Tickle v. Long Term Disability Plan of Marathon Ashland Petroleum, LLC

34 F. App'x 909
CourtCourt of Appeals for the Fourth Circuit
DecidedMay 10, 2002
Docket01-2100
StatusUnpublished
Cited by2 cases

This text of 34 F. App'x 909 (Tickle v. Long Term Disability Plan of Marathon Ashland Petroleum, LLC) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tickle v. Long Term Disability Plan of Marathon Ashland Petroleum, LLC, 34 F. App'x 909 (4th Cir. 2002).

Opinion

OPINION

PER CURIAM.

Shelby Tickle filed suit in federal district court against the Long Term Disability Plan of Marathon Ashland Petroleum, LLC (“the Plan”), after the Plan Administrator denied Tickle’s application for benefits. See 29 U.S.C.A. § 1001 et seq. (West 1999 & Supp.2001) (“ERISA”). The court granted the Plan’s motion for summary judgment, finding that the Administrator did not abuse his discretion in denying Tickle’s claim. Tickle appeals, and we affirm.

I.

Shelby Tickle was employed as a buyer for a subsidiary company of Marathon Ashland Petroleum (“MAP”). Upon beginning employment with the company in 1979, Tickle elected to participate in a group long-term disability plan offered by the company. The Plan was sponsored and insured by MAP, but was fully funded by participating employees by way of payroll deductions. If the benefits ultimately paid to employees under the Plan exceeded contributions, MAP, as sponsor and insurer of the Plan, was responsible for making up the difference. The Plan Administrator — -the person with the ultimate authority to decide whether to grant benefits under the Plan — was Rodney Nichols, an employee of MAP.

The Plan operates as follows. When a claim is made, the application for benefits and the supporting materials are sent to Connecticut General Life Insurance Company (“CIGNA”), which notifies the applicant of the decision on the application. If an applicant is dissatisfied with the result, he or she may appeal to the Plan Administrator, at which time additional materials may be submitted in support of the claim. CIGNA then reviews the file again and makes a recommendation to the Administrator, who is free to decide the claim as he sees fit. It is undisputed that under the Plan’s terms the Administrator has broad discretion to interpret the Plan and make benefits eligibility determinations.

In October 1997, Tickle was involved in a car accident, but was able to return to work part-time afterward. The accident aggravated a pre-existing back condition, however, and in November 1998, Dr. Pa-nos Ignatiadis performed surgery on Tickle’s back. After undergoing surgery, Tickle claimed that, largely as a result of back pain and some psychiatric problems that she developed as a result of the pain, she was unable to return to work.

In March 1999, Tickle submitted to a functional capacity evaluation (“FCE”), and the results indicated that Tickle could perform sedentary work. Those results notwithstanding, Dr. Ignatiadis opined shortly after the FCE that Tickle was “to be disabled for at least a year.” J.A. 178. In May 1999, Tickle submitted to the Plan a claim for disability benefits. In order to *911 receive benefits for the period in question, Tickle was required to demonstrate that she was disabled from performing her own occupation, not that she was disabled from any occupation. Three medical personnel submitted forms in support of Tickle’s claim, indicating that in their opinions Tickle was unable to perform her previous position as a buyer. These three persons were Dr. Ignatiadis, Tickle’s attending physician, Dr. Debra Stultz, Tickle’s treating psychiatrist, and Hugh Murray, Tickle’s physical therapist. None indicated whether objective testing had been performed that would support their conclusions.

Having reviewed Tickle’s claim and the materials offered in support, CIGNA recommended that the claim be denied “as the medical information does not support her inability to perform her” own occupation. J.A. 113. In response to CIGNA’s recommendation, the Plan retained Dr. Joel Steinberg to conduct an independent review of the claim. He concluded that medical evidence did not support Tickle’s claim that she was not able to perform her duties as a buyer for MAP. Reviewing what little objective evidence was presented in support of Tickle’s claim, Dr. Stein-berg noted that even though the FCE indicated that Tickle failed to make consistent efforts during the examination, the results nevertheless showed that Tickle was capable of performing sedentary work, which would include the buyer position.

Similarly, with regard to Tickle’s psychiatric difficulties, Dr. Steinberg noted that the only test apparent from Dr. Stultz’s records was a Global Assessment of Function (“GAF”), which indicated a score of 60. According to the Diagnostic and Statistical Manual, fourth edition, a score of 51-60 indicates moderate symptoms, and a score of 61-70 indicates mild symptoms. A score of 60 thus meant that Tickle was “at the interface between moderate symptoms and mild symptoms. In either case, occupational activity is not precluded.” J.A. 96. Based on his review of the materials, Dr. Steinberg concluded that “Ms. Tickle appear[ed] to have the capacity to return to duty,” although he noted that she should “not work under conditions of high stress.” J.A. 96.

On August 30, 1999, CIGNA informed Tickle that her claim was denied. Tickle appealed the denial, and in support of her appeal, submitted additional materials from Drs. Ignatiadis and Stultz. The information from Dr. Ignatiadis reiterated his earlier opinion, stating that Tickle was still “apparently ... totally and permanently disabled” and would not be able to work. J.A. 76. The additional information from Dr. Stultz stated that Tickle was unable to work because of severe depression. None of the additional materials submitted indicated that any further objective testing had been performed, the results of which would support the doctors’ conclusions.

Pursuant to the Plan procedure for resolving an appeal, CIGNA again reviewed the claim and recommended that the Administrator deny benefits because Dr. Stultz’s report contained”[n]o formal testing results” and appeared to be based “only [on] Ms. Tickle’s self-reported complaints.” J.A. 67. Furthermore, “Dr. Ignatiadis’ report does not address the findings of the FCE or attempt to dispute the[ ] results.” J.A. 67. Dr. Ignatiadis provided no objective evidence to support his finding of disability, and like Dr. Stultz,”[h]e also appeared] to rely solely on [Tickle’s] complaints of back pain” rather than “attempting to support [Tickle’s] complaints with documentation to confirm a medical basis for the ongoing pain.” J.A. 67. CIGNA concluded that the additional materials did “not assist [CIGNA] in *912 understanding why' [Tickle] is unable to work as a Buyer in a sedentary capacity.” J.A. 67.

Meanwhile, Tickle had applied for disability benefits from the Social Security Administration (“SSA”). Although those too were initially denied, Tickle successfully appealed the denial and was awarded benefits. The letter memorializing Tickle’s award of social security benefits was sent to the Plan Administrator for consideration. Notwithstanding Tickle’s success in convincing the SSA that she was totally disabled, the Administrator accepted CIGNA’s recommendation and denied her appeal. That decision produced the proceedings in the district court that are the subject of the current appeal.

II.

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Bluebook (online)
34 F. App'x 909, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tickle-v-long-term-disability-plan-of-marathon-ashland-petroleum-llc-ca4-2002.