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Reliance on Lack of Objective Evidence of Limitations...

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  • Reliance on Lack of Objective Evidence of Limitations...

    Reliance on Lack of Objective Evidence of Limitations Not an Abuse of Discretion – D. Ma.

    Attached hereto is a case out of the District of Massachusetts, Parnagian v. MetLife Disability Insurance Company, et. al. In this case, plaintiff seeks long term disability benefits under an ERISA governed plan for hypersensitivity to various chemicals. Defendant’s plan requires objective evidence of disability. Defendant denied plaintiff’s claim. Plaintiff appealed, exhausted administrative remedies, and filed suit. While the court sympathizes with plaintiff, it ultimately determined that defendant did not abuse its discretion in denying plaintiff’s claim, nothing that plaintiff’s limitations should be verifiable by objective means.
    But at bottom, Plaintiff needed to demonstrate she was “fully disabled” in order to qualify for long term disability benefits under the Plan. Defs.’ St. Undisp. Facts [#60] ¶ 20; see Leahy, 315 F.3d at 18 (“We turn now to the merits of the denial of benefits. The Plan's definition of ‘fully disabled’ controls.”). To be “fully disabled,” Plaintiff has the burden of showing not only that she was under the care of a doctor (which is undisputed), but that she “cannot perform the essential elements and substantially all of the duties” of her job.” 4 MET-01668. And to make such demonstration, she needed to proffer “objective evidence satisfactory to the Claims Administrator,” who bears “sole discretion” to determine eligibility. MET-01680.

    The thrust of Plaintiff’s argument before this court is that her condition cannot be diagnosed via objective medical criteria, and that MetLife therefore erred in denying her claim based on the absence thereof. Pl.’s Mem. [#64] 6-14. She argues that in denying her benefits for want of objective medical evidence, MetLife eschewed not just the unique physiological nature of MCS and IEI, but also its own Plan’s procedures and guidelines which take into account these conditions’ symptoms-based and subjective realities. Id. She argues further that the physicians utilized by MetLife relied solely on the non-existence of objective medical evidence to the diminishment of her actual experienced symptomology, and that MetLife in turn failed to “properly address the functional impact of her chronic symptomology in its determination . . .” or “address the impact of [her] ongoing symptoms and limitations . . . .” Id. These combined errors, Plaintiff contends, amounted to a breach by MetLife of its obligation under the Plan to fully and fairly review her claim. Id. The court finds no reversible error.

    As to reliance on an absence of objective evidence, the First Circuit has drawn a distinction in these analyses between the error of requiring objective evidence to support the diagnosis of a disease that does not manifest itself in an objectively-verifiable manner (e.g. chronic fatigue syndrome or fibromyalgia), and the justified requirement that a claimant’s limitations be objectively verifiable. See Denmark v. Liberty Assur Co. of Boston, 481 F.3d 16, 37 (1st Cir. 2007), abrogated on different grounds by Denmark v. Liberty Assur Co. of Boston, 566 F.3d 1 (1st Cir. 2009) (“However, this court draws a distinction between requiring objective evidence of the diagnosis, which is impermissible for a condition such as fibromyalgia that does not lend itself to objective verification, and requiring objective evidence that the plaintiff is unable to work, which is allowed.”); Boardman v. Prudential Ins. Co. of Am., 337 F.3d 9, 16-17 n.5 (1st Cir. 2003) (“Rather, Prudential wanted objective evidence that these illnesses rendered her unable to work. While the diagnoses of chronic fatigue syndrome and fibromyalgia may not lend themselves to objective clinical findings, the physical limitations imposed by the symptoms of such illnesses do lend themselves to objective analysis.”). In other words, while it is unreasonable to rule out a disease because of the absence of objective clinical findings, the distinct inquiry of whether an impairment renders a claimant disabled under the governing plan may require objective evidence.

    Here, MetLife’s decisions denying Plaintiff’s claim respect this distinction. See MET-00941 (“ . . . for the reasons detailed below and based on a thorough review of all of the documentation on file, it is MetLife’s determination that the information does not support your inability to perform the duties of your job . . . .”); MET-01763 (“After a full and fair review of all the medical and vocational information on file, the documentation provided does not support the severity of a condition that that would have rendered Elaine Parnagian totally disabled and unable to perform the essential elements of her job . . . .”). And MetLife’s conclusions that Plaintiff presents no objective evidence supporting her limitations is based at least in part on the report from Dr. Mirkin, who concludes, after reviewing Plaintiff’s reported symptoms and the allergen test and genetic tests Dr. LaCava references in his opinion, that “[f]rom a physical standpoint, there was no objective evidence in the medical documentation provided[] sufficient to prevent the claimant from performing her job duties . . . .”). MET-00996, 01004.5 In response, although she presents the strong opinions of two treating physicians, Plaintiff has not demonstrated objective evidence in the record that runs contrary to this conclusion or, more to the point, that would render MetLife’s decision an abuse of discretion or otherwise outside the ambit of merely weighing conflicting evidence. See Vlass v. Raytheon Emps. Disability Tr., 244 F.3d 27, 32 (1st Cir. 2001) (administrator’s duty to weigh conflicting evidence); Black & Decker, 538 U.S. at 834 (no special deference owed to treating physicians akin to the Social Security Administration’s “treating physician rule”); see also Leahy, 315 F.3d at 16 (“Analyzing disability claims plainly requires expertise. It is, therefore, difficult to fault a plan administrator for seeking expert assistance (indeed, it probably would be easier to fault a plan administrator for not seeking such assistance.”)).

    Plaintiff’s argument that MetLife contradicted its own procedures in deciding her case also misses the mark. Plaintiff’s argument is twofold: that the Plan language requiring objective proof of disability is curtailed by the Guidelines found at MET-01765-01767, which provides additional guidance in the context of IEI and notes its subjective nature; and that MetLife failed, as required, to assess the limiting effects of her symptoms. But on review, the court does not find significant distinctions between what the Plan requires and what the Guidelines suggest a claims administrator do when presented with a case like Plaintiff’s, and what MetLife actually did in Plaintiff’s case: MetLife, per the Guidelines, submitted Plaintiff’s file for evaluation to assess how her symptoms affected her functioning, see supra 11 n.5., and those evaluators did in fact document Plaintiff’s symptoms as reported.6 In turn, MetLife’s own decision chronicles Plaintiff’s treatments and symptoms, but draws an unfavorable assessment of their severity.

    In sum, MetLife’s decision to deny Plaintiff’s claim for long-term disability was based on evidence that was “reasonably sufficient to support a conclusion”: the court does not find on this record an abuse of discretion or a decision made in a reversibly arbitrary or capricious manner. Although results may be unfortunate in light of Plaintiff’s reported subjective symptoms, where a record “is capable of supporting competing inferences as to the extent of the plaintiff’s ability to work . . . that clash does not suffice to satisfy the plaintiff’s burden.” Leahy, 315 F.3d at 18-19.
    Attached Files