Niles v. American Airlines, Inc.

269 F. App'x 827
CourtCourt of Appeals for the Tenth Circuit
DecidedMarch 17, 2008
Docket07-3032
StatusUnpublished
Cited by33 cases

This text of 269 F. App'x 827 (Niles v. American Airlines, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Niles v. American Airlines, Inc., 269 F. App'x 827 (10th Cir. 2008).

Opinion

ORDER AND JUDGMENT *

MICHAEL R. MURPHY, Circuit Judge.

Theresa F. Niles appeals the district court’s grant of summary judgment in favor of the defendants on her claim for *829 disability benefits brought pursuant to the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001-1461 (ERISA). Ms. Niles argues that summary judgment should be reversed because the district court (1) failed to apply the appropriate de novo standard of review to the defendants’ action in denying her disability benefits; (2) improperly relied on a surveillance video and portions of her deposition that were not part of the administrative record; and (8) improperly excluded documents she submitted to supplement the administrative record. We affirm in part, vacate in part, and remand.

BACKGROUND

Ms. Niles worked as a Mechanics Supervisor and Technical Quality Assurance Auditor for Trans World Airlines (TWA) from 1977 until November 1996. Her work for TWA ended after a motor vehicle accident in which she sustained neck injuries. Effective May 1997, she began receiving long-term disability benefits pursuant to TWA’s Group Benefits Plan.

In 2001, defendant American Airlines, Inc. (American) purchased certain TWA assets and created the TWA Airlines LLC Universal Welfare Benefit Plan (Plan). American sponsored and administered the self-insured Plan. As a former employee of TWA, Ms. Niles remained insured and received ongoing disability benefits under the Plan. The Plan provides disability benefits to an insured who becomes “[tjotally [disabled from any occupation while covered because of an accident, [sjickness or pregnancy.” Aplee SuppApp. at 70. An employee is considered totally disabled “during any period when, as a result of [i]njury, [s]ickness or pregnancy, the Employee is completely unable to perform the duties of his occupation and is not performing any other work or engaging in any other occupation or employment for wage or profit.” ApltApp., Vol. Ill, at 881.

In March 2002, Metropolitan Life Insurance Company (MetLife) began serving as the Plan’s third-party administrator. Met-Life decided to conduct a review of Ms. Niles’ continuing eligibility for disability benefits. As a part of the review, it required her to undergo a Functional Capacity Evaluation (FCE) to evaluate her physical ability to work.

The Functional Capacity Evaluation

MetLife hired a third-party evaluator, Isernhagen Work Systems (Isernhagen) to administer the FCE tests to Ms. Niles. Dan Van Buskirk, an occupational therapist, tested her on behalf of Isernhagen over a two-day period in October 2002. Mr. Van Buskirk concluded that she gave “maximal effort” on all of the test items. Id. at 990. He further noted that “[t]hroughout the lifting and carrying portions of the evaluation, [Ms. Niles] requested to momentarily sit down or lean against the shelves secondary to dizziness, nausea, and/or throbbing headache.” Id. Objective signs coincided with these expressions of subjective discomfort, but she was able to work through the discomfort and tolerated the activities safely despite her pain.

Mr. Van Buskirk’s report concluded that Ms. Niles was able to work at the “light” level, as defined by the United States Department of Labor. Id. at 991. With certain restrictions, she could also perform “medium” work. Id. at 995. She would, however, only occasionally be able to tolerate trunk flexion, the range of motion in her neck was limited, and “[w]ith increased physical exertion she complains of neck pain, headache, dizziness, and nausea.” Id.

With the FCE in hand, MetLife conducted a “Transferable Skills Analysis” in which it identified 95 occupations in the *830 “sedentary” or “light” categories that were “good” or “closest” to Ms. Niles’ skills and experience and that paid at least $11.63 per hour. Id. at 996. It then selected eighteen of these positions from the list and hired a third-party consultant, CorVel Corporation, to conduct a labor market survey. CorVel selected three of these jobs, “Quality Control Technician,” “Transportation Maintenance Supervisor,” and “Inspector, General,” interviewed local employers, and reported to MetLife concerning their availability.

The Surveillance Report and Video

MetLife also hired a private investigator to conduct surveillance of Ms. Niles. The investigator prepared a report and submitted a surveillance video to MetLife.

The report indicates that on September 6, 2002, the investigator conducted surveillance at Ms. Niles’ residence in Ottawa Kansas and observed a person described as a “50-year-old female, 5'8" tall, approximately 165 lbs., with shoulder length, brown hair” departing and returning to her residence. Id. at 978. The next day, the investigator observed this person washing her gray Buick LeSabre at a local caiwash. The investigator shot about twenty minutes of video that shows “Claimant exiting her vehicle, opening the hood and trunk of the vehicle, crouching down to wash the vehicle’s tires, and bending at times to wash under the vehicle.” Id. at 979. He noted that her movements were “fluid and without hesitation,” that she showed “no signs of pain or discomfort,” and wore “no visible medical aids or devices.” Id.

MetLife’s Initial and Second Review Denials

By letter dated December 31, 2002, Met-Life notified Ms. Niles that her benefits had been terminated because she no longer met the definition of total disability under the Plan. According to the letter, MetLife reached this determination based on the surveillance report and video and the results of the FCE.

On January 14, 2003, Ms. Niles requested a second review from MetLife of its disability determination. She contended that MetLife’s decision was “flawed, misleading or untrue” for the following reasons: (1) certain personal details about her provided by the investigator were incorrect, and she was not in Ottawa Kansas on September 6-8, 2002, as the investigator indicated; (2) Mr. Van Buskirk was instructed not to complete the evaluation portion of the FCE tests and his information sheet only listed partial information about her disabilities; and (3) MetLife’s decision was inconsistent with the Social Security Administration’s determination that she was unable to perform competitive employment at any exertional level and with the recent decision of her life insurance carrier to waive her annual premium based on her ongoing disability. Id. at 1013-14.

After considering the information provided by Ms. Niles, MetLife upheld the termination of her benefits. It rejected reliance on determinations made by the Social Security Administration (SSA) and Ms. Niles’s life insurance carrier. Without addressing Ms. Niles’s specific objections to the FCE and the surveillance, MetLife also noted that its decision was based primarily upon the results of the FCE and the labor market survey, stating that “[t]he surveillance done was a supplemental tool.” Id. at 1022.

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