Cortez v. General Mills, Inc.

Background

Enrique Cortez sought long-term disability benefits under an employee welfare benefit plan sponsored and administered by General Mills. Cortez applied for benefits in March 2017, claiming that back pain, neuropathy, Achilles tendinopathy, major depressive disorder, medication side effects, and other problems prevented him from working. The plan approved his claim and paid benefits for roughly four years.

In May 2021, the plan’s Long-Term Disability Committee determined that Cortez was no longer disabled and terminated his benefits effective May 31, 2021. The committee relied on, among other things, medical evaluations indicating that Cortez could work. Cortez appealed through counsel. The Claims Appeal Committee denied the appeal in April 2022, concluding that Cortez was not disabled by physical or mental-health conditions, that contrary evidence from a treating physician was outweighed by stronger evidence, that his combination of conditions did not make him disabled, and that his receipt of Social Security disability benefits did not control his eligibility under the plan.

Review standard

The parties filed competing motions for judgment on the administrative record. Because the plan gave the Long-Term Disability Committee and Claims Appeal Committee discretion to interpret the plan and decide benefits claims, the court applied abuse-of-discretion review rather than reviewing the matter anew. Cortez argued that the appeal committee’s failure to decide his appeal within the regulatory deadline required fresh review. The court rejected that argument because Cortez filed his initial benefits claim in March 2017, before the regulation he relied on applied, and because controlling Eighth Circuit precedent states that decisional delay alone does not trigger fresh review.

Under the applicable review, the court examined whether substantial evidence supported the plan’s decision. Substantial evidence means more than a small amount of evidence but less than a greater-weight-of-the-evidence standard.

Merits

The court found substantial evidence supporting the conclusion that Cortez was not disabled by a mental-health condition. In January 2021, treating provider Leah Streitman determined that Cortez was cleared to work eight hours per day without limitations beginning January 29, 2021. A neuropsychological evaluation by Douglas Whiteside, Ph.D., generally found Cortez’s cognitive functioning within expected limits and did not conclude that a mental-health condition disabled him. The court also found that Mary Kenning, Ph.D.’s earlier opinion that Cortez could return to work part-time and soon thereafter full-time reasonably supported the committee’s conclusion.

The court also found substantial evidence supporting the conclusion that Cortez was not disabled by a physical condition. Neurologist Beth Ann Staab, M.D., reviewed Cortez’s medical records, examined him, and concluded that his neck and back pain did not prevent him from performing his current job full-time. She also concluded that neuropsychological testing did not show significant impairment that would prevent him from completing his job. The court found that Cortez’s primary treating physician for his physical complaints did not provide evidence undermining Dr. Staab’s conclusions and sometimes identified mental-health conditions, rather than neck or back pain, as disabling conditions.

The court further found substantial evidence supporting the committee’s conclusion that Cortez could earn at least 60 percent of his pre-disability monthly earnings. Because Streitman and Staab concluded that Cortez could return to full-time work in his own occupation, the court reasoned that he could earn more than that threshold.

Cortez’s arguments

The court rejected Cortez’s arguments that the committee improperly relied on supporting medical records, selectively considered information, failed to account for his combined conditions or subjective complaints, or acted as his adversary. The court acknowledged that Dr. Paul Wicklund’s 2019 examination contributed little because it addressed Cortez’s ability to work from an orthopedic standpoint, but concluded that the remaining evidence was sufficient.

The court also rejected Cortez’s argument that the plan lacked new information justifying termination after paying benefits. It found significant, new information in Streitman’s January 2021 conclusion that Cortez could work full-time without restrictions and Staab’s April 2021 examination and conclusions. The court explained that prior benefit payments did not permanently prevent the plan from changing its decision when supported by significant new evidence.

Finally, the court held that Cortez’s receipt of Social Security disability benefits did not establish that the plan abused its discretion. Social Security decisions are not binding on an Employee Retirement Income Security Act plan administrator, and the record did not show that the Social Security Administration considered the same evidence as the appeal committee.

Disposition

The court denied Cortez’s Motion for Judgment on the Administrative Record, granted the defendants’ Motion for Judgment on the Administrative Record, and ordered judgment in favor of General Mills, Inc. and the General Mills, Inc. Long-Term Disability Income Plan on Cortez’s Employee Retirement Income Security Act claims, with prejudice and on the merits.