Submitted April 17, 2014
Appeal from United States District Court for the Eastern District of Arkansas - Pine Bluff.
For Christopher Hampton, Plaintiff - Appellee: Neil Chamberlin, Carter Stein, Mcmath & Woods, Little Rock, AR.
For Reliance Standard Life Insurance Company, Defendant - Appellant: Joshua Bachrach, Wilson & Elser, Philadelphia, PA; Brandon Bradshaw Cate, Quattlebaum & Grooms, Springdale, AR; Emmett B. Chiles, Quattlebaum & Grooms, Little Rock, AR.
For Ozark Motor Lines Inc. Benefit Plan, Defendant - Appellant: Joshua Bachrach, Wilson & Elser, Philadelphia, PA; Brandon Bradshaw Cate, Quattlebaum & Grooms, Springdale, AR; Emmett B. Chiles, Quattlebaum & Grooms, Little Rock, AR; James M. Simpson, Allen & Summers, Memphis, TN.
Before SMITH, COLLOTON, and GRUENDER, Circuit Judges. SMITH, Circuit Judge, dissenting.
COLLOTON, Circuit Judge.
After being diagnosed with insulin-dependent diabetes mellitus, Christopher Hampton ceased work as an over-the-road truck driver for Ozark Motor Lines, Inc. Pursuant to the company's employee-benefit plan--Ozark Motor Lines Inc. Benefit Plan--which is governed by the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § § 1001-1461, Hampton submitted a claim for long-term disability benefits to Reliance Standard Life Insurance Company, the Plan's insurer and claims-review fiduciary. Reliance Standard concluded that Hampton was not disabled under the terms of the Plan and denied the claim on that basis.
Hampton sued Reliance Standard and the Plan, arguing that Reliance Standard abused its discretion. The district court granted judgment on the record for Hampton. Reliance Standard and the Plan appeal, and we reverse.
From July 2008 to November 2010, Hampton worked as an over-the-road truck driver for Ozark Motor Lines, Inc. In November 2010, Hampton was diagnosed with diabetes mellitus. As a result of Hampton's diagnosis, he was unable to continue work as an over-the-road truck driver: Regulations of the United States Department of Transportation provide that any person with insulin-dependent diabetes mellitus is not qualified to operate a commercial motor vehicle. See 49 C.F.R. § § 391.11, 391.41(b)(3). As a result, Arkansas disqualified his commercial driver's license. See 001-00-004 Ark. Code R. 17.1.
Hampton filed claims for short-term and long-term disability benefits under the Plan. In support of his claims, he submitted a December 2010 statement from William Hawkins, M.D., the doctor who had diagnosed him, stating that Hampton could not work because he was " unable to obtain a DOT health card with this new diagnosis." Dr. Hawkins wrote a follow-up letter to Reliance Standard in June 2011 repeating that he " d[id] not feel that Mr. Hampton will be able to obtain gainful employment noting his insulin dependent diabetes mellitus, which precludes him from operating any sort of heavy machinery or motorized vehicles based on the Department of Transportation regulations."
Hampton received short-term benefits, but Reliance Standard denied his claim for long-term benefits. To qualify as " Totally Disabled" under the Plan's long-term disability policy, an insured must be unable to perform the material duties of his regular occupation due to injury or sickness. The Plan further provides that if the insured " requires a license for such occupation, the loss of such license for any reason does not in and of itself constitute 'Total Disability.'" In its July 2011 denial letter, Reliance Standard explained that although Hampton's submission asserted that his diagnosis of diabetes mellitus precluded him from maintaining a commercial driver's license under the federal regulations,
there was no evidence that any symptoms of diabetes mellitus prevented him from performing his occupation under the terms of the Plan.
Hampton filed an administrative appeal with Reliance Standard in January 2012, arguing that the diabetes-related loss of his commercial driver's license prevented him from performing his job duties. In May 2012, Reliance Standard upheld the denial, reasoning that the Plan " explains that loss of a license does not constitute disability" and that " there must be evidence that one is physically or mentally incapable of performing the material duties of his occupation as a truck driver" to qualify as totally disabled. Dr. Hawkins's submissions, the decision maintained, referred only to the federal regulations and " failed to identify any specific restrictions or limitations Mr. Hampton suffered due to insulin-dependent diabetes, nor provide any insight as to how Mr. Hampton's symptoms were preventing him from performing his duties as a truck driver." Reliance Standard also cited the conclusions of another doctor, who had reviewed Hampton's claim file and found that " there was no evidence to substantiate [Hampton's] inability to perform the duties of a truck driver, other than the regulation set forth by the Department of Transportation."
Hampton sued Reliance Standard in Arkansas state court in July 2012, and Reliance Standard removed the case to federal court. Hampton then filed an amended complaint, naming both Reliance Standard and the Plan as defendants. The amended complaint alleged that Reliance Standard unreasonably denied his claim for long-term disability benefits. The parties filed cross-motions for judgment on the administrative record, and the district court entered judgment for Hampton. The court also ordered Reliance Standard and the Plan to pay Hampton attorneys' fees and costs.
The district court reasoned first that although Reliance Standard had discretion to interpret the Plan, less deference than usual was appropriate, because Reliance Standard was also responsible for paying benefits under the Plan. The court then concluded that Reliance Standard abused its discretion by adopting an unreasonable interpretation of the Plan as applied to Hampton. The court determined that Hampton was totally disabled under the terms of the Plan, because he lost his license " as a result of an Injury or Sickness," namely his insulin-dependent diabetes mellitus. Citing the Department of Transportation's medical advisory criteria for evaluation under 49 C.F.R. § 391.41, the district court noted that the federal government forbids insulin-dependent diabetics from operating commercial motor vehicles because the stresses of long-haul driving exacerbate the symptoms of diabetes.
Reliance Standard and the Plan appeal, and we review the district court's grant of judgment on the record de novo. See McClelland v. Life Ins. Co. of N. ...