ELLIOTT v. SARA LEE CORPORATION, 1999 U.S. App. LEXIS 22093 (4th Cir. September 14, 1999)- Under a long-term disability plan, Elliott received benefits for a year due to her obesity and degenerative disc disease. Sara Lee then terminated Elliott's benefits, upon a finding that she could perform some sedentary work. This court affirmed the district court’s granting of Sara Lee’s motion for summary judgment.
Under the terms of the plan, the definition of total disability changes after the first year of disability from one requiring the employee to be unable to perform his/her job to one requiring the employee to be unable to "engage in each and every occupation or employment for wage or profit for which he or she is reasonably qualified by education, training or experience."
Before Elliot’s benefits were terminated, her doctor completed an Attending Physician's Statement in which he classified Elliott's physical impairment as moderate (35 to 55 percent) and found that she was capable of clerical or administrative activity. Several later doctors found varying degrees of impairment and varying prognoses for future improvement. Elliot argued, unsuccessfully, that other statements by her doctor, suggesting her inability to work full-time, created a fact issue sufficient to survive summary judgment.
The parties agreed that the proper standard of review was the abuse of discretion standard. "All proof submitted pursuant to this subsection must be acceptable to the administrator, which shall have sole discretion in determining the acceptability of such proof." Parties agreed this language granted discretion.
Pointing out that "the Fourth Circuit has held that it is not an abuse of discretion for a plan fiduciary to deny disability pension benefits where conflicting medical reports were presented," this court commented that "even if Dr. Liesegang's report suggested that Elliott could perform no work at all, that fact would not preclude the Plan Administrator from denying benefits."
Although Social Security Administration determinations of disability can be persuasive, this court found that Elliot’s SSA determination was not relevant, because there was no indication that the definition of "total disability" under the Plan in any way mirrored the relevant definition under the regulations of the SSA. Furthermore, the court declined to follow the "treating physician rule," suggesting that deference to a patient’s long-term physician could be outweighed by "persuasive contradictory evidence" provided by the several other physicians. Finally, the court found that Sara Lee was under no obligation to secure additional evidence from a vocational consultant regarding Elliot’s ability to perform work.
