Coker v. Metropolitan Life. Ins. Co., 01-2772.

• Decision Date: 28 February 2002
• Docket Number: No. 01-2772.,01-2772.
• Citation: 281 F.3d 793
• Parties: Kenneth COKER, Sr., Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, a/k/a MetLife and Allstate Insurance Company, Appellees.
• Court: U.S. Court of Appeals — Eighth Circuit

281 F.3d 793

Kenneth COKER, Sr., Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, a/k/a MetLife and Allstate Insurance Company, Appellees.

No. 01-2772.

United States Court of Appeals, Eighth Circuit.

Submitted: January 14, 2002.

Filed: February 28, 2002.

Rehearing Denied: April 23, 2002.

COPYRIGHT MATERIAL OMITTED

Keith D. Coker, argued, Russellville, AR, for appellant.

Leigh Anne Shults, argued, Little Rock, AR (Byron Freeland, on the brief), for appellee.

Before WOLLMAN,¹ Chief Judge, HANSEN, Circuit Judge, and OBERDORFER,² District Judge.

OBERDORFER, District Judge.

Appellant Kenneth Coker, Sr. appeals from the district court's³ decision in favor of appellees Metropolitan Life Insurance Company ("MetLife") and Allstate Insurance Company ("Allstate") on cross-motions for summary judgment. We have jurisdiction pursuant to 28 U.S.C. § 1291, and we affirm.

I.

Coker was an insurance agent for Allstate for thirty years. As an Allstate employee, Coker was a participant in the company's employee welfare benefit plan, for which MetLife serves as the insurer and claims administrator. The Allstate plan was established and is administered under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq. Coker applied for longterm disability benefits on August 26, 1996. MetLife denied coverage because Coker failed to prove that he was "totally disabled" to its satisfaction. The plan defines "totally disabled" as follows:

Totally Disabled or Total Disability means that due to Sickness or Injury: ! you are unable to perform the material duties of your occupation with your Employer during the Waiting Period and during the next 24 months; ! thereafter, you must be totally incapable due to Sickness or Injury of performing the material duties of any gainful occupation for which you are reasonably fit based on training, education, or experience.

App. at 11.

Coker was diagnosed with diabetes mellitus in 1985. Beginning in the spring of 1996, he reported several near-fainting, presyncopal episodes to his family physician, Dr. Stanley Teeter. Dr. Teeter referred Coker to a neurologist, Dr. Scott Schlesinger, who suspected that the episodes might be a symptom of subclavian steal syndrome, a condition where blood that should flow to the brain is diverted to a limb. Dr. Schlesinger in turn referred Coker to a cardiologist, Dr. Andy Henry. Dr. Henry found no evidence of cardiac abnormality, other than "mild mitral valve prolapse." Dr. Henry also assessed Coker for subclavian steal syndrome, based on Dr. Schlesinger's suspicion, but concluded that the patient did not have the typical symptoms of that disorder. Dr. Henry's tentative diagnosis was left subclavian stenosis (cut-off of blood flow) with asymptomatic reversal of flow in the left vertebral artery.

During an examination on May 15, 1996, Dr. Teeter found that Coker's recent blood sugar test results had deteriorated, which he and Coker attributed to work-related stress. Coker proposed taking medical leave from work. Dr. Teeter agreed and Coker did so on the following day. Coker began insulin treatment on June 13, 1996; previously, his diabetes had been managed through diet, exercise, and medication. Monthly check-ups in July, August, September, November, and December 1996 indicated that his blood sugar levels were improving and his near-fainting episodes had ceased, although Dr. Teeter continued to note that any return to the workforce would raise Coker's stress levels and worsen his diabetes. Coker, who needs to control his weight in order to manage his diabetes, also reported a weight gain of fourteen pounds from August to November 1996.

Following Coker's application for long-term disability benefits in August 1996, he submitted a form and a letter from Dr. Teeter outlining his condition. Dr. Teeter stated a primary diagnosis of "vascular headaches related to stress syndrome caused by his work situation and employer/employee relationships." App. at 45. Dr. Teeter identified "insulin-dependent diabetes mellitus" as a secondary medical problem. Id. Dr. Teeter noted that Coker's health had improved since May 15, 1996, when he began his medical leave, and expressed the opinion that Coker's health would deteriorate if he returned to work. "It seems to me that it would be in his best interest to obtain a medical retirement or disability retirement at this time." App. at 48.

At the request of MetLife, Coker met with a psychiatrist, Dr. Richard Sundermann, Jr., on October 11, 1996. Dr. Sundermann found no need for psychiatric treatment. The psychiatrist noted that Coker's "diabetes, proclivity for headache and sleep were severely adversely effected by the stress of his particular work situation and when working he suffered additional complications of insomnia, impaired concentration, and depressed mood." App. at 69. Dr. Sundermann concurred with Dr. Teeter that Coker "was dibilitated [sic] by his medical condition and other psychological [sic] while he was working and such in all probability would recur if he returned to this particular work situation." Id.

MetLife referred Coker's claim to its in-house Disability Nurse Specialist on November 4, 1996. The referral indicated the opinion that no objective information supported Coker's application for long-term disability benefits. The nurse agreed, and a MetLife letter of November 18, 1996 denied Coker's claim. Coker promptly requested a review of the denial; MetLife responded on December 11, 1996 with a letter stating that a review was not warranted because Coker had not submitted any new information. That letter gave Coker thirty days to submit new information in support of his claim. On January 13, 1997, MetLife sent a second letter, granting Coker an additional thirty days. Coker responded on January 14, 1997, with clinical notes from Dr. Teeter dating from May 1996 to December 1996. On January 21, 1997, MetLife referred Coker's claim to an independent medical review company, Network Medical Review. Two physicians at National Medical Review, Dr. Paul Caulford and Dr. Robert Porter, respectively certified in family medicine and occupational medicine, reviewed Coker's medical records and concluded, in a report dated February 7, 1997, that Coker "does not substantiate a claim for total disability." App. at 107. On February 11, 1997, MetLife denied Coker's claim for long-term disability benefits.

Following MetLife's denial in February 1997, Coker filed suit in the Circuit Court of Pope County, Arkansas on May 14, 1997. In the interim, on April 24, 1997, an Administrative Law Judge granted Coker's request for disability benefits under the Social Security Act.App. at 122-134. Because plaintiff's cause of action arises under ERISA, MetLife removed the case to federal court on June 13, 1997 pursuant to 28 U.S.C. § 1441 and 19 U.S.C. § 1132(e)(1). In an order dated September 23, 1998, the district court denied plaintiff's motion to supplement the record with evidence of the Social Security Administration's decision, but remanded Coker's claim to MetLife for reconsideration in light of his eligibility for Social Security disability benefits. App. at 113. MetLife, in a letter dated November 2, 1998, again denied Coker's claim. The parties subsequently submitted cross-motions for summary judgment, and the district court ruled in MetLife's favor on June 13, 2001. Coker filed a timely appeal on July 5, 2001.

II.

The district court's grant of summary judgment is reviewed de novo. See Riedl v. General American Life Ins. Co., 248 F.3d 753, 755 (8th Cir.2001). However, MetLife's underlying denial of benefits is reviewable only for abuse of discretion. "Where a plan gives the administrator `discretionary authority to determine eligibility for benefits,' we review the administrator's decision for an abuse of discretion." Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir.1998) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). Coker concedes that MetLife possessed discretionary authority when reviewing his claim.

The plaintiff raises five issues on appeal, alleging that: (1) the district court erred in applying Fletcher-Merrit v. NorAm Energy Corp., 250 F.3d 1174 (8th Cir.2001); (2) MetLife's decision was an abuse of discretion, in light of the contradictory ruling from the Social Security Administration; (3) MetLife's decision is undercut, rather than supported by, substantial medical evidence; (4) MetLife improperly relied on the conclusions of physicians who had never examined Coker; and (5) the reviewing physicians' report contained factual inaccuracies and misconstrued the findings of Drs. Teeter, Henry, and Sundermann. Given the lenient, abuse of discretion standard applied to a plan administrator's denial of benefits, none of these arguments justify reversing the district court's grant of summary judgment to MetLife.

A.

"A plan administrator's discretionary decision is not unreasonable merely because the reviewing court disagrees with it. Because the plan administrator offered a reasonable explanation for its decision, it `should not be disturbed even if another reasonable, but different, interpretation may be made.... Because substantial evidence supported the plan administrator's decision, the district court erred in its review for abuse of discretion." Fletcher, 250 F.3d at 1180-1181. The district court's June 13, 2001 summary judgment order applied the standard set forth in Fletcher in determining that the denial of Coker's application for benefits was supported by substantial evidence and was therefore within the defendant's discretion:

The record reflects that the administrator gathered the medical records documenting plaintiff's claim, was the moving force in obtaining a psychiatric evaluation, received a review of the records and evaluation conducted by two physicians, and even sua sponte extended the time to permit Coker to...