Howard v. HCA-The Health Care

IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
No. 02-40829
Summary Calendar
MICHAEL HOWARD,
Plaintiff-Appellant,
versus
HCA – THE HEALTH CARE COMPANY, Etc. ET AL.,
Defendants,
BAY AREA HEALTHCARE GROUP, LIMITED,
doing business as Corpus Christi Medical Center,
Defendant-Appellee.
Appeal from the United States District Court for
the Southern District of Texas
(USDC No. C-01-CV-296)
_______________________________________________________
January 31, 2003
Before REAVLEY, BARKSDALE and CLEMENT, Circuit Judges.
PER CURIAM:*
*
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not be published and is not precedent except under the limited circumstances set forth in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.
We affirm for the following reasons:
1. We essentially agree with the district court’s thorough opinion.
2. Appellant Howard did not, in our view, raise a material issue of fact on the
ultimate question of whether the plan administrator abused its discretion in deciding to
end further disability benefits to him. Howard does not persuade us that the district court
misunderstood its standard of review. In any event, conducting a de novo review of the
summary judgment motion, see Pratt v. City of Houston, 247 F.3d 601, 605-06 (5th Cir.
2001), we conclude that the motion was properly granted.
2. Howard complains that the plan administrator committed a violation of a then-
effective ERISA regulation by refusing to allow him to “[r]eview pertinent documents” in
the course of his administrative appeal. See 29 C.F.R. § 2560.503-1(g)(1)(ii) (1999);
Gooden v. Provident Life & Accident Ins. Co., 250 F.3d 329, 335 (5th Cir. 2001)
(discussing regulation). Without deciding whether, under abuse of discretion review, this
regulation always required a plan administrator to provide full disclosure of all
evidentiary materials on which it relied, Howard does not persuade us that a violation of
this regulation, if any, was sufficient to defeat the summary judgment motion. A
violation of a procedural requirement does not automatically entitle an ERISA claimant to
plan benefits. “Failure to fulfill procedural requirements generally does not give rise to a
substantive damage remedy. The exception occurs when the violations are continuous
and amount to substantive harm.” Hines v. Mass. Mut. Life Ins. Co., 43 F.3d 207, 211
(5th Cir. 1995) (citations omitted). Howard does not persuade us that full discovery
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during administrative proceedings would have allowed him to respond with explanations
or further evidence that would have so altered the mix of information before the plan
administrator as to raise a genuine issue of material fact on whether the administrator
abused its discretion. In particular, Howard does not persuade us that he could have
significantly altered the import of the videotape in the administrator’s possession.
3. The plan administrator, after reviewing the videotape and other materials,
concluded that further disability benefits under the plan should be terminated because the
plan provides for such termination in cases where the participant’s alleged injury is
“feigned, or an attempt to defraud the Employer,” or the participant engaged in “activity
that exceeds the Provider’s restrictions.” The summary judgment record establishes that
the administrator did not abuse its discretion in its interpretation of the plan document,
see Rhorer v. Raytheon Eng’rs & Constructors, Inc., 181 F.3d 634, 639-40 (5th Cir.
1999), and in its factual determination that Howard was not entitled to further to plan
benefits under the terms of the plan, see Sweatman v. Commercial Union Ins. Co., 39
F.3d 594, 597-98 (5th Cir. 1994).
AFFIRMED.
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