2007 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit 3-13-2007 

# D a s v . UNUM Li fe Ins C o P r e c e de nt i al or N on-P r e c e de nt i al : N on-P r e c e de nt i al D ocke t N o . 05-2408

F o llow thi s and a dd it ion al work s at : http://d i git alc ommon s .l a w . vi ll anova . e du/thir dc ir c uit_2007

Thi s de c i sion i s br ou ght t o you for f r e e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit at V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2007 D e c i sion s b y an author i z e d a dmini s tr at or of V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. F or mor e inform at ion, p le as e c ont a ct Be n j amin . C arl s on@l a

w . vi ll anova . e du . Re c omme nde d C it at ion " D as v . UNUM L i fe In s C o " (2007). 2007 D e cisio n s . P ape r 1495. http://d i git alc ommon s .l a

w . vi ll anova . e du/thir dc ir c uit_2007/1495Honora ble Dickinson R. Debevoise, Senior District Court Judg e for the District of New * J ersey , sitti ngby

designation. NOT P RE CE DE NT I AL UN I TED STATES CO UR T OF A PP EALS F O R T H E T H IR D C IR C U IT

____________________________________

N o. 05- 2408

____________________________________

RI TA D A S, A ppel l ant v. U N U M L I FE I N SU R A N C E C O M PA N Y O F A M E R I C A and TH E PEN N SY LV A N I A H EA LTH CA RE G RO U P I N SU RA N CE TR U ST

____________________________________ A p p ea l from the U n it ed S tat es D istri ct C o u rt F o r th e E a ste rn D istric t o f P e n n sy lv a n ia D . C . C i vi l N o. 04- 0971 D i s t r i ctJ udge: T he H onor abl e Ti m othyJ . Savage

____________________________________ Subm i t t ed U nderT hi r d C i r cui tL A R 34. 1( a)

J anuary30, 2007

____________________________________ B efor e: B A R R Y and R O T H , C i r cui tJ udges , and D E B E V O I SE , Seni orD i s t r i ctC our tJ udge * ( O pi ni on Fi l ed: M ar ch 13, 2007)

____________________________________

OP I NI ON

____________________________________2

D ebevoi s e, Seni or D i s t ri ct C ourt Judge A ppel l ant , R i t a D as ( “D as ”) , br oughtan ac t i on agai ns tdefe ndant s , U N U M L i fe I ns ur ance C om panyof A m er i ca ( “U N U M ”) and The Pennsy l vani a H eal t hcar e G r oup I n s u r a n c e Tru s t( “ He a l t h c a r e Tru s t ” ) , p u r s u a n tt o th e Em p l o y e e Re t i r e me n tI n c o me Secur i t yA ctof 1974 ( “ER I SA ”) , as amended, 29 U . S. C . §§1001- 1461. She al l eged that U N U M ’s te rm in a tio n o f h e r lo n g ter m d isa b ili tyb e n e f its u n d e r a U N U M g ro u p d isa b ili ty pol i cy( t he “Pol i cy ”) w as arbi t r aryand ca pr i ci ous beca us e U N U M ’ s fi ndi ng thather perm anenthear i ng l os s i n bot h ear s does notr enderhert ot al l ydi s abl ed underthe Pol i cy t erm s w as nots uppor t ed bys ubs t ant i al evi dence . T he D i s t r i ctC our tdeni ed D as ’ s m ot i on fors um m aryj udgm entand gr ant ed defe ndant s ’ m ot i on fors um m aryj udgm ent . D as appea l ed pro se , al l egi ng thatboth the admi ni s t r at i ve dec i s i on and the j udgm entof the D i s t r i ctC our tw er e err oneous as a mat t er of l aw beca us e ea ch w as bas ed on a l aborm arkets ur veythatcont ai ned err oneous and u n t ru t h f u l i n f o r ma t i o n . W e wi l l a f

f i r m. I . Backg r ound D a s h a s a B a c h e lo r o f

S c ien c e d e g re e in c h e m istry , a M a ste r o f S c ien c e d e g re e in bi ochemi s t r y , and a Ph. D . i n m ol ecul arbi ol ogyfr om C al cut t a U ni ver s i t y . She began he r e m p lo ym e n t at T h o m a s J e f f e rso n U n iv e rsitya s a R e se a rc h A ss ista n t P ro f e ss o r in N eur os ur geryi n 1994. She w or ked as a benc h s ci ent i s ti n a l abor at ory , s tudy i ng hum an br ai n tum or s . H erj ob dut i es i nvol ved per form i ng r es ear ch, over s eei ng m edi cal3

t echn i ci ans, and t eaching laborat oryt echn i qu es t o m edical stud ents . In 1 9 9 5 , D a s b e g a n to lo s e h e r h e a ri n g a n d in 1 9 9 7 b e g a n u s in g h e a ri n g a id s . W ith in tw o y e a rs, h e r b ilate ra l se n so rin e u ra l h e a rin g lo ss in b o th e a rs d e ter io ra ted to appr oxi m at el y96% , and i n 1999, D as t ook a medi cal l eave of abs ence and appl i ed for dis abil i t yben efi t s. T h e H ea lth ca re T rust, ad m inistrator o f T h o m as Je ff erso n U n iversity ’s l o n g term di s abi l i t ybenef

i t s pr ogr am, had pur chas ed a gr oup di s abi l i t ypol i cyfr om U N U M . T he Pol i cypr ovi ded fort w o defi ni t i ons of di s abi l i t y , one appl i cabl e t o t he fi r s t24 m onths of ben efi t s, t he o t her app l i cable t o the peri od thereaft er. F or the fir st24 m on t hs of b enef i t s, t he P oli cy ’s defini t i on of d i sabi l i t yi s as fol l ow s:

Y o u a re d isa b led w h e n U N U M d e ter m in e s th a t

- y ou ar e l i m i t ed fr om per form i ng the mat er i al and s ubs t ant i al dut i es of y ourr egul aroccupa t i on due t o y ours i cknes s ori nj ury ; and

- y ou have a 20% orm or e l os s i n y ouri ndexed mont hl yearni ngs due t o t h e s a m e s i c k n e s s o ri n j u r y. (S . A p p . , E x h . C , p . 3 0 (em p h asis in o ri g inal)). A f ter 2 4 m o n th s o f

b e n e f its h a v e b e e n p a id , the P o licyd e f in iti o n f o r d isa b ili ty s hi ft s t o an “a nygai nful occupa t i on” s t andar d, and bene fi t s w i l l cont i nue onl yi f:

U N U M d e ter m in e s th a t d u e to th e sa m e sic k n e ss o r in ju ry , y o u a re u n a b le to p erf o rm the d u ti es o f a n yg ainf u l occ u p ati o n fo r w h ich y o u are r eas onabl yfi t t ed byeduca t i on, tr ai ni ng orexper i ence . (S . A p p . E x h . C , p . 3 0 (em p h asis in o ri g inal)).4

T he Pol i cydefi nes “gai nful occupa t i on” t o m ean “ an occ upat i on thati s orcan be expec t ed t o pr ovi de y ou w i t h an i ncome atl eas tequal t o y ourgr os s di s abi l i t ypaym ent w ith in 1 2 m o n th s o f

y o u r re tu rn to w o rk .” (S . A p p ., E x h . C , p . 5 1 ). T h e tes t f o r th e p o st24- m ont h per i od i s no l ongerfocus ed on the i ns ur ed’ s abi l i t yt o per form the dut i es of her ow n occupa t i on. I ti s w hethers he i s abl e t o per form the dut i es of anygai nful occupa t i on forw hi ch s he i s r eas onabl yfi t t ed byeduca t i on, tr ai ni ng orexper i ence . U N U M det erm i ned, on t he bas i s of i nform at i on thatD as s uppl i ed, thati tw as un safe for a t otal l ydeaf person, such as D as, t o p erform l abo rat oryres earch. T hu s, U N U M found thats he w as l i m i t ed fr om per form i ng the mat er i al and s ubs t ant i al dut i es of herr egul aroccupa t i on due t o herdeaf nes s and aw ar ded herbenef i t s forthe fi r s t24 m ont hs . A ft erpay i ng D as benef i t s fortw o y ear s , U N U M conduct ed a r evi ew , as r equi r ed byt he Pol i cy . I tdet erm i ned thatt her e w er e a numberof gai nful occupa t i ons s ui t abl e for D a s g iv e n h e r h e a rin g lo ss , an d h e r e d u c a tio n , train in g a n d e x p e rie n c e , an d th a t, t h e r e f o r e , D a s w a s n o l o n g e re n t i t l e d t o f u r t h e rb e n e f

i t s u n d e rth e t e r m s o f

th e P o l i c y. O n February19, 2001, U N U M not i fi ed D as thatt o r emai n ent i t l ed t o benef i t s aft er 24 m ont hs of paym ent s , s he mustbe unabl e t o per form the mat er i al and s ubs t ant i al dut i es of anygai nful occupa t i on forw hi ch s he i s r eas onabl yfi t t ed byeduca t i on, tr ai ni ng or e x p e r i e n c e . I n r e s p o n s e , Da s ’ s a t t e n d i n g p h y s i c i a n , Dr . T h o ma s Wi l l c o x , a d v i s e d UNUM th a t D a s’s c o n d iti o n re stric ted h e r f ro m w o rk in g in “ a n ye n v iro n m e n t w h e re h e r sa f e tyis co m p rom ised d u e to h er h ea ri n g loss.” H e f u rth er a d v ised that D as h ad li m it ed w o rk5

capa ci t ybeca us e s he “c annotcomm uni cat e thr ough audi t orychanne l s , ” and thats he

“ n e e d s to b e a b le to lip re a d a n d w ri te .” O n A u g u st 2 3 , 2 0 0 1 , U N U M re q u e ste d a T ra n sf e ra b le S k ill s A n a ly sis (“ T S A ” ) to fur t heras s es s w hethert her e w as anygai nful occupa t i on s ui t abl e forD as . B as ed on the T S A , U N U M id e n tifie d f o u r su itab le g a in f

u l o c c u p a tio n s: B io c h e m ist, M icr o b io lo g ist, G enet i ci s tand W r i t er , T echni cal Publ i cat i ons . U N U M not i fi ed D as of the r es ul t s of the vo cat i on al revi ew and t hat herben efi t s w ou l d en d eff ect i ve D ecem ber 27, 2001 . Ital so a d v ise d D a s th a t sh e h a d th e rig h t to a p p e a l th e d e n ial. D a s a p p e a led , su p p o rtin g h e r a p p e a l w ith lette rs f ro m D r. W ill c o x a n d D r. D a v id W . A n d re w s, h e r f

o rm e r su p e rv iso r. D r. W ill c o x g a v e h is o p in io n th a t D a s is in c a p a b le o f w o rkin g in D r. A n d rew s’s rese arc h labo ratoryb ec au se o f sa fe tyco n ce rns. D r. A ndr ew s , w r i t i ng i n t he “c apac i t yof R i t a D as ’ s phy s i ci an and a s an A s s oci at e Pr ofes s or i n t he D epart m entof N eur os ur geryatT hom as J eff er s on U ni ver s i t y ” conc l uded thatD as

“ sh o u ld n o t co n tin u e h e r w o rk a s a m o lec u lar b io lo g ist” b e c a u se o f “ v e ryse rio u s s a f

e ty conce r ns . ” O n Ja n u a ry2 5 , 2 0 0 2 , af ter re v iew in g th e se lette rs, U N U M u p h e ld its d e n ial, i nform i ng D as t hati ) D as had pr evi ous l yexpr es s ed an a bi l i t yand i nt er es ti n r es ear ch publ i s hi ng i n a non- l abor at or ys ett i ng, and i i ) s he w as capa bl e of w or ki ng i n othergai nful em p loym en t bas ed o n h er e d u ca ti o n , tr ainin g an d ex p erien ce . In re sp o n se to D as’s cont i nued di s agr eement , U N U M rul ed outanypos i t i on r equi r i ng w or k i n a l abor at oryand6

rul ed outt he “w r i t er , t echni cal publ i cat i ons ” pos i t i on. I tr eques t ed fr om i t s aff i l i at e, G E N E X , a l aborm arkets ur veyi n w hi ch tw o addi t i onal occupa t i ons w er e i dent i fi ed: onli n e c o ll eg e ins tru ctor a n d o n -l ine s cien ti fic res ea rch er. I n t he cour s e of thi s s ur vey , G E N E X comm uni cat ed w i t h a numberof o rg a n iza tio n s th a t as sis t d e a f in d iv id u a ls w ith e m p lo ym e n t, i n c lu d in g th e M a ss a c h u se tts C om m i s s i on fort he D eaf , t he N ew J er s eyD epart m entof H um an Servi ces , G al l audet U n iv e rsity , the N e w H a m p sh ire D e p a rtm e n t o f V o c a tio n a l R e h a b ili tatio n , the C a lifo rn ia D epart m entof V ocat i onal R ehabi l i t at i on and the Penns y l vani a D i vi s i on of V ocat i onal R ehabi l i t at i on. Fort he mostpart , t hes e age nci es agr eed i n gener al t erm s thatw or k i n onlin e re se a rc h a n d a s a n o n -lin e in stru c to r w e re o c c u p a tio n s th a t “th e in su re d c o u ld pot ent i al l yper form ” or“w er e w or ki ng ar eas of expl or at i on” or“appe ar ed t o be good choi ces . ” G E N E X comm uni cat ed w i t h s i x empl oy er s aboutthe pos i t i on of “i ns t ruct or , onlin e .” T h e se in c lu d e d P e n n sy lv a n ia S tate U n iv e rsity , U n iv e rsityo f M iss o u ri, U n iv e rsity of Phoeni x, Seatt l e Paci fi c U ni ver s i t y , U ni ver s i tyof M as s achus et t s - B os t on, and U ni ver s i t yof Fl or i da. T hes e uni ver s i t i es al m os tuni form l yr es ponded thats uch a pos i t i on exi s t ed, buti n eac h cas e s t at ed thati thad no openi ngs . O ne r es ponded thati tfi l l ed s uch a p o s i t i o n f

r o m w i t h i n t h e u n i v e r s i t y. Fi nal l y , G E N E X comm uni cat ed w i t h s even e m pl oy er s aboutthe pos i t i on of “onl i ne ed i t or, sci enti fi c l i t erature. ” In i t s execu t i ve sum m aryof the res ult s of i t s i nq uir i es,The e x ecutive summar y ref erred to interview s of sixemployers. Theprec eding 1 pa ragra ph s o f t heRepo rt de sc ribe d s e ven e mpl oye r interv ie ws .

7 t he G E N E X r epor ts t at ed:

S ix e m p lo y e rs w e re c o n tac ted a b o u t th e p o sitio n o f o n -lin e sc ien tific 1 re se a rc h e rs. O f

th e six , fiv e e m p lo y e rs h ire tele c o m m u tin g sc ien tific rese arc h ers. O n e e m p loy er h ir ed o n lyo n -si te resea rch ers. T h ree em p loy ers had openi ng foron- l i ne r es ear cher s . T he fi ve empl oy er s thathi r e onl i ne re se a rc h sta f

f a g re e d th a t th e c laim a n t is a h ig h lyq u a lifie d a p p lica n t. T h e ir onl yconce r n w as w hetherthe ( s i c) s he has acc es s t o t he t echnol ogy nece s s aryt o per form the s ucce s s ful funct i ons of the j ob. G E N E X set fo rth the re su lt s o f it s lab o r m ark et su rve yin a J u n e 1 0 , 2 0 0 2 rep o rt ( S. A pp, E xh. B , pp. 408, ets eq. ) . R el y i ng on t he r epor t , U N U M r eaf fi rm ed i t s r ej ect i on of D as ’ s l ong t erm di s abi l i t ycl ai m . I ts o advi s ed D as byl et t erdat ed J une 13, 2002. D a s p e rsis ted in p u rsu it o f h e r c laim , reta in in g D a le G . L a tti m o re , E sq ., to r epr es enther . H e obt ai ned a c opyof the G E N E X r epor t , and D as w r ot e t o t he var i ous ent i t i es w i t h w hi ch G E N E X had comm uni cat ed. H erl ett er s i n eac h i ns t ance s t at ed:

I am w r i t i ng i n connec t i on of ( s i c) m ydi ffi cul t yi n i dent i fy i ng a s ui t abl e j ob acc or di ng t o m yeduca t i on and expe r i ence as a M ol ecul arB i ol ogi s tand I w a s s u p p lied w ith th e n a m e o f y o u r o rg a n iza tio n w h o h e lp p e o p le w ith th is ki nd of pr ofound hea r i ng l os s i n i dent i fy i ng s ui t abl e j obs acc or di ngl y . I am a t t a c h i n g a c o p yo f

myr e s u me a n d a l e t t e rf r o m mys u p e r v i s o rwi t h wh o m I w or ked unt i l 1999. I f y ou can he l p m e i n i dent i fy i ng a s ui t abl e j ob a c c o rd in g to m yq u a lific a tio n a n d e x p e rie n c e a n d a h e a rin g lo ss o f 9 6 % in bot h ear s . E s s ent i al l ythe j ob thatacc om m odat e ( s i c) deaf m ol ecul ar bi ol ogi s t . T hank y ou. (S . A p p . , E x h . B , p p 3 6 2 , et seq . ). T hes e l ett er s pr oduced a few r es pons es . T he N ew J er s eyD i vi s i on of V ocat i onal R e h a b ili tativ e S e rv ice s o f f e re d to a ss ist D a s c o m p e n sa te f o r h e r h e a rin g lo ss a n d to8

sec u re e m p loym en t. T h e U n iversityo f M issou ri resp o n d ed that itco u ld o n lyh ir e U n iv e rsityo f

M iss o u ri f

a c u lty . O ’R e ill y& A ss o c iate s, a p u b lish in g c o m p a n y , sta ted it h a d n o w a yto h e lp D a s id e n tifya su itab le jo b . S a g e P u b lica tio n s in v ited D a s to su b m it an appl i cat i on forempl oym ent , advi s i ng herthat“[s ] houl d a s ui t abl e openi ng l at erar i s e, w e maycont acty ou t o det erm i ne y ouri nt er es tatthatt i m e. ” The U ni ver s i t yof Fl or i da advi s ed D as t hatt her e w as no per s on t her e bythe name of D ean N or m an, t o w hom s he had addr es s ed herl ett er , and thati n anyevent , the U ni ver s i t ydi d notpr ovi de the ki nd of s ervi ces s he r eques t ed. T he C al i forni a D epart m entof V ocat i onal R ehabi l i t at i on r es ponded thati tw as nots ur e w hatD as w as as ki ng of i t , comm ent i ng thats i nce D as l i ved i n N ew J er s ey , i tw as “notatal l s ur e how C al i forni a ca n hel p y ou. ” The U ni ver s i t yof Phoeni x O nl i ne s t at ed, “W e have r evi ew ed y ourr es um e and a l t hough y ou have out s t andi ng qual i fi cat i ons , w e ar e unabl e t o i nvi t e y ou t o appl y , atthi s t i m e, bas ed on our curr entneeds . ” In f u rth e r p u rsu it o f

D a s’s c a u se , o n D e c e m b e r 2 1 , 2 0 0 2 , M r. L a tti m o re w ro te to U N U M , not i ng t he var i ous agenc i es upon w hi ch the G E N E X R epor tr el i ed and s t at i ng,

“ [ m] yc l i e n th a s s p e n tt h e p a s tf o u rmon t h s tr y i n g t o f

o l l o w up wi t h th o s e a g e n c i e s . To date s he h as been un able t o ident i fyor l ocate anyj ob that exi st s w i t h an yof these a g e n c ies th a t sh e w o u ld b e c a p a b le o f p e rf o rm in g . In f

a c t, M s. D a s h a s b e e n u n a b le to l ocat e anyj ob atal l t hats he ca n do w i t h herdi s abi l i t y . ” M r . L att i m or e as ked for“pr om pt r e c on s i de r a t i on of

t he de c i s i on t o t e r mi na t e M s . D a s ’ s l on g t e r m di s a bi l i t ybe ne fi t s . ” ( S.9

A p p . , E x h . B , p p . 3 5 6 , et. seq . ). U N U M r es ponded t o M r . L at t i m or e’ s l ett eron J anuary17, 2003, not i ng thatthe m at er i al t hatM r . L att i m or e had s ubm i t t ed on D ece m ber21, 2002 addr es s ed the av ail ab il ityo f jo b s w ith in the tw o p erti n en t categ o ri es, no t th e c ap ac ityo f D as to p erf o rm t he j obs , w hi ch w as t he r el evantques t i on. U N U M s t at ed that“[t ] her e has been no i nform at i on s ubm i t t ed thatw oul d i ndi cat e thatei t herof thes e tw o occupa t i ons does not exi s tw i t hi n t he nat i onal economyorthatM s . D as cannotper form thes e occ upat i ons due to h e r h e a rin g lo ss .” U N U M c o n c lu d e d th a t it s p re v io u s d e c isio n to d e n yf u rth e r b e n e f

its w a s c o rre c t an d u p h e ld it, n o tin g “ [ y ]o u h a v e e x h a u ste d a ll ad m in istra tiv e re m e d ies in reg ard to M s. D as’s a p p ea l fo r disab il ityb en ef it s. ” (S . A p p . , E x h . B , p p . 3 4 6 -47 ). I I . D i s t ri ct C ourt P roce edi ngs F o l l o wi n g t h e f

i n a l r e j e c t i o n o f

h e rc l a i m, Da s b r o u g h tth i s a c t i o n u n d e rE RI S A, as s er t i ng t hatt he t erm i nat i on of herl ong t erm di s abi l i t ybenef i t s w as arbi t r aryand capr i ci ous beca us e U N U M ’ s fi ndi ng thatherperm anenthear i ng l os s does notr enderher t ot al l ydi s abl ed undert he Pol i cyt erm s w as nots uppor t ed bys ubs t ant i al evi dence . Pr i or to ru li n g o n U N U M ’s an d D as’s c ross -m o ti o n s fo r sum m aryjud g m en t, the D istri ct C o u rt s t ruck fr om t he r ecor d fi ve af fi davi t s thatD as s ubm i t t ed i n s uppor tof hercas e. T he af fi davi tof D avi d W . A ndr ew s , M . D . , FA C S, Pr ofes s ori n t he D epart m entof N eu rosu rge ryat Jef

fe rson M ed ical C o ll eg e, st ated that h e h ad w o rke d w ith D as f o r a per i od of ni ne y ear s w hen s he w as a pos t - doct or al fel l ow and l at erw hen s he w as an10

A s s i s t antPr ofes s ori n hi s D epart m ent . H e des cr i bed herw or k forhi m and then gave vari ou s opini on s:

D r . R i t a D as has neverhad anyexper i ence on ( s i c) on- l i ne t eac hi ng and s he is th e re f o re n o t s u ite d f

o r a n ys o rt o f

o n -l in e m o le c u la r b io lo g yin s tru c tio n . I cannotfathom how s he coul d t eac h t hi s s ubj ectonl i ne ori n a cl as s , for ei t herm ol ecul arbi ol ogyunder gr aduat e orgr aduat e s tudent s , s i nce be nch r es ear ch i s t he onl yt r ai ni ng orexper i ence s he has had. B ym yre v iew o f

h e r re su m e , an d in m yn in e y e a rs o f w o rk in g w ith h e r, itis o b v iou s tha t D r. D as h as n o ex p erien ce as a classro o m teac h er o r i n stru ctor, noras an on- l i ne r es ear cher . I do nots ee how s he coul d be empl oy ed as an on- l i ne r es ear cher , s i nce a l l of herr es ear ch expe r i ence has been i n a l abor at or y . She w oul d be poor l yequi pped t o as s um e a pos i t i on i nvol vi ng th e se latte r a v e n u e s o f

e m p lo ym e n t. (A p p ell an t’ s R ef

ere n ce 5 ). T he af fi davi tof M adhu K al i a, M . D . , Ph. D . , M . B . A . , Pr ofes s ori n t he D epart m ent of B i ochemi s t r yand M ol ecul arPhar m acol ogyatJ eff er s on M edi cal C ol l ege, cont ai ned t he fo l l ow i ng op i nions:

I have r evi ew ed the cr edent i al s of D r . R i t a D as and not e thathertr ai ni ng and expe r i ence i s i n t he fi el d of m ol ecul arl abor at oryr es ear ch, w i t h no exper i ence i n cl as s r oom t eac hi ng. H eri nvol vementw i t h s tudent s has been l i m i t ed to the lab, w here she i nstruct ed a f ew stud ents i n lab t echn i qu es. D r. D as i s a nat i ve o f Indi a, and w hil e her com m and of the E ng l i sh l anguage i s adequa t e fors ci ent i fi c w or k i n t he l abor at ory , I know thats he w ou l d h ave co nsi derabl e diffi cultyw ri t i ng cl ass not es, prepari ng han do uts , w r i t i ng exam ques t i ons and i ns t ruct i ng s tudent s on- l i ne. O n- l i ne i ns t ruct i on r equi r es exce pt i onal l anguage s ki l l s as w el l as tr ai ni ng and expe r i ence as a t eac heri n a medi cal orgr aduat e s chool s ett i ng, and I not e thatD r . D as has none of thi s exper i ence and tr ai ni ng. Fort hes e r eas ons , i ti s m ypr ofes s i onal opi ni on thatthe occ upat i ons of on-11 lin e c o lleg e in stru c to r o r o n -lin e sc ien tific re se a rc h e r a re u n su itab le o cc u p ati o n s fo r he r. (A p p ell an t’ s R ef

ere n ce 5 ). B es i des t hes e tw o aff

i davi t s , D as s ubm i t t ed af fi davi t s of s i m i l arpurpor tof Pr ofes s orE . Pr emkum arR eddyof Tem pl e U ni ver s i t ySchool of M edi ci ne, Pr ofes s or Subhas i s B i s w as of The U ni ver s i t yof M edi ci ne and D ent i s t r yof N ew J er s eyand another on e from D r. A nd rew s. T he D i stri ctC ou rtstruck al l of these affi dav i t s. A d d re ss in g th e c ro ss -m o tio n s f o r su m m a ryju d g m e n t, th e D istric t C o u rt d e f in e d its t as k as “det erm i n[i ng] w hetherU N U M abus ed i t s di s cr et i on i n fi ndi ng D as , bas ed on her educa t i on, w or k exper i ence and tr ai ni ng, i s abl e and qua l i fi ed t o w or k i n t he al t ernat i ve j ob pos i t i ons U N U M i dent i fi ed forher . ” ( A ppel l ant ’ s R ef. 1, O pn. p. 2) . N ot i ng thatt he deni al of bene fi t s underan ER I SA qual i fi ed pl an mustbe r evi ew ed us i ng a def er ent i al s t andar d and thatw her e the pl an admi ni s t r at or , as her e, has di s cr et i on t o i nt erpr etthe pl an and t o deci de w hetherbenef i t s ar e pay abl e, the fi duci ary ’ s exer ci s e of di s cr et i on i s j udged bya n a rbi t r a r ya nd c a pr i c i ou s s t a nd a r d, Fi r e s t on e Ti r e & Rubbe rCo. v. Br uc h, 48 9 U. S. 10 1, 11 5 (198 9), t he D i stri ctC ou rtal so no t ed thatw here an insur ance c om pan yfun ds, i nt erpr et s and admi ni s t er s a di s abi l i t ypl an, the r es ul t i ng s el f i nt er es ti nher enti n t he r el at i ons hi p r equi r es cl os ers crut i ny . Pi nt o v. R el i ance St d. L i fe I ns . C o. , 214 F. 3d 377 ( 3d C i r . 2000) . T he D i s t r i ctC our tappl i ed the Pi nt o hei ght ened r evi ew s t andar d. T he D i s t r i ctC our t ’ s opi ni on r eci t ed the ext ens i ve ef for t s thatU N U M i t s el f and t hr ough G E N E X m ade t o det erm i ne i f D as w as capa bl e of pe r form i ng gai nful12

o c c u p a tio n s d e sp ite h e r d isa b ili ty , an d th e o p in io n re c ited th e e f f o rts th a t D a s m a d e to o b t a i n e mp l o yme n ti n p o s i t i o n s UNU M h a d d e t e r mi n e d Da s wa s f i t t e d t o p e r f

o r m. H av ing rev iew ed the e v iden ce u p o n w h ich U N U M reli ed , the D istri ct C o u rt concl uded: U N U M i nterpret ed it s poli cyi n the con t ext of i t s eval uati on of D as’

vocat i onal abi l i t i es and form erj ob dut i es . T hi s i nt erpr et at i on of the pol i cy ’ s “anyoccupa t i on” pr ovi s i on, even though i tdi s favor s the i ns ur ed, w as r easona ble. B ecause D as had the abil i t yt o p erform the ident i fi ed jobs, U N U M ’ s appl i cat i on of i t s pol i cyt o t hos e fa ct s w as notarbi t r aryand c a p ri c io u s . (A p p ell an t’ s R ef. 1 , O p n . p . 1 9 ). T h e D istric t C o u rt f

u rth e r h e ld th a t U N U M re a so n a b lyin terp re ted its p o licyto r equi r e onl yt hati tdemonstr at e thatpos i t i ons w er e ava i l abl e i n t he nat i onal economyfor w hi ch D as , w i t h herdi s abi l i t y , i s fi t t ed byr eas on of herpr i orw or k exper i ence , tr ai ni ng and educ at i on t o per form . D as ’ s i nabi l i t yt o obt ai n a pos i t i on w as notcontr ol l i ng. Fi nal l y , t he D i s t r i ctC our tr ej ect ed D as ’ s cont ent i on thatpr ocedur al i r r egul ar i t i es r equi r ed thatt he C our tl es s en i t s defe r ence t o U N U M ’ s deci s i on m aki ng. She had ar gued t hatU N U M ’ s B ay ar d’ s des i r e t o be kept“i n t he l oop” byG E N E X demonstr at ed a l ack of i n d e p e n d e n c e b y G E N E X . S h e a l s o a r g u e d th a tG E N E X ’ s c o n d u c t i n g s u c c e s s i v e s u r v e ys s ugges t ed goal - or i ent ed s tudi es des i gned t o pr oduce a fi ndi ng of no di s abi l i t y . D as cont ended thatU N U M pr ovi ded G E N E X w i t h fl aw ed and i ncompl et e i nform at i on about herpr i orj ob dut i es and fa i l ed t o comm uni cat e w i t h herform ers upervi s ort o det erm i ne w hethers he coul d per form t he tw o al t ernat i ve occ upat i ons . T he D i s t r i ctC our tr ej ect ed13

eac h of thes e cr i t i ci s m s as unw arr ant ed. B as ed on i t s fi ndi ngs and conc l us i ons , the D i s t r i ctC our tdeni ed D as ’ s m ot i on for s um m aryj udgm entand gr ant ed U N U M ’ s m ot i on fors um m aryj udgm ent . D as appea l ed pro se . Th e Di s t r i c tCo u r th a d j u r i s d i c t i o n o v e rth i s a c t i o n p u r s u a n tt o 2 9 U. S . C. § 1 1 3 2 (a)(1)(B ). W e h av e jurisdicti o n to rev iew the f inal jud g m en t of

the D istri ct C o u rt pur s uantt o 28 U . S. C . §1291. I I I . D i s cus s i on D as as s ert s t hr ee gr ounds forchal l engi ng the j udgm entof the D i s t r i ctC our t : i ) t he D i s t r i ctC our terr oneous l ys t ruck the fi ve af fi davi t s thatD as s ubm i t t ed i n s uppor tof her m ot i on fors um m aryj udgm entand i n oppos i t i on t o U N U M ’ s cr os s - m ot i on; i i ) the G E N E X rep o rtu p o n w h ich U N U M ’s de term ination an d the D istri ct C o u rtd ec isi o n w ere b a se d w a s re p lete w ith f a lse a n d e rro n e o u s in f

o rm a tio n ; an d iii ) th e C o u rt’s f a ilu re to cons i dert he af

fi davi t s and i t s r el i ance on a fa l s e and e r r oneous r epor tr equi r e that s um m aryj udgm enti n favorof U N U M be vac at ed. T he D i s t r i ctC our t ’ s rul i ng as t o t he admi s s i bi l i t yof evi dence i s r evi ew ed underan ab u se o f d iscreti o n stan d ard . In re P ao li R . R . Y ard P C B L it ig., 3 5 F . 3 d 7 1 7 , 7 4 9 (3d C ir . 1994) . D as ’ s cont ent i on t hatt he G E N E X r epor ti s r epl et e w i t h fal s e and e r r oneous i nform at i on i s bas ed pr i m ar i l yupon fac tual m at er i al pr es ent ed nei t hert o U N U M dur i ng t he admi ni s t r at i ve pr ocee di ngs nort o t he D i s t r i ctC our t . W hetheri tm aybe cons i der ed onSuppleme ntal mate ri a l mi ght b ea dmi ssibleat th eDi stric t Co ur t leve l if it w e rein 2 support of a c ontention that the administrator wa s actingin a manner requiringa heightened 14 t hi s appea l pr es ent s a ques t i on of l aw . A bnathy a v. H offmann - L a R oche, I nc. , 2 F. 3d 4 0 , 4 8 , n . 8 (3d C ir . 1 9 9 3 ). W ith resp ec t t o the g ran ti n g o f U N U M ’s m o ti o n fo r sum m ary j udgm ent , w e ca nnotaff i r m unl es s , vi ew i ng the fa ct s i n t he l i ghtm os tfavor abl e t o t he non- m ovi ng par t y , w e ar e convi nced thatno genui ne i s s ue exi s t s as t o anym at er i al fac t an d that the m o v ing p artyis en ti tl ed to jud g m en t as a m att er o f law . F ed . R . C iv. P. 56 (c). I tw i l l be as s um ed, w i t houtdeci di ng, thatthe pr ofes s or s w ho pr ovi ded the fi ve aff i davi t s w er e qual i fi ed t o gi ve opi ni ons as t o w hetherD as w as qual i fi ed t o be an on- l i ne t e a c h e ri n h e rf

i e l d . S u c h a n o p i n i o n wa s r e l e v a n tt o th e i n v e s t i g a t i o n i n wh i c h UNUM w a s e n g a g e d , an d u n d o u b ted lyU N U M w o u ld h a v e re c e iv e d a n d c o n sid e re d th e a f f id a v its had theybeen s ubm i t t ed t o i t . H ow ever , the af fi davi t s w er e nots ubm i t t ed t o U N U M , and U N U M r el i ed on i nform at i on aboutD as ’ s t eac hi ng qual i fi cat i ons thatD as her s el f had subm i t t ed an d w hich had been subm i t t ed o n p ri or occasi on s byher supervi sors . Ju d icia l re v iew o f

a n a d m in istra tiv e d e c isio n is lim ited to th e e v id e n c e p re se n ted to th e a d m in is tr a to r. K e a tin g v . W h itm o re M f g . C o ., 1 8 6 F .3 d 4 1 8 , 4 2 1 -2 2 (3 d C ir . 1 9 9 9 ). E R ISA cl ai m ants m ustexh austt heiradm i nis t rat i ve rem edies . H arr ow v. P rudenti al Ins. C o . o f A m ., 2 7 9 F .3 d 2 4 4 (3 d C ir. 2 0 0 2 ). A p e rso n a p p e a lin g a d e n ial o f d isa b ili ty cannotus e the di s t r i ctcourtas a vehi cl e t o s ubm i tevi dence he fa i l ed t o s ubm i tt o t he E R IS A p lan a d m in istra to r. T h u s, th e D istric t C o u rt p ro p e rlye x c lu d e d th e f iv e a f f id a v its e x p r e s s i n g e x p e r to p i n i o n s n o ts u b m i t t e d t o U N U M. 2standard of review. Pinto v. R elianceStd. L ife Ins. Co., 214 F.3d 377 (3d Cir. 2000). The aff idavits that the District Court struck did not address that issue. 15 In h e r b rie f

, D a s m a k e s n u m e ro u s c laim s th a t th e G E N E X R e p o rt o n w h ich b o th U N U M and the D i s t r i ctC our tr el i ed w as r epl et e w i t h “i ncorr ecti nform at i on and err oneous and untrut hful fi ndi ngs . ” ( D as ’ s B r i ef a t3) . B eca us e the D i s t r i ctC our tr el i ed t o t a l l yo n t h e GE NE X R e p o r t , Da s a r g u e s , i t s j u d g me n ti s e r r o n e o u s a s a ma t t e ro f l a w. A l t hough i t s concl us i ons w er e cha l l enged, the G E N E X R epor tw as notchal l enged a s f a c tu a llye rro n e o u s a n d f a lse in th e D istric t C o u rt. T h is is a n e w c h a rg e , rais e d o n th is appea l fort he fi r s tt i m e. I ti s bas ed l ar gel yupon gener al i zed c har act er i zat i ons cr i t i cal of th e R e p o rt th a t D a s e x p re ss e s in h e r b rie f. S h e re f e rs to tele p h o n e c o n f

e re n c e s a n d e -m a il c o m m u n ica tio n s s h e h a s h a d w ith p e rso n s n a m e d in th e R e p o rt. S h e d e sc rib e s a ttem p ts s he has m ade t o comm uni cat e w i t h per s ons orent i t i es named i n t he R epor t . She r eci t es t hatcomm uni cat i ons s he s entt o ent i t i es named i n t he R epor thave be en r eturned. She des cr i bes atcons i der abl e l ength heruns ucce s s ful eff or t s t o ver i fythe i nform at i on G E N E X s etfor t h i n i t s R eport . H eri ndepende nti nves t i gat i on i s the bas i s forher cont ent i on t hatm uch of the i nform at i on i n t he R epor ti s fal s e. B a se d u p o n h e r in v e stig a tio n s D a s u rg e s th a t th e “ H o n o ra b le th ird c irc u it m a yn o te t hatU N U M and G E N E X have a bus ed the trus tof J us t i ce s y s t em as D i s t r i ctJ udge H onor abl e Ti m ot hyJ . Savage, J r . has compl et el yr el i ed on thei rs ur veyt o gi ve hi s or der t o denyt he di s abi l i t ybenef i tof a di s abl ed per s on w i t h 98% hear i ng l os s and ca us i ng a l ot [of ] i nconveni ence fora t ot al l yhear i ng i m pai r ed per s on w i t h an untruthful s ur vey . ”16

(D as’s B ri ef

at 17 ). W e r ecogni ze thatD as i s pr ocee di ng pro se , w hi ch undoubt edl yexpl ai ns w hys he has s ubm i t t ed on thi s appea l and r el i ed upon mat er i al thatw e ca nnotcons i der . N ei t her herar gum entt hatt he G E N E X R eportw as err oneous and fa l s e northe al l egat i ons s uppor t i ng t hatar gum entw er e pr es ent ed t o t he D i s t r i ctC our t( pr ocee di ngs i n w hi ch D as w as re p rese n ted b yco u n sel). “[ A ] fa il u re to raise a n issue in the D istri ct C o u rt con st i tutes a w ai ver of the ar gu m ent. ” B renner v. U nit ed B hd . of C arpent ers and Joi ners, 9 2 7 F . 2 d 1 2 8 3 , 1 2 9 8 (3d C ir . 1 9 9 1 ). H avi ng det erm i ned thatt he D i s t r i ctC our tcorr ect l ys t ruck the fi ve af fi davi t s that D as s oughtt o s ubm i t , and thatD as w ai ved herar gum entthatthe D i s t r i ctC our t( and U N U M ) r el i ed on an e r r oneous and fa l s e G E N E X R epor t , w e turn t o D as ’ s r emai ni ng co n tention that the D istri ct C o u rterred in g ran ti n g U N U M ’s m o ti o n fo r sum m ary jud g m en t. W e h av e re v iew ed the e x tens ive re co rd in this case an d , ex erc isi n g p lena ry re v iew , af

f irm th e ju d g m e n t o f

th e D istric t C o u rt su b sta n tiallyf o r th e re a so n s s e t f

o rth in J udge Savage ’ s compre hens i ve opi ni on. I V . C oncl usi on F o r th e f o re g o in g re a so n s, w e w ill a f f irm th e o rd e r o f

th e D istric t C o u rt.