Judy Killen v. Reliance Stnrd Life Ins Co.
776 F.3d 303
5th Cir.2015Background
- Judy Killen, an ultrasound technician, stopped working in March 2009 due to neck, shoulder, and upper-back pain and received long-term disability (LTD) benefits from Reliance Standard from June 2009 to June 2011.
- Covenant’s LTD Plan (ERISA-governed) requires, after two years, that a claimant be "totally disabled" such that she cannot perform the material duties of any occupation for which she is qualified; Reliance Standard had discretionary authority under the Plan.
- Reliance Standard first denied continued benefits after an internal vocational analysis identified several sedentary occupations Killen could perform; additional medical records were submitted and denied in an ensuing appeal.
- Killen submitted to an in-person independent exam by Dr. Mary Burgesser in February 2012; Dr. Burgesser concluded Killen could perform full-time sedentary work and Reliance Standard again denied benefits on that basis.
- Killen exhausted internal appeals, then sued under 29 U.S.C. § 1132(a)(1)(B). The district court granted summary judgment to Reliance Standard; the Fifth Circuit affirmed, finding no abuse of discretion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Substantial evidence for denial | Killen: Reliance never showed she could perform all duties of sedentary work full-time and ignored objective pain evidence | Reliance: Independent exam and vocational analysis showed ability to do full-time sedentary work; treating docs equivocal | Held: Reliance had substantial evidence (Dr. Burgesser + vocational report); denial not arbitrary |
| Full and fair review (procedural) | Killen: Initial denial lacked sufficient evidence; Reliance "sandbagged" by adducing strongest evidence on final appeal | Reliance: Denials consistently relied on ability to perform sedentary work; claimant had notice and opportunity to rebut | Held: Reliance substantially complied with ERISA; no bait-and-switch; claimant had adequate opportunity |
| Conflict of interest (administrator-payor) | Killen: Reliance’s dual role tainted decision, particularly for not deferring to SSA award | Reliance: Addressed SSA award and explained differing standards and missing Dr. Burgesser’s report | Held: Conflict exists but was not given special weight; Reliance addressed SSA award—no procedural unreasonableness |
| Late supplementation of record | Killen: Reliance wrongly refused a Dr. Crow letter submitted after file closure | Reliance: Submission came after appeals closed and shortly before suit—no fair opportunity to reconsider | Held: Refusal proper under Vega; letter would not change outcome; district court did not err |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (establishes standard of review for plan denials)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (treating physicians’ opinions not entitled to special weight in ERISA claims)
- Glenn v. Metropolitan Life Ins. Co., 554 U.S. 105 (conflict-of-interest factor when administrator is payor)
- Holland v. Int’l Paper Co. Ret. Plan, 576 F.3d 240 (upholding denial where independent reviewers contradict treating physicians)
- Wade v. Hewlett-Packard Dev. Co., 493 F.3d 533 (procedural requirements for full and fair review under § 1133)
- Schexnayder v. Hartford Life & Accident Ins. Co., 600 F.3d 465 (addressing failure to consider SSA award in administrator-payor context)
- Lain v. UNUM Life Ins. Co. of Am., 279 F.3d 337 (abuse of discretion where record lacked concrete evidence supporting denial)
- Vega v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287 (scope of administrative record and requirements for supplementing it)