Reichard v. United of Omaha Life Ins. Co.
| Decision Date | 24 February 2020 |
| Docket Number | No. 18-2952,18-2952 |
| Parties | GIOVANNA REICHARD, Appellant v. UNITED OF OMAHA LIFE INSURANCE COMPANY |
| Court | U.S. Court of Appeals — Third Circuit |
NOT PRECEDENTIAL
On Appeal from the United States District Court for the Eastern District of Pennsylvania
Submitted Under Third Circuit L.A.R. 34.1(a)
on September 13, 2019
Before: HARDIMAN, GREENAWAY, JR., and BIBAS, Circuit Judges
Even if one doctor finds a patient disabled, an insurer can reasonably credit other doctors who examine her and disagree. United of Omaha Life Insurance denied Giovanna Reichard continued long-term disability benefits. After losing her internal appeal within United of Omaha, Reichard brought this suit. She sought discovery of her appeal reviewer's alleged conflict of interest, which the District Court denied. The District Court eventually granted summary judgment for United of Omaha. Reichard challenges both decisions.
We will affirm. The District Court's discovery ruling was reasonable, so we have no basis to disturb it. And we cannot override the insurer's decision to deny benefits unless we find that it was arbitrary and capricious, a deferential standard of review. As the District Court held, United of Omaha's decision was supported by substantial evidence. Most of the doctors who examined Reichard found that even with her physical limitations, she could still perform sedentary or light jobs. And the report of the one doctor who found her totally disabled appeared to be internally inconsistent. Reichard's objections to the insurer's procedures do not persuade us, and the alleged conflict of interest made no difference. So the insurer's denial of benefits was not arbitrary and capricious, and the District Court was correct to grant summary judgment for United of Omaha.
1. The insurance plan's terms. For four years, Reichard worked as a nurse for Coordinated Health, a hospital. She suffers from headaches, arthritis, Crohn's disease, and fibromyalgia. Eventually, because of her illnesses, she had to leave her job. As an employee, she was covered by Coordinated Health's group disability-insurance plan (the Plan), administered by United of Omaha. So when she left, she started collecting disability benefits under the Plan.
The Plan's definition of "disability" shifted over time. For up to two years, Reichard could get long-term disability benefits if she could not do her old job and could not earn at least 80% of her pre-disability income. But after two years, those benefits would end unless her disability prevented her from doing any job "for which [she was] reasonably fitted by training, education, or experience" that would pay at least 60% of her pre-disability earnings within a year of going back to work. Reichard v. United of Omaha Life Ins. Co., 331 F. Supp. 3d 435, 443 n.5 (E.D. Pa. 2018).
2. United of Omaha grants Reichard long-term disability benefits for the first two years. In her initial applications for short- and long-term disability benefits, Reichard submitted reports from Dr. Mark Osterman, her gastroenterologist, and Dr. Nicole Chiappetta, her rheumatologist. Dr. Osterman's report noted her arthritis symptoms and Crohn's disease and said tentatively that she could go back to work in six months.
Dr. Chiappetta also noted her Crohn's disease and the pain in her knees and hip. The doctor found that during an eight-hour workday, Reichard could sit for six hours, walk fortwo, and stand for one. She would need frequent breaks and could not climb, lift more than twenty pounds, or squat for more than twenty minutes. Even though she found that Reichard was only partially impaired, Dr. Chiappetta wrote that Reichard could not work. The doctor did not clarify whether she meant that Reichard could not work at all or that she could not do her old job.
United of Omaha granted Reichard's application for long-term disability benefits. But it notified her that in two years, the Plan's definition of "disability" would change.
3. After two years, United of Omaha denies Reichard long-term disability benefits. To gauge whether Reichard was disabled under the narrower definition, United of Omaha had four health-care professionals review her file. Based on their assessments, it denied her claim for continuing benefits.
First, a United of Omaha nurse reviewed Reichard's file and wrote a report. She found that Reichard's Crohn's disease was stable. She noted that Reichard's depression, headaches, hip pain, and vitamin deficiencies did not impair her ability to work. She also looked at images of Reichard's left knee, which had recently been replaced, and found it normal. The nurse concluded that Reichard could work a job that was not too taxing physically, if she could reposition herself and take short walks every couple of hours.
Second, a vocational rehabilitation consultant assessed Reichard's skills. Based on Reichard's work history and medical conditions, he found that she could work as an office nurse, school nurse, medical insurance clerk, hospital-admitting clerk, or administrative clerk. All but one of those jobs would pay more than 60% of her pre-disability earnings, and all were available in her area.
Third, a physician reviewed Reichard's medical records. Like the nurse, he found that her Crohn's disease was stable and that she was not functionally impaired. The physician purported to agree with Dr. Osterman on that point, though we have no record of any such statement by Dr. Osterman on the date he referenced.
Fourth, Dr. Golombek, a board-certified rheumatologist, examined Reichard, reviewed her records, and wrote his own report. In his report, he referred to the reports of Dr. Osterman, Dr. Chiappetta, a nurse practitioner, and the vocational rehabilitation consultant, but made typos in each of their names or titles. He concluded that Reichard could sit for six to eight hours per day and could both stand and walk for up to an hour straight.
After reviewing the four reports, United of Omaha denied Reichard's claim. Its denial letter to Reichard summarized the experts' findings and concluded that Reichard could do sedentary or light jobs, including the five listed by the consultant.
4. Reichard's internal appeal. Reichard filed an administrative appeal of the decision to deny her benefits. Her appeal criticized United of Omaha's supposed use of outdated and incorrect information, its failure to consider her medications' side effects, and its exclusion of some records. United of Omaha referred Reichard's appeal to an in-house appeal reviewer, Dr. Thomas Reeder. Dr. Reeder, who is board certified in internal medicine, also served as United of Omaha's senior vice president and medical director.
As part of his review, Dr. Reeder analyzed Reichard's file, including the reports of doctors who had examined and treated her. He reviewed records from Reichard's neurologist and orthopedist, cataloguing her headaches and knee pain. Dr. Reeder noted the medications she had been taking and their side effects, and described her knee replacement andimproved knee condition. He also found that Dr. Chiappetta's conclusion that Reichard could not work conflicted with the actual physical limitations Dr. Chiappetta had documented. While Dr. Reeder recognized Reichard's long history of gastrointestinal issues, he found no evidence that she could not do light or sedentary work.
Dr. Reeder sent letters to four of Reichard's doctors, describing his findings and asking them to reply if they disagreed. Only her neurologist responded, and that doctor voiced no objection.
United of Omaha thus denied Reichard's appeal. In doing so, it relied on Reichard's file and medical records, Dr. Reeder's review, and the lack of any objection from the four doctors to whom Dr. Reeder had sent his findings.
5. Reichard's Social Security benefits. At the same time, Reichard was seeking Social Security disability benefits. At first, the Social Security Administration denied her benefits. But after a hearing, it reversed course and granted them. The Social Security Administration's notice of award was dated twelve days after United of Omaha's letter denying her appeal.
After losing her internal appeal, Reichard sued United of Omaha in federal district court under the Employee Retirement Income Security Act of 1974 (ERISA), Pub. L. No. 93-406, 88 Stat. 829. ERISA gives a cause of action to those whose insurers have denied them benefits under an employee benefit plan. 29 U.S.C. §§ 1002(7), 1132(a)(1)(B).
Reichard moved to compel discovery on Dr. Reeder's possible conflict of interest. The District Court denied the motion, finding that the discovery request woulddisproportionately burden United of Omaha and disserve ERISA's goal of resolving claims efficiently. It later granted summary judgment for United of Omaha on the merits and denied Reichard's cross-motion for summary judgment. 331 F. Supp. 3d at 485.
Reichard now appeals the denial of her motion to compel discovery. She also appeals the denial of her summary judgment motion and the grant of summary judgment for United of Omaha. The District Court had jurisdiction under 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e)(1). We have jurisdiction under 28 U.S.C. § 1291.
We review the District Court's denial of Reichard's motion to compel discovery for abuse of discretion. Camiolo v. State Farm Fire & Cas. Co., 334 F.3d 345, 354 (3d Cir. 2003). That means we will not disturb it unless "no reasonable person would adopt the district court's view." Stecyk v. Bell Helicopter Textron, Inc., 295 F.3d 408, 412 (3d Cir. 2002) (quoting Oddi v. Ford Motor Co., 234 F.3d 136, 146 (3d Cir. 2000)).
We review the District Court's summary judgment rulings de novo. Viera v. Life Ins. Co. of N. Am., 642 F.3d 407, 413 (3d Cir. 2011). Because the policy delegates discretion to the plan...
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