BOATWRIGHT

v.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY

This matter is before the Court on “Defendant’s Dispositive Motion for Summary Judgment with Supporting Memorandum of Law” and “Plaintiff’s Dispositive Motion for Summary Judgment and Incorporated Memorandum of Law,” both filed December³, 2021.1 (Docs. 23; 25). Both parties filed responses in opposition (Docs. 39; 42) and replies (Docs. 49; 50). Upon review of the motions, responses, court file, and record, the Court finds as follows: Background2 Until 2003, Plaintiff Tracy Boatwright worked as a home care registered nurse for Senior Home Care, Inc. At that time, she was no longer able to work due to interstitial cystitis with Hunner’s ulcers, peripheral neuropathy, and fibromyalgia. Plaintiff had long-term disability “LTD” coverage under Group Policy

Defendant “discretionary authority” to determine eligibility for benefits and construe the Policy’s terms and provisions. In 2019, the administrator of the plan, Defendant Aetna Life Insurance Company, terminated these benefits. Defendant relied on, among other things, the lack of current medical information from her treating physicians, independent peer medical review from three doctors, and video surveillance obtained by an investigator to conclude that Plaintiff’s conditions did not prevent her from working in any reasonable occupation.³ Although Defendant acknowledged Plaintiff’s receipt of federal disability benefits,4 it explained that its decision was based on “new information” that has been unavailable to the Social Security Administration. Plaintiff contends that Defendant wrongfully and unreasonably denied her LTD benefits in violation of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1001 et seq. The parties have filed cross motions for summary judgment.

Lobby, Inc., 477 U.S. 242, 249 (1986). Only the existence of a genuine issue of material fact will preclude summary judgment. Id. The moving party bears the initial burden of showing that there are no genuine issues of material fact. Hickson Corp. v. N. Crossarm Co., Inc., 357 F. 3d 1256, 1260 (11th Cir. 2004). When the moving party has discharged its burden, the nonmoving party must then designate specific facts showing the existence of genuine issues of material fact. Jeffery v. Sarasota White Sox, Inc., 64 F. 3d 590, 593-94 (11th Cir. 1995). If there is a conflict between the parties’ allegations or evidence, the nonmoving party’s evidence is presumed to be true and all reasonable inferences must be drawn in the nonmoving party’s favor. Shotz v. City of Plantation, 344 F. 3d 1161, 1164 (11th Cir. 2003). Where, the moving party will bear the burden of proof on an issue at trial, demonstrating the absence of a genuine issue of material fact requires the submission of credible evidence that, if not controverted at trial, would entitle the moving party to a directed verdict on that issue. Fitzpatrick v. City of Atlanta, 2 F. 3d 1112, 1115 (11th Cir. 1993). Only if the moving party meets that burden is the non-moving party required to produce evidence in opposition. Chanel, Inc. v. Italian Activewear of Fla. Inc., 931 F. 2d 1472, 1477 (11th Cir. 1991). Summary judgment should be denied unless, on the record evidence presented, a reasonable jury could not return a verdict for the non-moving party. Id.; see also Fitzpatrick, 2 F. 3d at 1115-16. The standard for cross-motions for summary judgment is not different from the standard applied when only one party moves for summary judgment. Am.

Bankers Ins. Grp. v. United States, 408 F. 3d 1328, 1331 (11th Cir. 2005). The Court must consider each motion separately, resolving all reasonable inferences against the party whose motion is under consideration. Id. “Cross-motions for summary judgment will not, in themselves, warrant the court in granting summary judgment unless one of the parties is entitled to judgment as a matter of law on facts that are not genuinely disputed.” United States v. Oakley, 744 F. 2d 1553, 1555 (11th Cir. 1984) (quoting Bricklayers Int’l Union, Local 15 v. Stuart Plastering Co., 512 F. 2d 1017 (5th Cir. 1975)). Analysis Defendant seeks summary judgment, arguing that its decision to deny Plaintiff’s LTD claim was reasonable because it was based on careful consideration of the administrative record and supported by substantial evidence. Plaintiff also seeks summary judgment, contending that the decision to terminate benefits was wrong and unreasonable because Defendant selectively reviewed the medical evidence and failed to consider her chronic ailments. Plaintiff additionally points to a Social Security determination of disability to support her LTD claim and a conflict of interest because Defendant makes eligibility decisions and pays benefits out of its own funds. Summary judgment in the ERISA context operates differently than summary judgment in the normal course of litigation. “ERISA benefits denial cases place the district court as more of ‘an appellate tribunal than as a trial court.’” Graham v. Life Ins. Co. of North America, 222 F. Supp. 3d 1129, 1136 (N.D. Ga. 2016) (quoting Curran v. Kemper Nat. Servs., Inc., No. 04-14097, 2005 WL 894840, at *7 (11th Cir. 2005)). “Review of the plan administrator’s denial of benefits is limited to consideration of the material available to the administrator at the time it made its decision.” Blankenship v. Metropolitan Life Ins. Co., 644 F. 3d 1350, 1354 (11th Cir. 2011); see Alexandra H. v. Oxford Health Ins. Inc. Freedom Access Plan, 833 F. 3d 1299, 1312 (11th Cir. 2016); O’Leary v. Aetna Life Ins. Co., 2017 WL 6617052, at *1 (N.D. Fla. Oct. 19, 2017). When reviewing the plan administrator’s decision, the district court performs the following analysis: (1) Apply the de novo standard to determine whether the claim administrator's benefits-denial decision is “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 is in fact “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.

Blankenship, 644 F. 3d at 1355 (citation omitted).

In the initial de novo review, the plaintiff bears the burden to prove that he or she is disabled. Glazer v. Reliance Standard Life Ins. Co., 524 F. 3d 1241, 1247 (11th Cir. 2008). If the plaintiff is unable to carry that burden, the administrator’s determination was not “wrong,” and the court’s inquiry ends there. See id. at 1246- 47. If the court reaches the next stage, the plaintiff bears the burden of establishing that the plan administrator’s decision was “arbitrary and capricious.” Capone v. Aetna Life Ins. Co., 592 F. 3d 1189, 1195-96 (11th Cir. 2010). Under this standard, the administrator’s decision should be affirmed if it is reasonable given the available evidence, even if the court may have made a different decision itself had it been the original decision-maker. See Griffis v. Delta-Family Care Disability, 723 F. 2d 822, 825 (11th Cir. 1984). A conflict of interest exists where – as here – the plan administrator makes eligibility decisions and pays benefits out of its own funds. Blankenship, 644 F. 3d at 1355. That being said, a reviewing court still owes deference to the administrator’s discretionary decision. Id. The conflict is simply a factor for the court to consider when evaluating whether the benefits decision was arbitrary and capricious.⁵ Id. “If the evidence is close, then the administrator did not abuse its discretion, and the requisite deference compels the affirmance of the administrator’s

Although Plaintiff’s treating physicians had previously opined that she was disabled under the meaning of the Policy, there was no opinion from a treating

pushing a shopping cart, closing her car trunk, carrying objects, and traversing stairs. Even viewing in light most favorable to Plaintiff, the surveillance evidence appears to be a “close call.” In addition to her diagnoses and disagreement with inferences drawn from surveillance video, Plaintiff mainly argues that the termination decision is reversible due to (1) the fact that the SSA deemed her eligible for disability benefits and (2) the conflict of interest. As to the SSA’s disability determination, although the SSA may employ stricter criteria for disability, the SSA’s disability determination is not dispositive, particularly where the plan administrator relied on new evidence that had not been provided to the SSA, such as video surveillance.

See Ness, 257 F. Supp. 3d at 1291 (citing Oliver v. Aetna Life Ins. Co., 613 F. App’x 892, 897 (11th Cir. 2015)); Sobh v. Hartford Life and Acc. Ins. Co, No. 8:15-cv-716-T- 30EAJ, 2015 WL 7444336, at *8-9, aff’d, 658 F. App’x 459 (11th Cir. 2016)). Similarly, the conflict of interest is not dispositive – rather, it is one factor to consider. When evaluated in conjunction with the administrative record, this fact does not sway the Court. See, e.g., Ness, 257 F. Supp. 3d at 1288 (explaining that although conflict of interest may be a factor to consider, the court’s basic analysis still focuses on whether the administrator’s decision was reasonable). Conclusion The challenged benefits decision was probably not wrong, and it was certainly not “arbitrary and capricious.” See, e.g., Howard, 563 F. App’x at 663. Although Plaintiff believes that the administrator “cherry-picked” evidence, the administrator is entitled to weigh evidence, particularly where the evidence may conflict.¹⁰ Even considering Defendant’s conflict of interest, the Court finds that Defendant’s decision to terminate benefits past October 18, 2019, was reasonable.

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-TOMBARBER i (asssi(‘“‘C;:st*~™S

UNITED STATES DISTRICT JUDGE