Goodreau v. Hartford Life & Accident Insurance

500 F. Supp. 2d 1169, 2007 U.S. Dist. LEXIS 60384, 2007 WL 2350355
CourtDistrict Court, W.D. Arkansas
DecidedAugust 16, 2007
Docket07-5043
StatusPublished

This text of 500 F. Supp. 2d 1169 (Goodreau v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Goodreau v. Hartford Life & Accident Insurance, 500 F. Supp. 2d 1169, 2007 U.S. Dist. LEXIS 60384, 2007 WL 2350355 (W.D. Ark. 2007).

Opinion

MEMORANDUM OPINION & ORDER

DAWSON, District Judge.

This disability benefit claim is before the Court for decision on the stipulated administrative record (Doc. 6) and the respective briefs of the parties (Docs. 7 & 8). Plaintiff brings this action pursuant to the provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., alleging that Defendant’s decision to deny her claim for short-term disability benefits was unreasonable. For the reasons stated below, the Court finds that Defendant’s decision was supported by substantial evidence and is AFFIRMED. Plaintiffs claim is denied, and Plaintiffs Complaint (Doc. 1) is dismissed with prejudice.

Background

Plaintiff worked for Wal-Mart Stores, Inc. until February 8, 2006, where she held the position of collator operator. Plaintiff contends she ceased working due to pain associated with her fibromyalgia. Plaintiff filed her claim for short term disability benefits, but it was denied by the Plan Administrator on March 14, 2006. Plaintiff appealed, and her appeal was denied on June 13, 2006. (AR 93-94). Plaintiff exhausted her administrative remedies on June 13, 2006.

Plaintiff is a 58 year old woman who has suffered from “long standing fibromyal-gia.” (AR 96). Since at least the year 2000, Plaintiff complained of diffuse pain (AR 69), which her doctors labeled her condition as fibromyalgia. She was treated for this condition by Dr. Saitta, and then by Dr. Dykman. In July 2003, Dr. Dykman found “mild antalgia on examination of station and gait.” (AR 39). Dr. Dykman diagnosed Plaintiff with “fibro-myalgia noting pain along her neck, shoulders, upper back, lower back, hips, knees, hands, ankles and feet, and occasional pain along her elbows.” (AR 38). Upon inspection and “palpation of the head, neck, spine, hips, upper and lower extremities,” he found “severe tenderness to palpation over trigger points along the neck, upper back, and left knee with moderate tenderness to palpation over trigger points along the lower back, elbows, and right knee.” *1171 (AR 39). During treatments, Plaintiff rated her pain on a scale from one to ten, with ten being the worst, and consistently rated her pain as a five or six, except for once in 2004 when she rated it a seven and once in 2003 when she rated it as a four (AR 26 & 28).

Upon filing of Plaintiffs application for disability benefits, the Defendant hired a medical examiner, Dr. Dibble, to review the record and render an opinion as to Plaintiffs ability to perform her previous employment. Dr. Dibble, who is board certified in family practice, reviewed Plaintiffs records and spoke to Dr. Dykman. Dr. Dibble noted that Plaintiff suffered from a “chronic pain syndrome based on widespread soft tissue pain symptomatolo-gy of many years duration.” (AR 98).

Dr. Dibble noted that none of the medical records included any discussion of fatigue or lack of endurance. He found that none of the medical records identified any particular physical impairment that might require any specific workplace restriction. (AR 98). Dr. Dibble noted Plaintiff worked with her subjective complaints of pain for six years, and concluded that “it is my medical opinion with a reasonable degree of certainty that she is capable of the physical demands of full-time employment, and that there is no evidence of any particular physical impairment that should require any specific restriction relative to -workplace activities.” (AR 98).

ERISA

Under ERISA, a denial of benefits by a plan administrator must be reviewed de novo unless the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan, in which case the administrator’s decision is reviewed for an abuse of discretion. Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir.1998) citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Accordingly, the Court must be guided by the language of the plan to determine the proper standard of review.

The Plan provides, in pertinent part, “[t]hat Hartford has full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” Therefore, Hartford’s decision can only be reviewed for an abuse of discretion.

The Eighth Circuit Court of Appeals has “variously defined ... an abuse of discretion as being ‘extremely unreasonable,’ ‘virtually’ the same as arbitrary and capricious, and ‘extraordinarily imprudent.’ ” Shell v. Amalgamated Cotton Garment, 43 F.3d 364, 366 (8th Cir.1994) (citations omitted). “The proper inquiry into the deferential standard is whether ‘the plan administrator’s decision was reasonable; i.e., supported by substantial evidence.’ ” Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997) (quoting Donaho v. FMC Corp., 74 F.3d 894, 899 (8th Cir.1996)).

“While the word ‘reasonable’ possesses numerous connotations, this court has rejected any such definition that would ‘permit a reviewing court to reject a discretionary trustee decision with which the court simply disagrees!.]’ ” Id. at 641 (citation omitted). A decision is reasonable “if ‘a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision.’ If the decision is supported by a reasonable explanation, it should not be disturbed, even though a different reasonable interpretation could have been made.” Id. (citation omitted).

Where there is a difference of opinion between a claimant’s treating physi *1172 cians and the plan administrator’s reviewing physicians, the plan administrator has discretion to find that the employee is not disabled unless “the administrative decision lacks support in the record, or ... the evidence in support of the decision does not ring true and is ... overwhelmed by contrary evidence.” Donaho, 74 F.3d at 901 (8th Cir.1996).

Discussion

Plaintiff contends that because Hartford is both insurer and claims administrator, the Court should apply something less than the arbitrary and capricious standard of review. Plaintiff cites a Third Circuit Court of Appeals case in support of her proposition, but the Eighth Circuit Court of Appeals has a different position on this point.

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500 F. Supp. 2d 1169, 2007 U.S. Dist. LEXIS 60384, 2007 WL 2350355, Counsel Stack Legal Research, https://law.counselstack.com/opinion/goodreau-v-hartford-life-accident-insurance-arwd-2007.