Filed: Apr. 20, 2011
Latest Update: Feb. 22, 2020
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 04-2135 MARGARET MULLINS, Plaintiff - Appellee, v. AT&T CORPORATION, Defendant – Appellant, and CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES, Defendants. No. 04-2136 MARGARET MULLINS, Plaintiff - Appellant, v. CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T C
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 04-2135 MARGARET MULLINS, Plaintiff - Appellee, v. AT&T CORPORATION, Defendant – Appellant, and CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES, Defendants. No. 04-2136 MARGARET MULLINS, Plaintiff - Appellant, v. CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T CO..
More
UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 04-2135
MARGARET MULLINS,
Plaintiff - Appellee,
v.
AT&T CORPORATION,
Defendant – Appellant,
and
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL
EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES,
Defendants.
No. 04-2136
MARGARET MULLINS,
Plaintiff - Appellant,
v.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T
CORPORATION; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL
EMPLOYEES,
Defendants - Appellees.
No. 07-1717
MARGARET MULLINS,
Plaintiff - Appellant,
v.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T
CORPORATION; AT&T MEDICAL EXPENSE PLAN FOR OCCUPATIONAL
EMPLOYEES,
Defendants - Appellees.
No. 10-2010
MARGARET MULLINS,
Plaintiff - Appellant,
v.
AT&T CORPORATION,
Defendant – Appellee,
and
CONNECTICUT GENERAL LIFE INSURANCE COMPANY; AT&T LONG TERM
DISABILITY PLAN FOR OCCUPATIONAL EMPLOYEES; AT&T MEDICAL
EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES,
Defendants.
Appeals from the United States District Court for the Eastern
District of Virginia, at Alexandria. Gerald Bruce Lee, District
Judge. (CA-03-69; 1:03-cv-00069-GBL-TCB)
2
Argued: January 26, 2011 Decided: April 20, 2011
Before TRAXLER, Chief Judge, and NIEMEYER and AGEE, Circuit
Judges.
Affirmed by unpublished per curiam opinion.
ARGUED: Robert Barnes Delano, Jr., SANDS ANDERSON, PC, Richmond,
Virginia, for AT&T Corporation, Connecticut General Life
Insurance Company, AT&T Long Term Disability Plan for
Occupational Employees, and AT&T Medical Expense Plan for
Occupational Employees. Patricia Ann Smith, LAW OFFICES OF
PATRICIA A. SMITH, Alexandria, Virginia, for Margaret Mullins.
ON BRIEF: Jeffrey H. Geiger, SANDS ANDERSON, PC, Richmond,
Virginia, for AT&T Corporation, Connecticut General Life
Insurance Company, AT&T Long Term Disability Plan for
Occupational Employees, and AT&T Medical Expense Plan for
Occupational Employees.
Unpublished opinions are not binding precedent in this circuit.
3
PER CURIAM:
Margaret Mullins appeals the district court’s decision
granting summary judgment against her on her claim for
disability benefits under a long-term disability plan (the “LTD
Plan” or “Plan”) self-funded by her employer, AT&T Corporation
(“AT&T”), administered by Connecticut General Life Insurance
Company (“CGLIC”), and governed by the Employee Retirement
Income Security Act of 1974 (“ERISA”). See 29 U.S.C.
§ 1132(a)(1)(B). AT&T cross-appeals the district court’s
decision imposing a penalty under 29 U.S.C. § 1132(c)(1) for
AT&T’s failure to produce a copy of the Summary Plan Description
(“SPD”) upon Mullins’ request. We affirm.
I.
Mullins was employed by AT&T as a communications assistant.
In this capacity, she handled “relay” calls for disabled persons
that required her to type telephone conversations as quickly as
possible. While at AT&T, Mullins was covered by the LTD Plan.
Under the Plan, an employee is considered disabled, and
therefore entitled to LTD benefits, when:
in the sole opinion of [CGLIC], [the employee] is
determined to be incapable of performing the
requirements of any job for any employer (including
non-AT&T employment), (as a management or occupational
employee), for which the individual is qualified or
may reasonably become qualified by training, education
4
or experience, other than a job that pays less than 50
percent of [the employee’s] annual Base Pay.
J.A. 365.
In April 1998, Mullins was diagnosed with bilateral carpal
tunnel syndrome (“CTS”) which caused her to experience
sensitivity and pain in her hands. Mullins also had diabetes,
which was thought to aggravate her CTS condition. In late 1998
and early 1999, Dr. Stephen Schroering, an orthopedic surgeon,
performed carpal tunnel surgery on both of her hands. Mullins
returned to work at AT&T on April 8, 1999, but her physician
determined that she was unable to perform the continuous and
repetitive keyboarding duties required by her position. She
stopped working at AT&T effective April 16, 1999.
On April 23, 1999, Dr. Schroering stated that Mullins’
condition prohibited her from “work requiring repetitive or
forceful grasping with either hand, greater than 50% of her
maximum grip strength,” and other “work requiring repetitive
work with either hand, including keyboard work.” J.A. 548.
However, Dr. Schroering noted that Mullins “does well as long as
she is not doing” such repetitive work throughout the day. J.A.
548. He felt that Mullins was unable “to return to her usual
and customary work as an AT&T operator, and w[ould] require
vocational rehabilitation.” J.A. 548. Dr. Schroering assigned
Mullins a 10% permanent disability for mild residual carpal
5
tunnel symptoms in the right hand and a 10% permanent disability
for mild residual carpal tunnel symptoms in the left hand, which
equated to a 12% whole person permanent disability. Dr.
Schroering left his practice in mid-1999.
In September 1999, Mullins applied for benefits under the
LTD Plan, claiming that the pain and weakness in her hands
rendered her “incapable of performing the requirements of any
job for any employer” under the terms of the Plan. J.A. 365.
Mullins, a high school graduate with two years of college
education, was 35 years old at the time. CGLIC began its
evaluation of Mullins’ LTD claim by obtaining copies of the
medical records from the physicians identified in her
application. In addition to Dr. Schroering, Mullins listed Dr.
Leopoldo Bendigo, Dr. Robert Strang, Dr. Douglas Williams, and
Dr. N.C. Ratliffe as her treating physicians.
Dr. Bendigo, an orthopedic surgeon, performed an
independent medical examination of Mullins on May 14, 1999. He
stated that Mullins was unable to return to her duties at AT&T
“at this point in time.” J.A. 545. However, he felt that she
had not reached maximum medical improvement and prescribed three
to six months of physical therapy.
Dr. Strang, an orthopedic surgeon, began seeing Mullins in
early August 1999, after Dr. Schroering left his practice. Dr.
Strang suggested physical therapy and referred Mullins to Dr.
6
Williams, a neurologist, for his opinion and recommendations
regarding the continued pain and sensitivity in her hands. Dr.
Williams had previously performed nerve conduction studies on
Mullins in May 1998, prior to her CTS surgeries, but felt that
she did not have CTS at that time. On September 23, 1999, Dr.
Williams noted that Mullins had “pretty good grip strength,” but
was continuing to experience bilateral hand pain. J.A. 488. It
was his impression that she had a “small fiber neuropathy . . .
related to her diabetes.” J.A. 553. He continued to believe
that her problems were unrelated to CTS. He prescribed
medication and asked Mullins to follow-up with him in two weeks.
On September 28, 1999, Dr. Strang advised that Mullins had
“neuropathy of both hands due to the carpal tunnel syndrome and
the diabetic neuropathy,” and was unable to return to work “[a]t
this time.” J.A. 443.
Dr. Ratliff was Mullins’ family doctor. In October 1999,
he completed a statement of disability, stating that Mullins had
a “[s]evere limitation of functional capacity” and was
“incapable of minimal (sedentary) activity.” J.A. 492. It was
his opinion that Mullins was totally disabled from her position
at AT&T and from “any other work.” J.A. 492. However, he noted
that Mullins’ prognosis was “[g]uarded,” and offered no opinion
as to whether a fundamental or marked change was expected.
7
In October 1999, Dr. Strang and Dr. Williams each completed
a physical assessment at the request of CGLIC, based on their
evaluation of Mullins. Dr. Strang stated that Mullins could
sit, stand and walk for eight hours a day, and occasionally
reach above and below her shoulders, but was unable to lift,
carry, push or pull, perform simple or firm grasping, or perform
fingering/keyboarding or other fine manipulation. J.A. 444.
Dr. Williams stated that Mullins could sit for 8 hours a day,
stand and walk for 7 hours a day, lift and carry up to 20 pounds
frequently, lift and carry up to 50 pounds occasionally, push
and pull occasionally, reach above and below her shoulders
frequently, and perform simple grasping frequently, and
occasionally perform fingering/keyboarding and other fine
manipulation. On January 17, 2000, Dr. Williams reevaluated
Mullins. He stated that Mullins’ predominant deficits were
sensory and assigned Mullins a 4% functional impairment in each
upper extremity, which equated to a 4% overall impairment.
Due to the conflicting medical evidence as to Mullins’
physical abilities, particularly from her specialists, Dr.
Strang and Dr. Williams, CIGNA referred Mullins’ case to a
physician advisor, Dr. Thomas Franz, for his review. Dr. Franz
advised that the current information failed to allow for a
definitive diagnosis and failed to support a finding of physical
inability to work at a light or sedentary level.
8
On January 27, 2000, CGLIC denied Mullins’ claim for
benefits as submitted, advising her that there was insufficient
evidence to support her claim that she was “incapable of
performing the requirements of any job for any employer” under
the terms of the Plan. J.A. 365. In support of the decision,
CGLIC noted the differing views of Dr. Strang and Dr. Williams,
as well as the review by Dr. Franz.
Upon Mullins’ request for review of CGLIC’s denial, CGLIC
obtained updated medical records from her treating physicians.
In addition, CGLIC consulted a physician advisor, Dr. Edward
Kern, for an opinion as to whether Mullins had a psychological
condition that would impact her ability to work. Dr. Pierce
Nelson had previously diagnosed Mullins with major depression in
November 1999, and raised questions as to Mullins’ ability to
function as a result. However, Dr. Nelson also noted that
Mullins was able to drive to her examination and manage her
financial affairs. Dr. Kern, who is board-certified in
psychiatry and neurology, reviewed Mullins’ records, including
those of Dr. Nelson, and reported that the information did not
address functionality and that malingering was a concern.
The updated medical records from Mullins’ treating
physicians for her hand pain and sensitivity continued to
demonstrate conflicting opinions regarding both her diagnosis
and her ability to work. On April 18, 2000, Dr. Strang advised
9
that Mullins “has a confusing case of neuropathy of the hands.”
J.A. 528. He also noted that there was an additional dispute
between two neurologists, Dr. Williams and Dr. Dew, as to the
cause of her pain. Dr. Strang concluded that “[a]t any rate, it
would appear that [Mullins] does have significant pain in her
hands, and it would appear that she is still unable to do her
work.” J.A. 528.
On June 13, 2000, Dr. Erdogan Atasoy, a specialist in hand
surgery, evaluated Mullins. Dr. Atasoy diagnosed Mullins with
“thoracic outlet compression and associating myofascitis.” J.A.
581. Dr. Atasoy stated that Mullins could perform “[l]ight work
lifting 20 lbs maximum with frequent lifting or carrying
restricted to 10 lbs or less.” J.A. 582-83. She was to avoid
work requiring “constant repetitive/static use of both hands –
pushing/pulling, pinching/gripping, flexion/extension of
wrist/elbow, pronation/supination (palm down/palm up),” the “use
of vibratory tools,” overhead work, climbing poles or ladders,
and unprotected heights. J.A. 583. He suggested a “[s]lower
pace work” and limited her to a “[w]ork day not to exceed more
that 6 hours per day/5 days per week.” J.A. 583.
In light of the continuing conflict between Mullins’
physicians, CGLIC next referred Mullins for a functional
capacity examination (“FCE”). The evaluation took place for
several hours over 2 days, and identified a number of physical
10
strengths and limitations. Because Mullins was unable to lift
10 pounds occasionally and right-hand carry, the FCE indicated
that Mullins capabilities could not be classified as “sedentary”
under the Dictionary of Occupational Titles. However, the FCE
recommendation was that Mullins should be able to return to a
job within the specific capabilities and restrictions set forth
in the activity report of the FCE. No additional physical
rehabilitation was recommended.
CGLIC forwarded the results of the FCE to Drs. Ratliffe,
Strang, Williams, and Atasoy for their review and comment. Dr.
Ratliffe did not respond. Dr. Strang stated that Mullins was
still unable to work. Dr. Williams and Dr. Atasoy, however,
both agreed that Mullins was capable of performing full-time
sedentary work in accordance with the limitations listed in the
FCE.
In October 2000, CGLIC referred Mullins’ file for a
Transferable Skills Analysis (“TSA”) to determine whether there
were jobs that Mullins could perform within the limitations
identified in the FCE. The TSA revealed three jobs that Mullins
could perform based upon her skills, education, and abilities,
and which met the salary restrictions for resolution of her
claim. Specifically, Mullins was able to work as a space
scheduler, insurance clerk, or call-out operator. In November
2000, CGLIC also referred Mullins’ file for a Labor Market Study
11
(“LMS”), in order to determine whether there were employers
within Mullins’ geographical area that would actually
accommodate her limitations and meet the wage replacement
requirements of the Plan. The LMS identified six employers with
existing job openings that would accommodate Mullins’
limitations.
On November 27, 2000, CGLIC sent Mullins a letter upholding
the initial denial of LTD benefits, based upon its determination
that Mullins was able to perform sedentary work within her
limitations and, therefore, that she was not “incapable of
performing the requirements of any job for any employer” under
the terms of the Plan. J.A. 365. Mullins again requested
reconsideration of the decision. On January 9, 2003, after
review by an appeals team, CGLIC issued its final denial of
Mullins’ claim for LTD benefits.
II.
Mullins brought this lawsuit in district court under 29
U.S.C. § 1132(a)(1)(B), claiming that the defendants improperly
denied her benefits under the LTD Plan. Mullins later amended
her complaint to seek statutory penalties under 29 U.S.C. §
1132(c)(1)(B) for AT&T’s failure to produce to her a copy of the
SPD upon her request for the LTD Plan documents. On cross-
motions for summary judgment, the district court granted summary
12
judgment for the defendants on Mullins’ claim for LTD benefits.
However, the district court granted summary judgment to Mullins
on her claim for statutory penalties and ordered AT&T to pay
Mullins penalties totaling $18,400. Mullins appealed the
district court’s decision on her claim for LTD benefits and AT&T
appealed the district court’s imposition of the penalty.
This is the third appeal from the district court’s grant of
summary judgment to the defendants on Mullins’ claim for LTD
benefits. Mullins argued below that CGLIC had abused its
discretion by denying her claim in part because CGLIC had
violated its internal procedures during its consideration of her
claim. However, until recently, Mullins’ attempts to obtain the
production of the claims manuals, protocols, and other internal
guidelines relating to the processing of LTD claims and appeals
from claims denials had been unsuccessful. Without addressing
the merits of the issues, we twice remanded this matter to the
district court with instructions that it ascertain the existence
of any such claims-processing documents and produce the relevant
documents to Mullins. See Mullins v. AT&T Corp., 290 Fed. Appx.
642 (4th Cir. 2008) (unpublished). After the relevant documents
were produced to Mullins, the district court again granted
summary judgment to the defendants. The district court found
that CGLIC had substantially complied with its claims-processing
documents and that Mullins had failed to prove that CGLIC abused
13
its discretion in considering and denying her claim under the
LTD Plan. Accordingly, the parties’ cross-appeals are now back
before us and ready for disposition.
III.
We begin with Mullins’ appeal of the district court’s
decision awarding summary judgment to the defendants on her
claim for LTD benefits.
A.
We review the district court’s grant of summary judgment de
novo, applying the same legal standards that the district court
employed. See Evans v. Eaton Corp. Long Term Disability Plan,
514 F.3d 315, 321 (4th Cir. 2008). Where, as here, an ERISA-
covered plan confers discretion on the plan’s administrator to
interpret its provisions and issue a determination, we review
the administrator’s determination under an abuse-of-discretion
standard. See Metropolitan Life Ins. Co. v. Glenn,
554 U.S.
105, 111 (2008);
Evans, 514 F.3d at 321. Under the abuse-of-
discretion standard, we will not set aside the plan
administrator’s decision if it is reasonable, even if we would
have reached a different conclusion independently. See Booth v.
Wal-Mart Stores, Inc. Associates Health & Welfare Plan,
201 F.3d
335, 341 (4th Cir. 2000). The administrator’s decision is
reasonable “if it is the result of a deliberate, principled
14
reasoning process and if it is supported by substantial
evidence.” Bernstein v. CapitalCare, Inc., 70 F.3d 783, 788
(4th Cir. 1995) (internal quotation marks omitted).
In Booth, we set forth eight nonexclusive factors to be
considered by courts in reviewing the plan administrator’s
decision:
(1) the language of the plan; (2) the purposes and
goals of the plan; (3) the adequacy of the materials
considered to make the decision and the degree to
which they support it; (4) whether the fiduciary’s
interpretation was consistent with other provisions in
the plan and with earlier interpretations of the plan;
(5) whether the decisionmaking process was reasoned
and principled; (6) whether the decision was
consistent with the procedural and substantive
requirements of ERISA; (7) any external standard
relevant to the exercise of discretion; and (8) the
fiduciary’s motives and any conflict of interest it
may have.
Booth, 201 F.3d at 342-43; see also Williams v. Metropolitan
Life Ins. Co.,
609 F.3d 622, 630 (4th Cir. 2010). 1
B.
Mullins contends that the district court erred in
concluding that CGLIC’s decisionmaking process was reasoned and
1
In Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105
(2008), the Supreme Court clarified that an administrator’s
conflict of interest does not alter or modify the abuse-of-
discretion standard of review. See
id. at 115-16; see also
Williams v. Metropolitan Life Ins. Co.,
609 F.3d 622, 630-31
(4th Cir. 2010). Instead, the conflict of interest is to be
weighed along with other applicable factors. See
Glenn, 554
U.S. at 117;
Williams, 609 F.3d at 631. In this case, however,
the parties agree that there was no conflict of interest.
15
principled, and erred in concluding that substantial evidence
supported the denial of benefits. We disagree.
When Mullins first sought LTD benefits under the Plan, she
had been seen by two surgeons and a neurologist for the pain and
sensitivity in her hands. The medical opinions of Mullins’ own
treating physicians conflicted, however, both as to her specific
diagnosis as well as to her functional capacity to perform work.
Resolving such conflicts in the opinions of Mullins’ treating
physicians was CGLIC’s responsibility and well within the
discretion conferred to it under the terms of the LTD Plan. See
Booth, 201 F.3d at 345; Brogan v. Holland,
105 F.3d 158, 162-63
(4th Cir. 1997). In determining that Mullins had failed to
prove, as was her burden, that she was “incapable of performing
the requirements of any job for any employer,” J.A. 365, CGLIC
reasonably considered and relied upon the opinions of Dr.
Williams and Dr. Atasoy, as well as the results of the FCE,
which indicated that she was capable of performing sedentary
work within her limitations. CGLIC also took the additional
step of obtaining both the TSA and LMS, and determined that
there were actual jobs available in the market which Mullins
could perform within her limitations and which exceeded the
minimum wage requirement necessary for a finding against
disability under the definition in the LTD Plan. Thus, CGLIC’s
16
determination was clearly supported by substantial evidence in
the administrative record.
Mullins acknowledges that the medical evidence was
conflicting on the issue of her disability. However, she argues
that we should find that CGLIC abused its discretion because it
did not strictly adhere to its internal claims processing
procedures when considering her claim and, consequently, denied
her claim based upon evidence that it should have neither
solicited nor relied upon. Most notably, Mullins contends that
CGLIC was limited under its claims processing procedures to
considering the opinion of Mullins’ “attending physician,” and
asserts that while Drs. Ratliff, Strang, and Schroering might be
considered “attending physicians,” Drs. Williams and Atasoy
should not have been.
Although the term ”attending physician” is used in CGLIC’s
claims-processing materials, it is not defined therein and
common medical definitions of that term vary depending upon the
context in which it is used. For example, the meaning of
“attending physician” in a hospital setting might be quite
different from the meaning of that term in a non-hospital
setting. The district court rejected Mullins’ narrow definition
of the term “attending physician” and found that its use was not
intended to distinguish a claimant’s primary physician from all
other treating physicians, but rather to delineate physicians
17
who have actually seen and treated the claimant from those who
have not. 2 At the time that Mullins filed her claim for LTD
benefits, she had been seen on three occasions by Dr. Strang,
the orthopedic surgeon who assumed her care after Dr. Schroering
left his practice, and on one or two occasions by Dr. Williams,
the neurologist who had seen her previously and to whom she was
referred for additional evaluation and treatment by Dr. Strang.
Under these circumstances, we agree with the district court’s
determination that the term “attending physician” did not
exclude CGLIC’s initial consideration of Dr. Williams’ opinion
or its later consideration of the second surgical opinion
solicited from Dr. Atasoy. Furthermore, even if we were to
consider the term “attending physician” to be limited to a
single physician in other settings or circumstances, we cannot
say that CGLIC abused its discretion or otherwise acted
unreasonably in considering Drs. Williams and Atasoy to be an
attending or treating physicians here, or in requesting and
considering their medical records and opinions on the issue of
Mullins’ functional capacities and ability to work.
2
We also note that the LTD Agreement between CGLIC and AT&T
similarly defines an “Attending Physician” as “a duly licensed
physician, psychiatrist, or psychologist treating the Claimant
or Covered Person.” J.A. 70.
18
Building upon this “attending physician” argument, Mullins
also claims that CGLIC abused its discretion by failing to
strictly follow certain preferred procedures set forth in its
claims-processing documents for resolving conflicting medical
information. The district court found that although CGLIC had
an obligation to some degree to process Mullins’ claim in
accordance with these procedures, and that such compliance is
always a consideration on the question of reasonableness of a
decision, strict compliance is not a prerequisite to a finding
that the plan administrator’s overall decision was principled
and reasonable.
We agree. It is well settled that the decisionmaking
process by a claims administrator, including external standards
relevant to the exercise of the administrator’s discretion, is a
factor to be considered in the overall determination of whether
the administrator abused its discretion in denying LTD benefits.
See Booth, 201 F.3d at 342-43. However, it is but one factor to
weigh alongside the other factors and the administrative record.
Cf.
Glenn, 554 U.S. at 117;
Williams, 609 F.3d at 631. Indeed,
as noted by the district court, a contrary ruling would rob the
plan administrator of the discretion granted in the same
documents. Having reviewed the administrative record and the
claims processing documents, we agree with the district court’s
determination that CGLIC substantially complied with its
19
procedures and, to the extent it varied therefrom, did not abuse
its discretion in doing so.
As noted above, CGLIC was presented from the outset with
conflicting medical opinions among Mullins’ treating physicians
regarding both her diagnosis and her ability to work. Indeed,
the most direct conflict was between the surgeon who had
recently assumed her care and the neurologist to whom he
referred her for further evaluation and treatment. CGLIC
considered the conflicting opinions of Mullins’ treating
physicians, solicited the opinion of a physician consultant, and
obtained an FCE to independently evaluate her physical strengths
and limitations for employment. 3 CGLIC then made a reasonable,
principled determination that Mullins, who was in her mid-30s
with some college education at the time, had failed to prove
that she was “incapable of performing the requirements of any
job for any employer” for which she was or could become
reasonably qualified. J.A. 365.
3
As correctly noted by the district court, Mullins’
challenge to CGLIC’s FCE referral under its internal procedures
also fails to demonstrate an abuse of discretion. The procedure
relied upon by Mullins does not, by its terms, apply to the FCE
obtained.
20
IV.
We turn now to AT&T’s cross-appeal of the district court’s
decision to impose a statutory penalty upon AT&T under 29 U.S.C.
§ 1132(c)(1). We review the district court’s decision for an
abuse of discretion. See Davis v. Featherstone, 97 F.3d 734,
735-36 (4th Cir. 1996).
In February 2001, Mullins’ former counsel requested copies
of the “AT&T [LTD] policy . . . and a copy of all other plan
documents concerning that [LTD] policy.” J.A. 63. Two months
later, AT&T produced copies of the LTD plan and AT&T/CGLIC
Agreement, but did not include a copy of the SPD. In March
2003, after litigation was initiated by Mullins’ new counsel,
AT&T produced a copy of the SPD to Mullins.
Under 29 U.S.C. § 1132(c)(1), the district court may, in
its discretion, impose penalties of up to $100 per day against
plan administrators who fail to furnish certain documents
requested by plan participants under ERISA. See Faircloth v.
Lundy Packing Co., 91 F.3d 648, 659 (4th Cir. 1996). “Two
factors generally guide [the] district court’s discretion:
prejudice to the plaintiff and the nature of the administrator’s
conduct in responding to the participant’s request for plan
documents.”
Davis, 97 F.3d at 738; see also
Faircloth, 91 F.3d
at 659 (noting that the court may consider prejudice and bad
faith in exercising its discretion).
21
The district court found that Mullins’ written request for
“a copy of all other plan documents concerning [the LTD]
policy,” was sufficient to notify AT&T that the response should
include the SPD. With regard to prejudice, the district court
noted that while the SPD did contain some additional information
not otherwise provided in the documents produced, Mullins was
not ultimately prejudiced by the delay in obtaining the
information. With regard to the conduct of AT&T, the district
court found that AT&T did not act in bad faith, but nevertheless
had failed to produce complete information in violation of the
statute. Under the circumstances, the district court concluded
that the maximum penalty of $100 per day was unwarranted but
that a penalty of $25 per day would be appropriate.
We cannot say that this was an abuse of the district
court’s discretion. “Although prejudice is a pertinent factor
for the district court to consider, it is not a prerequisite to
imposing a penalty.” Davis, 97 F.3d at 738. It is also not
necessary that the plan administrator’s conduct rise to the
level of bad faith.
Id. Rather,
[t]he purpose of the penalty provision is to provide
plan administrators with an incentive to meet requests
for information in a timely fashion. When there is
some doubt about whether a claimant is entitled to the
information requested, the Supreme Court has suggested
that an administrator should err on the side of
caution.
22
Id. (citation omitted); see also
Faircloth, 91 F.3d at 659 (“The
purpose of [§ 1132(c)(1)] is not to compensate participants for
injuries, but to punish noncompliance with ERISA.”).
Accordingly, we affirm the grant of summary judgment to Mullins
on her claim for statutory penalties under § 1132(c)(1).
V.
For the foregoing reasons, we affirm the district court’s
grant of summary judgment to the defendants on Mullins’ claim
for LTD benefits under 29 U.S.C. § 1132(a)(1)(B), and we affirm
the district court’s grant of summary judgment to Mullins on her
claim for penalties under § 29 U.S.C. § 1132(c)(1).
AFFIRMED
23
