Opinion ID: 77935
Heading Depth: 2
Heading Rank: 1

Heading: Any Occupation Benefits

Text: Byars argues that the district court erred in deciding her entitlement to benefits beyond the first twenty-four months following her disability date. She argues that because the Committee never decided whether she was entitled to benefits under the any occupation definition, the court should have either remanded her claim to the Committee or held a de novo bench trial to consider evidence that she would have proffered to the Committee in support of any occupation benefits. The Coca-Cola Defendants argue that Byars invited the district court to rule on her entitlement to any occupation benefits because she requested relief up to the time of filing for summary judgment, well beyond the first twenty-four months following her disability date. The Coca-Cola Defendants also argue that Byars presented the issue of any occupation benefits to the district court and submitted evidence in support of those benefits, and therefore, judicial economy counseled that the district court decide her entitlement to them without remanding to the Committee. We do not write on a clean slate regarding this issue. In Oliver v. Coca Cola Co., 497 F.3d 1181 (11th Cir.2007), vacated in part on petition for reh'g, 506 F.3d 1316 (11th Cir.2007), a recent panel of this court held that a district court may rule on a beneficiary's entitlement to any occupation benefits even though the plan administrator had not yet done so. The plan in Oliver is the same Coca-Cola Plan that is before us. Further, the administrative history in Oliver is similar. A beneficiary filed a claim for LTD benefits and the Committee denied his claim under the own occupation definition, never reaching the any occupation definition. The district court reversed the Committee's denial of own occupation benefits, and then concluded that the beneficiary was also disabled under the any occupation definition. We held in Oliver that the district court did not abuse its discretion in excusing the beneficiary from exhausting his administrative remedies; that is, he was excused from seeking a decision by the Committee in the first instance on his entitlement to any occupation benefits. We said that [e]xcusal of the exhaustion requirement is appropriate `when resort to the administrative remedies would be futile or the remedy inadequate.' Id. at 1200 (quoting Counts v. Am. Gen. Life & Accident Ins. Co., 111 F.3d 105, 108 (11th Cir.1997)). We held that exhaustion of remedies would be futile in that case because the Committee had denied the plaintiff benefits based on the easier-to-satisfy own occupation definition of disability. We stated that [t]hat determination necessarily precluded [the plaintiff] from arguing with a straight face to the same insurance company that he was unable to perform the material and substantial duties of any occupation. Id. at 1200-01 (quoting Dozier v. Sun Life Assurance Co. of Can., 466 F.3d 532, 535 (6th Cir.2006)) (internal quotation marks omitted). This case, however, is materially different from Oliver in several respects. In Oliver, the parties apparently sought summary judgment on Oliver's entitlement to benefits under both definitions of disability. The district court said that it is called upon to determine from the record evidence whether Oliver was `disabled' during two separate periods of time, as the term `disabled' is separately and differently defined in the Plan for the two periods. Oliver v. Coca-Cola Co., 397 F.Supp.2d 1318, 1325 (N.D.Ala.2005). The court also noted that the claims administrator never voiced any distinction between Oliver's status or his ability to function in an employment environment during these separate periods of time. Id. In contrast, neither Byars nor the Coca-Cola Defendants sought summary judgment on the issue of Byars' entitlement to benefits under the any occupation definition. Thus, the district court granted summary judgment to the Coca-Cola Defendants on a claim for which they had not sought summary judgment. Although a court may sua sponte grant summary judgment on a claim not presented in a summary judgment motion, the court is required to give notice to the parties that it intends to address the claim on summary judgment. Here, the district court provided no notice that it intended to rule on the any occupation definition of disability. This was error. See Imaging Bus. Machs., LLC v. BancTec, Inc., 459 F.3d 1186, 1191 (11th Cir.2006) (holding that sua sponte grant of summary judgment without notice to the parties constitutes reversible error); Massey v. Cong. Life Ins. Co., 116 F.3d 1414, 1417 (11th Cir.1997) (explaining that notice is mandatory before sua sponte grant of summary judgment). The Coca-Cola Defendants argue that Byars invited the district court to rule on her entitlement to any occupation benefits, and thus we should not entertain her argument that the court erred in doing so. There is some confusion in the record to be sure, but we are unable to conclude that the grant of summary judgment was invited error. The Second Amended Complaint is not free of ambiguity. It is a rambling 74-page pleading that asks for a [d]eclaration of her right to benefits (past, present and future) under the terms of The LTD Plan, and [p]ayment of all past due benefits due her under the terms of the plan. . . . (R.9-131 at 69.) The complaint, however, only seeks review of the Committee's decision and nowhere references the any occupation definition. But, whether or not the complaint included a claim for any occupation benefits, Byars' summary judgment motion did not invite the district court to address the question. A careful review of the motions for summary judgment and the supporting memoranda reveals that neither Byars nor the Coca-Cola Defendants sought summary judgment on the issue of Byars' entitlement to any occupation benefits. [7] Byars' memorandum in support of summary judgment is filled with references and arguments pertaining only to the Committee's error under the own occupation definition. [8] Similarly, the Coca-Cola Defendants' supporting memorandum constantly refers to Byars' failure to prove that she could not perform her own job at Coca-Cola. [9] This case is different from Oliver in another respect. In Oliver, all parties agreed that there was no material issues of disputed fact, and no one suggested that the record was incomplete. On the other hand, there exists disputed issues of fact about whether Byars could satisfy the any occupation definition. For example, Dr. Payne indicated in his functional assessment of Byars that her full capacity for sitting and standing was limited to two hours a day, while her full capacity for walking was limited to one hour a day. (R.15-216 at CC111.) In this same assessment, Dr. Payne selected the option [s]evere limitation of functional capacity/incapable of sedentary work to describe Byars' physical impairment. (R.15-216 at CC114.) Dr. Payne also opined in a letter to the Committee that Byars is disabled and incapable of doing any type of work which requires prolonged periods of either sitting or standings as these only aggravate her sciatic symptoms. (R.15-216 at CC16.) Even more telling is the conclusion that Jack Sink, a vocational expert, arrived at in his Comprehensive Vocational Assessment of Byars: All of these facts must lead to the conclusion that Ms. Byars does experience pain which is debilitating and which prevents her from being a competitive worker. In brief, Ms. Byars simply does not have the ability for sustained physical and/or mental performance necessary to meet a competitive standard of work in her previous job, or in any other job, so long as she continues to have her current limitations. Since her physicians have found her to be at maximum medical improvement, it is assumed that the limitations she currently experiences will continue. (R.15-216, Ex. 10 to Ex. 2 Demand Letter at 10) (emphasis added). But, the Coca-Cola Defendants also presented evidence showing that although Byars has reached her maximum medical improvement, she is capable of doing some work, as long as she is able to frequently adjust positions. (R.15-216 at CC16) (letter of Dr. Payne opining that Byars is disabled and incapable of doing any type of work which requires prolonged periods of either sitting or standing). Furthermore, ReliaStar and its reviewing physicians believed the evidence did not support Byars' claim for disability even under the own occupation definition. (R.15-216 at 15) (ReliaStar physician review report that there is nothing documented that is objective that would support the patient's continued disability). Unlike in Oliver, there are genuine issues of fact regarding the extent of Byars' disability. The district court denied Byars benefits under the any occupation definition because [h]er medical records do not demonstrate that she is physically disabled from engaging in any occupation for which she is qualified. (R.15-221 at 14.) Byars, however, was never required to produce evidence supporting a claim for any occupation benefits because the Committee denied her claim before the any occupation definition became applicable at the twenty-fifth month following her disability date. Byars should not suffer an adverse decision because of a failure to present evidence supporting the any occupation definition. We hold, therefore, that the district court erred in deciding Byars' entitlement to any occupation benefits on summary judgment.