United States District Court, D. Connecticut
RULING ON CROSS-MOTIONS FOR SUMMARY JUDGMENT
R. Underhill United States District Judge.
1, 2015, Jeff Schuman filed this action against three
defendants-Ahold USA's Master Welfare Benefit Plan, the
Administrative Committee of Ahold USA as Plan Administrator,
and Aetna Life Insurance Co. (“Aetna”) as Claims
Administrator-alleging that they violated the Employee
Retirement Income Security Act (“ERISA”) by
denying him long-term disability benefits. See
Compl., Doc. No. 1; Am. Compl., Doc. No. 32-1. On March 20,
2017, I issued a ruling on the parties' cross-motions for
summary judgment (doc. nos. 36 and 37), in which I granted in
part and denied in part the defendants' motion and denied
Schuman's motion in its entirety. See Schuman v.
Aetna Life Ins. Co., 2017 WL 1053853, at *1 (D. Conn.
Mar. 20, 2017) (hereinafter “Schuman
I”). In light of various inadequacies in the
record, however, I ordered that the case be remanded to the
claims administrator for a correct evaluation of
Schuman's long-term disability claim. Id. at
*12. Specifically, I directed the defendants to complete
another vocational evaluation that would determine
“whether Schuman is or may become fitted to perform any
type of work that actually exists in the economy and whether
he is vocationally qualified to obtain such employment, and
to earn a reasonably substantial income from it.”
Id. at *18 (internal quotations omitted).
denied Schuman's renewed disability claim on August 4,
2017. See Supplemental Administrative Record
(“SAR”) at 1668. Schuman appealed that decision
September 1, 2017. Id. at 1675. On October 31, 2017,
I granted Schuman's motion to reopen the case (doc. no.
102) and noted that the case was “remanded to permit
Aetna to complete the administrative appeal process. Aetna
shall decide the administrative appeal within fourteen days
of the date of this order. Failure to issue a decision within
that deadline will be treated as a denial of the
appeal.” Doc. No. 104. Aetna upheld its denial decision
on appeal in a letter dated November 10, 2017. SAR at 1754.
On April 23, 2018 the parties again filed cross-motions for
summary judgment (doc. nos. 113 and 115).
review of the record and supplemental briefing, I
deny both motions.
Standard of Review
judgment is appropriate when the record demonstrates that
“there is no genuine dispute as to any material fact
and the movant is entitled to judgment as a matter of
law.” Fed.R.Civ.P. 56(a); see also Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 256 (1986) (plaintiff
must present affirmative evidence in order to defeat a
properly supported motion for summary judgment).
ruling on a summary judgment motion, the court must construe
the facts of record in the light most favorable to the
nonmoving party and must resolve all ambiguities and draw all
reasonable inferences against the moving party.
Anderson, 477 U.S. at 255; Matsushita Elec.
Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587
(1986); Adickes v. S.H. Kress & Co., 398 U.S.
144, 158-59 (1970); see also Aldrich v. Randolph Cent.
Sch. Dist., 963 F.2d 520, 523 (2d Cir. 1992) (court is
required to “resolve all ambiguities and draw all
inferences in favor of the nonmoving party”). In the
context of cross-motions for summary judgment, the same
standard is applied. See Scholastic, Inc. v. Harris,
259 F.3d 73, 81 (2d Cir. 2001). However, in deciding each
motion, the court must construe the evidence in the light
most favorable to the non-moving party. Id.
when reasonable minds could not differ as to the import of
the evidence is summary judgment proper.” Bryant v.
Maffucci, 923 F.2d 979, 982 (2d Cir. 1991); see
also Suburban Propane v. Proctor Gas, Inc., 953
F.2d 780, 788 (2d Cir. 1992). If the nonmoving party submits
evidence that is “merely colorable, ” or is not
“significantly probative, ” summary judgment may
be granted. Anderson, 477 U.S. at 249-50.
The mere existence of some alleged factual dispute between
the parties will not defeat an otherwise properly supported
motion for summary judgment; the requirement is that there be
no genuine issue of material fact. As to materiality, the
substantive law will identify which facts are material. Only
disputes over facts that might affect the outcome of the suit
under the governing law will properly preclude the entry of
summary judgment. Factual disputes that are irrelevant or
unnecessary will not be counted.
Id. at 247-48. To present a “genuine”
issue of material fact, there must be contradictory evidence
“such that a reasonable jury could return a verdict for
the non-moving party.” Id. at 248.
nonmoving party has failed to make a sufficient showing on an
essential element of his case with respect to which he has
the burden of proof at trial, then summary judgment is
appropriate. Celotex, 477 U.S. at 322. In such a
situation, “there can be ‘no genuine issue as to
any material fact,' since a complete failure of proof
concerning an essential element of the nonmoving party's
case necessarily renders all other facts immaterial.”
Id. at 322-23; accord Goenaga v. March of Dimes
Birth Defects Found., 51 F.3d 14, 18 (2d Cir. 1995)
(movant's burden satisfied if he can point to an absence
of evidence to support an essential element of nonmoving
party's claim). In short, if there is no genuine issue of
material fact, summary judgment may enter. Celotex,
477 U.S. at 323.
an ERISA plan participant challenges a denial of benefits,
the proper standard of review is de novo
‘unless the benefit plan gives the administrator or
fiduciary discretionary authority' to assess a
participant's eligibility.” Thurber v. Aetna
Life Ins. Co., 712 F.3d 654, 658 (2d Cir. 2013),
abrogated on other grounds by Montanile v. Bd. of
Trustees of Nat. Elevator Indus. Health Benefit Plan,
136 S.Ct. 651 (2016) (quoting Firestone Tire & Rubber
Co. v. Bruch, 489 U.S. 101, 115 (1989)). “If the
plan does reserve discretion, the denial is subject to
arbitrary and capricious review and will be overturned only
if it is without reason, unsupported by substantial evidence
or erroneous as a matter of law.” Id.
(internal quotation marks and citation omitted). The Second
Circuit held in Halo v. Yale Health Plan, however,
that the denial of a claim under a plan including
discretionary authority is not entitled to the great
deference afforded by the arbitrary and capricious standard
if the denial procedure failed to comply with the Department
of Labor's claims-procedure regulation, 819 F.3d 42, 56
(2d Cir. 2016). The Halo Court further stated that
“the plan bears the burden of proof on this issue since
the party claiming deferential review should prove the
predicate that justifies it.” Id. (internal
quotation marks and citation omitted).
previously held that Schuman's plan granted Aetna
discretionary authority, subject to arbitrary and capricious
review. See Schuman I at *14. Despite the plan's
adequate grant of discretion, Schuman identified several
potential violations of the claims-procedure regulations that
would trigger Halo's de novo review. Those
violations included Aetna failing to consider the vocational
report of Erin Bailey when making its appeal determination,
failing to identify Joseph Thompson as a vocational expert,
and failing to provide Schuman with ...