Cooper v. Hewlett-Packard Co.
Laurie M. COOPER, Plaintiff-Appellant, v. HEWLETT-PACKARD CO., Disability Plan, Defendant-Appellee
Attorneys
Lonnie Roach, Bemis, Roach & Reed, Austin, TX, for Cooper., Lonie A. Hassel, Julia Elizabeth Zuckerman, Groom Law Group, Chartered, Washington, DC, for Defendant-Appellee.
Full Opinion (html_with_citations)
This is an appeal of the district courtâs grant of summary judgment upholding the denial of Appellant Laurie Cooperâs claim for continued disability benefits under the Hewlett-Packard Company Disability Plan (the âPlanâ), governed by 29 U.S.C. §§ 1001 et seq. (âERISAâ). Cooper argues that she was denied a full and fair review of her claim and that the denial of benefits was an abuse of discretion because it was not supported by substantial evidence. Based on the following analysis, we affirm the judgment of the district court.
I.
Laurie Cooper worked for Hewlett-Packard (âH-Pâ) for 16 years in the position of content manager, which involved
On March 24, 2004, Cooper stopped working at HP. Cooper, then 43 years old, applied for Short Term Disability (âSTDâ) benefits pursuant to § 2(q)(I) of the Plan because of neck and back pain she had been experiencing. Section 2(q)(i)âs definition of âTotally Disabledâ provides that â[djuring the first twenty-six (26) weeks following the onset of an injury or sickness, the Participant is unable to perform the material and essential functions of his Usual Occupation in the Participating Company.â The Plan defines âUsual Occupationâ as âthe customary work assigned to the Participant by the Participating Company which employs the Participant and performed on the Participantâs customary schedule .... â In support of her claim, Cooper submitted medical evidence, including reports from her psychiatrist, Dr. Riaz Mazcuri, M.D., and another treating physician, Dr. Mehboob Nazarani, documenting chronic back pain, depression, bipolar disorder, and generalized anxiety. On April 20, 2004, VPA approved Cooperâs application for STD benefits under § 2(q)(i).
Following the initial 26-week period of STD benefits under § 2(q)(i), Cooper applied for Long Term Disability benefits under § 2(q)(ii) of the Plan. Section 2(q)(ii) provides that a participant is âTotally Disabledâ under that section if â[a]fter the initial twenty-six (26) week period and prior to the twenty-four (24) month period following the onset of injury or sickness, the Participant is unable to perform the material and essential duties of his Own Occupation.â The Plan defines âOwn Occupationâ as âthe type of work in which the Participant was engaged prior to the onset of his Total Disability and is not limited to the Participantâs Usual Occupation or to jobs that provide any particular earnings level.â Cooper submitted evidence of her continuing chronic back pain, depression, bipolar disorder, and generalized anxiety from her treating physician, Dr. Arthur Tullidge. Based on this evidence, VPA determined that Cooper was eligible for disability benefits under § 2(q)(ii), effective September 23, 2004.
On September 19, 2005, VPA again contacted Cooper regarding continuing eligibility for disability benefits, under § 2(q)(iii) of the Plan. The § 2(q)(ii) period of benefits would end on March 25, 2006, and VPA gave Cooper the opportunity to present any other diagnoses by any other treating physicians. Section 2(q)(iii) imposes a stricter standard for eligibility than those in §§ 2(q)(i) and (ii), requiring a participant to demonstrate that she is unable to perform âany occupation for which he is or may become qualified by reason of his education, training or experienceâ â not just the participantâs âUsual Occupationâ or âOwn Occupation.â Additionally, VPA notified Cooper that, unlike under §§ 2(q)(i) and (ii), under § 2(q)(iii) nervous or mental disorders are disregarded in the determination of the participantâs disability-
In support of her claim for benefits under § 2(q)(iii), Cooper submitted medical documentation from several physicians and other medical professionals relating to procedures she underwent to treat her chronic back pain and resulting pain management procedures. On November 1, 2005, Dr. James Rose, a neurosurgeon who examined Cooper following her October 19, 2005 anterior cervical discectomy and fusion surgery, remarked that Cooperâs neck and hand were healing well and that Cooperâs
VPA ordered an independent medical evaluation before determining whether to grant or deny benefits to Cooper under § 2(q)(iii). Dr. Andres H. Keichian, a neurologist, conducted the independent medical evaluation. In his April 19, 2006 report, Dr. Keichian found that Cooper had a moderate range of motions limitation of the cervical and lumbar spine. In evaluating her physical capabilities, Dr. Keichian determined that Cooper was able to stand, walk, sit, and drive for up to four hours each per day for one hour each at a time; occasionally to lift up to 10 pounds, bend, squat, crawl, reach above shoulder level, and fine manipulate with both hands; and frequently to push/pull and simple grasp with both hands. VPA also referred Cooperâs file, including Dr. Keichianâs report, to a vocational specialist, Renee Lange. Lange used Cooperâs medical history, including the physical capabilities determined by Dr. Keichian, to identify jobs in Cooperâs geographic area that Cooper could perform notwithstanding her physical restrictions. Based on this information, Lange identified three positions' â ⢠program manager, computer operations manager, and department manager â that Cooper could perform and that would not require sitting or standing for more than an hour at a time and allowed for alternating positions. Furthermore, Lange noted these occupations allowed for modifications such as a sit/stand workstation.
On July 19, 2006, VPA denied Cooperâs claim for benefits under § 2(q)(iii).
On February 13, 2007, Cooper appealed VPAâs decision. In support of her appeal, Cooper submitted further medical documentation from Dr. Rose. This documentation included a November 28, 2006 note in which Dr. Rose remarked that the âfusion of course [was] healing pretty well at [Cooperâs] C5-C6 and C6-C7â discs. He also commented, however, that Cooper âcontinuefd] to have some discomfort and neck pain which was aggravated by [her] work.â Dr. Rose stated that while the discs that had been operated upon were healing well, Cooper had âdegenerative disc disease at other levels above and below the fusionâ and that he thought this problem was giving Cooper pain to the point where she was âdisabled from [her] work.â He commented that he thought Cooper had a âsignificant physical disabilityâ and that her condition âhas prevented [her] from doing any meaningful work, especially doing [her] usual work, which is working at a computer and the like and writing.â Dr. Rose concluded that Cooper â[had] found that [she could] not work because of the increased pain.â
Additional notes submitted from Dr. Tullidge, Cooperâs treating physician, dated March 21, 2006, stated that Cooper would âstart [working at the] jewelry store next week,â that Cooperâs condition was âstable,â and that Cooper was ânot happy about ending of long term disability.â In notes from April 21, 2006, Dr. Tullidge commented that Cooper was âworking part time,â âexperiencing pain,â and âtolerating] med[ieation]s.â On June 28, 2006, Dr. Tullidge noted that Cooper was âworking part time (25 hours [per week])â and made no reference to any complaints of pain on the part of Cooper. On September 18, 2006, Cooper saw Dr. Are, one of her pain management providers, for an examination following an epidural injection to reduce pain. Dr. Are documented that Cooper had âincreased pain and pain going down her left thigh to her knee.â Dr. Are remarked that Cooper was in no acute distress and had intact reflexes. Dr. Are examined Cooper again on October 30, 2006. On that date, Cooper ranked her pain as a 4/10. Dr. Are again documented that Cooper was in no acute distress and had intact reflexes, and commented that she had some tenderness in the low lumbosacral region as well as painful flexation. Dr. Are scheduled Cooper for a caudal epidural steroid injection which was performed the following day, October 31, 2006.
At a January 18, 2007 follow-up visit with Dr. Are after the epidural injection, Cooper reported that pain control following the injection did not last very long, and that her pain was currently at the 4-5/10. During another examination by Dr. Are on February 12, 2007, Cooper ranked her pain as currently at 5/10. Dr. Are remarked that Cooper was working at a jewelry store as a sales clerk and was abiding by her restrictions of âno prolonged sitting or standing for more than 20-30 minutes.â He noted that Cooper was in chronic pain due to disc bulges in her thoracic and lumbar spine, that he âstrongly doubt[ed]â she was able to work on a full-time basis, and that she was âvery restrictedâ in her abilities and mobility due to her âchronic disablingâ pain from disc disease.
VPA requested and received copies of Cooperâs pay stubs from her employment as a sales clerk at the jewelry store. The pay stubs indicated that Cooper had been working between 28.44 to 92.61 hours at Ben Bridge Jewelers per two-week pay
On May 16, 2007, VPA denied Cooperâs claim on appeal. The denial letter noted Cooperâs examination by Physicians Assistant Lyons when Cooper reported that her symptoms were much better and ranked her pain level at 2/10. The letter further stated that VPA had attempted to contact Dr. Keichian following Cooperâs request that VPA clarify information with him, but that Dr. Keichian had not responded to VPAâs repeated requests for information. VPA did repeatedly note that the fact that Cooper was actually working supported its conclusion that Cooper could not establish her inability to perform âany occupationâ as required to qualify for continuing benefits under the Plan. On May 23, 2007, apparently in response to VPAâs earlier request, Dr. Keichian sent a four-sentence letter to VPA, stating that â[t]he primary diagnoses of Mrs. Cooper that impair her ability to work are cervical laminectomy and fusions, persistent spinal pain, and bipolar disease. She also has a retroperitoneal tumor resected, of unclear prognosis. In view of her medical pathology, Cooper is totally disabled and unable to be gainfully employed.â
Cooper filed this action against the Plan on September 6, 2007. The district court granted summary judgment in favor of the Plan on January 14, 2009. Reviewing VPAâs decision under the abuse of discretion standard, the district court rejected Cooperâs position that VPA had shifted the grounds for denying Cooperâs claim. The district court noted that, while VPA weighed Cooperâs new employment as strong evidence that Cooper did not meet the § 2(q)(iii) standard, Cooper lost her appeal on the same specific grounds as she lost the initial claim: her improved medical condition. The district court determined that substantial evidence supported VPAâs denial of Cooperâs claim for disability benefits, finding that no doctor had opined that Cooper was unable to perform âany occupationâ within the meaning of § 2(q)(iii). The district court highlighted the vocational specialistâs finding that Cooper was capable of performing three occupations, and the fact that Cooper herself reported feeling better and planning to lose weight and look for a job. That Cooper did begin employment a few months later, the district court found, tended to confirm that VPA was correct in relying on the signs of improvement shown by the vocational specialistâs report and on Cooperâs statements about her medical improved condition. Cooper timely appealed.
II.
âStandard summary judgment rules control in ERISA cases.â Vercher v. Alexander & Alexander Inc., 379 F.3d 222, 225 (5th Cir.2004). This Court reviews a district courtâs grant of summary judgment de novo, applying the same standards as the district court. Strong v. Univ. Healthcare Sys., L.L.C., 482 F.3d 802, 805 (5th Cir.2007). Under de novo review, we âreview the Planâs decision from the same perspective as did the district court, and we directly review the Planâs decision for an abuse of discretion.â Meditrust Fin. Servs. Corp. v. Sterling Chems. Inc., 168 F.3d 211, 214 (5th Cir.1999)
When an ERISA benefits plan provides the plan administrator with discretionary authority to construe the terms
III.
First, Cooper argues that she was denied the full and fair review mandated by § 1133(2) of ERISA because VPA did not provide review of its specific basis for rejecting her claim. 29 U.S.C. § 1133(2). To comply with the âfull and fair reviewâ requirement in deciding benefit claims under ERISA, a claim administrator must provide the specific grounds for its benefit claim denial. Robinson v. Aetna Life Ins. Co., 443 F.3d 389, 393 (5th Cir.2006). Challenges to ERISA procedures are evaluated under the substantial compliance standard.
Cooperâs claim that VPA changed its basis for denying her claim on appeal is without merit. VPAâs basis for denying Cooperâs claim on appeal was the very same as its original basis: the fact that her medical evidence failed to establish that she was incapable of employment.
Cooper, however, contends that VPA changed its original grounds for denying her claim when, on administrative appeal, VPA referenced Cooperâs subsequently acquired part-time job â instead of referring exclusively to the medical and non-medical evidence the Administrator relied upon in the original denial of benefits. To support this position, Cooper relies on this Courtâs decision in Robinson, in which this Court held that âsection 1133 requires an administrator to provide review of the specific ground for an adverse benefits decision.â
Cooperâs interpretation of Robinson is mistaken, and provides the Court with the opportunity to highlight the significant differences between the bait and switch tactic at issue in Robinson, and the honest, fair, and full review Cooper received here, with VPA. Cooperâs argument that Robinson applies is misplaced because although the VPA mentioned a new, additional fact that the Administrator had not considered in the initial denial of her claim (this new fact
Thus, while the Court agrees with Cooper that Robinson mandates that as a claimant, she âbe specifically notified of the reasons for an administratorâs decisionâ regarding the denial of her application (443 F.3d at 393), the Court disagrees with Cooper that she was not notified of the specific reasons supporting the Administratorâs decision in her case. The present case does not contain the bait and switch tactic this Court was presented with in Robinson.
The dissent mistakenly reads our precedent in both Robinson and Lafleur v. La. Health Serv. & Indem. Co., 563 F.3d 148 (5th Cir.2009), as requiring us to conclude that Cooper did not receive a âfair and full review.â As support for this proposition, the dissent cites VPAâs review letter on appeal, specifically the sentence: âAs a result, Ms. Cooper does not meet the any occupation definition of disability noted above.â According to the dissent, VPAâs use of â[a]s a result,â following its discussion of Cooperâs employment, indicates that the basis for VPAâs decision on appeal changed from Cooperâs ability to maintain employment to the fact that she is maintaining employment. Such a shift does not indicate a shift in the basis that first formed VPAâs decision, but rather, highlights two different aspects of the same basis for denying Cooperâs claim: her ability to maintain employment. The shift in language the dissent points to constitutes nothing more than a technical noncompliance. In both Robinson and Lafleur, this Court recognized that such a âtechnical noncompliance with ERISA procedures will be excused so long as the purpose of section 1133 has been fulfilled.â Lafleur, 563 F.3d at 154 (quoting Robinson, 443 F.3d at 393).
In the present case, there can be no doubt that âthe purpose of section 1133 has been fulfilled.â Id. âThe purpose of
Here, Cooper received notice that her claim was denied because VPA considered her capable of employment. It should come as no surprise that on appeal, VPA would consider her employment to be an affirmation that its original assessment of the medical evidence was correct. Because VPAâs initial reason for denying Cooperâs claim was the conclusion that her medical evidence indicated she was capable of employment, we cannot read § 1133(2) to require VPA to blind itself to the fact that Cooper, on appeal, is arguing she cannot maintain employment â while simultaneously maintaining employment. It is an insurmountable challenge to imagine just how requiring Administrators to ignore the disability claimantâs medical records mentioning a claimantâs current employment would serve to resolve a dispute before it reaches the district court.
That is, were we to agree with the dissent and send Cooperâs claim back to VPA based on the dissentâs analysis, we would be sacrificing the true statutory purpose behind section 1133âs âfair and full reviewâ for an unfortunate adherence to counterproductive technicalities. To attribute such a flawed reading to § 1133(2) would make a mockery of ERISAâs âfull and fair reviewâ and undermine the integrity of the administrative process as whole.
Where the evidence of subsequently acquired employment merely serves to support the Administratorâs original decision to deny the claimantâs claim based on the medical evidence contained within the record, we decline to interpret 29 U.S.C. § 1133(2) as requiring VPA to blind itself to the fact that the claimant is asserting she cannot maintain employment and simultaneously maintaining employment. Cooper had an adequate and fair opportunity to put forth evidence demonstrating that she cannot maintain âany occupationâ as required under § 2(q)(iii) of the Plan. The record reveals that she failed to adequately do so.
IV.
Cooper also contends that there is no âconcrete evidenceâ to support VPAâs finding that she not unable to perform âany occupation,â as required by § 2(q)(iii) of the Plan.
Support for the plaintiffs claim is not controlling because we must defer to the administratorâs decision if the plan administratorâs denial is supported by substantial evidence. Ellis, 394 F.3d at 273 (âWe are aware of no law that requires a district court to rule in favor of an ERISA plaintiff merely because he has supported his claim with substantial evidence, or even with a preponderance.â). VPAâs conclusion that Cooper is not disabled as defined in § 2(q)(iii) of the Plan is supported by substantial evidence. Lange, the vocational specialist, found that Cooper was able to perform three occupations based on the physical activities that Dr. Keichian found her capable of performing: program manager, computer operations manager, and department manager. Furthermore, Dr. Are noted significant improvements in Cooperâs condition and acknowledged Cooperâs ability to perform part-time work. The letter denying Cooperâs claim on appeal noted that Cooper had to establish she was disabled, under § 2(q)(iii) of the Plan, by March 25, 2006, the day her initial period of disability benefits under another part of the Plan, § 2(q)(ii), ended. Approximately three months before the date on which Cooper needed to qualify for benefits under § 2(q)(iii), Lyons noted that she had been able to decrease all medications, had started an exercise regimen, planned to lose weight, and was looking for a job.
Cooperâs claims that no âconcrete evidenceâ supports VPAâs conclusion is even further undermined by the fact that Dr. Tullidge, her own treating physician, stated on March 21, 2006 that she would âstart [working at the] jewelry store next week,â that Cooperâs condition was âstable,â and that Cooper was ânot happy about ending of long term disability.â In notes from April 21, 2006, Dr. Tullidge commented that Cooper was âworking part time,â âexperiencing pain,â and âtoleratfing] med[ication]s.â On June 28, 2006, Dr. Tullidge noted that Cooper was âworking part time (25 hours [per week])â and made no reference to any complaints of pain on the
Thus, we conclude that the record contains substantial evidence to support VPAâs conclusion that Cooper did not meet the definition of âTotal Disabilityâ since following the termination of her benefits under § 2(q)(ii) of the Plan, she was not unable to perform âany occupationâ as required by § 2(q)(iii).
V.
Based on the foregoing analysis, the judgment of the district court upholding the administratorâs denial of benefits is
AFFIRMED.
. Up until that point, the Plan had consistently paid Cooper her short-term disability benefits for twenty-four months, pursuant to Sections 2q(i) and (ii) of the Plan. Thus, Cooperâs disability payments terminated on March 24, 2006.
. The parties do not dispute that VPA, the Planâs administrator, has discretionary authority to construe the terms of the Plan. Cooper argues in her brief that the abuse of discretion standard applicable to administrators with discretionary authority may be altered in light of Metropolitan Life Ins. Co. v. Glenn, - U.S. -, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). However, Glenn addressed only the standard of review employed when the administrator has a conflict of interest, i.e. where a plan administrator "both evaluates claims for benefits and pays benefits claims.â 128 S.Ct. at 2348. Here, as Cooper conceded, there is no conflict of interest because H-P employs VPA â a contract administrator â to evaluate claims under the Plan. Therefore, the Courtâs holding in Glenn does not affect the standard of review employed in this instance.
. Given the fact that we review VPAâs decision on appeal under the substantial compliance standard, we are puzzled as to why the dissent attempts to cast the Courtâs decision as a review for harmless error. In contrast to the dissentâs assertion that we have reviewed Cooper's appeal for "any grounds in the record to support the judgmentâ Mangaroo v. Nelson, 864 F.2d 1202, 1204 n. 2 (5th Cir.1989), a more thorough review of the analysis contained herein clearly demonstrates that VPA's decision on appeal has been reviewed in full compliance with the correct standard. See Lacy, 405 F.3d at 257 (holding that "the substantial compliance standardâ is the appropriate standard of review). It is under this substantial compliance standard of review that we conclude that Cooper did receive a "full and fair reviewâ of the VPAâs initial determination that her medical condition did not qualify as a "Total Disabilityâ under the Plan.
. The definition of "Total Disabilityâ requires Cooper to demonstrate that, due to her alleged medical condition, she "is continuously
. Thus we consider it important to note that VPAâs initial assessment of Cooper's condition was not an assessment of medical records alone. In addition to the medical records from her doctors, VPA consulted with a vocational specialist. Based on the vocational specialistâs review that Cooper was capable of performing several different occupations, coupled with her medical records, VPA concluded that Cooper was "capable of performing other occupations for which [she was] or could become qualified as of March 25, 2006.â
. Cooper, however, is mistaken in her assertion that VPA relied on her recently acquired employment as the "specific groundsâ for affirming the Administratorâs decision. While the review letter did highlight the fact that Cooper had subsequently acquired employment, the review letter first discussed, in great detail, the significance of the medical records that alone initially supported the Administratorâs denial of Cooper's claim. The review letter noted that Cooper had to establish she was disabled, under § 2(q)(iii) of the Plan, by March 25, 2006, the day her initial period of disability benefits ended. The letter then noted that on January 9, 2006, less than three months before the date she needed to qualify for long term disability under 2(q)(iii) of the Plan, she was evaluated by the Anderson Cancer Center and was assessed as feeling decreased symptoms, requiring less medication, undertaking an exercise regimen, and looking for employment. The review letter stated that at that time, Cooper reported her "symptoms were much betterâ and her pain was only a 2/10. It is with great import that we note that VPA did not discuss Cooper's employment until after first discussing the significance of the medical evidence on record that established Cooper was capable of employment as of January, 2006 â prior to any recorded employment.
. In Robinson, the Court concluded that the procedural requirements of § 1133 were not met where the plaintiff was initially denied disability benefits on the grounds that his vision had improved sufficiently, but was subsequently denied benefits on appeal on different grounds â namely that good vision was not necessary to meet the definition of "capable of employmentâ under that plan. 443 F.3d at 393.
. Cooper argues that "any occupation for which [Cooper] is or may become qualified by reason of [her] education, training or experience,â the language used in § 2(q)(iii) of the Plan, should not include the ability to perform part-time work such as the work she performed at the jewelry store. However, there is no such restriction in the Plan. See Dramse v. Delta Family-Care Disability and Survivor-ship Plan, 269 Fed.Appx. 470, 481 (5th Cir. March 12, 2008) (affirming the district court's holding that the term "any occupationâ included part-time work); Doyle v. Paul Revere Life Ins. Co., 144 F.3d 181 (1st Cir.1998) (holding that claimant's ability to perform part time work precluded him from establishing that his disability prevented him from engaging in "any occupation for which he is or may become suited by education, training or experienceâ). Even if the Plan language would not apply to part-time work, there is evidence in the record, namely the analysis of the vocational consultant, that Cooper could perform work for eight hours a day in alternating positions.