Gary Carr v. Reliance Standard Life Insurance Company

*The Honorable William W Schwarzer, Senior United States District
Judge for the Northern District of California, sitting by designation.
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RECOMMENDED FOR FULL-TEXT PUBLICATION
Pursuant to Sixth Circuit Rule 206
ELECTRONIC CITATION: 2004 FED App. 0103P (6th Cir.)
File Name: 04a0103p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
_________________
GARY CARR,
Plaintiff-Appellant,
v.
RELIANCE STANDARD LIFE
INSURANCE COMPANY,
Defendant-Appellee.
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No. 02-2377
Appeal from the United States District Court
for the Eastern District of Michigan at Detroit.
No. 02-70387—Denise Page Hood, District Judge.
Submitted: March 17, 2004
Decided and Filed: April 14, 2004
Before: ROGERS and COOK, Circuit Judges;
SCHWARZER, Senior District Judge.*
2 Carr v. Reliance Standard Life Ins. Co. No. 02-2377
_________________
COUNSEL
ON BRIEF: Walter J. Goldsmith, Mark H. Fink, MADDIN,
HAUSER, WARTELL, ROTH, HELLER & PESSES,
Southfield, Michigan, for Appellant. Joshua Bachrach,
RAWLE & HENDERSON, Philadelphia, Pennsylvania, for
Appellee.
_________________
OPINION
_________________
WILLIAM W SCHWARZER, Senior District Judge. Gary
Carr appeals the district court’s judgment rejecting his claim
for long-term disability (“LTD”) benefits under the plan
maintained by his employer and administered by the
defendant, Reliance Standard Life Insurance Company
(“Reliance”).
Carr suffered from severe coronary artery disease and was
an insulin-dependent diabetic. He worked full-time until
June 27, 1999, when he left his position for treatment for
necrotizing fasciitis (“flesh-eating bacteria”). He returned to
work on a part-time basis on August 16, 1999. He continued
to work part-time until January 14, 2000, when he left his
position permanently on account of his disability. After
initially rejecting Carr’s claim for LTD benefits for lack of
sufficient clinical findings, Reliance again reviewed the claim
after Carr filed suit. It determined that Carr was not eligible
for benefits because he did not qualify under the definition of
Total Disability when he ceased being a full–time employee
on June 27, 1999.
The LTD plan provides in relevant part:
“Totally Disabled” and “Total Disability” mean, that as
a result of an Injury or Sickness:

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No. 02-2377 Carr v. Reliance Standard Life Ins. Co. 3
(1) during the Elimination Period, an Insured cannot
perform each and every material duty of his/her
regular occupation; and
(2) for the first 60 months for which a Monthly
Benefit is payable, an Insured cannot perform the
material duties of his/her regular occupation;
(a) “Partially Disabled” and “Partial Disability”
mean that as a result of an Injury or Sickness an
Insured is capable of performing the material
duties of his/her regular occupation on a part-
time basis or some of the material duties on a
full-time basis. An Insured who is Partially
Disabled will be considered Totally Disabled,
except during the Elimination Period. . . .
(Emphasis added.) Reliance determined that Carr was not
Totally Disabled during the Elimination Period because he
“demonstrated that he was not disabled from Each and Every
material duty of his occupation during the period that he
worked 20 hours weekly in his executive capacity with
several operating units reporting to him between August 16,
1999 and January 15, 2000.” It also determined that Carr
could not recover benefits beginning on January 14, 2000,
when he left work permanently, because his coverage had
terminated as of June 27, 1999, when he ceased being an
active, full-time employee as required under the terms of the
plan.
On cross-motions for summary judgment, the district court
granted Reliance’s motion, rejecting Carr’s claim for benefits
beginning on June 26, 1999. It held that “[i]t is clear from the
Policy language that an employee cannot be partially disabled
during the Elimination Period” and that here “[t]here is
nothing in the medical record that shows that Plaintiff was
unable to perform the material duties of his occupation while
he was working part-time between August 1999 and January
2000.”
4 Carr v. Reliance Standard Life Ins. Co. No. 02-2377
1W e reject Carr’s contention that Reliance should be estopped from
receiving the benefit of this provision of the plan because, in response to
a request made prior to the filing o f this lawsuit, the comp any erroneously
sent him an earlier version of the policy which did not give Reliance
discretion to interpret the plan and determine eligibility for benefits. Carr
has failed to establish the elements of an estoppel claim, in particular that
he detrimentally and justifiably relied on actions or representations of
Reliance. See Trustees of the Mich. Laborers’ Health Care Fund v.
Gibbons, 209 F.3d 58 7, 591 (6th Cir. 2000).
2Our application of the arbitrary and capricious standard of review
is “shaped by the circumstances of the inherent conflict of interest” arising
from the fact that Reliance bo th funded the p lan and determined eligibility
for bene fits. Borda v. Ho rdy, Lewis, P ollard & Page, P .C., 138 F.3d
1062, 1069 (6th Cir. 1998) (internal quotation omitted). However, we
have not found that this inherent conflict of interest in any way influenced
Reliance’s decisio n. See Peruzzi v. Summa M ed. Plan, 137 F.3d 431, 433
(6th Cir. 1998).
Carr timely appealed. The district court had jurisdiction
under 29 U.S.C. § 1132(e) and 28 U.S.C. § 1331, and we
have jurisdiction under 28 U.S.C. § 1291.
DISCUSSION
Under the terms of the plan at issue, Reliance serves as the
claims review fiduciary with respect to the insurance policy
and the plan and has the discretionary authority to interpret
the plan and the insurance policy and to determine eligibility
for benefits.1 We therefore review its “decision to deny
benefits using ‘the highly deferential arbitrary and capricious
standard of review.’”2 Killian v. Healthsource Provident
Adm’rs, 152 F.3d 514, 520 (6th Cir. 1998) (quoting Yeager v.
Reliance Standard Life Ins. Co., 88 F.3d 376, 380 (6th Cir.
1996)).
Carr contends that Reliance and the district court erred in
interpreting the plan’s definition of “Total Disability” to bar
recovery if the applicant can perform any of his material
duties during the Elimination Period. He argues that “the
Policy unmistakably manifests the intent and understanding

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No. 02-2377 Carr v. Reliance Standard Life Ins. Co. 5
that an Injured who, during the Elimination Period, is unable
to perform one or more of the material duties of his/her
regular occupation — even on a part-time basis — will be
deemed Totally Disabled.”
We disagree. The plan plainly limits finding “Total
Disability” to a claimant who “cannot perform each and every
material duty of his/her regular occupation” during the
Elimination Period. If a claimant can perform even one
material duty of his regular occupation during the Elimination
Period, he is not totally disabled. See Gallagher v. Reliance
Standard Life Ins. Co., 305 F.3d 264, 275 (4th Cir. 2002)
(“Because Gallagher could perform certain occupational
duties prior to [the date he resigned] and has not presented
evidence demonstrating that his condition became more
severe on or after [that date], we conclude that Gallagher has
not submitted objectively satisfactory evidence that he was
unable to perform each and every material duty of his
occupation during the elimination period.”); Porter v.
Metropolitan Life Ins. Co., 17 F. Supp. 2d 500, 506 (D.S.C.
1998) (affirming company’s determination that analogous
provision means “that it need only demonstrate that [the
applicant] is not wholly and continuously unable to do her job
(i.e. that there is some part of her job that she can do)”).
Here, it is undisputed that Carr returned to work on
August 16, 1999, before the end of the Elimination Period,
and continued to work part-time until January 14, 2000. He
worked approximately twenty hours per week and earned
roughly $4,400 every two weeks. This record supports the
finding that during the Elimination Period, Carr was not
unable to “perform each and every material duty of his
[occupation].” Indeed Carr’s situation falls squarely within
the plan’s definition of “Partial Disability” since he was
“capable of performing the material duties of his[] regular
occupation on a part-time basis.” The plan clearly states that
an insured who is only Partially Disabled during the
6 Carr v. Reliance Standard Life Ins. Co. No. 02-2377
3Carr also argues that his reasonable expectations concerning the
interpretation of the plan should control. He conced es on reply, however,
that this contra proferentum rule applies only where contractual language
is found to have more than one interpretation. See Marquette Gen. Hosp.
v. Goo dman F orest Indu s., 315 F.3d 629, 632 n.1 (6th Cir. 2003). As
discussed above, the plan is unambiguous on its face , rendering C arr’s
reaso nable expectations irrelevant.
Elimination Period will not be considered Totally Disabled
and thus eligible for benefits.3
Because we conclude that Reliance did not act arbitrarily or
capriciously in denying Carr’s claim for LTD benefits, the
judgment of the district court is AFFIRMED.

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