Boswell vs. Reliance Stnrd Life, (5th Cir. 2004)

Docket Number: 03-60308

Linked as:

Text

United States Court of Appeals Fifth Circuit FILED December 17, 2003 Charles R. Fulbruge III Clerk IN THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT

No. 03-60308 MICKEY W. BOSWELL, Plaintiff - Appellee, versus RELIANCE STANDARD LIFE INSURANCE COMPANY; COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY, Defendants - Appellants.

Appeal from the United States District Court For the Northern District of Mississippi (No. 2:01-CV-122) Before SMITH, BARKSDALE, and CLEMENT, Circuit Judges.

EDITH BROWN CLEMENT, Circuit Judge: * Appellants Rel iance Standard Life Insurance Company (Â“RelianceÂ”) and Colonial Life and Accident Insurance Company (Â“Colonial LifeÂ”) appeal the district courtÂ’s ruling that the decision of Reliance, the plan administrator of Colonial LifeÂ’s benefit plan, terminating the benefits of Appellee Mickey W. Boswell (Â“BoswellÂ”) was arbitrary and capricious. Because the district court substituted its judgment for that of the plan administrator, we REVERSE. I. FACTS AND PROCEEDINGS Boswell was employed by Colonial Life for twenty years as an insurance agent. On May 28, 1999, he underwent quintuple bypass surgery and cardiac catheterization. Following this surgery, Boswell suffered a stroke which affected his motor coordination on the left side of his body. After his release fro m t he hospital, Boswell underwent physical and occupational therapy. He was also treated with medication for depression. Pursuant to the requirements of Colonial LifeÂ’s benefit plan, in January 2000, Boswell made a claim for the payment of long-term disabilit y benefits for his total disabilit y 1 due to his heart surgery and stroke.

Reliance, the administrator of Colonial LifeÂ’s benefit plan, determined on April 12, 2000 that the last date on which Boswell was totally disabled was December 7, 1999. Reliance therefore denied pay ment of full benefits for total disability after December 7. In support of this denial of benefits, Reliance cited a list of reports from various doctors that indicated, among other improvements, that ninet y-five percent of BoswellÂ’s neurologic function had returned and that he was permitted to return to Â“full activityÂ”. Boswell appealed the plan administratorÂ’s decision.

On May 23, 2000, a new doctor diagnosed Boswell with chronic depression. This medical opinion was followed by that of another doctor on June 19, 2000, in which the doctor concluded that it might be Â“quite difficult for [Boswell] to return to work.Â” The plan administratorÂ’s determination that Boswell was not totally disabled within the meaning of the plan after December 7, 1999 was affirmed on October 18, 2000. Boswell subsequent ly filed suit in district court. After discovery, Colonial Life and Reliance moved for summary judgment. In denying their motion for summary judgment, the district court found that the administratorÂ’s decision to deny Boswell benefits was arbitrary and capricious. BoswellÂ’s motion for entry of final judgment was granted. Reliance and Colonial Life timely appeal.

II. STANDARD OF REVIEW The Employee Retirement Income Security Act of 1974 (§ 1132(a)(1)(B). Factual determinations under ERISA plans are reviewed for abuse of discretion. P ierre v. Conn.

Gen. Life Ins. Co. , 932 F.2d 1552, 1562 (5th Cir. 1991). Further, so long as the ERISA benefit plan provides the plan administrator with discretionary aut ho rity to construe the terms of the plan, the plan administratorÂ’s denial of benefits is also reviewed for an abuse of discretion. G osselink v. A T & T, Inc. , 272 F.3d 722, 726 (5th Cir. 2001). When a court applies the abuse of discretion standard, it analyzes whether the plan administrator acted arbitrarily or capriciously. L ain v. UNUM Life Ins. Co. of America , 279 F.3d 337, 342 (5th Cir. 2002). Â“An administratorÂ’s decision to deny benefits must be Â‘based on evidence, even if disputable, that clearly supports the basis for its denial.Â’ We must find that Â‘[w]ithout some concrete evidence in the administrative record that supports the denial of the claim, . . . the administrator abused its discretion.Â’Â” Id. (citations omitted).

III. DISCUSSION This Court must evaluate whether there was any concrete evidence before Reliance that would justif y t he denial of benefits. S ee Thibodeaux v. ContÂ’l Cas. Ins. Co. , 138 F.3d 593, 595 (5th Cir. 1998) (observing that when this Court reviews factual determinat io ns it Â“can consider only the evidence that was available to the administratorÂ”). We find that there was ample evidentiary support in the administrative record to demonstrate that Boswell was able to drive, write, and type well enough to be discha rged from occupational therapy. In fact, there was no evidence to the contrary. The district court concluded that Â“the administr at o r essentially picked and chose those parts of the administrative record which supported a denial of the claim while disregarding those parts which supported the claim.Â” Yet the district court failed to cite any medically-sound evidence that was before Reliance on April 12, 2000 to support the grant of benefits. No doctor offered evidence that, because of the bypass surgery and stroke, Boswell was unable to perform his job. Similarly, there seems to have been no evidence available to Reliance in April, 2000 that Boswell was Â“totally disabledÂ” by depression. Even after the initial denial of benefits, when a comprehensive diagnosis of major depression was finally made, there was no evidence that Boswell was anything more than mildly depressed and properly medicated. At most, there was some evidence that it would be difficult for Boswell to transition back to work. Nevertheless, no doctor offered evidence that, because of severe depression, Boswell was unable to perform his job. Under the terms of the plan, Boswell had the burden of submitting Â“satisfactory proof of Total Disabilit yÂ” to Reliance as a requirement for receiving a monthly benefit. Boswell failed to meet this burden, and the district court abused its discretion in finding otherwise.

IV. CONCLUSION Because the district court abused its discretion by substituting its judgment for that of the plan administrator, we REVERSE and RENDER in favor of Colonial Life and Reliance. Furthermore, becau se t he award of attorneysÂ’ fees depends upon a judgment in favor of Boswell, we also REVERSE the grant of fees.

* 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

1 Â“Totally disabledÂ” is defined in the benefit plan as Â“that as a result of an injury or sickness (1) during the Elimination Period and for the first 24 months for which a Monthly Benefit is payable, you cannot perform the material duties of your regular occupation.Â”