Vicki Johnson v. United of Omaha Life Ins. Co.
775 F.3d 983
| 8th Cir. | 2014Background
- Vicki Johnson worked as a sedentary rent-roll specialist from home and was covered by a United of Omaha long-term disability (LTD) plan purchased by her employer. She resigned in Feb 2009 and claimed disability based on fibromyalgia, chronic pain, anxiety, and depression.
- Treating physician Dr. MacDonald completed LTD paperwork imposing substantial physical limits (e.g., no sitting/standing for any length of time; walk ≤1 hour/day). Treatment notes were sporadic; Johnson had prior neck surgery (2004) and a 1999 fibromyalgia diagnosis but little treatment from 2005–Feb 2009.
- United denied short-term and then long-term benefits after internal review and an external review by Dr. James Boscardin (orthopedic surgeon), who found Johnson’s complaints largely self-reported and unsupported by objective findings; Boscardin concluded records did not support limitations beyond sedentary work.
- United forwarded Boscardin’s report to Johnson’s surgeon, Dr. McClellan, who generally agreed. United denied LTD on the ground that the medical evidence did not show functional impairment preventing performance of her occupation.
- Johnson sued under ERISA seeking reversal; the district court granted her summary judgment (applying de novo or alternatively finding an abuse of discretion) and awarded attorney’s fees. The Eighth Circuit reversed, holding abuse-of-discretion review applied and United’s denial was supported by substantial evidence; attorney’s fees award vacated.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review: whether plan grants administrator discretionary authority | Johnson: SPD-only discretionary language cannot confer deferential review; alleged procedural irregularities warrant de novo review | United: Certificate of Insurance integrates SPD and grants United discretionary authority; no serious procedural irregularities | Abuse-of-discretion review applies; no serious procedural irregularities shown |
| Integration of SPD and policy documents | Johnson: SPD cannot override or add discretion absent plan language | United: Certificate states the Certificate (including SPD) is part of the Policy; discretionary clause in SPD binds | Court: reasonable participant would view SPD as integrated; discretion vested in United |
| Procedural irregularities excusing deferential review | Johnson: lost/misplaced records, delays, failure to resubmit evidence created lack of faith in process | United: alleged irregularities would not change outcome and do not show total lack of integrity | No serious procedural irregularity; de novo review not triggered |
| Denial of benefits on the merits under abuse-of-discretion | Johnson: treating physician’s opinion and her diagnoses (fibromyalgia, depression) support disability; United improperly relied on single reviewer | United: record lacks objective support for the severe limitations; independent and surgeon reviews support denial | Denial supported by substantial evidence (conflicting opinions reasonable); decision upheld under abuse-of-discretion |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (establishes ERISA standard: de novo review unless plan grants discretionary authority)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (treating-physician rule does not control ERISA benefit determinations)
- Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (addresses conflict of interest and discretion in plan review)
- Jobe v. Medical Life Insurance Co., 598 F.3d 478 (SPD-only discretionary language may not confer discretion when plan conflicts)
- Ringwald v. Prudential Ins. Co. of Am., 609 F.3d 946 (reiterates Jobe on SPD vs. plan language conflict)
- McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921 (substantial-evidence standard; no special deference to treating physician under ERISA)
- Maune v. Int’l Bhd. of Elec. Workers, 83 F.3d 959 (abuse-of-discretion/reasonableness standard for benefit denials)
- Wakkinen v. UNUM Life Ins. Co. of Am., 531 F.3d 575 (defines substantial evidence as more than scintilla)
- Dillard’s, Inc. v. Liberty Life Assurance Co. of Boston, 456 F.3d 901 (vacatur of attorney’s-fee awards when underlying judgment reversed)