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Van Steen v. Life Insurance Company of North America

United States Court of Appeals, Tenth Circuit

January 2, 2018

CARL VAN STEEN Plaintiff-Appellee/Cross-Appellant,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant-Appellant/Cross-Appellee.

         APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO (D.C. No. 1:15-CV-00137-WYD-MJW)

          Kevin P. Ahearn (Bradley A. Levin with him on the brief) of Levin Sitcoff, PC, Denver, Colorado, for Plaintiff-Appellee/Cross-Appellant.

          Jack M. Englert, Jr., of Holland & Hart, LLP, Greenwood Village, Colorado, for Defendant-Appellant/Cross-Appellee.

          Before MATHESON, McKAY, and McHUGH, Circuit Judges.

          MCKAY, CIRCUIT JUDGE.

         These cross-appeals arise out of Life Insurance Company of North America's termination of Carl Van Steen's long-term disability benefits under Lockheed Martin's ERISA Plan. Life Insurance Company of North America appeals the district court's finding that its decision to terminate Mr. Van Steen's benefits was arbitrary and capricious. Mr. Van Steen, in turn, appeals the district court's denial of his attorney's fees request. We affirm the district court on both issues.

         I.

         Mr. Van Steen is employed as a Systems Integration Business Analyst at Lockheed Martin Corporation. As such, he is a participant in the Lockheed Martin Group Benefits Plan, which is administered by Life Insurance Company of North America, or LINA. LINA also funds Lockheed's long-term disability policy. ERISA governs the Plan and policy.

         In October 2011, Mr. Van Steen was physically assaulted during an altercation while walking his dog. The assault resulted in a mild traumatic brain injury (mTBI) that impacted Mr. Van Steen's cognitive abilities. Following the incident, Mr. Van Steen sought care from his primary treating physician, Dr. David Reinhard, neuropsychologist Dr. James Berry, and a handful of other providers.

         The cognitive dysfunction from Mr. Van Steen's mTBI prevented him from returning to work[1] until September 10, 2012, at which point Dr. Reinhard cleared him for part-time work every other day. Mr. Van Steen was allowed to return to part-time work on a daily basis roughly six weeks later. Even on a part-time schedule, however, Mr. Van Steen experienced cognitive fatigue and headaches that required him to frequently rest. He often worked from home where it was easier to take naps throughout the day. Due to his inability to stay organized and keep track of deadlines after the assault, Mr. Van Steen received poor feedback on his job performance.

         Mr. Van Steen's claim for partial long-term disability benefits was approved on March 30, 2012. Roughly a year later, LINA reviewed Mr. Van Steen's file and contacted Dr. Reinhard's office for more information about Mr. Van Steen's condition and restrictions. Dr. Reinhard's nurse told LINA that Mr. Van Steen's restrictions were basically permanent as he was "not likely to improve." (Appellant's App. at 620.) Despite this prognosis, LINA sent Mr. Van Steen a letter one week later terminating his long-term disability benefits, explaining that "the medical documentation on file does not continue to support the current restrictions and limitations to preclude you from resuming a full-time work schedule." (Id. at 813.)

         Mr. Van Steen appealed this decision on November 25, 2013, providing a list of his basic job duties and arguing that there was no evidence to support LINA's determination that he is or had been able to perform each and every material duty of his regular occupation full-time. Mr. Van Steen supplemented this appeal with a psychological and vocational evaluation from psychologist David Zierk. LINA denied Mr. Van Steen's appeal on February 27, 2014, asserting that "an explanation of [Mr. Van Steen's] functionality and how [his] functional capacity continuously prevented [him] from performing the material duties of [his] occupation from March 16, 2013 through the present and beyond was not clinically supported." (Id. at 800-01.) Mr. Van Steen appealed again on August 8, 2014, with supplemental medical records, only to receive LINA's second denial on October 28, 2014.

         Having exhausted his administrative appeals under the Plan, Mr. Van Steen next sought relief before the district court. The district court reversed LINA's decision to terminate Mr. Van Steen's partial long-term disability benefits on the grounds that it was ...


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