Hancock v. Montgomery Ward Long Term Disability Trust

• Decision Date: 17 April 1986
• Docket Number: No. 84-4201,84-4201
• Citation: 787 F.2d 1302
• Parties: Dorothy HANCOCK, Plaintiff-Appellant, v. MONTGOMERY WARD LONG TERM DISABILITY TRUST, an Illinois corporation, Defendant-Appellee.
• Court: U.S. Court of Appeals — Ninth Circuit

Page 1302

787 F.2d 1302

5 Fed.R.Serv.3d 575

Dorothy HANCOCK, Plaintiff-Appellant, v. MONTGOMERY WARD LONG TERM DISABILITY TRUST, an Illinois

corporation, Defendant-Appellee.

No. 84-4201.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted Sept. 4, 1985.

Decided April 17, 1986.

Thomas A. Caruso, Portland, Or., for plaintiff-appellant.

Jeffrey Batchelor, Richard C. Hunt, Paula B. Weiss, Spears, Lubersky, Campbell, Bledsoe, Anderson, & Young, Portland, Or., for defendant-appellee.

Appeal from the United States District Court for the District of Oregon.

Before SKOPIL and FLETCHER, Circuit Judges, and REED, ^* District Judge.

SKOPIL, Circuit Judge:

Plaintiff-appellant Dorothy Hancock ("Hancock") appeals the grant of summary judgment against her in this action to recover contractual benefits under an employee benefit plan administered by defendant-appellee Montgomery Ward Long Term Disability Trust ("Trust"). Hancock had also sought extracontractual damages allegedly caused by the Trust's denial of benefits. We affirm.

FACTS AND PROCEEDINGS BELOW

Hancock is a former employee of Montgomery Ward. In 1978 she began receiving medical treatments for back pain. She left work that same year and never returned. She alleges total disability from an arthritic disorder diagnosed as ankylosing spondylitis that causes severe pain in her back, shoulders, wrists, hips, and knees.

While an employee at Montgomery Ward, Hancock participated in the Montgomery Ward Long Term Disability Plan ("plan"). The Trust was established to receive contributions from employees and pay benefits to disabled employees. Disability benefits are paid under a two-tier system. Benefits are paid up to twenty-four months to employees unable to return to their former jobs. After twenty-four months, disability benefits continue only to those employees who can show they are unable to engage in any substantial gainful activity for which they are or might become qualified to perform. The plan pays no disability benefits if total disability was caused by or resulted from a "mental or nervous disorder" unless the employee is institutionalized.

Disability benefit decisions are made by the Benefit Plans committee which is given broad authority and responsibility for the administration and interpretation of the plan. The plan contains detailed provisions concerning claims procedures, including time limitations and processes. The committee is required to give written, specific reasons for disability decisions.

When Hancock did not return to work in 1978, the Trust paid her temporary, short-term disability benefits. In March 1979 she began receiving benefits under the twenty-four month provision. At that time her treating physician, Dr. Schoepflin, diagnosed "possible spondylitis with peripheral arthritis association with inflammatory bowel disorder." He opined she was unable to return to her previous work, but might be capable of sedentary work that allowed for frequent movement.

In May 1979 Dr. Schoepflin again reported to the Trust that Hancock continued to have "arthritic complaints." In July 1980, in response to the Trust's inquiry, Dr. Schoepflin declared Hancock was not totally disabled from any and all types of work. He thought her to be a suitable candidate for rehabilitation.

Meanwhile, Hancock unsuccessfully applied for social security disability benefits. She reapplied in October 1980 and was finally awarded benefits after hearings in October 1981. The Administrative Law Judge's opinion referred to Hancock's physical disabilities, vocational studies, and psychogenic difficulties, but did not indicate any particular basis for the award.

In addition, during this time Hancock applied for and was denied aid for retraining by the state Vocational Rehabilitation Division. The state concluded she was "unfeasible" for its services because letters from her treating physician indicated she was "unable to become gainfully employed." Upon learning of this denial of services, the Trust again wrote to Dr. Schoepflin requesting additional information on his opinion of Hancock's disabilities. He responded that if she had no stress in her life and had a job that did not demand prolonged sitting or stooping and bending, she might be able to work. He doubted, however, her life would ever be stress-free or such an ideal job was available to her without retraining.

The Trust requested clarification. Dr. Schoepflin responded that Hancock continued to suffer from fibromyositis. He opined if she were neither anxious nor depressed, the symptoms of fibromyositis would improve sufficiently to allow her to work.

In March 1981 Hancock was examined by Dr. Borman, an orthopedist who diagnosed "minimal degenerative osteoarthrosis." He recommended she return to some form of vigorous activity because there was no "orthopedic contraindication to such activity."

In March 1981, when the twenty-four month disability period ended, the Trust wrote to Hancock:

It is our Medical Board's opinion, based on all available information, that the evidence presented does not provide substantiation that you are totally disabled as required under the Plan after the twenty-fourth (24) month of disability. Therefore, we are unable to provide benefits after March 30, 1981.

The letter advised her she could seek review of the decision with the Trust's administrative director. Hancock requested such review and forwarded a copy of Dr. Schoepflin's latest report in which he certified Hancock was unable to work for at least sixty days. Dr. Schoepflin thought with "rest and time we may release for light clerical work in non-stressful situation."

In apparent response to Hancock's request for review of the Trust's decision, the Trust requested her to obtain an independent evaluation from another orthopedic surgeon, Dr. Berselli. Dr. Berselli reported Hancock's "symptoms were rather minimal in nature. She is limited to some degree by her back pain." The Trust asked for clarification and specifically inquired whether Hancock could engage in sedentary work. In response Dr. Berselli advised she "would be able to do sedentary-type work without any difficulty."

The Trust again denied Hancock's claim on the ground she was not totally disabled. She was advised she could seek a second and final review of the decision. She again appealed and added to her application the denial of aid from the state Vocational Rehabilitation Division and another employability report from Dr. Schoepflin. Dr. Schoepflin again diagnosed fibrositis and commented he believed a suitable job without emotional stress did not exist. On December 16, 1981 the Trust again denied her application for benefits.

After this final rejection, Hancock received notification she had been awarded social security benefits. The Trust was immediately notified. On January 5, 1982 the Trust responded "the Social Security decision has no bearing on whatever our decision might be." Shortly thereafter this action was filed in district court. In March 1983 the Trust sent Hancock's file to a vocational rehabilitation service for a "hypothetical evaluation" of Hancock's vocational options. The service reported a person with her level of disability could engage in any of several enumerated sedentary occupations. Additionally, after this action was filed, the Social Security Administration concluded Hancock was entitled to continue receiving benefits. An Administrative Law Judge found Hancock suffered from "severe psychogenic and orthopedic impairments which have significantly limited her from performing work-related activities...."

Plaintiff's initial complaint alleged claims for breach of contract, unlawful insurance practices under state law, and outrageous conduct under state law. Discovery was ordered to be completed by March 27, 1984. On February 13, 1984 defendant filed its first motion for summary judgment contending, inter alia, that Hancock's claims were preempted by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. Secs. 1001-1461 (1982). Hancock agreed and sought permission to file an amended complaint. The motion was heard and allowed after the discovery cutoff date.

Hancock's amended complaint alleged the Trust violated ERISA by (1) not providing specific reasons for denying her application; (2) ignoring evidence in the record in making its decision; and (3) arbitrarily and capriciously placing the blame for plaintiff's disabilities on psychological problems. She requested additional discovery. The Trust refused the discovery request. Hancock thereafter filed motions for a new discovery cutoff, a date for lodging of the pretrial order, and to compel discovery. Two days later the Trust filed its second motion for summary judgment. The Trust also sought to stay consideration of Hancock's motion to reopen discovery pending a ruling on its motion for summary judgment.

The court granted the motion to stay.

The district court granted the Trust's motion for summary judgment on the grounds that the denial of benefits was not arbitrary or capricious, was supported by substantial evidence, and was not made in bad faith. Hancock's discovery motion was thereby rendered moot. On appeal, Hancock contends the district court erred by (1) not allowing her to reopen discovery and (2) concluding the Trust did not wrongfully deny her benefits.

DISCUSSION

1. Discovery.

When a party opposing a motion for summary judgment cannot present "facts essential to justify his opposition" to the motion, Fed.R.Civ.P. 56(f) allows the party to submit an affidavit stating such reasons. Program Engineering, Inc. v. Triangle Publications, Inc., 634 F.2d 1188, 1193 (9th Cir.1980). The court may order a continuance to permit additional discovery. Id. The trial court's refusal to permit further discovery is reviewed for an abuse of discretion. Landmark Development Corp. v. Chambers Corp., 752 F.2d 369, 373 (9th Cir.1985) (per curiam).

We ...