Appeal from the United States District Court for the Western District of Kentucky at Paducah. No. 5:11-cv-00116--Thomas B. Russell, District Judge.
Geordi Garatt, Paducah, Kentucky, for Appellant.
Robert L. Steinmetz, Rebecca A. Wood, GWIN STEINMETZ & BAIRD, PLLC, Louisville, Kentucky, for Appellee.
Before: GILMAN, GIBBONS, and STRANCH, Circuit Judges. GIBBONS, J., delivered the opinion of the court, in which GILMAN, J., joined, and STRANCH, J., joined in part. STRANCH, J., delivered a separate opinion concurring in part and dissenting in part.
JULIA SMITH GIBBONS, Circuit Judge.
Gaylon Hayden, a participant in Martin Marietta Materials, Inc.'s long-term disability plan (" the Plan" ), appeals from two adverse judgments in her suit for long-term disability benefits under the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C. § 1001 et seq. In the district court's first order, it affirmed the plan administrator's denial of benefits on Hayden's physical-disability claim but remanded her mental-disability claim because
the plan administrator failed to consider medical evidence from three doctors. On remand, the plan administrator again rejected Hayden's claim, and the district court affirmed. For the reasons set forth below, we affirm with respect to Hayden's physical-disability claim but reverse with respect to her mental-disability claim. We further instruct the district court to award Hayden mental-health benefits consistent with the terms of the Plan.
Hayden was employed as an office manager at Martin Marietta beginning in 1997. She was covered by Martin Marietta's long-term disability plan, which was insured and administered by Liberty Life Assurance Company of Boston (" Liberty" ). She stopped working as an office manager on January 4, 2010, and applied for benefits under the Plan the next day.
Martin Marietta employees who provide proof that they are disabled due to injury or sickness are entitled to monthly disability payments under the Plan. The Plan defines " disability" and " disabled" :
1. For persons other than pilots, co-pilots, and crewmembers of an aircraft:
i. if the Covered Person is eligible for the 24 Month Own Occupation benefit, " Disability" or " Disabled" means that during the Elimination Period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and
ii. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.
In turn, the Plan defines " Any Occupation," " Own Occupation," and " Elimination Period" :
" Any Occupation" means any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.
" Own Occupation" means the Covered Person's occupation that he was performing when his Disability or Partial Disability began. For the purposes of determining Disability under this policy, Liberty will consider the Covered Person's occupation as it is normally performed in the national economy.
" Elimination Period" means a period of consecutive days of Disability or Partial Disability for which no benefit is payable. The Elimination Period is shown in the Schedule of Benefits and begins on the first day of Disability.
Employees disabled by mental illness are entitled to recover " a combined period of 24 months of Monthly Benefit payments while the Covered person is insured."
" Mental Illness" means a psychiatric or psychological condition classified as such in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) regardless of the underlying cause of the Mental Illness. If the DSM is discontinued, Liberty will use the replacement chosen or published by the American Psychiatric Association.
An employee is thus entitled to benefits for a period of 24 months if she cannot perform the duties of her own occupation from the first day of claimed disability through the next 180 days (the Elimination Period) and subsequent 24 months, and, thereafter is entitled to benefits if the employee cannot perform the material and
substantial duties of any occupation. Hayden claims that she was disabled within the meaning of the Plan by virtue of ...