Brantley v. PEPSI BOTTLING GROUP, INC.

718 F. Supp. 2d 903, 2010 U.S. Dist. LEXIS 63343, 2010 WL 2521350
CourtDistrict Court, E.D. Tennessee
DecidedJune 24, 2010
Docket3:09-cv-470
StatusPublished
Cited by3 cases

This text of 718 F. Supp. 2d 903 (Brantley v. PEPSI BOTTLING GROUP, INC.) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brantley v. PEPSI BOTTLING GROUP, INC., 718 F. Supp. 2d 903, 2010 U.S. Dist. LEXIS 63343, 2010 WL 2521350 (E.D. Tenn. 2010).

Opinion

MEMORANDUM OPINION

THOMAS A. VARLAN, District Judge.

This civil action is before the Court on defendants’ Motion for Entry of Judgment [Doc. 21]. Plaintiff has filed a response in opposition to this motion [Doc. 23]. Defendants have filed a reply to the response [Doc. 24].

This civil action is also before the Court on plaintiffs Motion for Judgment on the Administrative Record [Doc. 25], Defendants have filed responses to this motion [Docs. 27, 28]. Plaintiff has filed replies to the responses [Docs. 29, 30],

The Court has carefully considered the parties’ filings in light of the administrative record and the applicable law. For the reasons that follow, plaintiffs motion for judgment on the administrative record will be denied. Defendants’ motion for entry of judgment will be granted. This case will be dismissed.

I. Standard of Review

This is an ERISA case. “[T]he summary judgment procedures set forth in [Federal] Rule [of Civil Procedure] 56 are inapposite to ERISA actions and thus should not be utilized in their disposition.” Wilkins v. Baptist Healthcare Sys., 150 F.3d 609, 619 (6th Cir.1998) (Gilman, J., concurring); see also Buchanan v. Aetna Life Ins. Co., 179 Fed.Appx. 304, 306 (6th Cir.2006) (“Traditional summary judgment concepts are inapposite to the adjudication of an ERISA action for benefits ... because the district court is limited to the evidence before the plan administrator at the time of its decision.... ”). In resolving these cases, a district court should instead employ the following steps in adjudicating an ERISA action:

1. As to the merits of the action, the district court should conduct a de novo review based solely upon the administrative record, and render findings of fact and conclusions of law accordingly. The district court may consider the parties’ arguments concerning the proper analysis of the evidentiary materials contained in the administrative record, but may not admit or consider any evidence not presented to the administrator.
2. The district court may consider evidence outside of the administrative record only if that evidence is offered in support of a procedural challenge to the administrator’s decision, such as an alleged lack of due process afforded by the administrator or alleged bias on its part. This *907 also means that any prehearing discovery at the district court level should be limited to such procedural challenges.

Wilkins, 150 F.3d at 619 (Gilman, J., concurring). 1

“Under Wilkins, this Court has two possible standards of review.” Gibson v. Prudential Ins. Co. of Am., 513 F.Supp.2d 950, 956 (E.D.Tenn.2007). “If the trustees of an employee benefits plan do not have discretion to determine eligibility for benefits or to construe the terms of the plan in question, a court is required to undertake a de novo review of the administrators’ decision.” Id. “[W]here a benefits plan vests discretion with the administrators, a court may only disturb the administrators’ decision if it finds the basis of such a decision to be arbitrary and capricious.” Id.

The benefits plan in this ease — the Long Term Disability Plan (the “LTD Plan”), described infra Part II — vests discretion with the plan’s administrator-defendant Sedgwick CMS Claims Administrator (“Sedgwick”) — to determine the amount of benefits payable under the plan. See Doc. 1-2, p. 55 (“[Sedgwick] shall have such powers and duties as may be necessary to discharge its functions including: (1) To exercise its discretionary authority to determine the amount, manner and time of payment of any benefits, and to make determinations with respect to reimbursements of the [LTD] Plan____”). This Court may therefore only disturb Sedgwick’s benefits determination in this case if it finds the basis of the determination to be arbitrary and capricious. “Under [this] standard, [the Court] will uphold the administrator’s decision ‘if it is the result of a deliberate, principled reasoning process and if it is supported by substantial evidence.’ ” Glenn v. MetLife, 461 F.3d 660, 666 (6th Cir.2006) (quoting Baker v. United Mine Workers of Am. Health & Ret. Funds, 929 F.2d 1140, 1144 (6th Cir.1991)).

II. Findings of Fact

Plaintiff Ronald L. Brantley was at one time an employee of defendant The Pepsi Bottling Group, Inc. (“PBG”) [Doc. 8, ¶ 2]. Plaintiff alleges that he was injured on or about February 1, 2005 in connection with that employment [Doc. 1-2, ¶ 2; Doc. 8, ¶ 2]. Plaintiff alleges that he returned to his employment with PBG on or about June 14, 2005 [Doc. 1-2, ¶ 2]. Plaintiff further alleges that he suffered additional injuries in connection with his employment in or about August 2005 [Id.]. Plaintiff was thereafter diagnosed with bilateral epicondylitis [Doc. 8, ¶ 2].

Plaintiff is a participant in PBG’s LTD Plan [Id.]. Plaintiff qualified for benefits under the LTD Plan as a result of the injuries described above, and began receiving benefits in 2006 under the LTD Plan in the amount of $1,000.00 per month [Doc. 8, ¶ 5; Doc. 21-2; Doc. 28]. Prior to receiving these benefits, plaintiff signed a Right of Reimbursement Agreement (the “ROR”) [see Doc. 23]. The ROR provided that:

In connection with an illness or injury, I have applied for plan benefits. In return for payment of these benefits, if ... payments for the same illness or injury are received, I acknowledge that *908 I am obligated to reimburse the plan, as stated in the plan, up to 100%, or to the full extent of any net recovery.

[Doc. 21-2, p. 92].

At the same time that he applied for and received disability benefits under the LTD Plan, plaintiff filed a claim for workers’ compensation in Tennessee state court seeking recovery for the injuries that gave rise to his claim under the LTD Plan [see Doc. 22], On June 18, 2007, the Chancery Court for Union County, Tennessee approved a workers’ compensation settlement entered into among plaintiff, PBG, Old Republic Insurance Company, the State of Tennessee, and Paul G. Summers, the Attorney General for the State of Tennessee [see Doc. 1-2, pp. 80-84], In a “full, final, and complete settlement of all claims of [plaintiff] as a result of the accidents he sustained on or about February 1, 2005, June 14, 2005 and October, 2005,” plaintiff was awarded a lump sum settlement of $35,095.34 [Id, p. 82]. 2

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718 F. Supp. 2d 903, 2010 U.S. Dist. LEXIS 63343, 2010 WL 2521350, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brantley-v-pepsi-bottling-group-inc-tned-2010.