Smith v. Fortis Benefits Insurance

Not For Publication in West's Federal Reporter
Citation Limited Pursuant to 1st Cir. Loc. R. 32.3
United States Court of Appeals
For the First Circuit
No. 03-1490
WILLIAM SMITH,
Plaintiff, Appellant,
v.
FORTIS BENEFITS INSURANCE COMPANY,
Defendant, Appellee.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW HAMPSHIRE
[Hon. Paul J. Barbadoro, U.S. District Judge]
Before
Torruella and Howard, Circuit Judges,
and Schwarzer,* Senior District Judge.
James F. Lafrance, with whom Normandin, Cheney & O'Neil was on
brief, for appellant.
Joshua Bachrach, with whom Rawle & Henderson LLP, was on
brief, for appellee.
October 9, 2003
*
Of the Northern District of California, sitting by designation.
Per Curiam. William Smith ("Smith") appeals from the
district court's grant of summary judgment affirming the denial of
disability benefits under the Employee Retirement Income Security
Act ("ERISA"), 29 U.S.C. § 1132(a)(1). We affirm the district
court's judgment for the reasons stated by the district judge in
his Memorandum and Order. Smith v. Fortis Benefits Ins. Co., No.
Civ. 02-55-B (D.N.H. Mar. 6, 2003) (Barbadoro, C.J.). We outline
a few points relevant to appellant's claims.
As the relevant facts are set out in the district court's
Memorandum and Order, we give only the essentials. Smith was
employed as a project/test electronics engineer at New England
Semiconductor ("NES"). Smith sought benefits from Fortis Benefits
Insurance Company ("Fortis") in December 1999 under their Long Term
Disability Plan ("the Plan") after suffering a heart attack.
Fortis denied Smith's application for long term disability benefits
finding Smith's medical limitations did not prevent him from
performing any of the material duties of his position. Smith
exhausted his administrative appeals in September 2000, when
Fortis's Appeals Committee denied his appeal based on a finding
that he was capable of working at light to sedentary levels.
The district court granted Fortis's motion for summary
judgment, finding that there was substantial evidence reasonably
sufficient to support Fortis's decision. We review grants of
summary judgment de novo, applying the same standard of review to
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the administrative determination that was appropriate in the
district court. See Leahy v. Raytheon Co., 315 F.3d 11, 18 (1st
Cir. 2002).
Appellant's main assertion is that the district court
erred in applying the arbitrary and capricious standard to his
claims, because Fortis allegedly had a conflict of interest. The
Plan states that Fortis "has the sole discretionary authority to
determine eligibility for participation or benefits and to
interpret the terms of the Policy. All determinations and
interpretations made by [Fortis] are conclusive and binding on all
parties." Appellant contends this clause creates a conflict of
interest and, under Leahy, 315 F.3d at 16, and Doyle v. Paul Revere
Life Ins. Co., 144 F.3d 181, 184 (1st Cir. 1998), we are required
to apply a heightened standard to Smith's claim.
We agree with the district court that Smith is
overreaching. First, there is no indication of the type of actual
conflict that we counseled against in Leahy and Doyle. In Pari-
Fasano v. ITT Hartford Life & Accident Ins. Co., 230 F.3d 415, 418
(1st Cir. 2000), we held that the arbitrary and capricious standard
is not altered by a potential conflict of interest. Instead, "we
[take] into account the potential for conflict in considering
whether the insurer's decision had strayed outside the bounds of
reasonableness to become an abuse of discretion." Id. at 419. We
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can discern neither a conflict of interest nor an abuse of
discretion in Smith's case.
The rest of appellant's arguments cannot be successful.
The Supreme Court has held that the treating physician rule, which
appellant urged be applied to him, does not apply in ERISA cases.
See Black & Decker Disability Plan v. Nord, ___ U.S. ___, 123 S.
Ct. 1965, 1972 (2003). In addition, appellant urges us to reverse
the district court because Fortis did not give due deference to the
Social Security Administration's decision that he was disabled. We
have stated that these decisions should not be given controlling
weight. Lopes v. Metro. Life Ins. Co., 332 F.3d 1, 6 n.9 (1st Cir.
2003)(quoting Pari-Fasano, 230 F.3d at 420). Nor is there merit in
Smith's argument that Fortis erroneously classified Smith's duties
as light or sedentary. Substantial evidence supports that
determination.
For the foregoing reasons, the district court's grant of
summary judgment is affirmed.
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