Dubose v. Prudential Insurance Co. of America ( 2003 )

United States Court of Appeals
Fifth Circuit
F I L E D
IN THE UNITED STATES COURT OF APPEALS December 24, 2003
FOR THE FIFTH CIRCUIT
Charles R. Fulbruge III
Clerk
No. 03-60493
Summary Calendar
LAWRENCE DUBOSE, JR.,
Plaintiff-Appellant,
versus
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA,
Defendant-Appellee.
--------------------
Appeal from the United States District Court
for the Southern District of Mississippi
USDC No. 1:01-CV-458-GR
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Before HIGGINBOTHAM, DAVIS, and PRADO, Circuit Judges.
PER CURIAM:*
Lawrence Dubose, Jr., appeals the summary judgment dismissal
of his complaint arising under the Employee Retirement Income
Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. Dubose sought
benefits under his employee benefit plan, alleging that he had
become totally and permanently disabled due to coronary artery
disease and elevated blood pressure. He filed suit following
Prudential’s denial of his appeals for benefits.
*
Pursuant to 5TH CIR. R. 47.5, the court has determined
that this opinion should not be published and is not precedent
except under the limited circumstances set forth in 5TH CIR.
R. 47.5.4.
No. 03-60493
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We review de novo a summary judgment dismissal and apply the
usual summary judgment rules. Mace v. City of Palestine, 333
F.3d 621, 623 (5th Cir. 2003); Barhan v. Ry-Ron Inc., 121 F.3d
198, 202 (5th Cir. 1997). To defeat summary judgment, the
nonmovant must set forth specific facts showing the existence of
a genuine issue for trial. Fed. R. Civ. P. 56(e). The nonmovant
cannot meet his burden with unsubstantiated assertions,
conclusional allegations, or a scintilla of evidence. Little v.
Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994) (en banc).
Dubose contends that the district court applied an erroneous
standard of review. He argues that because Prudential was both
the insurer and administrator of the employee benefit plan,
Prudential had a conflict of interest and the district court
should have applied the “sliding scale” standard of review. He
asserts therefore that Prudential’s decision should have been
afforded less deference.
In Vega v. Nat. Life Ins. Servs., Inc., 188 F.3d 287, 296-97
(5th Cir. 1999) (en banc), we held that a conflict is a factor to
be considered in determining whether a plan administrator abused
its discretion in denying a claim for benefits. See Sweatman v.
Commercial Union Ins. Co., 39 F.3d 594, 599 (5th Cir. 1994).
Dubose conceded that Prudential had discretionary authority to
determine his eligibility for benefits under the plan. The
district court recognized Prudential’s conflict, evaluated
Dubose’s asserted reasons to afford less deference to
No. 03-60493
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Prudential’s decision to deny disability benefits, and found no
merit in Dubose’s arguments. Dubose has not shown that the
district court applied an incorrect standard of review.
Dubose contends that the district court erred in granting
summary judgment. He argues that material factual disputes exist
concerning Prudential’s decision to deny benefits. He asserts
that we should adopt the “treating physician rule” and accord
greater deference to his doctor’s opinion. Dubose argues that
Prudential did not consider the fact that he obtained a favorable
disability finding from the Social Security Administration. He
contends that Prudential did not disclose its relationship with
the independent medical examiner who evaluated Dubose’s file. He
asserts that Prudential completely ignored the opinion of his
treating physician and relied exclusively on an independent
medical examiner’s opinion to deny benefits.
In Black & Decker Disability Plan v. Nord, 123 S. Ct. 1965,
1972 (2003), the Supreme Court rejected a treating physician rule
in ERISA cases.
Dubose conceded that a favorable ruling by the Social
Security Administration is not binding on an ERISA plan
administrator. Dubose has provided no support for his
allegations that the independent medical examiner’s opinion was
inaccurate or biased.
The record shows that Prudential based its decision denying
benefits on the objective medical evidence provided by Dubose’s
No. 03-60493
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treating Cardiologist and the independent medical examiner’s
evaluation of Dubose’s medical record. Although Dubose’s primary
treating physician found him to be totally disabled, the record
shows that Prudential rejected the disability finding as not
supported by objective medical evidence. Substantial evidence
supports the disability determination. See Meditrust Fin. Servs.
Corp. v. Sterling Chems. Inc., 168 F.3d 211, 214-15 (5th Cir.
1999). Accordingly, we AFFIRM the judgment of the district
court.