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Abston v. Sedgwick Claims Management Services, Inc.

United States District Court, N.D. Alabama, Northwestern Division

June 30, 2017

TAMMY ABSTON, Plaintiff,
v.
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., et al., Defendants.

          MEMORANDUM OPINION

          ABDUL K. KALLON, UNITED STATES DISTRICT JUDGE

         Tammy Abston filed this action under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), challenging defendants' decision to deny her long term disability pension benefits. Presently before the court is defendants' motion for summary judgment, doc. 24, which is fully briefed, docs. 24-1; 33; 36, and ripe for review. For the reasons stated below, the motion is due to be granted.

         I. STANDARD OF REVIEW

         Rule 56's general principle that summary judgment is proper “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law” has limited application here, because the district court “sits more as an appellate tribunal than as a trial court” and “evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.” Leahy v. Raytheon Co., 315 F.3d 11, 18 (1st Cir. 2002). To that end, the court is guided by the Eleventh Circuit's six-step sequential framework for reviewing ERISA benefit denials, which requires the following:

(1) Apply the de novo standard to determine whether the claim administrator's benefits-denial decision was “wrong” (i.e., the court disagrees with the administrator's decision); if it is not, then end the inquiry and affirm the decision.
(2) If the administrator's decision in fact is “de novo wrong, ” then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.
(3) If the administrator's decision is “de novo wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the inquiry and reverse the administrator's decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and affirm the decision.
(6) If there is a conflict, the conflict should merely be a factor for the court to take into account when determining whether an administrator's decision was arbitrary and capricious.

Williams v. Bellsouth Telecommunications, Inc., 373 F.3d 1132, 1138 (11th Cir. 2004), overruled on other grounds by Doyle v. Liberty Life Assurance, 542 F.3d 1352 (11th Cir. 2008). This court's review of the administrator's decision is limited to “consideration of the material available to the administrator at the time it made its decision.” Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1355 (11th Cir. 2011). Moreover, the claimant has the burden of proving entitlement to ERISA benefits. Glazer v. Reliance Std. Life Ins. Co., 524 F.3d 1241, 1248 (11th Cir. 2008).

         II. FACTUAL BACKGROUND

         Abston worked for SunTrust Bank as an Area Manager 1 Branch Manager, a position in which she managed eleven branches and conducted annual and midyear reviews. See doc. 24-7 at 21. At some point during her employment, Abston's treating physician, Dr. David McLain, diagnosed Abston with lupus, psoriasis, arthritis, and fibromyalgia. See doc. 24-9 at 31. Consequently, Abston applied for, and received, long term disability benefits beginning August 5, 2013. Doc. 24-4 at 18. The discontinuation of these benefits is the basis for this lawsuit.

         SunTrust Long Term Disability (“LTD”) coverage is part of the SunTrust Banks, Inc. Employee Benefit Plan (“the Plan”), which is governed by ERISA and provides financial assistance to eligible employees who are unable to work, as determined by the claims administrator, due to an illness or injury after 180 days. Doc. 24-3 at 6, 23. The Benefits Plan Committee has “delegated the ministerial and discretionary ...


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