United States Court of Appeals

Fifth Circuit

FILED

August 20, 2007

Charles R. Fulbruge III

Clerk

UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 06-11370

Summary Calendar

ANDREA D. PYLANT,

Plaintiff-Appellant,

v.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, and

THE FIRST AMERICAN CORPORATION GROUP LIFE, MEDICAL, DENTAL, 

DISABILITY BENEFITS TRUST NO. 502,

Defendants-Appellees.

Appeal from the United States District Court for the

Northern District of Texas, Dallas Division

Before DAVIS, WIENER, and BENAVIDES, Circuit Judges.

BENAVIDES, Circuit Judge:

Plaintiff-Appellant Andrea Pylant appeals the district court’s

grant of summary judgment in favor of Defendants-Appellees Hartford

Life and Accident Insurance Co. (“Hartford”) and The First American

Corporation Group Life, Medical, Dental, Disability Benefits Trust

No. 502 (“Plan”). This case arises from the termination of longterm disability benefits (“LTD benefits”) by the administrator of

an employee welfare benefit plan governed by the Employee

Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §
2

1001, et seq. We AFFIRM. 

We review a grant of summary judgment de novo, using the same

criteria as the district court. Hanks v. Transcont. Gas Pipe Line

Corp., 953 F.2d 996, 997 (5th Cir. 1992). Summary judgment is

appropriate if the record reflects “that there is no genuine issue

as to any material fact and that the moving party is entitled to a

judgment as a matter of law.” FED. R. CIV. P. 56(c); see also

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). A court’s role

at the summary judgment stage is not to weigh the evidence or

determine the truth of the matter, but rather to determine only

whether a genuine issue exists for trial. Anderson v. Liberty

Lobby, Inc., 477 U.S. 242, 249 (1986). A genuine issue of material

fact exists “if the evidence is such that a reasonable jury could

return a verdict for the nonmoving party.” Id. at 248. 

Pylant worked as a technical writer for First American

Financial Corporation (“First American”) from September 2000 until

November 2001, when she quit because of fatigue and pain. In

February 2002, Pylant filed a claim for LTD benefits after being

diagnosed with chronic fatigue, Epstein Barr, cytomegalovirus, and

psoriatic arthritis. Her claim was approved on May 30, 2002, and

she began receiving LTD benefits. In October 2002, Hartford

reevaluated her eligibility for LTD benefits and, based upon an

Attending Physician Statement (“APS”) and Physical Capabilities

Form (“PCF”) completed by Pylant’s doctor, and her own self-
3

completed questionnaire, determined that Pylant continued to

qualify for benefits.

Hartford again reviewed Pylant’s eligibility for LTD benefits

in June 2003. This time, Pylant’s claimant questionnaire and the

APS and PCF presented divergent accounts of Pylant’s abilities.

While the questionnaire stated that she could perform almost all

activities of daily living without assistance, and occasionally

attended church and her children’s sporting activities, the APS and

PCF stated that she could never drive a vehicle and could only sit,

stand, or walk for less than fifteen minutes at a time. Based upon

this discrepancy, Hartford’s claims examiner referred Pylant’s

claim to Hartford’s Special Investigations Unit (“SIU”) for further

fact-gathering. 

Hartford’s SIU conducted video surveillance of Pylant’s daily

activities for two days in August 2003. During that time, the SIU

observed and recorded Pylant engaged in various activities that

contradicted assessment in the APS and PCF of her condition,

including driving her children to school, removing a child weighing

in excess of twenty pounds from the rear of her car, carrying that

child with both hands into her home, and holding an infant for

eighteen minutes while standing. Based on this surveillance, SIU

conducted an in-person interview with Pylant. Pylant admitted that

she was readily capable of performing the observed activities and

conceded that she had absolutely “no limitations or restrictions”

on how long she could sit. 
4

In September 2003, Hartford requested that Pylant submit

another claimant questionnaire and have her treating physician

complete another APS and PCF. Pylant’s revised questionnaire

reiterated her disabilities and contradicted her interview

admissions by stating that she could not sit for more than fifteen

minutes. Her doctor’s APS and PCF opined that she could sit,

stand, walk, and drive for approximately an hour at a time. Upon

receiving these documents, Hartford sent Pylant’s doctors copies of

the surveillance video and in-person interview, and asked them,

based on their contact with Pylant and those materials, whether she

could return to work subject to various, specified limitations.

One doctor left a voice mail stating that she agreed that Pylant

could return to work with those limitations. The other doctor

responded to Hartford’s request by stating that Pylant could return

to work on a full-time basis with the restrictions stated.

Hartford then notified Pylant that further benefits would not be

payable beyond January 31, 2004. 

Pylant appealed Hartford’s discontinuation of her LTD

benefits. Hartford referred her claim to another doctor, Dr. David

Trock, for independent medical review. Dr. Trock reviewed Pylant’s

medical records and surveillance video and contacted her previous

doctors. Dr. Trock subsequently concluded that Pylant was able to

return to work in a sedentary capacity with restrictions. Hartford

decided to uphold its termination of Pylant’s LTD benefits and sent

Pylant a letter on January 7, 2005, advising her that the appeal
5

had been denied. Pylant filed this lawsuit on February 24, 2005,

and the district court granted summary judgment for Hartford. 

In analyzing a claim for benefits allegedly due under an ERISA

plan, the district court reviews the plan administrator’s

determination for abuse of discretion when the plan expressly gives

the administration discretionary authority. Vecher v. Alexander &

Alexander Inc., 379 F.3d 222, 226 (5th Cir. 2004). If an

administrator’s decision is supported by substantial evidence, the

court must affirm that decision. Ellis v. Liberty Life Assurance

Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004). However, if

there is a potential conflict of interest, the abuse of discretion

inquiry is altered. Vega v. National Life Ins. Services, Inc., 188

F.3d 287, 297 (5th Cir. 1999). Here, because Hartford is both the

insurer and the administrator, but Pylant has not produced evidence

showing any greater conflict, Hartford’s decision is afforded “only

a modicum less deference” than it would receive in other

circumstances. Id. at 301. 

As a preliminary matter, Pylant argues Hartford incorrectly

defined the Plan term “your occupation,” which serves to establish

the minimal baseline of ability necessary to perform her job,

through reference to the Department of Labor’s Dictionary of

Occupational Titles, rather than according to the duties she

actually performed as a technical writer for First American. As a

result, the essential duties of her occupation were lesser than
6

those she actually performed with First American. Moreover, Pylant

argues that Hartford incorrectly included functional limitations in

her job description to accommodate her disability.

This Court uses a two-step analysis in determining whether a

plan administrator abused its discretion in construing plan terms.

Rhorer v. Raytheon Eng’rs & Constructors, Inc., 181 F.3d 634, 639

(5th Cir. 1999). First, we determine the legally correct

interpretation of the plan and whether the administrator’s

interpretation accords with that interpretation. Id. If that

construction is legally sound, then no abuse of discretion occurred

and the inquiry ends. Id. at 639–40. If, however, we conclude

that the administrator has not given the plan the legally correct

interpretation, we determine whether the administrator’s

interpretation constitutes an abuse of discretion. Id. at 640. A

substantial factor in determining whether the administrator’s

interpretation is a legally correct interpretation is whether the

interpretation is “fair and reasonable.” Lain v. UNUM Life Ins.

Co. of Am., 279 F.3d 227, 244 (5th Cir. 2002). 

The district court cited to a district court opinion from the

Eleventh Circuit in determining that reference to the Department of

Labor’s Dictionary of Occupational Titles was appropriate because

“insurers issuing disability policies cannot be expected to

anticipate every assignment an employer might place upon an

employee outside the usual requirements of his or her occupation.”
7

Richards v. Hartford Life & Accident Ins. Co., 356 F.Supp. 2d 1278

(S.D. Fla. 2004), aff’d, 153 Fed. Appx. 694 (11th Cir. 2005). We

agree. Moreover, while Pylant argues that Hartford’s inclusion of

“functional limitations” in the definition of her occupation was

legally incorrect, courts have consistently upheld administrative

claim denials where medical evidence indicates that some

limitations would enable the employee to perform sedentary work.

See, e.g. Walker-Stewart v. Fed. Express Corp., No. H-04-2187, 2005

WL 1185799, at *7 (S.D. Tex. 2005)(upholding denial of benefits

when treating physician and occupational therapist cleared

plaintiff for work with restrictions); Graham v. L&B Realty

Advisors, Inc., No. 3:02-CV-0293-N, 2003 WL 22388392, at *3–4 (N.D.

Tex. Sept. 30, 2003) (upholding denial where physician cleared

plaintiff for work with restrictions). In sum, we find that

Hartford’s interpretation was fair and reasonable, and that

Hartford did not abuse its discretion by relying on the Department

of Labor Dictionary to determine Pylant’s job duties.

Turning to Pylant’s argument that there is no substantial

evidence that she can perform her occupation given her cognitive

problems and inability to do frequent keyboarding, Hartford based

its decision on various sources. The surveillance videotape showed

a mobile person capable of performing a sedentary occupation. When

interviewed post-surveillance, Pylant herself conceded that she

could sit without restriction, contradicting her previous and later
8

assertions. Pylant’s own treating physicians stated that she could

return to work as a technical writer. The independent doctor to

whom Hartford subsequently referred Pylant agreed with that

assessment. 

It is true that one of the treating physicians later retracted

his statement and asserted that Pylant had “a lot of pain and

cognitive problems” and “was taking some medications that affect

her cognitive function,” but he only did so during the appeals

process, after meeting with Pylant’s attorney. Moreover, he never

mentioned either the type of medications taken or the extent to

which Pylant was affected. During Pylant’s interview, she stated

that she was taking no medications and had not filled a

prescription relating to her disability in a year. As such,

Hartford could rightly afford the doctor’s retraction and

subsequent statements lesser weight. See Gooden v. Provident Life

& Accident Ins. Co., 250 F.3d 329, 333-34 (5th Cir. 2001) (finding

no abuse of discretion when administrator did not give treating

physician’s changed opinion determinative weight because it was

contrary to physician’s previous opinion and was unaccompanied by

evidence that plaintiff’s medical condition had changed since most

recent evaluation). 

Even viewing all evidence in a light most favorable to Pylant,

it is apparent that Hartford based its decision on substantial

evidence. See Sweatman v. Commercial Union Ins. Co., 39 F.3d 594,
9

601–03 (5th Cir. 1994) (finding no abuse of discretion when

administrator relied on independent review of medical records and

hired investigator to interview plaintiff). Consequently, Hartford

did not abuse its discretion in terminating Pylant’s LTD benefits,

and the district court did not err in granting summary judgment as

there was no question of material fact. See FED. R. CIV. P. 56(c).

For the foregoing reasons, we AFFIRM the district court.