The opinion
□ Southern District of Texas
ENTERED
November 02, 2021
IN THE UNITED STATES DISTRICT COURT Nathan Ochsner, Clerk
FOR THE SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION
LILLIAN YIP, §
Plaintiff, §
§
V. § CIVIL ACTION NO. 4:19-CV-03588
§
THE EXXONMOBILE DISABILITY PLAN, §
Defendant. §
ORDER
In this Employee Retirement Income Security Act (ERISA) dispute, the Court has before
it cross-motions for summary judgment. Defendant ExxonMobil Disability Plan’s (“‘SEMDP”)
motion (Doc. No. 31) claims that it is a self-funded plan that delegates all administration to the
Life Insurance Company of North America (“LINA”) and as such a coverage decision by LINA
can be set aside only if there was an abuse of discretion. EMDP contends that no such abuse
occurred. The Plaintiff, Lillian Yip (“Yip”), has responded in opposition to this motion. (Doc.
No. 35). Yip has filed her own Motion for Summary Judgment (Doc. No. 27) in which she
claims the decision to deny her long-term disability benefits was “erroneous and against the great
weight of the evidence.” EMDP has responded in opposition to this motion. (Doc. No. 38).
LINA, the plan’s administrator, was initially sued, but was dismissed without prejudice pursuant
to a stipulation filed by the Plaintiff. (Doc. Nos. 24, 25). Thus, if the Court grants either of the
summary judgment motions, it will resolve all pending issues.
I. Factual Background
The basic facts are not in dispute. Yip is a chemical engineer who went to work for
ExxonMobil Corporation in July 2007. In her words, she worked as a “reservoir engineer
supporting oil and gas operations in the US” and “career development of other engineers.” (Doc.
No. 29-2 at 75). She described it as a “primarily office based job on the computer.” (/d.). By
June 2015, Yip had developed joint pain and was experiencing fatigue. Her rheumatologist, Dr.
John Gomez, diagnosed her as having fibromyalgia. He recommended she cut her work week
down to 30 hours and work from home when possible. By October 2015, Dr. Gomez had revised
his opinion to a finding that she was unfit for work. Her last day of work was October 8, 2015.
Starting on October 8, 2015, Yip began receiving short-term disability benefits. These
then transitioned to long-term disability benefits in June of the following year. She continued to
experience problems due to fibromyalgia, joint pain, and/or fatigue.! The next year, Yip applied
for Social Security disability benefits. These were denied on October 31, 2016 by the Social
Security Administration because it found her condition was not severe enough to classify her as
disabled. It concluded, “[a]lthough you said you have various limitations caused by your
symptoms, the evidence does not show that your ability to perform basic work activities is as
limited as you indicated. There are no major limitations placed on your ability to work.” (Doc.
No. 29-1 at 7). Yip sought a reconsideration, which reached the same result on March 15, 2017.
Ultimately, she requested a hearing, which was held in early 2018. On May 8, 2018, the
Administrative Law Judge concluded that:
Based on the testimony of the vocational expert, the undersigned concludes,
considering the claimant’s age, education, work experience, and residual
functional capacity, the claimant is capable of making a successful adjustment to
other work that exists in significant numbers in the national economy. A finding
of “not disabled” is therefore appropriate under the framework of the above-cited
rule.
(Id. at 77).
During the same time period that Yip was seeking Social Security Disability benefits, she
was reaching the end of her first two years of long-term disability on the EMDP. The standard
‘Some records describe Yip’s condition as “undifferentiated connective tissue disease, fibromyalgia, chronic
fatigue.” (See, e.g., Doc. No. 29 at 137).
for determining long-term disability under the EMDP changes after the initial two-year period.
During the first two years, a person is considered disabled if the person is:
[WJholly and continuously unable, by reason of a physical or mental health
impairment, to perform any work suitable to the person’s capabilities, training
and experience, that the person’s employer has available during the initial
period, and such inability to perform work is expected to continue for [at least six
months from the date the person’s ability to perform work is determined].
(Doc. No. 29-6 at 356) (emphasis added).
After the first two years the standard gets stricter. Following the initial period, a person is
“incapacitated” if the person is:
[W]holly and continuously unable, by reason of a physical or mental health
impairment, to perform any work for compensation or profit for which the
person is or may become reasonably fitted by education, training or experience,
and such inability to perform work is expected to continue for [at least six months
from the date the person’s ability to perform work is determined].
(Id.) (emphasis added).
Yip’s situation was then reevaluated by LINA2 It is this reevaluation and subsequent
denial of continued long-term disability benefits that is the lynchpin of this case. Yip’s benefits
would have expired on October 9, 2017—the end of her two-year period pursuant to the plan
(since her last day of work was October 8, 2015). She was pregnant at the time (with a due date
of November 9, 2017), and it was decided by the Administrator that she should remain covered
until the end of 2017 and that her reevaluation would proceed in the new year.
After she gave birth, LINA began its reevaluation in June 2018. Yip participated in a
Functional Capacity Evaluation and then a Transferrable Skills Analysis was performed. Based
upon the results, LINA denied the continuation of the long-term disability benefits in September
According to its Corporate Disclosure Statement, LINA is a wholly owned subsidiary of Connecticut General
Corporation, which is a wholly owned subsidiary of Cigna Holdings, Inc. Cigna Holdings, Inc. is a wholly owned
subsidiary of Cigna Holding Company, which is a wholly owned subsidiary of Cigna Corporation. (Doc. No. 20).
Many, if not most, of the communications between Yip and LINA are actually on Cigna letterhead.
2018. Plaintiff appealed this denial in April 2019. The Plaintiffs records on appeal were
reviewed by an independent psychiatrist and an independent rheumatologist, both of whom could
not find any impairment that would prevent gainful employment. Based upon those reviews,
LINA affirmed its earlier denial on May 7, 2019. Instead of pursuing a further internal appeal,
Yip filed the instant suit.
Il. Summary Judgment Standard
Summary judgment is warranted “if the movant shows 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). “The movant bears the burden of identifying those portions of the record it believes
demonstrate the absence of a genuine issue of material fact.” Triple Tee Golf, Inc. v. Nike, Inc.,
485 F.3d 253, 261 (Sth Cir. 2007) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322-25
(1986)). Once a movant submits a properly supported motion, the burden shifts to the nonmovant
to show that the Court should not grant the motion. Celotex Corp., 477 U.S. at 321-25. The non-
movant then must provide specific facts showing that there is a genuine dispute. Jd. at 324;
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). A dispute about a
material fact is genuine if “the evidence is such that a reasonable jury could return a verdict for
the nonmoving party.” Anderson vy. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The Court
must draw all reasonable inferences in the light most favorable to the nonmoving party in
deciding a summary judgment motion. Jd. at 255.
I. Controlling Law Concerning ERISA Review and Summary Judgments
29 U.S.C. §1132(a)(1)(B) permits a person who was denied ERISA benefits under an
employee benefit plan to appeal that decision to federal court. The Supreme Court has held that
the denial of benefits should be reviewed by the district courts using a “de novo standard unless
the benefit plan gives the administrator or fiduciary discretionary authority to determine
eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, 115 (1989). The Fifth Circuit, sitting en banc in Ariana M. v. Humana
Health Plan of Texas, Inc., 884 F.3d 246 (Sth Cir. 2018), interpreted this dictate to require
district courts to review both legal (plan interpretation) and factual (eligibility for benefits) using
a de novo standard (overruling its prior panel decision in Pierre v. Conn. Gen. Life Ins. Co., 932
F.2d 1552 (Sth Cir. 1991)).
In closing, the majority described its prior precedent and why reviewing all facets de
novo comported with those decisions:
Our leading case in this area is Vega v. National Life Insurance Services,
Inc., 188 F.3d 287 (Sth Cir. 1999) (en banc), overruled on other grounds by
Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299
(2008). Under Vega, a plan administrator must identify evidence in the
administrative record, giving claimants a chance to contest whether that record is
complete. Jd. at 299. Once the record is finalized, a district court must remain
within its bounds in conducting a review of the administrator’s findings, even in
the face of disputed facts. Id. Vega permits departure from this rule only in very
limited circumstances. One exception allows a district court to admit evidence to
explain how the administrator has interpreted the plan’s terms in previous
instances. Jd. (citing Wildbur v. ARCO Chem. Co., 974 F.2d 631, 639 n.15 (Sth
Cir. 1992)). Another allows a district court to admit evidence, including expert
opinions, to assist in the understanding of medical terminology related to a
benefits claim. Jd. Those situations are not actually expanding the evidence on
which the merits are evaluated but providing context to help the court evaluate the
administrative record.
Although some of Vega’s reasoning for limiting the district court record to
what was before the administrator depended on the abuse-of-discretion context,
other interests it recognized support the same rule for de novo review. Among
those is the interest in encouraging parties to resolve their dispute at the
administrative stage. Id. at 300. A different standard of review also does not
undermine Vega’s observation that there is not a “particularly high bar to a party’s
seeking to introduce evidence into the administrative record.” Jd. And generally
limiting the evidence to what was in front of the plan administrator when a
dispute ends up in court allows for speedier resolution. Id.
In short, overruling Pierre while adhering to Vega in the context of de
novo review serves the twin ERISA goals of allowing for efficient yet meaningful
judicial review. See 29 U.S.C. § 1001(b) (stating that ERISA is intended to
provide “ready access to the Federal courts”); Firestone, 489 U.S. at 113-14, 109
S.Ct. 948 (explaining that a deferential default standard “would afford less
protection to employees and their beneficiaries than they enjoyed before ERISA
was enacted”). Vega will continue to provide the guiding principles on the scope
of the record for future cases that apply de novo review to fact-based benefit
denials.
Ariana M., 884 F.3d at 256-57.
The only real exception to this application is that set out in Firestone: if the plan
specifically gives the administrator discretional authority.?
The plan in question, as quoted above, specifically delegates that discretional authority to
the administrator (LINA) and thus falls under the Firestone exception.
“When a plan grants the administrator discretion to determine claims for benefits,
claimants may recover under ERISA only if the administrator’s rejection of their claim was an
abuse of discretion.” Robinson v. Aetna Life Ins. Co., 443 F.3d 389, 395 (Sth Cir. 2006)
(emphasis added); see also Patterson v. Prudential Inc. Co. of Am., 693 F. Supp. 2d 642, 651
(S.D. Tex. 2010); Ellis v. Liberty Life Assur. Co., 394 F.3d 262, 269 (Sth Cir. 2004). That is the
situation that exists in the present case. As such, Plaintiffs claim for denial of benefits should be
reviewed for an abuse of discretion, and Plaintiff is entitled to recover under ERISA only if
LINA abused its discretion when it denied her claim. Plaintiff has, in fact, agreed with Defendant
that the abuse of discretion standard is the appropriate one to apply here. (Doc. No. 35 at 2).
An abuse of discretion occurs when “the plan administrator acted arbitrarily or
capriciously.” Burell v. Prudential Ins. Co. of Am., 820 F.3d 132, 138 (5th Cir. 2016). A decision
> Several states, including Texas, have passed statutes prohibiting such clauses. Tex. Ins. Code § 1701.062(a). Some
have argued that state statutes that prohibit discretionary clauses are ineffective because they are pre-empted. The
Fifth Circuit in Ariana M. elected to forego addressing the issue because the point was not raised. Similarly, this
Court need not address this point as it has not been raised by the non-movant in any point of error or argument.
is considered arbitrary only if it is “made without a rational connection between the known facts
and the decision or between the found facts and the evidence.’” See Baptist Mem. Hosp.—
Desoto, Inc. v. Crain Automotive, Inc., 392 F. Appx. 289, 296 (Sth Cir. 2010) (per curiam)
(quoting Bellaire Gen. Hosp. v. Blue Cross Blue Shield, 97 F.3d 822, 828-29 (Sth Cir. 1996)). If
LINA’s decision to deny Plaintiff's benefits is “based on evidence, even if disputable, that
clearly supports the basis for its denial,” then no abuse of discretion has occurred. See Vega v.
Life Ins. Servs., Inc., 188 F.3d 287, 299 (Sth Cir. 1999). When a court reviews an
administrator’s determinations, the court is limited to the evidence in the administrative record at
the time the determination was made. See Gooden v. Provident Life & Accident Ins., 250 F.3d
329, 333 (Sth Cir. 2001) Further, this Court’s review of LINA’s decision “need not be
particularly complex or technical; it need only assure that the administrator’s decision fall
somewhere on a continuum of reasonableness—even if on the low end.” Holland, 576 F.3d at
247,
The procedural aspects of resolving this case are well established.
“Standard summary judgment rules control in ERISA cases.” Cooper v. Hewlett—
Packard Co., 592 F.3d 645, 651 (Sth Cir. 2009) (internal quotation marks
omitted). We review a “district court's grant of summary judgment de novo,
applying the same standards as the district court.” Jd. Summary judgment is
appropriate when “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). “When
parties file cross-motions for summary judgment, we review each party's motion
independently, viewing the evidence and inferences in the light most favorable to
the nonmoving party.” Duval v. N. Assur. Co. of Am., 722 F.3d 300, 303 (Sth Cir.
2013) (internal quotation marks omitted).
Green v. Life Ins. Co. of North America, 754 F.3d 324, 329 (Sth Cir. 2014).
The manner in which the actual plan is interpreted is also well-established.
“Federal common law governs rights and obligations stemming from ERISA-
regulated plans, including the interpretation” of policy provisions at the heart of
this dispute. Provident Life & Accident Ins. Co. v. Sharpless, 364 F.3d 634, 641
(5th Cir. 2004). “When construing ERISA plan provisions, courts are to give the
language of an insurance contract its ordinary and generally accepted meaning if
such a meaning exists.” Jd. We “interpret the contract language in an ordinary and
popular sense as would a person of average intelligence and experience, such that
the language is given its generally accepted meaning if there is one.” Wegner v.
Standard Ins. Co., 129 F.3d 814, 818 (Sth Cir. 1997) (internal quotation marks
omitted). “Only if the plan terms remain ambiguous after applying ordinary
principles of contract interpretation are we compelled to apply the rule of contra
proferentum and construe the terms strictly in favor of the insured.” Jd.
Id. at 331.
IV. Analysis of the Motions
These competing motions for summary judgment and the respective responses set out in
detail the factual positions supporting the Plaintiff's argument that LINA (and therefore EMDP)
was wrong in its determination to discontinue long-term disability benefits to Yip, and they set
out in detail the factual support for the Defendant’s argument that LINA (and therefore EMDP)
was right in its denial. In most contexts, this factual dispute would make a judge’s job easy.
A factual dispute on critical elements usually requires a judge to deny the motions and to
place the case on the trial docket. ERISA cases, however, are rarely resolved in this fashion. The
controlling question is not whether a factual dispute exists—as it clearly does. The question is
whether LINA abused its discretion in the manner it resolved this dispute. Yip obviously thinks it
did; while EMDP contends otherwise.
A. Guiding Principles
The first step in resolving this dispute is establishing which side has the burden of proof.
This is the easier of the two questions the Court must answer. Initially, however, the Court finds
it appropriate to set out some guiding principles. First, it finds that EMDP is a self-funded plan
that has validly delegated and designated eligibility determinations to LINA.
The plan clearly states in § 2.1(B)(1): .
Discretionary Authority to Interpret Plan
The Administrator-Benefits (and those to whom the Administrator-Benefits has
delegated authority) shall be vested with full and final discretionary authority to
determine eligibility for benefits, to construe and interpret the terms of the
core benefit plans in their application to any participant or beneficiary, and to
decide any and all appeals relating to claims by participants or beneficiaries.
(Doc. No. 29-6 at 281) (emphasis added).
The plan, via §§ 5.13(B) and 5.16, then delegates to Connecticut General Life Insurance
Company, the parent company of LINA, the authority to administer its long-term disability
claims. (Doc. No. 29-6 at 356-58; see also Doc. No. 20).
As noted above, that delegation means the administrator’s decision can be set aside only
for an abuse of discretion—or, stated another way, it can be set aside only when that decision is
arbitrary or capricious. This has been interpreted as being a decision that is without a “rational
connection” with the known facts. Foster v. Principal Life Ins. Co., 920 F.3d 298, 304 (Sth Cir.
2019). The Court may not substitute its own judgment for that of the administrator. Killen v.
Reliance Standard Life Ins. Co., 776 F.3d 303, 307 (5th Cir. 2015). The existence of competing
facts or conclusions does not make an administrator’s decision arbitrary. Jd. at 308.
Finally, in answer to the question posed above, the ERISA claimant has the burden to
prove that the administrator’s decision constituted an abuse of discretion. Nichols v. Reliance
Standard Life Ins. Co., 924 F.3d 802, 808 (Sth Cir. 2019).
B. Did LINA Abuse Its Discretion When It Denied Long-Term Benefits to Yip?
Yip argues she has presented “substantial evidence that she is unable to perform any
occupation and is disabled under the terms of the plan.” (Doc. No. 27 at 7). To support this
contention, Yip, both in her Motion for Summary Judgment (Doc. No. 27) and in her response to
Defendant’s Motion for Summary Judgment (Doc. No. 35), highlights in detail various aspects of
the record before the Court. These include the following aspects of her medical picture. She has a
history of pain and fatigue as early as 2008. These symptoms increased in severity in the years
between 2012 and 2015—-so much so that her doctors recommended periodic medical leaves and
a curtailed work schedule. Thus, restrictions increased over time until, in approximately October
2015, her employer, ExxonMobil, could no longer accommodate her restrictions. She then went
on disability leave.
While her various ailments required care from several medical specialists, including a
rheumatologist, gynecologist, and a colorectal surgeon, her primary problems appear to have
been (and remain today) fibromyalgia and/or undifferentiated connective tissue disease.’ That
being the case, Yip emphasizes in her pleadings the observations and treatment she received
from her rheumatologist, Dr. Gomez, throughout the 2016-2018 time period. On some visits, her
symptoms were worse than others, but at no time did they fully resolve. Throughout his
treatment of Plaintiff, Dr. Gomez approved of her performing light duty work (usually from
home), but he generally conditioned such approval as depending on whether or not she was
experiencing a flare-up.
Plaintiff also points to the opinions of Andrea Higgins, a mental health counselor who
concludes that Yip’s “medical conditions in combination with the associated anxiety and
depression make it difficult for her to fulfill normal daily tasks and impair her ability to work in a
normal office setting or to keep a normal work pace” and that she “struggles to cope with the
stress/anxiety of daily functioning and would therefore struggle with additional stress in the
‘ The latter condition in layman’s terms is one in which the immune system malfunctions and attacks the healthy
tissue. Generally, but not always, it runs a mild course and has a low likelihood of progression to a more serious
state, Fibromyalgia is a chronic disorder characterized by widespread muscular skeletal pain, fatigue, and
tenderness. Its root cause is often undeterminable, but it can be triggered by physical trauma, infection, or stress. It is
not necessarily life-threatening, but it can certainly affect day-to-day activities and can lead to anxiety and/or
depression in addition to the pain it causes.
workplace.” Katherine Badgett, one of her physical therapists, concluded that Yip is only capable
of sitting or standing for 20 minutes at a time but not more than 2 hours total in a day and would
be off task during a typical workday 25% or more of the time. Finally, Ms. Badgett noted that
“[b]ecause Ms. Yip needs a lot of therapy to help moderate her pain in addition to days when she
simply can’t do things and frequent doctor’s appointment visits so she could easily miss a week
or more of every month of work (sic).” (Doc. No. 29-1 at 156).
Karen Kowenski, another one of Yip’s physical therapists, agreed with Badgett’s finding
that Yip could only sit for 10-45 minutes and only stand from 30-60 minutes, but never more
than 2 hours in an 8-hour workday. She projected that Yip would miss 50% of workdays per
month. (Doc. No. 29-2 at 56).
Overall, Plaintiff contends the evidence demonstrates proof of multiple medical issues
supporting a consistent diagnosis that would complicate, if not prohibit, her return to gainful
employment. EMDP does not contend that this evidence does not exist or even that it should be
ignored. It does, however, emphasize that there is contrary evidence that LINA considered and
that this Court should also consider.
First, it points to two “outside” factors that support LINA’s decision.° Yip applied for and
was denied social security disability in 2016. The decision found that she has certain limitations
but that she has “no major limitations placed on her ability to work.” (Doc. No. 29-1 at 3-6).
This decision was upheld on reconsideration in May 2017. It was then appealed to an
Administrative Law Judge who also found Yip was not entitled to disability benefits:
Based on the testimony of the vocational expert, the undersigned concludes,
considering the claimant’s age, education, work experience, and residual
functional capacity, the claimant is capable of making a successful adjustment to
° The Court uses the term “outside” advisedly. Here, it is used to denote that the facts represented determinations or
events that were necessarily not part of the LINA determination process. They are, however, documented in the
administrative record—so they are not “outside” the record before this Court.
other work that exists in significant numbers in the national economy. A finding
of “not disabled” is therefore appropriate under the framework of the above-cited
rule.
11. The claimant has not been under a disability, as defined in the Social
Security Act, from October 12, 2015, through the date of this decision (20
CFR 404.1520(g)).
DECISION
Based on the application for a period of disability and disability insurance benefits
filed on September 19, 2016, the claimant is not disabled under sections 216(i)
and 223(d) of the Social Security Act.
(Doc. No. 29-4 at 13).
The second “outside fact” that Defendant emphasizes is that during Yip’s disability leave,
Yip not only married, but also gave birth to a child. The social security opinion even noted that
she enjoyed “not working.” Ud. at 11). That same opinion matched the conclusion of other
therapists who noted that her complaints were inconsistent and did not match the actual evidence
of impairment. (/d. at 10). For example, one of the therapists noted:
The claimant was inconsistent in lifting/carrying capabilities. The claimant states
she is able to carry her 7 month old child at home that weighs 13 pounds but was
unable to lift/carry anything over 5 pounds.
(Doc. No. 29-1 at 111).
While these two observations suggest inconsistencies in Yip’s reporting and perhaps
undermine her claim, they are not the heart of EMDP’s argument. Its argument is more ~
straightforward. There is valid medical evidence that supports the decision not to award long-
term disability benefits. Therefore, that decision was not the product of an abuse of discretion by
LINA.
LINA informed Yip some six months after she gave birth that it was going to review her
disability status. Yip underwent a Functional Capacity Evaluation with a physical therapist. The
results of that evaluation demonstrated Yip had the capacity to complete “Frequent sitting,
Frequent standing, Frequent walking,...Frequent reaching at desk level, Frequent reach[ing]
floor level,...Constant object handling, Constant fingering, Constant simple hand grasp, Constant
firm hand grasp, Constant fine/gross hand manipulation.” (Doc. No. 29-4 at 30).
It was also noted that Yip “terminated the positional tolerance portion of her test after 20
minutes, due to reports of increased pain, but did not demonstrate appropriate physiological
changes that would concur with subjective complaints.” (/d.). Additionally, it was noted that Yip
described her typical day as taking care of her 7-month-old (feeding, changing diapers, lifting her
daughter) and going to physical therapy twice a day. (/d. at 33).
Yip also underwent two different Transferable Skills Analyses. On July 5, 2018,
Vocational/Rehabilitation Specialist Mary Faltaous performed a Transferable Skills Analysis,
which included a review of disability questionnaires, job description, dictionary of occupational
titles, OASYS, and the FCE completed by Castro. Ud at 47-48). At that time, Faltaous did not
find a job based on the available wages Faltaous was trying to find. (/d.). The following month,
Faltaous performed another Transferable Skills Analysis. Ud. at 49-50). At that time, following a
new wage data release, Faltaous determined that based on Yip’s skills, education attainment, and
work history, Yip could perform the job of a Chemical Design Engineer. (/d. at 50). Given these
results, LINA determined that Yip did not qualify for the continuation of long-term disability
benefits.
Yip then appealed that decision. In evaluating the appeal, LINA brought in a new
evaluation team that would not be tainted by its prior decision. It also requested that her medical
records be reviewed by two different board-certified physicians: a psychiatrist and a
rheumatologist. Dr. Peter Volpe, the psychiatrist, reviewed the medical records and spoke to
some of Yip’s caregivers. He ultimately agreed with Dr. Gomez, Yip’s treating physician, that
Yip had no function limitations or activity restrictions based upon her mental health.
Dr. Paramvir Sidhu, a rheumatologist, reviewed Yip’s medical records and her affidavit.
Dr. Sidhu found that Yip had no physical co-limiting conditions. (Doc. No. 29-5 at 110). In
reaching his conclusion, Dr. Sidhu observed that Dr. Gomez’s treatment notes did not indicate
“any joint deformities, limitations on range of motion of joints, or active synovitis of joints.”
(d.). Additionally, the results of bloodwork testing ordered by Dr. Gomez did not objectively
support Plaintiffs fibromyalgia diagnosis, with Dr. Sidhu noting: “Review of lab results show
that specific autoantibodies including anti-CCP antibody, SS-A antibody, SS-B antibody,
DsDNA antibody, RNP antibody, Smith antibody are negative. Complements C3 & C4 (which
are decreased in autoimmune connective tissue diseases) are normal.” (/d.). Dr. Sidhu also
opined, “[a] mere diagnosis of fibromyalgia does not preclude gainful employment. Dr. Gomez
has not described how fibromyalgia precludes [Plaintiff] from working.” Ud). Dr. Sidhu
concluded that the record viewed “‘in its totality does not demonstrate physical impairment that
precludes [Plaintiff] from working in her own occupation or that indicate working in her own
occupation is medically contraindicated.” U/d.). Based upon these findings, LINA affirmed its
prior denial.
A court must give deference to the decision of the plan administrator and may not
substitute its judgment for that of the administrator. Killen, 776 F.3d at 307. Here, there is clearly
evidence from which a reasonable finder of fact could decide either way. Indeed, if this Court
were writing on a blank slate, it would probably not reach the same decision as the one that
LINA reached here. Unfortunately for Yip, that is not the standard by which courts review these
matters. The evidence in support of the Administrator’s decision need only fall “somewhere on
the continuum of reasonableness—even if on the low end.” Porter v. Lowe's Companies, Inc.’s
Bus. Travel Acc. Ins. Plan, 731 F.3d 360, 362-64 (Sth Cir. 2013).
Stated differently:
[T]he job of weighing valid, conflicting professional medical opinions is not
the job of the courts; that job has been given to the administrators of ERISA
plans...Here, the administrator, and the medical experts upon which it relied,
understood and accepted the diagnosis of fibromyalgia; and they considered the
subjective evidence Corry offered. It is true that the administrator did not accept
the opinion of Corry’s experts as to the disabling effects of her symptoms.
However, given the three qualified medical experts who found no objective
medical evidence of disability, the administrator, under the established standard of
review that restricts the courts, was not obliged to accept the opinion of Corry’s
physicians. In this “battle of the experts” the administrator is vested with
discretion to choose one side over the other...In sum, the claim that the
administrator was arbitrary and capricious in failing to consider and give proper
weight to relevant evidence must be rejected.
Corry v. Liberty Life Assur. Co. of Boston, 499 F.3d 389, 401 (Sth Cir. 2007) (emphasis added)
(internal citations to Gothard v. Metro. Life Ins. Co., 491 F.3d 246, 249-50 (Sth Cir. 2007)).
The Court has detailed much of the evidence above. Yip implies that the evidence against
her position should be disregarded because the only evidence supporting LINA’s decision
emanates from those reviewers hired by it; however, such a conclusion is not accurate. As
already noted, the experts at the SSA found she was not permanently disabled (albeit using a
different standard). Even her own treating physician suggested she could work from home.
In May 2017, Plaintiff's own treating rheumatologist’s assessment indicated Plaintiff was
improving and recommended that Plaintiff work “part time at home with flexibility depending on
flares” (see Doc. No. 29-1 at 43), which is a change from his Individual Disability Report dated
October 5, 2015 that deemed Plaintiff “unfit for work” with or without limitations. (Doc. No. 29
at 147).
On August 16, 2018 and October 25, 2018, Dr. Garza, Yip’s own treating rheumatologist,
documented Plaintiff's improvement in his progress notes. On August 16, 2018, under “History
of Present I!ness,” he indicated Plaintiff was “having some headaches and associated rash, both
symptoms however seemed to have improved over the last few weeks.” (Doc. No. 29-5 at 10).
On August 16, 2018 and October 25, 2018, under the “Psychiatric” section, he indicated “no
Depression. No Anxiety.” Ud. at 11; Doc. No. 29-2 at 30). Under “Rheumatology” and
“Examination General,” he indicated Plaintiff had a normal range of motion and her general
appearance was “well nourished, well developed, no acute distress.” (Doc. No. 29-5 at 12; Doc.
No. 29-2 at 30-31). Taken as a whole, the records certainly document Yip’s medical problems,
but they do not necessarily support the conclusion that she cannot perform any “work for
compensation or profit” or that LINA’s decision was arbitrary and capricious.
V. Conclusion
The Court finds that LINA did not abuse its discretion in reaching the decision that Yip
did not qualify for long-term disability benefits. While this Court might not have reached the
same decision, it cannot say that there was not substantial evidence to support that decision. It
therefore grants EMDP’s Motion for Summary Judgment (Doc. No. 31) and denies Yip’s Motion
for Summary Judgment (Doc. No. 27).
‘ SIGNED at Houston, Texas this Ist day of November, 2021.
United States District Judge