Bishop v. Long Term Disability , 232 F. App'x 792 ( 2007 )

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES CO URT O F APPEALS
May 7, 2007
FO R TH E TENTH CIRCUIT Elisabeth A. Shumaker
Clerk of Court
KURT ANTH ONY BISHOP,
Plaintiff-Appellant,
v. No. 06-5097
(D.C. No. 04-CV-031-CVE-SAJ)
LONG TERM DISABILITY INCOM E (N.D. Okla.)
PLAN OF SA P A M ERICA, INC., an
ERISA qualified plan administered by
SAP American, Inc.; LIFE
IN SU RAN CE C OM PA N Y O F
N O RTH A ME RIC A; C IG N A ,
Defendants-Appellees.
OR D ER AND JUDGM ENT *
Before KELLY, L UC ER O, and HA RTZ, Circuit Judges.
Kurt Bishop worked as a technology consultant for SA P A merica, Inc.
(“SAP”) and participated in SA P’s Long Term Disability Income Plan (“the
Plan”). Life Insurance Co. of North America, Inc. (“LINA”) both insures and
*
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument. This order and judgment is
not binding precedent, except under the doctrines of law of the case, res judicata,
and collateral estoppel. It may be cited, however, for its persuasive value
consistent w ith Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
administers the Plan. After LINA terminated Bishop’s long-term disability
benefits and upheld termination in an administrative appeal, Bishop challenged its
decision in federal district court under the Employee Retirement Income Security
Act (ERISA), 29 U.S.C. §§ 1001-1461. The district court upheld LINA’s
termination of benefits.
On appeal, Bishop argues that: (1) LINA improperly used the Dictionary of
Occupational Titles (“DOT”) to define the essential duties of his own occupation
instead of considering his actual duties, and thus arbitrarily and capriciously
failed to determine w hether his own occupation required travel; and (2) LINA
failed to provide a full and fair review before terminating disability benefits. W e
VAC ATE and R EM A N D for further proceedings on the first claim, and
AFFIRM the district court’s rejection of the second claim.
I
In July 1994, SA P employed Bishop as a technology consultant, a position
requiring extensive travel. Due to health concerns that interfered with his ability
to travel, SA P accommodated Bishop in January 2001 by allowing him to work as
a technology consultant who did not travel. Six months later, SAP underwent a
company restructuring that resulted in the elimination of Bishop’s position, and
terminated Bishop.
In July 2001, Bishop submitted a claim for short-term disability benefits.
Under the Plan, an employee is totally disabled if he is “unable to perform all the
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essential duties of his occupation.” LINA awarded short-term disability benefits
and later approved Bishop’s claim for long-term benefits. However, it continued
to monitor Bishop’s status and eventually determined that Bishop was no longer
disabled based on the medical records of Dr. Piper, his treating physician. On
September 25, 2003, LINA informed Bishop that he no longer met the Plan
definition of total disability. In terminating Bishop’s long-term benefits, LINA
stated it had “consider[ed] the duties of the Regular Occupation as it is normally
performed in the general labor market in the national economy, not necessarily
your ability to perform your job duties per se.” It concluded that because Bishop
could perform light duty work and because the DOT defines technology
consulting as sedentary work, he was able to perform all the material duties of his
regular occupation as a technology consultant.
B ishop filed an administrative appeal of the adverse decision. On review ,
LINA upheld the termination of benefits after noting Bishop’s failure to provide
additional medical evidence. Thereafter, Bishop brought the instant action in
federal district court, arguing that LINA’s use of a DOT job description rendered
its decision arbitrary and capricious. In particular, he contended that LINA erred
in failing to consider whether travel was an essential duty of his job as a
technology consultant. The district court found that Bishop’s job at the time of
his termination did not require travel and upheld LIN A’s termination of benefits.
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Subsequently, the court denied Bishop’s motion to reconsider, and Bishop
appealed.
II
W e review the district court’s factual findings for clear error, W ilcott v.
M atlack, Inc., 64 F.3d 1458, 1461 (10th Cir. 1995), and its legal conclusions de
novo, applying the same standards as the district court. DeGrado v. Jefferson
Pilot Fin. Ins. Co., 451 F.3d 1161, 1167 (10th Cir. 2006). W hen a plan gives an
adm inistrator discretionary authority to determine eligibility for benefits, we
review the administrator’s actions under an arbitrary and capricious standard.
Fought v. Unum Life Ins. Co. of Am., 379 F.3d 997, 1002-03 (10th Cir. 2004).
However, when, as here, an administrator both insures and administers a plan and
thereby operates under an inherent conflict of interest, we accord less deference
to its decisions. Under this less deferential standard, an administrator must show
that “its interpretation of the terms of the plan is reasonable and that its
application of those terms to [the claimant] is supported by substantial evidence.”
Id. at 1006. Substantial evidence entails:
such evidence that a reasonable m ind might accept as adequate to
support the conclusion reached by the decision maker. It requires
more than a scintilla but less than a preponderance. In determining
whether the evidence in support of the administrator’s decision is
substantial, we must take into account whatever in the record fairly
detracts from its weight. M oreover, substantiality of the evidence is
based upon the record as a whole.
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Rekstad v. U.S. Bancorp, 451 F.3d 1114, 1119-20 (10th Cir. 2006) (quotations
and citations omitted).
W e start our analysis by considering the language of the Plan. As indicated
above, Bishop is totally disabled under the Plan if he is “unable to perform all the
essential duties of his occupation.” The Plan neither defines “essential duties” or
“his occupation” nor establishes a method for determining the “essential duties of
his occupation.” Notably, it does not reference DOT definitions.
In considering identical plan language, this court has stated that “the
relevant LINA standard for ‘own occupation’ disability is whether [the insured]
w as capable of performing his own job” with his employer at the time he was
terminated. Caldw ell v. Life Ins. Co. of N . Am., 287 F.3d 1276, 1283 (10th Cir.
2002) (emphasis in original). “A key determination in the inquiry before the
administrator was whether [the insured] could perform all the essential duties of
his job at the time he left [employment].” Id. at 1284. In Caldwell, we held
LINA failed to give adequate weight to evidence that the claimant could not lift
heavy objects as required of his particular position as a “customer service
representative.” Id. at 1285-86. Although customer service representatives did
not ordinarily engage in heavy lifting, Caldwell’s specific job required him to
occasionally fill in as a “rig hand” – a position that entailed lifting objects
between 50 and 100 pounds. Id. at 1284-85. Because evidence in the record
showed that Caldwell’s particular job required heavy lifting and that his disability
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prevented him from performing this duty, we determined that LINA’s denial of
benefits was arbitrary and capricious. Id. at 1285-86.
In the instant case, w hich centers around identical plan language, LINA
was likewise required to consider Bishop’s actual job duties in defining “his
occupation.” Failure to address whether traveling was an essential duty of
Bishop’s job at the time of his termination – as Bishop claimed it was – rendered
the decision arbitrary and capricious. Ordinarily, “the remedy when an ERISA
administrator fails to make adequate findings or to explain adequately the grounds
of her decision is to remand the case to the administrator for further findings or
explanation.” Id. at 1288 (citations omitted). However, we need not remand if
the record conclusively establishes that travel was not an essential duty of
Bishop’s job. In its M arch 2, 2006 Opinion and Order, the district court found
that “at the time plaintiff filed his initial disability benefits claim, his job did not
require him to travel.” This finding, however, does not address whether the
non-travel accommodation was permanent or merely temporary, and thus does not
conclusively determine whether travel was an essential duty of Bishop’s job at the
time of his termination. Cf. Blickenstaff v. R.R. Donnelley & Sons Co. Short
Term Disability Plan, 378 F.3d 669, 671, 678 (7th Cir. 2004) (concluding that
record showed insured’s job was accommodated permanently and that use of
accommodated job description was therefore not error).
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The record does not compel a conclusion that travel was not an essential
duty of Bishop’s job. The only job description in the record states that extensive
travel is an essential duty for the technology consultant job. 1 A series of email
messages between SAP and a LINA vocational rehabilitation counselor indicates
likewise. In response to LINA’s general question on whether an employee who
could not travel could work as a non-traveling technology consultant, SA P stated:
If an employee worked in the [Professional Services Organization]
group, which [Bishop] did, then it’s a technical consultant who needs
to travel. The Technical Consultants in other groups have
completely different job descriptions and we couldn’t just place the
traveling consultant in one of those jobs.
Aplt. A pp. at 374.
Nonetheless, SAP provided Bishop an accommodation, allowing him to
work without traveling from January to June 2001. LINA therefore argues that at
the time of Bishop’s termination in June 2001, accommodation rendered travel a
non-essential duty of his job. W e reject this contention. Again, our review does
not compel a finding that accommodation was permanent and does not reveal why
1
Although the long-term disability case manager for LINA asked SAP to prepare
a completed Job Requirements form without the travel requirement in January
2002, no such form appears in the administrative record. In any event, it seems
inappropriate for a plan administrator to request that an employer prepare job
descriptions omitting specific requirements. The employer, and not the plan
administrator, is in the position to independently and most accurately describe an
employee’s job duties.
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accommodation ended. Accordingly, we cannot conclude travel was not an
essential duty of Bishop’s job at the time of his termination. 2
LINA argues in the “Summary of Argument” section of its appellate brief
that even if travel were an essential duty, Bishop is not disabled as defined in the
Plan. This argument is not developed in the body of the brief. W e therefore need
not address it and deem it waived. Cf. Franklin Sav. Corp. v. United States,
180 F.3d 1124, 1128 n.6 (10th Cir. 1999) (deciding that superficially developed
argument w as waived); Sports Racing Servs., Inc. v. Sports Car Club of Am.,
Inc., 131 F.3d 874, 880 & n.9 (10th Cir. 1997) (holding that party who noted
issue and made “several broad, conclusory statements” on appeal waived
argument for failure to develop).
Accordingly, we remand to the district court with instructions to remand to
LIN A for further proceedings addressing whether travel was an essential job duty
for Bishop’s technology consultant position at the time of his termination. See
2
W e note that in assessing short-term disability, LINA seemed to consider the
non-travel accommodation temporary. Dr. Nackley, an independent doctor who
review ed Bishop’s claim for short-term benefits, stated in his assessment:
“[Bishop] reported that prior to the limitations, his employer accommodated him
with no travel responsibilities. As the limitations were placed on [Bishop], the
employer w as no longer able to accommodate these” (emphasis added).
Dr. Nackley based his statements on a history provided to him by LINA. Also, in
a July 6, 2001 medical assessment, Dr. Piper noted that “w ork now demanded = ie
travel.”
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DeGrado, 451 F.3d at 1175-76 (recognizing that remand is proper remedy when
plan administrator failed to make adequate findings). 3
III
Lastly, Bishop contends that LINA failed to provide a full and fair review
as required by ERISA . He first raised this claim in a Rule 59(e) motion for
reconsideration. W e review denial of a Rule 59(e) motion for abuse of discretion.
See Comm. for First Amend. v. Campbell, 962 F.2d 1517, 1523 (10th Cir. 1992).
“Grounds w arranting a motion to reconsider include (1) an intervening change in
the controlling law , (2) new evidence previously unavailable, and (3) the need to
correct clear error or prevent manifest injustice.” Servants of the Paraclete v.
Does, 204 F.3d 1005, 1012 (10th Cir. 2000) (citation omitted). Because B ishop’s
argument was not based on newly discovered law or facts and does not implicate
manifest injustice or clear error, we hold the district court did not abuse its
discretion in denying this motion. See id.3
The record reveals that LINA also failed to address the effect job stress
would have on Bishop’s ability to perform all the essential duties of his job.
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IV
W ith respect to the substantive denial of benefits, we VAC ATE and
R EM A N D with instructions to the district court to remand to LINA for further
proceedings. W e AFFIRM the district court’s denial of Bishop’s Rule 59(e)
motion.
Entered for the Court
Carlos F. Lucero
Circuit Judge
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