Manning v. American Republic Insurance

604 F.3d 1030, 2010 U.S. App. LEXIS 9674, 2010 WL 1875658
CourtCourt of Appeals for the Eighth Circuit
DecidedMay 12, 2010
Docket09-2625
StatusPublished
Cited by59 cases

This text of 604 F.3d 1030 (Manning v. American Republic 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
Manning v. American Republic Insurance, 604 F.3d 1030, 2010 U.S. App. LEXIS 9674, 2010 WL 1875658 (8th Cir. 2010).

Opinion

LANGE, District Judge.

Kim Iann Manning (“Manning”) was denied short-term disability benefits and subsequently terminated from employment by American Republic Insurance Company (“ARIC”). She sought judicial review of the benefits decision under the Employee Retirement Income Security Act. 29 U.S.C. § 1132 et seq. She also asserted ERISA retaliation and interference claims. The district court 2 affirmed ARIC’s denial of Manning’s benefits claim, finding that ARIC did not abuse its discretion in determining that Manning was not disabled. In a separate order, the district court granted ARIC’s motion for summary judgment on Manning’s ERISA retaliation and interference claims. Manning appeals both orders. Having jurisdiction under 28 U.S.C. § 1391, this Court affirms.

1. MATERIAL FACTS NOT SUBJECT TO GENUINE DISPUTE.

Beginning on January 31, 2005, Manning worked for ARIC as a Senior Account Specialist. Her job involved selling insurance products over the telephone and was sedentary in nature, consisting of calling prospective customers and determining their eligibility for insurance, providing insurance quotes, and data entry. Manning worked a total of 50 days for ARIC. Her last day worked was April 26, 2005.

ARIC sponsored and administered a self-funded short-term disability plan (“the Plan”) for its employees. As an ARIC employee, Manning was eligible to participate in the Plan. To qualify for short-term disability benefits under the Plan, eligible employees must: (1) be covered by the Plan; (2) be under the care of an “Approved Health Care Provider”; (3) have a “Medically Certified Health Condition” that lasts longer than the short-term disability waiting period; (4) receive appropriate care and treatment for the Medically Certified Health Condition; and (5) receive approval of short-term disability benefits in accordance with the provisions of the Plan. Under the Plan, ARIC reserved the right to have claimants submit to an Independent Medical Examination (“IME”) by an Approved Health Care Provider of its choice.

The Plan defines Approved Health Care Provider as: (1) licensed doctors of medicine or osteopathy; (2) licensed podiatrists, dentists, Ph.D.’s, psychologists, optometrists, or chiropractors; and (3) licensed nurse practitioners or nurse midwives. The Plan’s definition of Medically Certified Health Condition required the condition to *1036 be “[d]ocumented by objective disabling signs and symptoms.”

On May 9, 2005, Manning submitted a claim for benefits under the Plan by providing a Family Medical Leave Act Certification of Health Care Provider form completed by Physician Assistant Andra Kennedy dated May 5, 2005. Kennedy reported that Manning was experiencing “elevated blood pressure,” “increased frequency of migraines,” and “increased anxiety.” Kennedy also wrote that Manning’s conditions began approximately 90 days earlier. Kennedy recommended that Manning receive short-term disability benefits for two to three months. Kennedy failed to directly answer a question on the form asking whether Manning was “unable to perform work of any kind,” instead indicating that Manning should “avoid long periods of sitting or repetitive motion.”

On May 12, 2005, Jodi Lanphier, an ARIC benefit specialist, called Manning to request more information regarding her claim. Lanphier told Manning that ARIC needed Manning to specify why she was unable to work. In response, Manning faxed Lanphier a document the next day, signed by Kennedy, stating “dangerously high blood pressure,” “[ijncrease in frequency, severity, and duration of migraines,” and “hypertension.” However, the note did not explain why those conditions prevented Manning from working for an extended period.

On May 20, 2005, Lanphier again called Manning for more information in order to process her claim. Lanphier sent Manning a letter on May 24, 2005, explaining that the Plan required claims to be completed by an Approved Health Care Provider. The letter set forth in full the Plan’s definition of Approved Health Care Provider, which did not include physician assistants. The letter further notified Manning that her claim could not be considered until an Approved Health Care Provider submitted evidence of disability. The letter also explained that “[a] decision on STD eligibility will not be made until objective medical evidence to support your disability is received by the company.” Finally, Lanphier wrote that, consistent with the Plan’s terms, Manning had fifteen days after receipt of the letter to submit the required information to ARIC.

On June 8, 2005, Kennedy sent ARIC a handwritten letter, attaching two medical records from office visits during which Manning was examined by Dr. Kenneth Moon. The first record, from March 11, 2005, noted that Manning’s blood pressure was 148/110, that “she feels the best that she has felt in a long time,” and that she could return to work the following Monday. In the second record, from April 26, 2005, Kennedy reported that Manning’s blood pressure was 152/100 and that Manning felt “stressed out.”

On June 16, 2005, ARIC Senior Human Resources Business Partner Gina Moeckly Vernon sent a letter to Dr. Moon requesting a telephone conversation regarding Manning’s health status. Vernon attached a copy of ARIC’s job description for Manning’s position. On July 19, Vernon, Lanphier, and Manning participated in a conference call, during which Vernon advised Manning that she needed to speak with Dr. Moon regarding Manning’s medical condition. Vernon also explained that, under the Plan’s terms, ARIC could not make a determination as to Manning’s claim without documentation from an Approved Health Care Provider. On July 25, Vernon sent a second letter to Dr. Moon— with a copy to Manning — requesting a telephone conference regarding Manning’s claim.

On July 29, 2005, Vernon, Lanphier, and Dr. Moon participated in a teleconference to discuss Manning’s condition. Dr. Moon *1037 explained that he had not examined Manning since March 2005, but that upon examination of Kennedy’s records and notes, he found that Manning’s blood pressure level did not require placement on disability status. Inconsistent with this statement, however, Dr. Moon said that he believed Manning would not be able to return to work due to her blood pressure and migraines. He then said that he was not able to determine Manning’s eligibility to return to work at that time, and he would require further examination to make a disability determination.

On August 6, 2005, Dr. Moon returned to ARIC a completed Certification of Health Care Provider form and notes from an August 1, 2005 examination of Manning. On the form, Dr. Moon noted that Manning had been under stress from her bankruptcy, but that the stress would likely be lifted upon the upcoming completion of the bankruptcy proceedings around September 4, 2005. He also reported that Manning’s blood pressure was improving and her migraines were becoming less frequent. In response to the certification form’s question, “is the employee unable to perform work of any kind,” Dr. Moon answered “yes” without any explanation.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
604 F.3d 1030, 2010 U.S. App. LEXIS 9674, 2010 WL 1875658, Counsel Stack Legal Research, https://law.counselstack.com/opinion/manning-v-american-republic-insurance-ca8-2010.