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Sizemore v. Northwestern Mutual Life Insurance Co.

United States District Court, S.D. West Virginia, Charleston Division

June 26, 2019




         Before 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.

         I. BACKGROUND

         Plaintiff 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.)

         Plaintiff 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.)

         Plaintiff 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.


         Summary 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 omitted).

         “The 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)).

         III. ANALYSIS

         A. Applicable Standard of Review

         As an 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).

         Defendant 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.)

         However, 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 ...

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