Gross v. Sun Life Assurance Co. of Canada
Opinion of the Court
More than four years ago, we remanded this case with the instruction that appellant Sun Life Assurance Co. reconsider its rejection of Diahann Gross’s claim for disability benefits based on chronic and severe pain. See Gross v. Sun-Life Assurance Co. of Can. (Gross I),'
In this appellate sequel, Sun Life challenges the district court’s view of the expanded administrative record. It argues that Gross failed to adduce medical evidence in the renewed proceedings to offset the contradictory surveillance—and thus did not meet her burden to prove that she is totally disabled. Sun Life also claims the district court abused its discretion in failing to impose sanctions on one of Gross’s attorneys. In a cross-appeal, Gross assigns error to the district court’s calculations of prejudgment interest and attorney’s fees.
After careful review of the record and the law, we affirm the district court’s rulings on the disability claim and sanctions. However, we vacate the prejudgment interest award and remand for consideration of the appropriate rate of interest. We affirm the district court’s attorney’s fee calculation in all but two respects, concluding that two components of the award must be increased.
I. Background
A. The First Appeal
" Until she was placed on disability leave in August 2006, at age 34, Gross worked as an optician and office manager at Pinnacle Eye Care LLC in Lexington, Kentucky. In our prior decision, we described in great detail the facts then in the administrative record concerning Gross’s condition and medical evaluations. See
1. The Original Medical Evidence
Multiple medical professionals who examined Gross between 2005 and 2007 reported that she was experiencing a variety of debilitating symptoms, including “chronic pain, inability to sit or stand for extended periods of time, severely diminished functional capacity in her right arm, and inability to bend, kneel, or crouch.” Gross v.. Sun Life Assurance Co. of Can. (Gross Remand Op.), No. 09-11678-RWZ, slip op. at 2 (D. Mass. June 24, 2016). Gross’s treating physician, Dr. Rita Egan, a rheu-matologist, opined that Gross was incapable of performing even sedentary activity, and she concluded that Gross suffered from reflex sympathetic dystrophy (“RSD”), fibromyalgia, widespread pain, and chronic fatigue. Gross I, 784 F.3d at 17. In two reports completed in late 2006, Egan noted, with some variation between the statements, that Gross could not sit in one place for more than an hour to ninety minutes, drive for more than ninety minutes, use her right hand, or lift more than ten pounds. Id. at 17 & n.19.
Other practitioners echoed Egan’s diagnoses, noting, inter alia, abnormalities in the appearance of, and the way Gross positioned, her right hand. See id. at 18, 21, 22.
Significantly, Kaczmarek stated that Gross was cooperative and “willing to work to maximum abilities” when performing tasks for the FCE, Id. at 23. Additional evidence of Gross’s good-faith in describing her symptoms and limitations came from her co-workers and employers, who submitted letters “describing her persistence in continuing to work despite obvious pain and compromised physical capacity.” Id. Her boss observed that “[s]he wasn’t going to give in until she absolutely had to,” id at 23 n.29, and Pinnacle’s owner, Paul Wedge, stated that “[w]e stopped her from working when we received her doctor orders that she was not fit to work,” id at 23 (alteration in original).
The medical evidence, however, did not uniformly support Gross’s disability claim. All of her diagnostic tests were negative, and several doctors speculated that psychological factors might be contributing to
[O]n November 9, 2006, shortly after dropping off a teenager believed to be her stepdaughter at school, Gross was observed driving for about an hour and a half to her mother’s home, with a brief stop at a rest area along the way. Second, during the evening of January 11, 2007, Gross drove a short distance with her stepdaughter to a Kmart, where she was observed bending down toward lower-level shelves, extending her arms above her head to retrieve items, and kneeling to examine other items.[3 ] Third, on February 21, after receiving a phone call that her mother had been admitted to the hospital with chest pain, Gross drove to a gas station, pumped gas using her right hand, and then drove for two hours to the hospital, with a brief stop halfway through the trip. About two hours later, she left the hospital and drove home.
Id. at 19. •
In support of its original denial of benefits, Sun Life also had procured opinions from two medical consultants who conducted paper reviews of Gross’s medical records. In the first records review, Dr. James Sarni noted, that “the documentation does not strongly support a diagnosis of [RSD or CRPS].” Id. at 19 n.24. He suggested an evaluation by a neurologist, which Dr. Rukmaiah • Bhupalam subsequently performed on February 22, 2007, the day after Gross' had made the trip to the hospital. Although Bhupalam initially concluded that Gross was “totally disabled even for sedentary work on a part time basis,” he changed- his assessment after viewing the surveillance videotapes. Id. at 20. He observed that “she can function quite well and probably will be able to return to her previous occupation,” although he also noted that “a re-evaluation might'be beneficial.” Id.
After Bhupalam’s examination, the second non-examining consultant, Dr. William Hall, reviewed Gross’s medical records and concluded that “the surveillance videos undermined [her] subjective reports of pain and functional limitations.” Id; A third consultant performed a paper review after Gross appealed the initial benefits denial. That physician; Dr. Alan Neuren, noted the inconsistencies between Gross’s condition as reported by healthcare providers and her appearance under surveillance, and he stated that “‘[t]he only reasonable conclusion’ to be drawn ⅛ that she has deliberately embellished her symptoms to her providers for secondary gain.’ ” Id. at 21.
2. The Remand Rationale and Directive
Given the well documented history of pain and other symptoms recorded by the medical professionals who examined her, and the buttressing observations of her coworkers, we had “no difficulty” concluding that Gross had submitted adequate medical evidence to prove her entitlement to
We were concerned, however, about the “significant incompatibilities between Gross’s reports and her observed functional capacity” while under surveillance, particularly during the three episodes described above. Id. at 26. Yet, even faced with those contradictions, Dr. Bhupalam had suggested that a reevaluation of Gross could be helpful that’s—“an observation we understood] to suggest that the video surveillance, while damaging to Gross, did not necessarily undermine her claim.” Id. We also noted that the record did not reveal whether Bhupalam or Neuren had been told that Gross’s two-hour drive to a hospital in February 2007 was precipitated by news that her mother had suffered a medical emergency. Id. at 26-27. That seeming omission of context led us to question “whether Sun Life ha[d] -made a bona fide effort to determine Gross’s capabilities.” Id. at 27. At the same time, we noted the absence of a statement from Gross’s own doctor “refuting Sun Life’s assertion in its original denial letter that the surveillance ‘show[ed] a capacity for activity that far exceeds’ the limitations she claims.” Id, (alteration in original).
We thus concluded that, ori the record then before us, we could not answer the “open question” necessary to resolve the parties’ debate over Gross’s entitlement to benefits: “the effect that the surveillance evidence, when viewed in context, may haye on other evidence indicating disability.” Id. at 27. Accordingly, we remanded the case, “so that the parties can further address both the significance of the video evidence in assessing Gross’s limitations and the.veracity of her self-reported and observed symptoms, ¡particularly concerning the condition of her right arm.” Id. at 27-28.
B. The Evidence Produced on Remand
In the renewed administrative proceedings following remand, Gross and Sun Life each submitted additional' opinions from two medical professionals, none of which were based on new examinations of Gross. Sun Life relied primarily oh reviews of Gross’s medical file by two neurologists, Drs. David Ross and Rajat Gupta. Ross provided a nine-page report summarizing Gross’s medical • history and concluding that “[t]he medical evidence does not support a functional impairment as of August 1, 2006”—Gross’s claimed disability date. Ross stated that “[t]here is no medical
Gupta similarly prepared a report reviewing Gross’s medical history, beginning in March 2004, and responded in the negative to a question asking whether he detected “any physical condition(s) supported by the clinical evidence that are functionally impairing.” Gupta questioned the diagnoses of CRPS or RSD, noting that the symptoms on which those assessments were based—including the swelling, discoloration, and temperature of Gross’s right arm and hand—“are known to be occasionally self-induced by particularly savvy individuals.” Gupta highlighted Gross’s long-sleeved clothing seen in the videos, “which typically would be avoided by sufferers of CRPS due to the extreme amount of hypersensitivity typically present,” and he noted the “consensus among most of her providers that there is a psychological component to [her] presentation.”
In an addendum to his report, Gupta stated that Gross’s mother’s medical emergency “would not explain the apparent ease and fluidity of movement that the claimant nonchalantly and effortlessly displayed]” with the use of her right arm and hand as she prepared to drive to the hospital in February 2007—although he acknowledged that “[pressing circumstances may conceivably allow an individual to perform physical feats of strength and/or endurance that would otherwise be considered ‘unachievable.’” On that issue, Sun Life also obtained a follow-up opinion from Dr. Neuren, who stated that “[i]t is not credible that going to visit her mother due to illness would result in resolution of her condition even on a temporary basis. ... CRPS is not a part time condition.”
Gross’s additional medical evidence consisted of two letters, one from a pain management specialist, Dr. James Murphy, and one from the physical therapist who had performed her functional capacity evaluation in 2007, Chris Kaczmarek. Having reviewed Gross’s medical records and the surveillance evidence, Murphy concluded that nothing in the three noted surveillance reports and videotapes “would contradict or invalidate the restrictions and limitations placed upon Ms. Gross by her physicians.” Murphy stated that the physical effects of CRPS and fibromyalgia “can vary from day to day—even minute to minute,” and that the severity of symptoms “are dependent upon numerous factors, such as medication regimen,[
Kaczmarek submitted a two-page letter reporting that he had reviewed Gross’s records, the three identified surveillance reports and videos, and the FCE he had performed in 2007. He summarily concluded that Gross’s activities in the videos were consistent with his prior findings that she could neither sit “at a frequency sufficient to engage in sedentary employment” nor “ ‘exert up to 10 pounds of force’ on an ‘occasional’ basis sufficient to engage in sedentary employment.”
After briefly surveying the evidence described above, the district court observed that its task was to decide whether the surveillance evidence “casts doubt ... sufficient to dislodge” the panel’s conclusion that the medical evidence supported Gross’s claim of total disability. Gross Remand Op. at 5. To undermine the disability assessment, the court stated, “would require the videos to show Gross performing activities that ‘directly contradict’ the self-reported limitations upon which her treating physicians have offered their diagnoses.” Id. (quoting Gross I,
Among other factors, the court noted that only one professional who had both personally examined Gross and reviewed the surveillance records—Bhupalam—had disagreed with the diagnoses of disabling conditions. But the court discounted Bhupalam’s view because he initially had agreed that Gross was unable to work, and his later contrary opinion—after viewing the surveillance tapes—was “tempered” by his recommendation that a follow-up evaluation be performed. Echoing our own sentiment, the court observed that “[t]his recommendation makes sense only if the surveillance records did not unequivocally contradict Bhupalam’s; initial opinion that Gross was totally disabled.” Gross Remand Op. at 6; see also Gross I,
In a subsequent ruling, the district court determined that the applicable interest rate for Gross’s recovery of benefits is the rate set by
Both parties' have 'appealed from the district court’s judgment. In its briefs to us, Sun Life contends that the record does not support the court’s conclusion that Gross met her' burden to show -that she is totally disabled. The insurer also claims that the district court erred in failing to sanction one of Gross’s attorneys for threatening, to sue Bhupalam if he did not withdraw his revised opinion adverse,to Gross. In her cross-appeal, Gross argues that the district court abused its discretion in choosing a prejudgment interest rate that does not fully compensate her for the wrongful denial of benefits. She also asserts that the court abused its discretion in setting the amount of attorney’s fees for the pre-remand proceedings, which concluded with our decision in Gross II.
II. Total Disability Finding
A. Standard of Review
Our decision in Gross I established that Sun Life’s denial of benefits was subject to de novo review by the district court. See
We need not reach that issue here, however. Not only do both parties assume that our review is de novo, but application of that., standard-r-more favorable to Sun Life—nonetheless leads us to uphold the district court’s judgment. We therefore review the administrative record de novo without affording deference to the district court’s assessment of the record,
B. Discussion
1. Evaluating the Post-Remand Evidence
Sun' Life insists that the record as supplemented on' remand reinforces its original determination that Gross did not prove that she is totally disabled. In sum, it contends that Gross “failed to produce any evidence related to- the[ ] ‘open questions’ ” that prompted our remand, namely, “the significance of the video evidence in assessing Gross’s limitations and the veracity of her self-reported and observed symptoms.” Gross I,
We see the record differently. Sun Life both overstates the persuasive value of its own post-remand submissions and sidesteps the fact that we previously found Gross’s medical evidence sufficient to prove her entitlement to benefits. See
For its part, Sun Life did not have Gross reevaluated and, instead, secured opinions based on reviews of her existing records and the surveillance. These reports primarily reiterated what we already knew: Gross engaged in some activities that were inconsistent with the most severe symptoms and limitations she described to her doctors during years of treatment for pain, as well as with the severity and persistence of pain typically associated with a diagnosis of CRPS or RSD. The central theme of the new evidence, as Ross put it, is that “[t]he medical evidence does not support a functional impairment,” and, accordingly, “[t]he claimant’s observed activities are more consistent with her true functional status.”
Yet, “[t]he medical evidence” already was before us during Gross’s, first appeal, and we found adequate record support for her self-reported limitations to conclude, subject to further insight into the surveillance-evidence, that Gross had shown an entitlement to benefits. Moreover,-as noted above, Egan’s reports in the fall of 2006 set the outside range of Gross’s .abilities, as sitting in one place for two hours, driving for ninety minutes, standing, or walking for an hour, and lifting ten pounds. Gross I,
Indeed, Gross told Bhupalam that she can “function better” after changing her pain medication patch,
Ross and Gupta’s assessments, however, failed to evaluate the three highlighted surveillance' reports in the context of the entire surveillance investigation and the consistent perceptions of examining practitioners that her complaints of pain were genuine. In particular, Sun Life’s experts did not explain the contrast between the more ambitious surveillance activities that we highlighted and Gross’s numerous days of relative inactivity,-a noticeable gap in light of her reports that she could obtain temporary relief from pain medications.
As described above, the surveillance took place over nine days, and the investigator saw little activity by Gross on most of those days.
Ross and Gupta thus appeared to treat the most extreme surveilled activities as decisive over Gross’s long history of credible-pain, without confronting her inactivity during most of the surveillance. Moreover, Sun Life’s counsel acknowledged at oral argument that there is no record evidence that Ross was told that Gross’s travel on February 21 occurred after she learned that her mother had been taken to the hospital on an emergency basis.
.We recognize that Gupta’s addendum refers not only to the identified episodes, but also to Gross’s use of her right hand on the three successive days of surveillance in November 2006, including for the purpose of closing a car door and reaching into her purse, and he notes that she “is seen ambulating fluidly, with no limp, in all three days.” He similarly reports that, during the three days of surveillance in January 2007, Gross is seen walking “in a normal manner, using her right hand to brush her hair off of her face ... [and] adjusting] the shoulder strap of her purse with the same hand.” We consider brief actions by Gross, on days when she was largely inactive or also manifested limitations, of minimal significance. Some fluctuation in physical ability related to such factors as fatigue and the timing of medications is predictable, see
Sun Life emphasizes that it offered ample evidence that the inconsistency between Gross’s complaints and the surveillance indicates that she was either embellishing or self-inducing her symptoms, or both. Neuren’s original report noted both of those possibilities,
Even most of Bhupalam’s addendum, in which he retreats from his original finding of disability, consists of nothing more than what he sees on the videotape. He observes, .for example,-that Gross “does not appear to be in any pain or discomfort in the video recorded on February 21.” Bhupalam does not attempt to explain, however, how to reconcile what can be seen on the videotapes with his in-person evaluation. In all. likelihood, the puzzling dissonance is why he noted that a reevaluation could be helpful.
• We are frankly puzzled that .Sun Life did not act on Bhupalam’s suggestion of a reexamination,
To be clear, we are not saying as a general matter that the views of examining doctors' are entitled to more weight than the opinion of á doctor who performs only a records review. Indeed, we have held to the contrary. See Orndorf v. Paul Revere Life Ins. Co.,
Yet, Gross’s offerings, too, are less compelling than we would have anticipated. Neither of her two post-remand reports was based on a new medical examination, and both were summary in form. As described above, Murphy, the pain specialist, provided a one-page letter containing a number of general statements—e,g., that surveillance in general, and the surveillance of Gross in particular, is “not a reliable indicator of actual physical capacity” for someone with CRPS and fibromyalgia, and that the impact of her conditions “can vary from day to day” and “even minute to minute”—but he does not specifically address the gap between Gross’s reported symptoms and her seeming ability at times to “function quite- well” (Bhupalam’s words).
Although Gross’s supplemental material responds to the questions raised in our prior decision, its persuasive; force would have been enhanced if either practitioner had provided some elaboration of his opinion that the surveillance is consistent with a finding that Gross is totally disabled. In addition, although we noted in Gross I that Gross had not “submitted] a statement from her own doctor refuting Sun Life’s assertion ... that the surveillance
2. Our Conclusion
We have thus gained little additional knowledge from the remand about the significance of the surveilled activities that previously gave us pause. In assessing the competing undeveloped views that have been presented, however, we find more plausible Murphy’s opinion that those activities do not contradict Gross’s medical history because her most extreme symptoms are not always present. A commonsense view of Gross’s maladies—one not dislodged by any persuasive contrary medical evidence—supports Murphy’s statement that “numerous factors” can affect the severity of her symptoms.
Indeed, the investigator’s reports and videos displayed significant variations in Gross’s capacity at times when Gross would have had no reason to’ fabricate symptoms.
Hence, we think it fair to conclude that' Sun Life gave undue importance to the few occasions when Gross appeared not to be disabled by her symptoms, leading to a distorted view of her capacities. When the surveillance is instead viewed in context, it belies Gross’s ¿bility to engage in! fulltime employment. Indeed, she appearéd to suffer significant consequences on the two days that followed the hospital visit (i.e., both the day she was examined by Bhupa-lam and the following day, when she apparently did not leave home). Such adverse physical impact is what one would expect when an individual with serious medical issues disregards her doctor’s guidelines; That is to say, activity restrictions do not necessarily define an individual’s maximum capacities on any particular occasion. Rather, prescribed limits are just as likely intended to protect the individual from aggravating her physical condition. From that perspective, when the three days of February surveillance are taken together,
Moreover, the elusive source of Gross’s reported pain—perhaps fibromyalgia, perhaps RSD or CRPS, perhaps all three— gives particular importance to the credibility judgments of those who examined her. Neuren and Gupta emphatically rejected the possibility that the pain associated with CRPS could be sufficiently diminished to allow normal activity, but CRPS is not Gross’s only diagnosis. Gupta noted that, with respect to fibromyalgia, determining individuals’ “degree of impairment ... often rests on their credibility.” He went on to state that “[tjhere has not been enough credibility established for this claimant to allow for a determination of impairment to be based purely on her subjective complaints and allegations.” We disagree with his assessment of the evidence; while Gross’s credibility does find support in the record, the insinuations of fabrication do not.
To be sure, the record reflects some exaggeration by Gross, or perhaps selective reporting of her worst-case experiences. She evidently told Egan in the fall of 2006 that she “could not ... use her right hand,”
We thus reiterate our conclusion that the medical record “support[s] a finding of total disability.”
III. Sanctions
Sun Life argues that the district court abused its discretion by failing to impose sanctions on one of Gross’s attorneys for interfering with Sun Life’s post-remand investigation of Gross’s claim. We begin by describing the conduct underlying Sun Life’s contention.
A. Factual Background
In November 2014, while the renewed administrative proceedings were ongoing,
Bhupalam did not respond to the November letter, which was re-sent to him via fax on December 1. In early February 2015, Grabhorn sent him another letter. The attorney reiterated his incorrect assertion that Bhupalam had not been provided with all of Gross’s medical records or the FCE, -noted that these materials had been sent with his previous letter, and stated that Bhupalam had failed to comply with the request that he “amend [his] prior medical opinion so as to accurately confirm [that] Mrs. Gross’ physical restrictions and limitations precluded her from engaging in active full-time employment of any kind.” In other words, Grabhorn more directly asked Bhupalam in this letter to withdraw the April 2007 addendum in which he had changed his opinion of Gross’s ability to work based on the video surveillance. Grabhorn threatened legal action if Bhupa-lam failed to “correet[]” his medical opinions, and he included a draft complaint alleging claims of negligence, defamation, and fraud, and seeking punitive damages.
Sun Life learned of these communications several weeks later when it received a letter from Bhupalam’s attorney explaining that the doctor would not be responding to Sun Life’s request for follow-up comment on Gross’s “functionality back in February 2007.” After reporting that Grabhorn had threatened to sue Bhupalam if he failed to retract his addendum, the attorney’s letter continued as follows:
As you can imagine, Dr. Bhupalam does not wish to be further involved in any way in the ongoing litigation between Ms. Gross and Sun Life Financial. Therefore, he respectfully declines to render any additional opinions regarding Ms. Gross’ condition and would stand by his addendum report.
B. Discussion
Sun Life argues on appeal that the district court should have addressed Grab-horn’s “unacceptable” actions “in some manner,” and it asserts that it was harmed because Grabhorn’s threat of legal action kept Bhupalam from responding to Sun Life’s request iior clarification of his opinion. In particular, Sun Life states that it was unable to include in its final decision letter the fact that Bhupalam had reaffirmed his addendum opining that Gross was capable of sedentary employment. In urging the need for sanctions to deter Grab-horn’s “bad behavior,” Sun Life points to an unrelated disability case in which Grab-
Grabhom’s threat of litigation against a potentially adverse expert is troubling, particularly given that it was not an aberration. Sun Life, however, provided no assistance to the district court in evaluating the sanctions question. It merely argued in its brief in support of its motion for judgment that Grabhorn’s “tampering with a witness ... should ... be sanctioned in a manner deemed appropriate” by the court. Gross v. Sun Life Assurance Co. of Can.; No. 1:09-cv-11678-RWZ, Docket 107, at 24 (filed Mar. 4, 2016): Sun Life neither addressed the source for the court’s authority to discipline Grabhorn nor provided examples of measures that would -be within that authority.
The decision to impose sanctions is not to be made lightly. “The. Supreme Court has admonished courts to be cautious in using their inherent power to -sanction, explaining that -‘[b]ecause of. their very -potency, inherent powers must be exercised with restraint and discretion.’ ” United States v. Romero-Lopez, .
Here, notwithstanding its contention to the contrary, Sun Life has not demonstrated that it was disadvantaged by Grab-horn’s conduct. The follow-up information that Sun Life sought from Bhupalam was nonetheless added to the record. Sun Life asked Bhupalam to comment only on whether knowledge of the reason for Gross’s travel to the medical center “changes your opinion regarding her func
Under these circumstances, and without condoning Grabhorn’s actions, we see no reason to second-guess the district court’s judgment not to award sanctions. Yet Grabhorn’s conduct on appeal makes this a closer issue than it might otherwise be. In the appellate brief that Grabhom signed, Gross represents that the threatening letter was a reaction to multiple unsuccessful attempts to obtain medical records, from Bhupalam. The brief also states that, “[a]s indicated in her letter, upon Dr. Bhupalam providing a complete copy of his chart, Ms. Gross agreed to forgo legal action.” Neither of the letters described above, however, referenced a request for records. To the contrary, the threat of legal action was linked to the demand that Bhupalam “correct” his medical opinions.
In sum, while we uphold the district court’s exercise of discretion on the matter of sanctions, we Consider Grabhorn’s threat of litigation to Bhupalam, and his misrepresentations in defense of that conduct on appeal, worthy of reproach. Hence, in our mandate, we will direct the Clerk of Court to send a copy of this opinion to fhe Kentucky Office of Bar Counsel for whatever action, if any, it deems appropriate. See, e.g., Punzalan v. Holder,
IY. Prejudgment Interest
In her cross-appeal, Gross argues that the district court . abused its discretion .’in awarding her prejudgment interest at the federal statutory rate. See
A. Availability of Prejudgment Interest
ERISA does not explicitly provide for prejudgment interest, arid whether to grant such a remedy is thus within the discretion of the district court. Cottrill v. Sparrow, Johnson & Ursillo, Inc.,
We previously have identified two primary considerations when a,court decides to award prejudgment interest. First, ERISA’s remedial objectives are served by
In Cottrill, we endorsed the district court’s use of the rate prescribed by § 1961(a), noting that “this rate promotes uniformity in ERISA cases” and was “especially appropriate ,.. because the Plan’s funds were initially invested in Treasury bills.”
One complexity in selecting an appropriate rate is the ever-changing relationship between statutory interest rates and the actual cost of money. In Schumacher, for example, the Sixth Circuit held that the
In sum, when a district court has concluded that a plaintiff should be awarded prejudgment interest, its task in selecting the rate is to identify, in the particular case, a fair percentage reflecting “both the rationale of full compensation and ERISA’s underlying goals.” Cottrill,
B. Discussion
Gross asked for a prejudgment interest amount that would “reflect the actual interest earned -by Sun Life on Ms. Gross! withheld past due LTD benefits” or “interest calculated at her borrowing rate (e.g. the prime interest rate adjusted for risk of default).” Gross v. Sun Life Assurance Co. of Can., No. l:09-cv-11678-RWZ,-Docket No. 109, at 15 (filed Mar. 4, 2016). She asserted that interest should accrue from January 2007, the date of her benefits eligibility. The district court, without explanation, awarded prejudgment interest “from the date of the filing of the complaint in this action, calculated according to the method specified in 28 U.S.C. §' 1961.”
Gross argues that the court abused its discretion in selecting the federal rate because it is too low to make her whole “and by extension unjustly enrichjes] Sun Life at Mrs. Gross’ expense.”
Notwithstanding the district court’s considerable discretion in choosing the prejudgment interest rate, its decision must permit some scrutiny. Here, however, we are unable to .evaluate the court’s judgment call because it did not explain its reasoning, and its rationale is not apparent from the record. Cf. Enos,
In these circumstances, mechanical adoption of the § 1961(a) rate would be an abuse of discretion. Because we cannot discern whether the court had supportable reasons for choosing that rate based on the equities and ERISA’s goals, we must vacate the award of prejudgment interest and remand to the district court for reassessment or explanation, of its interest-rate determination.
V. Attorney’s Fees
ERISA’s attorney’s fee provision allows a court in its discretion to award reasonable attorney’s fees in benefits proceedings. See
We did . not ourselves perform “[t]he heavily fact-dependent lodestar analysis” that ordinarily is used to calculate fee awards, and instead instructed the district court to do so.
Utilizing the lodestar analysis, the district court ordered Sun Life to pay Gross $96,243.50 to- cover counsel fees through her first appeal, including for work on the post-judgment" fed petition that led to our decision in Gross II. See Gross v. Sun Life
We review a district court’s ruling on a fee request for abuse of-discretion. Cent. Pension Fund of the Int’l Union of Operating Eng’rs & Participating Emp’rs v. Ray Haluch Gravel Co.,
The district court wrote a thorough opinion based on “a detailed analysis of the submitted billing records.” Gross,
Although we also find no abuse of discretion in the court’s selected hourly rate for Grabhorn, we nonetheless think it useful to review our precedent on the choice of an appropriate rate. We also explain below why two adjustments in the fee award are necessary.
A, Grabhorn’s Hourly Rate
Both Grabhorn, a Kentucky-based ERISA lawyer, and Jonathan Feigenbaum, a Boston-based ERISA lawyer, sought to recover fees at a rate of $500 per hour. The district court found that rate reasonable for Feigenbaum, noting that Boston “hourly legal fees are among the highest in the country.” Gross,
Our court has endorsed the proposition that “reasonable hourly rates should be set by reference to rates in the court’s vici-nage rather than in the lawyer’s region of origin.” Gay Officers Action League,
Given this flexibility, we cannot say the district court exceeded its authority in determining that Grabhorn’s hours should be compensated at a lower rate than Feigenbaum’s. The court expressly recognized that it could properly award Grabhorn the Boston hourly rate. See Gross,
B. The Fee Petition
In calculating the attorneys’ compensation for litigating Gross’s fee petition following our decision in Gross I, the district court trimmed Gross’s request by two-thirds, awarding fees for only 22.4 of the 67.3 hours claimed. Gross,
The court’s characterization of ERISA fee petitions as “straightforward” may be apt for the ordinary case. See Matalón,
' Having reviewed the billing records ourselves, we are satisfied that the 67.3 hours billed—37.6 by one attorney, 27.7 by another, plus two paralegal hours—reflect a reasonable expenditure of time in light of both the difficulty of the legal questions and the multiple phases of the fee proceedings. Indeed, the 67.3 total appears to be both an accurate accounting of the time spent and an appropriate allocation of resources. On remand, the district court should adjust its calculation of compensa-ble hours to include the full 67.3 hours for the work on the fees petition.
C. Summary Judgment
Also problematic in the court’s lodestar analysis is its 50% reduction in
However, the court also expressed the view that the total hours devoted to the summary judgment motions—105.5 attorney hours and 5.5 paralegal hours—was unreasonable, and we find no abuse of discretion in that judgment. Accordingly, we conclude that a 25% downward adjustment in the hours sought would more accurately reflect both the success Gross achieved on her claim for benefits and the district court’s permissible view that the total of summary judgment hours was excessive.
We also wish to briefly comment on the district court’s 33% downward adjustment for the hours spent on Gross’s first appeal. That reduction was among those made to - account for “time spent pursuing unsuccessful claims and to reflect the quality of the plaintiffs victories.”
YI. Summary
We uphold the district court’s determinations on both of the issues appealed by Sun Life,' affirming the award of disability benefits to Gross and leaving intact the court’s judgment declining to impose sanctions on attorney Michael Grabhorn. On Gross’s cross-appeal, we remand to the district court the question of the appropriate rate of prejudgment' interest. We affirm in part and vacate in part the district court’s attorney’s fee calculation. As explained above, we direct the court to recal-
■ Affirmed in part, vacated in part, and remanded for further proceedings consistent with this opinion. The Clerk of Court is directed to send a copy of this opinion to the Kentucky OfSce of Bar Counsel. Costs to appellee/cross-appellant.
. More than a year later, in November 2007, Egan submitted a functional capacity report in support of Gross’s' appeal of Sun Life’s original denial of benefits setting out greater restrictions: she could not sit or stand for more than an hour each day, and she could not push or lift any weight. Gross I,
. For example, Dr. Fred Cqates reported in March 2007 that Gross appeared to be in “severe pain while seated” and that her right arm hung “limply at her side.” Gross I,
. Gross disputed that she bent down as described, stating that she "simply knelt down, with the bulk of her weight balance[d] on> her knee which was braced on the ground."
. We summed up our. assessment of the record as follows:
[T]he sustained and progressive nature of Gross’s complaints, their facial credibility to the medical practitioners who personally examined her, and the objective symptoms consistent with RSD—given the absence of any method for reaching a conclusive diagnosis—support a finding of total disability. Gross I,734 F.3d at 24-25 .
. As noted above, see supra note 1, Egan did submit a functional capacity evaluation in support of Gross's appeal of the initial denial of her claim, in which the doctor reiterated her diagnosis of CRPS in Gross’s right arm, fibromyalgia, severe migraines, chronic fatigue, and depression. See Gross I,
. As noted in our earlier opinion, the FCE prepared in January 2007 "lists numerous medications that Gross reported using on a daily basis: Wellbutrin, Duragesic patches, Klonipin, Tizanadine, Lortab, Ambien CR, Valtrex, Estrostep FE, Senokot, Tylenol Rapid Release, Excedrin Tension Headache, and Phaxyme.” Gross I,
. The new information in his letter was as follows:
*9 Based on my professional education, training and experience, below are my responses to the questions posed:
1. Based on my review of the surveillance videos, Ms. Gross’ activities are consistent with my prior examination findings that she is unable to "sit” at a frequency sufficient to engage in sedentary employment. [box labeled "Agree” is checked]
2. Based on my review of the surveillance videos, Ms. Gross' activities are consistent with my prior examination findings that she is unable to “exert up to 10 pounds of force” on an "occasional" basis sufficient to engage in sedentary employment.
[box labeled "Agree” is checked]
. Section 1961 calculates interest "at a rate equal to the weekly average 1-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding[] the date of judgment.”
. Gross’s motion for attorney's fees for work performed in connection with the post-remand review of her disability claim was stayed pending resolution of this appeal, now denominated Gross III.
. In response to the concurrence, the other panel members assert that we have followed the ordinary practice of "review[ing] and weighting] the administrative record as a whole.” That full-record review was simply divided between two decisions, with the current appeal (Gross III) addressing the issue ' left unresolved in Gross I: whether the medical evidence in Gross's favor was undermined by the surveillance evidence. These two decisions did not alter Gross’s burden of proof.
. She also reported to another doctor, in March 2007, that "she could lift her arm slightly after changing her pain medication patch.” Gross I,
. Sun Life's failure to provide that background would be contrary to our decision in Gross I, where we observed that "knowledge of the reason for Gross's unusual travel that day [is] essential for any reliable appraisal of her medical condition.”
. Neuren did state that CRPS is not a "part time condition,” and in his post-remand report, Gupta opined that the diagnosis of CRPS was likely wrong because “[n]o amount of pain control of CRPS would be so successful as to allow the absolutely normal functioning seen in the[] videos, in my experience.” However, Neuren’s general statement does not shed light on what temporary improvements in functioning could be expected from Gross's combination of medications. Gupta’s statement was muted by his acknowledgment that "[p]ressing circumstances” might allow someone to undertake activities "that would otherwise be considered ‘unachievable.’ ” Moreover, even if the diagnosis of CRPS were - incorrect—as Gupta posited—Gross’s other pain-related diagnoses would remain, including fibromyalgia and severe migraines, Neither doctor indicated that pain associated with those conditions could not be temporarily aljeviated with medication.
. Although it plays no role in our assessment of Sun Life’s benefits decision, we note that the Social Security Administration determined in August 2008 that Gross "became disabled under our rules on March 1, 2007,” and awarded her benefits.
. In his addendum, Bhupalam does note that, despite his conclusion of total disability based on his examination of Gross, "there were questions about validity of her sensory 1 examination and motor examination, especially with weakness and inability to use her right upper extremity and inability to transfer from the bed to the chair and bed tó examination table, etc., and requiring full assistance,” Those "questions about validity," however, did not prevent his conclusion of disability.
. For reasons discussed in Section III infra, Sun Life probably could not have obtained a reevaluation from Bhupalam. A physical examination could have been performed, however, by another medical professional who was given knowledge of the surveillance.
. Sun Life correctly points out that the district court factually erred in describing Murphy as a treating- physician. That mistake, however, has no import for our independent review of the evidence.
. On the day of her hospital travel, for example, Gross was seen with a severe limp as she walked from her front door to her car, before proceeding to the gas station.
. Sun Life argues that a finding of disability is improper because several doctors opined that Gross’s symptoms were partially attributable to emotional factors, and she failed to obtain counseling or behavioral treatment. As noted in our prior opinion, counseling is a recommended approach for treating the symptoms of CRPS, Gross I,
. Grabhorn also questioned whether Bhupa-lam had personally prepared the previous addendum, which Grabhorn described ás '.'[t]he unsigned addendum on your letterhead.”
. Sun Life states in its brief on appeal that Bhupalam did- have the FCE, and Gross does . not challenge that assertion.
. Sun Life presumably was relying on a federal court's “inherent power ‘to discipline attorneys who appear before it.' ” United States v. Romero-Lopez,
. Sun Life’s timing complaint—that it was "prevented ... from including in its decision letter information specifically requested by this Court”—is somewhat disingenuous given that Sun Life waited until very late in the remand process to seek the follow-up opinions from both Bhupalam and Neuren that'we indicated could be helpful. Sun Life denied Gross’s claim in July 2014, and Gross filed her response in November 2014. Sun Life sent its letter to Bhupalam seeking follow-up comment on January 30, 2015. Sun Life’s final decision was issued two weeks later.
. Moreover, although Grabhom had in other correspondence asked Bhupalam for the medical records, he previously had been told that the doctor would not release them without Sun Life’s permission. Grabhorn did not contact Sun Life to secure that permission.
. Although both Cottrill and Pacific Ins. Co, are ERISA cases, neither involved the precise question we face here. The issue in Cottrill was the proper accrual date for prejudgment interest. See
. Gross does not challenge the court’s choice of an accrual date, which we understand to be October 6, 2009, the date her complaint was removed to federal court.
. The Treasury website address listed in Section IV.A can be altered at the end to access data for other years; i.e., instead of inserting "&year=1991,” insertion of "&year=2009” would retrieve the-2009 data. The 2016 percentage noted infra is similarly available by changing the concluding portion of the website address to "&year=2016.”
. The rate dropped under \% in late 2.008 and remained below. that mark until late 2016, In 2017, the rate's low point was 0.79% and, as of December 29, 2017, the rate was 1.76%. See Treasury website & supra note 27.
. The district court accurately described Gross I as follows:
The appeal raised three issues: whether the ERISA safe harbor exception applied; if not, what standard of review governed plaintiff's ERISA claim; and, under that standard, whether she was entitled to relief. Plaintiff lost on the first issue, prevailed on the second, and won a reversal and remand on the third.
Gross,105 F.Supp.3d at 139 (citation omitted).
. We note that, with her success on the merits in the post-remand phase of the litigation, Gross will be eligible for additional attorney's fees. Her motion requesting a fee award for post-remand legal work, stayed pending appeal, will now be reactivated and can be expanded to cover fees incurred for this appeal.
Concurring Opinion
(Concurring)
The central merits issue in this case is whether Ms. Gross was physically-disabled within the- meaning of Sun Life’s group disability policy. The law is quite clear that Gross bore the burden of proof on that issue. See Orndorf, 404 F.3d.at 518-19 (characterizing the conclusion that claimant bears the burden .of proving disability as a “guiding principle” in the appellate court’s analysis). It is also quite clear that in resolving such an issue courts generally review and -weigh .the administrative record as a whole. See Scibelli v. Prudential Ins. Co. of Am.,
My colleagues, though,.-read Gross I as having bifurcated the usual ERISA merits inquiry. They conclude that some of the evidence (i.e., the evidence excluding both the video and conclusions to be drawn from the video) weighs in favor of finding of disability, and then treat this appeal as a proceeding in which Sun Life bears the burden of upsetting that conclusion. This bifurcated parsing of the evidence provides a potent tool for burden shifting. Here, for example, Gross I found the evidence as a whole did not justify the entry of judgment for Gross, where the only doctor who saw both Gross and the video recanted his opinion after he saw the video. Common sense would suggest that the case might therefore turn on what Gross’s, numerous treating physicians had to say in response, i.e., did.they stand by their opinions once shown the video? Instead, when the treating physicians remained mum, my colleagues (treating the Bhupalam opinion as old news) now find that Sun Life needed to do more “to show that ... the capabilities Gross demonstrated in the videos were incompatible ‘with the medical record of disability.” While'I'doubt that this is a proper way to proceed, I acknowledge that one could reasonably read Gross I as setting up such a burden-shifting inquiry. And while I would normally eschew such a reading in the absence of more express direction (and perhaps some support in the case law), I defer here to my colleagues, both of whom were on the Gross I panel and seem to regard such a reading as plainly manifest (or at least intended). For this reason alone, I concur.
Reference
- Full Case Name
- Diahann L. GROSS, Plaintiff, Appellee/Cross-Appellant, v. SUN LIFE ASSURANCE COMPANY OF CANADA, Defendant, Appellant/Cross-Appellee
- Cited By
- 76 cases
- Status
- Published