Rodney Waldoch v. Medtronic, Inc.

Procedural entryThis page is a short order in Rodney Waldoch v. Medtronic, Inc.. Read the opinion of the Court — 757 F.3d 822
Court of Appeals for the Eighth Circuit·Decided July 9, 2014·No. 13-2543·Published

Opinion

United States Court of Appeals For the Eighth Circuit

No. 13-2543

Rodney Waldoch

lllllllllllllllllllll Plaintiff - Appellant

v.

Medtronic, Inc.

lllllllllllllllllllll Defendant - Appellee

Appeal from United States District Court for the District of Minnesota - Minneapolis

Submitted: March 11, 2014 Filed: July 9, 2014 (Corrected: July 15, 2014)

Before COLLOTON, SHEPHERD, and KELLY, Circuit Judges.

SHEPHERD, Circuit Judge.

Rodney Waldoch sued his former employer Medtronic, Inc., alleging that Medtronic improperly denied his claim for benefits under a long-term disability plan (the Plan) governed by the Employee Retirement Income Security Act of 1974

(ERISA). The district court1 granted Medtronic’s motion for summary judgment. We affirm.

I. A.

Because this case arises from the grant of summary judgment, we recite the facts in the light most favorable to Waldoch. See Eisenrich v. Minneapolis Retail Meat Cutters & Food Handlers Pension Plan, 574 F.3d 644, 647 (8th Cir. 2009). Waldoch was a Senior Buyer-Planner for Medtronic from 2001 until his termination in 2008. Waldoch has Type I Diabetes Mellitus. In 2004, Waldoch’s endocrinologist wrote a letter to Medtronic advising that Waldoch’s diabetes control had become aggravated due to substantial stress at work. The doctor recommended that Waldoch’s workweek be reduced to 32 hours. At work, Waldoch struggled to balance his health needs with his position’s demands. He battled fatigue and mood swings and struggled with retinopathy, neuropathy, calf-tightening, hypertension, hyperlipidemia, and carpal-tunnel syndrome. In 2005, Waldoch was diagnosed with “hypoglycemia unawareness.” From 2006 to 2007, Waldoch’s work performance declined significantly, and he began for the first time to receive low marks on his performance evaluations. In 2007, another endocrinologist Dr. Montori, noted that Waldoch had less glucose variability and had been achieving “good results.” Nevertheless, Dr. Montori noted that recent layoffs at Medtronic had affected Waldoch’s stress levels and “his ability to cope with his disease.”

Waldoch’s work-related stress continued into 2008. Dr. Montori continued to opine that Waldoch’s job obligations contributed to his overall stress. Waldoch’s performance evaluations reflected his frustration and inability to interact with his co-

1 The Honorable Joan N. Ericksen, United States District Judge for the District of Minnesota.

workers. Despite Waldoch’s efforts to manage his health and improve his work performance, on November 24, 2008, he was terminated by Medtronic.

B.

Medtronic provided its employees a self-funded, self-administered long-term disability plan. The Plan was “designed to provide benefits for qualifying disabilities lasting longer than 26 weeks.” Benefits began when the employee “ha[s] been Totally Disabled for 26 weeks in a rolling 12-month period” and “ha[s] provided documentation satisfactory to Medtronic or its delegated claims administrator providing that [the employee is] Totally Disabled.” The Plan defined “Total Disability and Totally Disabled” as follows:

During the 26-week elimination period and during the first year that you are receiving Long Term Disability Benefits, you are considered to be Totally Disabled if you are under the care of a Physician and prevented from performing each of the essential functions of your regular occupation because of an illness or accidental injury and you are not working at all. The one year period begins on the first day as of which you have been approved to receive Long Term Disability Benefits.

To be considered Totally Disabled after this period of time, the illness or accidental injury must prevent you from working at any occupation for which you are, or could reasonably become, qualified by education, training or experience, and you are not working at all.

As the definitions of Total Disability and Totally Disabled indicate, the Plan broke up disability benefits into two categories: (1) “regular occupation” or as the parties refer to it “own occupation” LTD benefits and (2) “any occupation” LTD benefits.

In order to obtain LTD benefits under the Plan, a Medtronic employee was required to first submit an application to the Claims Administrator. The Claims Administrator would render a decision and notify the employee of the outcome. The

Plan provided that the Claims Administrator “may secure independent medical or other advice and require such other evidence as it deems necessary to decide [a] claim.” If a disability claim was denied, the employee retained the right to appeal the Claims Administrator’s decision. Throughout the process, the employee retained the responsibility to “provide medical evidence, satisfactory to Medtronic or its delegated claims administrator” of the employee’s Total Disability.

As to the issue of discretionary authority, the Plan stated:

The Plan Administrator has complete and total discretionary authority to interpret and administer the Plan. The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits, have the authority and responsibility to interpret the Plan, make rules, determine eligibility for benefits, determine coverage and benefit amounts, and resolve all claims and disputes regarding the Plan. The decisions of the Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits are final and binding on all persons. The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits may further delegate any and all authority under the Plan as they deem appropriate.

Medtronic entered into a Long Term Disability Benefit Administration Agreement (the Services Agreement) with Hartford-Comprehensive Employee Benefit Service Company (Hartford). In the Services Agreement, Hartford agreed to evaluate and calculate LTD benefits under the Plan. Moreover, the Services Agreement included an “Appeal Assistance” section under which Hartford agreed to assist Medtronic, “in a nonfiduciary capacity, with denied claims on appeal.” The section specifically provided that Hartford did “not make final claim determinations on appeal.” Instead, Hartford would merely provide Medtronic a recommendation. The Services Agreement emphasized that Hartford only acted as a provider of services to Medtronic’s Plan. Hartford did not “insure [Medtronic’s] Plan in any

way,” was “not a fiduciary,” and disclaimed any responsibilities to perform any of the functions required by ERISA.

To summarize Medtronic’s review procedures, Hartford collected and processed LTD benefit applications and made the initial, benefit-eligibility determination. If the plan participant was unhappy with Hartford’s decision, then the participant retained the right to appeal the decision to Medtronic. On appeal, Hartford considered the participant’s argument, conducted further investigation if required, and recommended action for Medtronic to ultimately take.2 Medtronic exercised final authority to determine the outcome of any contested benefit claims.

C.

Waldoch filed his claim for LTD benefits with Medtronic on July 27, 2009.

Waldoch attached to his application for LTD benefits Dr. Montori’s assessment of his condition. Dr. Montori opined that Waldoch had no physical restrictions, but that he could not engage in predictable ongoing activity, of any type, without disruption by variation in his blood sugar. In a supplemental report, Dr. Montori stated that Waldoch needed to “self-monitor frequently and be vigilant with his sugar levels.” Though the cause of the variations was “somewhat unclear,” Dr. Montori noted that blood sugar variability can lead to unexpected hypoglycemia, which in turn can alter concentration, mood, cognition, and judgment.

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Rodney Waldoch v. Medtronic, Inc., (8th Cir. 2014).

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