Blair v. Alcatel-Lucent Long Term Disability Plan
688 F. App'x 568
| 10th Cir. | 2017Background
- Tracy Blair, an Alcatel‑Lucent employee, received short‑term disability in 2011 and applied for long‑term disability (LTD) under the employer-funded, CIGNA‑administered Plan; CIGNA initially denied benefits, then awarded LTD benefits retroactive to Nov. 2011, and later reduced them by SSA offsets.
- SSA awarded Blair disability benefits with a May 23, 2011 onset; CIGNA had referred and funded SSA representation.
- From 2012–2013 Blair treated with psychiatrist Dr. Charles Lester; treatment notes showed improvement by mid‑2013, though Lester later asserted she remained unable to work due to depression, panic attacks, cognitive problems, and medication effects.
- In Oct. 2013 CIGNA, relying on Lester’s treatment notes, a file review by its medical director (Dr. Volpe), and input from Blair’s PCP (Dr. Beebe), terminated LTD benefits as not supported by psychiatric functional impairment sufficient to preclude working.
- Blair appealed; an independent reviewer (Dr. Acenas) concluded while Blair met DSM criteria for major depression, she was not functionally impaired to a disabling degree; CIGNA denied the appeal. Blair sought district court review under 29 U.S.C. § 1132(a)(1)(B).
- The district court affirmed CIGNA’s decision as supported by substantial evidence and not arbitrary or capricious; the Tenth Circuit affirmed on similar grounds.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review | Blair: denial of her second, uncapped appeal means de novo review because CIGNA did not decide the second appeal | CIGNA: Plan grants discretionary authority; first appeal was timely decided so abuse‑of‑discretion applies | Abuse‑of‑discretion (arbitrary and capricious) review applies; ERISA does not require a second appeal |
| Consideration of extra‑record materials / judicial notice | Blair: DSM provisions and drug prescribing info are indisputable and should be judicially noticed or included | CIGNA: Review is confined to administrative record; Blair failed to include those materials in her in‑house appeal | Court refused judicial notice and limited review to the administrative record; exclusion was proper |
| Substantial evidence supporting termination | Blair: Lester’s letters and medication changes show ongoing, disabling impairment; CIGNA improperly relied on file reviewers | CIGNA: Treatment notes, file reviews (Volpe, Acenas), PCP input, and activities of daily living support termination | Substantial evidence in the record (treatment notes showing improvement, independent reviews, PCP input) supports CIGNA’s decision |
| Duty to develop the record / need for independent exam | Blair: mental‑illness claims require an in‑person exam; CIGNA should have obtained SSA records, new therapist notes, and more from Lester | CIGNA: Requested SSA file and had no obligation to obtain records claimant did not furnish; Plan permits but does not require an exam | No affirmative duty here; claimant failed to provide additional records and CIGNA’s file‑review practice was permissible |
| Judicial estoppel (inconsistency with SSA position) | Blair: CIGNA is estopped from denying disability because it procured SSA benefits and previously treated her as disabled | CIGNA: ERISA and SSA use different disability standards; CIGNA’s later decision relied on more recent records | Judicial estoppel does not apply; differing standards and new evidence distinguish positions |
Key Cases Cited
- Foster v. PPG Indus., Inc., 693 F.3d 1226 (10th Cir.) (deferential review when plan grants discretionary authority)
- Gilbertson v. Allied Signal, Inc., 328 F.3d 625 (10th Cir.) (deemed denial and de novo review where administrator fails to decide required appeal)
- Hancock v. Metro. Life Ins. Co., 590 F.3d 1141 (10th Cir.) (ERISA requires at least one internal appeal; failure to timely decide results in deemed denial)
- Graham v. Hartford Life & Acc. Ins. Co., 589 F.3d 1345 (10th Cir.) (standard for arbitrary and capricious review and substantial evidence)
- Hall v. UNUM Life Ins. Co. of Am., 300 F.3d 1197 (10th Cir.) (review confined to the administrative record under abuse‑of‑discretion review)
- Murphy v. Deloitte & Touche Grp. Ins. Plan, 619 F.3d 1151 (10th Cir.) (limitations on extra‑record materials; administrative‑record focus)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (Sup. Ct.) (no special deference owed to treating physicians under ERISA)
- Caldwell v. Life Ins. Co. of N. Am., 287 F.3d 1276 (10th Cir.) (substantiality of evidence judged on record as a whole)