Filed: May 01, 2015
Latest Update: Mar. 02, 2020
Summary: Case: 14-13470 Date Filed: 05/01/2015 Page: 1 of 5 [DO NOT PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ No. 14-13470 Non-Argument Calendar _ D.C. Docket No. 1:12-cv-02188-RLV SANDRA E NOLLEY, Plaintiff-Appellant, versus THE BELLSOUTH LONG TERM DISABILITY PLAN FOR NON-SALARIED EMPLOYEES, a.k.a. AT&T Disability Income Program, et al., Defendants, AT&T SERVICES, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., a.k.a. AT&T Integrated Disability Service Center, Defendants
Summary: Case: 14-13470 Date Filed: 05/01/2015 Page: 1 of 5 [DO NOT PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ No. 14-13470 Non-Argument Calendar _ D.C. Docket No. 1:12-cv-02188-RLV SANDRA E NOLLEY, Plaintiff-Appellant, versus THE BELLSOUTH LONG TERM DISABILITY PLAN FOR NON-SALARIED EMPLOYEES, a.k.a. AT&T Disability Income Program, et al., Defendants, AT&T SERVICES, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., a.k.a. AT&T Integrated Disability Service Center, Defendants-..
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Case: 14-13470 Date Filed: 05/01/2015 Page: 1 of 5
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 14-13470
Non-Argument Calendar
________________________
D.C. Docket No. 1:12-cv-02188-RLV
SANDRA E NOLLEY,
Plaintiff-Appellant,
versus
THE BELLSOUTH LONG TERM DISABILITY
PLAN FOR NON-SALARIED EMPLOYEES,
a.k.a. AT&T Disability Income Program, et al.,
Defendants,
AT&T SERVICES, INC.,
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.,
a.k.a. AT&T Integrated Disability Service Center,
Defendants-Appellees.
________________________
Appeal from the United States District Court
for the Northern District of Georgia
________________________
(May 1, 2015)
Case: 14-13470 Date Filed: 05/01/2015 Page: 2 of 5
Before TJOFLAT, MARCUS and WILSON, Circuit Judges.
PER CURIAM:
Sandra E. Nolley, proceeding pro se, appeals from the district court’s order
granting summary judgment in favor of AT&T Services, Inc. (“AT&T Services”)
and Sedgwick Claims Management Services, Inc. (“Sedgwick”), in her civil action
alleging wrongful termination of long term disability (“LTD”) benefits, brought
pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §
1132(a). On appeal, Nolley argues that the district court erred by granting
summary judgment on her ERISA claims because: (1) Sedgwick’s decision to
terminate her LTD benefits was “ de novo” wrong; (2) Sedgwick was not vested
with discretionary authority to review claims; and (3) Sedgwick’s decision was not
supported by reasonable grounds. After thorough review, we affirm.
We review a district court’s ruling affirming a plan administrator’s ERISA
benefits decision de novo, applying the same legal standards as the district court.
Blankenship v. Metro. Life Ins. Co.,
644 F.3d 1350, 1354 (11th Cir. 2011).
Under ERISA’s civil enforcement provisions, a plan participant may bring a
civil action against the plan administrator to recover wrongfully denied benefits
due to her under the terms of the plan. See 29 U.S.C. § 1132(a)(1). Although
ERISA itself does not provide any standards for judicial review of a plan
administrator’s benefits determination, the Supreme Court has articulated a
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framework for judicial review, which we have distilled into a six-part test. Melech
v. Life Ins. Co. of N. Am.,
739 F.3d 663, 672 (11th Cir. 2014). Thus, a court
reviewing a plan administrator’s benefits decision should conduct the following
multi-step analysis:
(1) Apply the de novo standard to determine whether the claim
administrator’s benefits-denial decision is “wrong” (i.e., the court disagrees
with the administrator’s decision); if it is not, then end the inquiry and affirm
the decision.
(2) If the administrator’s decision in fact is “de novo wrong,” then determine
whether he was vested with discretion in reviewing claims; if not, end
judicial inquiry and reverse the decision.
(3) If the administrator’s decision is “de novo wrong” and he was vested
with discretion in reviewing claims, then determine whether “reasonable”
grounds supported it (hence, review his decision under the more deferential
arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the inquiry and reverse the
administrator’s decision; if reasonable grounds do exist, then determine if he
operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and affirm the decision.
(6) If there is a conflict, the conflict should merely be a factor for the court
to take into account when determining whether an administrator’s decision
was arbitrary and capricious.
Blankenship, 644 F.3d at 1355.
In tackling the first prong of the six-part test, we review the administrator’s
decision for correctness, based upon the evidence before the administrator at the
time of its benefits decision.
Melech, 739 F.3d at 672. If we would have reached
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the same decision as the administrator, the judicial inquiry ends, and judgment in
favor of the administrator is appropriate.
Id. at 672-73.
In this case, the district court did not err by granting summary judgment on
Nolley’s ERISA claims because Sedgwick’s decision to terminate Nolley’s LTD
benefits was not “de novo wrong.” As the record shows, Sedgwick based its
adverse benefits decision on the fact that Nolley no longer met the Plan’s definition
of “disabled,” and the record reveals that it relied on the judgment of independent
professionals in reaching this conclusion. Although Nolley’s psychiatrist
concluded that she was incapable of working due to her depression, his progress
notes indicate that the majority of her cognitive processes were within normal
limits. Furthermore, Sedgwick retained multiple independent physician advisors to
review Nolley’s medical records and assess whether she possessed any work
capacity, and each of them concluded that there were no objective findings
substantiating the conclusion that she was unable to work. As a result, the record
supports Sedgwick’s conclusion that Nolley no longer met the Plan’s definition of
“disabled,” and we cannot say that Sedgwick’s termination of her benefits was “de
novo wrong.”
Nor can we find error in Sedgwick’s benefits decision simply because it
denied her claim for LTD benefits based on her failure to furnish objective medical
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evidence of her disability. The relevant Plan document specifically provided that
LTD benefits would terminate if Nolley failed to furnish objective medical
evidence demonstrating the continuing nature of her disability, and the claims
administrator may rely on such a provision in making its determination to
terminate benefits. Moreover, a representative of Sedgwick actually informed
Nolley and her treating psychiatrist of the need to provide objective medical
evidence of her disability; notified them that her treating psychiatrist’s treatment
records were deficient in this respect; clarified that the requisite objective medical
evidence should support the conclusion that Nolley was not capable of performing
any occupational duties; and then provided an example of the type of evidence that
might suffice.
In short, based on the record available to Sedgwick at the time it terminated
Nolley’s LTD benefits, we cannot conclude that its decision was wrong. Because
we have not concluded that Sedgwick’s benefits-denial decision was “wrong,” our
judicial inquiry has ended, and we must affirm. See
Melech, 739 F.3d at 672.
AFFIRMED.
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