Jones v. Federal Express Corp.

984 F. Supp. 2d 1271, 57 Employee Benefits Cas. (BNA) 1003, 2013 WL 6038734, 2013 U.S. Dist. LEXIS 162616
CourtDistrict Court, M.D. Florida
DecidedNovember 14, 2013
DocketCase No. 6:12-cv-771-Orl-28KRS
StatusPublished
Cited by4 cases

This text of 984 F. Supp. 2d 1271 (Jones v. Federal Express Corp.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jones v. Federal Express Corp., 984 F. Supp. 2d 1271, 57 Employee Benefits Cas. (BNA) 1003, 2013 WL 6038734, 2013 U.S. Dist. LEXIS 162616 (M.D. Fla. 2013).

Opinion

ORDER

JOHN ANTOON II, District Judge.

In 2006, while employed as a courier by Federal Express Corporation (FedEx), Plaintiff Bobby C. Jones exacerbated a previous back injury. He received and exhausted his benefits under FedEx’s Short Term Disability (STD) Plan, as well as his benefits under the “Occupational Disability” definition of the Long Term Disability (LTD) Plan. (AR-000002).1 Ultimately, Aetna Life Insurance Company, the FedEx claims administrator, found that Mr. Jones did not meet the definition of “Total Disability” as required for continued benefits and denied his claim. (AR-000006-007). Upon denial of the claim, Mr. Jones sued FedEx and Aetna under the Employment Retirement Income Security Act of 1974 .(ERISA). (Compl., Doc. 1). FedEx filed a counterclaim, seeking reimbursement for benefits it paid Mr. Jones while he was also receiving Social Security benefits. (Answer & Countercl., Doc. 16).

Both, sides have filed motions for summary judgment. Defendants seek summary judgment on Mr. Jones’s claim, arguing that the Court should affirm Aetna’s denial of LTD benefits. FedEx also seeks summary judgment on its counterclaim brought under ERISA, 29 U.S.C. § 1132(a)(3), requesting equitable relief in the form of reimbursement by Mr. Jones for the overpayments he received. Mr. Jones requests entry of summary judgment on FedEx’s counterclaim, arguing that equitable relief is not available be[1274]*1274cause the funds in question have been dissipated. Mr. Jones’s motion for summary judgment (Doc. 89) as to FedEx’s counterclaim must be granted, and Defendants’ motion for summary judgment (Doc. 41) must be granted in part and denied in part.

1. Background

Mr. Jones has a long history of back problems.2 While he was a courier at FedEx,3 Mr. Jones participated in FedEx’s STD and LTD Plans. After aggravating his previously injured back in 2006, (AR-000024), he applied for and was granted STD benefits for the period of November 6, 2006, to May 6, 2007. (AR-000002). Later he applied for LTD benefits.

FedEx’s LTD Plan covers two types of disability — Occupational Disability and Total Disability. (See AR-000419). Occupational Disability means “the inability of a Covered Employee, because of a medically-determinable physical or functional impairment ... to perform the duties of his regular occupation.” (AR-000423-424). Total Disability is “the complete inability of a Covered Employee, because of a medically-determinable physical or functional impairment ... to engage in any compensable employment for twenty-five hours per week.” (AR-000427). Benefits for Occupational Disability last for a maximum of twenty-four months; after Occupational Disability benefits are terminated, the applicant must qualify for Total Disability to continue receiving benefits. (See AR-000435; see also Summary Plan Description, AR-000395).

To be considered disabled under the LTD Plan under either disability definition, an applicant’s disability must be “substantiated by significant objective findings which are defined as signs which are noted on a test or medical exam and which are considered significant anatomical, physiological or psychological abnormalities which can be observed apart from the individual’s symptoms.” (AR-000419-420). According to the Plan’s Summary Plan Description, “[significant objective findings are those that can be observed by [the claimant’s] health care professional through objective means, not just from [the claimant’s] description of the symptoms.” (AR-000395). Notably, “[p]ain, without significant objective findings, is not proof of disability.” (AR-000395).

Mr. Jones received LTD benefits under the “Occupational Disability” definition in the Plan from May 7, 2007, to May 6, 2009, because “he was unable to perform the duties of his job ... during that time-frame.” (AR-000002). However, on March 27, 2009, Aetna sent a letter to Mr. Jones informing him that “[i]t has been determined that no benefits are payable to [Mr. Jones] for [his Total Disability] claim beyond” May 6, 2009. (AR-000006). The letter stated that “[t]here was no documentation to indicate [his] inability to walk, stand, sit or use [his] upper extremities. As a result of the above review, it has been determined that there are no significant objective findings to support a Total Disability that would prevent [Mr. Jones] from engaging in any compensable employment for a minimum of twenty-five [1275]*1275hours a week in a sedentary position.” (AR-000007). Mr. Jones administratively appealed Aetna’s denial, and on June 25, 2009, Aetna sent a letter to Mr. Jones stating that the Aetna Review Committee had upheld the denial because of a lack of significant objective findings. (AR-000001). That letter stated that in making its decision the committee had reviewed the various treatments provided to Mr. Jones. (AR-000002).

The LTD Plan provides that benefits under the Plan must be reduced by the amount the beneficiary receives from other sources, including Social Security payments. (AR-000444-447). The Plan requires beneficiaries to reimburse the Plan for any overpayments. (AR-000467-468). It is undisputed that Mr. Jones received retroactive Social Security disability benefits for March 2009 to April 2010. (Jones Dep., Doc. 41-1 at 9).

II. LTD Benefits Claim

A. ERISA Review Standards

As other courts in this district have noted, “ ‘[i]n an ERISA benefit denial case ... in a very real sense, the district court sits more as an appellate tribunal than as a trial court. It does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.’ ” Crume v. Metro. Life Ins. Co., 417 F.Supp.2d 1258, 1272 (M.D.Fla.2006) (quoting Leahy v. Raytheon Co., 315 F.3d 11, 17-18 (1st Cir.2002)); see also Curran v. Kemper Nat’l Servs., Inc., No. 04-14097, 2005 WL 894840, at *7 (11th Cir. Mar. 16, 2005). “Accordingly, ‘[w]here the decision to grant or deny benefits is reviewed for abuse of discretion, a motion for summary judgment is merely the conduit to bring the legal question before the district court and the usual tests of summary judgment, such as whether a genuine dispute of material fact exists, do not apply.’ ” Crume, 417 F.Supp.2d at 1272 (alteration in original) (quoting Bendixen v. Standard Ins. Co., 185 F.3d 939, 942 (9th Cir.1999)).

“ERISA itself provides no standard for courts reviewing the benefits decisions of plan administrators or fiduciaries.” Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1354 (11th Cir.2011). However, the Eleventh Circuit has “established a multi-step framework to guide courts in reviewing an ERISA plan administrator’s benefits decisions.” Id. The six steps in this framework are:

(1) Apply the de novo

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984 F. Supp. 2d 1271, 57 Employee Benefits Cas. (BNA) 1003, 2013 WL 6038734, 2013 U.S. Dist. LEXIS 162616, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-federal-express-corp-flmd-2013.