McFadden v. Prudential Insurance Co. of America

877 F. Supp. 2d 481, 2012 WL 2839634, 2012 U.S. Dist. LEXIS 95034
CourtDistrict Court, S.D. Mississippi
DecidedJuly 10, 2012
DocketCivil Action No. 3:11-cv-108-CWR-FKB
StatusPublished
Cited by1 cases

This text of 877 F. Supp. 2d 481 (McFadden v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McFadden v. Prudential Insurance Co. of America, 877 F. Supp. 2d 481, 2012 WL 2839634, 2012 U.S. Dist. LEXIS 95034 (S.D. Miss. 2012).

Opinion

ORDER

CARLTON W. REEVES, District Judge.

Pending before the Court is The Prudential Insurance Company of America’s motion for summary judgment. Docket No. 31. Alan McFadden opposes the motion and has filed a cross-motion for summary judgment.1 Docket No. 35. Prudential has replied, Docket No. 44, McFadden has filed a sur-reply, Docket No. 45, and the matter is ready for disposition. After reviewing the administrative record, the pleadings, and the applicable law, Prudential’s motion will be granted and McFadden’s motion will be denied.

I. Background

On January 12, 2002, McFadden was employed by Encompass Mechanical Services Southeast and assigned to repair the roof of a Nissan North America construction project. Docket No. 1, at 3. A helicopter delivering construction materials to the roof flew near McFadden and caused the roof to lift. Id. McFadden was thrown into the air and injured when he struck the roof. Id. He was subsequently awarded temporary and permanent workers’ compensation benefits. Id. at 3-4. On February 5, 2005, McFadden was declared totally disabled by the Social Security Administration as of January 14, 2002. Id. at 4; see Docket No. 35, at 2.

On December 4, 2008, McFadden applied for short-term disability (“STD”) and long-term disability (“LTD”) benefits under a group plan managed and underwritten by Prudential, Encompass’s disability insurer. Docket No. 1, at 4. After an investigation, Prudential denied his claim. Id. at 6. In 2009 and 2010, two administra[485]*485five appeals were also denied. Id. at 6-8. This lawsuit followed.

II. Arguments

Prudential first argues that the plain language of the policy prevents McFadden from receiving STD benefits because his injury occurred on the job. Docket No. 32, at 2-3 and 20. Regarding LTD benefits, it contends that objective medical tests conducted by several physicians could not verify McFadden’s “subjective complaints of pain.” Id. at 3-4 and 23-24. Instead, it says, the records show a pattern of McFadden’s “drug seeking behavior” and “symptom magnification.” Id. at 23. Prudential asserts that McFadden’s delayed claim for benefits, filed almost seven years after his injury, left it “unable to obtain medical documentation contemporary to the injury” to resolve conflicts in the record. Id. at 4 and 25-26.

McFadden responds that he became aware of his right to seek STD and LTD benefits only through his filing of a separate, workers’ compensation-related lawsuit, and that Prudential has not been prejudiced by the delay. Docket No. 35, at 2-4. He then argues he was entitled to discovery to clarify the evidence of his functional impairment. Id. at 7-8. Regarding STD benefits, McFadden contends that it was unfair for Prudential to have collected premiums for those benefits since it had no intent to pay valid claims. Id. at 10. He argues Prudential abused its discretion in denying LTD benefits because it ignored reports from the Workers’ Compensation Commission, the Social Security Administration, and various medical providers who corroborate his functional impairment. Id. at 7 and 11-13.

Arguments contained in Prudential’s rebuttal and McFadden’s sur-reply will be mentioned where relevant below.

III. Standard of Review

“The summary judgment standard for ERISA claims is unique because the Court acts in an appellate capacity reviewing the decisions of the administrator of the plan.” Riley v. Blue Cross & Blue Shield of Mississippi, No. 3:09-cv-674, 2011 WL 2946716, *1 (S.D.Miss. July 21, 2011).

“Eligibility for benefits under any ERISA plan is governed in the first instance by the plain meaning of the plan language.” Threadgill v. Prudential Securities Group, Inc., 145 F.3d 286, 292 (5th Cir.1998) (citation omitted). Because the ERISA plan grants Prudential “discretionary authority to determine eligibility for benefits under the plan or to interpret the plan’s provisions,” the Court reviews Prudential’s decision for abuse of discretion. Ellis v. Liberty Life Assur. Co. of Boston, 394 F.3d 262, 269 (5th Cir.2004) (citation omitted). “A plan administrator abuses its discretion where the decision is not based on evidence, even if disputable, that clearly supports the basis for its denial.” Schexnayder v. Hartford Life & Acc. Ins. Co., 600 F.3d 465, 468 (5th Cir.2010) (quotation marks and citation omitted). “If the plan fiduciary’s decision is supported by substantial evidence and is not arbitrary or capricious, it must prevail.” Id. (citing Ellis, 394 F.3d at 273).2 “Substantial evi[486]*486dence is more than a scintilla, less- than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Ellis, 394 F.3d at 273 (quotation marks and citation omitted). “A decision is arbitrary-only if made without a rational connection between the known facts and the decision or between the found facts and the evidence.” Holland v. Int’l Paper Co. Ret. Plan, 576 F.3d 240, 246 (5th Cir.2009) (quotation marks and citation omitted).

Restated, the question is whether Prudential’s decision was supported by substantial evidence, “not [whether] substantial evidence (or, for that matter, even a preponderance) exists to support the employee’s claim of disability.” Ellis, 394 F.3d at 273 (citation omitted). “We are aware of no law that requires a district court to rule in favor of an ERISA plaintiff merely because he has supported his claim with substantial evidence, or even with a preponderance.” Id.

Judicial “review of the administrator’s decision need not be particularly complex or technical; it need only assure that the administrator’s decision fall somewhere on a continuum of reasonableness— even if on the low end.” Holland, 576 F.3d at 247 (quotation marks and citation omitted).

IV. Discussion

A. Discovery

McFadden claims an entitlement to “discovery to clear up any substantial question on the matter” of his pain condition and functional impairment. Docket No. 35, at 8. McFadden’s supporting legal argument, however, is that discovery is necessary to probe the extent of Prudential’s conflict of interest. Id. at 7. The request for discovery is thus unsupported, because discovery to establish the extent of a conflict of interest is different from discovery to establish a functional impairment.

In any event, the discovery McFadden seeks is not permitted.

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877 F. Supp. 2d 481, 2012 WL 2839634, 2012 U.S. Dist. LEXIS 95034, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcfadden-v-prudential-insurance-co-of-america-mssd-2012.