# U ni te d S ta te s Co ur t of A pp ea ls

For the Eig hth Circu it

__ __ __ __ __ __ __ __ __ __ __ __ __ _

No. 1 3- 27 82

__ __ __ __ __ __ __ __ __ __ __ __ __ _

Ch ris to ph er Ham

pt on ,

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff - App el le e ,

v.

Rel ia nc e St an da rd Life I ns ur an ce Co m pa ny; Ozark Mo to r Lin es Inc . Ben efi t Pl an ,

ll ll ll ll ll ll ll ll ll ll l Defe nd

an ts - App el la nt

s

.

__ __ __ __ __ __

App eal fro m

Uni te d S ta te s Di st ric t Co ur t
fo r th e Eas te rn Dis tri ct of Ark an sa s - P in e Bl uf f

__ __ __ __ __ __

Su bm it te d: Apri l 1 7, 2 01 4

Fil ed : Oct ob er 7 , 20 14

__ __ __ __ __ __

Befo re SM ITH, COLLOTO N, and GRUENDER, Circu it Ju dg es

.

__ __ __ __ __ __

COLLOTON, Ci rcu it Ju dg e.

Afte r be in g di ag no se d wit h in su li n- de pe nd en t di ab et es m el li tu s, Ch ris to ph er

Ham pt on ceas ed wor k as an ov er-t he -ro ad tru ck dri ve r fo r Ozark Mo to r Lin es , I nc

. Pu rs ua nt to th e co m

pa ny’ s em

pl oyee-b en efi t pl an —Oza rk Mo to r Lin es In c. Ben efi t

Pl an —wh ic h is go ve rn ed by th e Em pl oyee Ret ire m en t In co m e Secu rit y Act of 19 74
(“ ERISA”)

, 29 U.S.C. §§ 10 01 -1 46 1, Ham pt on su bm it te d a c l a im fo r lo ng -te rmdi sa bi li ty be ne fit s to Rel ia nc e St an da rd Life In su ran ce Co m pa ny, th e Pl an ’s in su rer

a n d c l ai m s- rev ie w fid uc ia ry

. Rel ia nc e St an da rd co nc lu de d th at Ham pt on was no t

di sa bl ed un de r th e te rm s o f th e Pl an an d d en ie d t he cla im on th at ba si s.

Ham pt on su ed Rel ia nc e St an da rd an d th e Pl an , arg ui ng th at Rel ia nc e St an da rd

ab us ed it s di sc ret io n. The di st ric t co ur t gr an te d jud gm en t on th e reco rd fo r Ham pt on

. Rel ia nc e St an da rd an d t he Pla n a pp eal , and we rev ers e.

I.

Fro m Ju ly 20 08 to Nov em be r 20 10

, Ham

pt on wor ke d as an ov er-t he -ro ad tru ck

dr iv er fo r Ozark Mo to r Lin es , In c. In Nov em be r 20 10

, Ham

pt on was di ag no se d wit h

di ab et es m el li tu s. As a res ul t of Ham pt o n ’s d i a g n o si s, he was un ab le to co nt in ue

wor k as an ov er-t he -ro ad tru ck dr iv er: Reg ul at io ns of th e Uni te d St at es Dep art m en t

of Tran sp or ta t i on pr ov id e th at an y pe rs on wit h in su li n- de pe nd en t di ab et es m el li tu s

is no t qu al ifi ed to op erat e a co m m erci al m ot or ve hi cl e. Se e 49 C.F. R

. § § 3 9 1

. 1 1

, 39 1.4 1( b) (3 ). As a res ul t, Ark an sa s di sq ua li fie d hi s co m m erci al dr iv er’s li cen se

. Se e

00 1- 00 -0 04 Ark. Co de R. 17 .1.

Ham pt on fil ed cl ai m s fo r sh or t-t erm an d lo ng -te rm di sa bility bene fit s un de r th e

Pl an

. In su pp or t of hi s cl ai m s, he su bm it te d a Decem be r 20 10 st at em en t fro m

W il li am Hawki ns , M.D., th e do ct or who ha d di ag no se d hi m , st at in g th at Ham pt on

co ul d no t wor k b e c a u s e h e was “ un ab le to ob ta in a DOT he al th card wit h th is ne w

di ag no si s.” Dr. Hawki ns wro te a fo ll ow- up le tt er to Rel ia nc e St an da rd in Ju ne 20 11

rep eat in g th at he “ d[ id ] no t feel th at Mr. Ham pt on wil l be ab le to ob ta in ga in fu l

em pl oym en t no ti ng hi s in su li n de pe nd en t di ab et es m el li tu s, whi ch pr ecl ud es hi m

fro m op erat in g an y so rt of he av y m ach in ery or m ot or iz ed ve h i c l e s b a se d on th e Dep art m en t o f Tran sp or ta ti on reg ul at io ns .”

-2

-Ham

pt on rece iv ed sh or t-t erm be ne fit s, bu t Rel ia nc e St an da rd de ni ed hi s cl ai m

fo r lo ng -te rm be ne fit s. To qu al ify as “ Tot al ly Dis ab le d” un de r th e Pl an ’s lo ng -te rm

di sa bi li ty p o l i c y, a n in su red m us t be un ab le to pe rfo rm th e m at eri al du ti es of hi s

reg ul ar oc cu pa ti on du e to in jury or si ck ne ss

. The Pl an fu r t h er pr ov id es th at if th e

in su red “ req ui res a li cen se fo r su ch oc cu pa ti on , th e lo ss of su ch li cen se fo r an y reas on

do es no t in an d of it se lf co ns ti tu te ‘T ot al Dis ab il it y .’ ” In it s Ju ly 20 11 de ni al le tt er,

Rel ia nc e St an da r d ex pl ai ne d th at al th ou gh Ham pt on ’s su bm is si on as se rte d th at hi s

di ag no si s of di ab et es m el li tu s pr ecl ud ed hi m fro m m ai nt ai ni ng a co m m erci al dr iv er’s

li cen se un de r th e fed eral reg ul at io ns , th ere was no ev id en ce th at an y sym pt om s of

di ab et es m el li tu s prev en te d hi m fro m pe rfo rm in g h is oc cu pa ti on un de r th e te rm s of

th e Pl an

.

Ham pt on fil ed an ad m in is tra ti ve ap pe al wit h Rel ia n c e S ta nd ard in Ja nu ary

20 12

, arg ui ng th at th e di ab et es -rel at ed lo ss of hi s co m m e r c i a l dr iv er’s li cen se

pr ev en te d h i m fro m pe rfo rm in g hi s job du ti es

. In May 20 12

, Rel ia nc e St an da rd

up he ld th e d e n i a l, reas on in g th at th e Pl an “ ex pl ai ns th at lo ss of a li cen se do es no t

c o ns ti tu te di sa bi li ty” an d th at “ th ere m us t be ev id en ce th at on e is ph y si cal l y o r

m en ta l l y i nc ap ab le of pe rfo rm in g th e m at eri al du ti es of hi s oc cu pa ti on as a tru ck

dr iv er” to qu al ify as to ta ll y di sa bl ed

. Dr. Hawki ns ’s su bm is si on s, th e de ci si on

m ai nt ai ne d, refe rred on ly to th e fed eral reg ul at io ns an d “ fai le d to id en ti fy an y sp eci fic

res tri ct io ns or l im it at io ns Mr. Ham pt on su ffer ed du e to in su li n- de pe nd en t d ia be te s,

no r pr ov id e an y in si gh t as to ho w Mr. Ham pt on ’s sym

pt om s were pr ev en ti ng hi m

fro m pe rfo rm in g hi s du ti es as a t r u c k d r iv er.” Rel ia nc e St an da rd al so ci te d th e

co nc lu si on s of an ot he r do ct or , who ha d rev ie wed Ham pt on ’s cl ai m fil e an d fo un d th at

“ th ere was no ev id en ce to su bs ta nt ia te [Ham pt on ’s] in ab il it y to pe rfo rm th e du ti es of

a tru ck dr iv er, ot he r th an th e reg ul at io n s e t f o r t h by th e Dep art m en t of

Tran sp or ta ti on .”

Ham pt on su ed Rel ia nc e St an da rd in Ark an sa s st at e c o u r t in Ju ly 20 12

, an d

Rel ia nc e St an da rd rem ov ed th e cas e to fed eral co ur t. Ham pt on th en fil ed an am en de d

-3

-co m

pl ai nt

, na m in g bo th Rel ia nc e St an da rd an d th e Pl an as de fen da nt s. The am en de d

co m pl ai nt al le ge d th at Rel ia nc e St an da rd un reas on ab ly de nie d his cl ai m fo r lon g- te rm

di sa bi li ty be ne fit s. The pa rti es fil ed cro ss -m ot io ns fo r jud gm en t on the ad m ini st rat iv e

reco rd

, an d th e di st ric t co ur t en te red jud gm en t fo r Ham pt on

. The co ur t al so or de red

Rel ia nc e St an da rd an d t he Pla n t o p ay Ham pt on att or ne y s’ fees an d c os ts

.

The di st ric t co ur t reas on ed fir st th at al th ou gh Rel ia nc e St an da rd ha d di sc ret io n

to in te rp ret th e Pl an , le ss de fere nc e th an us ua l w a s ap pr op ria te

, be cau se Rel ia nc e

St an d a r d w a s a l s o res po ns ib le fo r pa y in g be ne fit s un de r th e Pl an

. The co ur t th en

co nc lu de d th at Rel ia nc e St an da rd ab us ed it s di sc ret io n by ad op ti ng an un reas on ab le

in te rp ret at io n of th e Pl an as ap pl ie d to Ham pt on

. The co ur t de te rm in ed th at Ham pt on

was to ta ll y di sa bl ed un de r th e te rm s of th e Pl an , be cau se he lo st hi s li cen se “ as a

res ul t of an In

jury or Si ck ne ss ,” na m el y h i s in su li n- de pe nd en t di ab et es m el li tu s.

Ci ti ng t he Dep art m en t of Tran sp or ta ti on ’s m ed ic al ad vi so ry cri te ria fo r ev al ua ti on

un de r 49 C.F.R. § 39 1.4 1, th e di st ric t co ur t no te d th at th e fed eral go ve rn m en t fo rb id s

in su li n- de pe nd en t d ia be ti cs fro m op erat in g co m m erci al m ot or ve hi cl es be cau se th e

st res se s o f lo ng -h au l d riv in g e xa cerb at e th e sym pt om s o f di ab et es

.

Rel ia nc e St an da rd an d th e Pl an ap pe al

, an d we rev ie w th e di st ric t co ur t’s gr an t

of jud gm en t on th e reco rd de no vo

. Se e McCl el la n d v

. L i f e In s. Co . o

f N. Am. , 6 79

F.3 d 7 55 , 75 9 (8 th Cir . 20 12 ).

II.

W he re, as he re, an ER I S A -g ov ern ed em pl oyee-b en efi t pl an gr an ts th e pl an

ad m in is tra to r or an ot he r fid uc ia ry di sc re t i o n to in te rp ret th e pl an an d to de te rm in e

el ig ib il it y fo r be ne fit s, we rev ie w th e fid uc ia ry ’s de ci si on fo r ab us e of di sc ret io n. Se e

Wa k k i n e n v

. UNUM Li

fe In s. Co

. of Am.

, 53 1 F.3 d 57 5, 58 0- 81 (8 th Ci r. 20 08 )

. Und er th is st an da rd of rev ie w, we m us t up ho ld Rel ia nc e St an da rd ’s de ci si on so lo ng

as it is ba se d on a reas on ab le in te rp ret at io n of th e Pl an an d is su pp or te d by su bs ta nt ia l

-4

-ev id en ce. Se e Ki ng v. Har tf or d Li fe & Acci de nt In s. Co

. , 41 4 F.3 d 99 4, 99 8- 10 00
(8 th Ci r. 20 05 ) (en ba nc ). W he re a fi du ci ary bo th ev al ua te s clai m s for ben efi ts an d

pa y s be ne fit s cl ai m s, th e co ur t s t il l ap pl ie s th e de fere nt ia l ab us e-o f-d is cret io n

st an da rd

, bu t t he fid uc ia ry ’s co nf li ct of in te res t is on e fact or to be co ns id ered in th e

rev ie w. Met ro . Lif

e In s. Co . v. Glen n , 55 4 U.S. 1 05 , 11 2, 1 15 -1 8 (2 00 8)

.

W e fir st ad dr es s Rel ia nc e S t a nd ard ’s in te rp ret at io n of th e te rm s of th e Pl an

. The Pl an pr ov id es fo r be ne fit s in th e ev en t of “ Tot al Dis ab il it y ,” whi ch oc cu rs whe n

“ as a res ul t of an In

jury or Si ck ne ss

. . . , an In su red can no t pe rfo rm th e mat e r ia l

du ti es of hi s/ he r Reg ul ar Occu pa ti on .” The Pl an fu rth er pr ov id es th at “ [i]f an In su red

. . . req ui res a li cen se fo r su ch oc cu pa ti on , th e lo ss of su ch li cen se fo r an y reas on do es

no t in an d of it se lf co ns ti tu te ‘T ot al Dis ab il it y .’ ” Rel ia nc e St an da rd in te rp ret ed th is

la ng ua ge to req ui re “ ev id en ce th at on e is ph y si cal l y o r m en ta ll y in cap ab le of

pe rfo rm in g th e m at eri al du ti es of hi s oc cu pa ti on ,” in de pe nd en t of hi s lo ss of a li cen se

. Ham pt on arg ue s, an d t he di st ric t co ur t ag reed , th at a cl ai m an t qu al ifi es fo r be ne fit s

un de r th e Pl an if h e lo st hi s l ic en se as a res ul t o f an in jury or si ck ne ss

.

W e co nc lu de th at Rel ia nc e St an da rd ’s in te rp ret at io n of th e Pl an is reas on ab le

. The lo ss -o f-l i c e n s e p r ov is io n st at es th at th e lo ss of a li cen se fo r an y re as on is

in su ffi ci en t in an d of it se lf to en ti tl e a cl ai m an t to be ne fit s. Diag no si s wit h di ab et es

m el li tu s cau se d Ham

pt on to lo se hi s li cen se , bu t th at is no t en ou gh by it se lf to jus ti fy

be ne fit s. Rel ia nc e St an da rd ’s in te rp ret at io n do es no t fo recl os e a cl ai m an t who lo se s

hi s li cen se ba se d on in

jury or si ck ne ss fro m rece iv in g be ne fit s; it m erel y req ui res th at

th e cl ai m an t sh ow th at th e in ju r y o r si ck ne ss it se lf— in de pe nd en t of th e lo ss of

li cen se —re nd ers hi m

un ab le to pe rfo rm

hi s o ccu pa ti on

.

Und er Ham

pt on ’s co nt rary in te rp ret at io n, lo ss of li cen se b y i ts el f do es no t

en ti tl e th e cl ai m an t to be ne fit s if th e lo ss is fo r a no n- med ic al re as on , bu t it wou ld be

su ffi ci e nt if th e li cen se is lo st du e to si ck ne ss or in jury. Thi s in te rp ret at io n wou ld

ren de r th e lo ss -o f-l ic en se pr ov is io n su rp lu sa ge

. The de fin it io n of “ Tot al Dis ab il it y ”

-5

-in cl ud es on ly in ab il it y to wor k du e to in jury or si ck ne ss , so a dr iv er who is un ab le to

dr iv e fo r no n- m ed ic al reas on s ( e.g

. , a fai le d dr ug te st or a ba d dr iv in g reco rd ) wou ld

n ot qu al ify fo r be ne fit s in th e fir st pl ace. Fo r th e lo ss -o f-l ic en se pr ov is io n to ha v e

fo rce, it m

us t app ly to a lo ss of li cen se ba se d on th e dr iv er’s he al th

. At a m in im um , it was reas on ab le fo r th e fid uc ia ry to ad op t an in te rp ret at io n th at av oi ds ren de rin g th e

po li cy la ng ua ge m ean in gl es s. Se e Ki ng , 41 4 F.3 d at 99 9. Alt ho ug h R el ia nc e

St an da rd ’s c on fli ct of in te res t in se rv in g bo th as cl ai m s- rev ie w f id uc ia ry an d pa y er

of be ne fit s is a fact or to be co ns id ered in th e an al y si s, Rel ia nc e St an da rd ad va nc es th e

be tt er read in g of the di sp ut ed pr ov is io n, an d th is is no t th e so rt of case in whi ch th e

fid uc ia ry ’s co nf

li ct li ke ly was de te rm in at iv e. Se e Jo ne s v. Reli aS ta r Li fe In s. Co

. , 61 5

F.3 d 9 41 , 94 6 (8 th Cir . 20 10 ).

W e ne xt co ns id er whe th er R el ia nc e St an da rd ’s de te rm in at io n th at Ham pt on

was no t to ta ll y di sa bl ed was su pp or te d by su bs ta nt ia l ev id en ce— th at is

, “ su ch

rel ev an t ev id en ce as a reas on ab le m in d m ig ht acce pt as a d e q u a t e t o su pp or t a

co nc lu si on .” Ki ng , 41 4 F.3 d at 99 9 (in te rn al qu ot at io n om it te d)

. Rel ia nc e St an da rd

ex pl ai ne d it s vi e w o f th e ev id en ce in it s de ni al of Ham pt on ’s ap pe al

. Alt ho ug h

Ham pt on ’s ph y si ci an , Dr. Hawki ns , op in ed th at Ham pt on wou ld be un ab le to work

as an ov er-t he -ro ad tru ck dr iv er ba se d on th e Dep art m en t of Tran sp or ta ti on ’s

reg ul at io ns , he id en ti fie d n o p hysic al li m it at io ns on Ham pt on ’s abi li ty to do so as a

di rect res ul t of his di ab et es

. Rel ia nc e St an da rd als o a sk ed an ot he r do ct or to rev ie w

Ham pt on ’s cl ai m fil e, an d th at do ct or fo un d no ev id en ce th at di ab e t e s mel li tu s

im pa ire d Ham

pt on ’s abi li ty to p erfo rm

hi s o ccu pa ti on

.

Bas ed on th e e v i d e n c e b efo re it

, Rel ia nc e St an da rd ’s de ni al of be ne fit s was

reas on ab le

. The m at eri al s fro m Dr. Hawki ns ex pl ai ne d on ly th at Ham pt on wou ld be

un ab le to wor k du e to th e Dep art m en t of Tran sp or ta ti on ’s reg ul at io ns

. The m at eri al s

di d no t in de pe nd en tl y li nk Ham pt on ’s in ab il it y to wor k to th e sym pt om s of h i s

di ab et es m el li tu s. It was reas on ab le fo r Rel ia nc e St an da rd to vi ew th os e su bm is si on s

-6

-as in su ffi ci en t to sh ow th at Ham pt on was ph y si cal ly or m en ta ll y in cap ab le of wor ki ng

as an ov er-t he -ro ad tru ck dri ve r du e to hi s d ia be te s m el li tu s.

Ham pt on ci te s th e Dep art m en t of T ra nspo rt at ion ’ s m ed ic al ad vi so ry cri te ria fo r

ev al ua ti on un de r 4 9 C.F.R. § 39 1.4 1, whi ch effe ct iv el y ap pl y an irr eb ut ta bl e

pr es um pt io n th at a pe rs on affl ic te d wit h in su li n- de pe nd en t d i a be te s is at ris k of

pa ss in g ou t, be co m in g di so rie nt ed

, or go in g i n t o a d i ab et ic co m a or sh oc k whi le

wor ki ng as an ov er-t he -ro ad tru ck dr iv er. Bu t th e Pl an req ui res a cl ai m an t li ke

Ham pt on to pr es en t ev id en ce th at hi s il ln es s act ua ll y pr es en ts th os e ri s k s ; fo r

wha te ve r rea so n, Ham

pt on di d no t do so

. It wa s p erm is si bl e fo r Rel ia nc e St an da rd

to req ui re so m e ev id en ce sp eci fic to Ham pt on , as op po se d to th e ge ne ral iz at io ns up on

whi ch th e go ve rn m en t so m et im es m us t rel y in it s reg ul at or y cap aci ty to av oi d

si gn ifi can t adm in is tra ti ve bu rd en s. Se e W ar d v. Sk in ne r , 94 3 F.2d 15 7, 16 2- 64 (1 st

Ci r. 19 9 1 )

. A g a i n, whi le th e fid uc ia ry ’s co nf li ct of in te res t is rel ev an t, th e reco rd

do es no t s h o w a hi st or y of bi as ed cl ai m ad m in is tra ti on or ot he r ci rcu m st an ces

su gg es ti ng a hi gh li ke li ho od th at t h e fid uc ia ry ’s fin an ci al in cen ti ve s dr ov e th e

ev id en ti ary de te rm in at io n he re. Se e Glen n , 55 4 U.S. at 11 7- 18 ; Gre en v. Uni on Se c.

In s. Co

. , 64 6 F .3d 10 42 , 10 53 -5 4 (8 th Cir . 20 11 ).

* * *

The jud gm en t of th e di st ric t co ur t is rev ers ed

. Bec au se Ham pt on is no lo ng er

th e pr ev ai li ng pa rty in th e su it

, we al so va cat e th e di st ric t co ur t’s award of at to rn ey s’

fees an d c os ts

.

SMI TH, Circ ui t J ud ge , di ss en ti ng

.

I res pe ct fu ll y di ss en t. Lik e th e di st ric t co ur t, I co nc lu de th at Rel ia nc e St an da rd

ab us ed it s di sc ret io n in de nyin g Ham pt on lo ng -te rm di sa bi li ty be ne fit s. Sp eci fic al ly,

in reac hi ng it s de ci si on , Re l i a n c e St an da rd fai le d to co ns id er rel ev an t fed eral

-7

-reg ul at io ns sp eci fic al ly refe ren ced by Ham pt on 's ph y si ci an

. I w o u l d affi rm th e jud gm en t o f th e d is tri ct co ur t.

W he re "'t he be ne fit pl a n g i v es th e ad m in is tra to r or fid uc ia ry di sc ret io na ry

au th or it y to de te rm in e el ig ib il it y fo r be ne fit s or to co ns tru e th e te rm s of th e pl an ,'" we

rev ie w th e ad m in is tra to r's de ci si on fo r ab us e of di sc ret io n. Si eg el v. Co nn

. Gen

. Li fe

In s. Co

. , 70 2 F.3 d 10 44

, 10 49 (8 th Ci r. 20 13 ) (q uo ti ng Fir es to ne Ti re & Rub be r Co

.

v. Bru ch

, 48 9 U.S. 10 1, 11 5 (1 98 9) ). "'A pl an ad m in is tra to r ab us es it s di sc ret io n whe n

it ig no res rel ev an t ev id en ce.'" Ger ha rd t v. Li be rt y Ass ur an ce Co

. of

Bos to n , 73 6 F.3 d

77 7, 78 0 (8 th Ci r. 20 13 ) (q uo ti ng W il lc ox v. Li be rt

y Li fe Ass u r a nc e Co

. of Bos to n , 55 2 F .3d 69 3, 7 01 (8t h C ir. 2 00 9) ).

"[I ]f a be ne fit pl an gi ve s di sc ret io n to an ad m in is t rat or or fid uc ia ry who is

op era t i n g u n de r a co nf

li ct of in te res t, th at co nf

li ct m us t be weig he d as a fact or in

de te rm in in g whe th er th er e i s an ab us e of di sc ret io n." Fir es to ne , 48 9 U.S. at 11 5
(q uo ta ti on an d ci ta ti on om it te d)

. "[W] he n jud ge s rev ie w th e la wfu ln e s s of be ne fit

de ni al s, th ey w i l l o f

t e n ta ke acco un t of se ve ral di ffer en t co ns id erat io ns of whi ch a

co nf li ct of in te res t is on e." Glen n , 55 4 U.S. at 11 7. In th es e cas es , "an y on e fact or wil l

act as a ti eb reak er whe n th e ot he r fact or s are cl os el y ba la nc ed

, th e de gr ee of cl os en es s

ne ces sa ry de pe nd in g up on th e ti eb reak in g fact or 's in he ren t o r cas e-s pe ci fic

im po rta nc e." Id

. W he re "t h e reco rd in [a] cas e co nt ai ns li tt le ev id en ce ab ou t ei th er [th e ad m in is tra to r's ] cl ai m s ad m in is tra ti on hi st or y or it s effo rts to en su re th at cl ai m s

as se ss m en t is no t affe ct ed by th e c o nf li ct ," "t hi s Co ur t gi ve s th e co nf li ct so me weig ht ." Dar vel l v

. L i

f e In s. Co

. of N. Am.

, 59 7 F.3 d 92 9, 93 4 (8 th Ci r. 20 10 )

(em ph as is ad de d)

.

Here, Rel ia nc e St an da rd rel ie s on th e lo ss -o f-l ic en se cl au se in th e Pl an to arg ue

th at Ham pt on' s los s of hi s co m

m erci al dr iv er's li cen se do es no t al on e co ns ti tu te "To ta l

Dis ab il it y ." Rel ia nc e St an da rd 's in te rp ret at io n of th is cl au se is reas on ab le —a lo ss of

li cen se al on e do es no t eq ua te to

, o r i s n o t de te rm in at iv e of

, "To ta l Dis ab il it y ."

-8

-Howev er, Ham pt on 's cas e in cl ud e s mo r e t ha n th e ab se nc e of a li cen se ; it in cl ud es

pr oo f of th e pr es en ce of a di sa bl in g ph y si cal co nd it io n. The qu es ti on is whe th er ot he r

ev id en ce exi st s th at Ham pt on is "To ta ll y Dis ab le d" be cau se he can no t "pe rfo rm th e

m at eri al du ti es of

" a lo ng -h au l tru ck dr iv er "d ue to an In jury or Si ck ne ss ." I fin d th at

th ere is ev id en ce ap art fro m th e lo ss of li cen se de m on st rat in g Ham pt on 's "To ta l

Dis ab il it y "— sp eci fic al ly, th e fed eral reg ul at io ns —t ha t Rel ia nc e St an da rd fai le d to

co ns id er in de nyin g Ham

pt on 's cl ai m fo r lo ng -te rm di sa bi li ty be ne fit s. Se e Ger ha rd t

, 73 6 F .3d at 7 80

.

Th e r e l e v an t Fed eral Mo to r Carr ie r Safe ty Reg ul at io ns de fin e th e "g en eral

qu al ifi cat io ns of d riv ers " as fol lo ws:

(a) A p ers on sh al l no t dr iv e a co m m erci al m ot or ve h i c l e u n le ss he /s he

is qu al ifi ed to dr iv e a co m m erci al m ot or ve hi cl e. Exc ep t as pr ov id ed in § 39 1.6 3, a m ot or carr ie r sh al l no t requ ire or pe rm it a pe rs on to dr iv e a

co m m erci al m ot or ve hi cl e un le ss th at pe rs on is qu al if ie d to dr iv e a

co m m erci al m ot or ve hi cl e.

(b ) Exc ep t as pr ov id ed in su bp art G of th is pa rt, a pe rs on is qu al ifi ed to
dr iv e a m ot or

ve hi cl e if

he /s he

. . .

(4 ) Is ph ys ic al ly qu al if

ie d to d r i ve a co m

m erci al m ot or

v e h i c l e i n a c c o r d a n c e w i t h s u b p a r t E-

- P h ys i c a l Qua li fic at io ns an d Ex am in at io ns of t hi s p art

. . . .

49 C.F.R. § 39 1.1 1 (e m

ph as is ad de d)

.

I n t ur n, th e fed eral reg ul at io ns se t fo rth th e "p hysic al qu al ifi cat io ns f o r

dr iv ers ," p ro vi di ng :

(a)( 1) (i) A pe rs on su bjec t to th is pa rt m us t no t op erat e a co m

mercia l

m ot or v e h i c l e un le ss he or sh e is med ic al ly cer ti fi ed as ph

ys ic al ly

-9

-qu al if ie d to do so , an d,

. . . whe n on -d ut y ha s on hi s or he r pe rs on th e

or ig in al

, or a co py, of a cu rren t m ed ic al ex am in er's cert ifi cat e th at he or sh e is ph ys ic al ly qu al if

ie d to dri ve a co m

m erci al m ot or ve hi cl e . . . .

* * *

(b ) A pe rs on is ph

ys ic al ly qu al if

ie d to dr iv e a co m

m erci al m ot or ve hi cl e if t ha t p ers on —

* * *

(3 ) Has no es ta bl is he d m ed ic al hi st or y or cl in ic al di ag no si s of di ab et es mell it us cu rr en tl y re qu ir in g in su li n fo r co nt ro l

. . . .

49 C.F.R. § 39 1.4 1 (e m

ph as es ad de d)

.

The Uni te d St at es Dep art m en t of Tran sp or ta ti on (D O T) ha s pr ov id ed th e

fo ll owi ng reg ul at or y

gu id an ce fo r in te rp ret in g § 39 1.4 1:

Que st io n 1: W ho is res po ns ib le fo r en su rin g th at m ed ic al cert ifi cat io ns

m eet th e req ui rem en ts ?

Gui da nc e: Med ic al cert ifi cat io n de te rm in at io ns are th e res po ns ib il it y of

th e m ed ic al ex am in er. The m ot or carr ie r ha s th e res po ns ib il it y to en su re th at th e m ed ic al ex am in er is in fo rm ed of th e m in im um m ed ic al

req ui rem en ts an d th e ch arac t e r i s t i cs of th e wor k to be pe rfo rm ed

. The

m ot or c arri er is al so res po ns ib le fo r en su rin g th at on ly med ic al ly

qu al if ie d d ri ver s are o pe rat in g C MVs in in te rs ta te co m m erce

.

* * *

Que st io n 3: W ha t are th e ph ys ic al qu al if

ic at io n re qu ir emen ts fo r

op erat in g a CMV i n i nt ers ta te co m m erce ?

-1 0-Gui da nc e: The ph y si cal qu al ifi cat io n reg ul at io ns fo r dr iv ers in in te rs ta te

co m m erce are fo un d at §3 91 .41

. In st ru ct io ns to m ed ic al ex am in ers

pe rfo rm in g ph y si cal ex am in at io ns of th es e dr iv ers are fo un d at §3 91 .43

. In te rp ret iv e g ui de li ne s ar e d is tri bu te d u po n re qu es t.

The qu a l i f

i cat io n st an da rd s co ve r 13 area s whi ch di rect ly rel at e to th e dr iv in g fu nc ti on

. All bu t fo ur of th e st an da rd s req u i r e a jud ge m en t by

th e m ed ic al ex am in er. A pe rs on 's qu al ifi cat io n to dr iv e is de te rm in ed by

a m ed ic al ex am in er wh o i s k no wled ge ab le ab ou t th e dr iv er's fu nc ti on s

an d whe th er a pa rti cu la r co nd it io n wou ld in te rfer e wit h t h e dr iv er's

ab il it y to op erat e a CMV sa fel y

. In th e cas e of vi si on , he ari ng , in su li n- us in g di ab et es , an d ep il ep sy, th e cu rren t st an da rd s are ab so lu te

, pr ov id in g n o d is cret io n t o t he m ed ic al ex am in er.

Regula to ry Gui da nc e fo r th e Fed eral Mo to r Carr ie r Safe ty Reg ul at io ns , 62 FR 16 37 0-

01 , 19 97 W L 15 38 64 , at * 16 41 0– 11 (DOT Apr. 4 , 19 97 ).

In tu rn , th e Med ic al Adv is or y Cri te ria fo r Eva lu at io n ap pl i c a b l e to
§ 3 91 .41 (b )(3 ) st at es :

A pe rs on is ph

ys ic al ly qu al if

ie d to dr iv e a co m

m erc i a l ve hi cl e if th at

pe rs on :

Has no es ta bl is he d m ed ic al hi st or y or cl in ic al di ag no si s of di ab et es

m el li tu s cu rren tl y

req ui rin g i ns ul in for

co nt ro l.

Diab et es m el li tu s is a di se as e whi ch

, on oc cas io n, can res ul t in a lo ss of

co ns ci ou sn es s or di so rie nt at io n in ti m e an d sp ace. In di vi du al s who

req ui re in su li n fo r co nt ro l ha ve co nd it io ns whi ch can ge t ou t of co nt ro l by th e us e of to o m

uc h or to o li tt le in su li n, or fo od in ta ke no t co ns is te nt
wit h th e in su li n do sa ge

. In cap aci ta ti on m ay oc cu r fro m s ym p t o ms of

h y p e r g l y c e m i c o r h y p o g l y c e m i c r e a c t i o n s ( d r o w s i n e s s ,

se m ic on sc io us ne ss , di ab et ic co m a, or in su li n s ho ck ).

-1 1-The ad m in is tra ti on of in su li n is wit hi n it se lf, a co m pl ic at ed pr oc es s

req ui rin g in su li n, syrin ge , ne ed le

, al co ho l sp on ge an d a st eri le

te ch ni qu e. Fact or s rel at ed to lo ng -h au l co m m erci al m ot or ve hi cl e

ope ratio ns su ch as fat ig ue , la ck of sl eep , po or di et

, em ot io na l co nd it ion s,

st res s, an d co nc om it an t il lness

, co m poun d the dia

be tic pr obl em

. Bec au se of th es e in he ren t da ng ers , th e FMC SA ha s co ns is te n t l y he ld th at a 1

di ab et ic who us es in su li n fo r co nt ro l do es no t meet th e min imu m ph ys ic al req ui re men ts of

th e FMCS

Rs

. 2

(Em ph as es ad de d.)

In th e pr es en t cas e, D r

. Hawki ns op in ed in hi s Ju ne 20 11 le tt er to Rel ia nc e

S ta nd ard th at he "d [id ] no t feel th at Mr. Ham pt on wil l be ab le to ob ta in g a i n f u l

em pl oym en t no ti ng hi s in su li n de pe nd en t di ab et es m el li tu s, whi ch pr ecl ud es hi m

fro m op erat in g an y so rt of he av y m ach in ery or m ot or iz ed ve hi cl es ba se d o n th e Dep ar tmen t of Tr an sp or ta ti on re gu la ti on s [(" DOT reg ul at io ns ")]." App el la nt s' App

.

at 78 (em ph as is ad de d)

. Alt ho ug h Dr. Hawki ns m ak es on ly a ge ne ral refe ren ce to th e

D O T r eg ul at io ns , h is refe ren ce to Ham pt on 's "i ns ul in de pe nd an t di ab et es m el li tu s "

m ak es c l e a r th at he was refe ren ci ng 49 C.F.R. § 39 1.4 1( b) (3 ). In ren de rin g hi s

m ed ic al op in io n, Dr. Hawki ns ne ver st at ed th a t H a mp t o n was ph y si cal ly i nc ap ab le

of pe rfo rm in g th e m at eri al du ti es of hi s job be cau se he co ul d no t ob ta in a li ce ns e;

in st ead

, h e op in ed th at Ham pt on co ul d no t pe rfo rm su ch du ti es "b as ed on th e Dep art m en t of Tran sp or ta ti on reg ul at io ns ." As de ta il ed su pr a , th es e reg ul at io ns an d

th e acco m pa nyin g gu id an ce m ak e cl ear th at Ham pt on , who no on e di sp ut es is in su li nde pe nd en t wit h di ab et es m el li tu s, is ph ys ic al ly di sq ua li fie d fro m dr iv in g a lo ng -h au l

co m m erci al ve hi cl e be cau se of th e de li ne at ed ris ks an d in he ren t da ng ers ari si ng fro m

hi s si ck ne ss

. Pu t an ot he r way , Ham pt on is ph y si cal ly in cap ab le of p e r f o r mi ng th e

m at eri al du ti es of a lo ng -h au l t ru ck dri ve r be cau se of d ia be te s m el li tu s.

Fed eral Mo to r Car rie r Safe ty A dm in is tra ti on 1

Fed eral Mo to r Car rie r Safe ty Regu la ti on s 2

-1 2-In de nyin g Ham pt on be ne fit s, Rel ia nc e St an da rd ne ver refe rred to th e rel ev an t

fed eral reg ul at io ns in co nju nc ti on wit h Dr. Hawki ns 's Ju ne 20 11 le tt er. In do in g so , it fai le d to co ns id er al l rel ev an t ev id en ce. Se e Ger ha rd t

, 73 6 F.3 d at 78 0. Tak in g in to

acco un t's Rel ia nc e St an da rd 's po si ti on as bo th ad m in is tra to r an d in su rer, I co nc lu de

th at Rel ia nc e St an da rd ab us ed it s di sc ret io n in de nyin g Ham pt on lo ng -te rm di sa bi li ty

be ne fit s. Se e id . Acco rd in gl y , I wou ld affi rm th e jud gm en t o f th e d is tri ct co ur t.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

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