Briggs v. Marriott International, Inc. , 205 F. App'x 183 ( 2006 )

UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 05-1616
ROBERT BRIGGS,
Plaintiff - Appellant,
versus
MARRIOTT INTERNATIONAL, INCORPORATED; LIBERTY
LIFE ASSURANCE COMPANY OF BOSTON,
Defendants - Appellees.
Appeal from the United States District Court for the District of
Maryland, at Greenbelt. Alexander Williams, Jr., District Judge.
(CA-04-3427-8-AW)
Argued: September 19, 2006 Decided: November 28, 2006
Before NIEMEYER, Circuit Judge, HAMILTON, Senior Circuit Judge, and
Henry F. FLOYD, United States District Judge for the District of
South Carolina, sitting by designation.
Affirmed by unpublished per curiam opinion.
John Marshall, MULHERN, PATTERSON & MARSHALL, L.L.P., Rockville,
Maryland, for Appellant. Henry Mark Stichel, GOHN, HANKEY &
STICHEL, L.L.P., Baltimore, Maryland, for Appellees.
Unpublished opinions are not binding precedent in this circuit.
See Local Rule 36(c).
PER CURIAM:
Robert Briggs commenced this action under § 502(a) of the
Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.
§ 1132(a), for long-term disability benefits under an employee
benefit plan sponsored by his employer, Marriott International,
Inc., and administered by Liberty Life Assurance Company of Boston.
Beginning in September 2002, Liberty Life began paying Briggs
short-term disability benefits based on Briggs’ chronic lower-back
and leg pain, but, on August 21, 2003, following a review, it
denied his claim for long-term disability benefits. When Briggs’
treating doctor complained about the decision, Liberty Life
reopened Briggs’ claim, collected additional medical information,
and submitted the file to an independent orthopedic surgeon for
review, who concluded that Briggs was “capable of a sedentary job
with frequent position changes.” Liberty Life again denied Briggs’
long-term disability benefits on March 9, 2004. Briggs then filed
this action.
The district court granted summary judgment to the defendants,
concluding that based on the objective evidence relating to Briggs’
disability, “Liberty [Life] properly concluded that, with the
appropriate sedentary modifications, Briggs was able to perform the
duties of [his job].” The court explained:
In sum, the evidence supports Liberty’s discretionary
decision that Briggs did not provide sufficient evidence
of a disability under the Policy. While Liberty has a
conflict of interest, based on the reasons articulated
-2-
above, this court concludes that Liberty’s decision was
nevertheless “consistent with an exercise of discretion
by an [administrator] acting free of the interests that
conflict with those beneficiaries.”
Briggs v. Marriott Int’l., Inc., No. CA-04-3427-8-AW (D. Md. May 6,
2005) (quoting Ellis v. Metro. Life Ins. Co., 126 F.3d 228, 233
(4th Cir. 1997)). Based on our de novo review of the district
court’s decision, we affirm.
For some 21 years, Briggs worked for Marriott International in
its WorldWide Reservation Center as a senior systems analyst, a
sedentary job that primarily entailed computer work.
In 1989, Briggs was diagnosed with a herniated disc, and in
1991, he underwent surgery -- a discectomy to remove the herniated
portion of the disc and a laminectomy to remove a portion of the
vertebra that impinged on the nerve. Six years later, Briggs had
follow-up surgery, in which the fifth lumbar and first sacral
vertebrae were fused and a Ray Cage installed to limit movement of
his lower spine.
Even though the surgeries relieved Briggs’ pain for a while,
it returned, and Briggs continued to see several doctors -- Dr.
Michael Anchors, his primary physician; Dr. William Lauerman, an
orthopedic surgeon; Dr. Rosita Dee, a pain management specialist;
and Dr. Harikant Shah, his treating orthopedist.
In September 2002, Briggs made a claim to Liberty Life for
disability benefits and submitted records from his doctors, as well
as x-rays, myelogram results, and several MRIs. In addition, Dr.
-3-
Anchors and Dr. Lauerman submitted opinions on Briggs’ behalf,
concluding that Briggs was totally disabled. Liberty Life
investigated the claim and supplemented its file with video
surveillance of Briggs, which captured Briggs walking with and
without a cane, driving his car, checking his oil, carrying a trash
bag and a small suitcase, and picking up medications. Liberty Life
also had Briggs examined by Dr. Michael April, an internist who
performed work for Liberty Life. Dr. April found mixed results
from his tests of Briggs’ abilities, yet determined that Briggs had
a “sedentary functional capacity.” After submitting Dr. April’s
findings to Dr. Anchors, Briggs’ primary doctor, and receiving no
substantive response, Liberty denied Briggs’ disability claim with
a letter dated August 21, 2003, in which it stated:
Based on the medical information in relation to your
occupation requirements, you are able to perform the
duties of your Own Occupation. Therefore, you do not
meet your policy’s definition of disability. We must
close your claim as of August 22, 2003.
Shortly thereafter, Dr. Anchors sent Liberty Life a cryptic
letter, in which he suggested that Briggs was disabled by his pain
medications. Without a request from either Dr. Anchors or Briggs
himself, Liberty Life reopened the claim, collected more medical
information, and sent the entire file to Dr. Richard Silver, an
independent and elaborately credentialed orthopedic surgeon, for
another opinion. Based on his review of the file, Dr. Silver found
-4-
no objective evidence to support a finding of disability. He
stated:
Mr. Briggs is not capable of performing activities
consistent with a light or heavy work capacity. Mr.
Briggs is, however, capable of a sedentary job with
frequent position changes. . . . [H]e certainly could be
functional in a sedentary capacity as a senior system
analyst for Marriott.
Thus, on March 9, 2004, Liberty again denied Briggs’ claim for
long-term disability benefits, and this suit ensued.
The benefit plan under which Briggs brings his claim grants
Liberty Life “the authority, in its sole absolute and final
discretion, to construe the terms of this policy and to determine
benefit eligibility hereunder.” The plan also required Briggs to
prove his claim for disability with “objective medical evidence,”
a provision permitting Liberty Life to discount self-serving claims
and reports of disability in favor of objective evidence. The
administrator’s decision on a claim must nonetheless be the result
of a deliberate principled reasoning process and be supported by
substantial evidence. See Brogan v. Holland, 105 F.3d 158, 161
(4th Cir. 1997).
Because Liberty Life acts both as a trustee for the
beneficiaries and as a potential payor on the claim, we heighten
our scrutiny of Liberty Life’s discretionary decision to the extent
necessary to simulate review of an unconflicted trustee. See Ellis
v. Metro. Life Ins. Co., 126 F.3d 228, 233 (4th Cir. 1997); Doe v.
Group Hospitalization & Med. Servs., 3 F.3d 80 (4th Cir. 1993).
-5-
Briggs challenges the administrator’s discretionary decision
in two respects. First, he says that Liberty Life ignored evidence
of the effect of his medications on his ability to do his job.
While Briggs was taking an increasing amount of painkillers over
the years, he did not provide sufficient objective evidence that
the painkillers disabled him from working. His best evidence is a
letter from Dr. Anchors, his primary care physician, in which Dr.
Anchors stated:
I don’t believe [Briggs] can do serious mental work on
those meds, and I don’t see how he can sit without them.
In fact, when Robert sees me in the office, he remains
standing, propping himself against the wall or supporting
himself erect with hands on the exam table as people with
severe lumbar nerve compression characteristically do.
The relevant file also shows that when Briggs talked with
representatives of Liberty Life on the telephone, he sounded
“groggy” and “disoriented.” Briggs himself reported that the
medications interfered with his “ability to concentrate on complex
tasks.” This evidence, however, is not the objective medical
evidence required by the terms of the plan. Dr. Anchors’ letter
stops short of giving a medical opinion that Briggs was unable to
do his job because of the painkillers that he was taking, and the
other generalized anecdotes do not amount to objective medical
evidence. On this record, we cannot conclude that the
administrator acted unreasonably in rejecting this evidence and
denying Briggs’ claim.
-6-
Briggs also contends that Dr. Silver, Liberty Life’s hired
independent medical consultant, systematically misread the record.
He complains that Dr. Silver repeatedly and almost automatically
used the term “mild” to describe Briggs’ condition. Yet, Briggs
fails to recognize that nearly every use by Dr. Silver of that term
directly tracks language used by the MRI technicians who evaluated
Briggs’ back and whom no one has accused of any wrongdoing.
Even with heightened scrutiny applicable in this case, we
cannot conclude that the administrator’s decision was unreasonable
based on the record and the processes that the administrator
employed. As we have noted, the “trustee’s discretionary decision
will not be disturbed if reasonable, even if the court itself would
have reached a different conclusion.” Booth v. Wal-Mart Stores,
Inc., 201 F.3d 335, 341 (4th Cir. 2000).
AFFIRMED
-7-