William C. Davis, Cross-Appellee v. Unum Life Insurance Company of America, and Regal-Beloit Corporation Long Term Disability Plan

444 F.3d 569
CourtCourt of Appeals for the Seventh Circuit
DecidedApril 24, 2006
Docket05-2001, 05-2165
StatusPublished
Cited by109 cases

This text of 444 F.3d 569 (William C. Davis, Cross-Appellee v. Unum Life Insurance Company of America, and Regal-Beloit Corporation Long Term Disability Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
William C. Davis, Cross-Appellee v. Unum Life Insurance Company of America, and Regal-Beloit Corporation Long Term Disability Plan, 444 F.3d 569 (7th Cir. 2006).

Opinion

MANION, Circuit Judge.

While working at Regal-Beloit Corporation, William Davis participated in the company’s long-term disability plan, which is administered by Unum Life Insurance Company of America. After Regal-Beloit fired Davis, he sought benefits under the plan. Unum awarded Davis benefits for a mental disability but denied benefits for a physical disability. Davis sued. The district court denied summary judgment to Unum and the plan and partially granted summary judgment to Davis, remanding the matter for further administrative proceedings. Dissatisfied with his partial victory, Davis appealed. Unum and the plan then cross-appealed. Concluding that the district court misapplied the governing arbitrary-and-capricious standard, we reverse and remand, with instructions for the district court to enter judgment in favor of Unum and the plan.

I.

Regal-Beloit Corporation, an industrial machinery manufacturer, hired William Davis as a regional sales manager in February 1999. In January 2000, Regal-Beloit terminated him due to poor job performance. He was fifty-five at the time. During his brief term, Davis participated in the Regal-Beloit Corporation Long Term Disability Plan (“the plan”). The plan’s administrator is Unum Life Insurance Company of America.

Under this plan, the maximum period for which a claimant can receive disability benefits varies based upon a number of factors, including whether the disability is physical or mental in nature. Generally, for physical disabilities arising before age sixty, benefit payments continue until the *572 claimant turns sixty-five. To reach that maximum, the claimant must meet the plan’s definition of “disabled” throughout the period. During the first twenty-four months of benefit payments, the term disabled means that a sickness or injury limits the claimant’s performance of his “regular occupation.” After twenty-four months of payments, however, the standard becomes more difficult for the claimant to meet. The plan then defines disabled as being “unable to perform the duties of any gainful occupation for which [the claimant is] reasonably fitted by education, training or experience.” Further, separate from these provisions, there is a different time limitation for “disabilities due to mental illness.” These benefits are capped at twenty-four months.

After Davis’s termination, he searched for new positions and landed several interviews. Nevertheless, in July 2000, some six months after leaving Regal-Beloit, Davis remained unemployed and submitted a disability claim under the plan. On the initial form, Davis claimed to be disabled due to severe depression, memory loss, joint pain, and a stroke. He further stated that his condition prevented him from driving, lifting, and walking.

In a follow-up telephone interview, nonetheless, Davis stated that he was not restricted or limited as the result of any physical ailment; rather, he said the only reason that he was unable to work was his mental condition. According to Davis, he could not work because of depression, mood swings, forgetfulness, an inability to concentrate, and an inability to perform multiple tasks at the same time. Davis said he was homebound, adding that he did not drive at all, not even to the local market. Surveillance evidence obtained less than a month after this interview, however, showed Davis driving vehicles, refueling a vehicle, and engaging in routine outdoor chores.

Davis’s doctors backed up his claims of a disabling mental illness. According to Davis’s attending physician and internist, Alan Reich, M.D., the primary diagnosis was major depression. On the initial form submitted with Davis’s claim, Dr. Reich listed the symptoms as indecisiveness, forgetfulness, and difficulty concentrating. Dr. Reich also noted that Davis had no cardiac limitations but had some back and hip pain. This summary from Dr. Reich came after several other doctors had examined Davis in 2000. These doctors largely gave Davis a clean bill of physical health, but some noted psychiatric problems. For instance, Davis’s urologist, Gordon Gluckman, M.D., found no recurrence of Davis’s 1992 bout with prostate cancer and said Davis was “doing well.” Further, Davis’s neurologist, Barry Levy, M.D., in conjunction with a psychologist, Joshua Barras, Ph.D., found that depression was the source of Davis’s problems and recommended psychiatric treatment. It is worth noting that, according to Dr. Levy, Davis was “very unhappy” with Drs. Levy’s and Barras’s opinions. Further, while Davis’s disability claim was pending, Davis believed that he had a stroke, but Drs. Reich and Levy had reasons to question that belief. Particularly, Dr. Levy, in discussing the “suspected stroke,” stated that “nonphysiologic features are present and suggest a psychogenic component.” In other words, Davis’s problem was not physical but mental.

For its part, Unum responded to the claim by consulting Robert Buchanan, M.D., a psychiatrist who worked at Unum — i.e., an “in-house doctor.” The importance of this phrase will become apparent below. After reviewing Davis’s medical file, Dr. Buchanan generally concurred with the findings of Davis’s doctors, stat *573 ing that Davis had “significant impairment from depression.” In December 2000, Unum then approved Davis’s disability-claim pursuant to the plan’s mental disability coverage. Unum paid Davis benefits retroactive to July 2000 and continued to pay him benefits until Davis reached the plan’s twenty-four month limitation for mental disability benefits in July 2002.

Meanwhile, Davis began seeing a new primary doctor in February 2001, Michael Raymond, M.D. Dr. Raymond, an internist, immediately keyed in on Davis’s physical complaints, including problems walking and standing. Dr. Raymond also referred Davis to a new neurologist, Steven Meyers, M.D. Dr. Meyers found that Davis “cannot stand or walk for any distance” and concluded that Davis was “permanently disabled” due to lumbar spinal stenosis (a narrowing of the spinal canal in the lower back) and the aftereffects of childhood polio. However, according to Dr. Meyers, diagnostic testing revealed that Davis did not actually have a condition known as post-polio syndrome (progressive muscle weakness, muscle and joint pain, fatigue, etc.).

In May 2001, Davis then supplemented his existing file at Unum with the opinions of Drs. Raymond and Meyers. Davis thus began a sustained effort to obtain the more generous (i.e., longer lasting) physical disability benefits under the plan. Unum then had an orthopedic surgeon, Joseph Thomas, M.D., and an internist, Steven Feagin, M.D., review Davis’s updated file. Both worked in-house at Unum. Based upon their assessments of the medical evidence, Unum notified Davis in December 2001 that his eligibility remained unchanged and that his benefits were still due to expire in July 2002.

Davis then retained counsel and submitted more information from Dr. Raymond related to spinal stenosis and other physical ailments. Despite Dr. Meyers ruling out post-polio syndrome, Dr. Raymond’s papers still listed post-polio syndrome as a reason to support Davis’s disability claim. Dr. Raymond further concluded Davis should be restricted from walking, lifting, bending, carrying, and climbing. It is noteworthy, however, that in this submission, Dr. Raymond stated that Davis had no functional limitations as the result of a cardiac condition.

On Unum’s behalf, Dr.

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444 F.3d 569, Counsel Stack Legal Research, https://law.counselstack.com/opinion/william-c-davis-cross-appellee-v-unum-life-insurance-company-of-america-ca7-2006.