Opinion ID: 164951
Heading Depth: 3
Heading Rank: 1

Heading: Disability Status

Text: UNUM argues that even considering all the evidence “[Rev.] Sipp did not conclusively prove that he was totally disabled such that reasonable minds could not differ.” Aples’ Br. at 24. In support of his breach of contract claim, Rev. Sipp provided medical records from Dr. Jafet Gonzales, who treated Rev. Sipp in April -8- 2001; a letter from Dr. Harry Linneman, a clinical psychologist who began treating Rev. Sipp in early 2002; and the reports of two experts, one a clinical psychologist and one a vocational evaluator. UNUM filed a motion to strike these records “as they have not been authenticated and constitute hearsay.” App. vol. I, at 183. The district court denied the motion to strike and accepted authenticating affidavits that Rev. Sipp later provided. UNUM argues that this evidence is hearsay and that Rev. Sipp’s affidavits did not allow admissibility under any exception to the hearsay rule. We need not decide whether the district court abused its discretion in denying UNUM’s motion to strike, as we conclude that even if the evidence was admissible, it did not support summary judgment for Rev. Sipp. As UNUM’s experts clearly disagreed with the above evidence that Rev. Sipp was totally disabled as a result of his depression, summary judgment was inappropriate. The district court observed that “the record is replete with medical opinions indicating that Sipp’s personality traits and psychological depression interfered with his ability to interact well with his congregation, in what everyone acknowledges is a high-stress job.” App. vol. II, at 441. Furthermore, the court noted that “[t]he only contrary evidence comes from psychologists who did not examine Sipp and whose opinions are criticized by Plaintiff’s consulting psychologist, who did examine Sipp.” Id. at 439. Two UNUM experts determined that Rev. Sipp was not conclusively disabled, based on the documents in his -9- internal UNUM file. Consulting clinical psychologist Jennifer D. Lish conducted a review of all documents included in Rev. Sipp’s UNUM file and concluded that “[t]his file does not contain sufficient evidence to document that the Insured’s psychiatric symptoms rose to the level that would be expected to preclude occupational functioning.” App. vol. I, at 135. Similarly, Ann Ward-Bennett, a psychiatric case manager who also reviewed Rev. Sipp’s file, concluded that “there is no clear diagnostic formulation . . . to support a disabling condition other than an Adjustment Disorder with Mixed Anxiety and Depressed Mood. Nor does the information that has been submitted support a level of severity consistent with a compromising condition.” Id. at 133. However, generally speaking, summary judgment is not advisable in situations in which there is a conflict in expert testimony, even when the evidence leans one way. See Zuchel v. Spinharney, 890 F.2d 273, 275 (10th Cir. 1989) (“It makes no difference that [defendant]’s view of the evidence is supported by the majority of the witnesses whose testimony was submitted to the district court at the summary judgment stage. Neither we, nor the district court, are entitled to weigh evidence or pass on the credibility of witnesses in deciding summary judgment issues.”); see also Hudson Riverkeeper Fund, Inc. v. Atlantic Richfield Co., 138 F. Supp. 2d 482, 488 (S.D.N.Y. 2001) (noting that “where, as here, there are conflicting expert reports presented, courts are wary of granting summary -10- judgment”). Questions such as whether the insured is partially or totally disabled under a specific policy definition usually necessitate a jury determination, and “[c]ourts typically do not apply contract interpretation as a matter of law (absent a statute) to the determination of the insured’s disability.” 1 E RIC M ILLS H OLMES & M ARK S. R HODES , A PPLEMAN ON I NSURANCE § 1.27, at 138 (2d ed. 1996); see also Olson v. Aetna Life Ins. Co., 171 So. 2d 548, 548 (Fla. Ct. App. 1965) (noting that “[t]he ultimate factual question in this case is whether the insured was totally disabled from performing his duties,” and that while “[u]nder certain circumstances, the question of whether disability exists may be one of law, . . . more often this is a question of fact for determination by the jury.”) The fact that UNUM’s contrary evidence came from non-treating physicians certainly may affect the credibility and weight of the evidence, but it does not justify discounting the evidence entirely. For example, in the Social Security disability context, an Administrative Law Judge charged with determining whether a claimant is disabled, “[g]enerally . . . give[s] more weight to the opinion of a source who has examined [the claimant] than to the opinion of a source who has not.” 20 C.F.R. § 416.927(d)(1). In Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003), the Supreme Court applied the treating physician preference to the ERISA context, noting that “[a]s compared to consultants retained by a plan, it may be true that treating physicians, as a rule, have a greater opportunity to know -11- and observe the patient as an individual,” and acknowledging the “concern that physicians repeatedly retained by benefits plans may have an incentive to make a finding of ‘not disabled’ in order to save their employers money and to preserve their own consulting arrangements.” Id. at 832 (internal quotation marks omitted). The Court went on, however, to qualify the preference for the opinions of treating physicians: “But the assumption that the opinions of a treating physician warrant greater credit than the opinions of plan consultants may make scant sense when, for example, the relationship between the claimant and the treating physician has been of short duration, or when a specialist engaged by the plan has expertise the treating physician lacks.” Id. A jury charged with determining whether Rev. Sipp was totally disabled might accord more weight to the opinions of treating physicians and psychologists than to the opinion of non-treating psychologists. But as it “[i]t is the jury’s exclusive province to assess the credibility of witnesses and determine the weight to be given to their testimony,” Lamon v. City of Shawnee, 972 F.2d 1145, 1159 (10th Cir. 1992), we will not decide whether an expert’s opinion based on an examination of Rev. Sipp is entitled to more weight than that of a non-treating psychologist. We hold that such a conflict should not be resolved by summary judgment.