Paramore v. Delta Air Lines, Inc.
| Decision Date | 02 December 1997 |
| Docket Number | No. 96-8299,96-8299 |
| Citation | 129 F.3d 1446 |
| Parties | 11 Fla. L. Weekly Fed. C 804 Jacqueline PARAMORE, Plaintiff-Appellant, v. DELTA AIR LINES, INC., Defendant, Delta Family-Care Disability and Survivorship Plan, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
Laura M. Shamp, Atlanta, GA, for Plaintiff-Appellant.
Hunter R. Hughes, III, Rogers & Hardin, Monroe T. Hill, Jr., Delta Air Lines, Inc., Law Department, Atlanta, GA, for Defendant and Defendant-Appellee.
Appeal from the United States District Court for the Northern District of Georgia.
Before BIRCH, Circuit Judge, and HILL and FARRIS *, Senior Circuit Judges.
Jacqueline Paramore, a former flight attendant for Delta Air Lines, Inc. ("Delta"), filed this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(1)(b) and (e), in which she sought an award of long-term disability benefits pursuant to the Delta Family Care Disability and Survivorship Plan ("the Plan"). Paramore contended that the Administrative Committee, acting in its capacity as administrator and fiduciary, violated the terms of the Plan and the governing federal law embodied in ERISA by denying the requested benefits. The district court determined that the Administrative Committee's decision to deny long-term disability benefits was neither arbitrary nor capricious and granted summary judgment in favor of Delta. For the reasons that follow, we conclude that the "arbitrary and capricious" standard of review is the appropriate standard by which to evaluate a plan administrator's factual findings in cases involving the denial of benefits under ERISA. We further conclude that the district court properly applied this standard of review to the facts of this case in upholding the Administrative Committee's decision. We therefore affirm.
For the limited purpose of resolving the issues presented in this appeal, the following facts are found to be undisputed: Jacqueline Paramore worked for approximately eleven years as a flight attendant for Delta. In 1991, while performing her job during the course of a flight, Paramore was involved in an incident that resulted in injury to her neck and shoulder. After an initial period of recuperation at home, Paramore returned to work sporadically for approximately one year. Paramore subsequently sought and received short-term disability benefits pursuant to the Plan; these benefits were awarded based on certifications from two treating physicians, Dr. Kenneth Lazarus and Dr. Patricia Tewes, who affirmed that Paramore had experienced a cervical strain. Paramore next requested long-term disability benefits and sought certification for such benefits from Dr. Tewes. Dr. Tewes, however, indicated that Paramore could perform some light clerical work. Based on Dr. Tewes' observations, the request for long-term disability benefits was denied.
In accordance with the Plan's procedural framework, Paramore appealed this decision to the Administrative Subcommittee ("the Subcommittee"). Paramore specifically requested the Subcommittee to afford greater weight to the opinion of Dr. Lazarus, her treating physician, rather than Dr. Tewes, to whom she had been referred. At the Subcommittee's request, Paramore also was examined by Dr. Nicol, who withheld his opinion concerning Paramore's long-term prognosis pending further tests; Dr. Nicol did note his initial impressions of Paramore's condition as follows:
Difficult to know exactly what's going on with this lady. She has symptoms of cervical strain and sprain, but no focal organic neurological deficits and, in fact, she has some "deficits" that would lead me to believe that there is a very large functional component to her disorder at the present time.
Exh. 11 at 3. Dr. Lazarus forwarded to the Subcommittee a letter stating his belief that Paramore would be "unable to work in any capacity on even a part-time basis" and that her condition likely would "continue indefinitely despite maximum treatment." Exh. 12. Paramore also received a psychological examination by Dr. Wright, who rendered the following findings:
Psychological testing results with this patient suggest considerable stress, but very little subjective psychological discomfort. Most of her stress and psychological pressures are being diverted into somatic symptoms, and she is quite preoccupied with her somatic processes while attempting to deny and repress any subjective psychological discomfort. I could not rule out the possibility of a conversion disorder. She has developed most of the classic signs of "chronic pain syndrome." Test indications regarding cognitive and intellectual abilities show the patient to be functioning within the bright-normal range with no problems. There were indications of organic brain dysfunction on testing.
Exh. 17. Pursuant to these observations, Dr. Wright recommended that Paramore would benefit from psychotherapy in addition to any other treatment she was receiving for chronic pain. Dr. Nicol subsequently wrote to the Subcommittee after reviewing both Dr. Wright's report and the results of the tests he previously had ordered. With respect to psychological aspects of Paramore's condition, Dr. Nicol stated: "I don't think that Ms. Paramore is suffering from any major physical disability, but psychosomatic aspects of her illness have supervened and are causing the majority of her problems at the present time." Exh. 20. In a separate letter, Dr. Nicol stated, in pertinent part:
At the present time it would be my professional opinion that she is disabled, but I can't say as a result of demonstrable injury, because there was no demonstrable injury, at least from a purely physical standpoint. I think there probably is demonstrable injury from a psychological standpoint.
I hope that this answers your questions satisfactorily. I hope that you will be able to get Ms. Paramore some ongoing psychological help so that she will [be] able to get back to work full time in the not too distant future as a flight attendant once these other issues have been addressed.
Exh. 21. Dr. Nicol further observed that although Paramore, in his view, was not capable of performing her customary job on a full time basis without limitations, she nonetheless was physically capable of performing sedentary work. See id.
On the same date on which Dr. Nicol filed his report with the Subcommittee, Dr. Tewes notified the Subcommittee that Paramore was no longer under her care and that Dr. Lazarus should make any further decisions regarding her capacity to work. Dr. Lazarus subsequently wrote a letter to a Subcommittee representative concerning Paramore's case and stated:
With regard to Ms. Paramore's disability status, I believe that it would be appropriate for Ms. Paramore to return to some sort of sedentary work activity. I think this would be helpful to her, both with regard to her self-esteem and her recovery from her injury.... [I]n an appropriately supportive environment, I believe that Mrs. Paramore could and should return to some form of sedentary work.
After reviewing the doctors' submissions, the Subcommittee affirmed the denial of benefits and determined that Paramore's entitlement to disability benefits terminated as of November 14, 1992. Paramore appealed this decision to the Administrative Committee. Shortly thereafter, Dr. Lazarus wrote to the Administrative Committee a letter stating, in relevant part I have been the treating physician for Mrs. Paramore and have been primarily responsible for her care. Decisions on her benefit status were apparently made with reference to forms filled out from other treating physicians, despite the fact that I have been the primary treating physician in this case. I am not certain on what basis the other physicians made their determination. It is my opinion that Mrs. Paramore was unable to return to any sort of gainful employment, even on a part-time basis prior to February 22, 1993. From that time forward, however, I do believe she has been capable of part-time sedentary work.
Exh. 33. The Administrative Committee determined, "[b]ased on information obtained from Dr. Tewes and from independent examinations performed by Dr. Nicol and Dr. Wright, Ms. Paramore could perform some type of work; ..." Exh. 46 at 3. Consistent with this determination, the Administrative Committee decided that Paramore's disability benefits were correctly denied as of November 14, 1992.
The district court's grant of summary judgment is subject to plenary review. See Canadyne-Georgia Corp. v. Continental Ins. Co., 999 F.2d 1547, 1554 (11th Cir.1993). We therefore apply the same legal standards as those controlling the district court. Id. The standard that properly should have governed the district court's evaluation of the Administrative Committee's findings, however, is disputed by the parties. Paramore contends that, although the Administrative Committee's interpretation of the Plan's terms is subject to an arbitrary and capricious standard of review, the court should have reviewed the Administrative Committee's factual determinations de novo. Delta responds that the court appropriately examined the propriety of the Administrative Committee's factual and interpretive conclusions solely to ascertain whether the denial of benefits in this instance constituted either an abuse of discretion or an arbitrary and capricious resolution of Paramore's claim.
ERISA does not provide a standard to review decisions of a plan administrator. In Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court looked to the principles underlying trust law as largely defining the role and responsibilities of a plan fiduciary or administrator; 1 more specifically, the Court reasoned that, "where discretion is conferred upon the trustee with respect to the exercise of a power, its...
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