{"id":7502,"date":"2020-04-08T14:57:20","date_gmt":"2020-04-08T19:57:20","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7502"},"modified":"2024-01-30T17:07:42","modified_gmt":"2024-01-30T22:07:42","slug":"killen-v-reliance-standard-court-finds-there-was-no-abuse-of-discretion","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/killen-v-reliance-standard-court-finds-there-was-no-abuse-of-discretion\/","title":{"rendered":"Killen v. Reliance Standard – Court Finds There Was No Abuse of Discretion"},"content":{"rendered":"\n

Case Name:<\/strong> Killen v. Reliance Standard Life Insurance Company<\/p>\n\n\n\n

Court:<\/strong> United States Court of Appeals for the Fifth Circuit, Appeal from the United States District Court for the Northern District of Texas<\/p>\n\n\n\n

Type of Claim: <\/strong>Long-Term Disability<\/a><\/p>\n\n\n\n

Insurance Company:<\/strong> Reliance Standard Life Insurance Company (\u201cReliance Standard\u201d)<\/a><\/p>\n\n\n\n

Claimant\u2019s Employer:<\/strong>  Covenant Health Systems (\u201cCovenant\u201d)<\/p>\n\n\n\n

Disabilities:<\/strong>  Neck<\/a>, shoulder, and upper back pain<\/a>.<\/p>\n\n\n\n

Benefits Paid?<\/strong> Long-term disability benefits were initially approved and then cut off or terminated after two years when the definition of \u201ctotally disabled\u201d changed such that the claimant had to prove she was incapable of performing the material duties of any occupation for which she is qualified by way of education, training, or experience<\/p>\n\n\n\n

Issues: <\/strong>The central issue raised in this cause of action is whether Reliance Standard abused its discretion in denying the claimant\u2019s long-term disability benefits after two years.<\/p>\n\n\n\n

Holding: <\/strong>The Court affirmed the district court\u2019s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant\u2019s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.<\/p>\n\n\n\n

Summary: <\/strong>The Court held that there was substantial evidence to support Reliance Standard\u2019s decision to deny long-term disability benefits to the Plaintiff:<\/p>\n\n\n\n[The Plaintiff] Killen first challenges the district court\u2019s finding that substantial evidence supported the plan\u2019s denial of benefits. Substantial evidence is \u201cmore than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.\u201d Id.<\/em> (internal quotation marks and citation omitted). Killen claims that the Plan language requires Reliance Standard to show that she can perform all of the job duties of a sedentary vocation full-time before discontinuing benefits. While it might have shown she could perform sedentary work, she argues, Reliance Standard never showed she could do so full-time. Additionally, she claims the district court misconstrued the medical evidence and ignored objective documentation of her pain. \u201cMost disputed claims for disability insurance benefits are awash in a sea of medical evidence, often of contradictory nature,\u201d 10A Couch on Ins. \u00a7 147:33, and this case is no different. Indeed, counsel for Killen admitted as much at oral argument. Courts frequently hear cases like this, where the plaintiff\u2019s treating physicians generally support a finding of disability, and the defendant\u2019s vocational specialists and independent medical examiners disagree.<\/p>\n\n\n\n

In\u00a0Holland<\/em>, for example, a former paper machine specialist who had experienced a heart attack<\/a> sought long-term disability benefits. See\u00a0576 F.3d at 243. The Plan\u2019s language closely tracked the applicable language in this case.\u00a0See\u00a0id.\u00a0at 244. The employee\u2019s primary care physician equivocated but supported a finding of total disability, and a specialist\u2019s statements about his health were ambiguous: the specialist noted that the plaintiff had serious airway damage but was improving.\u00a0Id.\u00a0The administrator had a third and fourth doctor conduct a paper review of the medical records, and a fifth doctor conducted a physical examination; all three agreed that the employee was not totally disabled.\u00a0See id.<\/em>\u00a0at 244\u201345. The administrator never consulted a vocational expert.\u00a0Id.<\/em>\u00a0at 249. The internal claim for benefits was denied twice. This court held that there had been no abuse of discretion; the existence of contradictory evidence, the court noted, \u201cdoes not . . . make the administrator\u2019s decision arbitrary. Indeed, the job of weighing valid, conflicting professional medical opinions is not the job of the courts; that job has been given to the administrators of ERISA plans.\u201d\u00a0Id.<\/em>\u00a0at 250 (internal quotation marks and citation omitted);\u00a0accord Wade v. Hewlett-Packard Dev. Co.<\/em>, 493 F.3d 533, 540\u201341 (5th Cir. 2007), abrogated on other grounds by\u00a0Hardt v. Reliance Standard Life Ins. Co.<\/em>, 560 U.S. 242 (2010) (upholding a denial of benefits where the plaintiff\u2019s two treating physicians supported a disability finding but an examining neurophysiologist in a separate assessment found otherwise). [Footnote 2: \u201cThere is no obligation to weigh treating physicians\u2019 opinions any differently than those of other doctors or specialists. The Supreme Court recently clarified that \u201ccourts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant\u2019s physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician\u2019s evaluation.\u201d\u00a0Black & Decker Disability Plan v. Nord<\/em>, 538 U.S. 822, 834 (2003).]\n\n\n\n

When we find an abuse of discretion, the discrepancies between the facts and the administrator\u2019s findings are often stark. In\u00a0Lain v. UNUM Life Ins. Co. of Am<\/em>., a claimant had experienced serious chest pains and esophageal problems documented by multiple treating physicians.\u00a0See<\/em>\u00a0279 F.3d 337, 340\u201342 (5th Cir. 2002),\u00a0overruled on other grounds by Metro. Life Ins. Co. v. Glenn<\/em>, 554 U.S. 105, 115\u201319 (2008). Based on two internal reviews of the claimant\u2019s medical files\u2014one of which seemed actually to substantiate the individual\u2019s complaints\u2014and without an independent physical examination,[footnote omitted] the administrator denied benefits.\u00a0See id<\/em>. at 341\u201342. This court found an abuse of discretion, noting that there was a \u201ccomplete absence in the record of any \u2018concrete evidence\u2019 supporting [the administrator\u2019s] determination.\u201d\u00a0Id.<\/em>\u00a0at 347.<\/p>\n\n\n\n

In this case, substantial evidence supported Reliance Standard\u2019s decision to deny Killen long-term disability benefits. While there is evidence in the record to support Killen\u2019s claim for disability\u2014which the district court recognized\u2014there is also more than enough evidence supporting a denial to insulate the decision from reversal, particularly under our narrow review for abuse of discretion.<\/p>\n\n\n\n

Disclaimer:<\/strong> This case was not handled by disability attorney Nick A. Ortiz. The court case is summarized here to give readers a better understanding of how Federal Courts decide\u00a0long-term\u00a0disability ERISA claims.<\/p>\n\n\n\n

Here is a copy of the decision in PDF: Killen v. Reliance<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

The Court affirmed the district court\u2019s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant\u2019s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[259],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7502"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=7502"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7502\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7502"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7502"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7502"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}