Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-4_13-cv-01947/USCOURTS-alnd-4_13-cv-01947-0/pdf.json

Parties Involved:
Aetna Life Insurance Company
Defendant
Federal Express Corporation Long Term Disability Plan
Counter Claimant
Greg Oliver
Counter Defendant

Document Text:

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

MIDDLE DIVISION

GREG OLIVER,

Plaintiff,

v.

AETNA LIFE INSURANCE

COMPANY, et al.,

Defendants.

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Case No.: 4:13-CV-1947-VEH

 

MEMORANDUM OPINION

I. INTRODUCTION AND PROCEDURAL HISTORY

Plaintiff Gregory Oliver (“Mr. Oliver”), a former employee of Federal Express

Corporation (“FedEx”), initiated this employee benefits case in the Circuit Court of

Etowah County, Alabama, on September 11, 2013. (Doc. 1-1 at 4). On October 22,

1

2013, Defendant Aetna Life Insurance Company (“Aetna”) removed the lawsuit to

this court on the basis offederal question jurisdiction under the Employee Retirement

Income Security Act (“ERISA”) and the doctrine of complete preemption. (Doc. 1 at

2-3 ¶¶ 6, 7). On November 26, 2013, Mr. Oliver filed an amended complaint which

All page references to Doc. 1-1 correspond with the court’s CM/ECF numbering system. 1

FILED

 2014 Oct-27 PM 04:16

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 1 of 48
added Federal Express Corporation Long Term Disability Plan (the “FedEx Plan”)

as a co-defendant to his lawsuit. (Doc. 10 at 1).

Currently pending before the court are the six following contested motions:

(1) Mr. Oliver’s Motion for Summary Judgment on Appropriate Standard

of Review (Doc. 20) (the “SOR Motion”) filed on June 13, 2014;

(2) Mr. Oliver’s Motion for Judgment for Total Disability (Doc. 28) (the

“Disability Motion”) filed on July 3, 2014;

(3) Defendants’ Motion For Summary Judgment (Doc. 31) (the “Cross

Disability Motion”) filed on July 3, 2014;

(4) Mr. Oliver’s Motion To Add Documentsto the ClaimFile (Doc. 25) (the 

“Motion To Add”) filed on July 3, 2014;

(5) Mr. Oliver’s Motion To Strike (Doc. 40) (the “Strike Motion”) filed on

July 3, 2014; and

(6) Mr. Oliver’s Motion To Compel Log of Omitted Documents from the

Administrative Record (Doc. 49) (the “Compel Motion”) filed on August 29, 2014.

The court has studied all these filings as well as the parties’ respective

supporting and opposing materials. (Docs. 23, 26-27, 29-30, 32-39, 41-44, 51). For

the reasons explained below, (1) Mr. Oliver’s SOR Motion is due to be denied; (2)

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 2 of 48
Mr. Oliver’s Disability Motion is due to be denied; (3) Defendants’ Cross Disability

Motion is due to be granted; (4) Mr. Oliver’s Motion To Add is due to be denied and

alternatively is due to be termed as moot; (5) Mr. Oliver’s Strike Motion is due to be

termed as moot; and (6) Mr. Oliver’s Compel Motion is due to be denied.

II. FACTUAL BACKGROUND AND ADMINISTRATIVE HISTORY2

Mr. Oliver formerly worked as courier for FedEx. Mr. Oliver experienced an

on-the-job injury on August 15, 2009, and has the impairments of degenerative disc

disease and osteoarthritis in the left knee. Mr. Oliver submitted a disability claim

under the FedEx Plan, and received short-term disability benefits for the time period

of August 24, 2009, through February 21, 2010. (Doc. 23-1 at 2). Subsequently, Mr. 3

Oliver received long-term occupational disability benefits under the FedEx Plan for

the two-year period of February 22, 2010, through February 21, 2012. Id. This

provided Mr. Oliver with the maximum coverage for long-term occupational

Keeping in mind that when deciding a motion for summary judgment the court must view 2

the evidence and all factual inferences in the light most favorable to the party opposing the motion,

the court provides the following statement of facts. See Optimum Techs., Inc. v. Henkel Consumer

Adhesives, Inc., 496 F.3d 1231, 1241 (11th Cir. 2007) (observing that, in connection with summary

judgment, a court must review all facts and inferences in a light most favorable to the non-moving

party). This statement does not represent actual findings of fact. See In re Celotex Corp., 487 F.3d

1320, 1328 (11th Cir. 2007). Instead, the court has provided this statement simply to place the

court’s legal analysis in the context of this particular case or controversy. 

All page references to Doc. 23-1 correspond with the court’s CM/ECF numbering system. 3

3

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 3 of 48
disability, as the FedEx Plan places a 24-month cap on receiving that type of benefit.

(Doc. 23-7 at 50; Doc. 23-1 at 2).

Prior to the exhaustion of his long-term occupational disability payments, on

August 25, 2011, Aetna sent Mr. Oliver a letter which explained the more demanding

definition of disability that applied to long-term benefits “beyond 24 months . . . .”

(Doc. 23-2 at 4). More specifically, that standard requires a claimant to show a

4

“complete inability . . . to engage in any compensable employment for twenty-five

hours per week.” (Doc. 23-1 at 2; Doc. 23-7 at 42). 

Mr. Oliver sought to qualify for long-term total disability benefits to cover the

time period from February 22, 2012, to the present. (Doc. 23-1 at 2). This claim was

denied initially on January 12, 2012, and Mr. Oliver filed an appeal. Id. Subsequently,

on March 13, 2012, Linda Bizzarro (“Ms. Bizzarro”) sent a letter to Mr. Oliver on

behalf of the Aetna Appeal Review Committee (“AARC”) (Doc. 23-1 at 2-3),

notifying him that the AARC had denied his appeal on March 12, 2012, “because

there [wa]s a lack of significant objective findings to substantiate a claim under the

Plan for Total Disability.” (Doc. 23-1 at 3).

Before his long-term total disability claim was finally decided, Mr. Oliver

All page references to Doc. 23-2 correspond with the court’s CM/ECF numbering system. 4

4

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 4 of 48
received a favorable disability decision from the Social Security Administration

(“SSA”) on January 17, 2012 (Doc. 23-2 at 8-21), which concluded that Mr. Oliver

became disabled (within the meaning of the Social Security Act) on August15, 2009,

the same date as his job-related injury. Mr. Oliver contends that this SSA decision

satisfies the total disability standard under the FedEx Plan and that “[t]he medical

record reviewers were never provided [with a copy of it].” (Doc. 28 at 2). 

The record reflects that Aetna received notice of Mr. Oliver’s favorable SSA

decision (indicating a retroactive benefit amount of $28,334.00) sent via facsimile on

February 28, 2012, by a nonparty entity named Allsup. (Doc. 23-2 at 23-32). Further,

the appeal denial letter expressly references the AARC’s consideration of Mr.

Oliver’s favorable SSA award. However, the AARC ultimately discounted its

evidentiary importance. Specifically, the AARC pointed out that “the criteria utilized

by the Social Security Administration for . . . disability awards are different from the

definition for Total Disability set forth in the Plan,” and underscored its “duty to

follow the terms of the Plan.” (Doc. 23-1 at 3). 

III. STANDARDS

A. Summary Judgment

Summary judgment is proper only when there is no genuine issue of material

5

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 5 of 48
fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P.

56(c). Allreasonable doubts about the facts and all justifiable inferences are resolved

5

in favor of the nonmovant. See Fitzpatrick v. City of Atlanta, 2 F.3d 1112, 1115 (11th

Cir. 1993). A dispute is genuine “if the evidence is such that a reasonable jury could

6

return a verdict for the nonmoving party.”Anderson v. Liberty Lobby, Inc., 477 U.S.

242, 248, 106 S. Ct. 2505, 2510, 91 L. Ed. 2d 202 (1986). 

“Once the moving party has properly supported its motion for summary

judgment, the burden shifts to the nonmoving party to ‘come forward with specific

facts showing that there is a genuine issue for trial.’” International Stamp Art, Inc. v.

U.S. Postal Service, 456 F.3d 1270, 1274 (11th Cir. 2006) (citing Matsushita Elec.

Although this matter is before the court on cross motions for summary judgment pursuant 5

to Rule 56, the Eleventh Circuit has expressed that, due to the peculiar standards of review for

ERISA cases, traditional Rule 56 practice may be unnecessary. See Doyle v. Liberty Life Assur. Co.,

542 F.3d 1352, 1363 n.5 (11th Cir. 2008). Other decisions rendered within this circuit have similarly

recognized that the summaryjudgment standard is not appropriate in ERISA cases when “the district

court sits more as an appellate tribunal than as a trial court.” Curran v. Kemper Nat. Servs. Inc., No.

04-14097, 2005 WL 894840, at *7 (11th Cir. Mar. 16, 2005) (quoting Leahy v. Raytheon Co., 315

F.3d 11, 17–18 (1st Cir. 2002)); see Ruple v. Hartford Life & Accident Ins. Co., 340 F. App’x 604,

611 (11th Cir. 2009) (“[The] typical summary judgment analysis does not apply to ERISA cases.”);

Providence v. Hartford Life & Accident Ins. Co., 357 F. Supp. 2d 1341, 1342 n.1 (M.D. Fla. 2005)

(“[T]he Court’s task is to review the benefit decision based on the administrative record available

to the decision maker at the time he or she made the decision.”). 

Rule 56 was amended in 2007 in conjunction with a general overhaul of the Federal Rules 6

of Civil Procedure. The Advisory Committee was careful to note, however, that the changes “are

intended to be stylistic only.” Adv. Comm. Notes to Fed. R. Civ. P. 56 (2007 Amends.) (emphasis

supplied). Consequently, cases interpreting the previous version of Rule 56 are equally applicable

to the revised version.

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 6 of 48
Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S. Ct. 1348, 1356, 89 L.

Ed. 2d 538 (1986)). Although there are cross motions for summary judgment, each

side must still establish the lack of genuine issues of material fact and that it is

entitled to judgment as a matter of law. See Chambers & Co. v. Equitable Life Assur.

Soc. of the U.S., 224 F.2d 338, 345 (5th Cir. 1955) (“Both parties filed and argued

motions for summary judgment, but this does not warrant the granting of either

motion if the record reflects a genuine issue of fact.”). The court will consider each 7

motion independently, and in accordance with the Rule 56 standard. See United States

v. Diebold, Inc., 369 U.S. 654, 655, 82 S. Ct. 993, 994, 8 L. Ed. 2d 176 (1962) (“On

summary judgment the inferences to be drawn from the underlying facts contained

in such materials must be viewed in the light most favorable to the party opposing the

motion.”). “The fact that both parties simultaneously are arguing that there is no

genuine issue of fact, however, does not establish that a trial is unnecessary thereby

empowering the court to enter judgment as it sees fit.” Wright, Miller & Kane, Fed.

Practice & Proc. § 2720, at 327-28 (3d ed. 1998). 

Finally “[i]f the movant bears the burden of proof on an issue, because, as a

In Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc), the

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Eleventh Circuit adopted as binding precedent all decisions of the former Fifth Circuit handed down

prior to October 1, 1981.

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 7 of 48
defendant, it is asserting an affirmative defense, it must establish that there is no

genuine issue of material fact asto any element of that defense.” International Stamp,

456 F.3d at 1274 (citing Martin v. Alamo Community College Dist., 353 F.3d 409,

412 (5th Cir. 2003)). 

B. Discovery Rulings

Regarding discovery rulings:

A district court has wide discretion in discovery matters and our review

is “accordingly deferential.” Harbert Int’l, Inc. v. James, 157 F.3d 1271,

1280 (11th Cir. 1998). A court abuses its discretion if it makes a “clear

error of judgment” or applies an incorrect legal standard. Carpenter v.

Mohawk Indus., Inc., 541 F.3d 1048, 1055 (11th Cir. 2008) (per curiam).

Moreover, a district court’s denial of additional discovery must result in

substantial harm to a party’s case in order to establish an abuse of

discretion. See Leigh v. Warner Brothers, Inc., 212 F.3d 1210, 1219

(11th Cir. 2000).

Bradley v. King, 556 F.3d 1225, 1229 (11th Cir. 2009); accord Iraola & CIA, S.A. v.

Kimberly-Clark Corp., 325 F.3d 1274, 1286 (11th Cir. 2003) (“Moreover, we will not

overturn discovery rulings ‘unless it isshown that the District Court’s ruling resulted

in substantial harm to the appellant’s case.’” (quoting Carmical v. Bell Helicopter

Textron, Inc., 117 F.3d 490, 493 (11th Cir. 1997))).

C. Evidentiary Rulings

“All evidentiary decisions are reviewed under an abuse-of-discretion standard.”

8

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 8 of 48
See, e.g., General Elec. Co. v. Joiner, 522 U.S. 136, 141, 118 S. Ct. 512, 517, 139 L.

Ed. 2d 508 (1997). “An abuse of discretion can occur where the district court applies

the wrong law, follows the wrong procedure, bases its decision on clearly erroneous

facts, or commits a clear error in judgment.” United States v. Estelan, 156 F. App’x

185, 196 (11th Cir. 2005) (citing United States v. Brown, 415 F.3d 1257, 1266 (11th

Cir. 2005)).

Moreover, as the Eleventh Circuit has made clear, not every incorrect

evidentiary ruling constitutes reversible error:

Auto-Owners’ second argument is that it is entitled to a new trial

on the basis of what it describes as a number of erroneous evidentiary

rulings by the district court. Evidentiary rulings are also reviewed under

an abuse of discretion standard. Finch v. City of Vernon, 877 F.2d 1497,

1504 (11th Cir. 1989). Moreover, even if Auto-Owners can show that

certain errors were committed, the errorsmust have affected “substantial

rights” in order to provide the basis for a new trial. See Fed. R. Evid.

103(a). “Error in the admission or exclusion of evidence is harmless if

it does not affect the substantial rights of the parties.” Perry, 734 F.2d

at 1446. See also Allstate Insurance Co. v. James, 845 F.2d 315, 319

(11th Cir. 1988).

Haygood v. Auto-Owners Ins. Co., 995 F.2d 1512, 1515 (11th Cir. 1993). Therefore,

even the existence of many evidentiary errors does not guarantee the party appealing

a new trial. Instead, such erroneous rulings by a district court must “affect the

substantial rights of the parties” for reversible error to occur. 

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 9 of 48
IV. ANALYSIS

A. Overriding Principles Governing ERISA Benefits

ERISA does not contain a standard of review for actions brought under §

1132(a)(1)(B) challenging benefit eligibility determinations. Firestone Tire&Rubber

Co. v. Bruch, 489 U.S. 101, 108-09, 109 S. Ct. 948, 953 (1989) (“Although it is a

‘comprehensive and reticulated statute,’ ERISA does not set out the appropriate

standard of review for actions . . . challenging benefit eligibility determinations.”).8

Moreover, the case law that has developed over time governing such standards has

significantly evolved. A history of the transformation of these principles is useful to

understanding the presently applicable framework for evaluating § 1132(a)(1)(B)

ERISA challenges. 

In Firestone, the Supreme Court initially established three distinct standards

for courts to employ when reviewing an ERISA plan administrator’s benefits

ERISA provides “a panoply of remedial devices” for participants and beneficiaries of 8

qualifying benefit plans. Mass. Mutual Life Ins. Co. v. Russell, 473 U.S. 134, 146 (1985). Mr. Oliver

asserts that he is entitled to certain long-term disability benefits as a participant under the FedEx Plan

based on § 1132(a)(1)(B). “That provision allows a suit to recover benefits due under the plan, to

enforce rights under the terms of the plan, and to obtain a declaratory judgment of future entitlement

to benefits under the provisions of the plan contract.” Firestone Tire, 489 U.S. at 108. The following

analysis, therefore, is limited to the appropriate standard of review in § 1132(a)(1)(B) lawsuits

challenging benefit denials based on plan interpretations; the court does not address the appropriate

standard of review for actions arising under any other remedial provisions of ERISA.

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 10 of 48
decision: “(1) de novo where the plan does not grant the administrator discretion; (2)

arbitrary and capricious where the plan grants the administrator discretion; and (3)

heightened arbitrary and capricious where the plan grantsthe administrator discretion

and the administrator has a conflict of interest.” Capone v. Aetna Life Ins. Co., 592

F.3d 1189, 1195 (11th Cir. 2010) (citing Buckley v. Metro. Life, 115 F.3d 936, 939

(11th Cir. 1997) (discussing Firestone, 489 U.S. at 115)). In Williams v. Bellsouth

Telecomms., Inc., 373 F.3d 1132, 1137 (11th Cir. 2004), overruled on other grounds

by Doyle v. Liberty Life Assur. Co. of Boston, 542 F.3d 1352 (11th Cir. 2008), the

Eleventh Circuit fleshed out the Firestone test into a six-step framework designed to

guide courts in evaluating a plan administrator’s benefits decision in ERISA actions.

When the Eleventh Circuit created the Williams test, the sixth step of the sequential

framework required courts reviewing a plan administrator’s decision to apply a

heightened arbitrary and capriciousstandard if the plan administrator operated under

a conflict of interest. See id. The Eleventh Circuit later modified this step in response

to the Supreme Court’s ruling in Metropolitan Life Insurance Co. v. Glenn, 554 U.S.

105, 115-17 (2008), which concluded that a conflict of interest should be weighed

merely as “one factor” in determining whether an administrator abused its discretion.

See Doyle v. Liberty Life Assur. Co. of Boston, 542 F.3d 1352, 1359 (11th Cir. 2008)

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 11 of 48
(“As we now show, Glenn implicitly overrules and conflicts with our precedent

requiring courtsto review under the heightened standard a conflicted administrator’s

benefits decision.”). 

The Eleventh Circuit’s latest iteration of the Firestone standard-of-review

framework isfound in Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350 (11th Cir.),

cert. denied, 132 S. Ct. 849 (2011):

(1) Apply the de novo standard to determine whether the claim

administrator’s benefits-denial decision is “wrong” (i.e., the court

disagrees with the administrator’s decision); if it is not, then end the

inquiry and affirm the decision.

(2) If the administrator’s decision in fact is “de novo wrong,” then

determine whether he was vested with discretion in reviewing claims;

if not, end judicial inquiry and reverse the decision.

(3) If the administrator’s decision is “de novo wrong” and he was

vested with discretion in reviewing claims, then determine whether

“reasonable” grounds supported it (hence, review his decision under the

more deferential arbitrary and capricious standard).

(4) If no reasonable grounds exist, then end the inquiry and reverse the

administrator’s decision; if reasonable grounds do exist, then determine

if he operated under a conflict of interest.

(5) If there is no conflict, then end the inquiry and affirm the decision.

(6) If there is a conflict, the conflict should merely be a factor for the

court to take into account when determining whether an administrator’s

decision was arbitrary and capricious.

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 12 of 48
Id. at 1355. All steps of the analysis are “potentially at issue” when a plan vests

9

discretion to the plan administrator to make benefits determinations. See id. at 1356

n.7. Conversely, then, where a plan does not confer discretion, the court simply

applies the de novo review standard established by the Supreme Court in Firestone.

See Firestone, 489 U.S. at 115 (“[W]e hold that a denial of benefits challenged under

§ 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan

gives the administrator orfiduciary discretionary authority to determine eligibility for

benefits or to construe the terms of the plan.”). 

B. Mr. Oliver’s SOR Motion is due to be denied.

In this case, the parties dispute the appropriate standard of review for this court

to apply. In his SOR Motion, Mr. Oliver asserts that de novo review is called for,

10

“In ERISA cases, the phrases ‘arbitrary and capricious’ and ‘abuse of discretion’ are used 9

interchangeably.” Blankenship, 644 F.3d at 1355 n.5.

The answer to which standard applies carries great significance in relation to the scope of 10

this court’s evidentiary review. On one hand, if the de novo standard applies because of an absence

of discretionary authority, then the court is not limited in its review to simply those facts that were

before the administrator at the time of the decision. See Kirwan v. Marriott Corp., 10 F.3d 784, 789

(11th Cir. 1994) (“In this circuit, a district court conducting a de novo review of an Administrator’s

benefits determination is not limited to the facts available to the Administrator at the time of the

determination.”). On the other hand, if the arbitrary and capricious standard applies, triggering

application of the six-step analysis discussed above, then the court is limited in its review to the facts

available to the administrator at the time of the determination. See Glazer v. Reliance Standard Life

Ins. Co., 524 F.3d 1241, 1246-47 (11th Cir. 2008) (stating, in a case where the claims administrator

had discretion under the plan, that when evaluating whether the claims administrator’s decision was

wrong, “[w]e are limited to the record that was before [the claims administrator] when it made its

decision”).

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 13 of 48
while Defendants maintain that discretionary or arbitrary and capricious review is

required. Based upon the record in this case, the court sides with Defendants. 11

While Mr. Oliver bears the burden of proving his entitlement to ERISA

benefits under the FedEx Plan, Horton v. Reliance Std. Life Ins. Co., 141 F.3d 1038,

1040 (11th Cir. 1998), Defendants “bear[] the burden of proving that the arbitrary and

capricious standard of review applies.” Anderson v. Unum Life Ins. Co. of Am., 414

F. Supp. 2d 1079, 1095 (M.D. Ala. 2006) (citing Fay v. Oxford Health Plan, 287 F.3d

96, 104 (2d Cir. 2002)). After evaluating the substance of each plan document upon

which Defendants rely, and as discussed more fully below, the court finds that

Defendants have met their burden of demonstrating that arbitrary and capricious

review is proper. Accordingly, Mr. Oliver’s SOR Motion is due to be denied.

As the Eleventh Circuit explained in Jett v. Blue Cross and Blue Shield of Ala.,

Inc., 890 F.2d 1137 (11th Cir. 1989), regarding the de novo versus abuse of discretion

distinction:

The recent Supreme Court case which holds that a de novo standard of

review is proper under some plans validates the prior law of this Circuit

As a result of the Supreme Court’s decision in Glenn, as interpreted by the Eleventh 11

Circuit in Doyle, only two ERISA standards of review now exist in the context of challenging a plan

administrator’s claim decision—either de novo or modified arbitraryand capricious. Doyle, 542 F.3d

at 1359 (“As we now show, Glenn implicitly overrules and conflicts with our precedent requiring

courts to review under the heightened standard a conflicted administrator’s benefits decision.”). 

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 14 of 48
that the arbitrary and capricious standard of review is appropriate here.

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S. Ct. 948,

103 L. Ed. 2d 80 (1989). The [C]ourt held that

a denial of benefits challenged under [29 U.S.C.A.] §

1132(a)(1)(B) 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, 109 S. Ct. at 956.

The plan in this case does give the administrator of the plan

“discretionary authority to determine eligibility for benefits [and] to

construe the [plan’s] terms.” Id. For example, the plan states,

As a condition precedent to coverage, it is agreed

that whenever the Claims Administrator makes reasonable

determinations in the administration of the [plan]

(including, without limitation, determinations whether

services, care, treatment, or supplies are Medically

Necessary . . .) such determinations shall be final and

conclusive.

Jett, 890 F.2d at 1138-39 (emphasis added). Therefore, in Jett, the court first looked

to the language of the plan in order to evaluate the standard of review issue. Cf.

12

Cagle v. Bruner, 112 F.3d 1510, 1517 (11th Cir. 1997) (“Accordingly, we look to all

of the plan documents to determine whether the plan affords the Fund enough

In Jett, the parties agreed that the arbitrary and capricious standard of review applied. Id. 12

at 1138 (“The parties agree that a court reviewingBlueCross’ denial of benefits under this plan must

apply an arbitrary and capricious standard.”).

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 15 of 48
discretion to make the arbitrariness standard applicable.”) (emphasis added).

Article 1 (i.e., the “DEFINITIONS” section) of the FedEx Plan, as amended

and restated effective June 1, 2006 (the “2006 Restated FedEx Plan”) (Doc. 23-7 at

27), defines the terms “Company” as “Federal Express Corporation” (Doc. 23-7 at 13

30); “Administrator” as “the Company, which is charged with the administration of

the Plan, acting through its Employee Benefits Department” (id. at 31); and “Claims

Paying Administrator” as “Aetna Life Insurance Company or any other entity or

person designated as such by the Company.” (id. at 32). 

Under the 2006 Restated FedEx Plan, “[t]he Administrator shall appoint an

appeal committee for the purposes of conducting reviews of denial of benefits and

providing the claimant with written notice of the decision reached by such

committee.” (Doc. 23-7 at 78). The Appeal Committee is the entity responsible for

reviewing claims decided by the Claims Paying Administrator that are challenged by

a claimant and for issuing “a timely decision in writing [to that person] following its

review.” (Doc. 23-7 at 79).

Concerning discretionary authority, the 2006Restated FedEx Plan containsthe

following relevant provisions:

All page references to Doc. 23-7 correspond with the court’s CM/ECF numbering system. 13

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 16 of 48
Authority of Appeal Committee. The appeal committee, appointed

pursuant to Subsection (c), shall, subject to the requirements of the Code

and ERISA, be empowered to interpret the Plan’s provisions in its sole

and exclusive discretion in accordance with its terms with respect to all

matters properly brought before it pursuant to this Section 5.3,

including, but not limited to, matters relating to the eligibility of a

claimant for benefits under the Plan. The determination of the appeal

committee shall be made in a fair and consistent manner in accordance

with the Plan’s terms and its decision, shall be final, subject only to a

determination by a court of competent jurisdiction that the committee’s

decision was arbitrary and capricious.

(Doc. 23-7 at 81-82 (emphasis added)). 

Article 6 (i.e., the “ADMINISTRATION OF PLAN” section) of the 2006

Restated FedEx Plan providessimilar discretionary powersto the Administrator. (See

Doc. 23-7 at 88 (“The determination of the Administrator shall be made in a fair and

consistent manner in accordance with the Plan’s terms and its decision, shall be final,

subject only to a determination by a court of competent jurisdiction that the

committee’s decision was arbitrary and capricious.”) (emphasis added)).

Finally, Article 6 identifies a “Committee” that “shall be appointed by the

board of directors of FedEx Corporation to perform the administrative duties

hereunder other than the administration of claims which is the responsibility of the

Administrator and Claims Paying Administrator to the extent such duties are

delegated to it by the Administrator.” (Doc. 23-7 at 88). The 2006 Restated FedEx

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Plan purports to give the Committee discretionary authority. (See Doc. 23-7 at 89

(“The determination of the Committee shall be made in a fair and consistent manner

in accordance with the Plan’s terms and its decision, shall be final, subject only to a

determination by a court of competent jurisdiction that the [Committee]’s decision

was arbitrary and capricious.”) (emphasis added)). 

14

Thus, the 2006 Restated FedEx Plan bestows the Administrator, Appeal

Committee, and the Committee with discretionary authority when a decision is made

by that particular defined body. Defendants have not pointed to nor has the court has

been able to locate where the specific provisions of the 2006 Restated FedEx Plan

gives discretionary authority to any other entity besides these three.

Defendants assert that the Committee referenced in Section 6.2 of the 2006

Restated Plan is the Retirement Plan Investment Board (“RPIB”). (Doc. 26 at 6 ¶ 1).

Defendants also maintain that there is no group expressly designated as the “Appeal

Committee.” (Id. at 5 ¶ 5). Defendants instead represent that, prior to September 21,

2008, long-term disability appeals were decided by the Federal Express Corporation

Benefit Review Committee (“BRC”). (Id. at 6 ¶ 3). These representations are

substantiated by several documents contained in the record, including an inter-office

The alteration of “Committee” replacesthe apparent typographical error of “Administrator” 14

that actually appears in the 2006 Restated Plan. (Doc. 23-7 at 89).

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memo dated June 12, 2008, in which August C. Lauer, Managing Director of

Disability, Work/Life & HCMP recommended that long-term disability appeals be

outsourced to Aetna and that the BRC be eliminated (Doc. 27-1 at 2), and the July 15

14, 2008, minutes of the RPIB meeting in which the RPIB voted to approve the

recommendation “to outsource remaining long-term disability appeals effective

September 1, 2008, and effectively cease the operation of the [BRC].” (Doc. 27-3 at

3). 

Mr. Oliver does not dispute that the 2006 Restated FedEx Plan unambiguously

vests discretion in various entitiesformed by FedEx to interpret terms and make final

long-term disability benefits determinations, but instead argues that such

discretionary authority does not extend to the adverse appellate benefits

determination rendered by the AARC on March 12, 2012, mailed to him on March

13, 2012, and made effective as of February 22, 2012. (Doc. 23-1 at 2-3). Defendants

counter that a subsequent amendment to the 2006 Restated Plan (as well as other

documents) make it clear that the AARC had discretionary authority in its appellate

role over Mr. Oliver’s long-term disability claim, which wasfinally denied on March

12, 2012.

All page references to Doc. 27-1 correspond with the court’s CM/ECF numbering system. 15

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 19 of 48
Article 7 of the 2006 Restated FedEx Plan governs “AMENDMENT AND

TERMINATION” procedures. (Doc. 23-7 at 91). Section 7.1 specifically addresses

amendments and provides in relevant part that:

The Sponsoring Employers shall have the right at any time to modify,

alter or amend the Plan in whole or in part by an instrument in writing

duly executed by officers of each of the Sponsoring Employers or as

reflected in the minutes of FedEx Corporation’s board of directors or

any committee thereof or as reflected in the minutes of the Committee.

(Doc. 23-7 at 91 (emphasis added)). The 2006 Restated FedEx Plan defines

“Employer” as “the Company, FedEx Corporation, and all other Sponsoring

Employers, and each of them, which are subsidiary to or affiliated with the Company

. . . .” (Id. at 36).

Defendants rely upon several different documents in an effort to show that

AARC has the requisite discretionary authoritywhen deciding disability appeals. The

materials include the July 14, 2008, minutes of the RPIB meeting and an

“AMENDMENT TO SERVICE AGREEMENT” (the “2008 Service Amendment”)

entered into between FedEx and Aetna which memorializes that as of September 1,

2008, Aetna would “[b]e fully responsible for final appeal benefit determinations ...

for Long Term Disability Plans . . . .” (Doc. 27-4 at 2). The 2008 Service

16

All page references to Doc. 27-4 correspond with the court’s CM/ECF numbering system. 16

20

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 20 of 48
Amendment also “delegates to Aetna discretionary authority to render eligibility and

benefit determinations and otherwise interpret the terms of the . . . Long Term

Disability Plans on appeal.” (Doc. 27-4 at 2). 

Defendants also point to the “SECOND AMENDMENT TO THE FEDERAL

EXPRESS CORPORATION LONG TERM DISABILITY PLAN” (the “Second

FedEx Plan Amendment”) which, although not executed by the “Sponsoring

Employers” until January 2013 (Doc. 23-7 at 19-26), modifies Section 5.3 ofthe 2006

Restated FedEx Plan and clarifies “the terms of the Plan to reflect the delegation of

fiduciary duty to Aetna to determine claims under Plan that was effective September

1, 2008.” (Doc. 23-7 at 2). 

More specifically, modified Section 5.3 makes it clear that the Claims Paying

Administrator (i.e., Aetna) is now (and since September 1, 2008, has been) the party

responsible for deciding appeals of denial of benefits. (Doc. 23-7 at 4). Further, the

authority portion of revised Section 5.3 provides:

(d) Authority of Claims Paying Administrator. The Claims Paying

Administrator shall, subject to the requirements of the Code and

ERISA, be empowered to interpret the Plan’s provisions in its

sole and exclusive discretion in accordance with its terms with

respect to all matters properly brought before it pursuant to this

Section 5.3, including, but not limited to, matters relating to the

eligibility of a claimant for benefits under the Plan. The

determination of the Claims Paying Administrator shall be made

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 21 of 48
in a fair and consistent manner in accordance with the Plan’s

terms and its decision shall be final, subject only to a

determination by a court of competent jurisdiction that the

individual’s or committee’s decision was arbitraryand capricious.

(Doc. 23-7 at 4-5 (emphasis added)).

Nevertheless, Defendants’ reliance upon this Second FedEx Plan Amendment

to satisfy their burden of persuasion is not entirely convincing because, at the time

that Mr. Oliver’s final claims decision was made, this modification was not yet

formally in place. Further, the cases cited by Defendants do not concretely establish

that bestowing discretionary authority to a claims paying administrator under such

unique circumstances is a permissible retroactive amendment under the same type of

reasoning used in decisions such as Chiles v. Ceridian Corp., 95 F.3d 1505, 1510

(10th Cir. 1996) (upholding amendment which required participants to pay for a

portion of their health benefits), abrogated on other grounds by CIGNA Corp. v.

Amara, ___ U.S. ___, 131 S. Ct. 1866, 179 L. Ed. 2d 843 (2011), as recognized in

Tomlinson v. El Paso Corp., 653 F.3d 1281, 1295 (10th Cir. 2011) (“The Supreme

Court recently rejected Chiles’ reliance requirement.”), and Smith v. AEGON

Companies Pension Plan, 2013 U.S. Dist. LEXIS 10746 (W.D. Ky. Jan. 25, 2013)

(permitting retroactive application of change in choice of forum adopted in 2007 to

benefits that had accrued in 2000), and Dyce v. Salaried Employees’ Pension Plan of

22

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 22 of 48
Allied Corp., 15 F.3d 163, 166 (11th Cir. 1994) (permitting retroactive application of

amendment impacting pending claims for retirement benefits). 

In particular, none of these cases stands for the proposition that the reach of

a retroactive delegation of discretionary authority to a claims administrator

appropriately extends to a final benefits decision made before that plan was formally

amended. Therefore, in the absence of any other plan documents which establish

Aetna’s discretionary authority prior to its determination of Mr. Oliver’s appeal, the

court would likely be inclined to use de novo review.

However, in this instance, Defendants’ universe of plan documents is not

limited to the 2006 Restated FedEx Plan or the Second FedEx Plan Amendment.

Instead, Defendants have additionally pointed to other plan documents which existed

prior to the final decision made on March 12, 2012. Further, unlike the records

presented to the court in Huffstutler v. Goodyear Tire &Rubber Company, No. 4:11-

CV-3325-VEH (Doc. 18) and Glover v. Amcor Pet Packaging, USA, Inc., No. 4:09-

CV-65-VEH (Doc. 45), these other plan instruments confirm that discretionary 17

To be clear, in Huffstutler, the undersigned did not analyze any language from a summary 17

plan description, because that was not one of the plan documents offered by the defendant to carry

its burden. In Glover, the undersigned did discuss the discretionary provision included in the

summaryplan description, and found that the final disabilitydecisonmaker (who was outside counsel

for the defendant) did not fall within the scope of that provision.

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 23 of 48
authority was appropriately delegated to the AARC in advance of its decision on Mr.

Oliver’s appeal. 

More specifically, Defendants contend that this court should utilize ERISA’s

arbitrary and capricious standard because of the language contained in the 2011

summary plan description (the “2011 SPD”) and the 2012 summary plan description

update (the “2012 Update”). The 2011 SPD replaces all prior versions (Doc. 23-5 at

8) and explains that the “Plan Administrator – and sometimes the claims paying

18

administrator – has discretionary authority to interpret Plan provisions, clarify unclear

terms, determine eligibility for benefits and otherwise make all decisions about Plan

administration.” (Doc. 23-5 at 10 (emphasis added)); (see also id. (“For some Plans,

FedEx has delegated authority to an insurance company to administer benefit claims

under the Plan. . . . Subject to the overall authority of the Plan Administrator, the

claims-paying administrator has discretionary authority to interpret Plan provisions

and determine benefit claims.”) (emphasis added)).

Additionally, the 2012 Update (applicable to benefits being sought effective

January 1, 2012 (Doc. 23-6 at 2)), expressly identifies the “Aetna Appeal Review

19

All page references to Doc. 23-5 correspond with the court’s CM/ECF numbering system. 18

All page references to Doc. 23-6 correspond with the court’s CM/ECF numbering system. 19

24

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 24 of 48
Committee” (i.e., the previously defined AARC) as the “GROUP RESPONSIBLE

FOR FINAL REVIEW” of a disability appeal filed under the Plan. (Compare Doc.

23-6 at 25 (indicating “Aetna Appeal Review Committee”), with Doc. 23-5 at 58

(indicating “Aetna Appeals Committee”)). Therefore, the 2011 SPD in conjunction

with the 2012 Update confirm that discretionary review applies to the final denial of

Mr. Oliver’s long-term disability claim by the AARC on March 12, 2012.

This court’s conclusion that the contents of the 2011 SPD and the 2012 Update

effectively bestow the AARC with discretionary authority under ERISA isreinforced

by the Eleventh Circuit’s standard of review reasoning employed in Cagle:

Since there is no conflict of interest in this case, either the de novo

orthe arbitrary and capriciousstandard applies, depending uponwhether

the plan documents give the Fund sufficient discretion. The Fund argues

that it is provided sufficient discretion to interpret the plan in the Trust

Agreement and in the Rules and Regulations. In opposition, both

Genesis and Bruner argue that the plan’s Summary Plan Description

(“SPD”), not other plan documents, must contain the discretionary

language in order for the Fund to receive the deference required under

the arbitrariness standard. We reject that argument. Both the Supreme

Court and this Court have reviewed trust documents and other non-SPD

documents in the search for a reservation of discretion for plan

administrators or fiduciaries. See Firestone, 489 U.S. at 109-13, 109 S.

Ct. at 954-55; Guy v. Southeastern Iron Workers’ Welfare Fund, 877

F.2d 37, 39 (11th Cir. 1989). Accord Diaz v. Seafarers Int’l Union, 13

F.3d 454, 457 (1st Cir. 1994); Luby v. Teamsters Health, Welfare and

Pension Trust Funds, 944 F.2d 1176, 1180-81 (3d Cir.1991).

Accordingly, we look to all of the plan documents to determine whether

the plan affords the Fund enough discretion to make the arbitrariness

25

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 25 of 48
standard applicable.

Cagle, 112 F.3d at 1517 (emphasis added). 

Here, the position advanced by Mr. Oliver (i.e., a delegation of discretionary

authority must appear within the actual plan–as opposed to the summary plan

description–in order for it be effective) is the opposite of what the plaintiffs argued

in Cagle. However, Cagle’s overriding principle that no single instrument controls

the court’s standard ofreview inquiry still holds. Instead, as Cagle confirms, all planrelated documents (that are part of the record) are relevant when the parties disagree

over whether de novo or discretionary review applies to a disputed ERISA benefits

claim. 

C. Mr. Oliver’s Disability Motion is due to be denied and

Defendants’ Cross Disability Motion is due to be granted.

1. Mr. Oliver’s Long-Term Disability Claim

Turning to the court’s initial inquiry under ERISA:

[T]he court reviews the decision by the administrator to determine

whether it was “wrong.” Tippitt, 457 F.3d at 1232; see also Levinson v.

Reliance Standard Life Ins. Co., 245 F.3d 1321, 1326 (11th Cir. 2001)

(quoting Brown v. Blue Cross & Blue Shield of Ala., Inc., 898 F.2d

1556, 1566 n.12 (11th Cir.1990)). A decision is “wrong” if, after a

review of the decision of the administrator from a de novo perspective,

“the court disagrees with the administrator’s decision.” Williams, 373

F.3d at 1138 & n.8. The court must consider, based on the record before

the administrator at the time its decision was made, whether the court

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 26 of 48
would reach the same decision as the administrator. If the court

determines that the plan administrator was right, the analysis ends and

the decision is affirmed. Tippitt, 457 F.3d at 1232.

Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241, 1246-47 (11th Cir. 2008).

Here, the court concludes that the AARC’s final disability determination is de

novo correct for multiple reasons, including Mr. Oliver’s overall failure to objectively

establish that the vocational ramifications caused by his impairments satisfied the

requirements of the 2006 Restated FedEx Plan’s total disability provision, i.e., the

inability to work at any job for a minimum of twenty-five hours a week effective as

of February 22, 2012. Instead, Mr. Oliver, at best, has established a period of nonpermanent total disability under the SSA as ofJanuary 17, 2012. (See, e.g., Doc. 23-2

at 21 (“Medical improvement is expected with appropriate treatment.”); id.

(“Consequently, a continuing disability review is recommended in 12 months.”)).

Importantly (and as the AARC expressly recognized in reviewing Mr. Oliver’s

appeal), because significant differences exist between the SSA test and that governing

the 2006 Restated FedEx Plan, the former falls short of demonstrating that Aetna

committed de novo error under ERISA. 

For example, under step five of the SSA’s disability framework, the SSA takes

the position that “only an ability to do full-time work will permit the ALJ to render

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 27 of 48
a decision of not disabled.” Kelley v. Apfel, 185 F.3d 1211, 1214 (11th Cir. 1999); see

id. at 1214-15 (“Thus, if the government is correct in its interpretation, a claimant

could pass Step Five and be entitled to benefits even though capable of working on

a part-time basis.”) (emphasis added). Therefore, to what extent a favorable SSA

disability decision (which, like Mr. Oliver’s, turns on the fifth step of that statute’s

model) also demonstrates a claimant’s inability to work a minimum of twenty five

hours a week “in any compensable employment” is inconclusive. (See Doc. 23-7 at

42 (defining “Total Disability” under 2006 Restated FedEx Plan)). 

Another notable difference between the two disability models is that a fifthstep SSA disability determination is tied to a separate determination of whether a

significant number of jobs exist in the national economy which a claimant can

perform. In contrast, the availability of jobs (or part-time employment) is not a

component of the total disability definition under the 2006 Restated FedEx Plan. Put

differently, if a physically-impaired claimant is a capable of working in a sedentary

position for twenty five hours or more per week, under the 2006 Restated FedEx Plan

it is irrelevant to the disability determination whether a significant number of such

sedentary jobs exist.

Additionally, while under the SSA structure the lack of objective medical

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 28 of 48
evidence does not always disqualify a claimant from being found disabled so long as

his subjective allegations of pain are deemed credible, see, e.g., Francis v. Heckler,

749 F.2d 1562, 1564 (11th Cir. 1985) (“It is well established in the Eleventh Circuit

that pain alone can be disabling, even when its existence is unsupported by objective

evidence.” (citing Wiggins v. Schweiker, 679 F.2d 1387, 1390 (11th Cir. 1982))), the

2006 Restated FedEx Plan has a much stricter approach to dealing with subjective

complaints of pain.

Disability or Disabled shall mean either an Occupational Disability or

a Total Disability; provided, however . . . such Disability issubstantiated

by significant objective findings which are defined as signs which are

noted on a test or medical exam and which are considered significant

anatomical, physiological or psychological abnormalities which can be

observed apart from the individual’s symptoms. 

(Doc. 23-7 at 34-35 (emphasis added)); (see also Doc. 23-2 at 5 (“Pain, without

significant objective findings, is not proof of disability.” (emphasis in original)).

Therefore, in light of the above materially different underpinnings of the SSA’s

disability determination, Mr. Oliver’s SSA award does not constitute objective proof

that he is totally disabled under the 2006 Restated FedEx Plan.

The court also concludes that the form filled out by the office of Dr. Lawrence

Lemak on December 15, 2011 (Doc. 23-2 at 56) fails to establish that Aetna’s

decision on Mr. Oliver’s appeal was de novo wrong. In particular, even though the

29

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 29 of 48
box indicating that Mr. Oliver is “unable to work at any compensable employment for

a minimum of twenty-five hours a week” is marked (Doc. 23-2 at 56), the underlying

treatment records that either immediately precede or coincide with the completion of

this form show only that Mr. Oliver is precluded from returning to his former courier

position with FedEx. (See, e.g., Doc. 23-2 at 55 (“[I]t’s my professional opinion that

he will be unable to return to Federal Express as a Courier, secondary to total knee

replacement.”) (emphasis added)). 

Finally, none of the other evidence upon which Mr. Oliver relies nor his

rambling judicial estoppel argument raised for the first time in opposition to

Defendants’ Cross Disability Motion (Doc. 36 at 14-28) persuades this court that

Aetna’s decision to deny his disability appeal was incorrect. As it pertains to Mr.

Oliver’s judicial estoppel contentions more specifically, such a theory, which has not

been alleged by him in a pleading, is subject to summary judgment for procedural as

well as substantive reasons. 

From a procedural standpoint, the Eleventh Circuit has made it unmistakably

clear that “[a] plaintiff may not amend her complaint through argument in a brief

opposing summary judgment.” Gilmour v. Gates, McDonald and Co., 382 F.3d 1312,

1315 (11th Cir. 2004) (citing Shanahan v. City of Chicago, 82 F.3d 776, 781 (7th Cir.

30

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 30 of 48
1996)). Gilmour dealt with a plaintiff who was attempting to assert a new claim at the

summary judgment stage. Gilmour, 382 F.3d at 1314-15. 

Additionally, a more recent decision by the Eleventh Circuit cites to Gilmour

and confirms that a district court’s consideration of any critical amendment asserted

merely as part of the briefing process is disfavored.

The current practice in some district courts—especially in the

summary judgment setting—is to ignore what the respective parties

alleged in their complaint and answer and to consider their claims and

defenses as depicted in the memoranda they filed in support of or in

opposition to a motion for summary judgment. As is the situation here,

the claims and defenses presented in the memoranda supporting or

opposing summary judgment are not presented in the complaint and

answer with the specificity required by the Federal Rules of Civil

Procedure and the Supreme Court’s decisions in Bell Atl. Corp. v.

Twombly, 550 U.S. 544, 127 S. Ct. 1955, 167 L. Ed. 2d 929 (2007), and

Ashcroft v. Iqbal, 556 U.S. 662, 129 S. Ct. 1937, 173 L. Ed. 2d 868

(2009); rather, they are presented in a shorthand fashion. The result is

that on appeal we have difficulty in determining whether the district

court, in granting summary judgment, ruled on the claims and defenses

as stated in the complaint and answer or as stated in the memoranda

submitted to the court on summary judgment, as if the pleadings had

been amended by implied consent.

We encountered this dilemma most recently in

GeorgiaCarry.Org, Inc. v. Georgia, 687 F.3d 1244 (11th Cir. 2012),

cert. denied, ___ U.S. ___, 133 S. Ct. 856, 184 L. Ed.2 d 656 (2013).

There, in their motion for summary judgment, the plaintiffs sought to

eliminate a critical deficiency in the allegations of their amended

complaint by including additional facts. The defendants did not object

to this tactic on the ground that the plaintiffs were, in effect, seeking to

amend their complaint. And the district court, in ruling on the

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 31 of 48
sufficiency of the complaint, appeared to have considered the additional

facts as if they had been alleged in the complaint. In affirming the

district court’s dismissal of the claim at issue, we refused to consider

these additional facts, citing precedent that precludes a plaintiff from

amending its complaint “through argument at the summary judgment

phase of proceedings.” Id. at 1258 n. 27. “At the summary judgment

stage, the proper procedure for plaintiffs to assert a new claim is to

amend the complaint in accordance with Fed. R. Civ. P. 15(a).” Gilmour

v. Gates, McDonald & Co., 382 F.3d 1312, 1315 (11th Cir. 2004).

This court’s precedent foreclosedWell–Come’s attempt to amend

its complaint at the summary judgment stage without seeking leave of

court pursuant to Rule 15(a)(2). Accordingly, the District Court should

have disposed of Well–Come’s claim with a statement that Well–Come

failed to establish that ASRRG and ASIS issued a commercial general

liability policy and excess/umbrella liability policy to Flintlock LLC, as

alleged in paragraphs 6 and 7 of its complaint. We affirm the court’s

judgment on that ground. Krutzig v. Pulte Home Corp., 602 F.3d 1231,

1234 (11th Cir.2010) (“This court may affirm a decision of the district

court on any ground supported by the record.”).

Flintlock Const. Servs., LLC v. Well-Come Holdings, LLC, 710 F.3d 1221, 1227-28

(11th Cir. 2013) (emphasis added).

Neither Mr. Oliver’s complaint (Doc. 1-1 at 4-5) nor his amended complaint

(Doc. 10) advances a theory of judicial estoppel as a means for recovering long-term

disability benefits from Defendants. Thus, Gilmour and Flintlock procedurally

foreclose Mr. Oliver from belatedly attempting to amend his complaint in such a

critical manner through his briefing.

Mr. Oliver’s judicial estoppel theory also misses the mark substantively. In

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 32 of 48
particular, while Mr. Oliver spends multiple pages of his opposition brief

regurgitating portions of the Eleventh Circuit’s decision in Melech v. Life Ins. Co. of

North America, 739 F.3d 663 (11th Cir. 2014) as supportive of his position, he fails

to acknowledge a fundamental difference between Melech and the record here. In

Melech, the Eleventh Circuit remanded the case to “LINA . . . to decide Melech’s

claim with the full benefit of the results generated by the SSA process that it helped

to set in motion.” 739 F.3d at 676-77. In striking contrast to Melech, Aetna’s denial

of Mr. Oliver’s appeal expressly addressed why his favorable SSA award did not

warrant a finding that he was totally disabled under the 2006 Restated FedEx Plan.

(Doc. 23-1 at 3). 

Additionally, Melech by no means holds that a claimant’s favorable SSA award

is determinative of disability under an ERISA plan, as Mr. Oliver seems to suggest. 

Instead, as the Eleventh Circuit made plainly clear in ordering a remand to the claims

administrator for further development:

In doing so, we do not prejudge the ultimate outcome. LINA may be

able to draw a principled distinction between its own standards for

granting disability benefits under the Policy and the SSA'sstandards for

awarding SSDI. All we require of LINA isto decide Melech's claimwith

the full benefit of the results generated by the SSA process that it helped

to set in motion. 

Melech, 739 F.3d at 676-77 (emphasis added). Accordingly, as it pertains to

33

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 33 of 48
Defendants’ de novo liability pursuant to § 1132(a)(1)(B) of ERISA, Mr. Oliver’s

Disability Motion is due to be denied and Defendants’ Cross Disability Motion is due

to be granted. 

Alternatively, even if Aetna committed de novo error in deciding Mr. Oliver’s

appeal, the use of the more lenient discretionary review standard (which the court

above has decided appropriately applies in this instance) means that its disability

decision is, a fortiori, due to be upheld. Regarding this deferential review, which

within the Eleventh Circuit applies “both [to] the administrator’s plan interpretations

and [to] . . . factual determinations[,]”Blankenship, 644 F.3d at 1355 n.6, this court’s

evaluation is limited to whether Aetna’s decision was reasonable under the

circumstances. Furthermore, “[a]s long as a reasonable basis appears for [the] 20

decision [of the Committee], it must be upheld as not being arbitrary or capricious,

even if there is evidence that would support a contrary decision.” White v. Coca-Cola

Co., 542 F.3d 848, 856 (11th Cir. 2008) (internal quotation marks omitted) (emphasis

added) (quoting Jett, 890 F.2d at 1140). 

Importantly, other than repeatedly referencing the Supreme Court’s decision in 20

Metropolitan Life InsuranceCo. v. Glenn (discussed supra) within his various briefs, Mr. Oliver has

failed to articulate any convincing argument substantiated with underlying evidence that a conflict

of interest of the part of Aetna is a factor for the court to consider here. Instead, the 2006 Restated

FedEx Plan makes it clear that the FedEx Plan is funded by a trust established and maintained by

FedEx (Doc. 23-7 at 70), and not by an underlying policy of insurance issued by Aetna. 

34

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 34 of 48
As the Eleventh Circuit has explained regarding reasonableness:

Doyle argues that the district court erred in finding that Liberty

Life’s denial of her claim for disability benefits was reasonable.

Specifically, she argues that it was unreasonable for Liberty Life not to

consider her subjective claims of pain and suffering, which she argues

are substantiated by her fibromyalgia diagnosis.

Liberty Life considered Doyle’s medical records and employed

the services of two independent physicians to review those records. It

concluded that she was still able to perform the duties of her “Own

Occupation,” and so did not satisfy the prerequisite for obtaining LTD

benefits under the ChoicePoint policy. We conclude that it was not

unreasonable for Liberty Life to disregard Doyle’s complaints of

intangible pain and suffering. Under ChoicePoint’s policy, a plan

beneficiary must provide proof that she is disabled in order to obtain

LTD benefits. The policy defines “proof” as including “chart notes, lab

findings, test results, x-rays and/or other forms of objective medical

evidence in support of a claim for benefits.” (R.2-12 at 9) (emphasis

added). Therefore, it was reasonable for Liberty Life to rely only on

objective medical evidence supporting Doyle’s claim, evidence which

Liberty Life’s reviewing physicians found lacking. See, e.g., R.1-12 at

279 (statement of Liberty Life’s reviewing physician, Dr. Silver, that

Doyle’s complaints “are unsubstantiated byobjective clinical orthopedic

findings”); R.2-12 at 104 (statement of Liberty Life’s reviewing

physician, Dr. Truchelut, that Doyle’s “subjective reports are

disproportionate to the physical, radiological, laboratory, and

neurodiagnostic” records).

After reviewing the record, we find no error in the district court's

determination that Liberty Life’s decision was reasonable. 

Doyle, 542 F.3d at 1358 (emphasis by underlining added). The plan language at issue 

in Doyle is worded similarly to that utilized in the 2006 Restated FedEx Plan–

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Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 35 of 48
objective proof isrequired to substantiate total disability. Therefore, guided by Doyle,

and based upon the inadequaciesidentified by the court with the documentation relied

upon by Mr. Oliver in an effort to substantiate his claim on a de novo basis, Aetna

reached a reasonable determination that he did not objectively satisfy the definition

of total disability under the 2006 Restated FedEx Plan.

2. FedExPlan’sCounterclaim onOffset Calculation

Defendants additionally seek summary judgment on the FedEx Plan’s

counterclaim regarding the offset calculation which is also pled as Count II of Mr.

Oliver’s amended complaint. (Doc. 10 at 3 ¶¶ 1-3). The parties agree that the 2006

Restated FedEx Plan contains a provision that requires a claimant to reduce any longtermbenefits received by income received fromother sources, expressly including the

SSA, which has been triggered by Mr. Oliver’s SSA disability award. (Doc. 23-7 at

59-60, 62). Their disagreement arises over how much Mr. Oliver should reduce his

long-term occupational disability payment made to him under the 2006 Restated

FedEx Plan in light of his SSA award.

On or about March 29, 2012, Mr. Oliver sent a refund check made payable to

FedEx in the amount of $23,508.00 in connection with the proceeds he received from

36

Case 4:13-cv-01947-VEH Document 52 Filed 10/27/14 Page 36 of 48
the SSA. (Doc. 23-9 at 78). Defendants maintain that the FedEx Plan is owed an 21

additional amount of $5,912.63, which represents the amount that Mr. Oliver paid to

his attorney in connection with the SSA award subject to a 2012 tax adjustment.

(Doc. 23-8 at 3); (see also Doc. 33-1 at 3 ¶ 6 (substantiating Mr. Oliver’s still

outstanding setoff amount through declaration of Latona J. McGee, FedEx’s HR

Advisor in the Benefits Planning and Management Department)). In particular, 22

Defendants point out that the 2006 Restated FedEx Plan makes no exception for fee

or cost-sharing agreements that a claimant may have separately negotiated with his

SSA counsel. (Doc. 23-7 at 59-63).

Mr. Oliver’s opposition brief lacks any discussion which counters Defendants’

offset position. In particular, Mr. Oliver does not even include a passing reference to

this claim in his conclusion. (Doc. 36 at 44). Thus, in light of this omission, Mr. 23

Oliver either has abandoned Count II of his complaint and/or has conceded that the

All page references to Doc. 23-9 correspond with the court’s CM/ECF numbering system. 21

All page references to Doc. 23-8 and Doc. 33-1 correspond with the court’s CM/ECF 22

numbering system.

The court acknowledges that, within the factual section of his opposition, Mr. Oliver 23

asserts that, “[a]s a matter of equity, Oliver is entitled to a credit of $5,912.63–the amount of the fee

paid to his Social Security attorney.” (Doc. 36 at 6 ¶ 29). Mr. Oliver also later laments that “Aetna

refused to give Oliver credit for the attorney fee . . . .” (Doc. 36 at 13 n.2). However, Mr. Oliver

offers no authority in support of either one of these undeveloped points and, consequently, such

meager efforts to oppose are entirely ineffective. See Flanigan’s and Ordower, infra at 42-43.

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FedEx Plan is entitled to summary judgment on its setoff counterclaim. See, e.g.,

Resolution Trust Corp. v. Dunmar Corp., 43 F.3d 587, 599 (11th Cir. 1995) (“[T]he

onusis upon the partiesto formulate arguments; grounds alleged in the complaint but

not relied upon in summary judgment are deemed abandoned.” (citing Road Sprinkler

Fitters Local Union No. 669 v. Indep. Sprinkler Corp., 10 F.3d 1563, 1568 (11th Cir.

1994))); Coalition for the Abolition of Marijuana Prohibition v. City of Atlanta, 219

F.3d 1301, 1326 (11th Cir. 2000) (failure to brief and argue issue at the district court

is sufficient to find the issue has been abandoned); Wilkerson v. Grinnell Corp., 270

F.3d 1314, 1322 (11th Cir. 2001) (finding claim abandoned when argument not

presented in initial response to motion for summary judgment). 

Accordingly, the counterclaimportion of Defendants’ Cross DisabilityMotion

is due to be granted.

3. Aetna’s Independent Basis for Summary

Judgment

Aetna separately argues in Defendants’ brief in support of their Cross

Disability Motion that, as merely a claims administrator, it is not a proper party

defendant under 29 U.S.C. § 1132(a)(1)(B). (Doc. 32 at 20-23). Instead, Aetna

maintains the only appropriate real party in interest in connection with Mr. Oliver’s

ERISA benefits claim isthe FedEx Plan, which entity Mr. Oliver has separately sued. 

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In his opposition, Mr. Oliver never acknowledges this contention distinctly

raised by Aetna, much less addresses the on-point cases which Aetna has cited.

Accordingly, Aetna is independently entitled to summary judgment on its improper

party defense due to Mr. Oliver’s abandonment and/or concession of this issue.

D. Mr. Oliver’s Motion To Add is due to be denied and

alternatively is due to be termed as moot.

Mr. Oliver maintains in his Motion To Add that six different categories of

documents relating to his disability claim need to be added to the administrative

record because they reflect “facts known by Aetna but which are not accurately

reported in the Administrative Record.” (Doc. 25 at 3). Two of these (i.e., Doc. 25-1

(letter explaining distinction between occupational and total disability under the 2006

Restated FedEx Plan), and Doc. 25-3 (executed “AUTHORIZATION TO SHARE

AND USE MEDICAL INFORMATION”), predate the AARC’s final disability

determination made on March 12, 2012. One of these exhibits is undated. (Doc. 25-2

(uncompleted form relating to consent for release of information from the SSA)). 

The remaining three exhibits (i.e., Doc. 25-4, Doc. 25-5, and Doc. 25-6)

contain correspondence from Mr. Oliver’s attorney which post-date the AARC’s key

administrative decision. Doc. 25-5 additionallyattachestreatment records fromRehab

Partners spanning from December 22, 2003, until January 14, 2011. Doc. 25-6

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encloses records from Tennessee Valley Pain Consultants relating to an epidural that

Mr. Oliver received for pain on May 20, 2010.

Defendants counter with respect to Mr. Oliver’s Motion To Add that:

[Mr. Oliver] seems to be incorrectly conflating the “claim file” with the

Administrative Record that was considered during the decision-making

process. [Mr. Oliver] improperly moves to add documents that he never

submitted during the pendency of his claim for disability benefits and

also failed to submit during the appeal process. [Mr. Oliver] also moves

to “add” documents that are actually already contained in the “claim

file.”

(Doc. 34 at 1).

The Eleventh Circuit has made it clear that, when evaluating the correctness

of a claims administrator’s determination under an arbitrary and capricious standard,

the court is “limited to the record that was before [that entity] when it made its

decision.” Jett, 890 F.2d at 1139 (citing Brown v. Retirement Committee of Briggs &

Stratton Retirement Plan, 797 F.2d 521, 532 (7th Cir. 1986)); see also Lee v. Blue

Cross/Blue Shield of Alabama, 10 F.3d 1547, 1550 (11th Cir. 1994) (“Application of

the arbitrary and capriciousstandard requires usto look only to the facts known to the

administrator at the time the decision was made to deny Lee coverage.” (citing Jett));

cf. Blank v. Bethlehem SteelCorp., 926 F.2d 1090, 1093 (11th Cir. 1991) (referencing

factors applicable to “determining whether the contested [plan] interpretation was

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made rationally and in good faith”). 

While Mr. Oliver acknowledges the binding holdings contained in these legal

authorities, his briefing, nonetheless, fails to establish how these documents which

he seeks to add satisfy the Eleventh Circuit’s “facts known at the time of the

decision” standard. Mr. Oliver also fails to clarify why, some or even if all such

documents meet this test, the specific relief he seeks (i.e., adding these items to

Aetna’s administrative record) is appropriate, especially when the record before the

court on summary judgment already contains them. 

For example, while Mr. Oliver cites to the Blank and Harris v. Pullman

Standard, Inc., 809 F.2d 1494 (11th Cir. 1987) decisions as supporting his position,

the Blank panel merely assumed without deciding that certain post-decision records

were relevant to its arbitrary and capriciousreview despite the “facts known” test, see

id. at 1094 n.4 (“We assume without deciding that two of these sales, which occurred

after the transaction at issue here, nevertheless are relevant to whether the Board

acted arbitrarily at the time it denied benefits to the plaintiffs.”), and Harris does not

mention the standard at all.

Additionally, while the two non-binding cases cited by Mr. Oliver stand for the

general proposition that a reviewing court may, under certain circumstances, consider

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evidence outside of the administrative record when evaluating whether an

administrator acted arbitrarily in denying a claim (Doc. 25 at 3-4, 5-6), neither

opinion indicates that seeking to add those documents to the administrative record is

an appropriate or, much less, a necessary action–the reviewing court instead may

simply consider the impact of such evidence on the issue of arbitrariness without

undergoing this administrative procedural step. 

Further, Mr. Oliver sweepingly and unhelpfully asserts in his reply brief that

(i) “[t]he claim file and the Administrative Record are the same[;]” (ii) “[t]he claim

file or administrative record shall include the entire Record[;]” (iii) “Defendants have

no right to pick and choose what belongs in the Record[;]” and “[t]he file is

incomplete.” (Doc. 43 at 2, 3). However, Mr. Oliver never links these statements to

any cases which establish their validity as guideposts for deciding ERISA benefit

disputes, much less that the relief he seeks is warranted by his numerous conclusory

legal assertions. 

In sum, Mr. Oliver’s Motion To Add is due to be denied as perfunctorily made

and underdeveloped. Cf. Flanigan’s Enters., Inc. v. Fulton County, Ga., 242 F.3d

976, 987 n.16 (11th Cir. 2001) (holding that a party waives an argument if the party

“fail[s] to elaborate or provide any citation of authority in support” of the argument);

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Ordower v. Feldman, 826 F.2d 1569, 1576 (7th Cir. 1987) (stating that an argument

made without citation to authority is insufficient to raise an issue before the court). 

Alternatively, Mr. Oliver’s Motion To Add is also due to be termed as moot.

More specifically, even when considering all the documents which Mr. Oliver seeks

to add to the administrative record as “facts known” to Aetna, the court still,

nevertheless, concludes that the final decision made by Aetna (through the AARC)

that Mr. Oliver lacked objective proof to substantiate total disability under the 2006

Restated FedEx Plan for the time period beginning February 22, 2012, and forward,

is both de novo correct and reasonable.

E. Mr. Oliver’s Compel Motion is due to be denied.

Mr. Oliver’s Compel Motion seeks to obtain discovery-related information

from Defendants. Assuming without deciding that ERISA substantively entitles Mr.

Oliver to Defendants’ creation of a log of omitted items (which he has vaguely

described as missing), procedurally his Compel Motion is flawed because he ignores

the impact that Rule 16 has on it.

More specifically, on December 13, 2013, the court entered a scheduling order

(Doc. 17), which expressly provides that “all discovery must be commenced in time

to be completed by April 30, 2014.” (Id. at 1 (emphasis in original)). The scheduling

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order further states:

Any requests for extension of any deadlines must be filed at least

five days prior to that deadline to be considered. Good cause must be

shown for the extension of any deadline. Good cause includes a

showing of what discovery, etc., has already been completed and

precisely why the deadlines cannot be met.

(Doc. 17 at 2 (emphasis in original)).

Even though Mr. Oliver’s Compel Motion post-dates the parties’ discovery

completion deadline of April 30, 2014, by close to 4 months, Mr. Oliver does not

even acknowledge, much less separately seek to modify the scheduling order or

otherwise demonstrate good cause for extending the discovery deadline for the

production that he belatedly seeks. See Fed. R. Civ. P. 16(b)(4) (“A schedule may be

modified only for good cause and with the judge’s consent.”); see also Perez v.

Miami-Dade County, 297 F.3d 1255, 1263 n.21 (11th Cir. 2002) (“Whether a motion

was filed timely and is appropriate under a pretrial order is a question left to the

district court’s discretion.” (citing Spiller v. Ella Smithers Geriatric Ctr., 919 F.2d

339, 343 (5th Cir. 1990))); cf. Josendis v. Wall to Wall Residence Repairs, Inc., 662

F.3d 1292, 1307 (11th Cir. 2011) (“And though the court had the authority to grant

a post hoc extension of the discovery deadline for good cause, it was under no

obligation to do so; in fact, we have often held that a district court’s decision to hold

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litigants to the clear terms of its scheduling orders is not an abuse of discretion.”

(emphasis added) (citing Bearint ex rel. Bearint v. Dorell Juvenile Grp., Inc., 389

F.3d 1339, 1348-49 (11th Cir. 2004))); cf. also Bearint, 389 F.3d at 1349 (“Given the

wide latitude the district court has to exclude untimely submissions, we cannot say

that it abused its discretion to exclude this [expert] report.”). 

The failure of Mr. Oliver to even mention Rule 16’s good cause standard is

significant because, as a result, he has not even triggered a consideration of the

disputed discovery issue. As the United States District Court for the Southern District

of Alabama has observed:

“Judges are not like pigs, hunting for truffles buried in briefs.” Smith v.

Secretary, Department of Corrections, 572 F.3d 1327, 1352 (11th Cir.

2009). An issue must be “fairly presented” in order to trigger

consideration, and a glancing reference without discussion or legal

authority does not meet that standard. Id. As the Court has previously

noted, (Doc. 110 at 2), “[t]here is no burden upon the district court to

distill every potential argument that could be made based upon the

materials before it on summary judgment.” Resolution Trust Corp. v.

Dunmar Corp., 43 F.3d 587, 599 (11th Cir. 1995).

Amazing Grace Bed&Breakfast v. Blackmun, No. 09-0298-WS-N, 2011WL606126,

at *3 (S.D. Ala. Feb. 11, 2011). Therefore, similar to Amazing Grace, because Mr.

Oliver has not “fairly presented” to the court why he should be entitled to obtain

untimely discovery from Defendants, the court will not speculate as to any possible

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scenarios under which he might have met Rule 16’s good cause standard.

Accordingly, for all these reasons, Mr. Oliver’s Compel Motion is due to be

denied.

F. Mr. Oliver’s Strike Motion is due to be termed as moot.

In his Strike Motion, Mr. Oliver seeks to preclude from the record several

documents offered by Defendants to establish the appropriate standard of review for

this court to apply. These documents all relate to the handling of long-term disability

appeals under the Plan and include the FedEx inter-office memorandum dated June

12, 2008 (Doc. 27-1); the FedEx inter-office memorandum dated July 9, 2008 (Doc.

27-2); the minutes of the RPIB meeting held on July 14, 2008 (Doc. 27-3); and the

2008 Service Amendment. (Doc. 27-4). 

Mr. Oliver contends that because these records were not identified as part of

Defendants’ initial disclosures under Rule 26, Defendants are precluded under Rule

37(c) from relying upon such evidence in opposition to his SOR Motion. In

opposition, Defendants initially counter that, because Mr. Oliver’s complaint lacks

any allegations about which standard ofreviewapplies, Defendants did not appreciate

the relevance of these documents until after the filing of Mr. Oliver’s SOR Motion.

Defendants also respond that as this case is more akin to “an action for review of an

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administrative record[,]” the lawsuit is “exempt” from the requirement to exchange

initial disclosures. Fed. R. Civ. P. 26(a)(1)(B)(i). 

Based upon its analysis of Mr. Oliver’s SOR Motion, however, the court does

not need to reach any of the contested matters at stake in the Strike Motion. More

specifically, even in disregarding those pieces of evidence challenged by Mr. Oliver,

the court’s conclusion reached regarding arbitrary and capricious review would

remain unchanged due to the discretionary power unambiguously bestowed to the

AARC by way of the preexisting 2011 SPD and 2012 Update. Cf. McKnight v.

Southern Life and Health Ins. Co., 758 F.2d 1566, 1570 (11th Cir. 1985) (“ERISA

provides that the summary shall be an accurate and comprehensive document that

reasonably apprises the employees of their rights under the plan.”); id. (“As a

Southern Life employee, McKnight was justified in relying on the summary booklet

to determine his pension rights.”). Accordingly, Mr. Oliver’s Strike Motion is due to

be termed as moot.

V. CONCLUSION

In sum, (1) Mr. Oliver’s SOR Motion is due to be denied; (2) Mr. Oliver’s

Disability Motion is due to be denied; (3) Defendants’ Cross Disability Motion is due

to be granted; (4) Mr. Oliver’s Motion To Add is due to be denied and alternatively

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is due to be termed as moot; (5) Mr. Oliver’s Strike Motion is due to be termed as

moot; and (6) Mr. Oliver’s Compel Motion is due to be denied. The court will enter

a separate final judgment order consistent with this memorandum opinion.

DONE and ORDERED this 27th day of October, 2014.

 

 VIRGINIA EMERSON HOPKINS

United States District Judge

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