Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-05-02173/USCOURTS-ca8-05-02173-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 

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The Honorable J. Leon Holmes, Chief Judge, United States District Court for

the Eastern District of Arkansas.

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 05-2173

___________

Charlie Groves, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the 

* Eastern District of Arkansas.

Metropolitan Life Insurance Company, *

*

 Appellee. *

___________

Submitted: December 12, 2005

Filed: February 22, 2006

___________

Before LOKEN, Chief Judge, WOLLMAN and RILEY, Circuit Judges.

___________

RILEY, Circuit Judge.

Metropolitan Life Insurance Company (MetLife) terminated the payment of

long-term disability benefits to Charlie Groves (Groves) after determining Groves was

no longer disabled. Groves sought judicial review of MetLife’s decision by filing a

claim under the Employee Retirement Income Security Act (ERISA), 29 U.S.C.

§§ 1001-1461. Groves appeals the district court’s1

 grant of summary judgment in

favor of MetLife. We affirm.

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I. BACKGROUND

Groves worked for Great Lakes Chemical Corporation (Great Lakes) as a truck

driver and was eligible for benefits under a long-term disability plan (Plan) provided

by Great Lakes’s insurer, MetLife. Groves ceased working for Great Lakes on

December 17, 2000, after a tree fell on Groves while he was removing fallen branches

from his driveway. On March 1, 2001, Groves filed a claim with MetLife for longterm disability benefits. On May 2, 2001, MetLife approved the payment of long-term

disability benefits. 

Approximately two years later, on June 23, 2003, MetLife terminated Groves’s

long-term disability benefits. MetLife determined Groves was no longer disabled and

could return to a “sedentary to light work level position.” 

After exhausting his administrative remedies, Groves filed a claim under

ERISA, seeking judicial review of MetLife’s decision to terminate payment of longterm disability benefits. Both parties moved for summary judgment. The district

court granted summary judgment in favor of MetLife, concluding MetLife did not

abuse its discretion, as substantial evidence supported MetLife’s decision to terminate

benefits. Groves appeals, arguing (1) the district court erred in applying the abuse of

discretion standard, and (2) MetLife abused its discretion in terminating the payment

of long-term disability benefits to Groves.

II. DISCUSSION

A. Standard of Review for Plan Administrator’s Decision

We review de novo a challenge to the denial of ERISA benefits, “unless the

benefit plan grants the plan administrator discretionary authority to determine

eligibility for benefits or to construe the terms of the plan.” Ortlieb v. United

HealthCare Choice Plans, 387 F.3d 778, 781 (8th Cir. 2004) (citing Firestone Tire &

Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). If the benefit plan gives discretion

to the plan administrator, then we review the plan administrator’s decision for an

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Groves objects to any reference to the Plan booklet because MetLife failed to

place the actual Plan document or the controlling insurance policy in the record.

Groves does not challenge the Plan booklet as an inaccurate statement of the Plan

terms. Plan documents explaining an ERISA plan for employees are generally

acceptable evidence of the plan terms. See, e.g., Jensen v. SIPCO, Inc., 38 F.3d 945,

949 (8th Cir. 1994) (“[Summary Plan Descriptions] are considered part of the ERISA

plan documents.”). The district court did not abuse its discretion in using the Plan

booklet to evaluate the Plan terms.

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abuse of discretion. Id. We reverse the plan administrator’s decision “only if it is

arbitrary and capricious.” Hebert v. SBC Pension Benefit Plan, 354 F.3d 796, 799

(8th Cir. 2004). We review de novo the district court’s determination of the

appropriate standard of review of a benefit plan decision under ERISA. Ortlieb, 387

F.3d at 781. 

Groves contends the district court erred in failing to apply a de novo standard

of review because the Plan did not properly delegate discretionary authority to

MetLife. We disagree. 

The Plan booklet2

 distributed to Great Lakes employees, which summarized the

Plan for employees, states:

In the event that you properly submit a claim to be paid by the Plan and

the Plan denies the claim, you can appeal the denial through the appeal

process outlined above. However, if the appeal is made through the

internal appeals process, or to a court of law, you, by virtue of your

participation in the Plan, agree that the standard for review of the denial

of the claim will be whether the denial was made in an arbitrary and

capricious manner. Furthermore, the Plan Sponsor has discretionary

authority to determine eligibility for benefits and interpret uncertain

terms, unaddressed items, and other Plan [provisions].

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The Plan booklet also states Great Lakes appointed an administrator “to process and

pay claims for these benefits in accordance with the terms of the Plan.” 

We conclude the Plan provides discretionary authority to MetLife as plan

administrator. According to the Plan booklet, the “Plan Sponsor,” Great Lakes, had

discretionary authority to determine benefits eligibility, and Great Lakes granted its

discretionary authority to the plan administrator, MetLife, to act as its delegate.

Accordingly, the district court properly applied an abuse of discretion standard of

review in analyzing MetLife’s decision to terminate Groves’s long-term disability

benefits. 

B. MetLife’s Decision to Terminate Benefits

Having determined the district court applied the correct standard of review, we

next address whether MetLife abused its discretion in terminating Groves’s long-term

disability benefits. We review de novo the district court’s grant of summary

judgment, using the same standards as the district court. Ortlieb, 387 F.3d at 781. 

In applying an abuse of discretion standard, “we must affirm if a reasonable

person could have reached a similar decision, given the evidence before him, not that

a reasonable person would have reached that decision.” Ferrari v. Teachers Ins. &

Annuity Ass’n, 278 F.3d 801, 807 (8th Cir. 2002) (quotation omitted). A reasonable

decision is fact based and supported by substantial evidence. Norris v. Citibank, N.A.

Disability Plan (501), 308 F.3d 880, 883-84 (8th Cir. 2002). We may consider both

the quantity and quality of evidence before a plan administrator. Id. at 884. And we

should be hesitant to interfere with the administration of an ERISA plan. Id. at 883.

Under the deferential standard of review applicable in this case, we conclude

substantial evidence supported MetLife’s decision to terminate Groves’s long-term

disability benefits. MetLife reviewed Groves’s extensive medical records and then

sent them to Dr. Kevin Smith (Dr. Smith), an independent physician consultant.

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Dr. Smith reported Groves’s conditions prevented him from working as a truck driver,

but Groves retained “functional abilities within a sedentary to light work capacity

level.” MetLife then asked Dr. Larry D. Ezell (Dr. Ezell), Groves’s treating physician,

to comment on Dr. Smith’s report. Dr. Ezell opined:

[Groves] may be able to perform at the sedentary level. He might be

able to function as a motor vehicle dispatcher, freight-rate clerk, or train

dispatcher. . . . I do not think this patient is employable. I would not

hire this patient personally as an employer for even sedentary positions.

It remains my opinion that he should be considered permanently disabled

and incapable of even the most sedentary occupation.

MetLife was entitled to rely on the reviewing physician’s contrary opinion. See

Black & Decker Disability Plan v. Nord, 538 U.S. 822, 825 (2003) (holding that the

“treating physician rule” does not apply to disability determinations under employee

benefit plans covered by ERISA). It was not unreasonable for MetLife to reject Dr.

Ezell’s opinion in favor of Dr. Smith’s opinion in deciding to terminate Groves’s

long-term disability benefits. Dr. Ezell’s opinion was internally inconsistent, and it

provided no reliable objective evidence, such as testing, or other convincing medical

proof to support a finding of a long-term disability. “‘[I]t is not unreasonable for a

plan administrator to deny benefits based upon a lack of objective evidence.’”

Pralutsky v. Metro. Life Ins. Co., Nos. 04-2409/3239, 2006 WL 130935, at *5 (8th

Cir. Jan. 19, 2006) (quoting McGee v. Reliance Standard Ins. Co., 360 F.3d 921, 924-

25 (8th Cir. 2004)).

III. CONCLUSION

For the foregoing reasons, we affirm the district court’s entry of summary

judgment in favor of MetLife.

_____________________________

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