Green v. Union Security Insurance

646 F.3d 1042, 51 Employee Benefits Cas. (BNA) 2175, 2011 U.S. App. LEXIS 14994, 2011 WL 2936359
CourtCourt of Appeals for the Eighth Circuit
DecidedJuly 22, 2011
Docket10-2924
StatusPublished
Cited by52 cases

This text of 646 F.3d 1042 (Green v. Union Security Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Green v. Union Security Insurance, 646 F.3d 1042, 51 Employee Benefits Cas. (BNA) 2175, 2011 U.S. App. LEXIS 14994, 2011 WL 2936359 (8th Cir. 2011).

Opinion

STROM, District Judge.

After defendant-appellant Union Security Insurance Co. (“Union”) denied plaintiff-appellee Charles Green’s claim for long-term disability benefits (“LTD benefits”), Green filed a complaint against Union pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. The district court granted summary judgment in Green’s favor finding Union had abused its discretion in denying benefits to Green. Union appealed, challenging the district court’s summary judgment order. We have jurisdiction pursuant to 28 U.S.C. § 1291. We find the district court improperly determined Union abused its discretion when it ultimately denied Green’s LTD-benefits claim.

I.

In November 2000, when he was thirty-five years old, Green began working as a light industrial warehouse worker for Andersen Distribution, Inc. (“Andersen”). Previously, Green had obtained a GED in 1985 and had worked as a light industrial and warehouse worker for at least eight years. When he started working at Andersen, Green began participating in Andersen’s LTD-benefits disability plan, pursuant to Group Policy No. G 4,015,784 (“Policy”), which Union insured. Under the Policy, participants are eligible for LTD benefits if they are “disabled.” The *1046 Policy, as it pertained to Green, provided a participant is “disabled” if:

• during the first 24 months of a period of disability (including a qualifying period), an injury, or sickness, or pregnancy requires that you be under the regular care and attendance of a doctor, and prevents you from performing at least one of the material duties of your regular occupation; 2 and
• after 24 months of disability, an injury, sickness, or pregnancy prevents you from performing at least one of the material duties of each gainful occupation 3 for which your education, training, and experience qualifies you. 4

The Policy gave Union “sole discretionary authority to determine eligibility for participation or benefits and to interpret the terms of the Policy” and required Green to “furnish whatever items [Union] decide[s] are necessary as proof of loss or to decide [Union’s] liability.”

On February 20, 2001, Green stopped working at Andersen citing physical pain as preventing him from being able to work. Steven Rettinger, M.D., who was Green’s primary care physician, examined Green and noted the cause of Green’s pain seemed consistent with fibromyalgia. Despite this diagnosis, Dr. Rettinger anticipated Green would be able to return to work at some point and discussed with Green “how he needs to take control of his own life and call his place of employment so that he can get off disability and back to work.”

In November 2001, Green submitted an LTD-benefits claim to Union. In support of his claim, Green attached an Attending Physician Initial Statement of Disability completed by Dr. Rettinger, which stated Green suffered from chronic back pain, neck pain, fibromyalgia, and tremor. According to Dr. Rettinger, Green .was unable to perform any physical work and needed a sedentary work position due to these conditions. After conducting its review, Union found Green eligible for LTD benefits under the Policy’s own occupation definition and began paying LTD benefits to Green on February 6, 2002.

Soon thereafter, Union began investigating whether Green qualified for LTD benefits under the Policy’s any occupation definition. Union requested Green undergo a functional capacity evaluation (“FCE”) to be performed by Healthsouth, which took place on February 20 and 21, 2002. The FCE acknowledged Green had several musculoskeletal deficits but ultimately concluded he “demonstrate^] the ability to perform sedentary work for an eight hour day.” The Healthsouth FCE stated Green was capable of “lifting in the sedentary category of work” and could tolerate walking, climbing stairs, bending and twisting at the trunk, reaching overhead, reaching forward, and sitting.

In April 2002, Union sent a letter to Green encouraging him to apply for Social Security Disability Benefits (“SSD benefits”). Green submitted a claim for SSD benefits, but the Social Security Administration (“SSA”) initially denied the claim because Green’s “condition was not severe enough to keep [him] from working.” Also in April 2002, Union referred Green to its Vocational Services department. In an interview with a Vocational Services employ *1047 ee, Green stated his hobbies included fishing and camping, which he still enjoyed even after the onset of his painful condition. Green also stated he could use his home computer and could drive locally. With this information and the Healthsouth FCE in hand, Union requested Allen Par-met, M.D., an occupational medicine specialist, review Green’s file. Dr. Parmet diagnosed Green as suffering from fibromyalgia and migraines, but stated Green was “capable of performing sedentary activities.” Dr. Parmet also acknowledged the findings of the Healthsouth FCE that Green was capable of working a full-time sedentary job.

In May and July 2002, Green submitted supplemental reports from Dr. Rettinger to Union regarding Green’s condition. In assessing Green’s work capabilities, Dr. Rettinger wrote that Green could not sit or stand for extended periods and that he was incapable of doing minimal manual labor due to his neck and back pain. He also wrote Green was not a candidate for physical therapy. However, Dr. Rettinger continued to recommend vocational rehabilitation for Green.

On August 26, 2002, Union’s rehabilitation counselor, Julie Finnegan, conducted a Transferable Skills Analysis (“TSA”) with Green to help' identify potential occupations into which Green could transition. Finnegan determined Green’s medical conditions and work experience qualified him to work in several sedentary jobs. Finnegan believed suitable work could be found locally for Green at his Schedule Amount wage rate ($7.54 per hour). Thereafter, Union engaged an outside consultant, Brenda Umholtz, to conduct a Labor Market Survey (“LMS”). Umholtz identified ten potential employers with positions available at or above Green’s Schedule Amount wage rate for which Green was qualified and physically able to perform. Umholtz wrote that positions were “readily available” for which Green was qualified, that Green would not require vocational training to obtain a position paying between $8.00 and $10.00 per hour, and that “[e]mployers appeared very flexible and willing to accommodate someone with [Green’s] restrictions.”

In February 2003, Union had a psychologist on its staff, Patricia Neubauer, Ph.D., review Green’s records. In discussing Green’s condition, Dr. Neubauer stated Green’s “primary pain disorder relate[s] to both a general medical condition, fibromyalgia and migraines and has psychological factors that impact his pain complaints.” Dr. Neubauer suspected Green’s chronic pain condition was a psychological issue, but she stated she could not confirm this suspicion for lack of a psychological evaluation of Green to review. Dr.

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646 F.3d 1042, 51 Employee Benefits Cas. (BNA) 2175, 2011 U.S. App. LEXIS 14994, 2011 WL 2936359, Counsel Stack Legal Research, https://law.counselstack.com/opinion/green-v-union-security-insurance-ca8-2011.