17‐1593‐cv Marybeth M. Donlick v. Standard Ins. Co.
UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT
SUMMARY ORDER
RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A SUMMARY ORDER FILED ON OR AFTER JANUARY 1, 2007, IS PERMITTED AND IS GOVERNED BY FEDERAL RULE OF APPELLATE PROCEDURE 32.1 AND THIS COURTʹS LOCAL RULE 32.1.1. WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN ELECTRONIC DATABASE (WITH THE NOTATION ʺSUMMARY ORDERʺ). A PARTY CITING TO A SUMMARY ORDER MUST SERVE A COPY OF IT ON ANY PARTY NOT REPRESENTED BY COUNSEL.
At a stated term of the United States Court of Appeals for the Second Circuit, held at the Thurgood Marshall United States Courthouse, 40 Foley Square, in the City of New York, on the 21st day of February, two thousand eighteen.
PRESENT: JOHN M. WALKER, JR., GERARD E. LYNCH, DENNY CHIN, Circuit Judges.
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MARYBETH M. DONLICK, Plaintiff‐Appellant,
v. 17‐1593‐cv
STANDARD INSURANCE COMPANY, FKA STANCORP FINANCIAL GROUP, INC., Defendant‐Appellee.
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FOR PLAINTIFF‐APPELLANT: Ronald R. Benjamin, Law Office of Ronald R. Benjamin, Binghamton, New York.
FOR DEFENDANT‐APPELLEE: Brooks R. Magratten, Scott K. Pomeroy, Pierce Atwood LLP, Providence, Rhode Island.
Appeal from the United States District Court for the Northern District of
New York (Scullin, J.).
UPON DUE CONSIDERATION, IT IS HEREBY ORDERED,
ADJUDGED, AND DECREED that the judgment of the district court is AFFIRMED.
Plaintiff‐appellant Marybeth M. Donlick appeals from the district courtʹs
judgment entered May 2, 2017, in favor of defendant‐appellee Standard Insurance
Company (ʺStandardʺ). Donlick brought this action under the Employee Retirement
Income Security Act of 1974 (ʺERISAʺ), 29 U.S.C. § 1132(a)(1)(B), to challenge Standardʹs
decision to terminate her long‐term disability (ʺLTDʺ) benefits. The district court
granted Standardʹs motion for summary judgment by opinion and order filed the same
date. We assume the partiesʹ familiarity with the underlying facts, procedural history,
and issues on appeal.
Construed in the light most favorable to Donlick, the facts are
summarized as follows: On August 7, 2012, Donlick, who until that point had been
employed as a truck driver for Chesapeake Energy Corporation, was involved in a
motorcycle accident. Donlick was seriously injured ‐‐ her right leg was amputated 2
below her knee and her left ankle was fractured among other injuries. Donlick applied
for LTD benefits through her employee benefit plan (the ʺPlanʺ) with Standard.
Under the Plan, Standard had ʺfull and exclusive authority to control and
manage the [Plan], to administer claims, and to interpret the [Plan] and resolve all
questions arising in the administration, interpretation, and application of the [Plan].ʺ
J.A. at 95. To receive LTD benefits, Donlick had to prove that she had an injury that
prevented her from performing the ʺMaterial Dutiesʺ1 of her ʺOwn Occupation.ʺ2 Id. at
82; see, e.g., Pruter v. Local 210ʹs Pension Tr. Fund, 858 F.3d 753, 762 (2d Cir. 2017)
(establishing that plaintiff has burden of proof). Standard approved Donlickʹs claim in
January 2013, and began paying her monthly LTD benefits in March 2013. Standard
also notified Donlick that after two years the Planʹs definition of an LTD would shift
from an ʺown occupationʺ to an ʺany occupationʺ standard. 3
1 ʺMaterial Dutiesʺ are defined as ʺthe essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted.ʺ J.A. at 67. 2 ʺOwn Occupationʺ is defined as ʺany employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins.ʺ J.A. at 67. 3 ʺAny Occupationʺ is defined as ʺany occupation or employment which you are able to perform, whether due to education, training, or experience, which is available at one or more locations in the national economy and in which you can be expected to earn at least 60% of your Indexed Predisability Earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.ʺ J.A. at 67.
After paying her LTD benefits for two years, Standard reevaluated
Donlickʹs claim, determined that she did not satisfy the ʺany occupationʺ standard, and
terminated her LTD benefits. Donlick internally appealed, and after considering
additional medical evidence, on March 15, 2016, Standard upheld its earlier decision to
terminate Donlickʹs LTD benefits.
Donlick commenced this action. The district court granted summary
judgment in favor of Standard, finding that Standard did not abuse its discretion in
terminating Donlickʹs LTD benefits. This appeal followed.
On appeal Donlick argues, inter alia, that Standardʹs benefit determination
was an abuse of discretion, the district court applied the wrong standard of review, and
the district court should have considered evidence outside the administrative record.
Upon review, we conclude that Donlickʹs appeal is without merit substantially for the
reasons articulated by the district court in its thorough and well‐reasoned
memorandum decision and order.
We review de novo a district courtʹs grant of summary judgment,
ʺconstruing the evidence in the light most favorable to the non‐moving party and
drawing all reasonable inferences in its favor.ʺ Mitchell v. City of New York, 841 F.3d 72,
77 (2d Cir. 2016). Though we review the district courtʹs decision de novo, where, as is the
case here, ʺthe benefit plan gives the administrator . . . authority to determine eligibility
for benefits or to construe the terms of the plan,ʺ we review the administratorʹs
interpretation for abuse of discretion. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101,
115 (1989).
Donlick argues that because Standard had a conflict of interest, as it both
evaluates and pays benefit claims, we should review Standardʹs interpretation de novo.
Though this sort of conflict is a factor that should be taken into account in a courtʹs
evaluation, it ʺdoes not make de novo review appropriate.ʺ McCauley v. First Unum Life
Ins. Co., 551 F.3d 126, 133 (2d Cir. 2008) (citing Metro. Life Ins. Co. v. Glenn, 554 U.S. 105,
111 (2008)). ʺThis is true even where the plaintiff shows that the conflict of interest
affected the choice of a reasonable interpretation.ʺ McCauley, 551 F.3d at 133 (citing
Glenn, 554 U.S. at 111).
Donlick also suggests that de novo review is appropriate because Standard
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17‐1593‐cv Marybeth M. Donlick v. Standard Ins. Co.
UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT
SUMMARY ORDER
RULINGS BY SUMMARY ORDER DO NOT HAVE PRECEDENTIAL EFFECT. CITATION TO A SUMMARY ORDER FILED ON OR AFTER JANUARY 1, 2007, IS PERMITTED AND IS GOVERNED BY FEDERAL RULE OF APPELLATE PROCEDURE 32.1 AND THIS COURTʹS LOCAL RULE 32.1.1. WHEN CITING A SUMMARY ORDER IN A DOCUMENT FILED WITH THIS COURT, A PARTY MUST CITE EITHER THE FEDERAL APPENDIX OR AN ELECTRONIC DATABASE (WITH THE NOTATION ʺSUMMARY ORDERʺ). A PARTY CITING TO A SUMMARY ORDER MUST SERVE A COPY OF IT ON ANY PARTY NOT REPRESENTED BY COUNSEL.
At a stated term of the United States Court of Appeals for the Second Circuit, held at the Thurgood Marshall United States Courthouse, 40 Foley Square, in the City of New York, on the 21st day of February, two thousand eighteen.
PRESENT: JOHN M. WALKER, JR., GERARD E. LYNCH, DENNY CHIN, Circuit Judges.
‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐x
MARYBETH M. DONLICK, Plaintiff‐Appellant,
v. 17‐1593‐cv
STANDARD INSURANCE COMPANY, FKA STANCORP FINANCIAL GROUP, INC., Defendant‐Appellee.
‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐x
FOR PLAINTIFF‐APPELLANT: Ronald R. Benjamin, Law Office of Ronald R. Benjamin, Binghamton, New York.
FOR DEFENDANT‐APPELLEE: Brooks R. Magratten, Scott K. Pomeroy, Pierce Atwood LLP, Providence, Rhode Island.
Appeal from the United States District Court for the Northern District of
New York (Scullin, J.).
UPON DUE CONSIDERATION, IT IS HEREBY ORDERED,
ADJUDGED, AND DECREED that the judgment of the district court is AFFIRMED.
Plaintiff‐appellant Marybeth M. Donlick appeals from the district courtʹs
judgment entered May 2, 2017, in favor of defendant‐appellee Standard Insurance
Company (ʺStandardʺ). Donlick brought this action under the Employee Retirement
Income Security Act of 1974 (ʺERISAʺ), 29 U.S.C. § 1132(a)(1)(B), to challenge Standardʹs
decision to terminate her long‐term disability (ʺLTDʺ) benefits. The district court
granted Standardʹs motion for summary judgment by opinion and order filed the same
date. We assume the partiesʹ familiarity with the underlying facts, procedural history,
and issues on appeal.
Construed in the light most favorable to Donlick, the facts are
summarized as follows: On August 7, 2012, Donlick, who until that point had been
employed as a truck driver for Chesapeake Energy Corporation, was involved in a
motorcycle accident. Donlick was seriously injured ‐‐ her right leg was amputated 2
below her knee and her left ankle was fractured among other injuries. Donlick applied
for LTD benefits through her employee benefit plan (the ʺPlanʺ) with Standard.
Under the Plan, Standard had ʺfull and exclusive authority to control and
manage the [Plan], to administer claims, and to interpret the [Plan] and resolve all
questions arising in the administration, interpretation, and application of the [Plan].ʺ
J.A. at 95. To receive LTD benefits, Donlick had to prove that she had an injury that
prevented her from performing the ʺMaterial Dutiesʺ1 of her ʺOwn Occupation.ʺ2 Id. at
82; see, e.g., Pruter v. Local 210ʹs Pension Tr. Fund, 858 F.3d 753, 762 (2d Cir. 2017)
(establishing that plaintiff has burden of proof). Standard approved Donlickʹs claim in
January 2013, and began paying her monthly LTD benefits in March 2013. Standard
also notified Donlick that after two years the Planʹs definition of an LTD would shift
from an ʺown occupationʺ to an ʺany occupationʺ standard. 3
1 ʺMaterial Dutiesʺ are defined as ʺthe essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted.ʺ J.A. at 67. 2 ʺOwn Occupationʺ is defined as ʺany employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins.ʺ J.A. at 67. 3 ʺAny Occupationʺ is defined as ʺany occupation or employment which you are able to perform, whether due to education, training, or experience, which is available at one or more locations in the national economy and in which you can be expected to earn at least 60% of your Indexed Predisability Earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.ʺ J.A. at 67.
After paying her LTD benefits for two years, Standard reevaluated
Donlickʹs claim, determined that she did not satisfy the ʺany occupationʺ standard, and
terminated her LTD benefits. Donlick internally appealed, and after considering
additional medical evidence, on March 15, 2016, Standard upheld its earlier decision to
terminate Donlickʹs LTD benefits.
Donlick commenced this action. The district court granted summary
judgment in favor of Standard, finding that Standard did not abuse its discretion in
terminating Donlickʹs LTD benefits. This appeal followed.
On appeal Donlick argues, inter alia, that Standardʹs benefit determination
was an abuse of discretion, the district court applied the wrong standard of review, and
the district court should have considered evidence outside the administrative record.
Upon review, we conclude that Donlickʹs appeal is without merit substantially for the
reasons articulated by the district court in its thorough and well‐reasoned
memorandum decision and order.
We review de novo a district courtʹs grant of summary judgment,
ʺconstruing the evidence in the light most favorable to the non‐moving party and
drawing all reasonable inferences in its favor.ʺ Mitchell v. City of New York, 841 F.3d 72,
77 (2d Cir. 2016). Though we review the district courtʹs decision de novo, where, as is the
case here, ʺthe benefit plan gives the administrator . . . authority to determine eligibility
for benefits or to construe the terms of the plan,ʺ we review the administratorʹs
interpretation for abuse of discretion. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101,
115 (1989).
Donlick argues that because Standard had a conflict of interest, as it both
evaluates and pays benefit claims, we should review Standardʹs interpretation de novo.
Though this sort of conflict is a factor that should be taken into account in a courtʹs
evaluation, it ʺdoes not make de novo review appropriate.ʺ McCauley v. First Unum Life
Ins. Co., 551 F.3d 126, 133 (2d Cir. 2008) (citing Metro. Life Ins. Co. v. Glenn, 554 U.S. 105,
111 (2008)). ʺThis is true even where the plaintiff shows that the conflict of interest
affected the choice of a reasonable interpretation.ʺ McCauley, 551 F.3d at 133 (citing
Glenn, 554 U.S. at 111).
Donlick also suggests that de novo review is appropriate because Standard
violated Department of Labor (ʺDOLʺ) regulations, specifically 29 C.F.R. § 2560.503‐
1(f)(2)(iii)(B),4 when a Standard employee failed to return a phone call from Donlick.
4 The regulation reads: In the case of a post‐service claim, the plan administrator shall notify the claimant, in accordance with paragraph (g) of this section, of the planʹs adverse benefit determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be
Though ʺa planʹs failure to comply with the [DOLʹs] claims‐procedure regulation, 29
C.F.R. § 2560.503‐1, will result in that claim being reviewed de novo,ʺ the regulation cited
by Donlick pertains only to group health plans, not disability benefit plans. Halo v. Yale
Health Plan. Dir. of Benefits & Records Yale Univ., 819 F.3d 42, 57‐58 (2d Cir. 2016).
Moreover, we are not persuaded that Standardʹs alleged failure to return a phone call
would violate 29 C.F.R. § 2560.503‐1(f)(2)(iii)(B), especially in light of Standardʹs
evidence that it sent numerous notices to Donlick and her lawyer. Donlick also
suggests generally that Standard insufficiently communicated with her while
evaluating her claim, but cannot point to any regulation that Standard violated or
explain why this lack of communication should alter the standard of review.
Donlick next contends that the district court should have considered
outside records she submitted instead of limiting its review to the administrative
extended one time by the plan for up to 15 days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial 30‐day period, of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. If such an extension is necessary due to a failure of the claimant to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the claimant shall be afforded at least 45 days from the receipt of the notice within which to provide the specified information. 29 C.F.R. § 2560.503‐1(f)(2)(iii)(B).
record. Though the district court has discretion to consider evidence from outside the
administrative record, ʺthe presumption is that judicial review ʹis limited to the record
in front of the claims administrator unless the district court finds good cause to consider
additional evidence.ʹʺ Muller v. First Unum Life Ins. Co., 341 F.3d 119, 125 (2d Cir. 2003)
(quoting DeFelice v. Am. Intʹl Life Assurance Co. of N.Y., 112 F.3d 61, 67 (2d Cir. 1997)). A
conflicted administrator does not necessitate a finding of good cause. Locher v. Unum
Life Ins. Co. of Am., 389 F.3d 288, 296 (2d Cir. 2004). Donlick failed to demonstrate good
cause ‐‐ rather, she simply suggests in a conclusory manner that Standard is conflicted
and that the strength of the evidence outside the record is itself enough to constitute
good cause.
Lastly, Donlick challenges Standardʹs decision to terminate her LTD
benefits as an abuse of discretion. Standardʹs interpretation was not an abuse of
discretion. That is, it was not ʺwithout reason, unsupported by substantial evidence or
erroneous as a matter of law.ʺ Miller v. United Welfare Fund, 72 F.3d 1066, 1072 (2d Cir.
1995) (internal quotation marks and citation omitted). Standard gave Donlick several
opportunities to submit proof of continuing disability and considered the submissions
of her physicians and vocational expert. Though Donlick lost her leg and struggled to
find a suitable prosthetic, Standardʹs conclusion that Donlick could still perform
sedentary occupations, such as shipping traffic clerk, was reasonable and supported by
substantial evidence. Standard had several independent physicians and vocational
experts consider Donlickʹs claim and her additional submissions, leading to the
conclusion that Donlick did not meet the ʺany occupationʺ standard.
. . .
We have considered Donlickʹs remaining arguments and find them to be
without merit. Accordingly, we AFFIRM the judgment of the district court.
FOR THE COURT: Catherine OʹHagan Wolfe, Clerk