George Reeve v. UNUM Life Ins. Co. of America

170 F. App'x 108
CourtCourt of Appeals for the Eleventh Circuit
DecidedMarch 8, 2006
Docket04-16717; D.C. Docket 03-21665-CV-MGC
StatusUnpublished
Cited by2 cases

This text of 170 F. App'x 108 (George Reeve v. UNUM Life Ins. Co. of America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
George Reeve v. UNUM Life Ins. Co. of America, 170 F. App'x 108 (11th Cir. 2006).

Opinion

PER CURIAM:

George Reeve (“Reeve”) appeals the grant of summary judgment to Unum Life Insurance Company of America (“Unum”) on his claim for disability benefits under a group long term policy (the “LTD Policy”), and two group life insurance policies (the “Life Policies”) governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”). Unum denied Reeve’s claim for benefits on the grounds that he was not disabled under the terms of the policy, and he filed suit to challenge this decision. The district court determined that the decision of the administrator must be affirmed and summary judgment was granted.

On appeal, Reeve argues that the district court erred in not reviewing documents beyond those that were available to the plan administrator and that a review of such materials establishes genuine issues of material fact regarding whether Reeve was “disabled” which preclude summary judgment. We affirm.

BACKGROUND

Reeve’s claim for disability stems from a heart attack he suffered in 1993 which required numerous subsequent hospitalizations. Reeve claims that he has been totally “disabled” by his heart condition under the terms of both the LTD Policy 1 and the Life Policies 2 since August 15, 2001. In *110 January 2003 Reeve submitted a claim for benefits under all these policies, indicating that he was a construction supervisor whose responsibilities included supervising approximately 500 employees and inspecting construction projects, which required him to travel to construction sites and occasionally climb stairs and help workers lift heavy objects. Daniel Electrical Contractors, Inc. (“Daniel”), Reeve’s employer, notified Unum that Reeve’s job functions required continuous standing and walking, and that Reeve was unable to perform these functions due to his disability. 3

Reeve’s cardiologist, Reza Azar, submitted an Attending Physician’s Statement (“APS”) stating that Reeve had a condition known as ischemic cardiomyophy, and recommended that Reeve not engage in any heavy exertion including running, climbing, lifting, or stressful situations. Dr. Azar also recommended that Reeve retire since his job responsibilities would be detrimental to his health. Reeve also submitted to Unum a decision of the Social Security Administration, which eventually granted Reeve’s claim for disability income benefits, after this claim had originally been denied.

Unum denied Reeve’s claim on the basis of the medical opinions of Unum’s Medical Director, George DiDonna, who is board-certified in internal medicine, and Unum’s independent cardiologist, David Korn. Didonna inspected Reeve’s file and noted that Reeve had returned to work following his 1993 heart attack and had not had any recurrent myocardial infarction. Based on Reeve’s complete medical file, Dr. DiDonna concluded that Reeve had the exercise capacity of a “healthy, middle-aged, deeonditioned man.” David Korn reviewed Reeve’s medical record and found no evidence of cardiac impairment preventing Reeve from returning to work in his regular occupation.

Additionally, Unum performed a labor market survey to determine whether Reeve’s fieldwork constituted a “material and substantial duty” of Reeve’s occupation under the terms of the LTD Policy. Unum’s “vocational rehabilitation consultant” classified Reeve’s position as Vice President, Operations (Electrical Contractor) and reviewed the occupational duties of similar officers from twelve employers from various locations in the United States. The survey revealed that some level of field work and travel was required, and that the average time spent in the field was 25.4%. All but one employer indicated the presence of stress in this position. Further, the consultant noted that lifting significant amounts was not a material and significant duty of Reeve’s occupation. Pursuant to the findings of this survey, Unum’s consultant classified Reeve’s occupation as “light work.”

Following this review of his claim, Unum denied Reeve’s claim for benefits under all the policies, explaining that it had determined Reeve was not limited from performing the material and substantial duties of his regular occupation, or the duties of any gainful occupation for which he was reasonably fitted by education, training, or experience. Reeve appealed *111 the denial of his claims, and as part of this appeal Reeve’s file was examined by Dr. Alfred Parisi, Unum’s medical consultant board-certified in internal medicine with a subspeciality in cardiovascular diseases. Dr. Parisi concluded that there had been “no cardiac event or occurrence in 2001” that was different from anything that had happened in the years since Reeve’s heart attack, and that based on Reeve’s treadmill performance he was able to perform light work in a 40 hour work week. Pursuant to Dr. Parisi’s report, Unum reaffirmed its decision to deny benefits to Reeve under the policies.

Reeve filed suit in federal district court for payment of past disability benefits, attorneys fees, and costs under ERISA 4 which resulted in the Summary Judgement presently under review.

STANDARD OF REVIEW

We review de novo a district court’s grant of summary judgment, viewing all the evidence, and drawing all reasonable inferences, in favor of the non-moving party. Hulsey v. Pride Rests., LLC, 367 F.3d 1238, 1243 (11th Cir.2004). We will affirm the grant of summary judgment only if there is no genuine issue as to any material fact, and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). As the district court correctly noted, HCA Health Servs. of Ga., Inc. v. Employer’s Health Insurance, 240 F.3d 982, 992-93 (11th Cir.2001) sets out the relevant standard for reviewing denial of benefits by claims administrators. See also Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1137 (11th Cir.2004) (“recapitulating” the approach in HCA). In reviewing a denial of benefits, the court first looks “to the plan documents to determine whether the plan documents grant the claims administrator discretion to interpret disputed terms. If the court finds that the documents grant the claim administrator discretion, then at a minimum, the court applies arbitrary and capricious review,” whereas if it finds no discretion, it will apply de novo review. HCA, 240 F.3d at 993.

DISCUSSION

Reeve’s only argument on appeal is that the district court “failed to conduct a de novo review of the record” on the issue of whether Unum’s decision was “correct,” and that, had it done so, there would be a genuine issue of material fact as to whether Reeve was “disabled” under the policies since various materials Reeve filed with the district court allegedly presented such issues of fact. In support of this argument, Reeve cites to

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Related

Blair v. Metropolitan Life Insurance
955 F. Supp. 2d 1229 (N.D. Alabama, 2013)
Ray v. UNUM Life Insurance Co. of America
224 F. App'x 772 (Tenth Circuit, 2007)

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Bluebook (online)
170 F. App'x 108, Counsel Stack Legal Research, https://law.counselstack.com/opinion/george-reeve-v-unum-life-ins-co-of-america-ca11-2006.