2004 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
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w . v i l l a no va . e du/thir dc ir c uit_2004/1108NOT PRECEDENTIAL UNITED STATES COURT OF APPEALS FO R T HE TH IRD CIR CU IT

____________ No.: 02-3805

____________ STEPHEN S HAPIRO Appellant

v. PRUDENTI AL INSURANCE C OMPANY OF AMERICA

App eal from th e Un ited States District Co urt for the Dis tri ct of New Jersey (D.C. Civi l Action No. 99-CV-04325) Distri ct Judge: Honorable Dennis M. Cavanaugh

______________________ Submitte d Under Third Circ uit LAR 34.1(a)

on June 16, 2003 Be for e: A LIT O, R OT H, a nd H AL L* , Circuit Judges (Opinion fi led Januar

y 7, 2004)

____________________ *Th e H on. C ynthia H . Hall, C ircuit Jud ge fo r the U nited S tates C ourt o f A ppea ls for the Nint

h Circuit , si tti ng by des ignati on.

### 2 O P I N I O N ROTH , Circ uit J udge; Stephen Shapiro has appeal ed the j udgment in favor of defendant Prudentia l Insuranc e Company of American entered bythe Unite d States Distri ct Court f or the Dis trict o f N ew Jers ey. Shapiro, a f ormer em ployee of La nier Wo rldwide, w as covere d for long -term disabi lit y ( LTD) benefits byLanier’ s Group Policy G-59115 (the pl an), an e mployee benefit s plan governed by ERISA. The plan provides LTD benefit s for cover ed employees who meet all contractual requirements for such benefits, as follows:

Total Disability exist s when Prude ntial determines that all of t hese cond itions are met: (1) Due to si ckness or a ccident al inj ury , both of t hese are t

rue: (a) You are not

able t o perform, f

or wage or profi t, t

he materi al and substant ial dut ies y our occupation. (b) After the Initial Duration of a period of Total D isability , you are not ableto perform for wage or profit the material and substant ial duties of any j ob for which y ou are rea sonablyfitted by y our educ ation, train ing, or e xper ience . The Initial D uration is show n in the Schedule of Benefits.

### 3 (2) Y ou ar e not w orkin g at an y job for w age o r prof it. (3) Yo u are und er the regular care of a D octor.

In F ebr uar y 199 6, S hap iro le ft w ork as a major a cco unt rep rese ntati ve f or L anie r. He applied and received s hort term disabi lit y benefi ts. His doctor s anti cipat ed that he
wo uld be a ble to retu rn to wo rk in M arch . Sh apir o di d no t retu rn. In Ju ne 1 996 , Sh apir o su bm itted a cla im f or L TD ben efits und er th e pla n. Shapiro’ s clai m was approved, effec tive May 24, 1996. Accor ding to hi s medical records , Shapiro was sufferi ng from a degenerat ive dis c diseas e and a cervi cal herniate d disc, making it

diffi cult f

or him to carryhis fi fty -pound sal es bag and twenty- pound lapto p co mp uter on s ales calls
. On De cem ber 5 , 1997 , Prud ential w rote S hapiro to no tify him th at part 1 (b) of his plan’s totaldisabi lit

y defi niti on would become effecti ve May 24, 1998, pursuant to the policy ’s te rms. To det ermine whether totaldisabi lit

y continued as def

ined bypart 1( b) of the plan, Prud ential was g oing to con duct a thoro ugh rev iew of Shapiro’s c laim to ensure that h e w as sti ll elig ible f or L TD ben efits
. As a result

of its review, two administr ativeappeals by Shapiro, a survei llanc e video , and a final a dm inistrative appe al, Prud ential d enied Sha piro’s c laim o n the b asis that Sh apiro w as cap able o f perf orm ing se denta ry work . Shap iro then brou ght su it in Dis trict C our t.

### 4

Both Shapiro and Pr

udentia l fil ed cross- motions for summary j udgment. The Distri ct Court de termine d that Pr udentia l’s de cisi on was not arbi trary and caprici ous and granted s ummary judgment for Prudential. Shapiro appea led. We have juris dicti on of this appeal pur suant t o 28 U.S .C. § 1291. We exercise plen ary rev iew ove r a D istrict Co urt’s gra nt o f su mm ary jud gm ent. Pi Lambda Phi Fraterni ty v. Universi ty of Pi tts burgh , 299 F .3d 43 5, 441 (3d C ir. 2000 ). Thu s, we apply the same standard o f review to Pruden tial’s decision to deny bene fits as the District Cou rt sho uld hav e ap plied
. Smathers v. Multi-Tool /Multi -Plast ics Employee Healt h and Welfare Plan , 298 F .3d 19 1, 194 (3d C ir. 2002 ); Farrell v. Planters Lif

esavers Co. , 206 F.3d 27 1, 278 (3d Cir. 2000 ). Summ ary judgmen t is appropriate w hen the rec ord discl oses no genui ne issueof materi al fact and the moving party is entitl ed to judgment as
a m atter of la w. See F.C. R.P. 56(c ); Cleo tex v. C artrell , 477 U .S. 317 (198 6). We find th at Pru dentia l’s initial term ination of S hapiro ’s LT D b enef its, and its subsequ ent decisions to u phold this term ination, were b ased on Pruden tial’s determi nation, supporte d by i ndependent medic al eval uations and objective observation, that Shapiro was able to perform sedent ary work and was able to pe rform for wage or profit the material and substant ial dut ies of any

job for which he was reasonabl y fi tted by his educat

ion, t raini ng, or experience. Because Prudential bot h funds and admini ster s the benefit s at i ssue here , it s decis ion to terminat e benefit s is reviewed under a ‘ heighte ned arbit raryand capri cious st andard.’ Pinto v. Reliance St andard Life Ins. Co., 214 F. 3d 377,

### 5

378 (3d Cir. 2000). I n view of the above, we cannot saythat Pr udentia l’s de cisi on was wit hou t reas on, u nsu ppo rted by sub stan tial ev iden ce, o r erro neo us a s a m atter of la w. Thus, Prudential’s decisi on was neither arbitrarynor capricious. For th e fore goin g reas ons, w e w ill affirm the jud gm ent of the D istrict Co urt.

TO THE C LERK: Please fi le theforegoing Opinion.
By the C ourt,

/s / J ANE R. ROTH Circuit

Judge