Avery v. International Paper Co. Sickness & Accident Plan

833 F. Supp. 2d 1101, 2011 WL 2489923, 2011 U.S. Dist. LEXIS 66603
CourtDistrict Court, W.D. Arkansas
DecidedJune 22, 2011
DocketCase No. 09-01010
StatusPublished

This text of 833 F. Supp. 2d 1101 (Avery v. International Paper Co. Sickness & Accident Plan) is published on Counsel Stack Legal Research, covering District Court, W.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Avery v. International Paper Co. Sickness & Accident Plan, 833 F. Supp. 2d 1101, 2011 WL 2489923, 2011 U.S. Dist. LEXIS 66603 (W.D. Ark. 2011).

Opinion

MEMORANDUM OPINION AND ORDER

ROBERT T. DAWSON, District Judge.

Plaintiff brings this action pursuant to the provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., alleging Defendant’s decision to deny his claim for long-term disability benefits was unreasonable. Before the Court are the Stipulated Administrative Record (Doc. 9), Plaintiffs Complaint (Doc. 1), Defendant’s Answer (Doc. 5), Plaintiffs Motion for Order Directing Administrative Record to be Augmented and for De Novo Review (Doc. 10), Order Denying Motion to Supplement Record and for De Novo Review (Doc. 13), and Defendant’s Memorandum Brief in Support for Defendant’s Motion for Judgment on the Administrative Record and in Opposition to Plaintiffs Memorandum Brief in Support of Claim of ERISA Benefits (Doc. 15). Plaintiffs claim is DENIED, and Plaintiffs Complaint is DISMISSED WITH PREJUDICE.

I. BACKGROUND

Plaintiff began employment as a Make Ready Helper for International Paper’s Fordyce, Arkansas Ride Rite container plant on August 15, 2005. (AR-IP000190). As an hourly employee and union member, Plaintiff was eligible to apply for the Weekly Sickness and Accident Plan benefits under the International Paper Company Group Health and Welfare Plan (the “Plan”). (AR-IP000016). The Plan administrator, the senior vice president of human resources for International Paper, is given the discretionary authority to interpret and administer the provisions of the Plan and to decide any claims or disputes that may arise under the Plan. (AR-IP000009-10). The Plan administrator appointed Sedgwick Claims Management Services, Inc., (“Sedgwick”) as the claims administrator which is responsible for the initial Weekly Sickness and Accident benefit claims determination and the first appeal determination. (Exhibit A, ¶ 9). The Disability Review Committee (“DRC”) is given the authority to decide benefit determinations on the second and final appeal. (Exhibit A, ¶ 5).

On May 12, 2006, Plaintiff was absent from work. (AR-IP000097). Consequently, on May 16, 2006, Sedgwick notified Plaintiff a claim for disability benefits was initiated for Plaintiff under the Plan after being notified of his absence. (AR-IP000097). On June 5, 2006, Sedgwick notified Plaintiff that he did not qualify for disability benefits under the Plan after it reviewed the medical records and a completed disability form submitted by Plaintiffs physician, Dr. Dan A. Martin, M.D. (AR-IP000082).

On July 10, 2006, Plaintiff faxed Sedgwick his intention to appeal the denial of his claim for disability benefits. (AR-IP000081). On his appeal form, Plaintiff states he did not return to work due to “seizures of the brain, dilated (sic) blood vessels in the head, inflamed liver + hepatitis (sic) have to have a liver biopsy because it is causing physical problems, I can’t work or drive.” (AR-IP000081). Sedgwick received additional medical documentation regarding Plaintiff from Dr. Martin, Dr. Ghulam M. Khaheel M.D., and Dr. Don Greenway M.D. (AR-IP00008596, 000117-18).

Sedgwick referred Plaintiffs medical records to Network Medical Review Company (“NMR”) for an independent medical review. (AR-IP000107-08). NMR had Plaintiffs medical records reviewed by Dr. [1104]*1104Gary P. Greenwood, a board certified physician in Internal medicine and infectious diseases; Dr. James W. Brown, a board physician certified in Internal medicine and Gastroenterology; and Dr. Joseph J. Jares, III, a board certified physician in Neurology. (AR-IP000122-33). The three physicians concluded that the medical records did not support restrictions or limitations that would prevent him from performing his job duties. (AR-IP000122133). On October 26, 2006, Sedgwick notified Plaintiff the initial denial of benefits would be upheld. (AR-IP000119).

On December 21, 2006, Sedgwick received a letter from Plaintiffs attorney expressing Plaintiffs desire to appeal the determination of the Sedgwick Appeals Unit regarding his disability benefits. (AR-IP000109). Thereafter, Nina Bradley, Appeals Specialist at Sedgwick proceeded to conduct a review of the entire administrative record. (AR-IP000074; Exhibit B, ¶ 4).

Sedgwick also had additional independent physicians conduct another review of Plaintiffs medical records. Those physicians included Dr. Matthew O. Horowitz, a board certified physician in internal medicine and gastroenterology; Dr. Charles Brock, a board certified physician in neurology and pain management; and Dr. Joe Maslow, a board certified physician in internal medicine and infectious diseases. (AR-IP000062-72). Based on the medical records, all three physicians determined that no limitations or restrictions existed to prevent Plaintiff from performing his regular job duties. (AR-IP000062-72).

Nina Bradley recommended sustaining the denial of Plaintiffs claim to the DRC because the file did not support a finding of total disability. (AR-IP000053-54). The DRC reviewed the entire claim file along with Nina Bradley’s recommendation and determined the denial of benefits was proper as the Plaintiff was not totally disabled under the Plan provisions. (AR-IP000055).

II. STANDARD OF REVIEW

Under ERISA, a denial of benefits by a plan administrator must be reviewed de novo unless the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan, in which case the administrator’s decision is reviewed for an abuse of discretion. Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir.1998) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). Accordingly, the Court must be guided by the language of the plan to determine the proper standard of review.

The Plan provides, in pertinent part, “[t]he Plan administrator has discretion to interpret and administer the provisions of the Plan and to decide any claims or disputes that may arise under the Plan. The decision of the Plan administrator with respect to any such matters shall be final and binding on both the company and the members of the Plan.” (AR-IP000010). Therefore, the plan administrator’s decision may only be reviewed for an abuse of discretion.

The Eighth Circuit Court of Appeals has “variously defined ... an abuse of discretion as being ‘extremely unreasonable,’ ‘virtually’ the same as arbitrary and capricious, and ‘extraordinarily imprudent.’ ” Shell v. Amalgamated Cotton Garment, 43 F.3d 364, 366 (8th Cir.1994) (citations omitted). “The proper inquiry into the deferential standard is whether ‘the plan administrator’s decision was reasonable; i.e., supported by substantial evidence.’ ” Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997) [1105]*1105(quoting Donaho v. FMC Corp., 74 F.3d 894, 899 (8th Cir.1996)).

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833 F. Supp. 2d 1101, 2011 WL 2489923, 2011 U.S. Dist. LEXIS 66603, Counsel Stack Legal Research, https://law.counselstack.com/opinion/avery-v-international-paper-co-sickness-accident-plan-arwd-2011.