Sheryl Harvey v. Standard Insurance Company

503 F. App'x 845
CourtCourt of Appeals for the Eleventh Circuit
DecidedJanuary 14, 2013
Docket12-11978
StatusUnpublished
Cited by13 cases

This text of 503 F. App'x 845 (Sheryl Harvey v. Standard Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sheryl Harvey v. Standard Insurance Company, 503 F. App'x 845 (11th Cir. 2013).

Opinion

PER CURIAM:

Sheryl Harvey appeals from an adverse summary judgment upholding as reasonable Standard Insurance Company’s (“Standard”) denial of Harvey’s claim for long-term disability (“LTD”) benefits under her employer’s group policy as governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.

Harvey applied for disability benefits on April 13, 2009, stating that pain was preventing her from doing her job as a bookkeeper, and submitted her physician’s statement indicating a diagnosis of lumbar disc degeneration and scoliosis, with symptoms of back and leg pain and a recommendation that she return in six weeks for follow-up. Harvey’s physician did not provide information concerning Harvey’s level of functional impairment or what amount of work activity she could handle. Standard approved Harvey’s claim for short-term disability benefits for a period of thirty days and requested that she provide additional information.

Before approving Harvey to transition from short-term to LTD benefits, Standard had Harvey’s medical records reviewed by an Independent Physician Consultant Board-Certified in Physiatry and by a Vocational Consultant. Based on the recommendation of these two consultants, who both indicated that Harvey could perform sedentary work activities, and its own review of the medical records, Standard determined that Harvey was not eligible for LTD benefits. Harvey appealed and was interviewed by Standard’s benefits review specialist, who requested additional medical records from Harvey’s treating physician and from a pain management clinic. Standard had another Independent Physician Consultant, specializing in Phy-siatry, review all of Harvey’s medical records, including the latest ones from her physician and pain management clinic. He also concluded that Harvey could perform sedentary level work activities. Standard’s administrative review unit upheld the denial of Harvey’s LTD benefits and notified her of its decision on March 15, 2010.

Thereafter, Harvey, now through an attorney, requested the opportunity for another administrative review of Standard’s denial of her claim and notified Standard that Harvey had a pending claim for Social Security disability benefits. Standard notified Harvey’s attorney that it had already completed Harvey’s one administrative review as required by the LTD benefits policy but that it would agree to perform a

*848 voluntary “extra-contractual” review, which would not be subject to any regulatory timeframe. Harvey submitted additional information to Standard, including Harvey’s affidavit, medical records, a vocational report and a copy of the Social Security Administration’s award of disability benefits to Harvey. Standard sought further review from a third Independent Physician Consultant and a second Vocational Consultant. However, before Standard issued its decision on the voluntary “extra-contractual” review, Harvey filed this lawsuit.

We review de novo the district court’s decision affirming the ERISA plan administrator’s decision regarding benefit eligibility, applying the same standards as the district court. Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1354 (11th Cir. 2011). Although ERISA does not provide a standard by which to evaluate a plan administrator’s benefits determination, we have established a sixstep process 1 based on guidance from the Supreme Court in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989) and Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). See also Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352 (11th Cir.2008).

Harvey first argues that we should review her claim de novo and not apply the six-step deferential analysis because Standard’s failure to provide a decision on her voluntary “extra-contractual” appeal should be deemed a denial of her claim without having been provided a full and fair review that comports with ERISA requirements. She argues that some courts have suggested that “deemed denied” claims are subject to de novo review and do not require courts to give deference to the plan administrator. We find no merit to this argument because she received not only a timely decision on her initial claim (it was denied) but also a full administrative appellate review of her claim in accordance with the terms of her LTD benefits policy (which upheld the denial of her claim). At that point, Harvey was free to file suit in federal court having exhausted her administrative remedies under her LTD benefits policy, yet she requested Standard to conduct an additional administrative review of her claim, which Standard was not contractually bound, but voluntarily agreed, to do. Harvey was not denied a full and fair administrative review of her claim as her LTD benefits policy only required one administrative appeal for purposes of exhaustion and the regulations governing voluntary appeals do not provide any time frame for deeision-mak-

*849 ing. Thus, that Harvey chose not to wait for a decision on her voluntary appeal but instead filed this suit does not mean that she was denied a full and fair administrative review and final decision on her claim.

Next, we find no merit in Harvey’s argument that, the district court erred in its conclusion that Standard’s structural conflict of interest did not render its denial of her claim unreasonable and that Standard disregarded several pieces of evidence that show that she is disabled and that the district court erred as well in failing to consider that evidence. She points out that she submitted her favorable Social Security Administration determination of disability, a vocational expert’s, Dr. William Crunk’s, report confirming Harvey’s disability, the medical records of Dr. Michael Kendricks, a pain management specialist, and her own affidavit, which all support her claim of disability. However, the district court correctly determined that Standard did not unreasonably disregard these documents as they were not submitted to Standard until after it had rendered a final decision on her administrative appeal on March 15, 2010. Instead, Harvey submitted these documents as part of her subsequent voluntary review, on which she chose not to wait for Standard’s decision, but instead filed this suit on her original claim, which she had a right to do. See Blankenship, 644 F.3d at 1354. (“Review of the plan administrator’s denial of benefits is limited to consideration of the material available to the administrator at the time it made its decision.”). Therefore only the record before Standard during its consideration of Harvey’s initial claim or administrative review thereon is relevant.

Harvey also argues that Standard’s decision was unreasonable because Standard accepted the opinions of its alleged biased record reviewers over the opinion of Harvey’s treating physician.

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Bluebook (online)
503 F. App'x 845, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sheryl-harvey-v-standard-insurance-company-ca11-2013.