Jane Donaho v. Fmc Corporation, a Delaware Corporation, as Plan Administrator of the Fmc Long-Term Disability Plan

74 F.3d 894, 19 Employee Benefits Cas. (BNA) 2537, 1996 U.S. App. LEXIS 1205, 1996 WL 34483
CourtCourt of Appeals for the Eighth Circuit
DecidedJanuary 31, 1996
Docket95-1280
StatusPublished
Cited by218 cases

This text of 74 F.3d 894 (Jane Donaho v. Fmc Corporation, a Delaware Corporation, as Plan Administrator of the Fmc Long-Term Disability Plan) 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
Jane Donaho v. Fmc Corporation, a Delaware Corporation, as Plan Administrator of the Fmc Long-Term Disability Plan, 74 F.3d 894, 19 Employee Benefits Cas. (BNA) 2537, 1996 U.S. App. LEXIS 1205, 1996 WL 34483 (8th Cir. 1996).

Opinion

BRIGHT, Circuit Judge.

Jane Donaho appeals a district court order granting summary judgment in favor of her employer, FMC Corporation (FMC), in this suit to enforce her rights under an ERISA health benefits plan. See 29 U.S.C. § 1132(a)(1)(B). Under a deferential standard of review, the district court upheld FMC’s decision to deny Donaho’s application for long-term disability benefits under FMC’s employee-funded disability plan. Donaho contends that the denial of benefits is unreasonable and not supported by substantial evidence. Because we conclude that FMC’s denial of benefits to Donaho, at least until October 1993, was an abuse of discretion, we reverse and remand.

I. FACTUAL AND PROCEDURAL BACKGROUND

Jane Donaho was hired as a full-time employee of FMC Corporation in 1990. She held the position of senior software engineer at FMC’s Naval Systems Division, where her duties included planning, designing and writing computer software with military applications. Donaho’s position at FMC was demanding, requiring that she possess a very high level of analytical ability and communication skills to enable her to design complex *896 software, solve difficult technical problems and provide assistance to project leaders.

Donaho continued working full time at FMC until July 14, 1992, when she collapsed at work. Recurrent depression caused her collapse and subsequent inability to work. Donaho underwent psychological treatment with her psychotherapist, Dr. Patricia Al-etky, and saw a psychiatrist, Dr. Deanna Bass, who prescribed Prozac for the illness. In November 1992, Dr. Aletky approved Do-naho for part-time work at FMC; however, Donaho’s condition worsened after two weeks and she could not continue working.

FMC maintains an employee-funded benefits plan which includes both short-term and long-term disability benefits. During the initial period of her illness, Donaho collected short-term disability benefits. 1 On January 12, 1993, when these benefits expired, Dona-ho applied for long-term disability (LTD) benefits. Under FMC’s LTD plan, employees are entitled to LTD benefits if they are totally disabled, providing that they have satisfied a six-month qualifying period. For the first two years of disability, an employee is considered totally disabled when she is “wholly and continuously unable to perform every duty of [her] own job with FMC.” Appellant’s App. at A-150.

To evaluate Donaho’s initial application for LTD benefits, and pursuant to standard policy, the plan administrator retrieved Donaho’s personal, vocational and medical records. Dr. Richard Zaloudek, the plan administrator’s medical director and consulting psychiatrist, reviewed Donaho’s entire record and determined that she was not totally disabled. Specifically, Dr. Zaloudek reviewed Dr. Aletky’s patient notes and determined that Donaho had shown overall improvement since February 1993 and that her depression had improved in late 1992. Further, Dr. Zalou-dek found no evidence of “cognitive deficits or psychomotor abnormalities.” Dr. Zalou-dek approved of this “not totally disabled” evaluation prior to April 2,1993.

In addition to the medical review, FMC director of employee benefits Kenneth J. Morrissey discovered that Donaho had been assisting in the preparation of, and actively participating in, professional meetings and volunteer projects since late 1992 (although Donaho spent only a few hours per month on these activities). On the basis of this information, plus the medical review, Morrissey rejected Donaho’s application for LTD benefits on April 2,1993.

On May 27, 1993, Donaho filed an appeal with the plan administrator. In support of her appeal, Donaho included a letter from Dr. Aletky (dated May 25, 1993) that stated that Donaho was not currently able to perform every duty of her own job and that a return to full-time employment would create a “serious likelihood of relapse.” 2 Appellant’s App. at A-111. Donaho later sent to the plan administrator a letter from Dr. Bass (dated June 23, 1993) which stated that Donaho’s symptoms of impaired concentration and fatigue would “make it extremely difficult to attend consistently to the details that are involved in [Donaho’s] work.” Appellant’s App. at A-104. Bass further noted that Donaho’s depression would “most certainly interfere” with her ability to perform every duty of her job on a regular, sustained basis. Id. Finally, Donaho submitted an evaluation performed by Dr. Bass on April 26, 1993. In this evaluation, Dr. Bass concluded that “the patient has not returned to normal baseline mood and in fact would not be considered in partial remission since mood would plummet ... if stress increased_” 3 Appellant’s App. at A-123.

*897 Dr. Zaloudek, having reviewed the letters of Drs. Bass and Aletky, concluded on July 1, 1993 that “[s]ince the new evidence from Dr. Bass and Dr. Aletky are in close agreement, I would accept their conclusions. It appears now that the client did not have sufficient improvement to function appropriately as a computer software engineer.” Appellant’s App. at A-106.

However, after Dr. Zaloudek was contacted by the plan administrator, he reversed course and stated that Dr. Bass and Dr. Aletky did not provide “sufficient objective measurement of attention span, memory and concentration ...” (Appellant’s App. at A-101), and he recommended that a complete independent medical examination (IME) be performed.

Donaho’s IME was conducted on September 1, 1993 by Dr. Abuzzahab. He determined that Donaho suffered from a mild but recurrent depression that would be amenable to drug treatment. Dr. Abuzzahab concluded that, while Donaho had only a limited ability to complete assigned tasks and to function independently, she “should respond to the suggested pharmacologic approaches, and thus she will be able to resume working” (emphasis added). Appellant’s App. at A-51. Dr. Abuzzahab did not state that Donaho had already recovered; rather, his conclusions indicate that Donaho was still disabled but could recover in the future. His report was forwarded to the plan administrator on October 1,1993.

Dr. Zaloudek reviewed Dr. Abuzzahab’s findings. Dr. Zaloudek noted that “Dr. Abuzzahab did not find any significant cognitive problems. [Donaho’s] memory was fine.” He concluded that “while [Donaho] has not completely recovered, there is no objective evidence to show marked impairment in attention, memory, and concentration .... [She is] not totally prevented] from carrying out her software engineer duties as routinely expected.” (Emphasis added). Appellant’s App. at A-49. This report was dated October 20,1993.

In addition to these medical reports, Dona-ho was requested to execute a release of information permitting FMC to obtain and review her application files from the Social Security disability program. While Donaho’s file revealed that she had been denied Social Security benefits, 4

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74 F.3d 894, 19 Employee Benefits Cas. (BNA) 2537, 1996 U.S. App. LEXIS 1205, 1996 WL 34483, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jane-donaho-v-fmc-corporation-a-delaware-corporation-as-plan-ca8-1996.