Briggs v. Marriott International, Inc.

205 F. App'x 183
CourtCourt of Appeals for the Fourth Circuit
DecidedNovember 28, 2006
Docket05-1616
StatusUnpublished
Cited by6 cases

This text of 205 F. App'x 183 (Briggs v. Marriott International, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Briggs v. Marriott International, Inc., 205 F. App'x 183 (4th Cir. 2006).

Opinion

PER CURIAM:

Robert Briggs commenced this action under § 502(a) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a), for long-term disability benefits under an employee benefit plan sponsored by his employer, Marriott International, Inc., and administered by Liberty Life Assurance Company of Boston. Beginning in September 2002, Liberty Life began paying Briggs short-term disability benefits based on Briggs’ chronic lower-back and leg pain, but, on August 21, 2003, following a review, it denied his claim for long-term disability benefits. When Briggs’ treating doctor complained about the decision, Liberty Life reopened Briggs’ claim, collected additional medical information, and submitted the file to an independent orthopedic surgeon for review, who concluded that Briggs was “capable of a sedentary job with frequent position changes.” Liberty Life again denied Briggs’ long-term disability benefits on March 9, 2004. Briggs then filed this action.

The district court granted summary judgment to the defendants, concluding that based on the objective evidence relating to Briggs’ disability, “Liberty [Life] properly concluded that, with the appropriate sedentary modifications, Briggs was able to perform the duties of [his job].” The court explained:

In sum, the evidence supports Liberty’s discretionary decision that Briggs did not provide sufficient evidence of a disability under the Policy. While Liberty has a conflict of interest, based on the reasons articulated above, this court concludes that Liberty’s decision was nevertheless “consistent with an exercise of discretion by an [administrator] acting free of the interests that conflict with those beneficiaries.”

Briggs v. Marriott Int’l., Inc., 368 F.Supp.2d 461 (D.Md.2005) (quoting Ellis v. Metro. Life Ins. Co., 126 F.3d 228, 233 (4th Cir.1997)). Based on our de novo review of the district court’s decision, we affirm.

For some 21 years, Briggs worked for Marriott International in its Worldwide Reservation Center as a senior systems analyst, a sedentary job that primarily entailed computer work.

In 1989, Briggs was diagnosed with a herniated disc, and in 1991, he underwent *185 surgery — a discectomy to remove the herniated portion of the disc and a laminectomy to remove a portion of the vertebra that impinged on the nerve. Six years later, Briggs had follow-up surgery, in which the fifth lumbar and first sacral vertebrae were fused and a Ray Cage installed to limit movement of his lower spine.

Even though the surgeries relieved Briggs’ pain for a while, it returned, and Briggs continued to see several doctors— Dr. Michael Anchors, his primary physician; Dr. William Lauerman, an orthopedic surgeon; Dr. Rosita Dee, a pain management specialist; and Dr. Harikant Shah, his treating orthopedist.

In September 2002, Briggs made a claim to Liberty Life for disability benefits and submitted records from his doctors, as well as x-rays, myelogram results, and several MRIs. In addition, Dr. Anchors and Dr. Lauerman submitted opinions on Briggs’ behalf, concluding that Briggs was totally disabled. Liberty Life investigated the claim and supplemented its file with video surveillance of Briggs, which captured Briggs walking with and without a cane, driving his car, checking his oil, carrying a trash bag and a small suitcase, and picking up medications. Liberty Life also had Briggs examined by Dr. Michael April, an internist who performed work for Liberty Life. Dr. April found mixed results from his tests of Briggs’ abilities, yet determined that Briggs had a “sedentary functional capacity.” After submitting Dr. April’s findings to Dr. Anchors, Briggs’ primary doctor, and receiving no substantive response, Liberty denied Briggs’ disability claim with a letter dated August 21, 2003, in which it stated:

Based on the medical information in relation to your occupation requirements, you are able to perform the duties of your Own Occupation. Therefore, you do not meet your policy’s definition of disability. We must close your claim as of August 22, 2003.

Shortly thereafter, Dr. Anchors sent Liberty Life a cryptic letter, in which he suggested that Briggs was disabled by his pain medications. Without a request from either Dr. Anchors or Briggs himself, Liberty Life reopened the claim, collected more medical information, and sent the entire file to Dr. Richard Silver, an independent and elaborately credentialed orthopedic surgeon, for another opinion. Based on his review of the file, Dr. Silver found no objective evidence to support a finding of disability. He stated:

Mr. Briggs is not capable of performing activities consistent with a light or heavy work capacity. Mr. Briggs is, however, capable of a sedentary job with frequent position changes.... [H]e certainly could be functional in a sedentary capacity as a senior system analyst for Marriott.

Thus, on March 9, 2004, Liberty again denied Briggs’ claim for long-term disability benefits, and this suit ensued.

The benefit plan under which Briggs brings his claim grants Liberty Life “the authority, in its sole absolute and final discretion, to construe the terms of this policy and to determine benefit eligibility hereunder.” The plan also required Briggs to prove his claim for disability with “objective medical evidence,” a provision permitting Liberty Life to discount self-serving claims and reports of disability in favor of objective evidence. The administrator’s decision on a claim must nonetheless be the result of a deliberate principled reasoning process and be supported by substantial evidence. See Brogan v. Holland, 105 F.3d 158, 161 (4th Cir.1997).

Because Liberty Life acts both as a trustee for the beneficiaries and as a potential payor on the claim, we heighten our *186 scrutiny of Liberty Life’s discretionary decision to the extent necessary to simulate review of an unconflicted trustee. See Ellis v. Metro. Life Ins. Co., 126 F.3d 228, 233 (4th Cir.1997); Doe v. Group Hospitalization & Med. Servs., 3 F.3d 80 (4th Cir.1993).

Briggs challenges the administrator’s discretionary decision in two respects. First, he says that Liberty Life ignored evidence of the effect of his medications on his ability to do his job. While Briggs was taking an increasing amount of painkillers over the years, he did not provide sufficient objective evidence that the painkillers disabled him from working. His best evidence is a letter from Dr. Anchors, his primary care physician, in which Dr. Anchors stated:

I don’t believe [Briggs] can do serious mental work on those meds, and I don’t see how he can sit without them.

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