Manning v. Am. Repub. Ins. Co.
| Decision Date | 12 May 2010 |
| Docket Number | No. 09-2625.,09-2625. |
| Citation | 604 F.3d 1030 |
| Parties | Kim Iann MANNING, Plaintiff-Appellant,v.AMERICAN REPUBLIC INSURANCE COMPANY, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Eighth Circuit |
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Andrew Joseph Stoltze, argued, Des Moines, IA, Bruce Henry Stoltze and Eric M. Updegraff, on the brief, for appellant.
Thomas Walter Foley, argued, Des Moines, IA, Sarah J. Gayer and Debra L. Hulett, on the brief, for appellee.
Before GRUENDER and SHEPHERD, Circuit Judges, and LANGE,1 District Judge.
Kim Iann Manning (“Manning”) was denied short-term disability benefits and subsequently terminated from employment by American Republic Insurance Company (“ARIC”). She sought judicial review of the benefits decision under the Employee Retirement Income Security Act. 29 U.S.C. § 1132 et seq. She also asserted ERISA retaliation and interference claims. The district court 2 affirmed ARIC's denial of Manning's benefits claim, finding that ARIC did not abuse its discretion in determining that Manning was not disabled. In a separate order, the district court granted ARIC's motion for summary judgment on Manning's ERISA retaliation and interference claims. Manning appeals both orders. Having jurisdiction under 28 U.S.C. § 1391, this Court affirms.
Beginning on January 31, 2005, Manning worked for ARIC as a Senior Account Specialist. Her job involved selling insurance products over the telephone and was sedentary in nature, consisting of calling prospective customers and determining their eligibility for insurance, providing insurance quotes, and data entry. Manning worked a total of 50 days for ARIC. Her last day worked was April 26, 2005.
ARIC sponsored and administered a self-funded short-term disability plan (“the Plan”) for its employees. As an ARIC employee, Manning was eligible to participate in the Plan. To qualify for short-term disability benefits under the Plan, eligible employees must: (1) be covered by the Plan; (2) be under the care of an “Approved Health Care Provider”; (3) have a “Medically Certified Health Condition” that lasts longer than the short-term disability waiting period; (4) receive appropriate care and treatment for the Medically Certified Health Condition; and (5) receive approval of short-term disability benefits in accordance with the provisions of the Plan. Under the Plan, ARIC reserved the right to have claimants submit to an Independent Medical Examination (“IME”) by an Approved Health Care Provider of its choice.
The Plan defines Approved Health Care Provider as: (1) licensed doctors of medicine or osteopathy; (2) licensed podiatrists, dentists, Ph.D.'s, psychologists, optometrists, or chiropractors; and (3) licensed nurse practitioners or nurse midwives. The Plan's definition of Medically Certified Health Condition required the condition to be “[d]ocumented by objective disabling signs and symptoms.”
On May 9, 2005, Manning submitted a claim for benefits under the Plan by providing a Family Medical Leave Act Certification of Health Care Provider form completed by Physician Assistant Andra Kennedy dated May 5, 2005. Kennedy reported that Manning was experiencing “elevated blood pressure,” “increased frequency of migraines,” and “increased anxiety.” Kennedy also wrote that Manning's conditions began approximately 90 days earlier. Kennedy recommended that Manning receive short-term disability benefits for two to three months. Kennedy failed to directly answer a question on the form asking whether Manning was “unable to perform work of any kind,” instead indicating that Manning should “avoid long periods of sitting or repetitive motion.”
On May 12, 2005, Jodi Lanphier, an ARIC benefit specialist, called Manning to request more information regarding her claim. Lanphier told Manning that ARIC needed Manning to specify why she was unable to work. In response, Manning faxed Lanphier a document the next day, signed by Kennedy, stating “dangerously high blood pressure,” “[i]ncrease in frequency, severity, and duration of migraines,” and “hypertension.” However, the note did not explain why those conditions prevented Manning from working for an extended period.
On May 20, 2005, Lanphier again called Manning for more information in order to process her claim. Lanphier sent Manning a letter on May 24, 2005, explaining that the Plan required claims to be completed by an Approved Health Care Provider. The letter set forth in full the Plan's definition of Approved Health Care Provider, which did not include physician assistants. The letter further notified Manning that her claim could not be considered until an Approved Health Care Provider submitted evidence of disability. The letter also explained that “[a] decision on STD eligibility will not be made until objective medical evidence to support your disability is received by the company.” Finally, Lanphier wrote that, consistent with the Plan's terms, Manning had fifteen days after receipt of the letter to submit the required information to ARIC.
On June 8, 2005, Kennedy sent ARIC a handwritten letter, attaching two medical records from office visits during which Manning was examined by Dr. Kenneth Moon. The first record, from March 11, 2005, noted that Manning's blood pressure was 148/110, that “she feels the best that she has felt in a long time,” and that she could return to work the following Monday. In the second record, from April 26, 2005, Kennedy reported that Manning's blood pressure was 152/100 and that Manning felt “stressed out.”
On June 16, 2005, ARIC Senior Human Resources Business Partner Gina Moeckly Vernon sent a letter to Dr. Moon requesting a telephone conversation regarding Manning's health status. Vernon attached a copy of ARIC's job description for Manning's position. On July 19, Vernon, Lanphier, and Manning participated in a conference call, during which Vernon advised Manning that she needed to speak with Dr. Moon regarding Manning's medical condition. Vernon also explained that, under the Plan's terms, ARIC could not make a determination as to Manning's claim without documentation from an Approved Health Care Provider. On July 25, Vernon sent a second letter to Dr. Moon-with a copy to Manning-requesting a telephone conference regarding Manning's claim.
On July 29, 2005, Vernon, Lanphier, and Dr. Moon participated in a teleconference to discuss Manning's condition. Dr. Moon explained that he had not examined Manning since March 2005, but that upon examination of Kennedy's records and notes, he found that Manning's blood pressure level did not require placement on disability status. Inconsistent with this statement, however, Dr. Moon said that he believed Manning would not be able to return to work due to her blood pressure and migraines. He then said that he was not able to determine Manning's eligibility to return to work at that time, and he would require further examination to make a disability determination.
On August 6, 2005, Dr. Moon returned to ARIC a completed Certification of Health Care Provider form and notes from an August 1, 2005 examination of Manning. On the form, Dr. Moon noted that Manning had been under stress from her bankruptcy, but that the stress would likely be lifted upon the upcoming completion of the bankruptcy proceedings around September 4, 2005. He also reported that Manning's blood pressure was improving and her migraines were becoming less frequent. In response to the certification form's question, “is the employee unable to perform work of any kind,” Dr. Moon answered “yes” without any explanation.
On August 8, 2005, Vernon sent Manning a letter denying her short-term disability claim. Manning appealed the determination, but she did not provide ARIC any additional information regarding her medical status. On August 29, 2005, ARIC upheld the decision denying Manning's claim and sent Manning a letter stating that it had reviewed the contents of her medical file and was upholding denial of the claim “due to lack of objective medical information that illustrates that you are disabled from performing your job duties, as defined by American Republic's Short Term Disability Plan.”
Within the denial letter, ARIC informed Manning that because her claim had been denied, she had the following two options: (1) “Return to work on Wednesday, August 30, with certification from your Approved Health Care Provider that you are able to return to work”; or (2) “Provide us with objective medical information, from your Approved Health Care Provider, that you are disabled from performing your job duties.” (emphasis in original). ARIC purportedly required certification of ability to return to work as part of an internal policy to shield itself from liability by ensuring that employees do not risk their health or aggravate an injury by returning to work for financial reasons.
The letter also warned Manning that ARIC expected her employment would be terminated if she failed to return to work on August 31, 2005. Manning did not return to work. ARIC terminated her employment on September 6, 2005, which was communicated to Manning through a letter stating in part:
Because your absence is not covered by FMLA, you failed to provide objective medical information that you are disabled from performing your job duties as required by our Short-Term Disability Plan, and you have not returned to active status, your employment with American Republic is being terminated effective August 31, 2005.
Manning was ultimately released by her doctor to return to work in October 2005. She never applied for long-term disability benefits from ARIC and, even had she remained employed with ARIC, she would not have been eligible for long-term disability benefits because the six-month short-term disability period would not have expired by October 2005...
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