Duperry v. Life Insurance Co. of North America
632 F.3d 860
| 4th Cir. | 2011Background
- DuPerry worked as a payroll and benefits clerk for RFPC and participated in a LINA-administered LTD plan funded by an LINA policy.
- Elimination period for LTD was 180 days; disability during the regular-occupation period requires inability to perform material duties of the regular occupation and to earn 80%+ of Indexed Earnings.
- LINA denied benefits after initial claim review and later appeal reviews, relying on conflicting medical evidence and an independent reviewer’s conclusions.
- DuPerry submitted extensive medical records, treating-physician opinions, videos, and personal declarations showing disabling pain and fatigue.
- District court found LINA abused its discretion under ERISA and awarded benefits; court also considered the any-occupation period and declined to remand.
- LINA appealed, challenging the district court’s abuse-of-discretion ruling, the handling of any-occupation benefits, and later related fee awards.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether LINA abused discretion in denying LTD benefits | DuPerry argues LINA ignored treating physicians and objective evidence. | LINA asserts reasonable interpretation of plan and substantial evidence supported denial. | Yes, LINA abused discretion. |
| Whether the district court impermissibly imported SSA pain standard | DuPerry contends plan terms control; SSA rule not required. | LINA argues no principled basis to apply SSA rule beyond plan terms. | No strict SSA import; court found denial unreasonable under plan terms. |
| Whether remand for exhaustion was appropriate for any-occupation period | DuPerry contends remand futile given medical opinions. | LINA argues remand could be appropriate to develop any-occupation analysis. | Remand deemed futile; district court did not remand. |
| Whether DuPerry was entitled to benefits for the any-occupation period | Treating doctors indicated perpetual disability; earnings test not met. | Record insufficient on occupations and earnings; require remand. | Yes, benefits awarded for any-occupation period up to district court decision. |
| Whether attorneys’ fees were warranted under ERISA and the five-factor test | DuPerry seeks fee award for substantial benefit from reversal. | LINA argues no bad faith and factors do not favor fee shift. | Fees awarded; district court did not abuse discretion. |
Key Cases Cited
- Booth v. Wal‑Mart Stores, Inc. Associates Health & Welfare Plan, 201 F.3d 335 (4th Cir. 2000) (nonexclusive eight-factor reasonableness test for plan‑administrator decisions)
- Smith v. Continental Cas. Co., 369 F.3d 412 (4th Cir. 2004) (SSA pain standard not imported where plan terms govern)
- Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (2008) (conflict of interest is a factor in ERISA review, not controlling standard)
- Stup v. UNUM Life Ins. Co. of Am., 390 F.3d 301 (4th Cir. 2004) (eight-factor framework and deference to administrator under abuse‑of‑discretion)
- Oliver v. Coca Cola Co., 497 F.3d 1181 (11th Cir. 2007) (remand appropriate when exhaustion would be futile)