Morris v. American Electric Power Long-Term Disability Plane

399 F. App'x 978
CourtCourt of Appeals for the Sixth Circuit
DecidedOctober 15, 2010
Docket08-4412
StatusUnpublished
Cited by21 cases

This text of 399 F. App'x 978 (Morris v. American Electric Power Long-Term Disability Plane) 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
Morris v. American Electric Power Long-Term Disability Plane, 399 F. App'x 978 (6th Cir. 2010).

Opinions

BOGGS, Circuit Judge.

Paul Morris was injured in a work-related automobile accident in 1992 and, as a consequence, began receiving long-term disability benefits from the Appellee (“the Plan”) in 1993. In 2004, the Plan’s new third-party administrator, Broadspire, requested documentation of Morris’s ongoing disability. Following a series of independent examinations and Plan-sponsored file reviews, the Plan terminated Morris’s long-term disability benefits. Morris, after exhausting his internal appeals, appealed to the district court, which affirmed the Plan’s determination as being neither arbitrary nor capricious. For the reasons discussed below, we affirm the judgment of the district court.

I

Paul Morris was employed as a meter reader for American Electric Power (“AEP”) when he was injured in an on-the-job automobile accident in August 1992. Though he continued to work in the months immediately following the accident, by April 1993 his condition was such that he could not perform the walking, climbing, standing, and moving of objects that his job required. On that basis, and further claiming that he suffered from depression and post-traumatic stress disorder as a result of the accident, Morris applied for and was granted long-term disability status by AEP’s then-plan administrator, Aetna. At the same time, and with the encouragement of the Plan, he applied for and obtained Social Security disability benefits.

Under the terms of the Plan, disability determinations are two-tiered. For the first two years that a participant receives long-term disability benefits, he is considered disabled if he is unable to perform the work required of him in his “own occupation” — that is, the occupation he held immediately prior to going on disability. After that initial two-year period, in order for long-term disability benefits to continue, the participant must be unable to perform any occupation that he is qualified to perform, as long as that occupation pays at least 60% of his pre-disability base rate of pay and is consistent with the participant’s formal education, training, and work experience (the “any-oecupation standard”).

[980]*980In April 1995, Aetna informed Morris that he had met the any-occupation standard, entitling him to benefits beyond the initial two-year time frame. Under the terms of the plan, Morris was subject to provisions requiring him to provide continuing objective proof of his disability at least once each year.

Over the next ten years, Morris continued to see a neurologist, Dr. Nahid Dad-mehr, for complaints of headaches, pains in his back and legs, and right elbow pain. He also saw a psychiatrist, Dr. Maureen Stark, on several occasions for depression.

In June 2004, the Plan’s new claims administrator, Broadspire, sought updated documentation of Morris’s disability pursuant to the terms of the plan document. Broadspire asked Morris to complete a questionnaire and an “attending physician statement and evaluation of physical abilities” and to submit medical records as proof of continued disability. Morris eventually submitted those forms, which indicated that he was still limited by back and leg pain, as well as by panic attacks, depression, and irritability. The plan then requested that he complete a functional capacity evaluation (“FCE”), which resulted in a finding that Morris was “functioning in the Medium Physical Demand Category.” The FCE evaluator, Jessica lams, believed that Morris “appeared] rehabable if pain can be controlled,” and recommended “frequent change in position, allowances for self management of symptoms while working or exercising, and some type of work conditioning program” to facilitate a return to regular daily work.

The Plan also arranged for Morris to undergo an independent psychiatric examination by Dr. Don Mclntire, the results of which included a diagnosis of moderate Bipolar II Disorder and mild post-traumatic stress disorder. Morris tested within the average range for overall intellectual functioning, and did not exhibit any clinically significant behavioral impairments during the evaluation. Dr. Mcln-tire also administered an MMPI-2 personality inventory assessment, which revealed that Morris had significant difficulties with depression and anxiety and was likely to be uncomfortable being around other people.

Upon receiving the results of the FCE and Dr. Mclntire’s examination, Broad-spire forwarded them to its own reviewing physicians: Dr. Vaughn Cohan, a neurologist, and Dr. Barry Glassman, a psychiatrist. Dr. Cohan concluded that Morris’s medical file showed his neurological symptoms to be consistent with sedentary or light work, and that there was no indication that the medications Morris was taking would prevent him from working. Dr. Glassman agreed that Morris would be best placed in a low-stress, physically undemanding position, but also noted that there were no examination findings to indicate that such would be medically necessary.

The Plan then obtained an employment assessment report (“EAR”), which was prepared after a vocational consultant interviewed Morris and reviewed the results of the FCE and Dr. Mclntire’s psychiatric examination, as well as the reports of Drs. Cohan and Glassman. Taking into account the “sedentary or light work” limitations indicated by Dr. Cohan’s recommendation, the EAR identified two occupations that Morris could perform: Automatic Presser and Shirt Presser. Both of these jobs were indicated to be available in Columbus, Ohio, where Morris resided, and met the necessary salary and physical requirements. As a result of the EAR’s identification of jobs that Morris could perform, Broadspire determined that Morris did not meet the any-occupation standard and [981]*981would no longer be eligible for disability payments.

Morris appealed, using the Plan’s internal appeals process. Over the course of the two appeals permitted by the plan document, Morris submitted additional materials from his treating physicians and records from a recent hospital stay incurred after he experienced “seizure-like symptoms.” The Plan obtained reports from eight more reviewing physicians, each of which found no objective data to support a finding of disability under the any-occupation standard. The Plan denied Morris’s appeals, and this litigation followed.

II

A

We “review de novo the decision of a district court granting judgment in an ERISA disability action based on an administrative record.” Glenn v. MetLife, 461 F.3d 660, 665 (6th Cir.2006), aff'd, Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). If the plan administrator is vested with discretion to interpret the plan, we review the administrator’s denial of benefits to determine whether that denial was arbitrary and capricious. Ibid, (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). Though highly deferential, this standard nevertheless requires “some review of the quality and quantity of the medical evidence and the opinions on both sides of the issues” and does not require us merely to rubber-stamp the administrator’s decision. McDonald v. Western-Southern Life Ins. Co.,

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Bluebook (online)
399 F. App'x 978, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morris-v-american-electric-power-long-term-disability-plane-ca6-2010.