Ewing v. Metro. Life Ins. Co.

• Decision Date: 07 June 2011
• Docket Number: No. 10-20668,10-20668
• Parties: HABIBA EWING, Plaintiff-Appellant v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant-Appellee
• Court: U.S. Court of Appeals — Fifth Circuit

HABIBA EWING, Plaintiff-Appellant

v.METROPOLITAN LIFE INSURANCE COMPANY, Defendant-Appellee

No. 10-20668

UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT

Dated: June 7, 2011

Summary Calendar

Appeal from the United States District Court

for the Southern District of Texas

(08-CV-2697)

Before JOLLY, GARZA, and STEWART, Circuit Judges.

PER CURIAM:^*

Habiba Ewing appeals from the district court's grant of summary judgment to Metropolitan Life Insurance Company ("MetLife") on Ewing's claim that MetLife erroneously denied her long-term disability benefits. Ewing injured her shoulder, leading to shoulder surgery followed by ongoing complaints of pain. Ewing worked for Shell Oil Company and was covered by the company's long term disability benefits plan ("Plan"). MetLife insures the payment ofbenefits under the plan and reviews claims filed thereunder. Ewing filed for long-term disability benefits. MetLife denied her claim on the ground that she was not "disabled," as the term is defined by the Plan. Ewing administratively appealed MetLife's determination, but was unsuccessful. She filed this lawsuit challenging the denial of benefits.

The terms of the Plan grant MetLife "discretionary authority to interpret the terms of the plan and to determine eligibility for and entitlement to plan benefits in accordance with the terms of the plan." Where a plan governed by ERISA grants the administrator "'discretionary authority with respect to the decision at issue,'" we review a denial of benefits for abuse of discretion. Corry v. Liberty Life Assurance Co. of Bos., 499 F.3d 389, 397 (5th Cir. 2007) (quoting Vega v. Natl Life Ins. Serv., Inc., 188 F.3d 287, 295 (5th Cir. 1999) (en banc)). We apply this deferential standard of review even where the administrator is also the party obligated to pay the benefits, although we consider any conflict of interest as a factor in our review. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 118 (2008). The administrator's decision must be supported by substantial evidence. Id. (citing Ellis v. Liberty Life Assurance Co. of Bos., 394 F.3d 262, 273 (5th Cir. 2004)). ''Substantial evidence is more than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'' Ellis, 394 F.3d at 273.

E wing argues that MetLife abused its discretion by applying an incorrect definition of "disabled." The Plan provided the following definition of disability:

that, due to an Injury or Sickness, you require the regular care and attendance of a Doctor and . . . :

1.a. During the Elimination Period [before long term disability payments become available] and the 24 month period immediately following the Elimination Period, you are unable to perform each of the material duties of your regular job or a Comparable Occupation with the Employer which the Employer will have offered to such Employee, provided a Comparable Occupation is available; andb. after the first 24 months of benefit payments, you must be unable to perform each of the material duties of any gainful work or service for which you are reasonably qualified taking into consideration your training, education, experience and past earnings.

MetLife's summary plan description, see 29 U.S.C. § 1022(a), provided a briefer but similar definition:

To qualify for LTD benefits you must be disabled; that is, you must:

Be under a doctor's care;

Be unable by reason of your illness or injury to perform the duties of your own job, or another job available within a participating company for which you are reasonably qualified, for at least 52 consecutive weeks;

Apply for benefits, including submitting medical evidence of disability acceptable to MetLife; and

O btain MetLife's approval of your claim.

E wing argues that MetLife misinterpreted these definitions by erroneously considering Ewing's employer's willingness to accommodate her symptoms when evaluating whether those symptoms prevented her from doing the duties of her job. This argument is without merit. By the terms of both the Plan and the summary plan description, MetLife was required to consider whether Ewing's injury or illness prevented her from performing the duties of her job or a comparable position within the company. It was not an abuse of discretion for MetLife to consider the employer's accommodations as part of its inquiry into the scope of Ewing's duties.¹ See Plyant v. Hartford Life & Accident Ins. Co., 497F.3d 536 (5th Cir 2007) (rejecting argument that insurer "incorrectly included functional limitations in [beneficiary's] job description to accommodate her disability"); Vercher v. Alexander & Alexander, Inc., 379 F.3d 222, 231 (5th Cir. 2004) (affirming administrator's conclusion that "so long as [beneficiary] was able to perform all the substantial and important aspects of her job, with reasonable accommodation, and any aspects of the job that she could not...