United States District Court, S.D. West Virginia, Charleston Division
VAUGHN T. SIZEMORE, Plaintiff,
NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY, et al., Defendants.
MEMORANDUM OPINION AND ORDER
E. JOHNSTON, CHIEF JUDGE
this Court are cross-motions for summary judgment filed by
Plaintiff Vaughn T. Sizemore (“Plaintiff”), (ECF
No. 19), and Defendant Northwestern Mutual Life Insurance
Company (“Defendant”), (ECF No. 21). For the
reasons explained more fully herein, Plaintiff's motion,
(ECF No. 19), is DENIED. Defendant's
motion, (ECF No. 21), is GRANTED.
brings this action pursuant to the Employee Retirement Income
Security Act (“ERISA”), 29 U.S.C. § 1001,
et seq. (See ECF No. 1.) He alleges that
Defendant improperly discontinued his disability benefits,
which he received under a group insurance plan he obtained
through his former employer. (See id.) Plaintiff is
an attorney who, at the time he filed his claim for
disability benefits on February 17, 2012, was employed at a
law firm that sponsors the plan at issue in this case.
(See ECF No. 20 at 5; ECF No. 22 at 5.) Plaintiff
filed a claim for disability benefits after his billable
hours-and in turn, his overall compensation-decreased
significantly. (ECF No. 20 at 6, 17-18; ECF No. 22 at 8.) His
claim was approved on April 23, 2012, and he continued to
receive benefits until approximately June 22, 2015. (ECF No.
20 at 6, 9; ECF No. 22 at 9, 12.) In the interim, Plaintiff
resigned from the law firm and on January 20, 2015, began
full-time employment as an attorney in state government. (ECF
No. 22 at 11.)
submitted an internal appeal of Defendant's decision to
cease his disability benefits on July 1, 2015. (ECF No. 20 at
9-10; ECF No. 22 at 12.) Defendant upheld its decision on
December 15, 2015, after informing him on October 13, 2015,
that he did not qualify for benefits under any of the
plan's definitions of disability. (ECF No. 20 at 15-16;
ECF No. 22 at 14-15, 16.) On January 21, 2016, Plaintiff
requested a review of the December 15, 2015 decision, but
Defendant denied his request. (ECF No. 20 at 18-19; ECF No.
22 at 17.) Plaintiff then brought suit against Defendant on
January 23, 2017. (ECF No. 1.)
filed his motion for summary judgment on January 14, 2019.
(ECF No. 19.) Defendant filed a timely response, (ECF No.
24), and Plaintiff filed a timely reply, (ECF No. 25).
Defendant filed its motion for summary judgment on January
14, 2019. (ECF No. 21.) Plaintiff filed a timely response,
(ECF No. 23), and Defendant filed a timely reply, (ECF No.
26). As such, the motions for summary judgment are fully
briefed and ripe for adjudication.
judgment is appropriate when the moving party “shows
that there is no genuine dispute as to any material fact and
the movant is entitled to judgment as a matter of law.”
Fed.R.Civ.P. 56(a). “A fact is material when it
‘might affect the outcome of the suit under the
governing law.'” Strothers v. City of
Laurel, 895 F.3d 317, 326 (4th Cir. 2018) (quoting
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
(1986)). “A genuine dispute arises when ‘the
evidence is such that a reasonable jury could return a
verdict for the non-moving party.'” Id.
(quoting Anderson, 477 U.S. at 248). “Thus, at
the summary judgment phase, the pertinent inquiry is whether
there are any genuine factual issues that properly can be
resolved only by a finder of fact because they may reasonably
be resolved in favor of either party.” Variety
Stores, Inc. v. Wal-Mart Stores, Inc., 888 F.3d 651, 659
(4th Cir. 2018) (alteration and internal quotation marks
burden is on the nonmoving party to show that there is a
genuine issue of material fact for trial . . . by offering
‘sufficient proof in the form of admissible
evidence' . . . .” Guessous v. Fairview Prop.
Invs., LLC, 828 F.3d 208, 216 (4th Cir. 2016). In ruling
on a motion for summary judgment, this Court “view[s]
the facts and all justifiable inferences arising therefrom in
the light most favorable to the nonmoving party.”
Jones v. Chandrasuwan, 820 F.3d 685, 691 (4th Cir.
2016) (quoting Libertarian Party of Va. v. Judd, 718
F.3d 308, 312 (4th Cir. 2013)).
Applicable Standard of Review
initial matter, the parties disagree about the appropriate
standard of review this Court should apply to Defendant's
adverse benefit determination with respect to Plaintiff's
claim for disability benefits under the plan.
(Compare ECF No. 22 at 17-18, with ECF No.
25 at 6.) This Court's review “turns on whether the
benefit plan at issue vests the administrator with
discretionary authority.” Helton v. AT&T
Inc., 709 F.3d 343, 351 (4th Cir. 2013) (citing
Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101, 115 (1989); Woods v. Prudential Ins. Co. of
Am., 528 F.3d 320, 321-22 (4th Cir. 2008)).
Specifically, this Court “reviews challenges . . . for
denial of benefits ‘under a de novo standard
unless the benefit plan gives the administrator . . .
discretionary authority to determine eligibility for benefits
or to construe the terms of the plan.'”
Plotnick v. Comput. Scis. Corp. Deferred Compensation
Plan for Key Execs., 875 F.3d 160, 165 (4th Cir. 2017)
(quoting Firestone, 489 U.S. at 115). If the plan
vests such discretionary authority with the administrator,
this Court “evaluates the plan administrator's
decision for abuse of discretion.” Williams v.
Metro. Life Ins. Co., 609 F.3d 622, 629-30 (4th Cir.
2010) (citing Champion v. Black & Decker (U.S.)
Inc., 550 F.3d 353, 359 (4th Cir. 2008); Ellis v.
Metro. Life Ins. Co., 126 F.3d 228, 232 (4th Cir.
1997)). “[N]o specific words or phrases are required to
confer discretion, but . . . a grant of discretionary
authority must be clear.” Cosey v. Prudential Ins.
Co. of Am., 735 F.3d 161, 165 (4th Cir. 2013).
argues that the plan at issue grants it “broad
discretionary powers.” (ECF No. 22 at 17-18.) Indeed,
the plan provides that Defendant “has full and
exclusive authority to control and manage the [plan], to
administer claims, and to interpret the [plan] and resolve
all questions arising in the administration, interpretation,
and application of the [plan].” (ECF No. 18-1 at 33.)
This Court has previously held identical language sufficient
to accord discretionary authority with the plan administrator
and to warrant abuse-of-discretion review. Caldwell v.
Standard Ins. Co., No. 2:14-cv-25242, 2015 WL 5031485,
at *2-*3 (S.D. W.Va. Aug. 25, 2015) (Copenhaver, J.) (citing
Hankins v. Standard Ins. Co., 677 F.3d 830, 835 (8th
Cir. 2012); Fleisher v. Standard Ins. Co., 679 F.3d
116, 122 (3d Cir. 2012); Black v. Long Term Disability
Ins., 582 F.3d 738, 744 (7th Cir. 2009)); see
Dutkewych v. Standard Ins. Co., 781 F.3d 623, 633 (1st
Cir. 2015); McKeehan v. Cigna Life Ins. Co., 344
F.3d 789, 792 (8th Cir. 2003); McCready v. Standard Ins.
Co., 417 F.Supp.2d 684, 696 (D. Md. 2006). The plan also
gives Defendant “[t]he right to determine . . .
[claimants'] eligibility for insurance” and
“entitlement to benefits.” (ECF No. 18-1 at 99.)
Plaintiff contends that Defendant's failure to consider
his appeal of the adverse benefit determination made in
December 2015 entitles him to de novo review. (ECF
No. 25 at 6. But see ECF No. 20 at 19 (“[T]he
standard of review is abuse of discretion.”).) Whether
Defendant complied with its obligation to award Plaintiff
“a full and fair review” of the denial of his
claim for benefits, 29 U.S.C. § 1133(2), has no effect
on the applicable standard of review because Defendant
“must comply with these procedural guidelines”
“[u]nder either standard of review.” Hall v.
Metro. Life Ins. Co., 259 Fed.Appx. 589, 593 (4th Cir.
2007). Accordingly, because the plan under which Plaintiff