Brown v. Hartford Life Insurance Co. ( 2011 )


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  •                                                                        FILED
    United States Court of Appeals
    Tenth Circuit
    June 28, 2011
    UNITED STATES COURT OF APPEALS
    Elisabeth A. Shumaker
    Clerk of Court
    FOR THE TENTH CIRCUIT
    GERAL R. BROWN,
    Plaintiff-Appellant,
    No. 10-7081
    v.                                         (D.C. No. 6:06-CV-00115-JHP)
    (E.D. Okla.)
    HARTFORD LIFE INSURANCE CO.,
    Defendant-Appellee.
    ORDER AND JUDGMENT *
    Before TYMKOVICH and BALDOCK, Circuit Judges, BRORBY, Senior
    Circuit Judge.
    Geral R. Brown appeals the district court’s order granting summary
    judgment to Hartford Life Insurance Co. (Hartford) on his challenge to the
    termination of his long-term disability benefits. He sued Hartford under the
    Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132 (ERISA).
    In a prior appeal, this court remanded for the district court to re-examine the
    *
    After examining the briefs and appellate record, this panel has determined
    unanimously to grant the parties’ request for a decision on the briefs without oral
    argument. See Fed. R. App. P. 34(f); 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 This order and judgment is not binding
    precedent, except under the doctrines of law of the case, res judicata, and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
    with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
    evidence in light of the arbitrary and capricious standard of review. Brown v.
    Hartford Life Ins. Co., 301 F. App’x 772, 777 (10th Cir. 2008) (Brown I). We
    now exercise jurisdiction under 28 U.S.C. § 1291 and affirm.
    Background
    The underlying facts are set forth in Brown I, 301 F. App’x at 773-74.
    Briefly, Mr. Brown was employed by FedEx Freight East, Inc. (FedEx). He
    sustained serious injuries while unloading a FedEx delivery truck on March 3,
    2003. Mr. Brown was covered by FedEx’s employee welfare benefit plan, the
    “FedEx Freight East, Inc., Group Benefit Plan” (Plan). Mr. Brown received
    short-term disability benefits for six months, and long-term disability benefits for
    the twelve months from September 1, 2003 through August 31, 2004. After the
    end of that twelve-month period, the Plan provided that an employee “may
    continue to receive disability benefits only if the disability prevents him from
    performing one or more of the essential duties of any occupation for which he is
    qualified by training, education, or experience.” 
    Id. at 774.
    Hartford determined
    that Mr. Brown did not meet the “any occupation” standard as of August 31,
    2004, and terminated his benefits.
    Following his injury, Mr. Brown filed for social security disability benefits,
    as required by the Plan, and the Social Security Administration (SSA) awarded
    him benefits. The Plan then offset the monthly benefit it paid to Mr. Brown by
    the amount of the social security benefit. Mr. Brown also applied for benefits to
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    the Oklahoma Worker’s Compensation Court (OWCC), which also determined
    that he was disabled.
    Hartford denied Mr. Brown’s administrative appeal and he sought judicial
    review. Following the remand in Brown I, the district court first denied
    Mr. Brown’s motion to supplement the administrative record. The court then
    granted summary judgment in favor of Hartford after examining and weighing the
    evidence and applying the arbitrary and capricious standard of review. The court
    upheld Hartford’s decision to deny benefits because Mr. Brown did not meet the
    Plan’s requirement that he be unable to perform “any occupation.”
    Standards of Review
    “We review a plan administrator’s decision to deny benefits to a claimant,
    as opposed to reviewing the district court’s ruling.” Holcomb v. Unum Life Ins.
    Co., 
    578 F.3d 1187
    , 1192 (10th Cir. 2009). The Plan gives Hartford discretionary
    authority to interpret its terms and provisions and to determine eligibility for
    benefits. Brown I, 301 F. App’x at 775. Therefore, we apply an arbitrary and
    capricious standard of review, under which “we will uphold an administrator’s
    decision so long as it is predicated on a reasoned basis.” Graham v. Hartford Life
    & Accident Ins. Co., 
    589 F.3d 1345
    , 1357 (10th Cir. 2009) (internal quotation
    marks omitted), cert. denied, 
    130 S. Ct. 3356
    (2010). The arbitrary and
    capricious standard is a deferential one. Weber v. GE Group Life Assurance Co.,
    
    541 F.3d 1002
    , 1010 (10th Cir. 2008). An arbitrary and capricious denial of
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    benefits may be indicated by a “lack of substantial evidence, mistake of law, bad
    faith, and conflict of interest by the fiduciary.” 
    Graham, 589 F.3d at 1357-58
    (internal quotation marks omitted). Substantial evidence is “such evidence that a
    reasonable mind might accept as adequate to support the conclusion reached by
    the decision-maker. Substantial evidence requires more than a scintilla but less
    than a preponderance.” 
    Id. at 1358
    (internal quotation marks omitted). “Our
    review is limited to the administrative record–the materials compiled by the
    administrator in the course of making his decision.” 
    Holcomb, 578 F.3d at 1192
    (internal quotation marks omitted).
    Discussion
    A. Motion to Supplement the Administrative Record
    We first consider Mr. Brown’s contention that the district court erred in
    denying his motion to supplement the administrative record with documents filed
    in the social security proceedings. The district court observed that the Plan
    administrator had not relied on the documents in question.
    “[W]e have frequently, consistently, and unequivocally reiterated that, in
    reviewing a plan administrator’s decision under the arbitrary and capricious
    standard, the federal courts are limited to the administrative record.” Murphy v.
    Deloitte & Touche Group Ins. Plan, 
    619 F.3d 1151
    , 1157 (10th Cir. 2010)
    (internal quotation marks omitted). Following the Plan administrator’s initial
    decision to deny him long-term disability benefits, Mr. Brown filed an
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    administrative appeal and supplemented the record at that time. See Aplt. App. at
    67. And in the remanded proceedings, the district court permitted further
    discovery on issues relating to Hartford’s conflict of interest. See 
    Murphy, 619 F.3d at 1162
    (holding that although district courts are prohibited from
    considering extra-record materials related to a claimant’s eligibility for benefits,
    they may consider “extra-record materials related to an administrator’s dual role
    conflict of interest”). Consequently, the district court correctly denied
    Mr. Brown’s motion to supplement the administrative record with materials
    pertaining to his eligibility for benefits.
    B. Conflict of Interest
    Mr. Brown argues that the Plan administrator’s decision to deny him
    long-term disability benefits should be overturned because (1) the Plan required
    him to apply for social security disability benefits and it benefitted financially
    from the SSA’s finding that he was disabled, yet it ignored the SSA’s finding of
    disability by concluding that he was not precluded from performing “any
    occupation;” (2) the Plan operated under a dual-role financial conflict of interest
    as demonstrated by (a) its failure to consider the SSA’s award of disability
    benefits; (b) its failure to obtain records submitted to the SSA; (c) its failure to
    consider the OWCC’s January 24, 2005, finding that he was temporarily totally
    disabled; (d) its reliance on its consulting physician’s opinion; and (e) its failure
    to adopt the favorable opinions of Dr. Hastings and Ms. Mallon, a vocational
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    rehabilitation consultant; and (3) a fair review of the medical evidence established
    his total disability, which qualified under the Plan’s “any occupation” criteria.
    Although the district court did not correctly describe the Plan administrator’s
    treatment of the SSA and OWCC disability determinations, we conclude that this
    factor alone does not require reversal based on Hartford’s conflict of interest,
    when considered with other factors.
    Hartford was both the insurer and administrator of the Plan and thus acted
    under a dual-role conflict of interest. A conflict of interest is one of several
    factors courts must take into account when reviewing the lawfulness of benefit
    denials. Metro. Life Ins. Co. v. Glenn, 
    554 U.S. 105
    , 117 (2008). In Glenn, the
    Court considered the insurer’s dual-role conflict of interest as one of a
    combination of factors, stating that the lower court was justified in giving more
    weight to the conflict where the insurer “had encouraged [claimant] to argue to
    the [SSA] that she could do no work, received the bulk of the benefits of her
    success in doing so (the remainder going to the lawyers it recommended), and
    then ignored the agency’s finding in concluding that [claimant] could in fact do
    sedentary work.” 
    Id. at 118.
    Here, the district court recognized Hartford’s financial gain from
    Mr. Brown’s receipt of social security disability benefits, but erred in stating that
    the conflict was “minimal” because Hartford “simply suggest[ed] he apply for
    benefits.” Aplt. App. at 9. On the contrary, the Plan required Mr. Brown to
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    apply for those benefits. 
    Id. at 194;
    see also Brown I, 301 F. App’x at 774
    (“Hartford had instructed Mr. Brown to apply for Social Security disability
    benefits” (emphasis added)). Moreover, the district court held that the standards
    were different for determining eligibility for benefits under the Plan and under the
    SSA and OWCC. But the district court, like the Plan administrator, offered no
    explanation of the different standards or why the Plan administrator was not
    obliged to consider the SSA’s disability finding.
    Nevertheless, pursuant to the Supreme Court’s “combination-of-factors
    method of review,” 
    Glenn, 554 U.S. at 118
    , we conclude that the Plan
    administrator’s failure to distinguish or discuss the SSA’s and OWCC’s findings
    of disability does not weigh heavily against Hartford. The district court found
    that Hartford had taken steps to reduce potential bias and to minimize any conflict
    of interest “by separating the initial claims handler from the appeals specialist,
    paying a fixed salary to its decision makers without incentives for denying claims,
    and separating the financial department from the claims department such that the
    claims handlers do not interact with the underwriters or financial department in
    the handling of a claim.” Aplt. App. at 8. Mr. Brown does not challenge these
    findings. These factors weigh in Hartford’s favor.
    Mr. Brown also claims as evidence of Hartford’s conflict of interest the
    Plan administrator’s treatment of the medical evidence. He contends that the
    favorable opinions of Dr. Hastings and Ms. Mallon, the vocational rehabilitation
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    consultant, should have prevailed over those of Dr. Siegel, the consulting
    physician, and other physicians. The Plan administrator considered Dr. Hastings’
    opinion, as well as the opinions of Drs. Pardee, Moorad, Shaw, Pettingell, and
    Siegel, and noted that the opinions were not entirely consistent with one another.
    Dr. Hastings examined Mr. Brown on one occasion in June 2004. He noted
    Mr. Brown’s injuries to the left arm and opined that he had likely sustained more
    extensive injuries. He recommended that Mr. Brown undergo orthopedic and
    psychiatric evaluations.
    Dr. Shaw conducted a psychological evaluation in March 2005, but was
    unable to state whether Mr. Brown suffered from an “injury related psychological
    overlay” due to his failure “to respond in an open and honest manner on pain
    ratings, cognitive tasks, and endorsement of psychological symptoms.” Aplee.
    Supp. App., Vol. I at 237. The Plan administrator noted that Mr. Brown did not
    submit any documentation indicating that he had sought psychological or
    psychiatric care, other than the evaluation by Dr. Shaw.
    In October 2004, Dr. Pardee examined Mr. Brown, concluding that there
    was “no contraindication to Mr. Brown returning to the workforce, at any time.”
    
    Id. at 245.
    He opined that the injury was limited to the left arm and elbow and
    found “no evidence of impairment for psychological overlay.” 
    Id. at 244.
    Dr. Moorad performed an orthopedic evaluation in March 2005, and stated
    that Mr. Brown had “increasing pain and symptomatology” so was in need of
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    nerve blocks, which were helpful. Aplt. App. at 133. Dr. Moorad suggested that
    Mr. Brown’s pain medications be changed to non-narcotic medications and that he
    undergo further testing, after which he could be assessed for retraining. 
    Id. The record
    does not reflect that Dr. Moorad conducted additional testing and no
    further report from Dr. Moorad was submitted to the Plan administrator, 
    id. at 71.
    The latest report by Dr. Pettingell, Mr. Brown’s treating physician, was
    dated August 4, 2005. 
    Id. at 82-83.
    As with previous reports, Dr. Pettingell
    noted that Mr. Brown’s condition remained essentially unchanged. Mr. Brown
    was to continue on current medications and to continue with a home exercise
    program. Mr. Brown has identified no statement by Dr. Pettingell indicating that
    he is unable to work, and we have found none.
    The Plan administrator also relied on the report by consulting physician
    Dr. Siegel that noted Mr. Brown’s limitations and capabilities and concluded that
    he could “perform mostly one-handed work.” 
    Id. at 168.
    Mr. Brown argues that
    Dr. Siegel’s opinion should be given no weight because he did not examine
    Mr. Brown, he was employed by Hartford, and his opinion differed from those of
    Mr. Brown’s treating physician. 1 Those conclusory claims, unsupported by record
    1
    Mr. Brown also complains that Hartford never offered him vocational
    rehabilitation or job training, despite Dr. Siegel’s suggestion that it would be
    useful. This argument is irrelevant to the question of whether the medical
    evidence supported the Plan administrator’s determination that Mr. Brown was
    not entitled to long-term benefits.
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    evidence or legal authority, are not persuasive. As the Plan administrator
    discussed, Dr. Siegel reviewed the extensive medical reports submitted by other
    physicians and conferred with Dr. Pettingell. Moreover, Dr. Siegel’s opinion is
    closely linked to the medical evidence. Therefore, the Plan administrator
    appropriately considered Dr. Siegel’s opinion.
    Mr. Brown also asserts that Hartford unfairly kept crucial documents from
    Dr. Siegel, thus demonstrating its bias. Cf. 
    Glenn, 554 U.S. at 110
    (listing as a
    factor indicating a conflict of interest the insurer’s “failure to provide all of the
    treating physician reports to its own hired experts”). The documents Mr. Brown
    claims were not shown to Dr. Siegel are the reports by the vocational counselors.
    But those reports were derived from the limitations given by Dr. Pettingell, with
    whom Dr. Siegel discussed Mr. Brown’s condition. And those reports were not
    medical reports. Therefore, this argument does not demonstrate bias.
    As to Ms. Mallon’s opinion, the Plan administrator compared it to two
    other vocational evaluations, and discounted it because it afforded greater weight
    to Mr. Brown’s subjective view that he was unable to work and did not describe
    “any method utilized to attempt to identify or rule out occupations that may be
    performed within his vocational and medical qualifications.” Aplt. App. at 73.
    Based on our review of the medical evidence, we conclude that the Plan
    administrator’s treatment of Ms. Mallon’s opinion was reasonable. We further
    reject Mr. Brown’s bias challenge to a vocational assessment submitted by
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    Ms. Fant due to her status as a Hartford employee. As indicated in her report, she
    used a computer program to identify jobs Mr. Brown could do based on the
    limitations stated by Dr. Pettingell. Mr. Brown has made no challenge to
    Ms. Fant’s methodology.
    Finally, we address Mr. Brown’s argument that the Plan administrator
    disregarded the medical evidence of Mr. Brown’s severe chronic pain, his reflex
    sympathetic dystrophy (regional pain syndrome), and his dependence on and
    regular use of narcotic medications for pain control. He asserts that the Plan
    administrator’s failure to account for the effect of his pain and narcotic use on his
    employability requires a remand. It is undisputed that Mr. Brown had chronic
    pain and took narcotic medications to control the pain. But the record does not
    support an inference that either the pain or the medications adversely affected his
    ability to work. According to Dr. Pettingell’s reports, medications provided
    Mr. Brown “complete relief” from pain, Aplt. App. at 93, and Mr. Brown
    “tolerate[d] current medications without significant side effects,” 
    id. at 87.
    Mr. Brown points to no evidence in the record to support his claim that his pain
    or medications affected his ability to work.
    As the above discussion demonstrates, there is substantial evidence to
    sustain the Plan administrator’s determination. Therefore, we must reject
    Mr. Brown’s request for a remand and an award of benefits.
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    Conclusion
    We conclude that the circumstances under which Mr. Brown’s long-term
    disability benefits were terminated do not suggest a “likelihood that [Hartford’s
    dual-role inherent conflict of interest] affected the benefits decision.” 
    Glenn, 554 U.S. at 117
    . Rather, the conflict is made less important by Hartford’s “active
    steps to reduce potential bias and to promote accuracy.” 
    Id. Further, the
    Plan
    administrator’s decision is supported by substantial evidence. Accordingly, the
    judgment of the district court is AFFIRMED.
    Entered for the Court
    Bobby R. Baldock
    Circuit Judge
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Document Info

Docket Number: 10-7081

Judges: Tymkovich, Baldock, Brorby

Filed Date: 6/28/2011

Precedential Status: Non-Precedential

Modified Date: 11/5/2024