Berges v. Standard Ins. Co.
| Decision Date | 31 March 2010 |
| Docket Number | Civil Action No. 09-2129-DJW. |
| Citation | 704 F.Supp.2d 1149 |
| Parties | Marcey BERGES, Plaintiff,v. STANDARD INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — District of Kansas |
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Roger M. Driskill, Burnett and Driskill, Liberty, MO, for Plaintiff.
Richard J. Pautler, Thompson Coburn LLP, St. Louis, MO, for Defendant.
Pending before the Court are the following motions: (1) Defendant Standard Insurance Company's Motion for Judgment on the Administrative Record (doc. 15); and (2) Plaintiff Marcey Berges' Motion for Summary Judgment (doc. 28). For the reasons set forth below, the Court will construe Defendant's motion as one for summary judgment, and will grant it. The Court will deny Plaintiff's motion for summary judgment.
This is an action brought pursuant to section 502(a)(1)(B) of the Employment Retirement Income Security Act (“ERISA”) 1 to recover benefits Plaintiff claims are due her under the terms of a long-term disability plan. Plaintiff was a participant in her employer's long-term disability plan, which was insured and administered by Defendant. Plaintiff filed a claim for long-term disability benefits that Defendant denied. She now seeks judicial review of Defendant's decision denying her benefits.
Before proceeding further, the Court notes that Defendant's motion seeks “judgment on the administrative record.” As the Tenth Circuit recognized in an ERISA case similar to this one, “[t]he Federal Rules of Civil Procedure contemplate no such mechanism as ‘judgment on the administrative record.’ ” 2 The Tenth Circuit thus held that “[p]arties should avoid the practice of requesting it, and courts should avoid purporting to grant it.” 3 It did not provide specific guidance, however, as to how the lower court should treat such a motion.
Here, Defendant states that it “files this Memorandum in Support of its Motion pursuant Local Rule ... 56.1,” 4 which addresses motions for summary judgment. The Court will therefore treat Defendant's motion as one for summary judgment. The Court notes, however, that the distinction between a motion for judgment on the administrative record and a motion for summary judgment is really more a matter of form than substance, because the Court's review of the facts in an ERISA case such as this is limited to the facts that are in the administrative record
Summary judgment is appropriate if the moving party demonstrates that there is “no genuine issue as to any material fact” and that it is “entitled to judgment as a matter of law.” 5 In applying this standard, the court views the evidence and all reasonable inferences drawn from the evidence in the light most favorable to the nonmoving party.6 This legal standard does not change where, as here, the court is ruling on cross-motions for summary judgment,7 for each party has the burden to establish its entitlement to judgment as a matter of law.8
The Court notes that in ERISA cases seeking review of a denial of ERISA benefits, the court's review is “limited to the administrative record,” i.e., the materials compiled by the ERISA plan's administrator in the course of making its decision.9 Thus, any evidence presented to the Court on summary judgment motions in this type of ERISA case is limited to the administrative record. At the same time, however, the Court notes that its review of the facts is not necessarily limited to the facts that the parties set forth in their briefs as the “uncontroverted facts.” As is discussed in more detail below in Part V, the Court must review the administrative record in this case to determine whether Defendant's decision to deny Plaintiff benefits was arbitrary and capricious. And in doing so, the Court should consider whether “substantial evidence” supported the decision.10 Whether evidence is “substantial” must be “evaluated against the backdrop of the administrative record as a whole.” 11 Thus, in ruling on the parties' summary judgment motions in this case, the Court must evaluate the entire administrative record and not just those particular facts the parties have plucked from the administrative record and inserted into their summary judgment briefs.
In ruling on the parties' motions, the Court must keep in mind that cross-motions for summary judgment “are to be treated separately; the denial of one does not require the grant of another.” 12 To the extent the cross-motions overlap, however, the court may address the legal arguments together.13 The Court notes that in this case, the legal issues and arguments made with respect to both motions are virtually identical. Thus, the Court will address the legal issues together.
As is discussed below in greater detail, to recover on her ERISA claim, Plaintiff must establish that Defendant's decision to deny her long-term disability benefits was arbitrary and capricious. One way to do that is to show that the decision was not supported by substantial evidence. Plaintiff contends that Defendant's decision to deny her benefits was arbitrary and capricious and unsupported by substantial evidence. Plaintiff asserts the following seven reasons as grounds for the Court to enter summary judgment in her favor and award her benefits under the long-term disability plan.
First, the plan provides that the definition of disability applicable to a participant “will be the definition approved for your Employer by [Defendant]”; however, Plaintiff contends Defendant “has asserted nothing regarding the ‘definition approved for your employer.’ ” 14
Second, Plaintiff's job with her employer KCM Capital, Inc. required her to travel extensively and internationally, and Defendant failed to take this travel into consideration in concluding that Plaintiff was not disabled.
Third, the Dictionary of Occupational Titles (“DOT”) 186.117-054, which Defendant relied upon, defines the occupation of “President, Financial Institution,” and not “Chief Financial Officer.” Plaintiff therefore contends that it was improper for Defendant to refer to and rely upon DOT 186.117-054 in determining that Plaintiff was not disabled. It was also improper for Defendant to ignore Plaintiff's other job title of Chief Compliance Officer.
Fourth, Defendant never provided its two consulting physicians, Dr. Douglas Haselwood and Dr. Shirley Ingram, with Plaintiff's job titles, job descriptions, or statements made by Plaintiff regarding the requirements of her job.
Fifth, Drs. Haselwood and Ingram are not vocational experts.
Sixth, the administrative record does not make it clear what medical records Drs. Haselwood and Ingram reviewed.
Seventh, Defendant denied Plaintiff benefits without substantial evidence to support the decision.
Defendant, on the other hand, contends that its decision was not arbitrary and capricious, and that it was supported by substantial evidence. Defendant contends that it carefully and fully reviewed the medical and psychological evidence in the record. Defendant consulted two board-certified rheumatologists who reviewed the medical records and concluded that Plaintiff was not disabled from systemic lupus erythematosus (“SLE”), Raynaud's syndrome, or arthritis, the diseases she claimed resulted in her disability. Furthermore, Defendant reviewed and considered the reports of Plaintiff's treating rheumatologist, Dr. Kathryn Welch, who relayed Plaintiff's self-report that Plaintiff could not work but who never stated in her own treatment records that Plaintiff was disabled or could not work. Defendant therefore asks the Court to uphold its decision denying benefits as supported by substantial evidence.
IV. FactsA. General Information
Plaintiff Marcey Berges was an employee of KCM Capital, Inc. (“KCM”) and served as its Chief Financial Officer. Plaintiff also contends that she was employed as KCM's Chief Compliance Officer. In May 2006, Plaintiff was a participant in a long-term disability plan sponsored by KCM (the “LTD Plan”). The LTD Plan was an “employee welfare benefit plan” within the meaning of § 3(1) of ERISA. The LTD Plan provided disability benefits to eligible qualifying participants who complied with its terms and conditions.
Plaintiff stopped working for KCM on January 30 or 31, 2006. Plaintiff filed a claim for long-term disability benefits on June 7, 2006, using Defendant's form, entitled “Employee's Statement.” On the Employee's Statement, Plaintiff listed SLE, Raynaud's, and arthritis as the illnesses contributing to her “being unable to work at [her] occupation.” 15 She described her symptoms as “fatigue, pain, seizures, difficult breathing, [and] weakness.” 16
B. Plaintiff's Job with KCM
On the Employee's Statement, Plaintiff identified her job title as “CF-Admin-CCO.” 17 On the “Employer's Statement,” however, Plaintiff's employer, KCM, listed her job title as “CFO.” 18 On July 24, 2006, KCM submitted a job description for Plaintiff's job that was entitled “Chief Financial Officer/Chief Compliance Officer.” 19 That job description summarized the job as follows: 20 Either Plaintiff or her employer submitted a page from KCM's online personnel directory that identified Plaintiff as “CFO.” 21
In Plaintiff's “Attending Physician's Statement,” which was a form completed by both Plaintiff and her treating physician, Plaintiff listed her occupation as “CFO.” 22 This statement was submitted to Defendant in April 2006.
On July 28, 2006, Plaintiff provided a memo to Defendant outlining her job responsibilities which stated that her position “was at an executive level as the Chief Financial Officer, Chief...
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