Spencer Norris, Personal Representative of the Estate of Sue Pollock v. Citibank, N.A. Disability Plan (501), Aetna Life Insurance Company

308 F.3d 880, 29 Employee Benefits Cas. (BNA) 1666, 2002 U.S. App. LEXIS 21996, 2002 WL 31355247
CourtCourt of Appeals for the Eighth Circuit
DecidedOctober 21, 2002
Docket01-2886
StatusPublished
Cited by50 cases

This text of 308 F.3d 880 (Spencer Norris, Personal Representative of the Estate of Sue Pollock v. Citibank, N.A. Disability Plan (501), Aetna Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Spencer Norris, Personal Representative of the Estate of Sue Pollock v. Citibank, N.A. Disability Plan (501), Aetna Life Insurance Company, 308 F.3d 880, 29 Employee Benefits Cas. (BNA) 1666, 2002 U.S. App. LEXIS 21996, 2002 WL 31355247 (8th Cir. 2002).

Opinion

WOLLMAN, Circuit Judge.

This appeal arises out of Sue Pollock’s claim for disability benefits. The district court 2 entered judgment against the defendant Citibank, N.A. Disability Plan (501) (the Plan) on a stipulated record. We affirm.

I.

Citibank, N.A. (Citibank), adopted the Plan for the benefit of its employees. Pollock was an account collector for Citibank Credit Services and a participant in the Plan. Aetna Life Insurance Company (Aet-na) acted as the plan administrator.

The Plan includes two definitions of disability. During the first twenty-four months of an alleged disability, the employee will be deemed disabled if she cannot perform the job she previously held (the “own occupation” standard). After twenty-four months, however, the employee will be deemed disabled only if she cannot perform any job for which she is reasonably qualified (the “any occupation” standard).

In the spring of 1994, Pollock experienced severe back pain as the result of a herniated disc. Following two unsuccessful surgeries to reduce her pain, Pollock’s doctor diagnosed her with severe back pain with radiculopathy, a disorder of the spinal nerves. Despite her attempts to continue working on a light duty schedule, Pollock’s pain forced her to take disability. She was first placed on disability on April 29,1994.

Over the next two years, Pollock’s pain prevented her from working on a full-time basis, although she did, at one point, attempt to work a reduced schedule. During this two-year period, she received several different prescriptions for Vicodin, a painkiller, and her doctor continued to believe she was disabled. Pollock also developed left side pain and pain in her leg that included radiation into her foot. An orthopedic surgeon advised Pollock that she was not an appropriate candidate for surgery because of the degree of her spinal steno-sis. In October 1994, Pollock’s doctor indicated that as a result of inoperable spinal stenosis, Pollock had “no potential to ever return to work.” In March 1995, Aetna noted that Pollock had left side pain with bilateral neuropathy, inoperable spinal stenosis, degenerative joint disease, reduced sitting tolerance, and sleeping difficulties. Aetna also noted that Pollock had been approved for Social Security Disability Benefits. In August 1995, Pollock’s doctor advised Aetna that Pollock had failed a job modification work station test because her sitting tolerance was less than 45 minutes. On April 10, 1996, Pollock’s doctor again prescribed Vicodin.

During the two years after Pollock was placed on disability, Aetna continued to review her status, at all times concluding that she was eligible for disability benefits under the “own occupation” standard. In February 1996, Aetna’s rehabilitation unit reviewed Pollock’s file in preparation for the change from the “own occupation” standard to the “any occupation” standard. It concluded that Pollock was “unable to tolerate even part time sedentary work, so she [was] not reasonably employable ... *883 [and] it doesn’t appear that rehab can assist in any way in making her more employable.” On March 15, 1996, Aetna’s case manager noted that Pollock had been unsuccessful with multiple attempts at working partial hours, that she was incapable of sitting more than one-half hour, that she was positive for spinal stenosis, that she was obese, and that she had multiple problems.

On May 23, 1996, Aetna’s medical director spoke with Pollock’s doctor. Based on this conversation, the medical director noted that Pollock might not be permanently disabled, that she was on no pain medication, and that her pain “may not be that severe.” During this conversation, Pollock’s doctor also suggested that Pollock might be afraid to return to work. On June 27, 1996, Aetna conducted a rehabilitation review of Pollock’s circumstances. The review reported that although “[Pollock’s] treating [doctor] said she would be unable to tolerate even [part-time] sedentary employment” this doctor had also indicated that “[Pollock] could attempt a trial employment lifting max of 15 lbs with frequent changes of position.”

Aetna sent Pollock a letter on June 28, 1996, noting that her time away from work began on April 28, 1994, and informing her that she was expected to be able to return to work on or before April 28, 1996. By letter dated June 28, 1996, Citibank advised Pollock that “[d]ue to the lack of sufficient clinical information ... your period of disability could not be recertified.” Citibank also advised Pollock that she could submit a written request for reconsideration within 60 days. On July 9, 1996, Citibank notified Pollock that because she had not returned to work, she was terminated, effective April 28, 1996. On July 10, 1996, Pollock sent Aetna a handwritten letter labeled “Appeal.”

Earlier, on July 3, 1996, Aetna performed a functional capacity evaluation of Pollock. The tester reported that Pollock “did not do well” in the evaluation and that she seemed to be “self-limiting.” On July 30, 1996, Aetna’s medical director concluded that the functional capacity evaluation “showed symptom magnification and hence is not really valid” and that he doubted “that her pain is consistently that severe.” A rehabilitation specialist then evaluated Pollock’s vocational potential and concluded that there were several jobs Pollock could perform. All of these jobs were sedentary and directly related to the work she had previously performed for Citibank. After reviewing this evaluation, Aetna notified Pollock on August 29, 1996, that because it had concluded that she was capable of obtaining gainful employment, it was terminating her disability certification as of April 28, 1996. Pollock did not seek a review of this determination.

II.

“ERISA provides a plan beneficiary with the right to judicial review of a benefits determination.” Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir.1998) (citing 29 U.S.C. § 1132(a)(1)(B)). Because it is undisputed that the Plan gives the administrator discretionary authority to determine eligibility for benefits, we review the administrator’s decision for abuse of discretion. See id. “This deferential standard reflects our general hesitancy to interfere with the administration of a benefits plan.” Layes v. Mead Corp., 132 F.3d 1246, 1250 (8th Cir.1998) (citations omitted). Under the abuse of discretion standard, “the proper inquiry is whether the plan administrator’s decision was reasonable.” Fletcher-Merrit v. NorAm Energy Corp., 250 F.3d 1174, 1179 (8th Cir.2001) (internal quotations omitted). A plan administrator’s fact-based disability decision is reasonable if it is *884 supported by “substantial evidence.” Id. “Substantial evidence is more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.

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Bluebook (online)
308 F.3d 880, 29 Employee Benefits Cas. (BNA) 1666, 2002 U.S. App. LEXIS 21996, 2002 WL 31355247, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spencer-norris-personal-representative-of-the-estate-of-sue-pollock-v-ca8-2002.