FERNANDO J. GAITAN, JR., Chief Judge.
Currently pending before the Court is Defendant Standard Insurance Company's
This case was filed pursuant to the Employees Retirement Income Security Act of 1974 ("ERISA"). Plaintiff, Terry Carlson was an employee of Cargill and had the job title "Plant Operation Manager." Carlson was a participant in an employee welfare benefit plan sponsored by Cargill that paid long-term disability benefits to eligible, qualifying participants who complied with the terms of the plan ("Plan"). Standard Insurance Company ("Standard") insured benefits that became payable under the Plan. On or about March 29, 2011, Carlson submitted and "Employee Claim Submission Form for Cargill Incorporated — LTD" ("Claim Form"). On the Claim Form, Carlson represented that he was disabled because he had peripheral neuropathy that caused pain in both feet.
On October 3, 2011, Standard issued its final administrative denial of Carlson's claim by letter. The LTD Plan provides:
(Doc. No. 18).
On December 29, 2011 Plaintiff brought suit in the Circuit Court of Moniteau County, Missouri (Doc. No. 1). On January 10, 2012, the case was removed to this Court (Doc. No. 1). On April 19, 2012, Defendant filed the present Motion for Summary Judgment (Doc. No. 17).
Summary judgment is appropriate if the movant demonstrates that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law. Celotex Corp. v. Catrett, 477 U.S. 317, 327, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The facts and inferences are viewed in the light most favorable to the nonmoving party. Fed.R.Civ.P. 56(c); Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-590, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The moving party must carry the burden of establishing both the absence of a genuine issue of material fact and that such party is entitled to judgment as a matter of law. Matsushita, 475 U.S. at 586-90, 106 S.Ct. 1348.
Once the moving party has met this burden, the nonmoving party may not rest on the allegations in the pleading but by affidavit or other evidence must set forth facts showing that a genuine issue of material fact exists. Fed.R.Civ.P. 56(e); Lower Brule Sioux Tribe v. South Dakota, 104 F.3d 1017, 1021 (8th Cir.1997). To determine whether the disputed facts are material, courts analyze the evidence in the context of the legal issues involved. Lower Brule, 104 F.3d at 1021. Thus, the mere existence of factual disputes between the parties is insufficient to avoid summary judgment. Id. Rather, "the disputes must be outcome determinative under the prevailing law." Id.
Furthermore, to establish that a factual dispute is genuine and sufficient to warrant trial, the party opposing summary judgment "must do more than simply show that there is some metaphysical doubt as to the facts." Matsushita, 475 U.S. at 586, 106 S.Ct. 1348. Demanding more than a metaphysical doubt respects the appropriate role of the summary judgment procedure: "Summary judgment procedure is
A court reviewing an ERISA plan administrator's decision denying benefits should apply a de novo standard of review unless the plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the plan's terms. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). If a plan gives the administrator discretionary authority, then a court should review a plan administrator's decision only for abuse of discretion. Id. at 115, 109 S.Ct. 948. The parties here do not dispute that the Plan gives the Plan Administrator discretionary authority to interpret or construe the Plan terms.
Under the abuse-of-discretion standard, a court applies a deferential standard of review to an administrator's plan interpretation and fact-based eligibility determinations. See Donaho v. FMC Corporation, 74 F.3d 894, 898 (8th Cir. 1996) (abrogate don other grounds by Black & Decker Disability Plan v. Nord, 538 U.S. 822, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003)). The deferential standard does not allow a reviewing court to reject an administrator's discretionary decision simply because the court disagrees. Id. The proper inquiry is "whether the plan administrator's decision was reasonable; i.e. supported by substantial evidence." Donaho, 74 F.3d at 899. Substantial evidence "means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 924 (8th Cir.2004). A court will affirm an administrator's reasonable interpretation of a plan. Cox v. Mid-America Dairymen, Inc., 13 F.3d 272, 274 (8th Cir.1993); Finley v. Special Agents Mut. Benefit Ass'n, Inc., 957 F.2d 617, 621 (8th Cir. 1992).
A court's decision as to whether a plan administrator abused his or her discretion must be based on facts known to the administrator at the time the benefits claim decision was made. Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997); Collins v. Central States, Southeast and Southwest Areas Health & Welfare Fund, 18 F.3d 556, 560 (8th Cir.1994). When applying the arbitrary and capricious standard of review, the Court only considers evidence that is part of the administrative record. See Barnhart v. UNUM Life Ins. Co. of America, 179 F.3d 583, 590 (8th Cir.1999); Layes v. Mead Corp., 132 F.3d 1246, 1251 (8th Cir.1998). The court cannot substitute its own weighing of the conflicting evidence for that of the plan administrator. Cash, 107 F.3d at 641; Cox v. Mid-America Dairymen, Inc., 965 F.2d 569, 573 (8th Cir.1992).
Defendant moves for Summary Judgment of the present case (Doc. No. 17). First, Defendant states substantial evidence supported Standard's determination that Carlson did not have peripheral neuropathy. On March 15, 2011, Carlson was examined by a neurologist, Dr. Ahmad Hooshmand, to whom his own primary care physician had referred him. Dr. Hooshmand wrote to that primary care physician, "Patient is frustrated by working so many years and he asked me if he is a candidate for disability and my answer was negative." On September 7, 2011, Carlson wrote "He [Dr. Hooshmand] told
Second, Defendant states substantial evidence supported Standard's determination that Carlson's "own occupation" was "Production Superintendent", a light duty occupation. Anne Mileham, M.S. CRC, determined that Carlson's own occupation within the meaning of the Policy was "Production Superintendent." Karol Paquette, M.S. CRC, has 27 years of experience in vocational rehabilitation and counseling. Paquette also concluded that Carlson's "own occupation" within the meaning of the Policy was "Production Superintendent." The occupation of "Production Superintendent" is a light duty occupation according to the United States Department of Labor's Dictionary of Occupational Titles. Ms. Paquette thoroughly investigated Carlson's specific job in order to determine what he did so that she could determine what his occupation was. She reviewed both the Employer's Statement and the Employee's Statement. She considered correspondence from Carlson and his employer in which they described his specific job as well as correspondence from other doctors. She research the DOT, the O*NET and the Occupational Handbook. In her report, Paquette explained in detail her analysis and the rationale for her conclusions. Ms. Mileham reviewed most of the same materials as Paquette. Defendant states that although Plaintiff and his employer did assert that Carlson could no longer perform his specific job at Cargill, this is not the issue. The issue for Standard is not whether Carlson could perform his specific job, but rather if he could perform his occupation as performed in the national economy. Courts consistently recognize this distinction. (Doc. No. 18).
Finally, Defendant states substantial evidence supported Standard's determination that Carlson could work in his own occupation. Neither Dr. Hooshmand, Dr. Malone, nor Dr. Craighead signed any document opining that Carlson was disabled or that any restrictions or limitations applied to him. (Doc. No. 18).
Plaintiff asserts that summary judgment should not be granted (Doc. No. 20). First, Plaintiff states Defendant disregarded favorable evidence from Plaintiff and Plaintiff's physicians, medical tests, and even the Plaintiff's Human Resources Manager that Plaintiff was disabled from performing the duties of his occupation due to severe pain in both lower extremities. As such, Standard's denial was arbitrary and capricious. A statement from Plaintiff's primary personal physician, Dr. Ronald Strong dated July 22, 2011, states that Plaintiff's symptoms "do[ ] indicate a rather significant neuropathy being present." Further, a neurological exam conducted by Dr.
Second, Plaintiff states that after Standard's denial, he received a fully favorable decision from the Social Security Administration granting him total disability to a higher standard of proof of disability than required by the terms of Plaintiff's contract with Defendant, based upon the same facts and medical evidence. This should serve as evidence that Defendant's denial was arbitrary and capricious. (Doc. No. 20).
The Court finds that Standard's denial was not arbitrary and capricious and thus, summary judgment is proper. First, the opinions of each doctor upon which Standard based its denial constitutes substantial evidence. Plaintiff's diagnosis of neuropathy was inconsistent and in some cases, mild. Second, the Defendant properly defined "own occupation" to mean a participant's occupation as it is generally performed in the national economy. Berges v. Standard Ins. Co., 704 F.Supp.2d 1149, 1182 (D.Kan.2010). Defendant was not limited to looking at the way Plaintiff performed her job, specifically. Id. Given the above, a reasonable person could have reached a similar decision with the evidence before him. Green v. Union Sec. Ins. Co., 646 F.3d 1042, 1050 (8th Cir. 2011). Finally, the Court will not consider Plaintiff's Social Security award
Defendant Standard Insurance Company's Motion for Summary Judgment (Doc. No. 17) is hereby