Mitchell v. Fortis Benefits Insurance

163 F. App'x 183
CourtCourt of Appeals for the Fourth Circuit
DecidedJuly 29, 2005
Docket04-2307
StatusUnpublished
Cited by2 cases

This text of 163 F. App'x 183 (Mitchell v. Fortis Benefits Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mitchell v. Fortis Benefits Insurance, 163 F. App'x 183 (4th Cir. 2005).

Opinion

PER CURIAM:

This lawsuit involves a claim for long-term disability benefits under a group plan (“the Plan”) governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Paul Mitchell (“Mitchell”) claims that Fortis Benefits (“Fortis”) wrongfully terminated his long-term disability benefits, thus abusing its discretion, in violation of various procedures under ERISA and North Carolina law. Fortis appeals from the district court’s denial of its motion for summary judgment, the court’s judgment in Mitchell’s favor on his claim for disability benefits, and the awarding of attorney’s fees to Mitchell. After careful review, we affirm in part, vacate in part, and remand for further proceedings in accordance with this opinion.

I.

Mitchell began working for Advanced Polymer, Inc. (“Advanced Polymer”) 1 as a sales representative in the textile chemical industry on September 1, 1997. Mitchell’s job involved a substantial amount of travel, , driving an average of five hours a day, for a total of approximately 1500 to 2000 miles per week. According to Mitchell, he began experiencing symptoms of back pain in June 1998.

In April 1999, Mitchell’s treating physician, Mark A. Goodson, M.D. 2 determined that Mitchell suffered from chronic lumbar discogenic disease primarily due to degenerative changes in his lower back. Dr. Goodson advised Mitchell against surgical intervention. He did recommend a regular course of care with a chiropractor, physical therapy, a low impact exercise regimen, and anti-inflammatory medication. He further advised Mitchell “that 1500 miles per week in an automobile is certainly contraindicated for his low back problem” and would likely “advance the progression of his disease.” J.A. 897. Dr. Goodson suggested that Mitchell obtain a “sit down job where he would be able to stand up and walk around approximately every 20 minutes.” Id.

By November 1999, Mitchell’s condition had worsened. He complained to Dr. Goodson that his back pain increased with prolonged sitting or prolonged driving and that he found it difficult to assume an erect posture after a long drive. Once again, Dr. Goodson recommended that he discontinue the extensive travel. On November 16, 1999, Mitchell submitted a *185 long-term disability claim based on complaints of chronic back pain. By November 17, 1999 he was no longer reporting to work. Mitchell underwent further testing on November 22, 1999 and radiology reports revealed that he suffered from mild scoliosis of the lumbar spine with slight retrolisthesis of L2 and L3. Later that month, Mitchell requested a prescription for pain from Dr. Goodson and was prescribed Darvocet-N 100.

On December 6, 1999, Mitchell reported to Dr. Goodson that his pain, which he described as “a burning type pain with an occasional ‘numb’ type pain,” had improved since he had resumed physical therapy and quit working. Record on Appeal, Doc. Entry #22 at 542. On December 10, 1999, Mitchell saw T. Scott Ellison, M.D., an orthopedic specialist. Dr. Ellison obtained x-rays of Mitchell’s back, which revealed a degenerative collapsing lumbar scoliotic pattern, apex to the left. He noted that Mitchell’s disc spaces were fairly well preserved, with some narrowing of L4-5 with facet joint arthrosis. After reviewing Mitchell’s MRI scan from February 16, 1999, Dr. Ellison indicated that there were degenerative disc signal changes at multiple levels. Dr. Ellison advised Mitchell that his symptoms could be caused by the degenerative disc in his back, but that his lifestyle habits, namely extensive driving could be the cause as well.

Mitchell’s claim was referred to Fortis’ Clinical Services Department (“Clinical Services”) for review on March 6, 2000. Based on medical and physical-therapy notes from December 22, 1999 through February 23, 2000, Mitchell’s condition had improved — he showed increased range of movement and his area of pain had diminished. However, Dr. Goodson determined on February 22, 2000 that he “had suffered permanent partial impairment of his spine 5% relative to his lower thoracic and lumbar spine injuries requiring long-term pain management and likely long-term chiropractic manipulative care.” J.A. 900. Nevertheless, Clinical Services reviewed Mitchell’s medical records and concluded that no compelling medical information supported limitations from a primarily sedentary position that allowed for position changes. However, Clinical Services noted it “appears pain would prevent claimant from performing his occupation on a full-time basis.” Record on Appeal, Doc. Entry # 22 at 486.

On March 24, 2000, Clinical Services conducted a phone interview of Mitchell. Its report indicates that Fortis was aware that Mitchell’s therapy was being phased out and that he was able to drive for 10-30 minutes at a time, but experienced significant pain when driving 30-45 minutes. Mitchell informed Clinical Services that he had discussed the possibility of another sedentary job with his employer and that he did not know whether Advanced Polymer would be willing to decrease the number of miles he had to travel. Clinical Services concluded that the medical information supported a finding that Mitchell’s physical limitations prevented him from returning to work in his own occupation.

On March 28, 2000, Mitchell received notification of Fortis’ decision to grant his claim for long-term disability. Fortis considered November 17,1999 as his disability onset date, commencing benefits on February 17, 2000 (following the three months expiration of his qualifying period, as described in the Plan). On May 11, 2000, Mitchell’s case manager from Concentra Managed Care Services, Inc. (“Concentra”), 3 Cordeila Bortner, accompanied him *186 to his appointment with Dr. Goodson. 4 Ms. Bortner asked about the feasibility of Mitchell returning to work with a decreased route, given his improvement. Dr. Goodson prescribed a Functional Capacity Evaluation (“FCE”) to determine what level of activity Mitchell could tolerate. The following day, Fortis deferred all activity pending clarification of issues surrounding the worker’s compensation claim filed by Mitchell, the recent medical records noting improvement, and their bearing on Mitchell’s disability. 5 In May 2000, Mitchell participated in the FCE. Both Dr. Good-son, claimant’s treating physician, and Dr. Craig S. Heligman, from Clinical Services, reviewed the results and generally found that Mitchell would be able to do light work.

Although, Mitchell’s low back pain continued to improve, he reported to Dr. Goodson that he had developed pain over his left hip and buttocks. On January 19, 2001 Mitchell was diagnosed with moderate degenerative joint disease of the hip. Dr. Goodson noted that he remained active and was not taking Darvocet, but remained on Neurontin. Dr. Goodson advised his patient to continue chiropractic care, his home exercise program, and the Neuron-tin. Mitchell continued to see Dr. Goodson on a regular basis.

In January 2001, a nurse with Clinical Services reviewed Mitchell’s file and found that based upon the “available medical records” and multi-discipline reviews, including the peer review performed by Dr.

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163 F. App'x 183, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mitchell-v-fortis-benefits-insurance-ca4-2005.