WALKER v. LIFE INSURANCE COMPANY OF NORTH AMERICA (2024)

ORDER

This matter appears before the Court on Plaintiff's Motion for Summary Judgment (Doc. No. [14]) and Defendant's Motion for Judgment on the Administrative Record (Doc. No. [16]).¹

I. JUDGMENT ON THE ADMINISTRATIVE RECORD

In this action pursuant to 29 U.S.C. § 1132(A)(1)(B), Plaintiff Alana Walker challenges Defendant Life Insurance Company of North America's (“LINA”) denial of long-term disability (“LTD”) benefits.²

Walker contends that while she provided objective evidence of her disability, LINA rested its decision on the subjective opinions of two non-examining doctors who failed to provide meaningful reasons for disagreement with Walker's objective evidence and an examining physician who did not have the benefit of key evidence. Doc. No. [22-1], 17. Moreover, Walker argues that even if the Court finds that LINA correctly considered Walker able to perform a sedentary occupation (as proposed by the medical providers retained by LINA), she is still “disabled” under the terms of the applicable policy because, in the opinion of Walker's vocation expert Larry Underwood, Walker is not qualified by education, training, or experience to perform either of the two sedentary occupations (Manager, Financial Institution and Manager, Broker Office (AR 001364)) that LINA identified as allowing Walker to earn 60% or more of her Indexed Earnings. Doc. No. [22-1], 21–23.

On cross motions for review of the Administrative Record, Walker requests summary judgment in her favor under Federal Rule of Civil Procedure 56, and LINA requests judgment in its favor under Rule 52. Doc. Nos. [14]; [16]. Because the Parties seek a decision based on an agreed-upon administrative record, “judicial economy favors using findings of fact and conclusions of law pursuant to [Rule] 52 rather than summary judgment under [Rule] 56.” Acree v. Hartford Life & Accident Ins. Co., 917 F. Supp. 2d 1296, 1304 (M.D. Ga. 2013).³

The record shows that Walker has medical conditions associated with her back, knees, and right shoulder that cause her pain and restrict her movement. The question is whether Walker's pain and movement restrictions disable her from performing an occupation that she is (or reasonably may become) qualified for and that would allow her to earn 60% or more of her Indexed Earnings.

II. FINDINGS OF FACT

A. Background

From October 2013, through September 1, 2018, Walker worked as a “branch supervisor” for D.R. Horton, Inc. AR 000450, 0514, 1439. Her annual salary at the time was $286,844.29. AR 000223.

Walker stopped working due to pain in her right shoulder and both knees.⁴ AR 000230. Walker claimed and received disability benefits under D.R. Horton's employee benefits plan (the “Plan”)⁵ for the 24-month period from November 30, 2018, through November 30, 2020. AR 000508, 001317, 1013. The Plan's LTD benefits are funded by Group Policy No. LK-963793 issued by LINA (the “Policy”). AR 002472–2509.

After 24 months of disability benefits payments, LINA denied Walker's LTD benefits claim. AR 001317. Under the Policy, the definition of “disability” is two-phased. Initially, an employee is “disabled” “if, solely because of Injury or Sickness, he or she is: 1. unable to perform the material duties of his or her Regular Occupation ⁶ ; and 2. unable to earn 80% or more of his or her Indexed Earnings ⁷ from working in his or her Regular Occupation.” AR 002518. Twenty-four months after an employee's disability benefits become payable, the employee is “disabled” “if, solely due to Injury or Sickness, he or she is: 1. unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and 2. unable to earn 60% or more of his or her Indexed Earnings.” Id.

While LINA denied Walker's LTD benefits claims past November 30, 2020, on May 19, 2020, the Social Security Administration (SSA) awarded Walker Social Security Disability Insurance (SSDI) benefits, retroactive to October 1, 2018. AR 000899, 1956.⁸ ,⁹ LINA determined that Walker was not “disabled” under the second phase of the Policy's definition of that term, and it denied Walker's claim for future LTD benefits (and Walker's appeal of the denial) on considering, among other things, the following:

• An October 30, 2020 independent medical evaluation (“IME”) of Walker conducted by Dr. Douglas Murray, board certified in Orthopedic Surgery. AR 001269–74.

• LINA's vocational assessment. AR 001278–79.

• An April 2021 peer review of Walker's medical records by Dr. Donald Getz, board certified in Orthopedic Surgery, and addendum to the peer review report. AR 001384–94, 1616–17.

• A May 2021 peer review of Walker's medical records by Dr. Roger Belcourt, board certified in Occupational Medicine and addendum to the review report. AR 001376–83, 1625–27.

• LINA's transferable skills analysis (“TSA”). AR 001348–50.

As part of their review, Drs. Getz and Belcourt considered Walker's functional capacity evaluation (“FCE”) report of March 18, 2021, by Daniel Navarro, MPT, OCS, MTC (AR 002068–86), and the accompanying Treating Physician Questionnaire completed by Walker's orthopedist Dr. Adil Ansari (AR 002087).¹⁰ AR 001386–87, 1380, 1626.

Having exhausted her administrative remedies (AR 001654), Walker filed the instant action for judicial review of LINA's decision. Doc. No. [22-1], 1. Walker challenges LINA's denial of her LTD claim, arguing that the Administrative Record contains objective evidence establishing that she is “disabled” from performing any occupation, as required by the Policy. Among other things, Walker relies on the following:

• Findings from the magnetic resonance imaging (MRI) of Walker's back and shoulder and from x-rays of her knees. AR 02443–44, 2335.

• Walker's March 18, 2021 FCE report, which concluded that Walker's capacity was “below sedentary” and that she was incapable of working a full 8-hour day with breaks. and the accompanying Treating Physician Questionnaire in which Walker's treating physician, Dr. Adil Ansari, agreed with the restrictions and limitations in the FCE. AR 002068–87.

• The reports of vocation expert Mr. Larry Underwood. AR 001407–13, 1586–91.

• An August 30, 2021 letter from Dr. Jyoti Gundavarapu, a treating physician of Walker's, opining that Walker “is unable to work including sedentary work due to chronic arthritis.” AR 001577.

• Walker's SSDI award.

B. IME

Walker's back and shoulder MRI reports and her knee x-ray report show pathologies. AR 02443–44, 2335. In conducting Walker's IME, in addition to examining her, Dr. Murray reviewed Walker's medical record, including her right shoulder MRI and x-rays of her knees and back. AR 001271–72. Dr. Murray diagnosed Walker with bilateral knee and right shoulder pain with arthritis and low back pain with degenerative changes, but he placed no restrictions on Walker's ability to sit, perform fine manipulations or firm and simple grasps, or lift and carry up to 10 lbs. AR 001271, 1273–74. He did limit Walker to only occasionally walking, standing, or using her lower extremities for foot controls. AR 001273–74. And he restricted her from reaching overhead; lifting, carrying, pushing, or pulling more than 20 lbs.; climbing stairs and ladders; and balancing, stooping, kneeling, crouching, or crawling. Id.

Walker criticizes Dr. Murray's report, arguing that Dr. Murray did not have the benefit of Walker's FCE report and does not appear to have reviewed the MRI report of Walker's back, which showed nerve root compression. However, Dr. Murray did review Walker's back x-rays, which showed “mild chronic multilevel degenerative changes,” and he conducted a low back exam of Walker to assess her pain and function. AR 001271. Based on his exam and review, Dr. Murray assigned to Walker specific limitations and restrictions in function. AR 001271–74. Both Drs. Getz and Belcourt, each of whom conducted a peer review of Walker's medical records for LINA, substantially agreed with the limitations and restrictions Dr. Murray proposed. AR 001393, 1381–82.¹¹

C. Peer Review

As part of their review, Drs. Getz and Belcourt considered the MRI of Walker's back and her FCE report. AR 001376–77, 1380, 1387, 1389, 1626. Walker criticizes their reports, arguing that they did not explain their basis for rejecting the findings of the FCE. Walker is incorrect.

Dr. Getz reviewed and summarized the FCE report (AR 001386–87) and disagreed with its finding that Walker's physical demand level was below sedentary, explaining that while Walker's “low back, bilateral knee and right shoulder” issues rendered Walker “physically functionally limited” and required her to have “medically necessary work activity restrictions,” “there is no clinical support for total impairment,” which the FCE report proposed. AR 01392–93. Moreover, Dr. Getz contacted Dr. Ansari, one of Walker's treating physician's, who had expressed agreement with the restrictions included in the FCE report and obtained more information from him. AR 001391. Specifically, Dr. Getz spoke with Dr. Ansari and learned that Dr. Ansari had only seen Walker twice and felt that she would have “some functional limitations” due to her knee osteoarthritis and would not be able to stand or walk for long periods. Id. It does not appear that Dr. Getz or Drs. Murray and Belcourt disagreed with that assessment by Dr. Ansari, as each of them recommended that Walker be restricted to only occasional standing and walking and also agreed that she would have some other functional limitations. Ultimately, Dr. Getz reached his opinion regarding Walker's restrictions and functional impairment level following his review of Walker's medical record and contact with her treating physician.

On reviewing Walker's FCE report, Dr. Belcourt concluded that the functionality demonstrated by Walker was inconsistent with his review of her medical record and, thus, did not accurately represent her function. AR 001626. He explained that while Walker had degenerative changes in her knees, right shoulder, and lumbar spine and used an assistive device (cane or walker) to walk, she had appropriate strength in her major muscle groups and was neurovascularly intact and did not have neurological focal deficits. AR 001626. Dr. Belcourt did not discount Walker's reports of pain, recognizing that she has primary osteoarthritis in both knees and degenerative changes in both her right shoulder and back. AR 001623, 001625. He also considered the fact that Dr. Ansari, Walker's treating physician, had agreed with the restrictions noted in the FCE report. AR 001622. Expressing his disagreement, however, Dr. Belcourt explained that Dr. Ansari's opinion was not well supported and inconsistent with Walker's claim file because, among other things, although Walker had limited range of motion in her right shoulder, she had no significant deficits in her left shoulder and both her lower extremities retained good strength and were neurovascularly intact. AR 001622. He similarly disagreed with the opinion of another of Walker's treating physicians (Dr. Gundavarpu) that Walker was unable to perform sedentary work due to her chronic arthritis, because there was no additional clinical evidence to support that opinion. AR 001627. From his review of Walker's medical records, Dr. Belcourt deemed Walker functionally limited to a moderate degree and proposed restrictions substantially similar to those proposed by Dr. Murray. AR 001623–24, 1626. He considered her able to work 8 hours per day and 40 hours per week. AR 001625.

D. FCE

Walker argues that her FCE objectively establishes the restrictions and limitations resulting from her orthopedic conditions and should not be doubted. Doc. No. [22-1], 13–15. Based on an evaluation of Walker, the FCE report concludes that Walker should be restricted from kneeling, squatting, stair-climbing, balancing, and ladder-climbing; should be limited to rare walking (using an assistive device) and occasional standing during the day; and should avoid ground-level lifting or carrying with both hands. AR 002068. According to the FCE report, Walker is able to carry up to a 3 lbs. weigh unilaterally on rare occasions and sit at a desk frequently. Id. The FCE report notes that because erect sitting would exacerbate her lower back and leg pain, Walker is required to take “extended reclined sitting periods.” Id. (emphasis added).

The sitting restrictions the FCE report proposes are based on observations of Walker as she sat for “prolonged periods” while filling out intake paperwork and while she interacted with the examiner. AR 0020803. Walker adjusted her sitting position and, at times, reclined in her chair with one leg extended. Id. During a 40-minute span, while she interacted with the examiner, Walker moved around in her seat as if searching for comfort and, after sitting continuously for 30 minutes, she took a short standing break due to reported pain in her back and thighs. Id.

The FCE report does not explain why short standing breaks, which Walker appears able take, would not relieve Walker's pain from prolonged sitting. Also, although the FCE report notes that Walker should remain in a reclined position while sitting for extended periods (a position Walker herself adopted at times during her FCE), the report does not indicate that the reclined sitting position would interfere with seated work performance. Finally, the FCE report fails to explain why Walker is unable to sit for more than a “frequent” period in a reclined position and with standing breaks.

Although, according to her FCE, Walker was capable of frequently sitting, occasionally standing, and walking (limited to rare occasions), the FCE report concludes that Walker is not able to work a full 8-hour day with breaks and that her physical demand is “below sedentary.” AR 002071. Even assuming the appropriateness of the restrictions and limitations proposed in the FCE report, the report fails to explain why Walker does not qualify for sedentary work. According to Walker, the Dictionary of Occupational Titles (“DOT”) (4th ed., Rev.1991) defines “sedentary work” as follows:

Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Doc. No. [24], 3; AR 001284. Walker, according to the FCE report, can sit for frequent periods and can walk and stand for brief periods. The FCE report limits Walker to carrying 3 lbs., but it is silent on the amount of force Walker can exert. Thus, the FCE report also fails to address one of the requirements of sedentary work—i.e., whether Walker is incapable of exerting up to 10 lbs. of force occasionally to move objects (including herself).

E. Vocational Analysis

Following Dr. Murray's IME of Walker, LINA conducted a vocational assessment (the first TSA) and, using D.R. Horton's job description for Walker's position (that of “branch supervisor”) (AR 001439–41), among other things, LINA determined that Walker was qualified to perform the occupation of “Manager, nancial Institution.”¹² AR 001278–79. LINA determined that the occupation of financial institution manager met the limitations and restrictions identified by Dr. Murray.

LINA conducted a second TSA following the reviews of Walker's medical record by Drs. Getz and Belcourt. AR 001348–50. Again, relying on the description of Walker's job at D.R. Horton, among other things, LINA determined that Walker was qualified to perform the occupation of “Manager, Financial Institution,” which it considered analogous to Walker's occupation at D.R. Horton, and also another occupation, that of “Manager, Brokerage Office,” both of which have a special vocational preparation (“SVP”) level 8 classification. AR 001349. In identifying these occupations, LINA relied on the functional restrictions and limitations proposed by Drs. Getz and Belcourt and concluded that Walker would be able to perform the identified occupations with those restrictions and limitations. AR 001350. Walker would be able to earn at least 60% of her Indexed Earnings in either of the identified occupations. See AR 001349–50.

According to the DOT, the “Manager, Financial Institution” “[m]anages branch or office of financial institutions, such as commercial bank, credit union, finance company, mortgage company, savings bank, or trust company.” AR 001447. That manager undertakes the following tasks:

1. Directs and coordinates activities to implement institution policies, procedures, and practices concerning granting or extending lines of credit, commercial loans, real estate loans, and consumer credit loans.

2. Directs, through subordinate supervisors, activities of workers engaged in implementing establishment services and performing such functions as collecting delinquent accounts, authorizing loans, or opening savings account.

3. Establishes procedures for custody and control of assets, records, loan collateral, and securities to ensure safekeeping.

4. Contacts customers and business, community, and civic organizations to promote goodwill and generate new business.

Id.

According to D.R. Horton's job description, its branch supervisor undertakes “[m]anagement of [o]ffice or [o]ut-stationed [l]ocation [m]anagement, [b]usiness development, origination of loans, relationship management with customers and clients.” AR 001439. The following essential duties of the position overlap with the task requirements listed in the DOT for the financial institution manager position: (1) “[d]evelop[ing] a detailed marketing plan annually to include business development/sales strategy with on-site sales representatives and outside Realtors”; (2) “manag[ing] the activities of their location and up to one additional employee. Carr[ying] out supervisory responsibilities in accordance with the organization's policies and applicable laws”; and (3) “[s]pend[ing] adequate time in builder communities earning the business ․ [,] [d]evelop[ing] sales leads for mortgages in builder communities[,]” and “represent[ing] [employer] in a professional matter at industry-related functions.” AR 001439–40.

Walker's vocational expert, Larry Underwood, disagrees with LINA's TSAs, opining instead that Walker is not qualified to perform the SVP level 8 occupations identified by LINA because, based on Walker's description of her job duties, Walker's occupation was a combination or composite of two different sedentary occupations—namely, mortgage loan interviewer and loan officer—with an SVP level of 7.¹³ AR 001412. In an addendum to his report, Underwood also opines that LINA's position that Walker's job as a branch supervisor with D.R. Horton was analogous to that of a financial institution manager is erroneous because (1) Walker supervised only one employee, while a financial institution manager is responsible for managing numerous departments; and (2) the D.R. Horton job description provided that the branch supervisor was to report to “Branch Manager / Regional Manager.”¹⁴ ,¹⁵ AR 001586–87. According to Underwood, when a TSA was conducted based on the two occupations that best describe Walker's own occupation, the only occupation identified was that of “Skip Tracer,” an SVP level 4 sedentary job with an annual wage of $60,100, which does not meet the Policy's salary requirements. AR 001412. He also maintains that the DOT does not include any below sedentary level occupations. Id. Underwood concludes that there are no occupations in the national economy that Walker can perform with the restrictions proposed by her own physicians, LINA's peer reviewers, or the FCE report that also meet the Policy's salary requirements. Id.

LINA reviewed Underwood's report but concluded that its classification of Walker's own occupation as a financial institution manager under the DOT was correct because the job description for Walker's position with D.R. Horton was consistent with the DOT position LINA identified. AR 001451. LINA also reviewed the addendums to Underwood's report. AR 001504, 1506, 1586, 1628. To Underwood's criticism that Walker could not perform the occupations identified by LINA because those occupations require the employee to reach overhead, while Walker is restricted from that movement on her right side, LINA responded that the occupations did not require a bilateral overhead reach and that the left side could be used to perform the requirement for reaching overhead occasionally. AR 001629. LINA remained unpersuaded by Underwood's opinion. AR 001629.

III. CONCLUSIONS OF LAW

A. Legal Standard

As to the standard of review, “[a] denial of benefits challenged under 29 U.S.C. § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Harris v. Lincoln Nat'l Life Ins. Co., 42 F.4th 1292, 1294 (11th Cir. 2022) (cleaned up). Walker represents (Doc. No. [14-1], 12–13), and LINA does not dispute, that the Plan does not appear to contain language vesting the administrator with discretionary authority over benefits determinations or Plan-term construction. Thus, here, the Court conducts a de novo review.

On de novo review, “the district court's charge is to put itself in the agency's place, to make anew the same judgment earlier made by the agency.” Harris, 42 F. 4th at 1294; see also Acree v. Hartford Life & Acc. Ins. Co., 917 F. Supp. 2d 1296, 1306 (M.D. Ga. 2013) (“In making this determination, the Court does not give any deference to [the administrator's] decision and, instead, stands in the shoes of the administrator and starts from scratch, examining all the evidence before the administrator as if the issue had not been decided previously.”) (cleaned up). Thus, the court will deem a benefits denial “wrong” if, after reviewing of the administrative record de novo, “the court disagrees with the administrator's decision.” Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241, 1246 (11th Cir. 2008).

As to the burden of proof, because Walker (pursuant to § 1132(a)(1)(B)) seeks to recover benefits under the Plan, she “bears the burden of proving his entitlement to contractual benefits.” Horton v. Reliance Standard Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir. 1998).

B. LINA's Claim Denial Was Not Wrong

1. Medical Assessment

Based on its de novo review of the Administrative Record, the Court concludes that LINA's denial of Walker's claims for LTD benefits past November 30, 2020, was not wrong.

Dr. Murray's IME of Walker was not entitled to less weight because he does not appear to have reviewed the report of Walker's back MRI and the IME was conducted before Walker's FCE.

Walker also contends that the value of Dr. Murray's IME report is reduced because Dr. Belcourt stated that it was “inaccurate.” Doc. No. [22-1], 16. Walker misapprehends Dr. Belcourt's statement. LINA asked Dr. Belcourt to review Walker's “10/13/20” IME and her FCE and respond to the question “Is the demonstrated functionality consistent with your review of the records, and are the results an accurate representation of the customer's functionality from 12/1/20 to the present.” AR 001625. Dr. Belcourt responded by summarizing first the IME report and then the FCE report. AR 001626. He followed his summaries by noting that no IME dated “10/13/20” was available for review but an IME dated “11/10/30” was provided. Id. Immediately after making that correction, Dr. Belcourt answered LINA's question as follows: “The demonstrated functionality is not consistent with my review of the records. The results are not an accurate representation of the customer's functionality from 12/1/20 to the present.” Id. Because the criticism follows Dr. Belcourt's reference to the IME report, Walker points to it as a criticism of Dr. Murray's findings. That reading, however, is nonsensical considering that Dr. Belcourt agreed with Dr. Murray that Walker had degenerative changes in her knees, back, and right shoulder and suggested restrictions substantially similar to those proposed by Dr. Murray. A reasonable reading of Dr. Belcourt's report makes apparent that his disagreement was directed to the FCE report.

The Court concludes that Drs. Getz and Belcourt considered the FCE report and sufficiently explained their reason for disagreement. Thus, there is no basis to discount their reports, and LINA was not wrong in relying on the peer review reports. See Jorgensen v. Metro. Life Ins. Co., No. 1:09-CV-3108-CC, 2013 WL 12239342, at *5–6, 9 (N.D. Ga. Mar. 26, 2013) (finding, on de novo review, that the plan administrator was not wrong in denying claim where, among other things, its physician reviewers had reviewed the FCE results and found them inconsistent with the clinical findings”). Moreover, LINA was not wrong in relying on the peer review reports, although one of Walker's treating physician's (Dr. Ansari) concurred with the restrictions of the FCE report and another (Dr. Gundavarpu) opined that Walker is unable to work. Not only is “[n]o special weight ․ to be accorded the opinion of a treating physician,” Ray v. Sun Life & Health Ins. Co., 443 F. App'x 529, 533 (11th Cir. 2011), but here, Dr. Getz spoke with Dr. Ansari, who expressed an opinion that appears consistent with Dr. Getz's, and Dr. Belcourt explained that Dr. Gundavarpu's opinion was not supported by the clinical evidence he had reviewed.¹⁶

Walker also argues that the FCE represents the “gold standard” for gauging the extent to which a person can complete work-related tasks and its findings should outweigh the “subjective estimates” of LINA's physicians. Doc. No. [22-1], 16–17. While an FCE may be “among the most effective means of objectively measuring an individual's functional limitations,” Lesser v. Reliance Standard Life Ins. Co., 385 F. Supp. 3d 1356, 1371 (N.D. Ga. 2019), Walker's FCE report is not entitled to elevated consideration and does not outweigh the opinions of Drs. Getz and Belcourt who reviewed but disagreed with it. Walker's FCE report fails to adequately support the basis for its “sitting” restriction or explain why the restrictions it imposes on Walker render her incapable of performing sedentary work in an 8-hour workday with breaks.

In sum, Walker has failed to show that she is incapable of performing sedentary work, and LINA was not wrong in concluding (based on the opinions of Drs. Murray, Getz, and Belcourt) that Walker can perform sedentary work.

2. Vocational Assessment

LINA was not wrong in determining that Walker's own occupation was that of a financial institution manager by comparing D.R. Horton's job description for Walker's position and the DOT's description. Stiltz v. Metro. Life Ins. Co., No. 1:05-CV-3052, 2006 WL 2534406, at *9 (N.D. Ga. Aug. 30, 2006), aff'd, 244 F. App'x 260 (11th Cir. 2007) (administrator “not wrong in applying the employer's definition [of the job] along with that of the DOT to the Plaintiff's occupation”). The Court agrees with LINA's determination. Although not identical, there is substantial overlap between the tasks required of a financial institution manger (as identified in the DOT description) and those a D.R. Horton branch supervisor is required to undertake (per the D.R. Horton job description). Moreover, although Underwood opines that Walker was not a manager because she only supervised one employee and did not have the authority to hire or fire employees, per D.R. Horton's job description, Walker's position included supervisory duties and “management of office.” These duties are consistent with those of a financial institution manager, who, according to the DOT, manages a branch or office.

Based on her experience, Walker is qualified to work as a financial institution manager. The occupation of financial institution manager is sedentary, and, thus, Walker can perform this occupation. This occupation would enable Walker to earn at least 60% of her Indexed Earnings.¹⁷

3. LINA's Initial Disability Benefits Award and SSDI Award

Walker argues that because LINA paid her disability benefits for two years, based on its determination that Walker was unable to perform her own occupation, it now has the burden of establishing that Walker's condition has improved before terminating her benefits. The Eleventh Circuit case Walker relies on, Levinson v. Reliance Standard Life Ins. Co., 245 F.3d 1321, (11th Cir. 2001), is inapposite. In Levinson, because the plaintiff had “satisfied his obligation under the terms of the plan” by submitting proof that he was “totally disabled,” the Eleventh Circuit concluded that the administrator had to produce evidence that the plaintiff was “no longer disabled” before terminating his benefits. 245 F.3d at 1331. In contrast, here, Walker has not established that she is “disabled” under the second phase of the definition under the Policy to be entitled to a continuation of disability benefits past November 30, 2020.

Regarding Walker's SSDI award, not only is “the approval of disability benefits by the SSA ․ not considered dispositive on the issue of whether a claimant satisfies the requirement for disability under an ERISA-covered plan,” Oliver v. Aetna Life Ins. Co., 613 F. App'x 892, 897 (11th Cir. 2015) (cleaned up), but here, additional information (i.e., the peer reviews by Drs. Getz and Belcourt) was presented after the SSDI award decision and, as Walker's SSA file is not in the Administrative Record, the SSA's reason(s) for the award cannot be determined. Accordingly, the SSDI award to Walker is unpersuasive.

In sum, the Court concludes that Walker has failed to meet her burden of establishing that she is “disabled” under the second phase of that term's definition under the Policy. As such, LINA's decision to deny Walker's LTD benefits claim past November 30, 2020, was not wrong.

IV. CONCLUSION

For the foregoing reasons, Plaintiff's Motion for Summary Judgement (Doc. No. [14]) is DENIED and Defendant's Motion for Judgment (Doc. No. [16]) on the Administrative Record is GRANTED.

IT IS SO ORDERED this 4th day of September, 2024.

FOOTNOTES

1.   All citations are to the electronic docket unless otherwise noted, and all page numbers referenced are those imprinted by the Court's docketing software.

2.   The record here includes the Administrative Record of Walker's LTD benefits claim (Doc. Nos. [16-2–16-6]), and the Parties do not dispute that the Court may resolve this matter based on the Administrative Record. See Doc. No. [16-1], 1 n.1. For ease of reference, the Administrative Record is cited using the associated Bates numbers (i.e., AR 000001–2529).

3.   With regard to LINA's Motion for Judgment, rather than replying to all of the arguments in Walker's response, LINA cherry-picks arguments that is considers not having been raised in Walker's Motion for Summary Judgment and only replies to those. In reply to Walker's remaining arguments, LINA “incorporates by reference” its brief in opposition to Walker's summary judgment motion. Doc. No. [23], 2, n.1. The Court does not condone this practice.

4.   Walker's record citations for the reason of her disability are not on point. Walker asserts that she stopped working in 2018 due to “multiple orthopedic conditions affecting her back, knees, and shoulders,” but she references a letter from LINA regarding “Waiver of Premium benefits,” which contains no reference to Walker's medical condition(s), and a physician assessment dated August 25, 2020, which does not include a date of onset. Doc. No. [22-1], 2.

5.   The Plan is governed by the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1001, et seq. Doc. No. [16-1], 1.

6.   “Regular Occupation” is the “occupation the Employee routinely performs at the time the Disability begins.” AR 002539. Under the Policy, LINA considers “the duties of the occupation as it is normally performed in the general labor market in the national economy” and “not work tasks that are performed for a specific employer or at a specific location.” Id. The Court's references below to Walker's “own occupation” are references to her “Regular Occupation.”

7.   “Indexed Earnings” are the employee's salary just prior to the date of disability plus a yearly increase. AR 00540, 2539.

8.   Walker repaid to LINA the overpayment ($29,100) resulting from the SSDI award. AR 001812.

9.   Although LINA was unsuccessful in obtaining Walker's file from the SSA, it considered Walker's SSDI award in denying Walker's claim and her subsequent appeal. AR 001285, 1650. LINA concluded, however, that it had “more recent information than the SSA had to consider at the time of its decision” and that the SSDI “award was less significant because [Walker] was age 50+ and considered approaching advanced retirement age by SSA. SSA has internal administrative standards that reduce the standard of proof for older customers. These standards were inconsistent with the policy under which [Walker] was covered so the award's relevance was reduced.” Id.

10.   These documents were not available to Dr. Murray when he conducted Walker's IME because Walker had not yet undergone the FCE.

11.   Dr. Getz (1) did not restrict Walker's ability to sit; (2) limited Walker from standing or walking to 30 minutes at a time, bending more than occasionally, climbing up and down stairs more than one once per day, lifting more than 5 lbs. frequently, or lifting, carrying, pushing, or pulling 10 lbs. more than occasionally; and (3) restricted her from reaching overhead using her right shoulder or squatting, crawling, kneeling, stooping, or ladder climbing. AR 001393. Similarly, Dr. Belcourt (1) did not restrict Walker's ability to sit; (2) limited Walker from standing or walking for more than 30 minutes at a time or from more than occasionally lifting, carrying, pushing, or pulling 20 lbs., climbing stairs, stooping, kneeling, crouching, or reaching overhead; and (3) restricted her from crawling or balancing. AR 001381–82.

12.   LINA determined that this occupation was analogous to Walker's own occupation of branch supervisor. AR 001279.

13.   Underwood does not contend that the two occupations identified by LINA are not sedentary occupations.

14.   Walker argues that this “clearly indicates that Walker reported to the Branch Manager as well as a Regional Manager.” Doc. No. [22-1], 9. The Court disagrees with this interpretation. The job description is reasonably read as indicating that the branch supervisor reports to either the branch manager or the regional manager. Thus, where the branch supervisor is the branch manager, that individual would report to the regional manager.

15.   Underwood also opines that a college degree, which Walker does not have, is preferred for the managerial position LINA identified. AR 001408, 1419. A college degree, however, is not indicated as a requirement for the position.

16.   Walker also argues that the peer reviewers did not have the benefit of examining Walker and, thus, the value of their opinion is reduced. Doc. No. [22-1], 16. However, the peer reviews substantially corroborate the conclusions of Dr. Murray, who did examine Walker, and the reviewers explain the bases for their conclusions. Accordingly, the Court is not persuaded by Walker's argument. Moreover, “[i]t is entirely appropriate for an administrator to rely on written reports of consultants who have done paper reviews of a claimant's medical records.” Jorgensen, 2013 WL 12239342, at *9.

17.   The Court does not analyze the alternate occupation (that of brokerage office manager) that LINA identified.

STEVE C. JONES, UNITED STATES DISTRICT JUDGE