In Campbell v. Reliance Standard Life Ins. Co., No. 20-13393, __F.App’x__, 2021 WL 2099810 (11th Cir. May 25, 2021), Plaintiff-Appellant Gregory Campbell appealed the district court’s grant of summary judgment to Defendant-Appellee Reliance Standard Life Insurance Company in his claim for continued long-term disability benefits under the group policy’s “any occupation” definition of disability. Campbell argued that Reliance Standard’s denial of benefits was wrong, and it also denied him a “full and fair review” as required under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1133(2).
Campbell worked as a car salesman until he stopped working to undergo surgery for aortic valve replacement, attempted mitral valve repair, and mitral valve replacement. He experienced significant complications after the surgery, including cardiogenic shock and multisystem organ failure. He then underwent another significant surgery and at least two echocardiograms after his discharge from the hospital. The second one showed decreased left ventricular systolic function. Reliance Standard paid Campbell’s claim under its policy’s definition of Total Disability from his “regular occupation,” which it deemed to be a “light duty” occupation. After twelve months, Campbell had to prove he is unable “perform the material duties of any occupation.” Any occupation is one that the claimant’s “education, training or experience will reasonably allow.”
Reliance Standard denied his claim for “any occupation” benefits after identifying five alternative sedentary occupations that he could perform. Campbell appealed the denial to Reliance Standard, which included two identical letters from his treating providers which stated, “I am writing to inform you that Mr. Gregory Campbell has been evaluated today. Mr. Campbell has been diagnosed with a cardiovascular disease and uncontrolled high blood pressure. Due to his diagnosis, Mr. Campbell is unable to return to work.” Reliance Standard had Campbell evaluated in person by Dr. Jaime Llobet, who claimed that “[s]trictly from the cardiac point of view I see no anatomic, physiologic, hemodynamic or structural heart illness that would prevent this gentleman from returning to work as a car salesman. He is a functional Class II-B and he is limited in his activities to LIGHT WORK.” After some back and forth with Campbell’s two treating doctors, Dr. Llobet did not change his opinion. Finally, one of Campbell’s treating doctors wrote a letter stating that Campbell “has multiple runs of Arrhythmia noted on his ICD check. Patient is having multiple runs of non-sustained VT – which are symptomatic. Also has runs of atrial-tachycardia and atria-flutter He is symptomatic with dizziness and near syncope. Mr. Campbell is not able to work due to these events.” Reliance Standard did not provide this letter to Dr. Llobet because it did not contain new medical evidence.
The Eleventh Circuit assumed, without deciding, that Reliance’s decision was “de novo wrong,” and proceeded to determine whether Reliance was vested with discretion. It is undisputed that Reliance Standard had discretion as the administrator of the group policy. Because it had discretion, the court reviews its decision under the arbitrary and capricious standard. The court found that all the medical records and physician testimony provided reasonable grounds to support Reliance Standard’s decision. The court was unmoved by the fact that Reliance did not provide its reviewing doctor with Campbell’s doctor’s last letter. “[T]here is nothing in the ERISA regulations or our precedent that requires a plan administrator to provide every piece of medical evidence—especially repetitive, conclusory evidence—to the administrator’s independent expert before rendering a final decision.” The Eleventh Circuit agreed with the district court that Campbell failed to establish he was totally disabled, and Reliance’s decision was not arbitrary and capricious.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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