Monica Crox v. Unum Group

655 F. App'x 490
CourtCourt of Appeals for the Sixth Circuit
DecidedJuly 21, 2016
Docket15-6006
StatusUnpublished

This text of 655 F. App'x 490 (Monica Crox v. Unum Group) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Monica Crox v. Unum Group, 655 F. App'x 490 (6th Cir. 2016).

Opinion

ALICE M. BATCHELDER, Circuit Judge. .

In this ERISA action challenging the denial of long-term disability benefits, the district court accepted and adopted the magistrate judge’s report and recommendation (R & R), and consequently dismissed the plaintiffs complaint with prejudice. The plaintiff appeals but, finding no merit to her appeal, we affirm.

I.

Monica Crox was a nurse. When her divorce led to emotional distress with physical and medical manifestations, she quit working and sought disability benefits from her ERISA Plan. Defendant Unum Group is both Plan payer and administrator and paid Crox benefits for two years. Under the terms of the Plan, in order to continue to receive benefits beyond that point, Crox had to show that she was incapable of engaging in even a purely sedentary occupation.

Unum determined, based on several specific findings, that Crox could perform a sedentary occupation. Crox’s file contained multiple MRIs that revealed no degenerative back problem that would explain or support her claims of a disabling back condition. A “neurological and movement disorder” specialist (Dr. Stover), acting on referral by Crox’s treating physician because Crox claimed an autonomic dysfunction, had diagnosed Crox with conversion disorder—a mental-health condition in which a person shows psychological stress in physical ways—and had prescribed psychotherapy, but Crox refused psychiatric treatment. Two of Unum’s medical consultants reviewed Crox’s full medical record and agreed with the diagnosis of conversion disorder, concluding that even if Crox was disabled due to mental illness she was not precluded from sedentary work as required to receive benefits under the Plan.

*492 Unum also contacted the treating physicians from Crox’s medical records as well as some others whom Crox had named. Five of those physicians told Unum that Crox was capable of working full time in a sedentary job while five others declined to comment because they were not actually treating Crox. One physician (Dr. Trudell) delegated the task to his nurse practitioner (Jennifer Sparks), who said that Crox’s “hand tremor makes it difficult to work with her hands; worsens with activity,” but concerning restrictions or limitations, said, “I have only seen this patient once and I am unsure.” When Unum followed up with several telephone calls seeking elaboration or clarification, neither Dr. Trudell nor Nurse Sparks responded.

Unum .had a vocational-rehabilitation specialist review Crox’s file; the specialist identified several sedentary jobs suitable to Crox and available in the geographic area. Finally, Unum obtained video surveillance of Crox in her daily activities; driving, walking, smoking, using her cell phone, and doing other routine activities, all without assistance and showing no obvious symptoms of dizziness, tremors, or pain. Based on these findings, Unum denied Crox’s claim and discontinued her benefits. Unum later denied her administrative appeal. Crox sued in federal- court, pursuant to ERISA, and the court delegated the case to a magistrate judge.

Crox argued two issues to ttye magistrate judge: (1) that a de novo standard of review should apply and (2) that Unum erred by finding her capable of sedentary work. Crox argued for de novo review by claiming that the Plan is self-contradictory in that, while it gives discretion to the administrator, it denies discretion by requiring the administrator to be “reasonable.” The magistrate judge answered that “reasonableness [is] the touchstone of the arbitrary and capricious standard,” so the Plan is not contradictory and the proper standard of review is arbitrary-and-capricious, not de novo. As for Crox’s second argument, the magistrate judge compiled and considered all of Unum’s record evidence in a lengthy R & R, and concluded:

After a review of the evidence and, given that [Crox] has not produced an opinion from a single physician to dispute the numerous opinions that [Crox] is not precluded from sedentary work by her physical impairments, the undersigned [magistrate judge] concludes that Unum’s decision to deny benefits was not arbitrary and capricious; rather, it was reasonable.

R. 31 at 17. In reaching this conclusion, the magistrate judge had also addressed Crox’s argument that the Social Security Administration (SSA) had declared her disabled, explaining that neither Unum nor the court was bound by the SSA’s decision and, in any event, Unum had specifically addressed and rejected the SSA decision in its denial when it explained that the SSA had seen neither Dr. Stover’s diagnosis of conversion disorder nor the surveillance video. The magistrate judge recommended that the court grant summary judgment to Unum.

Crox filed objections to the magistrate judge’s report, arguing that: (1) a de novo standard of review applied and (2) the magistrate judge failed to consider the conflict of interest resulting from Unum’s both administering the Plan and paying benefits out of it. With respect to the former argument, the court adopted the magistrate judge’s “well-reasoned conclusions” that the reasonableness requirement did not make the Plan contradictory, so the court must apply the arbitrary-and-capricious standard of review. With respect to the latter, the court recognized that Unum had a facial conflict and that the magistrate judge had not expressly *493 addressed it, but that Unum had taken sufficient steps to overcome any bias and ensure accuracy, concluding:

Unum contacted all of [Crox]’s physicians, not just those employed by Unum, to inquire about [Croxj’s ability to work. As stated above, none of these physicians opined that [Crox] was incapable of working full-time in a sedentary capacity. Even considering Unum’s conflict of interest, the [c]ourt finds that, given the dearth of evidence in [Croxj’s favor, Unum’s decision to deny [Crox] benefits was reasonable, and thus was neither arbitrary nor capricious.

R. 34 at 3-4. The district court dismissed Crox’s complaint with prejudice. Crox appealed.

II.

We apply de novo review to questions of law, such as “the district court’s determination [of] the proper standard [of review] to apply in its review of a plan administrator’s decision.” Frazier v. Life Ins. Co. of N. Am., 725 F.3d 560, 565-66 (6th Cir. 2013) (quotation marks and citation omitted). In reviewing “the district court’s judgment on [a] [plaintiffs ERISA claim,” we “apply[ ] the same standard of review to the plan administrator’s action as required [of] the district court.” Javery v. Lucent Techs., Inc. Long Term Disability Plan, 741 F.3d 686, 700 (6th Cir. 2014). That is, when the “plan gives the administrator ... discretionary authority to determine eligibility for benefits or to construe the terms of the plan ..., we review the denial of benefits only to determine if it was arbitrary and capricious.” McClain v. Eaton Corp. Disability Plan, 740 F.3d 1059

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655 F. App'x 490, Counsel Stack Legal Research, https://law.counselstack.com/opinion/monica-crox-v-unum-group-ca6-2016.