Chandler v. Hartford Life

United States Court of Appeals
Fifth Circuit
F I L E D
April 28, 2006
Charles R. Fulbruge III
Clerk
In the
United States Court of Appeals
for the Fifth Circuit
_______________
m 05-50688
Summary Calendar
_______________
LINDA CHANDLER,
Plaintiff-Appellant,
VERSUS
HARTFORD LIFE, ET AL.,
Defendants,
HARTFORD COMPREHENSIVE EMPLOYEE BENEFIT SERVICE COMPANY
AND THE ERISA PLAN,
Defendant-Appellee.
____________________________________
Appeal from the United States District Court
for the Western District of Texas
m 5:-01-CV-1159
_____________________________________

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Before SMITH, GARZA, and PRADO,
Circuit Judges.
PER CURIAM:*
Linda Chandler appeals a summary judg-
ment in favor of Hartford Comprehensive Em-
ployee Benefit Service Company (“Hartford”),
administrator of her employer’s Short-Term
Disability Plan (“the Plan”), on her claim for
benefits under the Plan. We affirm.
I.
Chandler worked at Time Warner, Inc.
(“Time Warner”), from April 27, 1988,
through September 8, 1999. At the time rele-
vant to this action, she held the position of
account executive.
In August 1999 Chandler filed a claim with
Hartford, the administrator of Time Warner’s
Short-Term Disability Plan, seeking benefits
under the Plan, which provides benefits to em-
ployees who are “totally disabled.” An em-
ployee is totally disabled if he is prevented by,
inter alia, bodily injury, sickness, or mental ill-
ness from performing the essential duties of his
occupation. A statement submitted to Hart-
ford by Time Warner described the activities
of an account executive as “sedentary or light
work.”
The Attending Physician’s Statement, sub-
mitted by Chandler along with her claim form
and signed by Dr. Alex de Jesus, stated that
she had been diagnosed in April 1998 with
undifferentiated connective tissue disease
(“UCTD”), a chronic inflammatory auto-
immune disorder.1 The symptoms of which
Chandler complained were pain, stiffness,
weakness, fatigue, fever, and depression. Ac-
cording to the Attending Physician’s State-
ment, Chandler’s physicallimitations consisted
of “[s]evere limitation of functional capacity;
incapable of minimal (sedentary) activity.”
From a psychiatric standpoint, the Statement
described her as “[u]nable to engage in stress-
ful situations or in interpersonal relationships
. . . .” Despite the severe characterization of
Chandler’s illness and limitations, de Jesus left
blank the space under the heading of “Physical
Findings,” where the attending physician is
asked to list all relevant laboratory tests and
results. Chandler ceased working because of
her impairment on September 8, 1999.
After receiving Chandler’s claim, Hartford
requested her tests results from de Jesus and
asked him to explain what, exactly, prevented
her from performing the largely sedentary
duties of an account executive. De Jesus did
not send any test results and failed to give
Hartford a precise explanation of Chandler’s
physical limitations. Accordingly, in Novem-
ber 1999 Hartford denied Chandler’s claim for
benefits under the Plan, stating that the evi-
dence submitted in support of her claim did
not establish that she was totally disabled.
Hartford informed Chandler that she could ap-
* Pursuant to 5TH CIR. R. 47.5, the court has de-
termined that this opinion should not be published
and is not precedent except under the limited
circumstances set forth in 5TH CIR. R. 47.5.4.
1 Generally, individuals diagnosed with UCTD
display symptoms indicative of an autoimmune dis-
order or connective tissue disease but do not have
enough symptoms to meet the diagnosis for a well-
defined connective tissue disease such as rheuma-
toid arthritis, lupus, or scleroderma. Connective
tissue includes skin, cartilege, and other tissue in
the joints and surrounding the organs. An autoim-
mune disorder is characterized by an immune
system’s turning on the individual’s body, attack-
ing parts of the body as if they were foreign invad-
ers such as bacteria.

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peal its decision and was free to submit addi-
tional information that would help it evaluate
her claim. Chandler subsequently appealed
three times, and Hartford reaffirmed its denial
on each occasion.
During this series of appeals, Time Warner
submitted to Hartford a more detailed descrip-
tion of Chandler’s job, which consisted of
making sales calls, preparing and implementing
strategy, processing paperwork, and inter-
facing with staff personnel. The physical de-
mands of the position included sitting for long
periods of time, reaching with hands and arms,
working rapidly under pressure for eight hours
a day, and occasionally lifting 10-20 pounds.
After receiving this information from Time
Warner, Hartford sent the administrative
record in Chandler’s case to two doctors,
George Kazda, Associate Medical Director of
Hartford, and Harvey Schwartz, board-certi-
fied in rheumatology. Following a review of
the record and a telephone interview with de
Jesus, Kazda concluded:
Ms. Allshouse-Chandler continues to have
multiple variable complaints with minimal
findings on clinical examination. Specifi-
cally, there is no evidence of active arthri-
tis. There is normal range of motion of all
her joints. There is normal muscle strength.
Dr. De Jesus does not report any need for
specific physical restrictions . . . . There is
compelling evidence that stress of daily life,
work, and depression significantly contrib-
ute to her subjective symptoms . . . . Dr.
De Jesus feels that there is no need to place
any specific physical restrictions on the
claimant. . . . [I]t is my opinion that Linda
Allshouse-Chandler should be able to carry
out her own sedentary occupation. It may
be prudent for her to limit her excessive
working hours.
Dr. Schwartz similarly opined that
the primary symptoms that [Chandler] has
regarding the musculoskeletal system . . .
are best considered as part of fibromyalgia
and not connective tissue disease symp-
toms. In addition, it has been pointed out
in other reports, she never had evidence of
organ involvement with connective tissue
disease. Dr. De Jesus’ office notes . . . de-
scribe[] various joint and muscle pains, but
there is no documentation of loss of mobil-
ity or function. All the conclusions appear
to be based on that obtained from the pa-
tient (subjective data as opposed to objec-
tive data.) . . . I conclude that . . . patient
could work an eight-hour workday with no
overtime
Hartford’s repeated denials of Chandler’s
claim for short-term disability benefits were
based largely on the conclusions of these doc-
tors, coupled with Chandler’s continual failure
to present satisfactory evidence of total dis-
ability.
Following Hartford’s fourth denial of her
claim in July 2000, Chandler continued,
through July 2001, to submit additional evi-
dence to the company. In December 2001, she
sued Hartford under ERISA § 502(a)(1)(B),
29 U.S.C. § 1132(a)(1)(B). The parties
agreed in September 2002 to remand to the
claims administrator for a final review of all
the evidence, including that which Chandler
had submitted between July 2000 and July
2001. Hartford retained two independent
physicians to review the complete
administrative record and, on the basis of their
analyses, concluded that its prior assessments
of Chandler’s case were correct and upheld its
denial of her claim.
The case then went back to court, where

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Hartford moved for summary judgment, argu-
ing that Chandler had failed to prove that she
is totally disabled and that its denial of benefits
was neither arbitrary nor capricious. The
district court granted Hartford’s motion.
II.
A.
Rule 56 of the Federal Rules of Civil Pro-
cedure states that summary judgment “shall be
rendered forthwith if the pleadings, deposi-
tions, answers to interrogatories, and admis-
sions on file, together with affidavits, if any,
show that there is no genuine issue as to any
material fact and that the moving party is en-
titled to a judgment as a matter of law.” FED.
R. CIV. P. 56(c). We review a grant of sum-
mary judgment de novo, using the same crite-
ria as employed by the district court. Pat-
terson v. Mobil Oil Corp., 335 F.3d 476, 487
(5th Cir. 2003).
B.
“Whether a district court employed the ap-
propriate standard in reviewing an eligibity de-
termination made by an ERISA plan admin-
istrator is a question of law” that we review de
novo. Ellis v. Liberty Life Ins. Co., 394 F.3d
262, 269 (5th Cir. 2004). The district court
determined that Hartford’s denial of Chand-
ler’s claim should be reviewed only for an
abuse of discretion. We agree.
“Consistent with established principles of
trust law, a denial of benefits challenged under
§ 1132(a)(1)(B) is to be reviewed under a de
novo standard unless the benefit plan gives the
administrator or fiduciarydiscretionary author-
ity to determine eligibility for benefits or to
construe the terms of the plan.” Estate of
Bratton v. Nat’l Union Fire Ins. Co., 215 F.3d
516, 521 (5th Cir. 2000). When an adminis-
trator or fiduciary is given such discretionary
authority, however, a denial of benefits is r-
eviewed for an abuse of discretion. Ellis, 394
F.3d at 269.
Under the Plan, it is the duty of the claims
administrator (Hartford) to “(1) determine
benefits payable according to the terms and
conditions of the Plan; (2) make payment for
benefits payable; and (3) decide appeals of
claims.” The claims administrator “has full
discretion and authority to construe and inter-
pret all terms and provisions which relate to
the amount of, or eligibility for, benefits under
the Plan.” Hartford argues that this language
grants it the discretionary authority to deter-
mine eligibility for benefits, notwithstanding
that the Plan also states that “the Employer has
the responsibility for making final determina-
tions regarding eligibility for coverage.”
We agree with Hartford. The fact that
Time Warner possesses the final authority to
determine eligibility for coverage does not
deprive Hartford of discretionary authority
with respect to the determination of the bene-
fits available under the Plan for discrete claims.
Additionally, as the district court noted,
Chandler has not challenged Hartford’s inter-
pretation of any Plan term. Rather, she claims
that she has submitted sufficient proof of total
disability. Accordingly, this case turns on
Hartford’s factual determination that Chandler
is not totally disabled. “Regardless of the ad-
ministrator’s ultimate authority to determine
benefit eligibility . . . factual determinations
made by the administrator during the course of
a benefits review will be rejected only upon the
showing of an abuse of discretion.” Meditrust
Fin. Serv. Corp. v. Sterling Chem., Inc., 168
F.3d 211, 213 (5th Cir. 1999).
C.
To determine whether a plan administrator
abused its discretion in denying benefits, we

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ask whether the administrator acted arbitrarily
or capriciously. Id. at 214. “When reviewing
for arbitrary and capricious actions resulting in
an abuse of discretion, we affirm an
administrator’s decision if it is supported by
substantial evidence. A decision is arbitrary
only if made without a rational connection
between the known facts and the decision or
between the found facts and the evidence.” Id.
at 215 (internal quotations and citations omit-
ted).
Hartford’s denial of Chandler’s claim was
based on the conclusions of its own medical
director and the analyses of independent physi-
cians. Chandler places special weight on the
conclusions of her own treating physician.
Nothing in ERISA, however, “suggests that
plan administrators must accord special defer-
ence to the opinions of treating physicians.”
Black & Decker Disability Plan v. Nord, 538
U.S. 822, 831 (2003). Additionally, courts
“may not impose on plan administrators a dis-
crete burden of explanation when they credit
reliable evidence that conflicts with a treating
physician’s evaluation.” Id. at 834.
Though Chandler may disagree with Hart-
ford’s determination that she is not totally dis-
abled, it cannot be said that there is no rational
connection between the administrator’s found
facts and the evidence, particularlyconsidering
that Chandler arguably never submitted any
information, other than her own subjective
complaints, that supports a conclusion that her
physical abilities have been limited to such a
degree that she cannot perform the largely sed-
entary position of an account executive. Con-
cluding that the administrator’s denial of
Chandler’s claim for benefits under the Plan
was not an abuse of discretion, we AFFIRM
the summary judgment.

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