Opinion
No. C03-32-LRR.
March 11, 2005
ORDER REGARDING MOTIONS FOR SUMMARY JUDGMENT
I. INTRODUCTION
On April 16, 2003, Plaintiff Joseph Alberts ("Alberts") filed a complaint against Defendant The Prudential Insurance Company of America ("Prudential") to recover short term disability benefits under an employee benefits plan provided by Alberts's employer, Dr. Pepper/Seven Up Bottling Group ("Dr. Pepper"). The court has subject matter jurisdiction over this dispute pursuant to 28 U.S.C. § 1331 in that Alberts's claim for benefits arises under ERISA, 29 U.S.C. § 1132(a)(1)(B).
The matter before the court is the Motion for Summary Judgment filed by Prudential (docket no. 24) and the Cross-Motion for Summary Judgment filed by Alberts (docket no. 27). The court held a hearing on these motions on September 1, 2004. Prudential was represented by attorney Paul Del Aguila and Alberts was represented by attorneys Robert Wilson and Kay Johansen. At the hearing, counsel for both parties agreed there was no need for a trial in this case, rather the motions for summary judgment are dispositive. The matter therefore is fully submitted and ready for decision.
The court notes Prudential filed a Motion to Strike Plaintiff's Cross Motion for Summary Judgment (docket no. 29). The parties agreed at the hearing on the motions for summary judgment this case can be resolved on summary judgment. The court finds Alberts's Motion for Summary Judgment to be helpful in resolving the issues involved in this case and therefore, in its discretion, denies Prudential's Motion to Strike.
II. FACTUAL BACKGROUND
At all times relevant to this case, Alberts was employed by Dr. Pepper as a Route Supervisor. Prudential issued to Dr. Pepper the Group Insurance Contract (the "Policy") that funded the ERISA benefits at issue. As an employee of Dr. Pepper, Alberts was covered by Dr. Pepper's Short Term Disability Plan (the "Plan"). Alberts was provided with a Summary Plan Description which described to Alberts the scope of coverage under the Plan.
Alberts states initially he had some problems obtaining a copy of the Summary Plan Description, but eventually he received it.
On September 18, 2002, Alberts applied for short term disability benefits ("STD benefits") under the Plan. In his application, Alberts represented to Prudential he was unable to continue working as a Route Supervisor, effective as of October 1, 2002, because he had discovered he had an enlarged aorta. Due to Alberts's condition, his cardiologist, Dr. Todd Noreuil, restricted him from lifting items weighing over 40 pounds and from engaging in strenuous activities.
The Plan defines the term "Disability" in pertinent part as follows:
During the elimination period, you are disabled when Prudential determines that:
• you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
• you are not working at any job.
After the elimination period, you are disabled when Prudential determines that:
• you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
• you have a 20% or more loss in weekly earnings due to the same sickness or injury.
Admin. Record at 00230. The Plan provides the "elimination period" for STD benefits is seven continuous days of disability due to sickness. Id. at 00229.
The Plan defines the term "material and substantial duties" to mean duties that:
• are normally required for the performance of your regular occupation; and
• cannot be reasonably omitted or modified, except that if you are required to work on average in excess of 40 hours per week, Prudential will consider you able to perform that requirement if you are working or have the capacity to work 40 hours per week.
Admin. Record at 00230.
The term "regular occupation" is defined in the Plan as "the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location." Id.
The Summary Plan Description provides:
The Prudential Insurance Company of America as Claims Administrator has sole discretion to interpret the terms of the Group Contract, to make factual findings, and to determine eligibility for benefits. The decision of the Claims Administrator shall not be overturned unless arbitrary and capricious.Id. at 00244.
On September 6, 2002, Alberts visited Dr. Todd Noreuil, a cardiologist, for evaluation of his widening aortic root. On that date, Dr. Noreuil diagnosed Alberts with an "enlarged aortic root by cardiac echo dated September 4, 2002." Id. at 00032. On September 18, 2002, Alberts applied for STD benefits under the Plan. In his application, Alberts represented to Prudential he would complete his last day of work on September 30, 2002. Alberts further represented he was unable to work because he had an enlarged aorta. Alberts stated his enlarged aorta interfered with his ability to perform his job as a Route Supervisor because his condition prevented him from lifting over 40 pounds, and his job required that he lift over 40 pounds on a somewhat regular basis. On September 19, 2002, Dr. Noreuil filed an "Attending Physician's Statement" with Prudential. Admin. Record at 00097-99. Dr. Noreuil indicated therein that he had diagnosed Alberts with an aortic root dilatation and had recommended that Alberts be placed on the following restrictions at work: "not to lift greater than 40 pounds," and "not to engage in strenuous activities." Id. Dr. Noreuil also recommended to Alberts that Alberts keep his blood pressure under good control. Id. On October 2, 2002, Dr. Pepper submitted its Employer Statement to Prudential in conjunction with Alberts's claim for STD benefits. On October 22, 2002, Alberts saw Dr. Marcia Willing, a Geneticist at the Connective Tissue Disorders Clinic at the University of Iowa Hospital. Dr. Willing diagnosed Alberts with a significant aortic root dilatation.
On October 28, 2002, Dr. Pepper faxed to Prudential Alberts's completed claim for STD benefits, including the Employer Statement. On October 30, 2002, a member of Prudential's clinical team telephoned Alberts to discuss his medical condition. Alberts indicated to the Prudential employee he had testing done in August and September and was diagnosed with an enlarged aorta by Dr. Maria Noce, his primary care physician and by Dr. Noreuil, his cardiologist.
On November 21, 2002, Prudential notified Alberts it was awaiting receipt of additional medical documentation from the University of Iowa Hospitals Clinics before it could complete its evaluation of Alberts's claim for STD benefits.
Prudential reviewed the information Alberts submitted in support of his application for STD benefits under the Plan and, by letter dated December 17, 2002, Prudential notified Alberts it had denied his claim for STD benefits. Prudential informed Alberts:
We received your complete claim for STD benefits on October 28, 2002. You went out of work on October 1, 2002 due to aortic root dilation [sic]. Your physician, Dr. Noreuil, has given you a restriction and limitations of no lifting over forty pounds. Your job is a Route Supervisor. We have reviewed you [sic] job duties under Department of [Labor's Dictionary of Occupational Titles] (DOT) guidelines and your job is considered to be light duty. A light duty job requires lifting, carrying, pushing and pulling 20 pounds occasionally and frequently up to 10 lbs.
To further understand your condition and how it prevents you from performing the duties of you [sic] job, a member of our clinical team contacted you on October 30, 2002. During this call, you indicated that you had testing done in August and September and were diagnosed with an enlarged aorta. Based on this diagnosis, your primary care physician gave you restrictions of no lifting over forty pounds. You went for a second opinion with Dr. Noreuil, a [c]ardiologist and was [sic] given the same diagnosis and restrictions. You state your job requires 40-85 pounds. Your last office visit with your cardiologist was on September 6, 2002 and your next office visit is not scheduled until March 2003. You went to a geneticist to see if this is something that could run in the family. We have attempted to obtain these records, without success. We again contacted you on December 17, 2002, to clarify when you went for genetic testing. You state [sic] that you only had a consultation with the doctor but never had any actual genetic testing. You stated that your doctor gave you restrictions and you are staying out of work based on this.
A review of medical records in file [sic] indicate that your diagnosis was an incidental finding on the echocardiogram you had on September 4, 2002. The significance of this finding of aortic root dilatation is unclear and the restrictions and limitations placed by your [c]ardiologist appear to be a preventative measure. You were advised to keep your blood pressure under control, however during a phone call with Dr. Noreil's [sic] office we were advised that your blood pressure has not been a problem. There is also no current evidence suggesting the presence of an aneurysm for which such restrictions and limitations would be appropriate. A letter dated September 6, 2002 from your [c]ardiologist indicates that your breathing problems in November 2001 and recurrence in Spring 2002 have since been diagnosed as exercise and viral induced asthma and do not appear to be a factor.
On November 21, 2002, we sent you a status letter requesting that you have records forwarded to our office to support your claim for STD benefits. To date, we have not received any records to support your inability to perform the duties of you [sic] job. While we understand that you have a condition, there is no medical [sic] to support the restrictions and limitations your doctor has given you. Restrictions appear to be of a preventative measure. Not working due to a preventative measure would be considered a life choice and not a disability. Additionally, DOT guidelines for your regular occupation are considered to be light duty. Therefore your doctor's restrictions of no lifting over forty pounds are not within the duties of your regular occupation and we have disallowed your claim for STD benefits.
Admin. Record at 00049. Prudential also informed Alberts in the letter of his right to appeal Prudential's decision and to submit additional evidence in support of his claim. Id.
On January 13, 2003, Dr. Noreuil submitted a letter to Prudential in which Dr. Noreuil indicated Alberts had been diagnosed with dilatation of his aortic root and that, according to Dr. Willing, Alberts's physicians suspected he had Thoracic Aortic Aneurysm Syndrome ("TAA"). In light of this fact, Dr. Noreuil recommended Alberts take certain precautions, such as refraining from lifting more than 40 pounds. Dr. Noreuil also stated in his letter Alberts should refrain from engaging in any strenuous activity because strenuous activity could cause Alberts's aorta to rupture.
By letter dated January 23, 2003, Alberts appealed Prudential's decision to deny his claim for STD benefits. In support of his appeal, Alberts submitted: (1) the January 13, 2003 letter from Dr. Noreuil to Prudential; (2) a letter from Dr. Noreuil to Dr. Doce in which Dr. Noreuil reported the results of his examination of Alberts to Dr. Doce; (3) a letter from Dr. Willing to Dr. Noreuil in which Dr. Willing reported to Dr. Noreuil the results of her examination of Alberts; (4) Alberts's September 4, 2002 echocardiogram; and (5) information regarding acceptable levels of exercise for people who have been diagnosed with TAA.
Prudential informed Alberts in a letter dated February 26, 2003 that Prudential declined to change its decision to deny Alberts claim for STD benefits. Prudential stated, in pertinent part:
On January 27, 2003, we received your request for reconsideration along with additional medical documentation from Dr. Norieul [sic] for the period between September 4, 2002 and January 13, 2003 including narratives from Dr. Norieul [sic] and Dr. Willing. In your letter of appeal, you stated that your job requirements are very physical and include repetitive pushing, pulling and lifting well over 40 lbs. daily. You further indicated that your recommended restrictions were not preventative measures. In a narrative dated October 22, 2002, Dr. Willing opined that you may have a form of thoracic aneurysm syndrome (TAA) given your significant aortic root dilation [sic] and family medical history.
Dr. Noreiul [sic] indicated in his narrative dated January 13, 2002, that you have been diagnosed with a very serious problem, that being dilation [sic]of your aortic root. He states that this is a markedly abnormal finding in a young man, and there is no situation in which this can be considered normal. Furthermore, people with this condition often go on to have rupture of the aorta, which is usually catastrophic and fatal. Nevertheless, Dr. Noreiul [sic] states that you can do simple chores and suggests that walking, bowling, leisurely bicycling and swimming would be safe. He recommends that you return to work with restrictions of no lifting above 40 pounds.
According to the U.S. Department of Labors' [sic] Dictionary of Occupational Titles (DOT), your job is considered light duty. Based on the DOT, your primary job responsibilities include supervising the presell deliverymen. The presell deliverymen are primarily responsible for the delivery and merchandising of the product. While your physical job requirements do include some lifting, per the DOT only light lifting is required. Light work is defined as exerting up to 20 pounds of force occasionally, or up to 10 pounds of force frequently, or a negligible amount of force constantly to move objects.
Review of the additional medical information in file [sic], does show that you may have TAA and may be at risk of future aortic dissection of a life-threatening nature with a requirement to reduce this risk by avoiding heavy lifting or related strenuous exertion. In lieu of those functional limitations, your proposed restrictions are appropriate and nonpreventative as previously determined. However, due to the nature of your regular job duties it is unclear how these restrictions would prevent you from performing your job as Route Supervisor. You have been placed on restrictions of no lifting above 40 pounds which are well within the normal duties of your regular occupation. Therefore, we have upheld our original decision to deny your STD claim and have disallowed your LTD claim in accordance with the policy provisions cited above.
Admin. Record at 00016. Prudential also informed Alberts in its letter of his right to appeal its decision regarding Alberts's entitlement to benefits. Id.
On March 11, 2003, Robert Wilson, Alberts's attorney, sent to Prudential a letter in which Wilson appealed Prudential's decision on Albert's behalf. Wilson indicated therein the basis for Alberts's appeal was Prudential's categorization of Alberts's position with Dr. Pepper as a light duty position using the U.S. Department of Labor's Dictionary of Occupational Titles (the "DOT"). Wilson argued that the job description of a Cedar Rapids Route Supervisor, which applied to all Route Supervisors at Dr. Pepper nationwide, required that Alberts be able to: (1) lift and handle cases of product that will weigh up to eighty pounds on a repetitive basis during the day; (2) drive a company-owned tractor-trailer combination, straight truck, pickup truck or automobile; (3) possess a commercial driver's license and be able to make up to fifty account stops or deliveries per day; and (4) account for and reconcile inventory assigned to him; and (5) perform on the Norand Route Commanders Commuters Computer System. In light of these aspects of Alberts's job description, Wilson argued to Prudential that its decision to categorize Alberts's "regular occupation" as a light duty position as defined in the DOT was in error. Wilson asserted the DOT definition Prudential used failed to take into account many of the duties of the Route Supervisor position as that job was defined within the Dr. Pepper company nation-wide. Wilson further asserted if Prudential had used a job description that took into account the actual duties of a Route Supervisor, Prudential should have come to the conclusion Alberts was disabled under the terms of the Plan.
On March 26, 2003, Prudential responded to Wilson's letter. Prudential informed Wilson Prudential upheld its initial decision to deny Alberts's claim for benefits under the Plan. In support of its decision to deny benefits, Prudential stated:
Regular Occupation means the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location.
Under the above "regular occupation" provision, Prudential examines a person's job duties as it is [sic] normally performed in the national economy, not necessarily how it is performed at a particular employer or specific location. To that end, Prudential used the Dictionary of Occupational Titles ("DOT"), as published by the United States Department of Labor.
Mr. Alberts worked as Route Supervisor with Dr. Pepper Bottling, since 1988. He stopped working in September 2002 and is diagnosed with a congenital deformity of his aorta. Mr. Alberts' treating physicians have restricted him from lifting greater than 40 pounds and to avoid strenuous exertion.
The DOT job description for a Route Supervisor is most closely matched by: Supervisor, Route Sales-Delivery Drivers, DOT Code 292.137-014. The description states that the employee supervises and coordinates activities of sales route drivers (retail trade; wholesale trade.) engaged in selling and distributing products or services.
The physical requirements include lifting, carrying, pushing, pulling 20 pounds occasionally; frequently up to 10 Lbs, or negligible amount constantly. Can include walking and/or standing frequently even though weight is negligible. Can also include pushing or pulling of arm or leg controls. It is considered to be a "light" duty job.
Based on the above, it was determined that the job material and substantial duties of a Route Supervisor were within the restrictions and limitations placed by his physicians. His claim application was disallowed.
Mr. Alberts appealed our decision and provided updated medical information regarding his condition. His claim was reviewed with our medical director who agreed that the forty pound weight restriction was reasonable.
We reviewed the DOT job description to ensure it was appropriate and determined it was. In the DOT there is no bottling industry, but a beverage industry. Primarily, the beverage industry is responsible for bottling, labeling, inspecting and packaging beverages in a production environment. While Mr. Alberts is employed for a bottling company, his primary job functions are not represented above.
The Route Supervisor, per the job description provided, is responsible for the supervision of the Pre-Sell Deliverymen. The Pre-Sell Deliverymen are primarily responsible for the delivery and merchandising of the product.
The Route Supervisor is best described as a First-Line Supervisor/Manager of Transportation and Material-Moving Machine and Vehicle Operators. The industry would be retail/wholesale sales and distribution.
According to the DOT an occupation is not any one single job, but a cluster of closely related jobs, which make up an "occupation." The DOT occupation previously identified as Supervisor, Route Sales-Delivery Drivers-DOT Code 292.137-014 is appropriate.
In your letter dated March 11, 2003, you indicate that you disagree with the DOT classification used, and provided a job description for a Cedar Rapids Route Supervisor, which indicates the need to lift 80 pounds. Cedar Rapids refers to the location and as described above, the material and substantial job duties of a Route Supervisor are considered light duty in nature.
Although Mr. Alberts was diagnosed with a cardiac condition that would prevent him from performing physical work, we are unable to issue benefits under the terms of the Group Policy. After a thorough review of the above information, we have determined that our previous decisions were appropriate and have upheld the determination to disallow Mr. Alberts [sic] claim for LTD benefits.
Admin. Record at 00003-04. Prudential also offered Alberts vocational rehabilitation services to assist him in transitioning back to work and informed Alberts once again of his right to appeal Prudential's decision.
Alberts then filed the instant lawsuit seeking judicial review of Prudential's decision to deny him STD benefits under the Plan pursuant to 29 U.S.C. § 1132(a)(1)(B).
III. LEGAL ANALYSIS A. Summary Judgment Standard
Summary judgment is appropriate only when the record, viewed in the light most favorable to the nonmoving party, shows there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Carter v. Ford Motor Co., 121 F.3d 1146, 1148 (8th Cir. 1997) (citing Yowell v. Combs, 89 F.3d 542, 544 (8th Cir. 1996)). An issue of material fact is genuine if it has a real basis in the record. Hartnagel v. Norman, 953 F.2d 394, 395 (8th Cir. 1992) (citing Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986)). A fact is material when it is a fact that "might affect the outcome of the suit under the governing law." Rouse v. Benson, 193 F.3d 936, 939 (8th Cir. 1999). In considering a motion for summary judgment, a court must view all facts in the light most favorable to the nonmoving party. Matsushita Elec. Indus., 475 U.S. at 587. Further, the court must give such party the benefit of all reasonable inferences that can be drawn from the facts. Id.
Procedurally, the moving party bears "the initial responsibility of informing the district court of the basis for its motion and identifying those portions of the record which show lack of a genuine issue." Hartnagel, 953 F.2d at 394 (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). Once the moving party has successfully carried its burden under Rule 56(c), the nonmoving party has an affirmative burden to go beyond the pleadings and by depositions, affidavits or otherwise, designate "specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The nonmoving party must offer proof "such that a reasonable jury could return a verdict for the nonmoving party." Anderson, 477 U.S. at 248.
B. ERISA Standard of Review
"ERISA provides a plan beneficiary with the right to judicial review of a benefits determination." Shelton v. ContiGroup Cos., Inc., 285 F.3d 640, 642-43 (8th Cir. 2002) (quoting Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir. 1998)). A district court must review a denial of benefits challenged under ERISA section 1132(a)(1)(B) under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan. Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 111 (1989). When a plan gives the administrator "discretionary authority to determine eligibility for benefits or to construe the plan's terms," the court must review the administrator's decision for an abuse of discretion. Id. at 115. "This deferential standard reflects [the court's] general hesitancy to interfere with the administration of a benefits plan." Layes v. Mead Corp., 132 F.3d 1246, 1250 (8th Cir. 1998) (citing Cox v. Mid-America Dairymen, 13 F.3d 272, 274 (8th Cir. 1993)).
In this case, the parties agree the Plan gives Prudential discretionary authority to interpret the terms of the Plan and to determine benefit eligibility under the Plan. Accordingly, the parties agree the court should use the abuse of discretion standard in reviewing Prudential's interpretation of the Plan terms at issue and its resultant decision to deny benefits.
1. Review of Plan Administrator's Interpretation of Plan Terms
In determining whether a plan administrator has abused its discretion in interpreting the terms of a plan, the court must consider the following factors:
whether [the plan administrator's] interpretation is consistent with the goals of the [p]lan; whether [the plan administrator's] interpretation renders any language in the [p]lan meaningless, or internally inconsistent, whether [the plan administrator's] interpretation conflicts with the substantive or procedural requirements of the ERISA statute, whether [the plan administrator has] interpreted the words at issue consistently, and whether [the plan administrator's] interpretation is contrary to the clear language of the [p]lan.Finley v. Special Agents Mut. Ben. Ass'n, Inc., 957 F.2d 617, 621 (8th Cir. 1992). See also Tillery v. Hoffman Enclosures, Inc., 280 F.3d 1192, 1199 (8th Cir. 2002) (citing Finley, 957 F.2d at 621); Ferrari v. Teachers Ins. Annuity Ass'n, 278 F.3d 801, 808 n. 4 (8th Cir. 2002); Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir. 1997). Thus, the court will consider each of these factors in its examination of whether Prudential's interpretation of the Plan terms at issue was reasonable
a. Interpretation of the Plan consistent with its goals
The first factor the court will consider is whether Prudential's interpretation of term "regular occupation" is consistent with the goals of the Plan. Finley, 957 F.2d at 621. The Plan defines the term "Disability" to mean:
During the elimination period, you are disabled when Prudential determines that:
• you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
• you are not working at any job.
After the elimination period, you are disabled when Prudential determines that:
• you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
• you have a 20% or more loss in weekly earnings due to the same sickness or injury.
Admin. Record at 00229. Thus, the goal of the Plan is to pay disability benefits to insured persons who are disabled as defined by the Plan.
In determining whether Alberts's condition constituted a disability as defined in the Plan, Prudential had to examine whether Alberts's condition rendered him unable to perform the "material and substantial duties" of his "regular occupation." Prudential interpreted the Plan's definition of "regular occupation" to require an analysis of Alberts's regular occupation — that of Route Supervisor — in the national economy rather than the occupation as performed for Dr. Pepper, Alberts's employer. Thus, in making its decision whether Alberts was disabled as defined in the Plan, Prudential did not use Alberts's actual job description, which both parties agree is the job description for a "Route Supervisor" at all Dr. Pepper locations and employers. Instead, Prudential looked to the DOT and adopted what Prudential found to be the closest occupation to that of Alberts. Because the DOT does not include a "bottling" industry, Prudential first looked to the "beverage" industry. Prudential determined the "beverage" industry is described in the DOT as an occupation responsible for bottling, labeling, inspecting and packaging beverages in a production environment. Prudential concluded Alberts's primary job functions were not included in the "beverage" industry. Prudential's analysis of the occupations defined in the DOT led it to conclude Supervisor, Route Sales-Delivery Drivers, DOT Code 292.137-014, most closely described Alberts's occupation. After Alberts appealed Prudential's decision to use this occupation to determine his disability status under the Plan, Prudential performed a labor market search of similar jobs in the bottling industry. This research revealed that, while Dr. Pepper required that its Route Supervisors fill in for absent delivery drivers, this was not an essential or primary job function for all Route Supervisors in the bottling industry. Thus, Prudential determined Alberts's "regular occupation" as defined in the DOT is considered a "light duty" occupation which entailed an occasional lifting, carrying, pushing or pulling of up to 20 pounds. Prudential determined the requirement in Alberts's job description for Cedar Rapids Route Supervisor that "[s]ome job duties will involve physical labor that will require the employee to lift and handle cases of product that will weigh up to eighty (80) pounds on a regular basis throughout the day" was not an essential function of Alberts's regular occupation as it is defined in the national economy.
Prudential argues its interpretation of these terms is consistent with the goal and purpose of the Plan because it is the goal and purpose of the Plan to pay benefits to insured persons who are disabled as defined by the Plan. Prudential posits its interpretation of the terms of the Plan led it to the conclusion Alberts could perform the material and substantial duties of a Route Supervisor in the national economy and that Prudential's decision in this regard was reasonable. Alberts argues in response Prudential's interpretation of the Plan was not consistent with the goals of the Plan because, presumably, it is not the goal of the Plan to force an insured to continue to perform a job that likely could kill him. Alberts further asserts Prudential's decision Alberts could perform the job duties of his regular occupation as defined by a DOT job description that excluded a comparable job duty of heavy lifting is not consistent with the goals of the Plan.
The court's review of the record and the language of the Plan leads it to conclude Prudential's interpretation of the term "regular occupation" is consistent with the goals of the Plan. It is uncontested an important goal of the Plan is to provide benefits to those who suffer from a disability as that term is defined in the Plan. It also is uncontested the Plan defines "regular occupation" to mean "the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location." The court finds the Plan's definition of "regular occupation" unquestionably apprises each Plan participant that Prudential will not look to the participant's individual job description but rather will look to the participant's occupation in the national economy when assessing whether the participant suffers from a disability as defined by the Plan. There is nothing in the administrative record that suggests the DOT definition of the occupation of "Supervisor, Route Sales-Delivery Drivers" is not an accurate description of the occupation of "Route Supervisor" as it is performed in the national economy. Accordingly, the court concludes Prudential's interpretation of the Plan terms at issue here is consistent with the Plan goal of providing benefits to people who suffer from a disability as that term is defined in the Plan. Thus, this factor weighs in favor of a finding Prudential's interpretation of the Plan terms at issue was reasonable.
b. Interpretation of the Plan consistent with ERISA statute
The second factor requires the court to consider whether Prudential's interpretation conflicts with the substantive or procedural requirements of the ERISA statute. Finley, 957 F.2d at 621. Here, Alberts has not identified any substantive or procedural requirements of the ERISA statute that are in conflict with Prudential's interpretation of the Plan's STD benefits provision. Accordingly, this factor does not render unreasonable Prudential's interpretation of the Plan.
c. Interpretation of the Plan consistent with other interpretations
The next factor the court must consider in its analysis of the reasonableness of Prudential's interpretation of the Plan terms at issue is whether the plan administrator has interpreted the relevant terms consistently. Finley, 957 F.2d at 621. There is no evidence in the record to show Prudential has interpreted the Plan terms at issue here inconsistently with the way in which Prudential has interpreted them in this case. Thus, this factor does not provide a basis for determining Prudential's interpretation of the Plan terms at issue was unreasonable. d. Interpretation of the Plan renders any language in the Plan meaningless or internally inconsistent
The court must now consider whether Prudential's interpretation renders any language of the Plan meaningless or internally inconsistent. Finley, 957 F.2d at 621. Alberts argues Prudential's failure to take into account Alberts's actual job duties when Prudential defined Alberts's "regular occupation" renders meaningless the terms "you" or "your" when used in describing a participant's "regular occupation." Alberts asserts because the Plan uses these modifiers, there must be a connection between a participant's actual job duties and a generic job description's job duties. Prudential asserts its interpretation of the Plan's terms is not contrary to the Plan's clear language.
The court disagrees with Alberts's assertion Prudential's interpretation of the Plan terms at issue renders meaningless the terms "you" or "your" as used in the Plan. The administrative record makes it readily apparent Prudential took into account Alberts's duties as a Route Supervisor for Dr. Pepper when it considered Alberts's "regular occupation" for purposes of determining Alberts's entitlement to disability benefits under the Plan. The fact that Prudential did not adopt Alberts's job description as a Route Supervisor at Dr. Pepper, but rather used the objective DOT definition of Alberts's occupation, does not necessitate a finding Prudential failed to consider Alberts's actual job duties. Rather, the record shows Prudential considered Alberts's job duties as a Route Supervisor for Dr. Pepper and then compared those duties to occupations defined in the DOT. Prudential then chose the definition of an occupation from the DOT that most closely matches Alberts's job as a Route Supervisor. Alberts has not produced any evidence there was an occupational definition in the DOT that more closely matches his job as a Route Supervisor for Dr. Pepper. Accordingly, the court finds Prudential's interpretation of the Plan terms at issue did not meaningless the terms "you" and "your" in the definition of "regular occupation." The court concludes this factor bolsters the reasonableness of Prudential's interpretation of the Plan terms at issue.
e. Interpretation of the Plan is contrary to the clear language of the Plan
The final factor the court must consider in assessing whether Prudential's interpretation of the Plan terms at issue was reasonable is whether Prudential's interpretation of the Plan contradicts the clear language of the Plan. Alberts takes the position Prudential's interpretation of the term "regular occupation" to exclude comparable job duties contradicts the clear language of the Plan. Alberts contends if Prudential wanted to limit the definition of "regular occupation" to a DOT job description that was not required to include all comparable job duties, Prudential should have amended the Plan.
The court disagrees with Alberts's contention the Plan language cannot be interpreted in a manner that would allow Prudential to use an occupational definition from the DOT to assess whether Alberts meets the Plan's definition of "disability" in this case. The Plan states Prudential will define the insured's "regular occupation" as it is "normally performed instead of how the work tasks are performed for a specific employer or at a specific location." This language makes clear Prudential will assess the insured's regular occupation from an objective, rather than from a subjective standpoint. This practice finds support in the case law. The Eighth Circuit Court of Appeals has not addressed the issue whether an ERISA fiduciary may use the DOT to provide an objectively reasonable job description for assessment of disability in ERISA cases. Accord White v. Healthsouth Long-Term Dis. Plan, 320 F. Supp. 2d 811, 819 (W.D. Ark. 2004). However, other circuit courts have ruled the DOT is a proper source from which to obtain an objectively reasonable job description in an ERISA case. See Lasser v. Reliance Std. Life Ins. Co, 344 F.3d 381, 395 (3d Cir. 2003) (approving of the use of a DOT job description to assess a beneficiary's job duties and stating, "the DOT is a recognized authority in the vocational industry"); Gallagher v. Reliance Std. Life Ins. Co., 305 F.3d 264, 273 (4th Cir. 2002) (holding DOT job description is an "objectively reasonable job description to define [the beneficiary's] material duties"); Kinstler v. First Reliance Std. Life Ins. Co., 181 F.3d 243, 253 (2d Cir. 1999) (finding plan administrator's use of DOT job description appropriate where the term "regular occupation" was not defined in the Plan itself and noting the definition of the term "regular occupation" "requires consideration of what sort of position is `of the same general character as the insured's previous job'"). The court finds Prudential's decision to use the DOT definition of Alberts's "regular occupation" rather than Alberts's actual job description and every job duty it entailed, did not conflict with the clear language of the Plan.
As the preceding analysis shows, the court's review of Prudential's interpretation of the Plan terms at issue using the framework provided by the Eighth Circuit Court of Appeals leads the court to conclude Prudential's interpretation of the Plan terms at issue was not an abuse of discretion. The court must now consider whether Prudential's decision to deny Alberts disability benefits under the plan was an abuse of discretion.
2. Review of Plan Administrator's Decision to Deny Benefits
In applying the abuse of discretion standard to a plan administrator's decision regarding eligibility for benefits, the district court must affirm the decision of the plan administrator if a "reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable would have reached the same decision." Smith v. UNUM Life Ins. Co. of America, 305 F.3d 789, 794 (8th Cir. 2002) (quoting Ferrari, 278 F.3d at 807). See also, Tillery, 280 F.3d at 1199 ("A plan administrator's decision is reasonable if a reasonable person could have, based upon the same evidence, reached a similar decision."). A plan administrator has made a reasonable decision where such decision is one that is based on substantial evidence that actually was before the administrator. Donoho v. FMC Corp., 74 F.3d 894, 899 (8th Cir. 1996). Substantial evidence is "more than a scintilla but less than a preponderance." Schatz v. Mutual of Omaha Ins. Co., 220 F.3d 944, 949 (8th Cir. 2000). The district court may consider both the quantity and the quality of the evidence before a plan administrator. Smith, 305 F.3d at 794.
The court has reviewed the entirety of the information considered by Prudential as part of the administrative record in this case and finds Prudential's decision to deny Alberts benefits under the Plan was not an abuse of discretion. The court finds the medical records Alberts provided in support of his application for STD benefits show only that Alberts was unable to lift 40 pounds or more on a regular basis because of his condition. As the preceding analysis shows, the court finds reasonable Prudential's interpretation of Alberts's "reasonable occupation," to be one that does not include as a "material and substantial duty" that of lifting more than 40 pounds on a regular basis. Accordingly, the court finds Prudential's decision to deny benefits finds substantial support in the record.
IV. CONCLUSION
In light of the foregoing, IT IS ORDERED:
1. Prudential's Motion for Summary Judgment (docket no. 24) is GRANTED.
2. Alberts's Cross Motion for Summary Judgment (docket no. 27) is DENIED.
3. Prudential's Motion to Strike Alberts's Cross Motion for Summary Judgment (docket no. 29) is DENIED.
4. Alberts's claims against Prudential in this matter are DISMISSED with prejudice and all court costs are assessed against Alberts.
5. The Clerk of Court shall enter judgment accordingly.
SO ORDERED.