VIRGINIA EMERSON HOPKINS, District Judge.
Plaintiff Kevin McCay ("McCay") initiated this lawsuit against his former employer, Defendant Drummond Company, Inc. ("Drummond") on September 29, 2008, in the Circuit Court of Etowah County, Alabama. (Doc. 1 at Ex. 1). On October 24, 2008, Drummond removed the case to this court on the basis that McCay's claims against it arise under the Employee Retirement Income Security Act of 1974 ("ERISA"), and more specifically under 29 U.S.C. § 1132(a)(1)(B), which provides that ERISA supplies the exclusive remedy for claims brought by employee benefit plan participants. (Doc. 1 ¶¶ 6, 8). In his complaint, McCay challenges Drummond's denial of his application for a disability retirement pension, alleging that he subsequently received a favorable award of Social Security benefits, and that Drummond was under a continuing duty to consider this new evidence of disability. (Doc. 1, Ex. 1, Compl. ¶¶ 1-9).
Shortly after removing the case to federal court, Drummond filed a Motion to Dismiss (Doc. 2), which the court denied without prejudice because the motion relied upon documents outside the pleadings that were not otherwise appropriately before the court. (Doc. 12). McCay then filed a Motion to Remand to the Plan Administrator. (Doc. 8). Pursuant to its discretion, the court granted the motion so that McCay could present to the Pension Committee additional evidence in support of his disability claim; accordingly, the case was remanded on March 2, 2009. (Docs. 16, 17). Upon remand, Drummond upheld its previous denial, and McCay then filed a Motion to Reinstate Claim. (Doc. 20). The court granted the motion and reopened this case on August 16, 2010. (Docs. 25, 26).
Now before the court are the following cross-motions for judgment on the merits: McCay's Motion for Judgment on Liability With Submissions (Doc. 35) (the "Motion for Judgment on Liability"), and Drummond's Motion for Summary Judgment (Doc. 25) (the "Motion for Summary Judgment"). The parties have fully briefed these motions, and they are now under submission. For the reasons explained below, the court concludes that Drummond's Motion for Summary Judgment is due to be granted and McCay's Motion for Judgment on Liability is due to be denied.
McCay is a former Drummond employee who worked nearly 20 years for the company
McCay's medical history reveals that he generally suffers from back, hip, and leg pains. In November 2002,
Independently, an arm accident on June 14, 2004 caused his left elbow tendon to rupture, requiring surgery. On June 23, 2004, McCay underwent surgery to repair both his left tendon and the herniated disc in his lumbar spine at L4-5. (A.R. 0023). First, Dr. Timothy A. Cool
On June 15, 2004, one day after the arm accident, McCay came out of work. He drew six months of short-term disability benefits, until his employment was terminated on December 15, 2004.
Subsequent to his termination, McCay continued to experience back pain and was referred to Dr. Goodman for further treatment with epidural blocks, as well as to Dr. Matthew Berke and Dr. Wayne Gossman of the Birmingham Pain Center. Additionally, in November 2005, approximately one year after the termination of his employment with Drummond, McCay underwent a right knee replacement surgery, also performed by Dr. Cool. (A.R. 0024).
As an employee, McCay was eligible to apply for disability benefits under the Drummond Company, Inc. United Steelworkers of America and Local 12136 Second Revised Pension Agreement, as amended (the "Pension Agreement" or the "Plan").
(Id.) (emphasis added).
The Pension Agreement vests discretion in the Pension Committee to make disability determinations: "Such disability and the continuance and permanency thereof and such other qualification shall be determined by the Pension Committee and such determinations of the Pension Committee shall be controlling." (Doc. 1-3 at 14-15).
On November 15, 2004, McCay filed a disability pension application under the Pension Agreement. McCay alleged that his disability onset date was November 2002, and that he was disabled as a result of "severe back pain [that] continued down my leg, and into my foot. Accident w/ arm in June, 2004. Knee pain since 1978." (A.R. 0033). The Pension Committee processed McCay's application, and McCay was provided the opportunity to submit any and all medical information and to identify physicians who could provide information regarding the nature and severity of his alleged disabling condition. (A.R. 0034, 0072). McCay submitted information from the treating physicians who performed his June 2004 surgery procedures. Dr. Berchuck and Dr. Cool. (A.R. 0039-0071). Dr. Berchuck answered the question "Explain [McCay's] specific restrictions and limitations" as follows: "None. May return to full duty [November 24, 2004] from spine standpoint." (A.R. 0040). Evaluating the extent of McCay's disability, Dr. Berchuck opined that he was not "totally disabled" for either "any occupation" or for "his regular occupation." (A.R. 0041).
Likewise, Dr. Cool advised of a 30-pound lifting restriction as a result of the left elbow, but noted that he expected McCay to return to full duty without restriction
On February 11, 2005, the Pension Committee issued its determination denying McCay's application for a disability pension. The Committee considered the following physicians' reports, which McCay submitted in support of his claim:
(A.R. 0008). After reviewing this evidence, the Committee, in explaining its determination to deny pension benefits, stressed that both of McCay's treating physicians "clearly state that claimant is not permanently and totally disabled by bodily injury or disease to such an extent as to render it impossible for claimant to engage and/or to follow a substantially gainful occupation." (A.R. 0008). Accordingly, the Committee found that McCay "d[id] not satisfy the requirements of permanent and total disability within the meaning of the pension plan." (A.R.0008).
McCay admits receiving a copy of Drummond's denial decision in February 2005. (Req. for Admission, Doc. 39-3, at 5, 11).
The Pension Agreement provides the following appeal rights: "A claimant may, within 180 days after receipt of a notice of claim denial, appeal to the Pension Committee and request a review of the denial of benefits." (Req. for Admission, Doc. 39-3, at 6, 11) (emphasis added). McCay was notified in the determination letter that "You, the claimant, have 180 days from receipt of this determination within which to submit an appeal to the company." (A.R. 0032). The notice also outlined Drummond's procedures for such appeals, which includes the opportunity to "submit comments, documents, records, and other information relating to your claim." (A.R. 0032). Further, the appeals procedure provides that "[a]ll comments, documents, or other information that you submit relative to your claim will be taken into account, even if that information was not submitted or considered in connection with this determination." (A.R. 0032) (emphasis added).
Admittedly, McCay did not appeal the decision of the Pension Committee within 180 days, nor did he submit any additional comments, records, or documents relating to his claim during that time frame. (Req. for Admission, Doc. 39-3 at 6, 11). The
More than one year after the expiration of McCay's 180-day appeal period, on September 19, 2006, McCay submitted a second Disability Pension Application to Drummond, informing the Pension Committee that he had recently been approved for Social Security disability benefits. (A.R. 0010-0011).
The Pension Committee responded by letter dated November 21, 2006. (A.R. 0004-0005). The letter acknowledged receipt of the favorable September 11, 2006, SSA determination, but stated "that the standard used by the [SSA] in deciding whether you are entitled to government benefits is not the same standard contained within the Drummond [Pension Agreement]." (A.R. 0004). Further, the Pension Committee rejected what it interpreted to be a second application for benefits and advised McCay that:
(A.R. 0004) (emphasis added). The Pension Committee also noted: "[t]o the extent that you intended to submit the recent information as an appeal from the Committee's February 2005 decision, any such appeal would not be timely." (A.R. 0005).
On March 10, 2008, McCay's attorney, Myron Allenstein, sent a purported "Notice of Appeal" letter to Drummond on behalf of McCay, arguing without citation to authority that "the law of the Eleventh Circuit always allows consideration of newly submitted evidence of disability." (A.R. 0081).
The Pension Committee rejected the attempted Notice of Appeal, as well as the alternative request for a new benefits application, as untimely. (A.R. 0092). The letter explained that Drummond's Pension Agreement "does not contemplate tolling the time for appeal while `waiting on the Social Security decision.'" (A.R. 0092). Moreover, Drummond denied any deficiency under ERISA in its initial denial notice, pointing out that McCay's Notice of Appeal failed to identify the nature of any alleged deficiencies. Finally, the letter explained that McCay's Notice of Appeal "d[id] not contain any pertinent medical information concerning Mr. McCay's medical condition during employment (which ended on December 15, 2004), beyond the information he submitted with his 2004 claim." (A.R. 0092).
On September 23, 2008, McCay filed his complaint against Drummond in the Circuit Court of Etowah County, Alabama, asserting a claim for pension benefits under ERISA, and Drummond thereafter removed the case to this court based upon federal question jurisdiction. (Doc. 1). McCay alleged in his complaint that he "exhausted his administrative remedies," (Complt. ¶ 13), yet also asserted that "[d]uring 2004, 2005, and 2006, Plaintiff suffered significant depression which interfered with his ability to understand and follow through with detailed actions and to effectuate an appeal." (Complt. ¶ 12).
Around the same time, McCay was pursuing his appeal of his denied SSA disability application. (Req. for Admission No. 7, Doc. 39-3 at 6, 11).
On March 2, 2009, the court exercised its discretion and remanded the case to the Pension Committee to allow McCay to submit additional evidence in support of his disability benefit claim, including the recent favorable SSA determination. (Docs. 16, 17). In its Memorandum Opinion and Remand Order, the court did not make any finding that the initial denial of McCay's claim was erroneous, nor did it reach any holding as to whether the 180-day time period for McCay to challenge the denial was unreasonable or arbitrary.
The Committee then convened in person on April 20, 2009, to review the court's order granting remand, to review Dr. Romeo's response letter dated April 11, 2009, and to discuss the SSA decision rendered September 11, 2006, which awarded government disability benefits to McCay. (A.R. 0100). The Committee discussed how the SSA determination followed a different legal standard and considered a knee replacement surgery and other medical conditions that were not present at the time of McCay's termination. (A.R. 0100). Ultimately, the Committee unanimously agreed that none of the additional information submitted supported a reversal of its initial determination that McCay failed to meet the requirements for disability pension benefits according to the terms of the Pension Agreement. (A.R. 0100).
Thereafter, the Pension Committee issued its written determination, dated June 18, 2009, holding that the disability application was again denied under the following reasoning:
(A.R. 0104-0105) (emphasis in original).
After the Pension Committee's written determination upholding denial of McCay's pension application post-remand, McCay's attorney continued to submit additional information on four separate occasions between July and August of 2009. (A.R. 0107-0270 (submitted on July 6, 2009); A.R. 0271-0309 (submitted on July 20, 2009); A.R. 0310-0560 (submitted on July 20, 2009); A.R. 0561-0681 (submitted on August 30, 2009)). In light of this additional information, Drummond decided to submit its June 18, 2009, determination to another round of administrative review by Terry Whitt, Vice President of Human Resources. (A.R. 0684-0692). Whitt also consulted with Dr. Thomas E. Powell,
(A.R. 0693). Upon this independent review, Whitt upheld the decision as the final step of the appeal process in a nine-page Determination on Appeal Notice dated September 24, 2009. (A.R. 0684-0692). The Determination Notice explained in relevant part:
(A.R. 0691) (emphasis added).
Six months after receipt of Drummond's final determination on remand, McCay's attorney continued to submit additional information, including newly obtained letters from Dr. Berke, Dr. Gossman, and Dr. Berchuck. (A.R. 0694-0699 (submitted March 24, 2010); A.R. 0704-0707 (submitted April 29, 2010)). Although these submissions were considered untimely by Drummond because the appeal process was complete, the Pension Committee nonetheless considered this additional evidence and also sent all information from McCay's entire claim history to Dr. Romeo for yet another medical review. (A.R. 0700-0703).
Dr. Romeo reported his findings to the Committee in May 2010, and again concluded that the November 2004 pension application was appropriately denied. (A.R. 0708-0709). By letter dated June 11, 2010, the Pension Committee communicated to McCay, through his attorney, that it would not disturb its final determination denying the disability claim that was rendered on September 24, 2009. (A.R. 0710-0713).
On June 15, 2010, the Plaintiff filed his Motion to Reinstate Claim, which the court granted. (Doc. 20).
"Once the moving party has properly supported its motion for summary judgment, the burden shifts to the nonmoving party to `come forward with specific facts showing that there is a genuine issue for trial.'" International Stamp Art, Inc. v. U.S. Postal Service, 456 F.3d 1270, 1274 (11th Cir.2006) (citing Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986)). Although there are cross-motions for summary judgment, each side must still establish the lack of genuine issues of material fact and that it is entitled to judgment as a matter of law. See Chambers & Co. v. Equitable Life Assur. Soc. of the U.S., 224 F.2d 338, 345 (5th Cir.1955) ("Both parties filed and argued motions for summary judgment, but this does not warrant the granting of either motion if the record reflects a genuine issue of fact.").
The parties have raised several pivotal issues in their briefs, and the court considers those issues in the following order: (1) whether McCay's failure to exhaust his administrative remedies should be excused; (2) assuming McCay's claim is not barred by his failure to exhaust administrative remedies, what standard of review should the court apply to Drummond's denial of ERISA pension benefits; and (3) applying that review, whether either party is entitled to summary judgment.
Throughout the course of this lawsuit, Drummond has consistently maintained its position that McCay has failed to exhaust his administrative remedies relating to his disability pension claim and, accordingly, his ERISA claims are barred from litigation in this court. Because the court's
The ERISA statute mandates that employee benefit plans subject to its coverage "shall ... afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim." 29 U.S.C.A. § 1133(2) (emphasis added).
The Eleventh Circuit generally requires exhaustion of administrative remedies as a precondition to filing an ERISA action. Perrino v. Southern Bell Tel. & Tel. Co., 209 F.3d 1309, 1315 (11th Cir.2000) ("Our law is well-settled that `plaintiffs in ERISA actions must exhaust available administrative remedies before suing in federal court.'" (quoting Counts v. Amer. Gen. Life & Accident Ins. Co., 111 F.3d 105, 108 (11th Cir.1997))); Mason v. Continental Group, Inc., 763 F.2d 1219, 1225-27 (11th Cir.1985) ("We therefore hold that the district court did not err in holding that plaintiffs must exhaust their remedies under the pension plan agreement before they may bring their ERISA claims in federal court.").
As to the futility exception, the Eleventh Circuit has clarified that it does not apply simply because the same parties who made the initial benefits determination were also the decision makers in the administrative appeal process. Lanfear v. Home Depot, Inc., 536 F.3d 1217, 1224 (11th Cir.2008). Rather, "the futility exception protects participants who are denied meaningful access to administrative procedures, not those whose claims would be heard by an interested party." Id. For instance, in Curry, the Eleventh Circuit found that the futility exception applied where the "plan administrators had denied a participant meaningful access to administrative proceedings by repeatedly ignoring requests for documents supporting the denial of benefits." 891 F.2d at 846. Conversely, in Springer v. Wal-Mart Assoc. Group Health Plan, 908 F.2d 897 (11th Cir.1990), the Eleventh Circuit reversed the district court's application of the futility exception where the plan participant invoked the exception on the basis that the initial internal decision maker and the decision maker on appeal shared "an interest in holding costs down." Id. at 901.
As to the inadequacy of remedy exception, the Court in Perrino acknowledged, based on "clear" prior precedent, "that the exhaustion requirement for ERISA claims should not be excused for technical violations of ERISA regulations that do not deny plaintiffs meaningful access to an administrative remedy procedure through
Moreover, the Eleventh Circuit has expressed a disinclination toward expansion of the exceptions to exhaustion. In Perrino, for example, the Eleventh Circuit rejected a proposed "new exception to our exhaustion requirement; namely, that an employer's noncompliance with ERISA's technical requirements (for example, creating a summary plan description, or delineating a formal claims procedure) should excuse a plaintiff's duty to exhaust administrative remedies." Id. In declining to further expand the exceptions to exhaustion based on technical noncompliance with ERISA, the Court provided the following instructive guidance:
Id. at 1318 (emphasis added).
As a preliminary matter, Plaintiff acknowledges his failure to exhaust his administrative remedies in this case by admitting his failure to appeal Drummond's initial denial of pension benefits within the set 180-day time frame. (See Background section, supra).
Despite McCay's several attempts to evade the exhaustion requirement, which the court will address in turn, the court does not find that any of the currently developed exceptions in Eleventh Circuit case law, described supra, apply to his case. Further, McCay does not argue that any of these established exceptions apply. Instead, McCay unpersuasively asserts that he should be excused from his admitted failure to follow the administrative appeals process because of his depression. McCay alleges in his complaint that depression interfered with his ability to timely appeal Drummond's denial of his disability
First, McCay has not argued, much less provided evidence, that his depression was severe enough to constitute mental incapacity. As Drummond observes in its briefing, McCay does not argue or allege "mental incompetence" or "legal incompetence." (Doc. 38 at 18.).
Next, the court observes an irreconcilable tension between the pre-litigation position advocated by McCay's attorney— informing Drummond by letter dated March 10, 2008, letter that "Mr. McCay delayed filing an appeal of the disability pension because he was waiting on the Social Security decision" (A.R. 0081) (emphasis added)—and his post-litigation position that the delay was based on his depression. Similarly, based on this court's review of the administrative record, it can find no evidence that Drummond was informed prior to the filing of this lawsuit of McCay's depression as a reason for his failure to timely appeal.
Finally, the court observes an unexplained discrepancy in the time frame within which McCay asserts that he was unable to pursue Drummond's appeals process due to depression, which is the same general time frame within which McCay apparently hired an attorney and successfully appealed his unfavorable Social Security benefits determination. In his response to Drummond's Requests for Admission, McCay admitted that he "appealed the denial of his SSA claim in 2005," (Doc. 39-3, at 6, 11)
For all these reasons, McCay's alleged depression does not serve to excuse the exhaustion of remedies requirement imposed by the Eleventh Circuit, as it neither has a reasonable basis based on the facts of this case, nor does it fit into one of
Likewise, nor does McCay's passing argument that certain alleged deficiencies contained in Drummond's notice of denial of benefits (which Drummond denies) excuse McCay's failure to appeal within the designated 180-day time period. See Perrino, 209 F.3d at 1315 (rejecting exception to ERISA exhaustion requirement based on employer's "noncompliance with ERISA's technical requirements"). McCay's counsel sent a letter to Drummond on July 14, 2008, asserting that the denial notice failed to include a "notice of waiver of rights if no formal notice was filed in 180 days," and that "[t]he denial did not explain what evidence would be required to substantiate his claim." (A.R. 0093-0094). The court finds that, even if true, the type of "noncompliance with ERISA's technical requirements" that McCay alleges is of the type that the Court in Perrino concluded was insufficient to excuse ERISA's administrative exhaustion requirement. Id. at 1317 ("[T]he exhaustion requirement for ERISA claims should not be excused for technical violations of ERISA regulations that do not deny plaintiffs meaningful access to an administrative remedy procedure through which they may receive an adequate remedy.").
Therefore, the court finds that McCay has failed to exhaust his administrative remedies, and as such, his ERISA claim is barred from further litigation in this court. Despite the court's holding on this issue, however, the court will proceed to analyze, as an alternative basis for its decision, the second and third issues raised concerning which standard of review applies, and whether either of the parties are entitled to summary judgment under that standard.
ERISA does not contain a standard of review for actions brought under § 1132(a)(1)(B) challenging benefit eligibility determinations. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 108-09, 109 S.Ct. 948, 953, 103 L.Ed.2d 80 (1989) ("Although it is a `comprehensive and reticulated statute,' ERISA does not set out the appropriate standard of review for actions... challenging benefit eligibility determinations.").
In Firestone, the Supreme Court initially established three distinct standards for courts to employ when reviewing an ERISA plan administrator's benefits decision: "(1) de novo where the plan does not grant the administrator discretion; (2) arbitrary and capricious where the plan grants the administrator discretion; and (3) heightened arbitrary and capricious where the plan grants the administrator
Id. at 1355.
In this case, the parties dispute the appropriate standard of review for the court to apply.
While McCay bears the burden of proving his entitlement to ERISA benefits under Drummond's pension plan, Horton v. Reliance Std. Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir.1998), Drummond bears the burden of proving that the arbitrary and capricious standard of review applies. Anderson v. Unum Life Ins. Co. of America, 414 F.Supp.2d 1079, 1095 (M.D.Ala. 2006) (citations omitted). Based upon the terms of the Plan as discussed more fully below, the court agrees with Drummond that the modified arbitrary and capricious review is proper.
As the Eleventh Circuit explained in Jett v. Blue Cross and Blue Shield of Alabama, Inc., 890 F.2d 1137 (11th Cir.1989), regarding the de novo versus abuse of discretion distinction:
Jett, 890 F.2d at 1138-39 (emphasis added). Therefore, in Jett, the court first looked to the language of the plan in order to evaluate the standard of review issue.
Here, the terms of the plan clearly and expressly confer discretion to the plan administrator, the Pension Committee, to interpret and apply the provisions of the Pension Agreement: "Such disability and the continuance and permanency thereof and such other qualification shall be determined by the Pension Committee and such determinations of the Pension Committee shall be controlling." (Doc. 1-3 at 14-15). McCay does not dispute that the Pension Agreement unambiguously vests discretion to the Pension Committee to interpret its terms and make benefits determinations, but instead conclusorily argues, without any analysis or citation to legal authority, that because Drummond vested discretion to itself, the arbitrary and capricious standard does not apply. McCay's entire argument on this point is set out below:
(Doc. 36 at 17). Further, after review, the court has found no legal or persuasive support for McCay's position.
Accordingly, the court agrees with Drummond that the language of the Pension Agreement sufficiently confers discretion to the plan administrator as to make McCay's ERISA claim appropriately reviewed under the modified arbitrary and capricious standard.
Even if McCay's claims were not barred because of his failure to comply with the exhaustion requirement, the court alternatively finds that the Pension Committee's decision denying benefits was nevertheless supported by reasonable grounds under the modified arbitrary and capricious standard. Cf. Shannon v. Jack Eckerd Corp., 113 F.3d 208, 210 (11th Cir.1997) ("A decision to deny benefits is arbitrary and capricious if no reasonable basis exists for the decision."). Therefore, McCay's claim would also be denied under that standard, and summary judgment is due to be granted in favor of Drummond.
The underlying theme of McCay's continual attempts to submit newly obtained documentation in this case is his perception that "Drummond was under a continuing duty to consider new evidence." (Doc. 16, at 2). Plaintiff relies solely on the authority of Shannon v. Jack Eckerd Corp., 113 F.3d 208, 210 (11th Cir.1997), to support his proposition that "the administrator always has the duty to examine new evidence of disability." (E.g., Doc. 8 at 1). In Shannon, the "district court relied on Bucci v. Blue Cross-Blue Shield of Conn., 764 F.Supp. 728, 732 (D.Conn.1991), holding that since a defendant's duty to provide
Moreover, the continuing obligation of review proposition discussed in Shannon was in the context of the district court's discretionary decision to remand the case to the plan administrator for review of additional evidence. Shannon does not stand for the proposition that an ERISA plaintiff may keep submitting additional evidence in perpetuity—a notion that would run afoul of the Eleventh Circuit's policy reasons for imposing an exhaustion of remedies requirement in ERISA cases. See Mason, 763 F.2d at 1227 (discussing the "compelling considerations ... for plaintiffs to exhaust administrative remedies prior to instituting a lawsuit" (emphasis added)).
Turning back to one of the cases discussed in the court's previous Memorandum Opinion granting remand, the reasoning of Levinson v. Reliance Standard Life Ins. Co., 245 F.3d 1321 (11th Cir.2001) supports the idea that McCay's window of opportunity within which to submit documents in support of his disability pension claim has long expired.
245 F.3d at 1328 (emphasis added). The court recognizes some similar themes here. Before commencement of this litigation, McCay had "more than adequate opportunities to establish an administrative record" demonstrating his total disability as of December 15, 2004 (the date he was terminated and no longer eligible for pension benefits). Even after the litigation commenced, the court exercised its discretion to order remand to the plan administrator, allowing McCay an opportunity to submit the evidence described in his Motion for Remand (Doc. 8), including the recently obtained favorable SSA determination, for further review. Yet, after the court's remand, and even after the Pension Committee's reviewed the additional information on remand and
For all these reasons, the court finds that the Pension Committee articulated reasonable grounds for declining to consider the evidence obtained and submitted post-remand.
Although the court finds that Drummond was under no obligation to consider the additional evidence obtained and submitted post-remand, Drummond nevertheless (without waiving its determination that these documents were untimely) considered them along with all other additional documentation submitted pre-remand. After submitting McCay's additional documentation to two different medical reviewers for independent assessments of the new information in the context of the entire claim file, Drummond found no grounds upon which to alter or reverse its initial determination, and it articulated reasonable grounds for discounting the additional documentation.
McCay, in essence, agrees with Drummond about a critical point regarding his disability pension application: that "the case boils down to whether Drummond's denial of a disability pension should be allowed based on Dr. Berchuck's statement on [November 24, 2004] and the medical records of [November 23, 2004], that McCay after surgery on [June 23, 2004] could return to work." (Doc. 36 at 2). McCay argues that he is entitled to the pension because, in fact, he was not able to return to work, as evidenced by 1) pain treatment by Dr. Berke in January and February 2005, including two epidurals, 2) his referral to the Birmingham Pain Clinic on June 14, 2005, and 3) his subsequent award of SSA disability benefits on September 11, 2006, which ascribed an onset date of June 15, 2004. (Id.).
McCay misses several key points, which Drummond repeatedly articulated in its correspondence concerning the pension denial. First, the activity that occurred in January, February, and June 2005 related to his pain treatment could and should have been brought to Drummond's attention during McCay's 180-day appeal period, which ran from February 11, 2005, to August 10, 2005. McCay presents no reasonable explanation as to why he failed to inform Drummond about these continuing pain treatments post-release from his back surgery.
Second, according to the terms of the Pension Agreement, as negotiated by Drummond and the union, the Pension Committee's assessment of McCay's disability for the purpose of determining his eligibility for pension benefits must be
Despite McCay's strong suggestions that Drummond neglected to consider the favorable SSA determination, the record clearly evidences that the Pension Committee did, in fact, review and consider the SSA determination upon remand. McCay inaccurately states that the Committee "disregarded" (Doc. 36 at 20), "never considered" (id. at 23), and "ignore[d]" (id.) the SSA determination. To the contrary, the Committee's determination letter on remand shows that it not only reviewed the SSA determination but carefully distinguished it, articulating its reasons for doing so:
(A.R. 0104-0105) (emphasis added).
As the court previously stated in its Memorandum Opinion granting remand (Doc. 16), McCay's award of Social Security benefits is a potentially relevant, though not dispositive, factor in determining benefits in an ERISA case. See Paramore v. Delta Air Lines, Inc., 129 F.3d 1446, 1452 n. 5 (11th Cir.1997) ("Although a court may consider this information in reviewing a plan administrator's decision regarding eligibility for benefits under an ERISA-governed plan, an award of benefits by the Social Security Administration is not dispositive of the issue before us." (internal citation omitted)); see also Ray v. Sun Life & Health Ins. Co., 443 Fed.Appx. 529, 533 (11th Cir.2011) ("[W]hile approval of social security benefits may be considered, it is not conclusive on whether a claimant is also disabled under the terms of an ERISA plan."). The court finds that Drummond articulated reasonable grounds for distinguishing the favorable SSA determination, after due consideration of that determination.
Finally, the court is unpersuaded by McCay's efforts to convince the court that a conflict of interest tainted Drummond's unfavorable benefits determination. Under Glenn, the court must weigh an alleged conflict of interest as merely "one factor" in determining whether an administrator abused its discretion. 554 U.S. at 115-17, 128 S.Ct. 2343. Here, McCay sets out three reasons why Drummond's decision was tainted by self-interest. None has merit.
First, McCay argues that self-interest is evident in Drummond's "disregard for the SSA favorable decision." (Doc. 41 at 10). As discussed above, however, Drummond did not disregard the SSA's favorable decision. While McCay acknowledges that "[t]he Social Security decision is not binding," he asserts that Drummond's "failure to address SSA award of disability benefits in a
Next, McCay contends that conflict is evidenced by Drummond's "disregard of the opinion of the treating physician for the use of biased record reviewers." (Id. at 14). It is well-established in ERISA cases that "[n]o special weight is to be accorded the opinion of a treating physician." Ray, 443 Fed.Appx. at 533 (citing Black & Decker Disability Plan v. Nord, 538 U.S. 822, 123 S.Ct. 1965, 1970-72, 155
Finally, McCay suggests conflict because "the Pension Committee never objectively reviewed and discussed the evidence." (Doc. 41 at 15). This contention also fails. After having carefully reviewed the entire administrative record, including the Committee's multiple communications with McCay and his counsel, the court finds that Drummond acknowledged, considered, and discussed the flood of information McCay's counsel has continued to pour into the record throughout the course of this litigation. By necessity, and in the interests of finality, the time has come to shut the valve and bring this litigation to a close.
In sum, the court finds no evidence of arbitrary and capricious conduct on behalf of Drummond's Pension Committee in adjudicating (and re-adjudicating, time and again) McCay's claim for disability pension benefits. To the contrary, its determination was supported by reasonable grounds, as explained above.
In sum, Drummond's Motion for Summary Judgment is due to be granted based on McCay's failure to exhaust his administrative remedies. Alternatively, summary judgment in favor of Drummond is appropriate under the arbitrary and capricious standard of review because its decision denying benefits upon remand was reasonable. Accordingly, under either reasoning, McCay's Motion for Judgment on Liability is due to be denied. The court will enter a Final Judgment Order consistent with this Memorandum Opinion.
Pending before the court are the parties' cross-motions for judgment on the merits: McCay's Motion for Judgment on Liability With Submissions (Doc. 35) (the "Motion for Judgment on Liability"), and Drummond's Motion for Summary Judgment (Doc. 25) (the "Motion for Summary Judgment"). Consistent with the court's Memorandum Opinion entered on this date, Drummond's Motion for Summary Judgment is hereby
(Doc. 16 at 8-9) (emphasis in original).
29 C.F.R. § 2560.503-1(b)(2)(A)-(B).
763 F.2d at 1227.