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August 2010

Gwendolyn Byrd. v. Unum Life Insurance ? Summary Judgment Granted in Favor of Insurer/Claims Administrator Under an Unaltered Abuse of Discretion Standard

Insurer Did Not Abuse Discretion Where the Record Established that Plaintiff's Medical Records Were Reviewed and Thoroughly Considered

(S.D. Tex. August 5, 2010) 2010 U.S. Dist. LEXIS 78974

The United States District Court for the Southern District of Texas (Houston Division) granted insurer Unum Life Insurance of America's motion for summary judgment that under ERISA its decision denying disability benefits was correct as a matter of law.  The district court also denied Plaintiff Gwendolyn Byrd's cross motion for summary judgment that she was entitled to disability benefits.

Byrd worked as an accounting assistant for Accenture.  Her job required frequent computer use and prolonged sitting, in addition to occasional standing, walking and lifting of up to 10 pounds.  In July 2003, Byrd suffered from lumbar radiculopathy, cervical discogenic pain, cervical radiculopathy, cervical spondylosis with C6-6 radiculopathy and tendonitis, epicondylitis, bilateral carpal tunnel and ulnar syndrome.  Byrd applied for disability benefits in July 2004.  Unum approved benefits from September 2003 to July 25, 2008.  Unum thereafter terminated benefits based on medical evidence and opinions that Byrd was physically able to return to work in her own occupation.  Byrd appealed and the decision terminating benefits was upheld.

Unum was the claims administrator and Accenture was the plan administrator.  The district court found no structural conflict of interest where Unum was the claims administrator and Accenture, as the plan administrator, retained financial responsibility to pay benefits due to plan participants. 

Applying an unaltered abuse-of-discretion standard, the district court found no abuse of discretion by Unum.  The record revealed that in January 2008, Unum's on-site physician reviewed Byrd's medical records and questioned some of the restrictions and limitations placed on her.  It was noted that in a 2006 functional capacity evaluation, Byrd indicated that she could perform sedentary/light level work.  It was recommended that Unum obtain an orthopedic independent medical examination of Byrd.  Unum arranged for an independent medical examination in March 2008, but Byrd declined the examination.  In April 2008, Unum again scheduled an independent medical examination with an orthopedic surgeon.  The exam concluded with a finding of no conditions in Byrd's shoulders, elbows, hands or lower extremities that would impair her ability to perform her work responsibilities. 

In May 2008, Unum provided Byrd's treating orthopedic surgeon with a written questionnaire.  In response, no specific physical restrictions or limitations were imposed, although cervical epidural steroid injections were recommended.  In June 2008, Unum had Byrd's medical records reviewed by an on-site orthopedic surgeon.  The reviewer concluded the restrictions and limitations were not supported by medical evidence and that Byrd could return to work on a full time basis in a sedentary occupation, with frequent keyboarding.  In July 2008, Unum had Byrd's medical records reviewed by Unum's in-house orthopedic surgeon.  The doctor concluded that the clinical information was not consistent with the impediment of the cervical or lumbosacral spine severe enough to preclude full time sedentary work, and the recommended epidural steroid injections could be done in conjunction with work and would not usually require more than a day or two out of work.  Around the same time, Unum's in-house vocational rehabilitation consultant reviewed Byrd's occupational and vocational records and concluded that Byrd could work on a full time basis in a sedentary occupation with frequent keyboarding.  Byrd could alternate her position as needed to avoid straining her neck. 

On appeal, Unum had Byrd's medical records reviewed by a third on-site orthopedic surgeon.  The doctor concluded Byrd could perform a full eight-hour day and no further medical intervention was needed.  Unum had a second vocational rehabilitation consultant review Byrd's records.  The consultant found Byrd's occupation was sedentary and could be performed within the restrictions and limitations of occasional lifting of up to 20 pounds, frequent lifting of up to 10 pounds and sitting for six to seven hours in an eight hour day with changing of position as needed.

The district court held Unum considered the opinion of Plaintiff's treating physician, along with the opinion of three doctors who concluded that Byrd could perform her own sedentary occupation.  The medical records relating to Byrd's cervical and lumbar complaints were reviewed and thoroughly considered by three board-certified orthopedic surgeons, in addition to the independent medical examination.  The medical restrictions and limitations were reviewed by two vocational specialists who concluded Byrd was not precluded from performing the responsibilities of her own job. 

The district court also considered the Social Security Administration ("SSA") finding that Byrd was ineligible for benefits.  While receiving benefits from Unum, Byrd applied for Social Security Disability Income benefits.  Her initial claim was denied.  On appeal, the Administrative Law Judge issued a decision that Byrd did not have an impediment that met the criteria of any listing of the relevant social security disability regulations. 

The district court also dismissed Byrd's claim for ERISA breach of fiduciary duty under ERISA section 502(a)(3) because Byrd's claim was for denial of benefits.  ERISA affords relief for benefit claims under section 502(a)(1)(B).  The district court looked to Varity Corp. v. Howe 516 U.S. 489, 512 (1996) in holding that relief under section 502(a)(3) is restricted to "appropriate equitable relief for injuries caused by violations that § 502 does not elsewhere adequately remedy."

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This opinion may be cited as precedent now.  The result in this case could change, however, if a subsequent petition for rehearing or review by the Fifth Circuit Court of Appeals is granted. 

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