United States District Court, District of Columbia
N. McFADDEN, U.S.D.J.
Kemathe seeks to recover benefits under the Employee
Retirement Income Security Act (“ERISA”), 29
U.S.C. § 1001, et seq., claiming that Reliance
Standard Life Insurance Company (“Reliance”)
improperly terminated her disability benefits. Ms. Kemathe
overlooks that to qualify for the disability benefits that
she seeks, she must prove that she cannot perform the
material duties of any occupation, not just her old
one. She did not do so, so the Defendant's Motion for
Summary Judgment will be granted.
Kemathe was a respiratory care practitioner at a hospital,
but she stopped working in 2014 because of asthma. A.R. 269.
She submitted a claim to Reliance for “Total
Disability” benefits, and Reliance approved the claim
and paid her benefits. Compl. ¶ 18, 20, ECF No. 1. Under
Ms. Kemathe's policy, there are two definitions of
“Total Disability.” A.R. 14. For the first two
years when a benefit is payable, the insured is
“totally disabled” if she “cannot perform
the material duties” of her regular job. Id.
But after the insured has received benefits for two years,
she is “totally disabled” only if she
“cannot perform the material duties of Any
Occupation.” Id. In other words, the
disability bar is raised after two years.
paying benefits for two years, Reliance concluded that Ms.
Kemathe was no longer “totally disabled” under
the policy because she could perform the “material
duties” of another job, so Reliance discontinued her
benefits as of November 2016. A.R. 246-51. Ms. Kemathe
administratively appealed Reliance's decision. A.R.
1404-06. Reliance upheld its decision. A.R. 258-68. Reliance
explained that while Ms. Kemathe may have persistent symptoms
from asthma, it believed that “the level of severity
specific to this condition does not preclude [Ms. Kemathe]
from sedentary work function.” A.R. 266. For
instance, Reliance proposed that Ms. Kemathe could work as a
telemetry technician, blood bank booking clerk, admissions
clerk, information clerk, or appointment clerk. A.R. 1599.
Kemathe sued Reliance, alleging that its denial of her
benefits violated ERISA.Compl. ¶ 1. Reliance now moves for
summary judgment. Mem. of Law ISO Mot. for Summ. J.
(“Def.'s Mem.”), ECF No. 25-2. Naturally, Ms.
Kemathe opposes. Mem. in Opp. (“Pl.'s Opp.”),
ECF No. 30.
judgment is appropriate when “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); see also Anderson v. Liberty Lobby,
Inc., 477 U.S. 242, 247-48 (1986). “A fact is
material if it ‘might affect the outcome of the suit
under the governing law,' and 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.'” Steele v. Schafer, 535 F.3d 689,
692 (D.C. Cir. 2008) (quoting Anderson, 477 U.S. at
Court must view the facts in the light most favorable to the
non-moving party, but her opposition must consist of more
than mere unsupported allegations or denials, and it must be
supported by affidavits, declarations, or other competent
evidence setting forth specific facts showing that there is a
genuine issue for trial. See Fed. R. Civ. P. 56(e);
see also Celotex Corp. v. Catrett, 477 U.S. 317, 324
(1986). The non-moving party must provide evidence that would
permit a reasonable factfinder to find in her favor.
Laningham v. U.S. Navy, 813 F.2d 1236, 1242 (D.C.
Cir. 1987). A “mere . . . scintilla of evidence”
in support of the non-movant's position cannot defeat a
motion for summary judgment. Anderson, 477 U.S. at
Ms. Kemathe's policy does not grant discretion to
Reliance, the parties agree that the Court should review the
denial of benefits under a de novo standard, not the
deferential arbitrary and capricious standard sometimes
applicable in ERISA cases. See Pettaway v. Teachers Ins.
& Annuity Ass'n of Am., 644 F.3d 427, 433 (D.C.
Kemathe first asks the Court to consider two documents
outside the administrative record: (1) her August 25, 2017
Social Security Administration decision; and (2) her
affidavit describing her “Independent Medical
Examination.” Pl.'s Opp. at 4. She claims that both
are relevant to whether Reliance provided her “a full
and fair review of her claims.” Id.
to the parties, the D.C. Circuit has not determined whether
district courts should admit evidence outside the
administrative record under de novo review.
See Def.'s Reply at 3, ECF No. 31; Pl.'s
Mem. at 3. Regardless, these items do not create a genuine
issue of material fact about whether Reliance erred in
denying her benefits.
the Social Security Administration issued its decision
after Reliance made its final benefits decision.
“Courts review ERISA-plan benefit decisions on the
evidence presented to the plan administrators, not on a
record later made in another forum.” Block v.
Pitney Bowes Inc., 952 F.2d 1450, 1455 (D.C. Cir. 1992)
(giving no weight to a Social Security Administration
determination made after the defendant's decision). The