MAX O. COGBURN JR., District Judge.
This matter is before the court upon Defendant's Motion for Summary Judgment (#24) and Plaintiff's Cross-Motion for Summary Judgment (#26). After the parties fully briefed the issues, the court heard oral arguments on the motions.
Plaintiff Martin McGhee brought this action to recover short-term disability benefits from Defendants, Aetna Life Insurance Company ("Aetna") and Bank of America Short Term Disability Plan ("STD Plan") (collectively "Defendants"). As a former employee of Bank America ("BOA"), Plaintiff was enrolled in the STD Plan, which is funded by BOA and administered by Aetna, pursuant to the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. (1982). Plaintiff submitted a claim for STD benefits in October 2011, which was denied initially and again upon review. Plaintiff argues that Aetna's assessment of his STD claim was not supported by substantial evidence and that Defendants abused their discretion in denying his claim. Defendants contend that Plaintiff has no right to bring this action, arguing that Plaintiff waived and released his claims against Defendants upon execution of a General Release & Program Agreement in exchange for a severance package with BOA upon leaving the company. Alternatively, Defendants argue that their decision to deny Plaintiff's claim for STD benefits should not be disturbed because substantial evidence in the record supports the decision. For the reasons that follow, the court finds that Plaintiff is entitled to seek relief in this court despite the agreement he signed with BOA in exchange for his severance package. However, the court also finds that Defendants did not abuse their discretion in denying Plaintiff STD Benefits. Accordingly, the court will grant Defendants' Motion for Summary Judgment and deny Plaintiff's Motion for Summary Judgment.
Plaintiff worked for BOA from June 2004 to October 2011, holding several high-level positions throughout his tenure with the company. As a BOA employee, Plaintiff was eligible to participate in, and did participate in, the STD Plan established by BOA. His final position with BOA was as a Senior Vice President and a Senior Change Analyst. In this position, Plaintiff
Plaintiff's last full day of work at BOA was on October 4, 2011. On October 18, 2011, Plaintiff requested short-term disability leave starting on October 4, 2011, claiming he was disabled due to severe anxiety, depression, and post-traumatic stress disorder. Plaintiff informed Aetna that he was currently being treated by his physician, Dr. Holly Layman. Aetna faxed a behavioral health clinician statement form (BHCS) to Dr. Layman, who returned the form to Aetna on November 3, 2011. Dr. Layman diagnosed Plaintiff with anxiety, depression, and chest pains, and stated in her cover note that Plaintiff "is unable to perform his daily functions at work until proper psychiatric counseling has begun." Administrative Record ("Admin. R.") at 7000121. Dr. Layman did not include any behavioral observations, but noted that Plaintiff was "normal but stressed." Id. at 7000123. On November 7, 2011, Aetna denied Plaintiff's entitlement to STD benefits, stating that Plaintiff had not provided sufficient evidence showing that he was unable to complete the duties of his job. Aetna explained in a letter to Plaintiff:
Letter from Aetna to Martin McGhee (Nov. 7, 2011), Admin. R. at 7000076. Plaintiff appealed Aetna's decision by a letter dated April 19, 2012. Plaintiff claimed that a number of personal situations contributed to his anxious and depressed condition, including a breakup with his girlfriend of 2½ years, his mother's illness, sleep deprivation, and the death of his grandfather. Throughout the spring, Plaintiff submitted additional records from Dr. Layman, as well as from Dr. Jonathan Stoudmire, a psychiatrist, and Jennifer Overton, a licensed clinical social worker. On May 31, 2012, Aetna acknowledged Plaintiff's appeal and placed it on hold until June 28, 2012 to allow Plaintiff to continue to submit additional information from his medical providers. Aetna then extended its review until August 1, 2012 pending a peer review, which was ultimately performed by Dr. Lawrence Burstein, Ph.D. on July 13, 2012. Dr. Burstein, stating that he had reviewed the full record of medical treatment that Plaintiff supplied, found the record did not support impairment from a psychological standpoint. He noted that while the record substantiated Plaintiff's subjective complaints of anxiety and depression, "they did not contain any findings to corroborate Plaintiff's complaints." Id. at 7000095.
On August 1, 2012, Aetna provided Dr. Layman and Dr. Stoudmire with a copy of
The STD plan under which Plaintiff asserts benefits allows BOA employees time off from work as well as financial benefits that replace a portion of the employee's income for up to 26 weeks from the date of disability. The Plan states that "[f]or purposes of determining eligibility for STD benefits, disabled is defined as your inability to perform your essential occupation functions, including working your regularly scheduled hours, for more than seven consecutive calendar days because of a pregnancy, illness, injury, non-elective surgery or hospitalization." Def. Mem. S. J., Exhibit A, 2. To be eligible for benefits, Plaintiff must provide evidence of his inability to perform his occupational duties:
Appropriate care and treatment must meet the following conditions:
Id. The Plan also states that STD benefits will be paid only if there is satisfactory objective medical evidence of disability:
Id.
On October 1, 2013, Plaintiff signed a General Release & Program Agreement (the "Agreement") with BOA in exchange for a severance package. The Agreement provides several provisions relating to Plaintiff's ability to bring lawsuits, either pending or in the future, against BOA and several related parties. Section 3(a) of the Agreement, titled, "General Release of Claims/Covenant Not to Sue," states:
Def. Mem. S. J., Exhibit C, 1. The agreement also requires the signer to represent that he has not brought any legal action against BOA or certain affiliated parties and to acknowledge that the signer's rights to benefits under the Agreement are limited. Section 5 of the Agreement, entitled "Absence of Certain Claims," provides as follows:
Id. at Sections 5(a), (b). Finally, the Agreement specifically references ERISA claims:
Id. at Section 14(a) (emphasis added).
A motion for summary judgment "shall be rendered ... if the pleadings,
ERISA allows plan participants or beneficiaries who are denied benefits under an employee benefit plan to challenge the plan administrator's denial in federal court. Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). Unlike claims made on over-the-counter insurance plans that a consumer may acquire in the marketplace,
Id. at 115, 128 S.Ct. 2343 (citations omitted). In the Fourth Circuit, a district court reviewing the final decision of a plan administrator
Champion v. Black & Decker (U.S.), Inc., 550 F.3d 353, 358 (4th Cir.2008) (citations omitted).
Here, the BOA STD Plan gives Aetna (the STD Plan administrator) discretion in deciding questions of eligibility for benefits; thus, this court reviews such determinations for an abuse of discretion. See Williams v. Metropolitan Life Ins. Co., 609 F.3d 622, 629-30 (4th Cir.2010). Under an abuse of discretion standard, the court may not "substitute [its] own judgment
Finally, this court's review is limited to the record that was before the plan administrator at the time of final determination. Sheppard & Enoch Pratt Hosp., Inc. v. Travelers Ins. Co., 32 F.3d 120, 125 (4th Cir.1994) ("[A]n assessment of the reasonableness of the administrator's decision must be based on the facts known to it at the time.").
With such framework in place, the court has carefully considered the cross motions for summary judgment. Where cross motions for summary judgment are filed, such motions are
Wright & Miller, 10A Fed. Prac. & Proc. Civ.3d § 2720. In reviewing the arguments of the parties, the court has treated the motions and the citations of evidence in the administrative record in the manner it would a bench trial by first considering the evidence contained in the administrative record which Plaintiff has cited in his favor and then considering the record evidence by Defendant. See Stewart v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, 2012 WL 122362 (D.Md.2012). For the reasons that follow, the court upholds the final decision of Defendants.
Plaintiff filed suit against Defendants approximately two weeks before executing the Agreement with BOA in exchange for his severance package. At the time he executed the Agreement, Plaintiff did not notify BOA of his claims against Defendants nor did he attempt to carve out this claim from the General Release provision, but instead represented that he had no pending claims against the "Released Parties." Defendants argue that they are Released Parties and therefore, Plaintiff waived and released his claims against them by signing the Agreement. Plaintiffs read the Agreement differently,
More persuasively, Plaintiff argues that regardless of whether Defendants were intended to be "Released Parties" under the "General Release" section of the Agreement, he preserved his rights to pursue STD benefits in light of the clear and unambiguous language of Section 14(a) of the Agreement. As noted above, Section 14(a) provides, "Nothing in this Agreement shall impair, diminish or interfere with any rights, privileges or benefits I have with respect to ERISA plans, equity award agreements or similar governing documents." Defendants argue that this language is intended to comply with the anti-alienation provision of ERISA, 29 U.S.C.A. § 1056, which provides, "[e]ach pension plan shall provide that benefits provided under the plan may not be assigned or alienated." 29 U.S.C.A. § 1056(d)(1). The court finds Defendants' argument futile. Section 14(a) stands on its own in the Agreement under "Miscellaneous Provisions" within the subsection "Other Benefit Plans." It makes no reference whatsoever to the anti-alienation provision of ERISA. In fact, it specifically references eligibility for benefits under "plans governed by [ERISA]," like the STD Plan at issue here. The court finds that while BOA may have very well intended to release Defendants through the language of Section 3(a), the language of 14(a) clearly and unambiguously establishes that Plaintiff, as the signatory to the Agreement, maintained his "rights, privileges [and] benefits ... with respect to ERISA plans." One such right of Plaintiff is to bring a civil action, as he has done here, under Section 502(a) of ERISA to "recover benefits due to him under the terms of his plan [or] to enforce his rights under the terms of the plan." 29 U.S.C. § 1132. In light of the conflicting terms of the Agreement, one of which purports to waive all claims that Plaintiff might have against BOA and its affiliates (which quite possibly was intended to include Defendants), and another that expressly reserves his right to seek ERISA benefits (from Defendants), the court cannot find that by signing the Agreement, plaintiff waived and released his claims against these particular Defendants in this particular case. The plain language of the Agreement does not bar Plaintiff's claim in this court challenging Defendant's denial of his claim for STD benefits. The court will therefore review the decision itself for an abuse of discretion.
In considering whether Defendants' decision to deny Plaintiff's claims was reasonable, the court first finds that Aetna's decision resulted from a deliberate, principled reasoning process. In processing Plaintiff's claim initially, Aetna reviewed the sole piece of medical evidence that Plaintiff provided — the BHCS form from Dr. Layman. In its initial denial letter, Aetna explained that Plaintiff had a right to appeal the denial of benefits, and very clearly stated the type of medical evidence it needed in order to find that Plaintiff was entitled to STD benefits due to an inability to perform his job:
Plaintiff argues that Aetna's decision-making process was not reasoned and principled because it proffered two different reasons for denying Plaintiff's claim initially and upon review, which he argues, violates the "fair and full review" guarantees of ERISA claims under 29 U.S.C. § 1133. This argument is without merit because Plaintiff misconstrues the facts.
Letter from Aetna to Martin McGhee (Aug. 24, 2012), Admin. R. at 70000784. Thus, Defendants denied Plaintiff's claim on appeal for the same reason it denied his claim initially — a lack of objective medical evidence in the record of Plaintiff's disability.
In addition to stating that it denied Plaintiff's claim based on lack of objective medical evidence, Aetna cited the provision of the plan stating that a claimant "must be receiving appropriate care and treatment on a continuing basis from an eligible treating health care provider while on STD." Id. Neither party disputes the fact that Plaintiff did receive medical treatment in November and December 2011. By not obtaining treatment during this time, Plaintiff failed to comply with the terms of the STD Plan.
In considering the second prong of whether Defendants' decision to deny Plaintiff's claims was reasonable, the court finds that Aetna's decision is supported by substantial evidence. After a careful review of the record, the court agrees with Defendants that the medical records, peer review, and Aetna's correspondence with Plaintiff's treating physicians indicate that while Plaintiff had many subjective complaints at the time he made the claim for STD benefits, he provided no objective medical evidence of disability to support the conclusion that he was unable to perform the essential functions of his occupation. For example, Dr. Layman's records simply reiterated Plaintiff's subjective complaints of stress and anxiety — she made no reference to Plaintiff's ability to concentrate, communicate, or organize his thoughts. See Admin. R. at 7000122-124. Instead, based on her observations, she concluded that Plaintiff was able to follow commands and that his reasoning and judgment were within normal limits. Id. Similarly, Dr. Stoudmire opined that Plaintiff was unable to work, but failed to provide any information explaining his conclusion. Admin. R. at 7000128.
Plaintiff argues that Aetna's decision was unreasonable in light of his physicians' statements regarding his anxiety and depression, but Plaintiff fails to articulate
In considering the factors of reasonableness as articulated in Williams, the court finds that the STD Plan language was clear, its terms were well-established, and that Plaintiff had no apparent difficulty understanding the plan. Moreover, the court finds that Aetna's potential conflict of interest by serving as both the fiduciary and the plan administrator did not prejudice the outcome of Plaintiff's STD claim. Here, Aetna gave Plaintiff guidance on the type of information it needed in order to find that Plaintiff qualified for STD benefits under the plan. Upon reviewing the medical information that Plaintiff submitted, Aetna, in its discretion, found that Plaintiff had not submitted sufficient evidence showing that his condition qualified him for benefits. A review of the record affirms Aetna's conclusion.
Because the court finds that Defendants' decision to deny Plaintiff STD benefits was reasonable in that it resulted from a deliberate, principled reasoning process and was supported by substantial evidence, it will uphold Aetna's decision denying Plaintiff the requested benefits. See Williams v. Metropolitan Life Ins. Co., 609 F.3d 622, 629-30 (4th Cir.2010).
