Green v. Union Security Insurance
646 F.3d 1042
| 8th Cir. | 2011Background
- Green, insured under Union's LTD plan, sought benefits under the ERISA policy with own-occupation and any-occupation definitions.
- Union denied LTD benefits in 2003 for not meeting any-occupation disability; Green appealed administratively through 2006.
- HealthSouth two-day FCE (Feb 2002) indicated sedentary capacity; other medical opinions varied.
- Union conducted surveillance (Sept 2004) and an IME (Jan 2005) finding sedentary capacity; Green disputed.
- Labor market studies (TSA/LMS) and vocational assessments suggested several sedentary jobs, including customer service.
- District court awarded Green past-due benefits in 2010; on appeal, court reversed, holding Union did not abuse discretion; remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the district court erred in applying abuse-of-discretion review. | Green | Union | No; court reviews de novo with abuse-of-discretion standard under ERISA. |
| Whether HealthSouth FCE constitutes substantial evidence supporting denial. | HealthSouth favorable to Green's claim should carry weight | FCE is substantial evidentiary support for sedentary capacity | Yes; HealthSouth FCE is substantial evidence supporting denial. |
| Whether video surveillance properly supported the denial. | Surveillance showed activity not consistent with disability | Video evidence is valid objective evidence | Yes; surveillance corroborates denial. |
| Whether LMS/TSA and vocational evidence justified denial. | Study revisions undermine reliability | Revisions still support vocational capacity conclusions | Yes; LMS/TSA evidence supported denial. |
| Whether Union's structural conflict of interest affected the decision. | Conflict should bias results in Green's favor | Conflict weight negligible under Glenn framework | No; conflict-weight at vanishing point; not enough to show abuse. |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (establishes abuse-of-discretion standard for ERISA determinations)
- Midgett v. Washington Group Int'l Long Term Disability Plan, 561 F.3d 887 (8th Cir. 2009) (deferential review for discretionary plan decisions)
- Jackson v. Metro. Life Ins. Co., 303 F.3d 884 (8th Cir. 2002) (standard for evaluating substantial evidence in ERISA claims)
- Groves v. Metro. Life Ins. Co., 438 F.3d 872 (8th Cir. 2006) (substantial evidence suffices if reasonable person could uphold decision)
- Ferrari v. Teachers Ins. & Annuity Ass'n, 278 F.3d 801 (8th Cir. 2002) (labor-market and vocational-evidence can support denial)
- Morgan v. UNUM Life Ins. Co. of Am., 346 F.3d 1173 (1st Cir. 2003) (recognizes surveillance evidence context and reliability considerations)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) (ERISA administrator not required to give special deference to treating physicians)
- Coker v. Metro. Life Ins. Co., 281 F.3d 793 (8th Cir. 2002) (fibromyalgia and disability determinations under ERISA)