Filed: May 16, 2012
Latest Update: Feb. 12, 2020
Summary: 11-974-cv Testa v. Hartford Life Ins. UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT SUMMARY ORDER RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A SUMMARY ORDER FILED ON OR AFTER JANUARY 1, 2007, IS PERMITTED AND IS GOVERNED BY FEDERAL RULE OF APPELLATE PROCEDURE 32.1 AND THIS COURT’S LOCAL RULE 32.1.1. WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN ELECTRONIC DATABASE (WITH THE NOTATION “SUMMARY
Summary: 11-974-cv Testa v. Hartford Life Ins. UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT SUMMARY ORDER RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A SUMMARY ORDER FILED ON OR AFTER JANUARY 1, 2007, IS PERMITTED AND IS GOVERNED BY FEDERAL RULE OF APPELLATE PROCEDURE 32.1 AND THIS COURT’S LOCAL RULE 32.1.1. WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN ELECTRONIC DATABASE (WITH THE NOTATION “SUMMARY ..
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11-974-cv
Testa v. Hartford Life Ins.
UNITED STATES COURT OF APPEALS
FOR THE SECOND CIRCUIT
SUMMARY ORDER
RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A SUMMARY ORDER FILED ON OR AFTER JANUARY 1,
2007, IS PERMITTED AND IS GOVERNED BY FEDERAL RULE OF APPELLATE PROCEDURE 32.1 AND THIS COURT’S LOCAL RULE 32.1.1.
WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN
ELECTRONIC DATABASE (WITH THE NOTATION “SUMMARY ORDER”). A PARTY CITING A SUMMARY ORDER MUST SERVE A COPY OF IT ON
ANY PARTY NOT REPRESENTED BY COUNSEL.
1 At a stated term of the United States Court of Appeals
2 for the Second Circuit, held at the Daniel Patrick Moynihan
3 United States Courthouse, 500 Pearl Street, in the City of
4 New York, on the 16th day of May, two thousand twelve.
5
6 PRESENT: RICHARD C. WESLEY,
7 RAYMOND J. LOHIER, JR.,
8 CHRISTOPHER F. DRONEY,
9 Circuit Judges.
10
11 JOSEPHINE TESTA,
12
13 Plaintiff-Appellant,
14
15 v. 11-974-cv
16
17 HARTFORD LIFE INSURANCE COMPANY
18
19 Defendant-Appellee,
20
21 MARSH & McLENNAN COMPANIES, INC.,
22
23 Defendant-Appellee.
24
25
26
27 FOR PLAINTIFF-APPELLANT: JASON NEWFIELD (Justin C.
28 Frankel, on the brief), Frankel
29 & Newfield, P.C., Garden City,
30 NY.
31
32 FOR DEFENDANT-APPELLEE MICHAEL H. BERNSTEIN (Matthew P.
33 HARTFORD LIFE Mazzola, on the brief),
34 INSURANCE COMPANY: Sedgwick LLP, New York, NY.
35
36
1 FOR DEFENDANT-APPELLEE MICHAEL J. DELL (Natan M.
2 MARSH & McLENNAN Hamerman, on the brief), Kramer
3 COMPANIES, INC.: Levin Naftalis & Frankel LLP,
4 New York, NY.
5
6
7 Appeal from the United States District Court for the
8 Eastern District of New York (Block, J.).
9
10 UPON DUE CONSIDERATION, IT IS HEREBY ORDERED, ADJUDGED
11 AND DECREED that the judgment of the United States District
12 Court for the Eastern District of New York is AFFIRMED.
13 Plaintiff-Appellant Josphine Testa ("Testa") appeals
14 from the March 1, 2011 Memorandum and Order of the United
15 States District Court for the Eastern District of New York
16 (Block, J.), granting summary judgment to the defendants-
17 appellees and dismissing Testa’s claims pursuant to the
18 Employee Retirement Income Security Act (“ERISA”). Testa is
19 a member of employer-provided health care plans (the
20 “Plans”) governed by ERISA and administered by Defendant-
21 Appellee Hartford Life Insurance Company (“Hartford”), which
22 denied Testa’s claim for long-term disability benefits in
23 2008. On appeal, Testa argues that Hartford’s decision was
24 not supported by substantial evidence and Hartford failed to
25 provide her a full and fair review of her claim as required
26 by ERISA.
27
2
1 In an ERISA action, we review a district court's grant
2 of summary judgment de novo and apply the same legal
3 standard as the district court. Firestone Tire & Rubber Co.
4 v. Bruch, 489 U.S. 101, 115 (1989). “[W]here, as here,
5 written plan documents confer upon a plan administrator the
6 discretionary authority to determine eligibility, we will
7 not disturb the administrator's ultimate conclusion unless
8 it is ‘arbitrary and capricious.’” Hobson v. Metro. Life
9 Ins. Co.,
574 F.3d 75, 82 (2d Cir. 2009) (citation and
10 internal quotation marks omitted). Under the arbitrary and
11 capricious standard, a decision to deny benefits will be
12 overturned only if it is "without reason, unsupported by
13 substantial evidence or erroneous as a matter of law."
14 Kinstler v. First Reliance Standard Life Ins. Co.,
181 F.3d
15 243, 249 (2d Cir. 1999) (citation and internal quotation
16 marks omitted).
17 Hartford’s decision to terminate Testa’s disability
18 benefits was reasonable and supported by substantial
19 evidence. Hartford relied on the opinions of three
20 independent physicians and one independent psychologist, all
21 of whom reviewed Testa’s medical record and independently
22 determined that there was insufficient evidence to support a
23 finding of total disability. Specifically, as all doctors
3
1 found—and the record on appeal demonstrates—virtually all of
2 Testa’s symptoms were self-reported and supported by little,
3 if any, objectively verifiable evidence. Moreover, that
4 Hartford chose to credit its own doctors over Testa’s
5 treating physicians is not, in and of itself, grounds for
6 reversing the determination. “Nothing in the Act . . .
7 suggests that plan administrators must accord special
8 deference to the opinions of treating physicians,” Black &
9 Decker Disability Plan v. Nord, 538 U.S. 822, 831 (2003),
10 and “courts have no warrant to require administrators
11 automatically to accord special weight to the opinions of a
12 claimant's physician; nor may courts impose on plan
13 administrators a discrete burden of explanation when they
14 credit reliable evidence that conflicts with a treating
15 physician's evaluation,”
id. at 834.
16 Testa also contends that several procedural
17 irregularities evidence that Hartford failed to provide a
18 “full and fair review” of her claim as required by ERISA.
19 See 29 U.S.C. § 1133(2). None of these claims has merit.
20 First, contrary to Testa’s contention otherwise, following
21 the initial denial of long-term disability benefits,
22 Hartford provided Testa with "adequate notice in writing
23 . . . setting forth the specific reasons for such denial,
4
1 written in a manner calculated to be understood by the
2 participant." 29 U.S.C. § 1133(1). To satisfy the ERISA
3 notice requirement, regulations provide that the
4 administrator must furnish the claimant with: "[t]he
5 specific reason or reasons for the adverse determination";
6 “[r]eference to the specific plan provisions on which the
7 determination is based”; "[a] description of any additional
8 material or information necessary for the claimant to
9 perfect the claim and an explanation of why such material or
10 information is necessary"; and “[a] description of the
11 plan’s review procedures and the time limits applicable to
12 such procedures.” 29 C.F.R. § 2560.503-1(g). Substantial
13 compliance with the regulations is all that is needed to
14 constitute "adequate notice" under ERISA. See Hobson, 574
15 F.3d at 87.
16 Here, Hartford's three-page letter, dated May 15, 2007,
17 notifying Testa of the denial of her long-term disability
18 benefits claim substantially complied with the ERISA notice
19 requirements. The letter made specific reference to the
20 definition of “Total Disability” on which the denial was
21 based and provided information as to how to appeal the
22 denial of benefits. The letter also explained that Testa's
23 claim was denied because "the information provided did not
5
1 support any restrictions/limitations from a mental/nervous
2 condition" and "there was no data to support any long-term
3 cognitive or motor dysfunction due to migraine headaches or
4 any inability to sit and perform most fine motor and
5 fingering activities."
6 Second, Testa contends that Hartford improperly
7 required objective evidence of her medical conditions; she
8 notes that the Plans do not require objective proof to
9 approve a claim. An administrator may require objective
10 medical support, even when the requirement "is not expressly
11 set out in the plan," so long as the claimant was so
12 notified. Hobson, 574 F.3d at 88. In Hartford's denial
13 letter, it informed Testa that "there was no data to support
14 any long-term cognitive or motor dysfunction due to migraine
15 headaches or any inability to sit and perform most fine
16 motor and fingering activities." In light of this
17 notification, Hartford acted within its discretion in
18 requiring some objective evidence that Testa was totally
19 disabled.
20 Third, Testa’s claim that Hartford failed to retain
21 "appropriately qualified medical personnel" is unavailing.
22 ERISA regulations provide that the plan administrator must
23 retain physicians who have "appropriate training and
6
1 experience in the field of medicine involved in the medical
2 judgment." 29 CFR § 2560.503-1(h)(3)(iii). Hartford's
3 choice of independent physicians clearly satisfies this
4 provision. Each independent consultant was licensed and/or
5 board certified in the requisite field of medicine
6 applicable to Testa's diagnosis.
7 Fourth, Testa’s argument that Hartford failed to
8 consider all of the evidence is meritless. In its initial
9 decision, and at each stage of appeal, Hartford set forth an
10 exhaustive list of the evidence it had considered, and it
11 also offered Testa multiple opportunities to support her
12 claim with additional objective evidence.
13 Fifth, we reject Testa’s contention that the district
14 court should have considered materials outside the
15 administrative record. A district court reviewing a denial
16 of disability benefits under ERISA is generally limited to
17 the materials in the administrative record. See, e.g.,
18 Miller v. United Welfare Fund, 72 F.3d 1066, 1071 (2d Cir.
19 1995). In any event, Testa’s contention that the extra-
20 record material demonstrates, inter alia, that Hartford has
21 a "pervasive culture of claim bias" is purely speculative
22 and thus there was no need for the district court to
23 consider it.
7
1 Finally, there is no merit to Testa’s contention that
2 Hartford failed to properly consider her disability award
3 from the Social Security Administration (“SSA”). While SSA
4 awards may be considered when determining whether a claimant
5 is disabled, a plan administrator is not bound by the award
6 and is not required to accord that determination any
7 "special deference." Durakovic v. Bldg. Serv. 32 BJ Pension
8 Fund, 609 F.3d 133, 141 (2d Cir. 2010). In its final denial
9 letter to Testa, Hartford noted that it considered the SSA
10 award but was not bound by it. Although Hartford did not
11 explain why it did not credit the SSA award, it was not
12 required to do so, “especially in light of the substantial
13 evidence supporting its determination.”
Hobson, 574 F.3d at
14 92.
15 We have considered all of Testa’s remaining arguments
16 and, after a thorough review of the record, find them to be
17 without merit. For the foregoing reasons, the judgment of
18 the district court is hereby AFFIRMED.
19 FOR THE COURT:
20 Catherine O’Hagan Wolfe, Clerk
21
22
8
