Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-06-01996/USCOURTS-ca8-06-01996-0/pdf.json

Parties Involved:
Liberty Life Assurance Company of Boston
Appellee
Ronald H. Rutledge
Appellant

Document Text:

1

 The Honorable Donald P. Lay took permanent disability retirement on January

3, 2007. This opinion is being filed by the remaining judges of the panel pursuant to

8th Cir. Rule 47E. 

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 06-1996

___________

Ronald H. Rutledge, *

*

Plaintiff-Appellant, *

* Appeal from the United States District

v. * Court for the District of Minnesota.

*

Liberty Life Assurance Company *

of Boston, *

*

Defendant-Appellee. *

___________

Submitted: November 13, 2006

Filed: March 30, 2007

___________

Before LOKEN, Chief Judge, and LAY1

 and MELLOY, Circuit Judges.

___________

MELLOY, Circuit Judge.

Plaintiff-Appellant Ronald H. Rutledge appeals a grant of summary judgment

in favor of Defendant-Appellee Liberty Life Assurance Company of Boston (Liberty

Life) on his claim for long-term disability benefits pursuant to a plan under the

Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001-1461.

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 The Honorable Paul A. Magnuson, United States District Judge for the District

of Minnesota.

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Rutledge argues the district court2 erred in finding that Liberty Life did not abuse its

discretion in denying Rutledge continued long-term disability benefits. For the

reasons set forth below, we affirm. 

I. Background

Andersen Corporation (Andersen) hired Rutledge as a factory window

assembler in 1983. Rutledge worked for Andersen for seventeen years. During his

employment at Andersen, Rutledge participated in an ERISA group disability income

policy (the Policy) offered and administered by Liberty Life. The Policy provides for

a twenty-four month period of disability for an employee unable to perform the duties

of his own occupation. After twenty-four months, a participating employee may

receive disability benefits if he is unable to perform “any occupation.” “Any

occupation” is defined as an occupation that the insured person “is or becomes

reasonably fitted [to perform] by training, education, experience, age, [and] physical

and mental capacity.”

Prior to his employment at Andersen, Rutledge was injured in a snowmobile

accident. He suffered a compression fracture of a vertebra that left him with slight

numbness in his left leg and difficulty with urination. These injuries did not hinder

his ability to perform his job at Andersen. 

In 1998, Rutledge began to experience additional physical ailments arising from

the snowmobile accident. In February 2000, Rutledge underwent surgery to relieve

pressure on his spinal cord. On June 27, 2000, Rutledge submitted a disability claim,

declaring himself disabled as a result of the snowmobile accident. Liberty Life

considered his claim and approved “own occupation” disability benefits for Rutledge

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beginning on August 8, 2000. Liberty Life paid Rutledge “own occupation” disability

benefits for the full twenty-four-month period provided by the Policy. 

While he was receiving “own occupation” benefits, Rutledge saw a number of

physicians. In October 2000, Dr. Thomas Rieser, an orthopedic surgeon and the lower

back specialist responsible for Rutledge’s back surgery, examined Rutledge and stated

Rutledge had “no real back pain at this time.” In February 2001, Dr. Neal Melby, a

general practitioner and Rutledge’s primary physician, noted Rutledge was developing

numbness and weakness in his legs. Also in February 2001, Dr. Robert Maxwell, a

neurosurgeon, examined Rutledge and concluded Rutledge had perfect strength in his

legs. Dr. Maxwell noted that any loss of sensation in Rutledge’s legs did not affect

his ability to walk. By May 2001, Dr. Rieser approved Rutledge for work, with

restrictions: Rutledge could not lift more than twenty to thirty pounds and should not

repetitively lift, bend, or twist. In January 2002, Dr. Steven Siegel, a urologist,

performed surgery on Rutledge. In July 2002, Dr. Siegel reported Rutledge had

benefitted from the surgery, but had begun to experience other complications

requiring the attention of a colorectal specialist. 

In February 2002, Liberty Life informed Rutledge his “own occupation”

disability benefits would expire in August 2002. Liberty Life explained it would seek

additional medical evidence supporting Rutledge’s disability claim under the “any

occupation” standard.

In August 2002, Dr. Melby provided conflicting accounts of Rutledge’s

condition. On August 7, Dr. Melby opined that Rutledge had success with his

urological issues. On August 15, 2002, Liberty Life informed Rutledge of its tentative

decision not to provide benefits under the “any occupation” provision. A few weeks

later and after learning about Liberty Life’s decision, Dr. Melby reversed his opinion

of Rutledge’s urological status. Dr. Melby also recorded that Rutledge complained

of numbness in his pelvic region and right lower leg, weakness, chronic pain in his

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lower back, and intense discomfort if he stood for more than one hour. Dr. Melby did

not prescribe any pain medication. Dr. Melby described Rutledge as “essentially []

a paraplegic, although he is able to walk.”

In addition to his physical ailments, in December 2002, Rutledge reported to

Dr. Melby that he suffered from periods of depression. Rutledge declined a

prescription for anti-depressants. There are no records of Rutledge receiving

treatment from a psychiatrist or psychologist. 

While receiving “own occupation” benefits from Liberty Life, Rutledge applied

for Social Security Disability Insurance Benefits. The Social Security Administration

initially denied Rutledge’s application in July 2002. Rutledge appealed, and an

administrative law judge (ALJ) awarded Rutledge benefits in March 2003. In granting

the benefits, the ALJ noted that Rutledge was scheduled to have additional procedures

that might improve his medical condition and recommended Rutledge’s file be

reviewed within a year. 

To confirm Rutledge’s physical limitations, Liberty Life hired a company to

conduct surveillance of Rutledge. On February 18, 2003, an investigator observed

and covertly videotaped Rutledge spending five hours in a local bar. While in the bar,

Rutledge consumed approximately five beers and at least one non-alcoholic beverage

and went to the restroom three times. He sat for three hours before going to the

restroom for the first time. The investigator saw Rutledge walking without limitation

on this day and numerous other days. 

Other physicians were involved in treating Rutledge’s medical problems. Dr.

Susan Congolisi Parker, a colorectal specialist, treated Rutledge. Dr. Parker and Dr.

Siegel, Rutledge’s urologist, agreed in May 2003 the only work restriction Rutledge

required was access to a bathroom. Dr. Melby disagreed with this assessment and

categorized Rutledge as totally disabled in May 2003. 

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Liberty Life referred Rutledge’s file to Dr. John Holbrook, a specialist in

internal medicine, for a complete review. In a report dated July 2, 2003, Dr. Holbrook

noted Rutledge’s medical records did not support Dr. Melby’s conclusions. He found

no objective medical evidence substantiating Dr. Melby’s conclusion that Rutledge

was essentially a paraplegic, and nothing in the file demonstrated Rutledge suffered

from leg weakness or an inability to sit for more than one hour. Dr. Holbrook

concluded Rutledge could work full-time in a sedentary job with minimal restrictions.

Mary O’Malley, a vocational consultant for Liberty Life, reviewed Dr.

Holbrook’s report. In an August 6, 2003 report, O’Malley listed a number of

available jobs Rutledge would be physically capable of performing with his physical

limitations. In reaching her conclusion, O’Malley considered Dr. Holbrook’s

conclusions as to the restrictions required for Rutledge to be able to work. 

On March 29, 2004, Dr. Parker, Rutledge’s colorectal specialist, performed

surgery on Rutledge. Dr. Parker considered the surgery successful and informed

Liberty Life on June 2, 2004, that Rutledge could work without restriction. Liberty

Life then requested documentation from Rutledge to substantiate his continuing claim

of disability. In response to this request, Liberty Life received a letter from Dr. Melby

dated June 30, 2004. Dr. Melby stated Rutledge remained disabled due to bladder and

sphincter problems, numbness in his legs, and chronic pain in his lower back. Dr.

Melby also commented that Rutledge suffered from depression. Dr. Melby considered

no new information in rendering this opinion: Dr. Melby last examined Rutledge in

January 2003 and last spoke to him on August 5, 2003. 

Rutledge completed two self-assessments of his physical condition. In April

2003, Rutledge reported he could sit for twelve hours a day, forty-five minutes to an

hour at a time; stand for four hours a day, forty-five minutes to an hour at a time; and

walk for one hour a day. On March 3, 2004, Rutledge reported he could sit for eight

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hours a day, one hour at a time; stand for two hours, thirty minutes at a time; and walk

for one hour, thirty minutes at a time. When asked what prevented him from engaging

in any gainful employment, Rutledge referred only to his urological and colorectal

problems; he did not mention lower back pain, numbness in his legs, or depression.

Dr. Holbrook conducted another review of Rutledge’s records in July 2004. As

part of his review, Dr. Holbrook contacted Dr. Parker, the colorectal specialist who

performed Rutledge’s surgery. Dr. Parker opined that Rutledge could work full-time

with minimal restrictions. Dr. Holbrook concluded Dr. Melby’s assessment and

Rutledge’s self-reported limitations were inconsistent with the record. Dr. Holbrook

determined Rutledge was capable of working in a full-time, sedentary job, so long as

he had a lifting restriction of twenty pounds and access to a bathroom.

Dr. Anthony Parisi, an orthopedic surgeon, reviewed Rutledge’s file in August

2004. While his review was limited to orthopedic conditions, he concurred in Dr.

Holbrook’s assessment. He indicated Rutledge could work in a full-time, sedentary

job with a lifting restriction of twenty to thirty pounds and no repetitive lifting,

bending, or twisting. 

In August 2004, Patricia Thal, a vocational case manager for Liberty Life,

reviewed the report prepared by Mary O’Malley, in light of the file reviews by Drs.

Holbrook and Parisi. Thal concluded O’Malley’s assessment remained accurate. Like

O’Malley, Thal listed a number of sedentary jobs in the economy Rutledge could

perform. 

On September 2, 2004, Rutledge received a phone message stating he would

receive “any occupation” long-term disability benefits. However, this phone message

was based upon a misreading of Thal’s report, and when Rutledge’s case manager

realized the mistake, Liberty Life officially denied Rutledge’s claim. Liberty Life

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determined Rutledge was not eligible for long-term disability benefits because he did

not qualify under the “any occupation” provision. Liberty Life informed Rutledge of

its decision to deny his claim on October 5, 2004. In a five-page letter, Liberty Life

explained the reasoning behind its decision, highlighting the opinions of Drs. Parker,

Holbrook, and Parisi. The letter noted that Rutledge was capable of work as a

machine operator and was therefore not entitled to “any occupation” benefits.

Rutledge received long-term disability benefits throughout the time Liberty Life

considered his claim. 

Rutledge appealed Liberty Life’s decision. As part of his appeal, Rutledge

submitted medical records to Liberty Life. The materials submitted addressed

Rutledge’s condition from January 2001 through January 2003 – not his condition at

the time his benefits were denied – and had already been provided to Liberty Life.

Liberty Life denied Rutledge’s appeal. 

Rutledge then filed an ERISA action in the district court, seeking review of

Liberty Life’s denial of continuing long-term disability benefits. The court granted

summary judgment to Liberty Life. The court concluded Liberty Life’s decision was

supported by substantial evidence and, thus, not an abuse of discretion. This appeal

followed. 

II. Discussion

We review the district court’s grant of summary judgment de novo. Smith v.

United Television, Inc. Special Severance Plan, 474 F.3d 1033, 1035 (8th Cir. 2007).

“Where, as here, an ERISA plan gives the administrator ‘discretionary authority to

determine eligibility for benefits,’ we review the administrator’s decision for an abuse

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 A less deferential standard of review would apply if Liberty Life operated

under a conflict of interest or engaged in procedural irregularities. See Woo v. Deluxe

Corp., 144 F.3d 1157, 1160-62 (8th Cir. 1998). Because we conclude no such flaws

existed, a more searching review is not required.

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of discretion.”3 House v. Paul Revere Life Ins. Co., 241 F.3d 1045, 1048 (8th Cir.

2001) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). 

In considering whether Liberty Life abused its discretion, “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.” Groves v.

Metro. Life Ins. Co., 438 F.3d 872, 875 (8th Cir. 2006) (internal quotation omitted).

The essence of the inquiry is whether the decision is supported by substantial

evidence. See McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 924 (8th Cir.

2004) (noting that a reasonable decision is one supported by substantial evidence).

We consider “both the quantity and quality of evidence” in determining whether

substantial evidence supports the decision to deny benefits. Groves, 438 F.3d at 875.

Substantial evidence is “more than a scintilla, but less than a preponderance.” Ferrari

v. Teachers Ins. & Annuity Ass’n, 278 F.3d 801, 807 (8th Cir. 2002) (internal

quotation omitted). 

Applying this deferential standard of review, we conclude substantial evidence

supports Liberty Life’s decision to deny Rutledge long-term disability benefits; thus,

Liberty Life did not abuse its discretion. Liberty Life considered opinions offered by

Rutledge’s many treating physicians and conducted multiple thorough reviews of his

entire medical treatment file. Many of Rutledge’s treating physicians, including the

specialists treating the problems Rutledge himself identified as preventing him from

engaging in any occupation, concluded Rutledge was able to work with minimal

restrictions. Additionally, the physicians retained by Liberty Life to review

Rutledge’s medical file concluded Rutledge was capable of performing sedentary

work with limited restrictions. 

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While one of Rutledge’s physicians, Dr. Melby, maintained that Rutledge was

completely disabled, Liberty Life was not required to accept Dr. Melby’s assessment

of his condition over that of Rutledge’s other treating physicians or the opinions of the

reviewing physicians. See, e.g., Groves, 438 F.3d at 875 (stating that plan

administrator was not required to accept treating physician’s assessment over that of

a reviewing physician). “Where the record reflects conflicting medical opinions, the

plan administrator does not abuse its discretion in finding the employee not to be

disabled.” Delta Family-Care Disability and Survivorship Plan v. Marshall, 258 F.3d

834, 843 (8th Cir. 2001). Moreover, Dr. Melby’s opinion of June 30, 2004 was offered

without a recent examination of or consultation with Rutledge. Dr. Melby provided

no objective evidence to support his opinion. It was not unreasonable for Liberty Life

to reject Dr. Melby’s unsupported opinion and rely upon the opinions of Rutledge’s

other treating physicians, as well as those of the reviewing physicians. See Groves,

438 F.3d at 875 (upholding a plan’s rejection of a treating physician’s opinion when

it was internally inconsistent and offered without support from objective evidence).

Rutledge argues that Liberty Life abused its discretion because: 1) it failed to

consider Rutledge’s medical conditions in combination; 2) it didn’t consider the

Social Security Administration’s grant of disability benefits to Rutledge; and 3) it

failed to employ an independent expert to examine and evaluate Rutledge’s condition.

These arguments fail. First, Liberty Life considered Rutledge’s many medical

conditions and his physical status as a whole in determining he did not qualify for

“any occupation” long-term disability benefits. Dr. Holbrook considered all of

Rutledge’s ailments and the treatments he received in conducting his file reviews.

Although Dr. Parisi limited his opinion to orthopedic issues, Dr. Parisi also considered

Rutledge’s complete medical file in conducting his review. 

Second, there is no evidence in the record Liberty Life failed to consider the

Social Security Administration’s award of benefits. The decision was in the claim

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file, and Liberty Life’s decision was made based upon consideration of the entire file;

Liberty Life was not required to specifically mention each document it considered in

reaching its decision. In addition, the Social Security Administration’s decision was

of little probative value as it was rendered over a year before Liberty Life’s decision

to terminate benefits and before significant changes in Rutledge’s medical status,

including his colorectal surgery. Moreover, Liberty Life was not bound by the Social

Security Administration’s decision. See Farfalla v. Mutual of Omaha Ins. Co., 324

F.3d 971, 975 (8th Cir. 2003) (“[A]n ERISA plan administrator or fiduciary generally

is not bound by an SSA determination that a plan participant is disabled, even when

the plan’s definition of disabled is similar to the definition the SSA applied.”) (internal

quotations and alterations omitted).

 

Finally, Liberty Life was free to rely upon their regular consultants and

employees in considering Rutledge’s claim for long-term disability benefits. An

ERISA plan administrator need not order an independent medical examination when

the insured’s evidence supporting a disability claim is facially insufficient. See Layes

v. Mead Corp., 132 F.3d 1246, 1251-52 (8th Cir. 1998). Three of Rutledge’s own

treating physicians – Drs. Rieser, Parker, and Siegel – all concluded he could work

with minimal restrictions, and these conclusions were supported by objective medical

evidence. Under these circumstances, it was not an abuse of discretion for Liberty

Life not to seek an independent medical examination. 

III. Conclusion

For the foregoing reasons, the judgment of the district court is affirmed. 

______________________________

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