United States District Court, E.D. Virginia, Alexandria Division
ROGER D. SHEPARD, Plaintiff,
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, Defendant.
M. HILTON UNITED STATES DISTRICT JUDGE
MATTER comes before the Court on both Plaintiff and
Defendants' Motions for Summary Judgment.
was a former employee of The Turner Corporation where he
worked as a Senior Construction Superintendent. On November
22, 2011, while still employed with Turner, Plaintiff was
injured in a motor accident. Following the accident, an
emergency physician tightly placed a neck brace on him
resulting in additional injury.
returned to work after the accident but by early 2013 his
condition had deteriorated. In August 2013, Plaintiff filed
for short term disability benefits under Liberty Life
Assurance's Group Disability Income Policy. As part of
the records Plaintiff submitted to Liberty for his claim, he
included a report from one of his treating doctors, Dr.
Crouse, recommending that Plaintiff pursue long term
disability. Dr. Crouse reported that Plaintiff suffered from
a variety of cognitive disorders due to brain injury.
granted Plaintiff short term disability benefits but
requested additional records from one of Plaintiff s doctors,
in addition to having its own doctors review Plaintiff's
reports. On November 27, 2013, Liberty temporarily granted
Plaintiff long term disability while continuing its
investigation. Liberty's reviewers found that there was
insufficient evidence to support a diagnosis of cognitive
disorder due to brain injury. They concluded that
Plaintiff's condition was attributed to a mental disorder
and fell under the 24-month mental nervous limitation of the
April 2014, Liberty sent Plaintiff a letter stating that
Plaintiff's long term benefits would be approved but were
subject to certain limitations, namely, the limitation due to
a mental disorder with non-verifiable symptoms. During this
time Plaintiff also applied for and was approved for social
September 2015, Liberty decided to close Plaintiff's
claim and notified Plaintiff that his 24-month benefit period
under the mental nervous limitation would conclude in
November 2015. In May 2016, Liberty ended Plaintiff's
waiver of premium under his life insurance policy.
the expiration of benefits, Plaintiff appealed the decision
to end the benefits and premium waiver which Liberty
Federal Rule of Civil Procedure 56, a court should grant
summary judgment if the pleadings and evidence show that
there is no genuine dispute as to any material fact and that
the moving party is entitled to judgment as a matter of law.
Fed.R.Civ.P. 56(c); see Celotex Corp. v. Catrett,
477 U.S. 317, 322 (1986). In reviewing a motion for summary
judgment, the court views the facts in the light most
favorable to the non-moving party. See Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). Once a
motion for summary judgment is properly made, the opposing
party has the burden to show that a genuine dispute of
material fact exists. See Matsushita Elec. Indus. Co. v.
Zenith Radio Corp., 475 U.S. 574, 586-87 (1986).
denial of benefits challenged under [ERISA] is to be reviewed
under a de novo standard unless the benefit plan
gives the administrator or fiduciary discretionary authority
to determine eligibility for benefits or to construe the
terms of the plan." Firestone Tire & Rubber Co.
v. Bruch, 489 U.S. 101, 115 (1989) . When the plan
confers discretionary authority, the district court applies a
deferential or abuse of discretion review. Metropolitan
Life Ins. Co. v. Glenn, 128 S.Ct. 2343, 2348 (2008) .
the policy establishes Liberty's "authority, in its
sole discretion, to construe the terms of this policy and to
determine benefit eligibility" under it. See,
e.g., Thomas v. Liberty Life Ass. Co. of
Boston, 226 F.Supp.2d 735, 742 (D. Md. 2002) (finding
such language conferred discretion). Thus, an abuse of
discretion standard applies. Under the abuse of discretion
standard, a court will not disturb a plan administrator's
decision if the decision is reasonable, even if the court
would have come to a contrary conclusion independently.
Williams v. Metropolitan Life Ins. Co., 609 F.3d
622, 630 (4th Cir. 2010} . "To be held
reasonable, the administrator's decision must result from
a deliberate, principled reasoning process and be supported
by substantial evidence." Williams, 609 F.3d at
630. Substantial evidence is "evidence that a reasoning
mind would accept as sufficient to support a particular
conclusion." Laws v. Celebrezze, 368 F.2d 640,
642 (4th Cir. 1966) .
Fourth Circuit has identified eight nonexclusive factors that
a court may consider to determine abuse of discretion by a
(1) the language of the plan; (2) the purposes and goals of
the plan; (3) the adeguacy 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 decision making
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.
Williams, 609 F.3d at 630 (quoting Booth v.
Wal-Mart Stores, Inc. Assocs. Health & Welfare Plan,
201 F.3d 335, 342-43 (4th Cir. 2000)).
taking into consideration the Booth factors, to the
extent they are relevant, the Court finds no evidence that
Liberty abused its discretion. Liberty's process was
reasoned and principled, it had adequate materials that
supported its decision, and the ...