Anderson v. Cytec Indus. Inc.
| Decision Date | 14 September 2010 |
| Docket Number | No. 09-30333.,09-30333. |
| Citation | 619 F.3d 505 |
| Parties | Dennis ANDERSON, Plaintiff-Appellant, v. CYTEC INDUSTRIES, INC., Defendant-Appellee. |
| Court | U.S. Court of Appeals — Fifth Circuit |
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Joseph S. Piacun (argued), Gennusa, Piacun & Ruli, Metairie, LA, for Plaintiff-Appellant.
Benjamin Hayden Bant (argued), Ernest Roland Malone, Jr., Vasilios Manthos, Kullman Firm, New Orleans, LA, for Defendant-Appellee.
Appeal from the United States District Court for the Eastern District of Louisiana.
Before SMITH, GARZA and CLEMENT, Circuit Judges.
Dennis Anderson appeals the district court's denial of his ERISA claim for short-term disability benefits. Because we agree with the district court that the ERISA plan administrator did not abuse her discretion in denying the benefits, we affirm.
In 1976, Dennis Anderson began working at a chemical plant owned by Cytec Industries (Cytec) in Waggaman, Louisiana. By 2005, he was working as a “panel operator,” running the computers and machinery that manufacture sulfuric acid. The job requires sharp concentration and attention to detail. In August 2005, Anderson and his wife, who is disabled and wheelchair-bound, were displaced by Hurricane Katrina. The hurricane destroyed their New Orleans home and most of their possessions. They moved to Atlanta and have not returned to New Orleans.
Anderson served in the Vietnam War, where he saw combat, and in the first Gulf War. He developed post-traumatic stress disorder (PTSD) as a result of his military service, but was able to manage it with medication and treatment while he worked at Cytec. Anderson did not have his medication with him when he evacuated before the hurricane. Approximately four weeks after arriving in Atlanta, he began receiving outpatient treatment at a specialized PTSD clinic at the Atlanta Veterans Affairs Medical Center. Treatment notes from the psychiatrist and nurse who were treating Anderson describe an increase in PTSD symptoms, including nightmares, intermittent auditory hallucinations, and irritability. Anderson was prescribed medication and began attending a weekly support group for PTSD patients.
Cytec's facilities sustained some wind damage but were not flooded by the hurricane. The plant reopened within several weeks. The company set up trailers for employees whose homes were damaged and offered to place Anderson in one of them. He declined. He reported, on several occasions, that he could not return to work because he could not leave his wife in Atlanta and because of the difficulty of finding appropriate housing for her in New Orleans. Cytec paid Anderson his regular salary through September 9, 2005.
As a Cytec employee, Anderson was enrolled in two disability benefits programs, the Short-Term Disability Plan (STDP) and the Long-Term Disability Plan. 1 Cytec directs applications for STDP benefits to a third-party administrator for an initial benefits determination. 2 While the STDP itself is not clear about the number of appeals available to claimants, Anderson was allowed two: one with third-party claims administrator Broadspire and a final appeal with Carol Van Rensalier, a Cytec human resources executive designated as the company's plan administrator.
The STDP requires an employee to have a “total disability” or be “totally disabled” to receive disability benefits. It defines “total disability” and “totally disabled” as “the complete inability of the Participant, due to sickness, injury or pregnancy, for which the Participant is and remains under the care of a licensed physician, to perform any and every duty pertaining to his occupation with his Employer and/or any similar occupation which his Employer may provide.” 3
Anderson applied for STDP benefits in early October 2005. He supported his claim with a form filled out by his treating psychiatrist, Dr. Aida Saldivia. Dr. Saldivia noted that Anderson The form showed that Anderson was unable to perform one test for “cognition/memory” but was able to complete other cognitive tests. The form also indicated that Anderson was able to go about the “activities of daily living” without assistance; in fact, during the time period in question, Anderson was actively involved in caring for his wife. Dr. Saldivia prescribed medication, noted that Anderson's plans to return to work were “undetermined at this time,” and stated that Anderson's symptoms had intensified and “rendered him incapable of performing job duties.” The administrative record does not indicate whether Dr. Saldivia reviewed Anderson's formal job description.
In late October, Broadspire's initial review found support for a functional impairment, and Broadspire approved STDP benefits for Anderson from September 27, 2005-the day Anderson first sought treatment-through November 21, 2005. At the same time, Broadspire decided to send the case for an independent “peer review” and to seek additional documentation from his care providers to determine whether to continue benefits past November 21. The company was skeptical of the extent of Anderson's functional limitation, especially considering his repeated statements-before he sought treatment-that he could not return to work because he could not secure adequate housing for his wife in New Orleans. The administrative record shows that Anderson was aware of the requirement that he keep Cytec informed of his medical status, but he did not send any additional forms documenting his ongoing disability from Dr. Saldivia or any other treating physician while his case was under review. 4
Dr. Elana Mendelssohn, Psy.D., conducted the initial independent peer review. She examined Anderson's treatment records from September and October 2005, the form completed by Dr. Saldivia, and Anderson's job description; she did not personally examine Anderson. She spoke with Dr. Saldivia on November 8, but noted that Dr. Saldivia could not recall who Anderson was. Dr. Saldivia did not get back in touch with Dr. Mendelssohn after she faxed Dr. Saldivia a copy of the form Dr. Saldivia had filled out in support of the benefits claim. Dr. Mendelssohn found that Anderson's medical records did “not support a functional impairment.” She considered the symptoms Anderson had reported but stated that “it was unclear how these symptoms were impacting [Anderson's] functionality”; she emphasized the lack of “specific examination findings or behavioral observations” that would substantiate an impairment in cognitive or psychological functioning. Dr. Mendelssohn acknowledged that the nurse who saw Anderson during his bi-weekly visits had noted the presence of impaired memory and concentration, but Dr. Mendelssohn also stated that treatment notes from the PTSD group therapist had shown intact thought processes and intact memory, “which is inconsistent with [the nurse's] report.” In conclusion, Dr. Mendelssohn wrote that the documentation she reviewed “primarily includes self-reported complaints and clinical impressions,” and that the “[e]xamination findings fail to describe a psychological condition impacting the claimant's functioning to such a degree to preclude him from performing his own occupation.”
In December 2005, Broadspire denied an extension of Anderson's STDP benefits. The denial letter cited Dr. Mendelssohn's conclusion that there were no examination findings or behavioral observations that showed the presence of an impairment in psychological functioning sufficient to prevent Anderson from working. Anderson appealed and had 38 additional pages of progress notes from Steven Barrett, his therapist, sent to Broadspire. Broadspire then instituted a second independent peer review, this one conducted by Dr. Lawrence Burstein, who holds a Ph.D. in psychology. Dr. Burstein reviewed Anderson's medical file, the prior peer review conducted by Dr. Mendelssohn, and Anderson's job description.
Dr. Burstein found that the medical records did not support a finding of functional impairment that would have precluded Anderson from working from November 21, 2005 through early March 2006, when he completed his review. Like Dr. Mendelssohn, Dr. Burstein found that the medical records documented Anderson's subjective complaints and the impressions of his clinicians, but that they did not “contain specific examples of the claimant's behavior or measurements of the claimant's cognitive functioning to support these impressions.” He also noted that no other information was available. Broadspire informed Anderson that his appeal was denied in March 2006. Like the earlier denial letter, the appeal denial stated that Anderson's physician's opinion that he would be unable to cope with the stress of his job was not supported by examples of behavior or measures of cognitive functioning showing a functional impairment that would prevent Anderson from working.
Anderson appealed again. His final appeal was handled by Cytec's plan administrator, Van Rensalier. She denied relief on July 10, 2006. Van Rensalier's letter to Anderson upheld Broadspire's earlier denials for largely the same reasons. In May 2006-while Anderson's final appeal was pending-Cytec terminated his employment.
Anderson's mental health underwent a temporary but severe downturn after Cytec's final denial of his STDP claim. Auditory hallucinations that had plagued him intermittently intensified, and Anderson voluntarily entered inpatient treatment after recognizing signs of “homicidal ideation” toward his former employer. He was released several days later, and he continued to attend group therapy sessions.
In 2007, after retaining counsel, Anderson attempted to submit additional materials to Cytec in further support of his STDP claim,...
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