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Muniz v. Amec Construction Management

October 27, 2010

DIERRO MUNIZ, PLAINTIFF-APPELLANT,
v.
AMEC CONSTRUCTION MANAGEMENT, INC., A CORPORATION, DEFENDANT-APPELLEE.



Appeal from the United States District Court for the Central District of California Christina A. Snyder, District Judge, Presiding. D.C. No. 2:07-cv-08066-CAS-AJW.

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

FOR PUBLICATION

OPINION

Argued and Submitted May 7, 2010-Pasadena, California

Before: John T. Noonan, Richard R. Clifton and Jay S. Bybee, Circuit Judges.

OPINION

Dierro Muniz appeals the district court's decision upholding Connecticut General Life Insurance Company's ("CGLIC") termination of Muniz's disability benefits. The district court held that Muniz did not qualify for disability benefits under the terms of his disability insurance plan. We affirm.

I. Background

Muniz was insured under a long-term disability insurance plan issued by CGLIC as a benefit of his employment with Morse Diesel International, predecessor of Amec Construction Management, Inc. This plan is governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), as amended, 29 U.S.C. §§ 1001, et seq. Under the CGLIC plan, a claimant will continue to receive benefits after 24 months if he is "totally disabled," which is defined as "unable to perform all the essential duties of any occupation for which [he is] or may reasonably become qualified."

Muniz was diagnosed with HIV in 1989 and stopped working on August 1, 1991, due to the effects of his infection. He began receiving total disability benefits under the CGLIC plan in February 1992. In April 2005, Muniz's claim came up for periodic review.

As part of the review process, Muniz completed forms on which he indicated he had "debilitating fatigue," "asthma [that] compounds [him] from being ambulatory," difficulties with "concentration and attention span," and "intermittent malaise." Muniz also noted he engaged in light household activities and exercise. Muniz's treating physician, Dr. William Towner, completed a Physical Activities Assessment, on which he checked boxes indicating that he found Muniz could sit, stand, and walk "occasionally (1-33%) (< 2.5="" hours)."="" dr.="" towner="" also="" indicated="" that="" muniz's="" ability="" to="" work="" extended="" shifts="" or="" overtime="" fell="" into="" the="" same="" "occasionally"="">

Based on a review of these forms and Muniz's medical records, CGLIC determined in its vocational assessment that Muniz could perform "sedentary employment," which qualified him for clerical positions. A CGLIC nurse case manager also found that the "current medical [record] does not support the severity of symptoms as stated by [Muniz]."

The vocational assessment and the nurse case manager's evaluation were shared with Dr. Towner, and CGLIC requested that Dr. Towner provide further medical documentation should he disagree with the analysis. Dr. Towner informed CGLIC that he disagreed with its assessment and he noted the number of medications Muniz took daily, which left him "extremely fatigued and unable to concentrate," as well as Muniz's persistent contraction of methicillin-resistant staph aureus infections. Dr. Towner concluded it was his "professional medical opinion that Mr. Muniz will be unable to work in any field, sedentary or otherwise, in the foreseeable future." He did not provide any documentation of the fatigue or lack of concentration.

CGLIC requested medical records from Dr. Towner in support of his opinion, including testing of Muniz's cognitive status, and after the records were received, CGLIC found them incomplete and determined that Muniz ...


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