OPINION AND ORDER
WILLIAM STOCKS, Bankruptcy Judge
This case came before the court on October 5, 2010, for hearing on a Motion to Alter or Amend Order Approving Form and Manner of Service of Notice of Foreign Claims Procedure filed on behalf of the United States ("Movant"). Lawrence P. Blaskopf appeared on behalf of the Movant and Stephen M. Packman and Benjamin A. Kahn appeared on behalf of the Debtor, De Coro, Limited ("Ltd."). Having considered the motion, the Debtor's objection, the briefs submitted by the parties and the arguments of counsel, the court finds and concludes as follows:
1. On or about February 18, 2009, James Wardell and Chan Wai Dune were appointed as the Provisional Liquidators to oversee the administration and liquidation of Ltd. in certain insolvency proceedings pending before the High Court of the Hong Kong Special Administrative Region Court of First Instance, Companies (Winding-Up) No. 93 of 2009 (the "Hong Kong Court"), pursuant to the Hong Kong Companies Ordinance, Chapter 32 of the Laws of Hong Kong (the "Hong Kong Proceeding").
2. Ltd. is a Hong Kong limited liability company formed on December 11, 1996, and is the parent company and shareholder of DeCoro USA, Ltd. ("USA"). USA is currently a debtor in bankruptcy, having filed a voluntary petition for relief under Chapter 11 of Title 11 of the United States Code (the "Bankruptcy Code") on May 12, 2009, Case No. 09-10846 (the "Chapter 11 Case").
3. On February 24, 2009, the Hong Kong Court entered an amended order appointing the Provisional Liquidators and enumerating the powers and duties of the Provisional Liquidators vis-a-vis the winding down of the De Coro Group (the "Appointment Order"). The Appointment Order vests the Provisional Liquidators with sole authority to administer the winding down of Ltd. and its subsidiaries, including, without limitation, Ltd. and USA.
4. On March 5, 2009, the Provisional Liquidators filed a voluntary petition (the "Chapter 15 Petition") under Chapter 15 of the Bankruptcy Code in the United States Bankruptcy Court for the Middle District of North Carolina (the "Bankruptcy Court"), Case No. 09-10369 (the "Chapter 15 Case"), seeking, inter alia, recognition of the Hong Kong Proceeding as a "foreign main proceeding" as such term is used in Chapter 15 of the Bankruptcy Code.
5. On March 11, 2009, the Bankruptcy Court entered an order granting the provisional relief sought by the Provisional Liquidators. On April 2, 2009, the Bankruptcy Court entered an order granting the Chapter 15 Petition, recognizing the Hong Kong Proceeding as a foreign main proceeding, and extending certain relief to the De Coro Group [Docket No. 36] (the "Recognition Order").
6. On or about June 5, 2009, the IRS filed Claim Number. 4-1 in the Chapter 15 Case, asserting a total claim of $99,764,687.00 against Ltd., comprised of $84,379,425.00 as an unsecured priority tax claim, and an additional $15,385,262.00 as a general unsecured claim (the "Original IRS Chapter 15 Claim").
7. On or about January 20, 2010, the IRS filed Claim Number 5-1 in the Chapter 15 Case, amending the Original IRS Chapter 15 Claim, and asserting a total claim of $133,990,621.57 against Ltd., comprised of $118,605,359.57 as an unsecured priority tax claim, and an additional $15,385,262.00 as a general unsecured claim (the "Amended IRS Chapter 15 Claim").
8. On or about April 28, 2010, in connection with the administration of the Chapter 15 Case, the Provisional Liquidators filed with the Bankruptcy Court a Motion For Order Approving Form and Manner of Service of Notice of Foreign Claims Procedure [Docket No. 49] (the "Claims Procedure Motion") in the Chapter 15 Case. The Claims Procedure Motion sought, inter alia, the Bankruptcy Court's approval of the form and manner of service of that certain Notice of (I) Recognition of Hong Kong Proceedings; (II) Foreign Claims Procedure; and (III) Related Relief (the "Claims Procedure Notice"). As evidenced by the BNC Certificate of Mailing filed in the Bankruptcy Court on May 8, 2010, the IRS was among numerous parties receiving service of the Claims Procedure Motion.
9. The Claims Procedure Motion asserted that the Bankruptcy Code does not provide guidance for an independent claims procedure mechanism in cases arising under Chapter 15 and that creditors in the United States possessing claims against a foreign debtor subject to a Chapter 15 proceeding instead must file their claims in such form and substance as may be required under the laws of the jurisdiction which is home to the "foreign main proceeding." See Claims Procedure Motion, ¶ 7. Accordingly, the Provisional Liquidators sought by their Motion to provide creditors of Ltd. with appropriate notice of how to file their claims against Ltd. in the Hong Kong Proceeding.
10. No objections to the Claims Procedure Motion were filed with the Bankruptcy Court.
11. On June 1, 2010, following a hearing that was held on May 18, 2010, the Bankruptcy Court entered an order granting the Claims Procedure Motion and approving the form and manner of service of the Claims Procedure Notice [Docket No. 53] (the "Claims Procedure Order"). In accordance with the Claims Procedure Order, and as evidenced by the certificate of service filed by the Provisional Liquidators on June 3, 2010, the Claims Procedure Order, together with the Claims Procedure Notice and Hong Kong Proof of Debt forms, were served upon all creditors of Ltd. and other parties in interest, including, without limitation, the IRS.
12. On June 16, 2010, the United States, on behalf of the IRS, filed a Motion to Alter or Amend Order Approving Form and Manner of Service of Notice of Foreign Claims Procedure [Docket No. 56] ("Motion to Amend"). The Motion to Amend seeks entry of an amended Claims Procedure Order, in the form of a "clarification of [the Claims Procedure Order] so that it is apparent that it does not apply to assets of [Ltd.] that are located within the United States." See Motion to Amend, ¶ 4. The Motion to Amend further states that the United States "is concerned that if this Court's [Claims Procedure Order] pertained to [Ltd.'s] assets within the United States, the United States could be compelled to defend its federal tax claim in a foreign court with respect to assets that are located within the United States." See, Motion to Amend, ¶ 7.
13. The Motion to Amend was filed pursuant to Rule 59(e) of the Federal Rules of Civil Procedure which is made applicable in bankruptcy cases by Rule 9023 of the Federal Rules of Bankruptcy Procedure. Rule 59(e) provides for motions to "alter or amend" a judgment or order. This does not mean, however, that a Rule 59(e) motion may be used merely to re-litigate the same matters already determined by the court in an earlier order or judgment. See Dale Selby Superette and Deli v. United States Dep't of Agric., 838 F. Supp. 1346, 1347-48 (D. Minn. 1993). Nor is a Rule 59(e) motion appropriate merely because the movant disagrees with the court's application of the law in a previous order or judgment.See Hutchinson v. Staton, 994 F.2d 1076, 1082 (4th Cir. 1993).
14. A Rule 59(e) motion may be granted (1) to accommodate intervening change in the law, (2) to account for new evidence not available at trial, (3) to correct clear error of law, or (4) to prevent manifest injustice. See EEOC v. Lockheed Martin Corp., 116 F.3d 110, 112 (4th Cir. 1997). The moving party has the burden of establishing one of these grounds in order to obtain relief under Rule 59(e). See In re Bell, Case No. 09-10941-8-JRL, 2010 WL 3517062 at *1 (Bankr. E.D.N.C. Sept. 3, 2010) ("The bankruptcy court will deny a motion to reconsider unless the movant can make a showing of one of the enumerated grounds for relief.).
15. The basis for the Motion to Amend now before the court is that the Claims Procedure Order will result in manifest injustice as to the IRS. According to the IRS, this manifest injustice results from the requirement under the Claims Procedure Order that the IRS file its claims against Ltd. in the Hong Kong Proceeding. The alleged manifest injustice is described by the IRS in its brief as follows:
Here, clear inequity would result if the government were required to file its tax claims in Hong Kong. Under the common law revenue rule, the Hong Kong courts could not consider these claims. Therefore, as a practical matter, if the United State were required to file its tax claims in Hong Kong, those claims would effectively be denied without their merits ever being considered.
Because this argument could have been, but was not, raised before the Claims Procedure Order was entered, the Motion to Amend the Claims Procedure Order is fatally deficient.
16. "Rule 59(e) motions may not be used . . . to raise arguments which could have been raised prior to the issuance of the judgment, nor may they be used to argue a case under a novel legal theory that the party had the ability to address in the first instance." Pac. Ins. Co. v. American Nat. Fire Ins. Co., 148 F.3d 396, 403 (4th Cir. 1998) (citing Russell v. Delco Remy Div. of Gen. Motors Corp., 51 F.3d 746, 749 (7th Cir. 1995);Concordia College Corp. v. W.R. Grace Co., 999 F.2d 326, 330 (8th Cir. 1993); FDIC v. World Univ., Inc., 978 F.2d 10, 16 (1st Cir. 1992); Simon v. United States, 891 F.2d 1154, 1159 (5th Cir. 1990)). See also Steele v. Young, 11 F.3d 1518 (10th Cir. 1993) ("Rule 59(e) cannot be used to expand a judgment to encompass new issues which could have been raised prior to issuance of the judgment.").
17. The IRS had ample opportunity to raise its objections prior to the entry of Claims Procedure Order, but failed to do so. The Claims Procedure Motion and a notice of hearing on the Claims Procedure Motion were duly and properly served on the IRS. Yet, no objection to the Claims Procedure Motion was filed by the IRS nor did the IRS appear at the hearing to object to the Claims Procedure Motion based upon the "revenue rule" or to request an alternative claims procedure. Instead, the IRS has raised such objections for the first time in the Motion to Amend. This failure to timely object constitutes grounds for denial of the Motion to Amend.See In re Enron, 356 B.R. 343, 363 (Bankr. S.D.N.Y. 2006), where the movant had not earlier raised the arguments relied upon in seeking relief under Rule 59 and provided no justification for having failed to do so, the court declined to find manifest injustice, stating: "Such failure hardly could warrant a finding of manifest injustice under Rule 9023 because there is no justification for Enron not raising any Rule 37(c)(1) arguments timely."
18. The IRS apparently contends that it was not required to respond to the Motion to Amend or appear at the hearing because the Claims Procedure Motion was not properly served. This argument is without merit. Pursuant to Federal Rule of Bankruptcy Procedure 5003(e), the IRS has designated "Internal Revenue Service, P.O. Box 21126, Philadelphia, PA, 19114," as its nationwide noticing address for bankruptcy-related matters. This is consistent with the Registration of Addresses of Federal State Governmental Units available on the Bankruptcy Court's website. Moreover, both of the proofs of claim previously filed by the IRS directed that notices in this case should be sent to "Internal Revenue Service, P.O. Box 21126, Philadelphia, PA 19114." In addition to the nationwide noticing address set forth above, the Provisional Liquidators also served the Claims Procedure Motion on the local office of the IRS, located at "320 Federal Place, Greensboro, NC, 27401" as reflected on the certificate of service for the Claims Procedure Motion, dated April 28, 2010. The Clerk's Office also served notice of the hearing on the Claims Procedure Motion on the IRS at both its Philadelphia and Greensboro addresses. The IRS thus was provided notice that afforded the opportunity to raise objections to the Claims Procedure Motion prior to entry of the Claims Procedure Order. Despite such notice, the IRS was unresponsive until after the hearing was held and the Claims Procedure Order was entered.
19. The IRS argues that service of the Claims Procedure Motion was defective because it was not made in accordance with Rules 7004 and 9014 of the Federal Rules of Bankruptcy Procedure, which govern service of pleadings and papers in adversary proceedings and contested matters, respectively. See Fed.R.Bankr.P. 7004 and 9014. Specifically, the IRS is now contending that in addition to service of the Claims Procedure Motion in the manner set forth above, the Claims Procedure Motion was required to be served upon the Attorney General of the United States and the local United States Attorney's Office. See Second Supplemental Brief, pg. 4. This argument is unpersuasive and not accepted. Until the IRS filed its Motion to Amend — nearly two months after the Provisional Liquidators filed and served their Claims Procedure Motion — there was no dispute regarding the Claims Procedure Motion and there was no basis prior to the filing of the Motion to Amend to classify the Claims Procedure Motion as a contested matter within the meaning of Rule 9014 of the Federal Rules of Bankruptcy Procedure. Before a motion or application will constitute a contested matter, there must be a dispute regarding the matter. See Leavell v. Karnes, 143 B.R. 212, 217 (S.D. Ill. 1990) ("Thus, a contested matter does not arise until there is an actual dispute-raised by an objection to an application for compensation. The application itself does not present an actual dispute."); see also, 10 Collier on Bankruptcy ¶ 9014.01 (15th ed. rev. 2010) ("Contested matters resemble adversary proceedings in that there are (at least) two parties opposing each other with respect to the relief sought by one of them."). Thus, an essential ingredient for a matter to qualify as a contested matter is that the matter involve an "actual dispute" in which there are parties opposing each other. Such a situation obviously did not exist in this case before the Motion to Amend was filed. And the fact that the IRS subsequently sought to contest the Claims Procedure Motion by filing the belated Motion to Amend cannot serve to ex post facto convert the Claims Procedure Motion from a simple administrative matter into a contested matter between the Provisional Liquidators and the IRS. See In re Bankest Capital Corp., No. 04-10941-BKC-AJC, 2007 WL 656557, at *1 (Bankr. S.D. Fla. Feb. 27, 2007). The Claims Procedure Motion was an administrative measure for the benefit of all domestic creditors of Ltd. and did not focus specifically upon IRS or seek relief or raise issues that were specific or unique to the IRS. The Provisional Liquidators were not required to anticipate the IRS's objection to the Claims Procedure Motion in advance. See In re GST Telecom, Inc., No. 00-1082 GMS, 2002 WL 1737445, at *5 n. 4 (D. Del. July 29, 2002) (concluding that it would be unreasonable to require that debtors anticipate which matters will be contested). Once the IRS filed its Motion to Amend, the Provisional Liquidators began serving subsequent pleadings and papers related to the dispute raised by the Motion to Amend directly upon Mr. Blaskopf at the United States Department of Justice. That is all that was required of them.
The IRS' argument that "it was hampered in being able to file a timely opposition to the [Claims Procedure Motion]" is not supported by the record. The record reflects that the IRS had nearly a month to respond to the Claims Procedure Motion before the Court heard the matter, and nearly another entire month elapsed between the date of the Court's hearing and the date the IRS finally filed its Motion to Amend.
20. An additional reason why the IRS is not entitled to any relief regarding the Claims Procedure Order is that the IRS has not substantiated the assumptions relied upon in arguing that the Claims Procedure Order will result in manifest injustice. The basis for the IRS's argument that manifest injustice will occur consists entirely of a supposition by the IRS that if the IRS filed its claims in the Hong Kong proceeding, the revenue rule would be invoked and applied by the Hong Kong court in such a manner that the IRS claims would be denied without any consideration of the merits of the claims. This argument is not based upon the IRS actually having filed a claim in the Hong Kong proceeding that was not recognized by that court. Rather, the only basis for the requested amendment to the Claims Procedure Order is the supposition that if the IRS claims were filed in the Hong Kong proceeding such claims would not be considered on the merits as a result of the revenue rule being applied in that court. However, it is unclear and speculative from the showing made by the IRS in support of the Motion to Amend whether the revenue rule, in fact, would be invoked in the Hong Kong court and, if so, the manner in which the rule would be applied by that court in response to claims filed by the IRS. The result is that the court is left with an untested and unsupported supposition by the IRS that the IRS claim would not be recognized in the Hong Kong proceeding as a result of the revenue rule, which is not a sufficient basis for the granting of relief pursuant to Rule 59. The IRS having failed to substantiate the assumptions underlying its argument that the Claims Procedure Order will result in manifest injustice, the court need go no further in concluding that the Motion to Amend should be denied.
For the foregoing reasons, the court has concluded that the Motion to Amend should be overruled and denied.
IT IS SO ORDERED.
This 13th day of December, 2010.
ecision after Fourney had failed to demonstrate her continued disability. (AR at 64). Specifically, the claim strategy form notes that
[Fourney] is a 42 year old former staff nurse who initially ceased working due to a renal transplant, gastroparesis and severe diabetes. The . . . medical [records] submitted to date document[] EF of 66 percent, Dr. Bowden provided script for [Fourney] to participate in FCE and [Fourney] did not show. Dr. Hatfield states that [Fourney] is medically stable — Surveillance documents [Fourney] is still active. The decision was made to proceed with claim closure as the medical [records] submitted do[] not support continued benefits.
(Id.). On October 30, 2007, Fourney was informed of LINA's decision to terminate her disability benefits. (AR at 57). She indicated to LINA that she intended to submit additional information for review. (AR at 57).
On December 27, 2007, LINA received a letter, dated December 17, 2007, from Dr. Bowden, Fourney's primary care physician. (AR at 54; 261). The letter informed LINA of Dr. Bowden's opinion regarding Fourney's disability, providing pertinently as follows:
Mrs. Fourney continues to suffer from recurrent chronic renal failure. She is status post renal transplants times two and is currently undergoing evaluation for repeat transplant. She also suffers from type 1 diabetes mellitus, hyperlipidemia, and gastroesophageal reflux.
It is my opinion that Ms. Fourney remains and will remain chronically disabled due to her chronic medical problems. It appears there is some controversy over her current activity. From my impression, Mrs. Fourney is able to do her activities of daily living alone, but does require assistance in any type of minimally strenuous activity. She is very limited in her mobility with regard to strength and duration of activity.
In regard to her physical dependency, she also has multiple physicians and appointments and routine lab work due to her chronic kidney failure and possible retransplantation of her kidneys which, in my opinion, would make it impossible for her to keep any type of employment.
(AR at 261). Notwithstanding Dr. Bowden's letter, LINA adhered to its earlier determination that Fourney had failed to prove her continued disability. (AR at 262). By letter dated January 3, 2008, LINA informed Fourney that the information from Dr. Bowden "does not change the claim determination which was based on a review of the previous medical documentation and surveillance documentation." (Id.). LINA stressed that Dr. Bowden's letter "did not contain measurable or observable data to support [Fourney's] inability to function in any capacity." (Id.). Accordingly, LINA refused to reinstate Fourney's long-term disability benefits.
On January 28, 2008, Fourney appealed LINA's decision to deny her benefits under the Plan. (AR at 259-60). With respect to the parties' failed attempts to conduct an FCE, Fourney asserted that she "should not be penalized for and cannot be held responsible for the failure to conduct the FCE, as previously scheduled attempts to do so have failed to be completed because of circumstances beyond [her] control." (AR at 259). Fourney further stressed that she "remain[ed] willing to undergo the FCE" and requested that LINA reschedule the FCE at the earliest possible date, before resolving her appeal. (Id.).
By letter dated January 31, 2008, LINA responded to Fourney's request for an appeal, asserting that it would "consider any additional relevant information which supports [her] disability." (AR at 258). LINA directed Fourney to provide any such information no later than February 21, 2008. Despite Fourney's request that LINA schedule an FCE before resolving the appeal, the letter did not mention an FCE or any other evaluation of her disability. (Id.).
On February 13, 2008, LINA received a letter from Dr. Greta Guyer, Fourney's endocrinologist. In pertinent part, Dr. Guyer's letter provided as follows:
[Fourney] is status post a renal transplant in 2001. She has had a history of type I diabetes since college and currently her creatinine level is 3.6 and her GFR equals 15. Her most recent hemoglobin Alc value is 9.3%. She takes Lantus Insulin 13 units in the morning and Novolog Insulin she takes 1 unit for every 15 grams of carbohydrate as well as 1 unit for every 70 mg/dl that her blood sugar is greater than 110. She has to set an alarm at 3:00 a.m. every night to check her blood sugars for hypoglycemia. She has a history of hypoglycemia unawareness and will get blood sugars two times a week that require assistance that are in the hypoglycemia range. She also has peripheral neuropathy which makes it difficult for her as far as standing or sitting for long periods of time and difficulty as far as proprioception with walking.
I feel that this patient is permanently disabled secondary to her diabetes and the severe hypoglycemic episodes that she gets which can occur without notice. At least two times a week she has episodes of hypoglycemia that require assistance. She needs to check her blood sugars frequently throughout the day and as well as eat meals frequently to avoid hypoglycemia. I think that these restrictions would preclude her from any type of employment. She also has peripheral neuropathy and hypertension. She also has a pituitary adenoma which I am following as well as she is status post a renal transplant and has chronic kidney disease after that.
(AR at 251).
By letter dated May 7, 2008, LINA upheld the denial of Fourney's claim. (AR at 221-23). LINA acknowledged the recommendations of Drs. Bowden and Guyer that Fourney not return to work, but asserted that its own medical director, Dr. John Mendez, had reached the opposite conclusion. (AR at 221-22). Specifically, Dr. Mendez found the following:
Based on the provided records, including surveillance, it is medically probable that Ms. Fourney is capable of at least sedentary to light physical demand level work duties full time. This is because . . . she appears very functional on surveillance conducted over 4 days. . . . She states in her 8/24/07 [disability questionnaire] that she is unable to drive. Dr. Bowden's 12/17/07 letter indicates she is very limited in mobility regarding strength and activity duration and Dr. Guyer's 2/13/08 letter describes peripheral neuropathy with difficulty standing or sitting for long periods and walking and severe hypoglycemic episodes occurring without notice at least twice per week. In contrast, the surveillance video shows her driving for extended periods on separate days and walking up to 1 mile[] with her dog. . . . She also underwent exercising testing for surgery clearance on 7/5/07. . . . She exercised 11 minutes, [which] is compatible with medium work capacity. So, because of the multiple reasons above, Ms. Fourney's and her physician's reported work capacities are significantly less than those demonstrated by surveillance video and exercise testing.
(AR at 44). Based on Dr. Mendez's evaluation, LINA identified several occupations suitable for Fourney, including the following: nurse consultant, utilization coordinator, school nurse, office nurse, and inservice coordinator. (AR at 222). Inasmuch as it no longer considered Fourney unable to perform all the material duties of any occupation for which she was qualified, LINA concluded that Fourney was no longer disabled, as defined by the Plan. (Id.).
In January 2009, Fourney initiated this action in the Circuit Court of Kanawha County. (Notice of Removal 2). On February 25, 2009, LINA removed. (Id. at 1). In her complaint, Fourney alleges that she is disabled as defined by the Plan and that LINA "arbitrarily and capriciously cut off [her] entitlement to disability benefits." (Compl. ¶ 5).
II.
A. Standard of Review
The standard of review for a decision made by an administrator of an ERISA benefit plan generally is de novo. Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); Bynum v. Cigna Healthcare of North Carolina, Inc., 287 F.3d 305, 311 (4th Cir. 2002); Richards v. UMWA Health Retirement Fund, 895 F.2d 133, 135 (4th Cir. 1989); de Nobel v. Vitro Corp., 885 F.2d 1180, 1186 (4th Cir. 1989). Where the plan gives the administrator discretion to determine benefit eligibility or to construe plan terms, however, the standard of review is whether the administrator abused its discretion. Firestone, 489 U.S. at 111;Stup v. Unum Life Ins. Co. of Am., 390 F.3d 301, 307 (4th Cir. 2004); Bynum, 287 F.3d at 311.
Our court of appeals has held that an ERISA plan can confer discretion on its administrator in two ways: "(1) by language which `expressly creates discretionary authority,' and (2) by terms which `create discretion by implication.'" Woods v. Prudential Ins. Co. of Am., 528 F.3d 320, 322 (4th Cir. 2008) (quoting Feder v. Paul Revere Life Ins. Co., 228 F.3d 518, 522-23 (4th Cir. 2000)). Whether discretion is created expressly or implicitly, however, "the plan must manifest a clear intent to confer such discretion" for the abuse of discretion standard to apply. Id.; see also Gallagher v. Reliance Std. Life Ins. Co., 305 F.3d 264, 270 n. 6 ("If a plan does not clearly grant discretion, the standard of review is de novo."). Finally, in determining whether a plan sufficiently confers discretion, the reviewing court must construe any ambiguity in the plan against its drafter and in accordance with the insured's reasonable expectations. Woods, 528 F.3d at 322.
B. The Standard Applicable to LINA
With these principles in mind, the court must determine whether the Plan confers discretionary authority on LINA over benefit determinations. Although the parties appear to agree that the Plan does not do so expressly, LINA contends that such authority should be implied inasmuch as the Plan specifies that a claimant is eligible for benefits when "[LINA] determines he or she is . . . Disabled." (AR at 13). LINA further emphasizes the Plan's requirement that a claimant, to maintain eligibility, must submit to it "proof of earnings and continued Disability." (AR at 3). LINA maintains that the Plan language makes clear that it "is the sole decision-maker with regard to the provision of [long-term disability] benefits to plan participants," thereby warranting application of the deferential standard of review. (Def.'s Resp. at 2).
The Fourth Circuit recently addressed and rejected a similar argument. See Woods v. Prudential Ins. Co. of Am., 528 F.3d 320, 322-24 (4th Cir. 2008). In Woods, the administrator of an ERISA benefits plan asserted that the abuse of discretion standard should govern its benefits determination, inasmuch as the plan at issue specified that a claimant was eligible for benefits only if the administrator determined that eligibility exists. Id. at 322. The Fourth Circuit found this contention unpersuasive, noting that "discretionary authority is not conferred by the mere fact that a plan requires a determination of eligibility or entitlement by the administrator." Id. (internal quotation marks omitted). Indeed, inasmuch as "almost all ERISA plans designate an administrator who . . . must determine whether a participant is eligible for benefits," the court observed that acceptance of the administrator's contention would result in application of the deferential standard of review in nearly every ERISA benefits case. Id. at 323-24. Accordingly, the court concluded that, where the benefits plan merely assigns authority with the administrator to make benefit designations, de novo review is appropriate. Id. at 324.
Like the benefits plan in Woods, the Plan at issue here confers mere authority, as opposed to discretion, on LINA. To be sure, the Plan vests with LINA the authority to determine whether a claimant is disabled and therefore eligible for benefits. For instance, the Plan alerts the claimant that he must submit to LINA proof of earnings and continued disability to be eligible for benefits and that benefits will be terminated when "[LINA] determines he . . . is not Disabled." (AR at 3, 13). Nothing in these phrases, however, alerts the claimant that LINA "will enjoy wide discretion in wielding its authority as well as freedom from searching judicial scrutiny," as is required to trigger the abuse of discretion standard. Woods, 528 F.3d at 323; cf. United McGill Corp. v. Stinnett, 154 F.3d 168, 171 (4th Cir. 1998) (finding discretionary authority where benefits plan granted administrator authority to "construe the terms of the Plan and resolve any disputes which may arise with regard to the rights of any persons under the terms of the plan"). Fourth Circuit precedent therefore compels application of de novo review in this matter.
III.
Under the Plan, an insured employee is generally entitled to disability benefits if he or she is "unable to perform all the material duties of his or her Regular Occupation or a Qualified Alternative." (AR at 3). When disability benefits have been payable for twenty-four months, however, a different standard applies. Under this so-called "any occupation" standard, which the parties agree governs this dispute, the insured employee is entitled to continued receipt of disability benefits if he or she is either (1) "unable to perform all the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience;" or (2) "unable to earn 80% or more of his or her Indexed Covered Earnings." (AR at 3). Accordingly, to qualify for disability benefits, Fourney must submit satisfactory proof that she was unable to perform all the material duties of any occupation for which she is, or may reasonably become, qualified based on education, training or experience. See Gallagher v. Reliance Standard Life Ins. Co., 305 F.3d 264, 270 (4th Cir. 2002) (noting that burden of proving disability falls on employee).
A. Evidence Supporting Fourney's Disability
Fourney submitted substantial evidence demonstrating her inability to perform the material duties of any occupation for which she is or may become qualified. Most important are the opinions of her treating physicians, all of whom concluded that Fourney's end-stage renal failure precludes her from working. Dr. Bowden, for example, reviewed Fourney's extensive medical problems in December 2007 and concluded that "[s]he is very limited in her mobility with regard to strength and duration of activity." (AR at 261). Dr. Bowden also observed that Fourney, due to her serious medical condition, "has multiple physicians and appointments" and must regularly undergo "routine lab work," making it "impossible for her to keep any type of employment." (Id.). Dr. Guyer raised similar concerns in her February 2008 letter, noting that Fourney's peripheral neuropathy "makes it difficult for her as far as standing or sitting for long periods of time" and that Fourney has "severe hypoglycemic episodes" twice per week. (AR at 251). Citing a host of objective evidence supporting Fourney's medical condition, Dr. Guyer concluded that Fourney's medical condition "would preclude her from any type of employment." (Id.). Finally, Fourney's disability was supported by the opinion of Dr. Cangro, her nephrologist. In January 2006, Dr. Cangro observed that Fourney "has many of the complications of long-standing type one diabetes," including "hypoglycemia unawareness, unpredictable ability to take in food secondary to nausea, vomiting and gastroparesis, as well as two . . . deconditioning and failing renal transplants." (AR at 666). Based on these severe conditions, Dr. Cangro recommended that Fourney "be categorized as fully disabled for an indefinite time." (Id.).
The medical evidence submitted by Fourney in support of her disability is noteworthy in a number of respects. First, Fourney's medical record demonstrates that every single physician who examined her in person during the relevant time frame has concluded that she is disabled and thus incapable of working. (AR at 251, 261, 666, 735, 1104, 1134, 1154). The consistency in her physicians' recommendations is certainly compelling evidence that Fourney was, and indeed remains, fully disabled. Second, each of Fourney's physicians rested their recommendations not only on her physical limitations, but also on the substantial impact Fourney's medical condition has on her day-to-day life. The physicians observed, for example, that Fourney was incapable of long periods of certain physical activities, including standing and walking. (AR at 251, 666). They also highlighted, however, the substantial number of appointments and tests Fourney must undergo to manage her complicated medical conditions. (AR at 251, 261). Such constant interruptions in Fourney's daily life, the physicians concluded, would make employment "impossible." (AR at 261). Third, with respect to physical limitations, it is worth noting that Fourney's physicians focused on her inability to perform certain physical activities for long periods of time. For example, Dr. Guyer observed that Fourney, due to her medical condition, would have difficulty "standing or sitting for long periods of time." (AR at 251).
B. Evidence Supporting LINA's Benefits Decision
The administrative record demonstrates that LINA relied on two items in electing to terminate Fourney's disability benefits. First, LINA concedes that its decision was predicated in large part on the surveillance video, which depicted Fourney engaging in various activities that, according to LINA, contradict her asserted limitations. (Def.'s Resp. at 3). Second, LINA emphasized the evaluation of its medical director, Dr. Mendez, who reviewed the documents submitted with Fourney's administrative appeal and supported LINA's original decision to terminate benefits. The court reviews each of these items in turn.
1. Video Surveillance
LINA contends that the video surveillance provides substantial evidence for its decision to deny Fourney's claim for benefits, inasmuch as the video depicts Fourney engaging in activities that, according to LINA, are beyond her stated limitations. Specifically, LINA emphasizes that Fourney participated in an aerobics class, walked with a Labrador that pulled on the leash a few times, and drove in excess of thirty miles during the four-day span in which surveillance was conducted. LINA maintains that these activities demonstrate that Fourney was at least capable of sedentary work, supporting its decision to terminate her claim for disability benefits.
There are, of course, situations in which video surveillance is useful in determining the veracity of a claimant's subjective complaints. Indeed, courts routinely consult such evidence in reviewing the reasonableness of an administrator's denial of benefits. See, e.g., Cusson v. Liberty Life Assur. Co., 592 F.3d 215, 229-30 (1st Cir. 2010) (concluding that video surveillance supported administrator's decision to terminate benefits); Mote v. Aetna Life Ins. Co., 502 F.3d 601, 609 (7th Cir. 2007) ("In short, the videotapes show [the claimant] engaging in many of the activities that she claimed to be unable to accomplish in her application for long-term disability benefits and, consequently, the Plan properly considered them.").
Surveillance evidence, however, is generally limited in temporal scope in comparison with a regular work week. As a result, these cases make clear that, although an administrator may consider surveillance evidence in reviewing a claim for benefits, the administrator should place significant weight on such evidence only when it stands in stark contrast to the subjective evidence submitted by the claimant. See Coffman v. Metro. Life Ins. Co., 217 F. Supp. 2d 715, 733 n. 5 (S.D. W. Va. 2002). This point is further illustrated by cases from the First and Eighth Circuits. In Cusson, the First Circuit determined that video surveillance provided substantial evidence for the plan administrator's decision to terminate the claimant's disability benefits, even though the video depicted the claimant outside of her home for only a short amount of time. 592 F.3d at 228-29. The court noted that the evidence was pertinent inasmuch as it "shows [the claimant] doing particular activities that she claimed she could not do." Id. at 229. By contrast, in Morgan v. Unum Life Insurance Co. of America, the Eighth Circuit concluded that video surveillance, which depicted the claimant "driving his car, . . . carrying light objects, . . . and stretching and doing light aerobic exercise at the gym for about forty-five minutes," failed to support the plan administrator's decision to terminate benefits. 346 F.3d 1173, 1178 (8th Cir. 2003). The Eighth Circuit deemed the surveillance evidence unremarkable inasmuch as the claimant had already alerted the administrator that his typical day included the very activities in which he was seen engaging. Id. at 1178. Accordingly, the court concluded that the video "revealed nothing new and was not substantial evidence supporting" the administrator's decision.Id.
The video surveillance in this case is remarkably similar to that at issue in Morgan and simply does not support LINA's decision to rescind Fourney's disability benefits. As an initial matter, the evidence is entirely consistent with Fourney's medical record. The surveillance demonstrates that, over a four-day period in April 2007, Fourney walked between one and two miles with a dog; engaged in light aerobic exercise, consisting of repeated step-ups onto a block some six inches off the ground; and drove her car approximately thirty miles while running various errands. (AR at 349-65, 1480). Notably, however, none of Fourney's treating physicians asserted that such activities were beyond her physical capabilities. Dr. Bowden, for example, observed that Fourney was capable of engaging in such "minimally strenuous" activities, though only for a limited duration. (AR at 261). That Fourney walked less than two miles and partially completed an aerobics class is entirely consistent with her physicians' recommendations.
Moreover, and perhaps more damaging to LINA's contention that the video evidence substantially supports its decision, Fourney had previously alerted LINA that she regularly engaged in the very activities depicted in the surveillance video. Notwithstanding these admissions, Fourney continued to receive disability benefits for nearly seven years. With respect to the physical activities observed, Fourney indicated to LINA as early as October 2000 that she regularly exercised by, among other things, engaging in activities similar to those depicted in the video surveillance. (AR at 550, 738, 1429). Indeed, in her April 2006 questionnaire, completed nearly one year before the surveillance was conducted, Fourney informed LINA that she was a regular participant in the very aerobics class that is at the heart of LINA's benefits decision. (AR at 550). Consistent with what the private investigator observed, Fourney indicated in her April 2006 questionnaire that she participated in the aerobics class but often had to quit early due to fatigue. (Id.). Thus, that Fourney engaged in such activities while under surveillance is entirely unremarkable, considering LINA's decision to pay her disability benefits for seven years despite its knowledge that she engaged in such activities.
Similarly unremarkable is the fact that Fourney, while under surveillance, walked between one and two miles with a Labrador appearing to weigh in excess of seventy-five pounds. The video depicts Fourney walking with the dog for only about ten minutes, and the dog is not leashed for much of that time. (AR at 1480). Moreover, that the dog "yanked" Fourney several times during the short period it was leashed is of little consequence.
Fourney had also indicated to LINA well before the April 2007 surveillance that she was capable of driving and, in fact, often drove to her various medical appointments and other activities. Between June 2002 and September 2004, Fourney submitted three disability questionnaires, each of which indicated that she regularly drove, sometimes up to one hundred miles at a time. (AR at 737, 767, 1303). To be certain, Fourney advised LINA in April 2006 and August 2007 that her driving had been restricted at those times. (AR at 247, 549). Her medical records, however, explain the source of the restrictions: Fourney underwent corrective eye surgery in February 2006 and September 2007, meaning that she was either recovering from or preparing for surgery when she completed the April 2006 and August 2007 questionnaires. (AR at 255, 539-40). That Fourney was unable to drive at these times yet was capable of driving in April 2007, over one year after her first eye surgery and several months before her second, is neither inconsistent with her medical records nor indicative of her ability to perform sedentary work despite her medical conditions.
In short, the video evidence merely confirms what Fourney's physicians had concluded all along: that she was capable of engaging in minimally strenuous activity, albeit for short periods of time only. Even if the surveillance demonstrated that Fourney had engaged in physical activities beyond her physicians' recommendations, the evidence is yet insufficient to support LINA's decision; LINA was well aware that Fourney regularly engaged in these activities yet continued to pay her disability benefits for approximately seven years. Accordingly, the surveillance evidence "revealed nothing new" about Fourney's ability to work and does not provide substantial support for LINA's decision. See Morgan, 346 F.3d at 1178.
2. Dr. Mendez's Evaluation
LINA also relied heavily on the evaluation of its own medical director, Dr. Mendez. (AR at 44). Following Fourney's administrative appeal of the termination of her disability benefits, LINA submitted Fourney's medical records, including the video surveillance, to Dr. Mendez and requested that he review its decision. Based on his review, Dr. Mendez concluded that Fourney was capable of at least sedentary work. (Id.). He acknowledged that she suffered from Type 1 diabetes, proliferative diabetic retinopathy in her right eye, chronic renal failure, "and other multiple medical problems," but noted simply that "she appears very functional on surveillance conducted over 4 days." (Id.). By way of example, Dr. Mendez highlighted Fourney's driving while under surveillance, as well as an exercise stress test in July 2007 during which she walked for approximately eleven minutes. (Id.). Dr. Mendez concluded that such activities were "compatible with a medium work capacity" and thus agreed with LINA's decision to terminate her disability claim. (Id.).
Dr. Mendez's opinion that Fourney was capable of sedentary work provides only minimal support for LINA's benefits decision. To begin with, Dr. Mendez's opinion was directly contrary to the opinions of Fourney's treating physicians, all of whom concluded after examining Fourney that she was incapable of holding regular employment. (AR at 251, 261, 666, 735, 1104, 1134, 1154). Although "courts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant's physician," Black Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003), LINA can offer no reason why Dr. Mendez's opinion, which resulted from a mere administrative review, should be valued over the unanimous conclusions of Fourney's own physicians.
Furthermore, unlike Fourney's treating physicians, who cited lab results and other objective evidence to support their recommendations, Dr. Mendez relied exclusively on the surveillance evidence that, as discussed, was not indicative of her ability to work. Indeed, Dr. Mendez ignored the severity of Fourney's medical condition, including the fact that her kidneys were apparently functioning at less than twenty percent and that she may well need to undergo a third kidney transplant. Dr. Mendez also failed to acknowledge the significant impact Fourney's continuing treatment would have on her ability to maintain employment. In light of the overwhelming evidence to the contrary, the court finds that Dr. Mendez's evaluation does little to support LINA's benefits decision. See Love v. Nat'l City Corp. Welfare Benefits Plan, 574 F.3d 392, 396-97 (7th Cir. 2009) (overturning administrator's decision to deny benefits for failing to explain "why it chose to discount the near-unanimous opinions of [the claimant's] treating physicians); Kalish v. Liberty Mut./Liberty Life Assurance Co., 419 F.3d 501, 510 (6th Cir. 2005) (reversing denial of disability benefits when administrator's medical consultant failed to rebut contrary medical conclusions of claimant's primary physician); Morgan, 346 F.3d at 1178 (concluding that opinion of administrator's in-house physician "was directly contrary to the opinions of [the claimant's] two primary treating physicians" and did not provide support for decision to rescind benefits).
Dr. Mendez cited an exercise test conducted on July 5, 2007, as further support for his conclusion that Fourney was capable of sedentary work. Fourney did not undergo such a test in July 2007; rather, she underwent exercise stress tests in November 2003 and February 2006, the results of which were disclosed to LINA as early as June 26, 2006. (AR at 538-39, 757).
C. Conclusion
In summary, Fourney submitted overwhelming medical evidence demonstrating her inability to perform the material duties of any occupation for which she is or may become qualified. No less than three physicians, all of whom saw Fourney in person numerous times during the relevant time period, concluded that she was incapable of working. By contrast, LINA can point only to video surveillance and the opinion of its own medical director to support its decision to terminate Fourney's disability benefits. For the reasons outlined above, however, this evidence provides little support, inasmuch as it was entirely consistent with Fourney's medical records and her own admissions to LINA regarding her physical activities. Accordingly, following de novo review, the weight of the evidence demonstrates that Fourney was entitled to continued receipt of her disability benefits and that LINA thus erred in terminating her disability claim.
IV.
Based on the foregoing discussion, it is ORDERED as follows:
1. That plaintiff's motion for summary judgment be, and it hereby is, granted;
2. That defendant's motion for summary judgment be, and it hereby is, denied;
3. That judgment be entered in favor of plaintiff as to her claim for disability benefits; and
4. That the parties are directed to submit, on or before November 30, 2010, a proposed judgment order for entry in keeping with this memorandum opinion and order.
The Clerk is directed to forward copies of this written opinion and order to all counsel of record and any unrepresented parties.
DATED: November 15, 2010