Dabon v. Aetna Life Ins Co

U.S. Court of Appeals for the Fifth Circuit

Dabon v. Aetna Life Ins Co

Opinion

IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 02-30742 Summary Calendar

JULES DABON,

Plaintiff-Appellant,

versus

AETNA LIFE INSURANCE COMPANY,

Defendant-Appellee.

Appeal from the United States District Court for the Eastern District of Louisiana (USDC No. 01-CV-1930-C ) _______________________________________________________ January 29, 2003

Before REAVLEY, SMITH and STEWART, Circuit Judges.

PER CURIAM:*

Jules Dabon sued Aetna Life Insurance Co. under the Employee Retirement

Income Security Act of 1974 (“ERISA”),

29 U.S.C. § 1132

(a)(1)(B), seeking

* Pursuant to 5TH CIR. R. 47.5, the Court has determined that this opinion should not be published and is not precedent except under the limited circumstances set forth in 5TH CIR.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. review of Aetna’s decision to terminate Dabon’s long-term disability (“LTD”)

benefits under its policy with Dabon’s former employer, Goodyear Tire & Rubber

Company. The district court found that Aetna did not abuse its discretion by

discontinuing Dabon’s LTD benefits. We affirm for the following reasons:

1. If a plan gives the administrator discretionary authority to determine eligibility

or to construe the terms of the plan, her decisions are reviewed for abuse of

discretion. Firestone Tire & Rubber Co. v. Bruch,

489 U.S. 101, 115

(1989).

The parties agree that Aetna had such discretionary authority, thus we review

its decision for abuse of discretion. We may only reverse the district court’s

judgment if the record does not adequately support Aetna’s decision to

discontinue benefits; that is, if the decision to discontinue benefits was

arbitrary or capricious.

2. Under the Aetna plan, the claimant must be totally disabled to recover

benefits:

You are deemed to be totally disabled . . . if you are not able,

solely because of injury or disease, to work at any reasonable

occupation. (This is any gainful activity for which you are, or

may reasonably become, fitted by education, training or

experience, and in which other people of similar background are

2 actually employed as their principal means of support.)

The record supports the conclusion that Dabon was capable of light duty or

sedentary work. Although during his administrative appeal Dabon offered the

opinions of two doctors who stated he was totally disabled due to the

secondary effects of pain, these opinions were entirely unsupported by

objective medical evidence. Aetna did not abuse its discretion by placing

more weight on the objective medical evidence contained in the

administrative record.

3. Dabon suggests that Aetna abused its discretion by discussing the need for

vocational evidence and then failing to obtain it. First, the record indicates

that Aetna employees discussed the need for a comprehensive Labor Market

Survey; it does not indicate that they concluded it was necessary. Second,

Aetna had a rehabilitation consultant review the file and conduct a brief

internet job search. Third, even if they had stated a more comprehensive

Labor Markey Survey was needed, an administrator has no obligation to

reasonably investigate a claim. Vega v. Nat’l Life Ins. Servs. Inc.,

188 F.3d 287, 298

(5th Cir. 1999). In Vega, the Fifth Circuit rejected a rule that would

place a duty of reasonable investigation on an administrator. Instead, the

court chose to “focus on whether the record adequately supports the

3 administrator’s decision.”

Id.

Thus, if the record adequately supports

Aetna’s decision, we must conclude that it did not abuse its discretion.

4. The facts of this case are not distinguishable from Duhon v. Texaco,

15 F.3d 1302

(5th Cir. 1994). In Duhon, this Court held that a plan administrator did

not abuse its discretion by determining that a high-school educated man with

moderate restrictions on his physical activity could perform “any job for

which he is, or may become, qualified by education, training, or experience”

without vocational rehabilitation evidence.

Id. at 1309

. Dabon is a high-

school educated man who is, according to three physicians, capable of

performing light capacity to sedentary work.The plan only requires he be able

to perform “any gainful occupation” for which he is, or may reasonably

become, qualified. “Given this undemanding language and the medical

evidence in this case, the plan administrator could competently determine

disability without vocational testimony.”

Id.

Additionally, Aetna conducted

a search for jobs for which Dabon is qualified, and concluded at least three

occupations existed. In light of Duhon and the administrative record, we

cannot say it was unreasonable for the plan administrator to find that Dabon

could perform a gainful activity.

4 Aetna’s decision to terminate Dabon’s benefits is fully supported by the

administrative record. Considering this Court’s holding in Duhon, the facts of this

case do not compel us to conclude that vocational evidence was necessary before

Aetna could reasonably decide to terminate Dabon’s benefits. Accordingly, the

judgment of the district court is AFFIRMED.

5

Reference

Status
Unpublished