TIMOTHY L. BROOKS, UNITED STATES DISTRICT JUDGE.
This case comes before the Court following Liberty Life Assurance Company of Boston's ("Liberty Life") decision to terminate Brenda Mackey's long-term disability benefits. The dispute arises under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et. seq., which gives participants in an employee welfare benefit plan a cause of action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." 29 U.S.C. § 1132(a)(1)(B). Ms. Mackey filed her Complaint (Doc. 1) on January 16, 2015, asking the Court to order Liberty Life to pay her the benefits to which she argues she is entitled. Liberty Life filed its Answer (Doc. 6) on February 20, 2015, generally denying the allegations against it. Ms. Mackey filed her "ERISA Brief" (Doc. 13) on May 13, 2015, and Liberty Life filed its "ERISA Brief" (Doc. 14) on June 12, 2015. The case now being ripe for decision, the Court
Brenda Mackey was employed as a registered nurse ("RN") by Baxter Regional Medical Center ("BRMC") for approximately 20 years. During the relevant portion of this time, she was enrolled in BRMC's employee welfare benefit plan, which was underwritten and administered by Liberty Life. Following a bout with chronic knee pain, Ms. Mackey had a total knee arthroplasty on August 1, 2011. The medical experts who have treated Ms. Mackey or reviewed her files are all in material agreement that the surgery resulted in postoperative femoral nerve palsy with resulting quadriceps dysfunction. In layman's terms, this means that Ms. Mackey suffered some nerve damage during her knee surgery, and that the nerve damage has caused her quadriceps muscle to become significantly weakened.
Ms. Mackey applied for long term disability ("LTD") benefits pursuant to BRMC's employee welfare benefit plan. Liberty Life approved her request, and began paying her LTD benefits on January 28, 2012. Per the benefit plan, a "Covered Person" is "Disabled" if she "is unable to perform the Material and Substantial Duties of [her] Own Occupation." (Doc. 12-1, p. 6) (emphasis added). After 24 months, however, a "Covered Person" continues to be "Disabled" only if she "is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation." Id. (emphasis added). The benefit plan defines "Any Occupation" as "any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity." Id. at
In so doing, Liberty Life relied primarily on medical information from: Ms. Mackey's treating physician, Dr. Knox; BRMC's Rehab Services Department; Twin Lakes Neurology; and Drs. Boswell, Pennington, and Johnson, all of whom were hired by Liberty Life to review Ms. Mackey's medical records. Liberty Life also relied upon a report titled "Transferable Skills Analysis/Vocational Review," drafted by Ellen Levine, a Vocational Case Manager employed by Liberty Life. Based on these sources of information, Liberty Life sent Ms. Mackey a letter on December 16, 2013, informing her that they were terminating her LTD benefits effective January 27, 2014. Ms. Mackey requested a review of this decision. As part of the review, her complete file, including additional records received with her appeal, was reviewed by Liberty Life's Managed Disability Services unit. The additional records included a vocational analysis performed by Tanya Owens, Ph.D., and submitted by Ms. Mackey. On July 17, 2014, Liberty Life sent a letter to Ms. Mackey's attorney, Rick Spencer, informing him that it was affirming its decision to terminate Ms. Mackey's benefits. Ms. Mackey timely appealed that decision to this Court.
Generally, once a plaintiff has exhausted her administrative remedies, the Court's function is to conduct a review of the record that was before the administrator of the plan when the claim was denied. Farfalla v. Mutual of Omaha Ins. Co., 324 F.3d 971, 974-75 (8th Cir.2003); Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). A denial of benefits claim under ERISA is reviewed for an abuse of discretion when "a plan gives the administrator discretionary power to construe uncertain terms or to make eligibility determinations." King v. Hartford Life & Accident Ins. Co., 414 F.3d 994, 998-99 (8th Cir.2005) (en banc) (citing Firestone, 489 U.S. at 111, 109 S.Ct. 948). The parties agree that the benefit plan in the instant case gives Liberty Life such discretion. Accordingly, the Court must defer to the determination made by the administrator or fiduciary unless such determination is arbitrary and capricious. Firestone, 489 U.S. at 115, 109 S.Ct. 948. "[R]eview for an `abuse of discretion' or for being `arbitrary and capricious' is a distinction without a difference" because the terms are generally interchangeable. Jackson v. Prudential Ins. Co. of Am., 530 F.3d 696, 701 n. 6 (8th Cir.2008), citing Schatz v. Mutual of Omaha Ins. Co., 220 F.3d 944, 946 n. 4 (8th Cir.2000).
This standard of review, "though deferential, is not tantamount to rubber-stamping the result." Torres v. UNUM Life Ins. Co. of Am., 405 F.3d 670, 680 (8th Cir.2005). Indeed, the decision of a plan administrator may be overturned if it is not "reasonable, i.e., supported by substantial evidence." Donaho v. FMC Corp., 74 F.3d 894, 899 (8th Cir.1996), abrogated on other grounds by Black & Decker Disability Plan v. Nord, 538 U.S. 822, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003). An administrator's decision will be deemed reasonable
There are five factors the Court will consider to determine whether Liberty Life's decision was reasonable:
Torres, 405 F.3d at 680 (citing Shelton v. ContiGroup Cos., Inc., 285 F.3d 640, 643 (8th Cir.2002)).
Lastly, where — as is the case here — the benefit plan administrator is the same party that pays the claims for benefits, the Court will consider the conflict of interest arising from such an arrangement. See Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 112-19, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). The importance of this factor will vary depending on whether circumstances suggest a high or low likelihood that the conflict of interest affected the benefits decision. Id. at 117, 128 S.Ct. 2343. For example, where an administrator has a history of biased claims administration, the factor may be more significant. Id. But where an administrator has taken "active steps to reduce bias and to promote accuracy," the factor may be less significant. Id.
As an initial matter, there is an apparent disagreement among the medical experts in this case. Dr. Knox, who performed the surgery on Ms. Mackey's knee, stated on August 20, 2013, that he considered Ms. Mackey disabled "from her occupation as a registered nurse." (Doc. 12-3, p. 107). This was so, at least in part, because of how her dependence on prescription narcotics would impair her legal and ethical decisions. (Doc 12-3, pp. 105-106). While these statements suggest that Dr. Knox considered Ms. Mackey to be disabled only from her former occupation, when prompted by Liberty Life with the general question of whether she was capable of performing sedentary, light, medium, heavy, or very heavy work, Dr. Knox did not select any of the corresponding boxes. This suggests instead that Dr. Knox considered Ms. Mackey to be disabled from performing any occupation whatsoever.
Assuming that Dr. Knox intended to reach this latter conclusion, the three doctors
These restrictions are apparently consistent with Liberty's Life's definition of "sedentary" work,
Dr. Robert Pennington reviewed Ms. Mackey's records and concluded that her quadriceps dysfunction results in "impairment of ability to squat, kneel, stand, and walking." (Doc. 12-3, p. 160). "Given the reported job duties of the claimant as an operating room nurse, the impairment would translate into restrictions and limitations of her ability to perform usual and expected duties which would include prolonged standing, walking, kneeling, and squatting." Id. Finally, Dr. Anthony Johnson concluded that:
Both of these conclusions — like Dr. Boswell's — are consistent with an ability to perform "sedentary" work.
The Court believes that Liberty Life was within its discretion to conclude that Ms. Mackey's impairments do not generally prevent her from performing sedentary work, as Drs. Boswell, Pennington, and Johnson all reached that conclusion. Dr. Knox's opinion on the matter, moreover, was somewhat ambiguous. Even if it weren't, Liberty Life was not required to defer to his opinion as the treating physician. Nord, 538 U.S. at 822, 123 S.Ct. 1965. And, with all three reviewing doctors reaching essentially the same conclusion, the Court cannot say that this conclusion was unreasonable, and not supported by substantial evidence.
This, however, does not end the Court's inquiry. Liberty Life also relied on a "Transferable Skills Analysis/Vocational Review" performed by one of its Vocation Case Managers, Ellen Levine. (Doc 12-3, pp. 78-81). The report begins by listing Ms. Mackey's age and some general information about her monthly income and former
In advance of Liberty Life's review of her claim, Ms. Mackey commissioned her own "Vocational Analysis," performed by Tanya Owen, Ph.D. (Doc. 12-3, pp. 54-61). This analysis was significantly more detailed than the one performed by Liberty Life. It examined, for example, limitations on Ms. Mackey's ability to perform daily activities, her dependence on hydrocodone to manage her pain, and her limited computer knowledge. Based on these factors and more, the report identified three "Sedentary" occupations matching Ms. Mackey's transferable skills. Namely, "Cardiac Monitor Technician," "Optometric Assistant," and "Medical case manager." Id. at 59. However, the report concluded that Ms. Mackey's dependence on hydrocodone precluded her from employment in any of the identified occupations, including those identified by Liberty Life. In each occupation:
Id. at 60. Given Ms. Mackey's dependence on hydrocodone, a controlled substance, Ms. Owen's report charged that Liberty Life's denial of LTD benefits was erroneous.
Id. (emphasis in original). Relying on a 2014 report from Dr. Knox, Ms. Owen also
These conflicting vocational reports reveal three ways in which Liberty Life abused its discretion in denying Ms. Mackey's claim.
In discussing the effects of Ms. Mackey's narcotics dependence on her employability, Liberty Life abused its discretion by failing to accept or investigate Ms. Owen's claim that mere use of narcotics prohibited Ms. Mackey from utilizing her RN license. The Nurse Practice Act of Arkansas provides that the Arkansas State Board of Nursing shall have the power to "[p]romulgate whatever regulations it deems necessary for the implementation of this chapter." Ark. Code. Ann. § 17-87-203(1)(A). Acting pursuant to this authority, the Board of Nursing established disciplinary proceedings for, amongst other infractions, "unprofessional conduct." See Arkansas State Board of Nursing Rules, Ch. 7, § IV; Doc. 12-3, pp. 47-48. Unprofessional conduct includes "[p]racticing nursing when unfit to perform procedures and make decisions in accordance with the license held because of physical, psychological, or mental impairment." Id.
According to Ms. Owen, she contacted an employee of the Nursing Board who interpreted this regulation as prohibiting nurses from taking controlled substances during working hours. Instead of adopting this interpretation, or contacting the Nursing Board to seek clarification of the interpretation, Liberty Life disregarded it entirely in favor of its own interpretation. See Doc. 12-2, pp. 6-7. It determined that Ms. Mackey would only be prohibited from utilizing her RN license if her narcotic usage created a secondary impairment, for which it further asserted there was no evidence.
By doing so, Liberty Life abused its discretion. The principle of judicial deference to an agency's interpretation of its own laws and regulations is deeply ingrained in the law. See Chevron, U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984); Bowles v. Seminole Rock & Sand Co., 325 U.S. 410, 65 S.Ct. 1215, 89 L.Ed. 1700 (1945); Skidmore v. Swift & Co., 323 U.S. 134, 65 S.Ct. 161, 89 L.Ed. 124 (1944). Given the respect accorded to agency interpretations by the nation's courts, it is inconceivable that a private actor would supplant the interpretation of an agency employee for its own, without additional inquiry. Liberty Life should have either accepted Ms. Owen's characterization of the Nursing Board employee's interpretation, or contacted the Nursing Board itself for clarification. Instead, it chose to do neither. Based on the Nursing Board employee's interpretation, Ms. Mackey's ability to perform the material and substantial duties of at least two of the three occupations identified in Liberty Life's vocational report is in serious doubt.
The Court next finds that Liberty Life abused its discretion by not considering Ms. Mackey's age in evaluating her ability to perform the occupations its vocational report identified. Age is an explicit factor that Liberty Life is required to consider per the terms of the benefit plan. "`Any Occupation' means any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity." (Doc. 12-1, p. 5) (emphasis added). Liberty Life's vocational report, however, did not factor in Ms. Mackey's age when it concluded which occupations she could be suited to perform.
Liberty Life relied in large part on its vocational report in reaching its ultimate conclusion that Ms. Mackey was not entitled to LTD benefits. Given how that report
Similar to Ms. Mackey's age, sorely missing from Liberty Life's vocational report is any analysis of how Ms. Mackey's lack of computer skills affects her ability to perform the material and substantial duties of the identified occupations. The report admits that Ms. Mackey does not own a computer, but that she uses her phone to send email. (Doc. 12-3, p. 79). The vocational report commissioned by Ms. Mackey expands on her computer skills — or lack thereof. "Ms. Mackey has limited computer knowledge and does not regularly use a computer. When she left [BRMC], she spent approximately 60 minutes per day (10 minutes per patient, 6 patients per day) using electronic medical records systems. She reports that the transition to electronic records was `ridiculously difficult' for her." (Doc. 12-3, p. 56).
The importance of possessing at least some base-line computer skills cannot be overstated in today's economy. This is particularly true for occupations which may be classified as sedentary. Many — and likely most — of these jobs involve sitting at a desk and operating a computer for much of the work day. For example, being a volunteer coordinator presumably requires, in at least some part, use of Microsoft Office, managing an electronic database of volunteers, crafting and sending mass emails, and perhaps managing social media pages.
Yet, Ms. Mackey's undisputed lack of computer skills appears not to have factored into Liberty Life's calculus at all. It is not one of the "Transferable Skills" identified in Liberty Life's vocational report, nor is it mentioned at all in its July 17, 2014 letter announcing the reasoning behind its decision to terminate Ms. Mackey's benefits.
Absent consideration of Ms. Mackey's age and lack of computer skills, Liberty Life's vocational analysis was little more than a formulaic document, insufficiently
While not without value, such an analysis lacks the sort of individualized consideration necessary to determine whether the actual member, and not just a generic person with their educational and occupational background and physical limitations, can perform the material and substantial duties of an occupation. This type of formulaic vocational analysis can serve as important evidence for determining whether a plan member is suited to an occupation, see Green v. Union Sec. Ins. Co., 646 F.3d 1042, 1052 (8th Cir.2011), but a benefit plan administrator must also consider its member as an individual, factoring the material characteristics of the person, such as (in this case) age and computer skill.
The Eighth Circuit has instructed its district courts to consider five factors to determine whether a benefit plan administrator's decision to terminate benefits was unreasonable. See Torres, 405 F.3d at 680. Based on the issues identified herein, the Court finds that several of the factors are satisfied. Most notably, Liberty Life's failure to consider Ms. Mackey's age renders that term in the plan meaningless, as it is explicitly listed as a factor in determining whether a member can perform "Any Occupation." (Doc. 12-1, p. 5). This also makes Liberty Life's interpretation of "Any Occupation" contrary to the clear language of the plan. Similarly, by failing to consider Ms. Mackey's lack of computer skills, Liberty Life rendered the important phrase "material and substantial duties" at least partially meaningless. Given the centrality of computer usage to most sedentary occupations in the national economy, some analysis of the extent of computer skill required, and whether the member possesses — or can achieve — that level of skill, is necessary to give that phrase real meaning.
Accordingly, for the reasons stated herein, the Court finds that Liberty Life abused its discretion in denying Ms. Mackey's claim. The Court additionally finds that the proper remedy in this case is to