*

The Honorable William W Schwarzer, Senior United States District

Judge for the Northern District of California, sitting by designation.

1

RECOMMENDED FOR FULL-TEXT PUBLICATION

Pursuant to Sixth Circuit Rule 206

ELECTRONIC CITATION: 2004 FED App. 0103P (6th Cir.)

File Name: 04a0103p.06

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

_________________

GARY CARR,

Plaintiff-Appellant,

v.

RELIANCE STANDARD LIFE

INSURANCE COMPANY,

Defendant-Appellee.

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No. 02-2377

Appeal from the United States District Court

for the Eastern District of Michigan at Detroit.

No. 02-70387—Denise Page Hood, District Judge.

Submitted: March 17, 2004

Decided and Filed: April 14, 2004 

Before: ROGERS and COOK, Circuit Judges;

SCHWARZER, Senior District Judge.*

2 Carr v. Reliance Standard Life Ins. Co. No. 02-2377

_________________

COUNSEL

ON BRIEF: Walter J. Goldsmith, Mark H. Fink, MADDIN,

HAUSER, WARTELL, ROTH, HELLER & PESSES,

Southfield, Michigan, for Appellant. Joshua Bachrach,

RAWLE & HENDERSON, Philadelphia, Pennsylvania, for

Appellee.

_________________

OPINION

_________________

WILLIAM W SCHWARZER, Senior District Judge. Gary

Carr appeals the district court’s judgment rejecting his claim

for long-term disability (“LTD”) benefits under the plan

maintained by his employer and administered by the

defendant, Reliance Standard Life Insurance Company

(“Reliance”). 

Carr suffered from severe coronary artery disease and was

an insulin-dependent diabetic. He worked full-time until

June 27, 1999, when he left his position for treatment for

necrotizing fasciitis (“flesh-eating bacteria”). He returned to

work on a part-time basis on August 16, 1999. He continued

to work part-time until January 14, 2000, when he left his

position permanently on account of his disability. After

initially rejecting Carr’s claim for LTD benefits for lack of

sufficient clinical findings, Reliance again reviewed the claim

after Carr filed suit. It determined that Carr was not eligible

for benefits because he did not qualify under the definition of

Total Disability when he ceased being a full–time employee

on June 27, 1999.

The LTD plan provides in relevant part:

“Totally Disabled” and “Total Disability” mean, that as

a result of an Injury or Sickness:
No. 02-2377 Carr v. Reliance Standard Life Ins. Co. 3

(1) during the Elimination Period, an Insured cannot

perform each and every material duty of his/her

regular occupation; and

(2) for the first 60 months for which a Monthly

Benefit is payable, an Insured cannot perform the

material duties of his/her regular occupation;

(a) “Partially Disabled” and “Partial Disability”

mean that as a result of an Injury or Sickness an

Insured is capable of performing the material

duties of his/her regular occupation on a parttime basis or some of the material duties on a

full-time basis. An Insured who is Partially

Disabled will be considered Totally Disabled,

except during the Elimination Period. . . .

(Emphasis added.) Reliance determined that Carr was not

Totally Disabled during the Elimination Period because he

“demonstrated that he was not disabled from Each and Every

material duty of his occupation during the period that he

worked 20 hours weekly in his executive capacity with

several operating units reporting to him between August 16,

1999 and January 15, 2000.” It also determined that Carr

could not recover benefits beginning on January 14, 2000,

when he left work permanently, because his coverage had

terminated as of June 27, 1999, when he ceased being an

active, full-time employee as required under the terms of the

plan.

On cross-motions for summary judgment, the district court

granted Reliance’s motion, rejecting Carr’s claim for benefits

beginning on June 26, 1999. It held that “[i]t is clear from the

Policy language that an employee cannot be partially disabled

during the Elimination Period” and that here “[t]here is

nothing in the medical record that shows that Plaintiff was

unable to perform the material duties of his occupation while

he was working part-time between August 1999 and January

2000.”

4 Carr v. Reliance Standard Life Ins. Co. No. 02-2377

1We reject Carr’s contention that Reliance should be estopped from

receiving the benefit of this provision of the plan because, in response to

a request made prior to the filing of this lawsuit, the company erroneously

sent him an earlier version of the policy which did not give Reliance

discretion to interpret the plan and determine eligibility for benefits. Carr

has failed to establish the elements of an estoppel claim, in particular that

he detrimentally and justifiably relied on actions or representations of

Reliance. See Trustees of the Mich. Laborers’ Health Care Fund v.

Gibbons, 209 F.3d 587, 591 (6th Cir. 2000).

2

Our application of the arbitrary and capricious standard of review

is “shaped by the circumstances of the inherent conflict of interest” arising

from the fact that Reliance both funded the plan and determined eligibility

for benefits. Borda v. Hordy, Lewis, Pollard & Page, P.C., 138 F.3d

1062, 1069 (6th Cir. 1998) (internal quotation omitted). However, we

have not found that this inherent conflict of interest in any way influenced

Reliance’s decision. See Peruzzi v. Summa Med. Plan, 137 F.3d 431, 433

(6th Cir. 1998).

Carr timely appealed. The district court had jurisdiction

under 29 U.S.C. § 1132(e) and 28 U.S.C. § 1331, and we

have jurisdiction under 28 U.S.C. § 1291.

DISCUSSION

Under the terms of the plan at issue, Reliance serves as the

claims review fiduciary with respect to the insurance policy

and the plan and has the discretionary authority to interpret

the plan and the insurance policy and to determine eligibility

for benefits.

1

 We therefore review its “decision to deny

benefits using ‘the highly deferential arbitrary and capricious

standard of review.’”2 Killian v. Healthsource Provident

Adm’rs, 152 F.3d 514, 520 (6th Cir. 1998) (quoting Yeager v.

Reliance Standard Life Ins. Co., 88 F.3d 376, 380 (6th Cir.

1996)). 

Carr contends that Reliance and the district court erred in

interpreting the plan’s definition of “Total Disability” to bar

recovery if the applicant can perform any of his material

duties during the Elimination Period. He argues that “the

Policy unmistakably manifests the intent and understanding
No. 02-2377 Carr v. Reliance Standard Life Ins. Co. 5

that an Injured who, during the Elimination Period, is unable

to perform one or more of the material duties of his/her

regular occupation — even on a part-time basis — will be

deemed Totally Disabled.” 

We disagree. The plan plainly limits finding “Total

Disability” to a claimant who “cannot perform each and every

material duty of his/her regular occupation” during the

Elimination Period. If a claimant can perform even one

material duty of his regular occupation during the Elimination

Period, he is not totally disabled. See Gallagher v. Reliance

Standard Life Ins. Co., 305 F.3d 264, 275 (4th Cir. 2002)

(“Because Gallagher could perform certain occupational

duties prior to [the date he resigned] and has not presented

evidence demonstrating that his condition became more

severe on or after [that date], we conclude that Gallagher has

not submitted objectively satisfactory evidence that he was

unable to perform each and every material duty of his

occupation during the elimination period.”); Porter v.

Metropolitan Life Ins. Co., 17 F. Supp. 2d 500, 506 (D.S.C.

1998) (affirming company’s determination that analogous

provision means “that it need only demonstrate that [the

applicant] is not wholly and continuously unable to do her job

(i.e. that there is some part of her job that she can do)”). 

Here, it is undisputed that Carr returned to work on

August 16, 1999, before the end of the Elimination Period,

and continued to work part-time until January 14, 2000. He

worked approximately twenty hours per week and earned

roughly $4,400 every two weeks. This record supports the

finding that during the Elimination Period, Carr was not

unable to “perform each and every material duty of his

[occupation].” Indeed Carr’s situation falls squarely within

the plan’s definition of “Partial Disability” since he was

“capable of performing the material duties of his[] regular

occupation on a part-time basis.” The plan clearly states that

an insured who is only Partially Disabled during the

6 Carr v. Reliance Standard Life Ins. Co. No. 02-2377

3

Carr also argues that his reasonable expectations concerning the

interpretation of the plan should control. He concedes on reply, however,

that this contra proferentum rule applies only where contractual language

is found to have more than one interpretation. See Marquette Gen. Hosp.

v. Goodman Forest Indus., 315 F.3d 629, 632 n.1 (6th Cir. 2003). As

discussed above, the plan is unambiguous on its face, rendering Carr’s

reasonable expectations irrelevant.

Elimination Period will not be considered Totally Disabled

and thus eligible for benefits.3

Because we conclude that Reliance did not act arbitrarily or

capriciously in denying Carr’s claim for LTD benefits, the

judgment of the district court is AFFIRMED.