Opinion ID: 2974039
Heading Depth: 2
Heading Rank: 3

Heading: Discussion of MetLife’s Appeal

Text: The district court held that MetLife’s denial of LTD benefits to Evans was arbitrary and capricious for two reasons. First the district court found, based on statements in MetLife’s motion for judgment on the administrative record, that MetLife considered unsubstantiated information reported by several of Evans’ fellow employees when it decided to deny Evans LTD benefits. According to an entry in the administrative record, the employees informed Kroger that they saw Evans jet skiing, riding a motorcycle, and working on cars while she was off work for her disability. The district court concluded that MetLife’s reliance on this report was arbitrary and capricious because MetLife never determined the No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 8 identity of the employees and because MetLife’s subsequent surveillance of Evans failed to corroborate the employees’ claims. Second, finding that the modified position Kroger offered Evans did not accommodate all of her work restrictions, the district court held that it was arbitrary and capricious for MetLife to rely on the offer in concluding that Evans was capable of earning at least 80% of her Predisability Earnings at her “Own Occupation.” As an initial matter, Evans asserts that because MetLife specifically argued below that its decision to deny Evans benefits was supported by her motorcycle riding, jet skiing, and work on cars, it should be estopped from arguing on appeal that the report of these activities by her fellow employees was not relevant to its decision. MetLife contends that estoppel should not apply because its counsel erred in making the argument below as the administrative record in fact does not suggest that MetLife relied on this report when it rendered its decision. We agree. A court’s review of a plan administrator’s decision in an ERISA case– whether the court is conducting a de novo review or a review under the arbitrary and capricious standard– must be based solely on the administrative record. See Yaeger, supra; see also Wilkins v. Baptist Healthcare Sys., 150 F.3d 609, 619 (6th Cir. 1998). Arguments and factual assertions made by the parties which are not supported in the administrative record should not be considered. Wilkins, 150 F.3d at 619. While the administrative record in this case contains a note regarding the report by Evans’ fellow employees, there is no evidence in the record No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 9 to suggest that MetLife gave any credence to the report. In fact, except for MetLife’s reference to the report as a basis to initiate surveillance of Evans, the administrative record contains no further mention of the report or the allegations made therein. Moreover, MetLife initially granted LTD benefits to Evans after it received the employees’ claims regarding Evans’ activities. The administrative record does not suggest that MetLife considered the employees’ allegations in rendering its decision to deny LTD benefits to Evans as of December 21, 2002. We therefore find no basis to support the argument that MetLife’s decision was premised, at least in part, on those allegations. As a result, the district court erred in concluding that MetLife’s decision was arbitrary and capricious as a result of its supposed reliance on those claims. The district court also concluded, and Evans argues on appeal, that MetLife acted arbitrarily and capriciously when it relied on Kroger’s offer to accommodate Evans’ work restrictions to find that she was capable of earning at least 80% of her Predisability Earnings at her “Own Occupation” and thus was not disabled under the Plan because the modified job did not accommodate all of Evans’ work restrictions. Specifically, the district court concluded that the modified position Kroger offered Evans did not accommodate Evans’ inability to (1) engage in medium work, (2) bend, twist, and crouch/stoop, or (3) routinely work overtime. The administrative record, however, does not support the district court’s No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 10 finding that these restrictions were unequivocally recommended for Evans or that the modified position did not accommodate these restrictions. The district court apparently concluded that the modified position Kroger offered Evans required medium work, rather than light work, since it occasionally involved lifting 21 to 50 pounds.4 We are not convinced that the job Evans previously performed constituted medium work because it involved occasional lifting of 21 to 50 pounds.5 Nevertheless, Kroger specifically indicated that it was willing to remove any lifting from Evans’ job responsibilities in order to accommodate her work restrictions. The district court concluded that Evans was restricted from twisting and crouching/stooping, restrictions the court found lacking in the modified job Kroger proposed.6 None of the physicians on whose opinions MetLife relied, however, imposed a 4 In her brief, Evans describes the Inventory Control Supervisor position as involving “intensive manual labor.” Nothing in the administrative record describes the position in these terms and a review of the responsibilities set forth in the job description does not suggest that “intensive manual labor” was required. 5 See 20 C.F.R. § 404.1567. According to the Administrative Law Judge’s decision, the vocational expert who testified at Evans’ Social Security Administration hearing classified her past work– including her job as a warehouse worker– as light work. 6 The district court also concluded that Kroger’s job description failed to accommodate Evans’ work restrictions because it did not specify that no bending would be required. While Dr. Hauge stated and Dr. Moyer concurred that “the less lifting and bending the better in a patient with this degree of scoliosis . . . ,” neither doctor specifically imposed a no bending work restriction. Moreover, it would have been reasonable for MetLife to conclude that the amount of bending necessary to fulfill the Inventory Control Supervisor position would be diminished due to the removal of any previous lifting requirement. MetLife apparently made this assumption as it stated in its letter to Evans on February 11, 2003, that Kroger is capable of accommodating her lifting and No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 11 no-twisting-or-crouching/stooping restriction. Dr. Hauge concluded that Evans was “physically capable of doing light work with 20 pounds occasional lifting but the less lifting and bending the better . . .” Dr. Moyer, the first physician MetLife consulted to independently review Evans’ file, equated Evans’ condition to sciatica and wrote: Persons with sciatica and low back pain are commonly able to perform at a sedentary or sedentary to light level with avoidance of prolonged sitting, standing or walking while working at their own pace so that changes of position can be afforded on an as needed basis. The records provided would support that this person would also reasonably be restricted to sedentary to light work where she may lift up to 20 pounds occasionally but should alternate between sitting, standing and walking for pain relief and comfort. The records provided would not support that this person is incapable of doing any type of work, however, the medium level work described in her current job description may not be reasonable under the circumstances. Dr. Silverman, the second independent physician MetLife consulted, concurred with Drs. Hauge’s and Moyer’s recommendations. Only Dr. Watters, Evans’ treating physician, recommended a-no-twisting-orcrouching/stooping restriction. While the district court recognized that MetLife was not bound by Dr. Watters’ opinion and that it was not arbitrary or capricious for MetLife to rely instead on Dr. Hauge’s assessment, the court proceeded to find Kroger’s proposed job offer lacking because it failed to incorporate restrictions recommended by Dr. Watters, but not Dr. Hauge. This was improper under an arbitrary and capricious standard of review. repetitive bending restrictions. No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 12 Finally, the district court concluded that it was arbitrary and capricious for MetLife to rely on Kroger’s offer because the modified job did not accommodate her inability to routinely work overtime. The district court acknowledged that none of the physicians who reviewed Evans’ case, including her treating physician, specifically addressed the question of whether Evans could routinely work overtime. Nevertheless, the court surmised that “Dr. Moyer’s statement that Evans would need to avoid prolonged sitting, standing or walking while working at her own pace, strongly suggests that her scoliosis would produce some limitation/restriction on Evans’ ability to routinely work overtime.” We do not infer a necessary correlation between the need to change positions or work at one’s own pace and the ability or inability to work overtime and believe that it was error for the district court to assume that such a correlation exists. We therefore conclude that the district court erred in finding that Evans was incapable of working overtime when– as the district court itself recognized– there is no indication of this restriction in the administrative record. Moreover, there is evidence in the administrative record suggesting that the position Kroger offered Evans did not require overtime work. In Kroger’s e-mail to MetLife describing the modified position, Kroger provides: “The hours are 10:00 PM to 6:30 AM Sunday through Thursday – a 40 hour work week.” (Emphasis added.) Evans raises other arguments not addressed by the district court to support her assertion that MetLife acted arbitrarily and capriciously when it denied her claim for LTD No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 13 benefits based on the modified position offered by Kroger. First, Evans argues that the “sedentary position” Kroger offered did not accommodate her inability to sit for prolonged periods of time and to concentrate. In her brief, Evans declares that “[i]t goes without saying that a sedentary position is one that requires a great deal of sitting.” She further claims that a sedentary position “also certainly requires focused concentration and mental clarity.” Evans, however, does not cite any authority to support her description of a sedentary position. In fact, there are numerous jobs qualifying as sedentary positions which do not require prolonged sitting without the benefit of occasional standing and walking or focused concentration and mental clarity.7 Evans also argues that the accommodated position offered by Kroger is so different from the Inventory Control Supervisor position she previously worked that it cannot possibly be considered her “Own Occupation” under the terms of the Plan. As set forth previously, the Plan defines the term “Own Occupation” to mean “the activity that you regularly perform 7 The Court can take judicial notice of the following definition of “sedentary work” set forth in the Department of Labor’s Dictionary of Occupational Titles, which has been adopted by the Social Security Administration in 20 C.F.R. § 404.1567(a): Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. No. 05-5791/05-6327 Evans v. Metro. Life Ins. Co. Page 14 and that serves as your source of income.” The Plan further provides, however, that “[i]t is not limited to the specific position you held with your Employer. It may be a similar activity that could be performed with your Employer or any other employer.” (Emphasis added.) Kroger informed MetLife that it was willing to return Evans to the specific supervisory position she previously held. We do not believe that there was any reason for MetLife to question that representation or to question whether the modified position would involve at least similar activity to that which Evans previously performed, particularly as the description of the supervisory position Evans held prior to her disability lists numerous tasks that can be performed in a sedentary environment without the need to lift more than 20 pounds. This Court finds no basis to conclude that MetLife’s decision to deny Evans LTD benefits was arbitrary and capricious. The decision is rational in light of the Plan’s provision that employees are not disabled if they are able to earn more than 80% of their Predisability Earnings at their “Own Occupation.” Drs. Hauge, Moyer, and Silverman agreed that Evans was capable of working in a sedentary position with 20 pounds occasional lifting, restrictions the administrative record indicates Kroger accommodated in the modified Inventory Control Supervisor position it offered Evans. The district court erred in holding otherwise.