United States District Court, S.D. West Virginia, Huntington Division
MEMORANDUM OPINION AND ORDER
C. CHAMBERS UNITED STATES DISTRICT JUDGE.
before the Court are the Motions for Summary Judgment
submitted by Defendants University Physicians & Surgeons,
Inc., Long Term Disability Plan (the “Plan”) and
Northwestern Mutual Life Insurance Company
(“Northwestern”),  and Plaintiff Genka
Popov. Plaintiff alleges, in her complaint,
claims against Defendants under only one cause of action:
violation of § 502 (a)(1)(B) of the Employee Retirement
Income Security Act (“ERISA”). See
Compl., ECF No. 1, at 6.
now move for summary judgment on the single count Plaintiff
has asserted against them, arguing that Northwestern's
decision to deny Plaintiff's claim for benefits is
entitled to deference, and its findings should not be
disturbed because of the reasonableness of its investigation.
See Mem. in Supp. of Defs.' Mot. for Summ. J.,
ECF No. 14, at 18-24. Plaintiff also moves for summary
judgment on its single count, arguing that Defendant
Northwestern is biased, failed to consider some of her
injuries, and was incorrect in determining that she is not
entitled to benefits. See Mem. in Supp. of Pl.'s Mot.
for Summ. J., ECF No. 12, at 8-17.
parties have fully briefed the issues and the motions are now
ripe for adjudication. As explained below, the Court
GRANTS Defendants' Motion for Summary
Judgment, and DENIES Plaintiff's Motion
for Summary Judgment.
worked for Marshall Health as a pathology technician,
preparing tissue slides. See ECF No. 11-2, at 186,
192-93. She ceased work on April 18, 2016, and sought
disability benefits under the Plan based on complaints of
carpal tunnel syndrome, neck pain, and back pain. See
Id. at 166, 180, 184. Defendant Northwestern evaluated
her medical records, consulted with a physician, and
determined that the medical testing and clinical examination
findings failed to support that Plaintiff satisfied the
Plan's definition of a “Disability.” See
Id. at 160-63.
February 2, 2017, Plaintiff, through counsel, timely
submitted an administrative appeal of Defendant
Northwestern's denial of her claim. See Id. at
147. In her appeal, for the first time, Plaintiff also
claimed to be disabled from a broken arm and other injuries
sustained in a fall during European travel on July 29, 2016,
more than three months after she stopped working for Marshall
Health. See Id. at 147-151. Defendant Northwestern
upheld its decision to deny her claim for multiple reasons.
See Id. at 126-135. Most relevant, Defendant
Northwestern found that, under the terms of the Plan,
Plaintiff's coverage terminated when she stopped working
and ceased to be a participating member, and thus her
injuries from the July 29, 2016, incident were irrelevant.
See Id. at 133.
2, 2017, more than one month after Defendant
Northwestern's appellate determination, Plaintiff faxed
to Defendant Northwestern a letter from Marshall Health,
dated April 6, 2017. See Id. at 122. In the letter,
Marshall Health stated that Plaintiff's employment
terminated August 1, 2016, and that her “employer paid
Long Term Disability benefit, through North Western Mutual,
ended as of 08/31/2016.” See Id. at 123.
Plaintiff did not request further administrative review of
her claim, and filed a complaint the following day, May 3,
2017, in the Southern District of West Virginia Case. See
Compl., at 5.
Northwestern then initiated and agreed to further
administrative review of Plaintiff's ongoing eligibility
for coverage under the Plan at the time of her fall on July
29, 2016. See Compl., at 5; ECF No. 1-4. Plaintiff
then dismissed her initial lawsuit and Defendant Northwestern
proceeded with a second administrative review, limited to
evaluating whether Plaintiff's Plan coverage remained in
force at the time of her fall on July 29, 2016. See
ECF No. 1-6. On September 28, 2017, Defendant Northwestern
advised Plaintiff that it was upholding the determination
that she was no longer covered under the Plan at the time of
her fall on July 29, 2016. See Id. Plaintiff then
re-filed her lawsuit on February 12, 2018, and all parties
filed their motions for summary judgment on June 12, 2018.
See Compl.; ECF Nos. 12, 13.
Standard of Review
Motion for Summary Judgment
obtain summary judgment, the moving party must show that no
genuine issue as to any material fact remains and that the
moving party is entitled to judgment as a matter of law.
Fed.R.Civ.P. 56(a). In considering a motion for summary
judgment, a court will not “weigh the evidence and
determine the truth of the matter[.]” Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). Instead,
a court will draw any permissible inference from the
underlying facts in the light most favorable to the nonmoving
party. Matsushita Elec. Indus. Co. v. Zenith Radio
Corp., 475 U.S. 574, 587-88 (1986). Any inference,
however, “must fall within the range of reasonable
probability and not be so tenuous as to amount to speculation
or conjecture.” JKC Holding Co. v. Wash. Sports
Ventures, Inc., 264 F.3d 459, 465 (4th Cir. 2001)
(citation omitted). Therefore, summary judgment will not be
granted if a reasonable jury could return a verdict for the
non-moving party on the evidence presented. See
Anderson, 477 U.S. at 247-48.
ERISA, courts must review an administrator's decision to
deny pension plan benefits de novo, unless the plan
itself confers discretionary authority upon the administrator
“to determine eligibility for benefits or to construe
the terms of the plan.” Firestone Tire and
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).
When an administrator possesses such discretion, courts may
review the eligibility determination only for an abuse of
discretion. See id; Barron v. UNUM Life
Ins. Co. of Am., 260 F.3d 310, 315 (4th Cir. 2001). In
considering whether an administrator abused its discretion,
the Fourth Circuit identified, in Booth v. Wal-Mart
Stores, Inc. Assoc. Health & Welfare Plan,
201 F.3d 335 (4th Cir. 2000), multiple non-exclusive
factors that a court may consider:
(1) the language of the plan; (2) the purposes and goals of
the plan; (3) the adequacy of the materials considered to
make the decision and the degree to which they support it;
(4) whether the fiduciary's interpretation was consistent
with other provisions in the plan and with earlier
interpretations of the plan; (5) whether the decisionmaking
process was reasoned and principled; (6) whether the decision
was consistent with the procedural and substantive
requirements of ERISA; (7) any external standard relevant to
the exercise of discretion; and (8) the fiduciary's
motives and any conflict of interest it may have.
201 F.3d at 342-43.