United States Court of Appeals

For the Eighth Circuit

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No. 20-1593

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Ronald Bernard

lllllllllllllllllllllPlaintiff - Appellee

v.

Kansas City Life Insurance Company

lllllllllllllllllllllDefendant - Appellant

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Appeal from United States District Court 

for the Western District of Missouri - Jefferson City

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 Submitted: January 12, 2021

Filed: April 5, 2021 

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Before COLLOTON, WOLLMAN, and SHEPHERD, Circuit Judges. 

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WOLLMAN, Circuit Judge.

After admitting to using fentanyl at work, Ronald Bernard was terminated from

his position as a certified nurse anesthetist at Mid-Missouri Anesthesiologists, Inc.

(Mid-Missouri). Bernard thereafter submitted claims for short- and long-term

disability benefits to Kansas City Life Insurance Co. (Kansas City Life), which had

issued disability insurance policies to Mid-Missouri as part of its employee benefit
plan. Kansas City Life denied Bernard’s claims after concluding that he was not

disabled under the terms of the policies. 

Bernard challenged the denial of benefits, bringing a civil action under section

502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), 29

U.S.C. § 1132(a)(1)(B). Ruling on cross-motions for summary judgment, the district

court1 concluded that Kansas City Life had abused its discretion in denying benefits.

We affirm.

Mid-Missouri hired Bernard in 1991. Bernard became addicted to fentanyl in

approximately 2000 and sought in-patient treatment in 2001. Mid-Missouri placed

him on probation for several years following treatment, during which Bernard was

subject to regular drug tests. Mid-Missouri’s employment contract with Bernard 

reserved the right to require that he be tested for drugs and to terminate him if a test

returned a positive result. 

After being released from probation and being drug-free for many years,

Bernard began using fentanyl at work in 2015. He explained that he would use “the

end of day drugs,” rather than destroying them. At the time, Bernard worked full time

as a certified nurse anesthetist at an orthopedic surgery clinic, administering

anesthesia to patients.2 

1The Honorable Nanette K. Laughrey, United States District Judge for the

Western District of Missouri.

2Mid-Missouri describes a certified nurse anesthetist’s occupation as follows,

“Under general supervision, administers local, inhalation, intravenous, and other

anesthetics during surgical or other medical procedures.” A certified nurse

anesthetist’s work includes administering general anesthetics to render patients

insensible to pain and taking “necessary remedial action to aspirate secretions from

throat larynx and trachea.” 

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On the morning of October 6, 2017, two nurses reported that Bernard had been

using syringes and that they suspected that he was using drugs. Bernard was

immediately removed from the operating room and taken to a drug-testing facility,

where he provided a sample. After Bernard admitted that he had been using fentanyl

at work, Mid-Missouri terminated his employment. His sample later tested positive

for fentanyl.

Bernard met with Paul Schoephoerster, M.D., on October 18, 2017. According

to Dr. Schoephoerster’s notes, Bernard reported that he had resumed using fentanyl

in 2015 and that he had acquired it “through [his] place of employment as [a] nurse

anesthetist.” During a March 2017 appointment with Dr. Schoephoerster, however,

Bernard had not disclosed that he had relapsed, claiming instead that he had not used

intravenous drugs for more than ten years. Bernard began meeting with addiction

specialist Patricia Altenburg, Ph.D., on October 30, 2017. 

Bernard submitted claims for short- and long-term disability benefits to Kansas

City Life in late October 2017, submitting in support statements of disability from

Drs. Schoephoerster and Altenburg. Dr. Schoephoerster stated that Bernard had

suffered from narcotic addiction since 2000 and had relapsed in 2015. He opined that

Bernard’s addiction and relapse rendered him unable to perform his duties as a

certified nurse anesthetist and that his disability would continue indefinitely. Dr.

Altenburg similarly stated that Bernard suffered from opioid abuse, with date of onset

in 2000 and relapse in 2015. She opined that Bernard was unable to work and that

his limitations were chronic.

Mid-Missouri reported to Kansas City Life that it had been satisfied with

Bernard’s work and did not know of his relapse until the date of his termination. 

Mid-Missouri’s report expressed frustration with Bernard, particularly in light of his

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earlier drug abuse and probationary period, noting, “who knows when he started

using [fentanyl] again.” 

To meet the insurance policies’ definition of disabled, an insured must be

unable to perform all the material and substantial duties of the insured’s regular

occupation due to sickness or injury. Kansas City Life determined that Bernard did

not meet this definition prior to his termination, when his disability insurance

coverage ended, and therefore was not eligible for benefits. As Kansas City Life

explained in its denial of his claim for short-term disability benefits: 

You were capable of, and would have remained capable of, performing

your regular occupation if you had not tested positive to the drug

screening. (sic) Your drug use did not preclude your ability to perform

your occupational duties. You ceased work because your employment

was terminated. As such, you do not meet the [policy’s] definition of

disability.

In denying both claims, Kansas City Life noted that Bernard’s coverage under the

policy had ended before he sought treatment for his addiction or was certified as

disabled by Dr. Schoephoerster. 

Bernard filed administrative appeals with Kansas City Life in May and June

2018. After completing additional review, Kansas City Life denied Bernard’s appeal

from the denial of long-term disability benefits because “there is no indication he was

impaired from functioning in his own occupation as of the time he tested positive for

drug use and he was terminated from employment and his insurance coverage ended.” 

His appeal from the denial of short-term disability benefits was also denied. In a

December 2018 letter to Bernard’s attorney regarding the final denial of benefits,

Kansas City Life reiterated that Bernard’s self-report was the only evidence in support

of his claim that he became disabled prior to October 6, 2017:

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Your client was performing his own occupation satisfactorily until he

was removed from the operating room due to suspected drug use for

which he tested positive on his last day worked. He was not terminated

due to work issues but rather due to his employer’s serious concern for

the safety of the patients. As noted, your client’s employment contract

indicates a positive drug test will result in termination of employment. 

In addition, your client was not treated for his addiction to fentanyl at

the time he stopped working and treatment began after his insurance

coverage was terminated. As a result, no benefits are payable on his

claim.

As set forth above, Bernard filed suit, alleging that Kansas City Life had erred

in denying him short- and long-term disability benefits. The parties agreed that there

were no factual disputes and that the lawsuit presented only questions of law. As

recounted above, the district court granted summary judgment in favor of Bernard

after determining that Kansas City Life had abused its discretion in denying Bernard

benefits. In light of the undisputed facts that Bernard was addicted to fentanyl, that

he had relapsed in 2015, and that he had regularly used fentanyl at work for the two

years preceding his termination, the district court concluded, “No reasonable person

could find that a nurse anesthetist so addicted to Fentanyl that he injects himself with

drugs during the work day while his medical co-workers are nearby is capable of

performing the duties of his job.” D. Ct. Order of Feb. 28, 2020, at 14. We review de

novo the district court’s grant of summary judgment in favor of Bernard. Green v.

Union Sec. Ins. Co., 646 F.3d 1042, 1050 (8th Cir. 2011). 

Bernard argues that the district court should have applied a de novo standard of

review to Kansas City Life’s denial of benefits under the short- and long-term

disability insurance policies, contending that the plan administrator was not granted

discretionary authority. A district court reviews de novo a plan administrator’s denial

of ERISA benefits, unless the plan gives the administrator “discretionary authority to

determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire

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& Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the plan gives discretionary

authority, the district court reviews the administrator’s denial of ERISA benefits for

abuse of discretion. Id. Because we conclude that Bernard is entitled to benefits

under either standard, we will assume without deciding that the abuse of discretion

standard of review applies to Kansas City Life’s denial of benefits.3

Reviewing for abuse of discretion, we consider whether Kansas City Life’s

decision to deny benefits is supported by substantial evidence, that is, “such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion.” 

King v. Hartford Life & Accident Ins. Co., 414 F.3d 994, 999 (8th Cir. 2005) (en

banc) (quoting Donaho v. FMC Corp., 74 F.3d 894, 900 & n.10 (8th Cir. 1996)). 

Kansas City Life maintains that the record lacks any evidence that Bernard’s fentanyl

use rendered him unable to perform the material and substantial duties of his

occupation prior to his termination. It argues that Bernard had adequately performed

the duties of a nurse anesthetist, even if he had done so under the influence of

fentanyl. 

We conclude that Kansas City Life’s denial of benefits is not supported by

substantial evidence. According to Kansas City Life’s final denial of benefits, Bernard

was terminated due to his “employer’s serious concern for the safety of the

patients”—that is, because Bernard could not safely administer anesthesia while under

the influence of fentanyl. In deciding Bernard’s claim, Kansas City Life did not

dispute that Bernard had relapsed prior to his termination or that he had administered

anesthesia while under the influence of fentanyl after relapse. A reasonable mind

could not reconcile Kansas City Life’s position that Bernard was unable to safely 

3Although Mid-Missouri was the plan administrator, Kansas City Life acted as

a claims-review fiduciary with authority to grant or deny Bernard’s claims. See 29

U.S.C. § 1002(21)(A). 

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administer anesthesia on October 6, 2017, with its position that he had safely

administered anesthesia while under the influence of fentanyl during the time period

between his relapse and termination. We thus conclude that the evidence that Bernard

made no medical errors and did not seek treatment until after he was terminated, as

well as the fact that the record does not disclose his exact date of disability, could not

support Kansas City Life’s conclusion that Bernard was not disabled before his

insurance coverage ended. 

The judgment is affirmed.

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