*1 trate future sex-crimes are insufficient to
justify of an imposition otherwise unre- special
lated software-installation condi-
tion.
III. reasons, foregoing
For the special requiring
condition software installation is
VACATED; this matter is REMANDED entry judgment. of the corrected GEORGE, Plaintiff-Appellant,
Robert
RELIANCE LIFE STANDARD COMPANY,
INSURANCE
Defendant-Appellee.
No. 14-50368.
United States of Appeals, Court
Fifth Circuit.
Jan. *2 Roach, Bemis, Reed, prevented Lonnie Roach him safely wearing his Austin, TX, Plaintiff-Appellant. prosthetic result, limb. As a he was no longer operate able to the foot controls of Bachrach, Wilson, Elser, Esq., Joshua a helicopter, and he was forced to retire Moskowitz, Dicker, L.L.P., Edelman & from flying. time, At that earning PA, Philadelphia, Claire Par- Winniford $75,495 per year. George filed a claim for *3 sons, Wilson, Elser, Moskowitz, Edelman long-term disability benefits with RSL. Dicker, L.L.P., Houston, TX, for Defen- dant-Appellee. Policy The contains two definitions of
“Totally Disabled” and “Total Disability,”
which apply during
periods.2
different time
During “the first 24 months for which a
KING, DENNIS,
Before
and
Monthly Benefit is payable,” these terms
CLEMENT,
Judges.
Circuit
mean that the
insured “cannot
material duties of
Regular Occupa-
his/her
CLEMENT,
EDITH BROWN
Circuit
tion.”
months,
After the
first
these
Judge.
terms mean that the insured “cannot per-
George
Robert
Appellant
(“George”) ap-
form the material duties of any occupation
peals from the district
judg-
court’s final
provides
which
substantially the same
affirming
ment
the decision of
earning capacity.”
Policy
also con-
plan
ERISA1
in
administrator
relevant
(the
tains a relevant
provision
limitation
part.
below,
For the
explained
reasons
Clause”).
“Exclusion
The Exclusion
REVERSE and RENDER judgment for
provides
Clause
“Monthly
Benefits for
George. We REMAND the case to the
Total
by
caused
or contributed
district court to determine the amount of
by
to mental or nervous disorders will not
George.
benefits to award to
payable beyond
be
an aggregate lifetime
(24)
maximum duration of twenty-four
Proceedings
Facts
Policy
months.” The
defines “Mental or
George served as a helicopter pilot in Nervous Disorders” to include “anxiety
Army.
the United States
In
George
disorders” and “mental illness.”3
injured
crash,
in helicopter
was
and doc-
RSL denied
long-
claim for
tors were
amputate
forced to
one of his
disability
term
legs at
benefits
a series of let-
George
the knee.
retired from
findings
conclusions,
ters. RSL’s
military
service
1987.
retiring,
After
George’s objections, can
George began
PHI,
be
flying helicopters for
summarized as
(“PHI”).
First,
Inc.
PHI
follows.
RSL
purchased
George
found that
long-term
(the
“capable
was
policy
“Policy”)
insurance
exertion work
George
stretch,
Appellee
from
Reliance
with the
to stand
Stan-
with
(“RSL”).
dard
permanent
Life Insurance Co.
standing, lifting,
restrictions to
flew for PHI
twenty years.
carrying
work,”
for more than
or over head
and that
began
But
2008 he
experiencing
severe
could work as a “Protective-Signal
pain at the site of
amputation,
Operator;
Scheduler;
which
Crew
and Aircraft-
Employee
Security
Retirement Income
disability”
Act 3.We will use the term "mental
(“ERISA”),
§
seq.
29 U.S.C.
et
when we refer to the "Mental or Nervous
Disorders” identified in the
"Totally
2. We will use the terms
Disabled”
Disability”
interchangeably.
"Total
authority
eligibility
fulfill
tionary
could
to determine
Because
Log Clerk.”4
occupations,
construe
the alternative
and to
the terms
Plan.
duties
not To-
was
the district
RSL
Thus
court reviewed RSL’s
of that
tally
under the definition
Disabled
under
the abuse of discretion
decision
24 months.
applied after
term that
standard. The district court held that the
by
that “none
arguing
George responded
supported
evidence
RSL’s determination
anywhere
positions pa[id]
identified
George’s depression
and PTSD con-
salary
making”
he
when
close to
Disability.
to his Total
tributed
Based
proof
As
of his
flying for PHI.
stopped
finding, the
held
district court
contention, George
printouts
attached
did not
deter-
abuse
which
“SimplyHired.com,”
the website
that the
mining
Exclusion Clause limited
salaries for the
average
that the
showed
George’s right
benefits. The district
$36,000,
were
positions identified
question
court did
reach the
*4
$28,000
$40,000,
respectively. RSL
and
under
Disabled
the
it
because
George’s evidence
dismissed
materials
ascertain if these
“[could not]
expert[s],”
vocational
prepared
were
Standard of Review
from
papers all stem[med]
“the Internet
trial,
appeal
On
from a bench
website,
deriving
as
versus
same
court
the factual
findings
“review[s]
being compared
differing sites
for
the trial court
clear error” and “conclu
expert,”
by an
contrasted
law de
sions of
novo.” LeTourneau Life
“any
studies
attach
labor market
failed to
Prosthetics,
like
Inc. v.
Orthotics
Wal-
argument.”
[his]
to substantiate
completed
Stores, Inc.,
348,
(5th
350
Mart
298 F.3d
Second,
that
RSL determined
Cir.2002).
review,
“Under
ap
de novo
“psychiatric
depression
conditions of
the same
the Plan
ply
standard to
Admin
(‘PTSD’)
post
stress disorder
traumatic
decision
istrator’s
as did
district
impairment
his
sta-
to’
overall
‘contributed
Paper
court.” Holland
Co.
v. Int’l
Ret.
Thus
tus”
retirement
in 2008.
since his
(5th Cir.2009).
240,
576 F.3d
246
that
claim for
RSL determined
an
“[W]hen
administrator
discretion
“subject
long-term
benefits was
ary authority with
to the
respect
decision
Duration of Benefits
a Maximum
issue, the
standard of review should be
(24)
Exclu-
months” under the
twenty-four
Vega
one of abuse of
v.
discretion.”
Nat’l
sion
contended
Clause.
Servs., Inc.,
287,
Ins.
188 F.3d
295
Life
“[considering only
ailments
(5th Cir.1999) (en banc), overruled on oth
record is clear
impairments,
grounds
er
Metro.
Ins. Co. v.
occupation
continue his usual
[he] cannot
Glenn,
105,
2343,
554 U.S.
128 S.Ct.
171
occupation
pays
sub-
in an
engage
(2008).
parties
L.Ed.2d
The
do not
occupa-
as
usual
stantially the
same
dispute
discretionary
that RSL had
au
Accordingly,
asserted that
tion.”
respect
thority with
to the benefits deter
issue,
any,
does not
“a mental/nervous
mination at issue here.
disability.”
to [his]
contribute
An
claimant
decision
ERISA
bears the
George sought review of RSL’s
court
burden to show that
the administrator
district
under
U.S.C.
1132(a)(1)(B).
parties agreed
§
abused its
v.
See Anderson
discretion.
Indus., Inc.,
granted
language
Cytec
RSL discre-
619 F.3d
Plan’s
occupations.”
occupations
as the
"alternative
We will refer to these
Cir.2010).
(5th
“A plan administrator
fits
on
“focus[es] whether the record ade-
quately supports
abuses its discretion where the decision
administrator’s deci-
”
added)
sion
evidence,
(emphasis
(quoting Vega,
even if disputable,.
based
298)).
F.3d at
Allowing plan administra-
clearly supports
basis
its deni
tors to
justifications
offer new
for a
(internal
denial
Holland,
al.”
Neither RSL did not controlling opinion George’s cites a claim be- cause he carry failed to that holds that a claimant burden. bears the bur- RSL denied his claim because it den to right during show a to benefits that was sufficient evidence in there initial proceeding.5 claims During oral ar- record to that show he was not however, gument, George’s counsel con- that, was, Disabled and even if he a mental that George ceded bore the initial burden disorder contributed to this Total Disabili- right to show a to benefits. Thus we ty. Because RSL George’s denied claim deciding assume without that George bore grounds, on these those reasons will be the this burden. focus of our review. Nevertheless, we hold that we are Accordingly, we decline to consider considering limited to whether "the record George whether carried his burden to supports provided the reasons that RSL to right a to benefits. show II. George during the proceeding. claims See Spradley v. Hourly Emps. Owens-Ill. Wel A. 686 F.3d fare Benefit (10th Cir.2012) same); Truitt, (holding cf.
sedentary Instead, George’s into claim. inquiry nature of its occupations. alternative purpose of [its] there is no evidence stated that “[t]he that RSL George argues occupations if showing that those to determine the medical review was the record earn- substantially the same of a provide presence would documents the data enjoyed helicop- as a ing capacity limit Mr. that would that condition pilot.6 ter any occupation for to suited, vocationally as is re- which he is ERISA, an administrator Under after benefits quired by group policy there is not when abuses its discretion (24) twenty-four paid for have been in the record evidence” “substantial refusal to consider months.” RSL’s decisions, including those “support [its] suggests also that RSL George’s evidence Ellis v. benefits.” deny or to terminate the similar income re- preferred ignore Bos., Co. Assurance Liberty George, In RSL quirement. its letter Cir.2004). reject RSL F.3d a voca- only report suggests (1) it deter claim because: ed expert persuasively could show tional “capable he was mined that Totally Disabled under was (2) work,” expert its vocational exertion required either Policy. But we have never work as could had determined hire a or a claimant to an administrator Operator; Crew “Protective-Signal expert its case. vocational Clerk,” Scheduler; Aircraft-Log then that it would continue to stated (3) therefore determined it had rely expert’s report, own which was its Totally Disabled under George was not qualified special- vocational prepared the facts consider We herring: a red Even argument ist. This evi provide substantial asserted prepared by an ex- report RSL’s for its determination dence argue in its letter to pert, RSL failed Totally Disabled. was not argued before this George, and never *6 abused its discretion hold that RSL We court, any expert report contained that the George that was not it when George that could earn sub- evidence any fails to cite Totally Disabled. RSL stantially salary occupa- in another similar supports that its in the record evidence tion. ability George’s that conclusion work, in and to work the alter- Texaco, maintains that Duhon v. George to occupations, native would allow Inc., Cir.1994), F.3d 1302 “substantially earning the same ca- obtain & Accident In Cochran Hartford Life In our pilot. that he obtained as pacity” 09-cv-11752, No. 2010 WL surance record, we have independent review (E.D.Mich. 20, 2010), Jan. show any unable to locate evidence also been it abuse its discretion. Those did not supports RSL’s conclusion. In easily distinguishable. Du- cases are hon, provided contract the relevant suggests contrary, To the the record claimant was not disabled he could attempted ignore that RSL Duhon, “any job.” in 15 F.3d For work See Policy’s requirement. similar income a simi- The contract did not contain example, failed to mention the similar above, any occupa- “perform material duties of explained pays dis- 6. As we after RSL months, ability substantially provides benefits for 24 the definition the same tion which Totally Disabled of Total earning capacity.” changes can to ask the claimant Cochran, salary requirement.7 lar In sion and PTSD contributed to his Total contract contained a similar income re- Disability.8 quirement, but the ERISA administrator George concedes that dis- proffered occupations evidence other may abilities allow him perform some earning requirements “met the under the sedentary jobs, and party neither disputes Cochran, Plan.” at *8. that George is no longer physically capable There is no evidence in the record that working as a helicopter Thus, pilot. shows that could earn a substan- supports record the conclusion that George tially salary similar in position. another was physically capable of performing at Thus there is no rational connection be- least some sedentary jobs, while there is tween the fact that can do seden- no evidence to the conclusion that work, tary including the alternative occu- physically capable of doing any- pations, and the conclusion that George thing more. substantially could earn a salary similar any position. alternative Accordingly, we record, There is evidence howev- hold that RSL abused its discretion when er, depression and PTSD it determined that was not impaired job. to hold down a Disabled. evidence, Based on this RSL determined “ that George’s mental disabilities ‘contrib- B. ’ uted to impairment status,” his overall The district court held that RSL and that he was thus barred from receiv- did not abuse its discretion when it deter ing by benefits the Exclusion Clause. We mined that a mental disorder contributed must decide whether there is substantial Total Disability. George ar evidence in the record to support RSL’s gues that there is no evidence the rec determination. ord to show absent his mental or conditions, nervous he could earn substan This court has never considered
tially the same amount in another occupa the meaning of the phrase by “caused or tion. RSL maintains that it did not abuse by” contributed to in a similar exclusion because failed to clause, but other federal circuit courts show that he was “physically unable to have done so. Each of those courts has perform the any occupation.” duties of interpreted the consider “caused We whether there is a contributed rational by” language connection between the coverage only facts asserted exclude *7 George’s RSL and its decision that depres- when physical the claimant’s disability was Duhon, education, Additionally, opinion 7. experience, this court's disability and a can $75,000 part earn turned in on the in a "common—and uncon- new career. “people tested—truth” that in their sixties parties 8. "Becausethe have not briefed and physical seventies who have similar 'legally whether [RSL’s] decision was cor job limitations established this record are rect,’ but rather debate whether the benefits employed employable throughout ultimately denial was an 'abuse of discre workplace today.” empha- at Id. 1308. We " tion,’ we need not decide whether RSL's sized, however, that courts must consider interpretation Policy "legally of the was correct.” disputes case-by-case ERISA on a basis. Id. Co., McC orkle v. Metro. Ins. 757 Life case, Considering at 1309. the facts in this 452, (5th Cir.2014). Instead, F.3d 457 n. 10 known, commonly note that it is neither we decide whether RSL’s benefits determina uncontested, person nor George's that a with arbitrary tion is under the terms of the 356 salary in totally him could have earned a render disabled.9
insufficient words, substantially courts have asked sedentary job those that was simi- In other disability is a mental but-for helicopter whether lar to the one he earned as a disability. See Black’s total of the cause pilot. there is no rational connection Thus ed.2014) (10th (defin- Dictionary 265 Law between fact that mental dis- a “cause cause” as without “but-for ing impaired have may abilities occurred”). have could not the event which job, hold and the conclu- down interpretation agree with this We mental caused sion that his disabilities or per- are further language. We relevant Disability. to his Total contributed is correct interpretation that this suaded Accordingly, we hold that RSL abused itself fact that advocated by when it litigation. interpretation past See right Clause limited Exclusion Gunn, at 151 (explaining Fed.Appx. 899 further that the benefits. We hold district “the language was that position that RSL’s court when it affirmed RSL’s deter- erred exclusion required mental illness mination on this basis. totally he was disabled to show that Gunn to his condition stem- solely physical due Conclusion sclerosis, multiple from his without ming For reasons we RE disabling explained, effects of taking into account the disorders”). judgment Thus the district any mental nervous VERSE court’s for George’s physical RSL; dis- judgment George; we consider RENDER sufficient to independently were abilities to the REMAND case district him Disabled. render court the amount of to determine benefits may George. The court award also George’s physical The record shows consider whether is entitled oth ceiling firm placed a on his disabilities relief, including interest, er prejudgment if George Even prospects.10 vocational fees, expenses. attorney’s Alexan of his completely healed mental dis- were Cf. Co., der v. & Acc. Ins. abilities, limited to he would still be seden- Hartford Life (5th Cir.2009) 123, above, (per explained Fed.Appx. cu- jobs. And as we tary riam) administrator, (reversing in the rendering is no evidence record there Co., Equitable Soc’y v. Reliance Standard Ins. chaels v. The Assurance 9. See Eastin 13-6247, (6th *2 Managers, Long-Term No. Emps., Agents U.S. curiam) 2014) July (per (explaining 896, 898, Cir. Fed.Appx. 907- did not abuse that administrator discretion (3d Cir.2009) (reasoning that exclusion "was where evidence showed claimant clause, coverage which barred if "the disabili totally purely the result of not disabled as ty or on ... a arises from account of mental condition”); Maurer v. physical Reliance condition,” apply would if “the claimant Fed.Appx. Standard Life can demonstrate Cir.2012) (reasoning that administrator independently precludes engaging him from where there evi did not abuse discretion any gainful occupation”). showing any that "in the absence of dence disorder, Plaintiff mental or nervous would be During process, repeatedly the claims capable working”); physically v. Re Gunn independent referred to an medical examin- *8 Co., Fed.Appx. 399 liance Standard Ins. Life "[wjithout psychiatric er's statement that fac- 147, (9th Cir.2010) (affirming 153 administra tors,” George "would to return be able there denial of benefits because was evi tor’s light physical type work at a demand level showing physical dence that claimant's dis assignment.” appears have that, treated disabling, ability “alone not but "light synonym physical demand” as a for psychiatric for his mental nervous disor ders, work”); "sedentary work.” he would be able to Mi cf.
357 claimant, remanding omitted), judgment for marks it is difficult to compre- determination). damages hend majority how the arrived at this re- sult. KING, Judge, dissenting: Circuit The majority reasons if “[e]ven majority’s agree analysis I with the con- George were completely healed of his men- I II.A opinion. tained Sections and of its disabilities, tal he would still be limited to However, respectfully I dissent from its sedentary jobs,” noting “George’s I with
judgment, disagree majority’s as physical placed disabilities a firm ceiling II.B conclusion Section that RSL on his vocational prospects.” I do not abused its discretion when it determined disagree with points. these I do disagree, George’s disability by was “caused however, that these compel facts the con- by” contributed to a mental disorder. clusion that the mental disorder exclusion majority The concedes that “George’s inapplicable. The majority relies on a depression impaired PTSD “but-for interpretation cause” of the exclu- job.” view, In my to hold down a supported sion that is only by dicta con- inquiry. should end the Based on this tained in several cases outside of this cir- impairment, it was more than reasonable cuit.1 Under the construction adopted by for RSL to conclude that mental majority, where physical symptoms in- conditions at least contributed to his dis- dependently person disabled, render a ability, triggering thus the exclusion. The mental disorder —no severity— matter its majority only disagrees with this con- can never cause or per- contribute to that clusion, must, but also determines —as it disability.2 son’s This “but-for cause” test judgment order to reverse the of the dis- appears to be at plain odds with the lan- trict court—that RSL abused its discretion guage exclusion, applies which in reaching it. Given that review of “[o]ur disability where the by is “caused or con- the administrator’s decision ... only need ” disorder, tributed to a mental (empha- assure that the administrator’s decision added). majority’s sis reading fall somewhere on a continuum of reason- also end,” assumes a certain operations— ableness —even on the low order of Holland Plan, 240, Paper Int’l Co. Ret. that we first F.3d look at the extent of the (5th Cir.2009) (internal quotation physical symptoms considering before say symptoms I "dicta” because in each independently of the cases ical render majority, cited the court affirmed the totally claimant disabled. insurer’s denial of benefits on the basis of the mental disorder limitation. See Eastin v. Re majority implies adopted 2. The that RSL itself Co., 13-6247, liance Standard Ins. No. Life construction, quoting this "but-for cause” 3397141, (6th 10, July at *2 Cir. portion argued of its brief in which it 2014); Maurer v. Reliance Standard Ins. Life prove physically "had to that he was Co., Fed.Appx. 627-28 Cir. any occupa- unable to the duties of 2012); Gunn v. Reliance Standard However, alternatively argued tion.” (9th Cir.2010); Fed.Appx. "[njotwithstanding [George’s ability to] Equitable Soc’y Michaels v. The Assur. perform the [] material duties of several dif- Emps., Managers, Agents Long-Term U.S. occupations, ferent alternative the district Fed.Appx. court did not err when it concluded that the (3d Cir.2009) (remanding to allow insured to supports evidence determination that [RSL's] demonstrate disability). extent of depressive [PTSD] disorder con- Those courts did not have the occasion to (internal disability.” quota- tribute to his total i.e., question address issue here — omitted). tion marks whether a can be "caused or con by” tributed to phys mental disorder where *9 causes or mental condition the I disability. nothing the see contributes analysis an such policy
in the all, is, an exclusion. after
what
Moreover, majority rec- because—as challenged not
ognizes George— “legally interpretation
whether RSL’s wheth-
correct,” deciding we are limited an abuse of decision constituted
er RSL’s least, was rea- very it At
discretion. RSL to determine
sonable contrib- mental conditions
George’s severe disability, view particularly
uted to own doctor so the fact Morris v. Standard
opined. Cf. 98-992-HU,
No. CIV. 1999) (D.Or. (concluding Sept.
*5 “caused for a
plan limitation ap- aby mental disorder”
contributed plaintiff “suffer[ed]
plied where mental which ... disorders
physical the material
affected her job,” “[w]hether of her because
functions separate
plaintiff suffered distinct disability is under immaterial language”).
[limitation’s] I hold that RSL did
Accordingly, would applying abuse disorder exclusion
mental result, It a dreadful driven
claim. policy. more provision
dreadful (and physical problems a claimant’s
serious
resulting employment problems), more to suffer from a “mental disor-
likely he is Roger TRENT; Dale Vickie Darlene just at the depression), time (e.g., der” Trent; Trent; and Richard Dale Ran coverage other- most needs the when he Trent, Plaintiffs-Appellees, Dean dal by policy like this. But wise afforded applying by RSL’s decision are bound
exclusion, Walling, its discretion. Matthew which was within Steven WADE and Defendants-Appellants. judgment I affirm the Because would basis, respect- I the district court No. 13-10960.
fully dissent. Appeals, United States Court of
Fifth Circuit. Jan.