Lisa Gerhardt v. Liberty Life Assurance Company

736 F.3d 777, 57 Employee Benefits Cas. (BNA) 1129, 2013 WL 6211808, 2013 U.S. App. LEXIS 23912
CourtCourt of Appeals for the Eighth Circuit
DecidedNovember 29, 2013
Docket12-3159
StatusPublished
Cited by17 cases

This text of 736 F.3d 777 (Lisa Gerhardt v. Liberty Life Assurance Company) 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
Lisa Gerhardt v. Liberty Life Assurance Company, 736 F.3d 777, 57 Employee Benefits Cas. (BNA) 1129, 2013 WL 6211808, 2013 U.S. App. LEXIS 23912 (8th Cir. 2013).

Opinion

WOLLMAN, Circuit Judge.

Lisa Gerhardt appeals from the district court’s 1 order denying her motion for *779 judgment on the record, affirming Liberty-Life Assurance Company of Boston’s (Liberty) decision to terminate payment of her long-term disability benefits, and dismissing her complaint with prejudice. • We affirm.

I. Background

Gerhardt obtained an associate’s degree in nursing in 1980 and thereafter obtained a registered nurse’s license. From 1980 to 2000, Gerhardt worked as a registered nurse and held other positions within -the healthcare field. In July 2000, Gerhardt stopped working because she suffered from osteoarthritis and needed to undergo anthroplasty surgery on each of her thumbs. At the time, she was employed as the Director of Addiction Services for a psychiatric hospital, the Bridgeway, Inc., which was owned and operated by Universal Health Services, Inc. 2 Universal Health Services provided long-term disability coverage to its employees under a Group Disability Income Policy (the Policy) issued by Liberty. Gerhardt filed a claim for long-term disability benefits with Liberty in October 2000.

To receive long-term disability benefits, the Policy required insured employees to provide Liberty with proof of disability. As relevant to this case, the Policy defines “Disability” or “Disabled” as follows:

i. If the Covered Person is eligible for the 24 Month Own Occupation Benefit, “Disability” or “Disabled” means during the Elimination Period and the next 24 months of Disability the Covered Person is unable to perform all of the material and substantial duties of his occupation on an Active Employment basis because of an Injury or Sickness; and

ii. After 24 months of benefits have been paid, the Covered Person 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 train- . ing, education, experience, age and physical and mental capacity.

Accordingly, the initial determination of whether an employee is “Disabled” is dependent upon whether the employee is able to perform his or her own occupation, whereas after the employee has, received benefits for twenty-four months, the determination is dependent upon whether the employee can perform his or her own occupation or any occupation for which the employee is reasonably fitted.

Liberty approved Gerhardt’s claim under the first standard and began paying her long-term disability benefits on November 5, 2000. • Thereafter, Gerhardt was diagnosed with various medical conditions including fybromyalgia, depression, arthritis, and Qsteoporosis. In 2002, Liberty reevaluated Gerhardt’s claim under the second standard — the “any occupation” standard — and determined that Gerhardt continued to qualify for benefits under the Policy. Liberty, however, notified Ger-hardt that her claim would be evaluated periodically.

In 2004 and 2005, Gerhardt participated in two separate Independent Medical Evaluations (IME) at Liberty’s request. Barry Baskin, M.D., and Bruce Safman, M.D., separately evaluated Gerhardt and concluded that she was capable of performing full-time sedentary work despite her various medical conditions. In 2005, Teresa Marques, a vocational consultant, completed a Transferable Skills Analysis (TSA) *780 based on her review of Gerhardt’s file and standard vocational resources. Marques identified five occupations Gerhardt could perform that were consistent with the “any occupation” standard.

Gerhardt’s family practice doctor, however, opined that Gerhardt was disabled and could not hold a full-time job. Thereafter, a physical therapist who had been hired by Liberty performed a Functional Capacity Evaluation (FCE) of Gerhardt and concluded that Gerhardt was capable of performing sedentary work. Additionally, Liberty hired a separate vocational consultant to review the TSA, who confirmed that Gerhardt was capable of performing each of the five occupations Marques had previously identified. On May 1, 2006, Liberty notified Gerhardt of its decision to terminate payment of her long-term disability benefits as of May 5, 2006. Liberty concluded that Gerhardt was no longer eligible for disability benefits because she was capable of performing full-time sedentary work.

Gerhardt appealed Liberty’s decision to terminate benefits, and Liberty again denied Gerhardt’s claim. Gerhardt then sought judicial review of Liberty’s adverse benefits determination under the Employee Retirement Income Security Act (ERISA). See 29 U.S.C. § 1132(a)(1)(B). The district court reversed Liberty’s decision to terminate benefits and remanded Gerhardt’s claim to Liberty for further proceedings. The district court concluded that substantial evidence supported Liberty’s determination that Gerhardt was physically capable of performing the occupations identified in the TSA, but concluded that Liberty had not adequately addressed whether Gerhardt was mentally capable of performing those occupations. Accordingly, the district court instructed Liberty to “consider not only Gerhardt’s physical impairments, but also her mental impairments, the side effects of any necessary medications, her age, and other considerations contained in the administrative record.” D. Ct. Order of June 17, 2008, at 29. The district court also advised the parties to “consider obtaining a new transferable skills analysis report.” Id. Liberty appealed, and we dismissed the appeal for lack of jurisdiction. See Gerhardt v. Liberty Life Assurance Co. of Boston, 574 F.3d 505 (8th Cir.2009). On remand, Ger-hardt submitted additional information for Liberty’s review and underwent further medical assessments. Ultimately, Liberty adhered to its decision to terminate benefits. Gerhardt moved to reopen the case and then moved for judgment on the record, requesting that the district court order Liberty to pay her claim.

II. Termination of Benefits

Because it is undisputed that the Policy gave Liberty discretionary authority to determine Gerhardt’s eligibility for benefits, we review Liberty’s decision for abuse of discretion. See Norris v. Citibank, N.A. Disability Plan (501), 308 F.3d 880, 883 (8th Cir.2002). Under the abuse of discretion standard of review, we do not “substitute our own weighing of the evidence for that of the administrator.” Sahulka v. Lucent Techs., Inc., 206 F.3d 763, 769-70 (8th Cir.2000). Instead, “a plan administrator’s decision will stand if reasonable; ‘i.e., supported by substantial evidence.’ ” Ortlieb v. United Healthcare Choice Plans, 387 F.3d 778, 781 (8th Cir.2004) (quoting

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
736 F.3d 777, 57 Employee Benefits Cas. (BNA) 1129, 2013 WL 6211808, 2013 U.S. App. LEXIS 23912, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lisa-gerhardt-v-liberty-life-assurance-company-ca8-2013.