordingly, because the Court does not believe that Hartford abused its discretion in denying Seddon's claim for benefits, Hartford's decision will be upheld.
IV. Conclusion
Accordingly, it is hereby
ORDERED that the Defendants' Motion for Summary Judgment [Doc. 12] is GRANTED.