Linda Gail Calvert v. Firstar Finance, Inc., F/k/a Star Bank Corporation, and Liberty Life Assurance Company of Boston

409 F.3d 286, 34 Employee Benefits Cas. (BNA) 2907, 2005 U.S. App. LEXIS 8684, 2005 WL 1281755
CourtCourt of Appeals for the First Circuit
DecidedMay 17, 2005
Docket03-5815
StatusPublished
Cited by279 cases

This text of 409 F.3d 286 (Linda Gail Calvert v. Firstar Finance, Inc., F/k/a Star Bank Corporation, and Liberty Life Assurance Company of Boston) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Linda Gail Calvert v. Firstar Finance, Inc., F/k/a Star Bank Corporation, and Liberty Life Assurance Company of Boston, 409 F.3d 286, 34 Employee Benefits Cas. (BNA) 2907, 2005 U.S. App. LEXIS 8684, 2005 WL 1281755 (1st Cir. 2005).

Opinion

*289 OPINION

O’MALLEY, District Judge.

Linda Calvert claims that Liberty Life Assurance Company of Boston (“Liberty”) wrongfully terminated her long-term disability (“LTD”) benefits in violation of the Employment Retirement Income Security Act of 1974 (“ERISA”). See 29 U.S.C. §§ 1001-1461. After reviewing the administrative record, the district court granted Liberty’s motion for judgment on the administrative record. Calvert appeals. While we agree with most aspects of the district court’s well-reasoned opinion, we disagree with its ultimate conclusion. We find that Liberty acted arbitrarily and capriciously in denying Calvert further LTD benefits, and, thus, REVERSE the district court’s judgment, and REMAND this matter for entry of judgment in favor of Calvert.

BACKGROUND

For 18 years, Calvert worked as a mortgage loan officer in the Seottsville, Kentucky branch of Star Bank. As a Star Bank employee, she participated in a long-term disability insurance plan issued by Liberty.

Three time periods are relevant to the determination of benefits under this plan. First is the “Elimination Period,” a period of 180 consecutive days of disability for which no benefit is payable. The second relevant time period covers the 24 months thereafter. To be deemed “disabled” for this second time period, an employee must be “unable to perform all of the material and substantial duties of his occupation.”

After receiving LTD benefits for 24 months, the plan’s definition of “disabled” becomes more strict. An employee is “disabled” under this final time period only if the employee “is unable to perform, with reasonable continuity, all of the material and substantial duties of his own or any other occupation for which he is or becomes reasonably fitted by training, education, experience, age and physical and mental capacity.” The insured employee bears the burden of proving his or her continuing “disability.”

In May 1998, Calvert suffered a back injury. On August 31, 1998, Calvert underwent a lumbar laminectomy and diskec-tomy. When she was discharged following surgery, her treating physician, Dr. Ray W. Hester, noted that he planned “to keep her off work probably six to eight weeks.” Calvert, in fact, never returned to work after her surgery. She applied for LTD benefits in February 1999, which Liberty authorized and made effective that same month.

Athough Dr. Hester noted after a follow-up visit in May 1999 that Calvert could “[t]ry sedentary work,” he was of the opinion a month later that Calvert would never be able to work again. Dr. Hester’s opinion was based, among other things, on x-rays and CT scans that indicated mild disc bulging and disc protrusion at the L5-S1 level. Dr. Hester opined that severe limitations on Calvert’s ability to sit, stand, or walk make it impossible for her to perform either her past work, as a loan officer, or other similar duties.

Liberty asked Dr. Harold P. Smith, a neurosurgeon, to perform an independent medical evaluation of Calvert in August 1999. Dr. Smith was concerned with the symmetrical nature of Calvert’s symptoms (e.g., pain, weakness, loss of muscle control in limbs, and extremities on both sides) and cautioned against any further surgery in light of that symmetry and her surgical history. Dr. Smith also found that Calvert suffered from certain limitations in her range of motion and ability to sit or stand for prolonged periods of time. Despite these concerns, however, Dr. Smith opined that Calvert “could possibly be employed *290 with appropriate attention to breaks and gradual work conditioning program.” He also recommended steroid injections, physical therapy, and/or water aerobics. After receiving Dr. Smith’s report, Liberty continued to pay benefits to Calvert.

During this time period, Liberty informed Calvert that her continued receipt of benefits was conditioned upon her making an application for benefits from the Social Security Administration (“SSA”), which she did. In September 1999, SSA determined that Calvert was “totally disabled” as of August 29, 1998. The SSA concluded that Calvert could not perform her past relevant work as a loan officer, and did not have transferrable skills to perform other work within her residual functional capacity. Specifically, the SSA found that:

Dr. Hester’s medical assessment is consistent with the claimant’s medical treatment, objective findings upon testing, clinical findings, and subjective complaints of pain. ... As Dr. Hester is the claimant’s treating neurosurgeon and has treated the claimant consistently over a year, he is in a better position to know the claimant’s limitations than the state agency physicians, who determined the claimant was capable of light exertional work. For this reason, the undersigned gives Dr. Hester’s medical assessment controlling weight and adopts his assessment in this case. The claimant cannot perform her past relevant work as a loan officer and does not have transferable skills to perform other work within her residual functional capacity .... Based upon the claimant’s residual functional capacity for less than a full range of sedentary work, and vocational factors, there are no jobs existing in significant numbers that she can perform.

After she was awarded benefits by the SSA, Liberty demanded reimbursement of a portion of the benefits previously paid to Calvert on the grounds that the plan provides for a proportionate reduction in benefits whenever benefits are received from an alternative source — such as the SSA— for the same disability. Liberty was reimbursed $4,309.29 for a portion of the benefits paid between February 1999 and September 1999, the date of the SSA award. Thereafter, while Liberty continued to pay Calvert benefits, it apparently did so at a reduced level because of her simultaneous receipt of benefits from the SSA.

In April 2001, Liberty had Calvert undergo a functional-capacity evaluation (an “FCE”) to assess her level of functioning and to determine her ability to return to “any occupation.” Rob Pearse, an exercise physiologist and a certified ergonomic specialist, conducted the FCE, after which he concluded that Calvert could work, but that she should perform sitting tasks “only occasionally” and should avoid stooping or repeated bending. Pearse also noted that Calvert would “need to change positions from sitting to standing frequently. Sitting is her main functional limitation.”

These results were used by a vocational rehabilitation specialist, Mary Titterington, in conducting a transferable-skills analysis for Calvert. While Titterington concluded that “the majority of [Calvert’s] most transferrable skills require extensive sitting beyond her tested tolerances,” there were some tasks Titterington felt Calvert could perform requiring minimal exertion. A representative sampling of jobs meeting this limitation included “drive thru bank teller; customer service representative; retail; security guard; cashier II; utility and government positions; bank loan officer.” Following the transferable-skills analysis, Liberty requested a labor-market survey to determine whether any of these *291 occupations were available in Calvert’s vicinity.

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409 F.3d 286, 34 Employee Benefits Cas. (BNA) 2907, 2005 U.S. App. LEXIS 8684, 2005 WL 1281755, Counsel Stack Legal Research, https://law.counselstack.com/opinion/linda-gail-calvert-v-firstar-finance-inc-fka-star-bank-corporation-ca1-2005.