2003 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
10-20-2003 

# N ichol s v . V e r i zon C omm I nc P r e c e de n t i al or N on-P r e c e de n t i al : N on-P r e c e de n t i al D ocke t N o . 02-3521

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Thi s de c i sion i s br ou gh t t o you for f r e e a nd 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 l l a no va U nive r sit y S choo l of L a

w Di g it al Re posit or y

. It h as be e n a c c e pt e d for inclusion in 2003 D e c i sion s b y a n author i z e d a dmini s tr at or of V i l l a no va U nive r sit y S choo l of L a

w Di g it al Re posit or y

. F or mor e infor m at ion, p le as e c on t a ct Be n j a min . C a rl s on@l a

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w . v i l l a no va . e du/thir dc ir c uit_2003/197NOT PRE CEDENT IAL THE UNITED STATES COURT OF APPEALS

FO R T HE TH IRD CIR CU IT

___________ No. 02-3521

___________ JACQUELINE N ICHOLS, Appellant

v.
VERIZON COMMUNICATI ONS INC. ; METLI FE, INC; THE BE LL ATL ANTI C EMPLOYE E BENE FI T PLAN ; THE BE LL ATL ANTI C LONG TE RM DIS ABI LI TY PLA N; THE BE LL ATL ANTI C PLAN AD MINI STRAT OR

___________ ON APPEAL FROM THE UNI TED STATES DIST RICT COURT

FOR THE DISTRICT OF NEW JERSEY (D.C. Civi l No. 01-cv- 00497) Distric t Judg e: Th e H ono rable J erom e B. S iman dle

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

September 3, 2003
BE FO RE : SL OV ITE R, N YG AA RD , and RO TH , Circu it Judges
.1. This par ty i s incor rect ly captioned as M etl if e, I nc. 2 (Fil ed: October

20, 2003)

___________ OPINI ON OF THE COURT

___________ NY GA AR D, Circu it Judge
.

Appellant

Jacqueli ne Nichols br ought thi s acti on against Appellees Metropolit an Life Ins urance Co. 1 (“Metli fe”) and Veri zon Communications, Inc., The Bell Atl antic Employee Benefi t Plan, The Bell Atlantic Long Term Disabi lit y Pl an, and the B ell Atla ntic Pla n A dm inistrator (c ollective ly “the V erizon defe ndan ts”). N ichols file d the sui t in an attempt to recove r benefi ts fr om Verizon’s l ong-term disabil ity plan (“the Plan”) u nder the E mployee R etirement Inco me S ecurity Act of 19 74 (“E RISA ”). Nichols now chall enges the Dis tri ct Court’ s grant of summary j udgment on behalf of Appellees, as well as the Dist rict Court’s refusal to hold that Metlife was a pr oper def end ant in her cl ai m. We wil l a ffirm. I. FACTS The facts cont ained i n the admini strative record of this cas e are extensive and d etailed. B ecau se they are we ll know n to the parties, w e w ill review them only br ief ly.3 Nicho ls worke d for B ell Atlantic, later Verizon, fo r approxim ately 10 years as a fr ame attend ant, be fore s he be cam e ill and bega n to rec eive sh ort-term disab ility benefit s. Fol lowing the termination of her s hort- term benefi ts, she fil ed an appli cati on on May 13, 1998 for l ong-term benefits under the Pl an. She cl ai med t hat shesuf fered f ro m a variety of ailments, including depression , anxiety, Chronic Fa tigue Syndrom e (“CF S”), severe al lergi es, as thma, neck and back pain, muscle weakness, and sensi tivi tyto li ght and sou nd. See J.A. at

63. The diagnos is of CFS recei ved support from her treati ng physi cian, who further noted that Nichols was “unabl e to do anyjobs that require eit her physi cal la bor or m enta l activ ities. Id. at 86.

Fo llow ing the s ubm issio n of exte nsiv e m edic al inf orm ation by N icho ls, a med ical ex amin ation b y a docto r selecte d by M etlife, an d a vo cation al revie w o f her s kills and limi tati ons, Metli fe denied Nichol s’ reque st for benefit s in a l ette r dated November 17, 1998, f

inding t hat she di d not meet t

he defini tion of total di sabil ity under the Pl an. The Plan stipulate s that in o rder to qualif y for long -term d isability ben efits, ap plican ts must be “ unable to e ngage in any occupa tion or emp loyment for w hich [they] are qualif ied (or mayreasonabl y become qual ifie d based on [the ir] educati on, tr aining or experie nce).” Id. at 284.

Nichols fi led an appealto the c laim determination, a ccording to the rul es of the Plan, and submitted additional medi cal re cords. Metlife s ubmitt ed her medicalrecords for revi ew by a nurs e consult ant and two doctors, one whom w as a consul tant at the4

Network M edical Review Com pany. Metlife then affirmed the initialdenial of benefits, findin g that “ the m edica l inform ation d oes n ot sup port a s evere cond ition tha t wo uld precludeemployment .” Id. at 27 6-7 7.

Nichols appea led thi s decis ion to t he District Court , and the parti es fil ed
cross- motions for

summary j udgment. Byan order dated August 16, 2002, the Dist rict Court granted Appellees ’ reques t for s ummary judgment . Since this ruli ng resul ted in t he dism issal of the en tire case , the C ourt d ecline d to m ake a findin g on M etlife’s se parate assert ion that it was not

a proper defe ndant. This Court has juri sdiction to review the grant of s ummary judgment under 28 U.S.C. § 1291. II . DIS CUSS ION

A. Summary Judgment This Court exe rcis es plenary r eview of the Dis tri ct Court’ s grant of
sum mary jud gm ent. See Blair v. Scott Speci alty Gases , 283 F.3d 595, 602 -03 (3d C ir. 200 2). A s did th e D istrict Co urt, w e exa mine the fa cts in the light m ost fav orab le to Appellant

and affirm the grant

of summary j udgment if t here is no genuine i ssue of materialfact

and Appel lees are e nti tl ed to judgmen t as a matter of l aw. Fed. R. Civ. P. 56(c). The D istri ct Court properlyfound that the denial of benefits in t his case shou ld be re view ed un der the arbitrary an d cap ricious stand ard. T his stan dard is appropri ate when, as in thi s case, the ERISA benefit pl an gives t he Plan’s administ

rator5

discr etion to determi ne eli gibil ity for benefi ts and aut

hority t o construe the t erms of the plan
. See M itche ll v. E astm an K oda k C o., 113 F.3d 433, 437- 39 (3d Cir. 1997). Under this highly

deferential s tandard, the deci sion of the Plan’s administ rator may be overturned onlyif it

is “wit hout reas on, unsupported bysubstant ial e vidence or

erroneous
as a ma tter o f law .” Ab nat hya v. H offm ann -La Ro che , Inc ., 2 F.3d 40, 45 ( 3d Cir. 1993) (internal quot ations and cit ations omitt ed). “A deci sion i s supported by s ubstantial evidence i f there is suff icie nt evide nce for a re asonable pe rson to a gree with t he decisi on.” Courson v. Bert Bell NFL Player Ret. Plan , 214 F.3d 136, 142 (3d Cir. 2000) (i nt erna l q uot atio ns an d c it atio n om it te d) . A re vi ewi ng c our

t m aynot

su bs ti tu te it s o wn jud gm ent f or th at of the P lan a dm inistr ator . See M itchell , 113 F.3d at 439. The arbit raryand capri cious st andard of revi ew controls the outc ome of this c ase. The volu mino us m edica l evide nce, in cludin g con flicting o pinion s by num erou s doc tors, is fairly subje ct to a f inding on eith er side . Un der the Sup reme Co urt’s rec ent de cision in Black & Decker Disabi lit y Plan v. Nord, 123 S.Ct. 1965, 1972 (2003), administ rator s of ER ISA p lans are not ob ligated to accord special defe rence to the o pinion of a claimant’s treating physician . Me tlife is ther efore justified in plac ing relia nce o n the o pinion s of its own consulti ng doctors and need not pr ovide a spec ial e xplanation of it s decis ion to do
so. Id. Nichols as sert s that Metlife’ s denialof benefit s was improper l argely because she contends i t was based on onl y a coupl e of factor s: the lack of obj ecti ve medical e vidence2. At leas t as s igni fi cant t o the opi nions of Drs. Byron Mui and RobertPetr ie was the o bse rvation that co ntrary to ph ysicia ns’ a dvic e, N icho ls had con tinued for 25 yea rs to sm ok e a pa ck of c iga rettes a d ay , des pite th e fa ct tha t she ha d b ee n d iag no sed w ith alle rgie s a nd va riou s re sp irato ry p rob lem s. See J.A. a t 91- 92 and 272-73. Dr. Mui the oriz ed tha t this ha bit m ay be the ca us e o f so m e o f N ich ols ’ sy m pto m s. Id. at 92. N icho ls do es n ot ad dres s this find ing in her b rief. 6 confirmi ng her diagnos is, and unsupport ed clai ms that her fati gue may be the resul t of eithe r mentalill ness or t he use of al cohol and i lli cit dr ugs. Nichol s is cor

rect i n clai ming that i f the deni al of her

clai m had been based sol elyupon the la ck of objective medical evide nce o f etiolo gy, wh ich a c laima nt w ith CF S w ould typically be un able to prov ide, it would run afoul of t

his Court ’s rul ing in M itchell , 113 F.3d at 442-43 (hol ding that

under the fact s of that

case, i t was arbi trary and caprici ous for a pl an to require objec tive evidence of t

he eti ologyof CFS, when it i s widelyrecogniz ed that there i s no conclus ive labo rato ry test f or C FS ). Bu t that is sim ply no t the c ase her e. The record r eveals t

hat thedenialof Nichols’ clai m was based on any number of factors, including th e lack of o bjective tests dem onstrating the ex istence of he r sy mptoms , something a c laimant

with CFS might rea sonablybe asked to provide. Although Metli fe does mention t

he possibi lit

y of an underly ing diagnos is of depression, and refer to the theore tical influ ence of d rug a nd alc oho l use (a n asse rtion tha t was appa rently
unsu bstan tiated), the se sup positio ns w ere no t centra l to the o pinion s of its d octors , or to its decisi on to deny benefits. 2

Even if thi s Court were i ncline d to dis agree with Metlife’ s determinati on based on a de novo review of the administ rati ve record, we may not subs tit ute ourjud gm ent f or th at of the P lan a dm inistr ator . See M itchell , 113 F.3d at 439. In this case

there w as clea rly adequ ate ev idenc e that m ight ca use a reaso nable perso n to ag ree w ith the d enia l of b ene fits. See Courson , 214 F.3d at 142. The District

Court’s gr ant of summary j udgment is t

herefore appropri ate. B. Metli fe as a Defendant Nichols chal lenges t

he District Court ’s fai lure to decide whether Metlife i s an appropri ate defendant

in her ERISA clai m. Since we willaffirm the dismis sal of her complaint

in it s enti rety , we joi n the Dist rict Court in dec lini ng to addres s thi s iss ue. II I. CONCLU SI ON For the r easons set

forth above , the Distri ct Court’ s grant of summary j udgment on behalf of Appell ees willbe affirmed.

_________________________ TO THE C LERK: Please fi le theforegoing opi nion.

/s/ Richard L . Nygaard Circuit Judge

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