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

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United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

No. 19-7032 September Term, 2019

FILED ON: APRIL 7, 2020

JOSEPHINE KEMATHE,

APPELLANT

v.

RELIANCE INSURANCE COMPANY,

APPELLEE

Appeal from the United States District Court

for the District of Columbia

(No. 1:17-cv-00903)

Before: SRINIVASAN, Chief Judge, and ROGERS and PILLARD, Circuit Judges.

J U D G M E N T

This appeal was considered on the record and on the briefs of the parties. See Fed. R. App. 

P. 34(a)(2); D.C. Cir. R. 34(j). The Court has accorded the issues full consideration and determined 

that they do not warrant a published opinion. See D.C. Cir. R. 36(d). For the reasons stated below, 

it is 

ORDERED and ADJUDGED that the judgment of the United States District Court for 

the District of Columbia be AFFIRMED.

Josephine Kemathe brought this action against Reliance Standard Insurance Company

(Reliance), the claims administrator of a long-term disability plan established by her former 

employer MedStar Health. Beginning in 2014, Kemathe’s asthma rendered her unable to continue 

working as a respiratory care practitioner at MedStar. Under the terms of MedStar’s disability 

plan, its employees qualify as disabled for the first two years of not working if they cannot perform 

the duties of their previous position. Kemathe met that standard, and Reliance thus paid her

monthly benefits until 2016.

After the first two years of not working, the plan’s definition of disabled narrows. At that 

point, an employee is considered disabled only if she “cannot perform the material duties of Any 

Occupation,” not merely her former occupation. Reliance Standard Life Insurance Company, 

MedStar Health Long Term Disability Insurance Policy at 2.1 (Policy), J.A. 45 (emphasis added). 

The plan defines “Any Occupation” as “an occupation normally performed in the national 

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economy for which [the claimant] is reasonably suited based upon his/her education, training or 

experience.” Id. at 2.0, J.A. 44. Reliance determined that Kemathe could perform at least five

such jobs with her asthma. As a result, Reliance discontinued her disability benefits.

Kemathe sued Reliance under the Employee Retirement Income Security Act (ERISA), 29 

U.S.C. §§ 1001 et seq., arguing that she was entitled to continued payments under the terms of the 

disability plan, see 29 U.S.C. § 1132(a)(1)(B). The district court granted summary judgment to 

Reliance. Kemathe v. Reliance Standard Life Ins. Co., No. 1:17-cv-903 (TNM), 2019 WL 415817

(D.D.C. Feb. 1, 2019). On appeal, Kemathe challenges two aspects of the district court’s decision. 

We reject both arguments.

First, Kemathe argues that the case should be remanded to allow further discovery of Dr. 

Ross Myerson, the third-party doctor who examined her as part of Reliance’s internal appeal

process. The district court allowed limited discovery about Dr. Myerson’s evaluation of Kemathe. 

But the court denied discovery into the matters on which Kemathe now seeks information, such as 

Dr. Myerson’s relationship with the third-party vendor Reliance uses to conduct claim evaluations. 

See Kemathe v. Reliance Ins. Co., No. 1:17-cv-903 (TNM) (D.D.C. May 9, 2018) (order granting 

in part and denying in part motion to compel discovery).

We reject the remand request for further discovery because we do not think the district 

court’s discovery ruling was an abuse of discretion. Kemathe argues that Reliance’s use of Dr. 

Myerson ran afoul of a Department of Labor regulation governing ERISA plans. See 29 C.F.R. § 

2560.503-1(h)(3)(v). That regulation, though, is inapposite. It dictates that the physician 

consulted during an internal plan appeal may not be the same “individual who was consulted in 

connection with the adverse benefit determination that is the subject of the . . . appeal.” Id. That 

limitation does not pertain to Dr. Myerson, who did not consult on Reliance’s initial “adverse 

benefit determination” regarding Kemathe. The initial physician instead was Dr. Ajeet Vinayak. 

Accordingly, we deny Kemathe’s request for further discovery into Dr. Myerson.

Second, Kemathe argues that the district court should have considered the decision of a

Social Security Administration Administrative Law Judge (SSA ALJ) who found that Kemathe

was eligible for social security disability insurance. The SSA decision postdated Reliance’s 

decision to discontinue benefits. Kemathe asks for a remand to allow the district court to consider 

the SSA decision.

The district court declined to consider the SSA decision on the basis that it was not part of 

the record before the plan administrator. Kemathe, 2019 WL 415817, at *2. Our circuit has not 

addressed whether courts may consider such extra-record evidence when reviewing an

administrator’s decision de novo, as we do here. The decision cited by the district court, Block v. 

Pitney Bowes Inc., 952 F.2d 1450, 1455 (D.C. Cir. 1992), concerned abuse-of-discretion review, 

USCA Case #19-7032 Document #1837050 Filed: 04/07/2020 Page 2 of 4
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not de novo review. And many other circuits allow consideration of extra-record evidence on de 

novo review. See Hurley v. Life Ins. Co. of N. Am., No. 1:04-cv-252 (CKK), 2006 WL 1883406, 

at *4–5 (D.D.C. July 9, 2006) (collecting cases). 

We need not resolve the issue, though, because summary judgment for Reliance is 

warranted even taking account of the SSA decision. See Wash.-Balt. Newspaper Guild, Local 35 

v. Wash. Post, 959 F.2d 288, 292 n. 3 (D.C. Cir. 1992) (we may affirm summary judgment on any 

ground found in the record). 

Nothing in the SSA decision creates a genuine issue of fact as to whether Kemathe could

perform the material duties of any occupation. The SSA examining physician concluded, just as

Drs. Vinayak and Myerson did, that Kemathe “could sit at a desk and do manual labor, walk several 

blocks[,] and climb a flight of stairs without difficulty.” Josephine M. Marangu Kemathe, Social 

Security Administration Office of Disability Adjudication and Review Decision at 5 (Aug. 25, 

2017) (Social Security Decision), J.A. 1684. That is, every doctor to examine Kemathe agreed 

that she could perform sedentary work. The SSA ALJ made the same factual finding. That

conclusion is consistent with Reliance’s determination that there were at least five sedentary jobs

“normally performed in the national economy” for which Kemathe would be “reasonably suited 

based upon her education, training, or experience.” Policy at 2.0–2.1, J.A. 44–45. Kemathe

provided no evidence to the district court contesting her ability to perform any of the five suggested 

jobs. There thus is no dispute of fact that she can perform them. Under the terms of the plan, then,

Kemathe is ineligible for continued disability payments.

Moreover, the SSA ALJ’s conclusion that Kemathe is disabled for purposes of social 

security disability benefits rested on a mechanical burden-shifting framework under which, for a 

person of Kemathe’s age, “job skills do not transfer” for sedentary work unless “the sedentary 

work is so similar to [the claimant’s] previous work that [she] would need to make very little, if 

any, vocational adjustment in terms of tools, work processes, work settings, or the industry.” 20 

C.F.R. § 404.1568(d)(4); see Social Security Decision at 5–6, J.A. 1684–85. There is no such agerelated presumption at work in the MedStar plan’s definition of total disability. Indeed, the 

importance of age to the social security disability framework stands in contrast to the importance 

of age to the plan’s framework: for the latter, age is irrelevant. See Policy at 2.0, J.A. 44. What

matters instead is Kemathe’s ability to “perform the material duties of . . . an occupation normally 

performed in the national economy for which [she] is reasonably suited based on education, 

training, or experience.” Id.

For the same reason, Kemathe’s ability to earn a “livable wage” in a different job, another 

factor she claims Reliance should have considered, is irrelevant to whether she is eligible for 

disability payments from Reliance. That is because “what qualifies as a disability for social 

security disability purposes does not necessarily qualify as a disability for purposes of an ERISA 

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benefit plan—the benefits provided depend entirely on the language in the plan.” Smith v. Cont’l 

Cas. Co., 369 F.3d 412, 420 (4th Cir. 2004). The MedStar plan here makes no mention of other 

occupations’ wages as a factor in determining whether an employee is entitled to disability 

payments. 

For the foregoing reasons, we conclude that the district court did not err in denying further 

discovery into Dr. Myerson, and we further conclude that Reliance was entitled to summary 

judgment. We thus affirm the decision of the district court.

* * * * *

Pursuant to D.C. Cir. R. 36(d), this disposition will not be published. The Clerk is directed 

to withhold issuance of the mandate until seven days after resolution of any timely petition for 

rehearing or rehearing en banc. See Fed. R. App. P. 41(b); D.C. Cir. R. 41(b).

Per Curiam

FOR THE COURT:

Mark J. Langer, Clerk

BY: /s/

Daniel J. Reidy

Deputy Clerk

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