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Balmert v. Reliance Standard Life Insurance Co.

April 6, 2010

MARIBEA BALMERT, PLAINTIFF-APPELLANT,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, DEFENDANT-APPELLEE.



Appeal from the United States District Court for the Southern District of Ohio at Columbus. No. 07-00095-James L. Graham, District Judge.

The opinion of the court was delivered by: Siler, Circuit Judge.

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206

Argued: December 1, 2009

Before: BATCHELDER, Chief Judge; SILER and GILMAN, Circuit Judges.

AMENDED OPINION

Pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., Maribea Balmert appeals the district court's judgment upholding the benefits determination of Reliance Standard Life Insurance Company ("Reliance Standard"). Concluding that Balmert received a full and fair review of her claim and that Reliance Standard's benefits determination was not arbitrary and capricious, we affirm.

BACKGROUND

Balmert began her employment with Big Lots, Inc. as an accountant-tax analyst in 2001. Her position required her to sit most of the day and manipulate her hands, fingers, and wrists to use a computer. As a Big Lots employee, Balmert subscribed to an employee benefit plan offering long-term disability insurance under a contract insured and administered by Reliance Standard.

In August 2004, she stopped working because of symptoms she believed were related to her rheumatoid arthritis. Balmert was evaluated by her rheumatologist, Kevin V. Hackshaw, M.D., on August 26, 2004, but the results of the examination were inconclusive. According to Dr. Hackshaw, Balmert described symptoms of pain in her hands, but "the pain that she complains of is disproportionate relative to the amount of synovitis that I see."*fn1 Noting that Balmert's symptoms suggested "some other etiology"--with stress as a possibility--Dr. Hackshaw referred her to a neurologist and a psychologist and placed her on temporary medical leave in order to obtain evaluations and recommendations from his colleagues.

On August 30, 2004, Balmert had her first consultation with her psychologist, Wanda McEntyre, Ph.D. Balmert told Dr. McEntyre that she had experienced pain from rheumatoid arthritis for a number of years, but her pain level had recently intensified. Dr. McEntyre noted that Balmert "expresses a strong desire to return to her job, but acknowledges that she does not perceive herself as capable of managing the hours, the pressure, and stress at this time." Balmert began meeting with Dr. McEntyre approximately once every two weeks until she discontinued counseling in December 2004. These counseling sessions generally focused on stress management techniques to prepare Balmert to return to work.

After evaluating Balmert on October 21, 2004, Dr. Hackshaw noted that he detected "[n]o active synovitis," that she was "doing well," and that her rheumatoid arthritis "seems to be under good control." Dr. Hackshaw also told Balmert that she could return to work with some limitations, but advised that she may wish to find a less stressful position or explore some type of flex plan that would allow her to take some of her computer typing work home. A few days later, Balmert tearfully expressed her concern to Dr. McEntyre regarding Dr. Hackshaw's determination that she could return to work. At future counseling sessions, Balmert continued to express concerns about her ability to return to work.

Following an evaluation of Balmert on February 10, 2005, Dr. Hackshaw noted that she had "no tender points and no synovitis that I could detect, so I think in general she is doing well." Regarding Balmert's work status, Dr. Hackshaw reported that "we had allowed her to return to work with limitations and they apparently stated that she would not be able to return to work due to the limitations."

After evaluating Balmert on May 19, 2005, Dr. Hackshaw noted that Balmert's rheumatoid arthritis was "somewhat stable," that she had "no synovitis," and that she had "[f]ull range of motion of joints." Dr. Hackshaw noted, after evaluating Balmert on August 18, 2005, that he was generally "pleased with how she is doing." After evaluating Balmert on November 21, 2005, Dr. Hackshaw observed "[m]inimal synovitis" and stated that "she is doing well with current medications."

Balmert filed for long-term disability benefits on February 15, 2005. In a letter dated June 2, 2005, Reliance Standard denied Balmert's claim for long-term disability benefits, stating that "there is no documentation of a physical condition that would preclude you from performing the material duties of your own occupation." Balmert appealed Reliance Standard's denial of her disability benefits. In support of her administrative ...


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