GRUENDER, Circuit Judge.
Nancy Kecso sued her employer, Meredith Corporation, seeking to overturn Meredith's decision to discontinue the long-term disability benefits that she had been receiving after being diagnosed with a brain tumor. On cross-motions for summary judgment, the district court denied Meredith's summary judgment motion but granted Kecso's and subsequently awarded her a money judgment. Meredith appeals, and we reverse.
Kecso began working for Meredith in 2001. In November 2002, Kecso suffered a seizure and was hospitalized. Scans taken that day revealed that Kecso had a tumor in her brain above her pituitary gland. In January 2003, doctors at the Mayo Clinic diagnosed the tumor as a benign astrocytoma. They recommended no treatment other than anti-seizure medication. Since her seizure, Kecso has had recurrent headaches, body aches and fatigue.
After the seizure, Kecso returned to work for a brief period in December 2002. Meredith subsequently granted Kecso leave under the Family Medical Leave Act. In February 2003, Kecso began receiving short-term disability benefits and then long-term disability ("LTD") benefits beginning in June 2003. The record is silent as to whether Meredith expressly determined that Kecso qualified for LTD benefits under its disability plan or whether Meredith simply decided to pay Kecso LTD benefits while attempting to ascertain her eligibility for them. Meredith both insures and administers its disability benefits plan, which is subject to the Employee Retirement Income Security Act ("ERISA"). Under the plan, Meredith has discretion to interpret the terms of the plan and to determine eligibility for benefits.
Kecso regularly saw a neurologist, Dr. David Friedgood, beginning in late 2002. In early December 2002, Dr. Friedgood certified to Meredith that Kecso's only medical restriction was "no driving." Later
Under Meredith's disability benefits plan, participants are required to provide all information that Meredith considers to be relevant to its disability determination on a continuing basis in order for the participants to maintain eligibility for benefits. Despite having signed an authorization to release all of her medical records to Meredith, Kecso balked at the release of notes related to her psychiatric and psychotherapy visits, ultimately refusing to release the notes of her psychotherapy sessions. Because Meredith believed that those notes were relevant and might explain inconsistencies in Kecso's other medical records, Meredith suspended Kecso's LTD benefits in February 2004. In March 2004, Kecso wrote to Meredith objecting to the suspension, and Meredith treated her letter as an administrative appeal under the plan.
From February through June 2004, while Kecso's administrative appeal was pending, the parties argued about the relevance of Kecso's mental health records to her eligibility for LTD benefits under the plan. Kecso insisted that they were irrelevant to her disability status, and Meredith sought to review them in an effort to reconcile inconsistencies in Kecso's other medical records, particularly with respect to Dr. Friedgood's inconsistent opinions regarding Kecso's ability to work and whether her tumor was causing her headaches and fatigue. Ultimately, the parties agreed that Meredith would evaluate Kecso's eligibility for LTD benefits without considering Kecso's mental health. In March 2004, in the course of these discussions, Kecso requested a complete copy of her claim file. Meredith enclosed a copy of her claim file with its June 18, 2004 letter to Kecso's attorney informing him of Meredith's determination that Kecso was not disabled within the meaning of the plan.
Kecso sought review in district court, where the parties filed cross-motions for summary judgment. The district court granted Kecso's motion and denied Meredith's, finding that Meredith's decision was not entitled to review under the plan's abuse of discretion standard and that the evidence, when viewed on a standard "approaching de novo review," established that Meredith wrongfully denied Kecso's claim for LTD benefits. The district court subsequently awarded a judgment of $42,398.00 to Kecso, representing unpaid benefits through the date of the district court's judgment and prejudgment interest. Meredith appeals the district court's summary judgment rulings.
We review an appeal from a grant of summary judgment de novo, viewing the evidence in a light most favorable to the nonmoving party. Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir.1998). Where, as here, an ERISA plan gives an administrator discretionary authority to determine eligibility for benefits, a district
The district court found that Meredith's roles as employer, insurer and plan administrator established a conflict of interest. We assume without deciding that Meredith had a palpable conflict of interest satisfying the first prong of Woo.
The district court also held that under the first prong of Woo, Meredith acted without proper judgment by failing to give appropriate weight to Dr. Friedgood's opinions and by initially paying LTD benefits and subsequently denying them based substantially on the same evidence. It then held that Meredith's failure to use proper judgment established the causal connection required under Woo's second prong. We do not agree that Meredith acted without proper judgment.
The district court concluded that Meredith failed to exercise proper judgment because "Meredith disregarded Dr. Friedgood's opinions that Kecso's pain, headaches, and fatigue were due to her astrocytoma despite his credentials as a neurologist . . . and the fact that he treated Kecso for over two years, from the time her tumor was diagnosed, before Meredith terminated her LTD benefits." Meredith did not disregard Dr. Friedgood's opinions. The record amply demonstrates that from March 2003 through June 2004, with two exceptions, Dr. Friedgood repeatedly certified to Meredith that Kecso had no medical restrictions. The first exception arose in a December 31, 2003 letter from Dr. Friedgood to Meredith stating, "[a]s a result of [Kecso's] condition she suffers from chronic headaches and excessive fatigue. She has been unable to return to her job because of these symptoms." Less than two months earlier, Dr. Friedgood had written to Kecso's primary physician that "[Kecso] continues to complain of chronic fatigue and a number of sensory complaints, the exact etiology of which is unknown." The record reveals no explanation as to how or why Dr. Friedgood's opinion about the causation of Kecso's sensory complaints changed in those two months. The second exception was Dr. Friedgood's medical certification to Meredith on February 4, 2004, in which he said, "[Kecso] is limited by her affective and cognitive response to her brain tumor. She finds it difficult to function and can not work because of these symptoms." In the letter reporting its decision to discontinue Kecso's LTD benefits, after recounting both Dr. Friedgood's observations and other relevant evidence, Meredith reasonably concluded, "[T]he medical records contain inconsistencies that cause Meredith to question the accuracy with which she is self-reporting her symptoms." As in Pralutsky v. Metropolitan Life Insurance Co., "[t]his is not a case where the plan trustee failed to inquire into the relevant circumstances at issue, or never offered a written decision that can be reviewed, or committed irregularities so severe that the court `has a total lack of faith in the integrity of the decision making process.'" 435 F.3d 833, 838 (8th Cir.) (quoting Buttram, 76 F.3d at 900), cert. denied, ___ U.S. ___, 127 S.Ct. 264, 166 L.Ed.2d 151 (2006). We similarly conclude that Meredith did
We also do not agree with the district court's conclusion that Meredith did not use proper judgment in initially paying LTD benefits and subsequently denying them based substantially on the same evidence. While we are mindful that "unless information available to an insurer alters in some significant way, the previous payment of benefits is a circumstance that must weigh against the propriety of an insurer's decision to discontinue those payments," McOsker v. Paul Revere Life Insurance Co., 279 F.3d 586, 589 (8th Cir. 2002), we are not convinced that McOsker compels a finding here of failure to use proper judgment, nor are we convinced that Meredith failed to use proper judgment under these circumstances, see id. ("We are not suggesting that paying benefits operates forever as an estoppel so that an insurer can never change its mind. . . ."). To the contrary, the record suggests that Meredith simply agreed to pay LTD benefits to Kecso while it sought to reconcile the conflicting medical information by obtaining all of Kecso's relevant medical records. Kecso's refusal to provide the psychotherapy records that might have revealed whether her symptoms were related to her tumor frustrated Meredith's investigation.
Because we find no basis warranting a review of Meredith's decision on a standard less deferential than abuse of discretion, the district court erred by failing to review Meredith's benefits decision on an abuse of discretion standard.
We now turn to the merits of Meredith's denial of Kecso's claim for LTD benefits. See Rittenhouse v. United-Health Group Long Term Disability Ins. Plan, 476 F.3d 626, 629-32 (8th Cir.2007) (holding that the district court erred in
Viewing the evidence in the light most favorable to Kecso, see Layes, 132 F.3d at 1251, Meredith did not abuse its discretion in determining that Kecso was not disabled under the plan. In order to be eligible for LTD benefits, Meredith's plan requires a finding that due to an illness or injury, Kecso was unable to perform the material duties of her regular occupation and would be unable to perform similar duties at any other employer. The only evidence suggesting that Kecso was unable to work can be found in Dr. Friedgood's statements in late 2003 and early 2004 that Kecso "is limited by her affective and cognitive response to her brain tumor. She finds it difficult to function and can not work because of these symptoms" and that she "is disabled by her subjective complaints of headache, fatigue, cognitive complaint." Against this and in support of Meredith's determination, both Dr. Friedgood and Dr. Corey Raffel at the Mayo Clinic released Kecso to return to work without restrictions in early 2003. Dr. Friedgood subsequently certified that Kecso had "no medical restrictions" in March, May, August, October and December of 2003. In November 2003, Dr. Friedgood wrote to Kecso's primary physician that "[Kecso] continues to complain of chronic fatigue and a number of sensory complaints, the exact etiology of which is unknown." In March 2004, in an effort to clarify Kecso's disability status, Meredith's corporate medical director conducted a telephone interview of Dr. Friedgood in which Dr. Friedgood admitted that Kecso had no medical restrictions and appeared to function well at home. Dr. Friedgood stated that he had no objections to Kecso's returning to work on a part-time basis. There is no evidence in the record explaining Dr. Friedgood's vacillating opinion, and the medical records from Kecso's late 2002 and early 2003 visits to the Mayo Clinic suggest that her tumor was not disabling. See Smith, 305 F.3d at 795 ("Where the record reflects conflicting medical opinions, the plan administrator does not abuse his discretion in finding that the employee is not disabled."). Viewing the evidence in the light most favorable to Kecso and applying an abuse of discretion standard of review, we conclude that Meredith's decision to terminate Kecso's LTD benefits was reasonable in that it was supported by substantial evidence.
We reverse the district court's grant of summary judgment to Kecso and remand the case for entry of judgment in favor of Meredith.